bluuebunny/crossref_metadata_2025 huggingface dataset:
Zidovudine (AZT) therapy in children with HIV infection: the Australian experience
Authors: PALASANTHIRAN P. , ZIEGLER J. B. , KEMP A. S. , EKERT H. , JUPE D. M. , GATENBY P. A. , KELLER A. J. , SMALES O.
Published: March 2008

Fifteen children (11 males and four females), on oral Zidovudine (AZT) for symptomatic HIV infection were studied retrospectively. Twelve acquired HIV via blood products, two from vertical transmission (maternal intravenous needle sharing) and one through breast feeding. Their mean age at the start of therapy was 8.6 years (s.d. 4.4 years, range 1.8‐15.3 years). The main indications for therapy were failure to thrive (FTT) in 10, recurrent respiratory tract infections (RRTI) in eight, and developmental delay (DD) in one, with overlapping indications being Pneumocystis carinii pneumonia (PCP) in one and pulmonary lymphoid hyperplasia (PLH) in two. The mean commencement dose was 24 mg/kg per day orally in 3‐6 divided doses (range 16‐35 mg/kg per day). The duration of therapy was 2 weeks‐21/2 years. Significant improvement in growth was observed by 2 months; at 6 months, growth was sustained in these otherwise ill children, with only two falling below pretreatment weight. Decrease in the frequency of RRTI based on subjective reports of the attending clinicians was observed in seven of the eight evaluable children still on therapy.

Improvement in PCP and PLH occurred in two children and modest improvement was subjectively reported in PLH in one while still early in the course of therapy. Overall, AZT was well tolerated. Dose modifications were for neutropenia in three (of which only two were drug related), rapidly falling neutrophil count in one, anaemia in two (with concurrent history of chronic gastrointestinal tract blood loss in one), severe GIT irritation in one and transient sedation in one. Seven opportunistic infections were reported (three in the same patient) of which two occurred following cessation of therapy, one after only 2 weeks of therapy, and one had not been on primary prophylactic therapy. Three deaths occurred, one associated with opportunistic infections and two while off therapy (one respiratory failure, one PCP).
Dialysis and renal transplantation in children: Long term and recent experience
Authors: LEWIS D. J. , McIVER M. , SCOTT D. F. , THOMSON N. M.
Published: March 2008

The outcome of 38 children with endstage renal failure who entered a dialysis and renal transplant programme over a period of 16 years is reported. The initial care was given in an adult programme but in 1985 this was changed to a comprehensive and specifically paediatric programme. Patient survival was 97, 86 and 80% at 1, 5 and 10 years respectively. Thirty‐four of the patients spent a mean period of 19 months (range 1‐160 months) on dialysis with the preferred form of dialytic therapy being continuous ambulatory peritoneal dialysis. Primary cadaveric graft survival was 72 and 42% at 1 and 3 years respectively; although since 1985 1 year graft survival has risen to 90%. The major long term problems have been growth failure and poor social development. Eighty‐seven per cent of children have been able to continue normal schooling, and of the 18 who have left school 14 (78%) are employed or undertaking tertiary education. Thus dialysis and transplantation has allowed not only excellent patient survival but also the achievement of satisfactory educational standards and subsequent employment for the majority of patients.
Malnutrition in cystic fibrosis: Psychosocial functioning of patients and their families
Authors: BRENNAN J.L. , TODD A.L. , JOOLS P.A. , GASKIN K.J.
Published: March 2008

Abstract The relationship between nutritional status and psychosocial functioning was examined in 35 children with cystic fibrosis, aged 7–16 years. Twelve malnourished children and their families were compared with 23 well nourished children and their families. Established measures of adjustment and coping in the children, parents and families were used. Few statistically significant differences between the two groups emerged, and all comparisons of psychosocial functioning were not significant. The results of the study suggest that there is no relationship between the nutritional status of the child with cystic fibrosis and the current psychosocial adjustment and coping of child, parents and family.
Antibody response of 18 month old children 1 month and 18 months following Haemophilus influenzae type b vaccine administered singly or with DTP vaccine
Authors: CLEMENTS D. A. , ROUSE J. B. , LONDON W.L. , YANCY W.S. , MOGGIO M.V. , WILFERT C.M.
Published: March 2008

Abstract Seventy‐six children (aged 17–19 months) received 10 μg of Haemophilus influenzae type b polyribosyl‐ribitol phosphate (PRP) vaccine, diluted with either phosphate‐buffered saline (PBS) or diphtheria‐tetanus‐pertussis (DTP) vaccine, in a singleblind randomized trial. There were few side effects when PRP was administered alone. Before vaccination 37 of 76 children (49%) had non‐protective antibody levels (<0.15 μ/mL); 26 of these 37 (70%) achieved antibody levels of >0.15 μg/mL 1 month after vaccination. Before vaccination 16 of 76 (21%) had antibody levels of >1.0 μg/mL; 1 month after vaccination 39 of 76 children (51%) achieved levels of >1.0 μg/mL. Of 12 infants who had antibody levels less than 0.15 μg/mL 1 month after immunization, 10 had protective levels 18 months later. Administration of PRP mixed with DTP did not affect antibody response to PRP. The potential use and limitations of PRP vaccine are discussed.
Recurrent tracheo‐oesophageal fistula: Experience with 24 patients
Authors: GHANDOUR K. E. , SPITZ L. , BRERETON R. J. , KIELY E. M.
Published: March 2008

Abstract Over an 11 year period, 275 infants with oesophageal atresia and tracheo‐oesophageal fistula were treated. Of these, 22 (8%) developed a recurrent fistula. An additional two patients with an established recurrent fistula were referred for secondary surgery. Infants who develop respiratory symptoms associated with feeding following repair of an oesophageal atresia should be investigated urgently with cine‐radiography and/or bronchoscopy. Once the diagnosis of a recurrent fistula has been firmly established, operative repair should be undertaken. In our series of 24 patients, there were three deaths (12.5%), four patients developed a second recurrence (16.6%), while a secondary oesphageal replacement was carried out on five patients.
An alternative approach to pyogenic hepatic abscess in childhood
Authors: LIU K. W. , FITZGERALD R. J. , BLAKE N. S.
Published: March 2008

Abstract Childhood pyogenic hepatic abscess is rare and remains a difficult diagnostic problem. Seven cases in six children were treated over a 13 year period. There was a recurrence in one patient 7 years after the first presentation. Four patients had identified predisposing factors, namely, chronic granulomatous disease, acute appendicitis, previous abdominal surgery and umbilical vein catheterization, while the other two were cryptogenic. There were no specific symptoms and signs but the combination of unexplained pyrexia, upper abdominal tenderness, hepatomegaly and leucocytosis should raise the suspicion of hepatic abscess. Four cases were diagnosed by ultrasound, one by radionuclide scan and the other two at laparotomy. Treatment in the earlier years was by transabdominal drainage. In the later part of the series, percutaneous catheter drainage using ultrasound guidance was achieved with satisfactory result. Ultrasonography can provide an early diagnosis and effective treatment can be achieved with percutaneous catheter drainage in combination with appropriate antibiotic therapy.
Mean organ weights of an Australian population of fetuses and infants
Authors: CUSSEN L. , SCURRY J. , MITROPOULOS G. , McTIGUE C. , GROSS J.
Published: March 2008

Abstract Charts of organ weights for an Australian population of fetuses and infants are presented. The organ‐weight charts were compiled from 1337 stillbirths and liveborn babies whose gestational age ranged from 20 to 43 weeks, and who lived less than 72 h. Macerated stillbirths, multiple births and malformed organs were excluded. Pathological conditions aside from malformations were not excluded, leading to higher standard deviations compared with currently used charts. The organ weights are presented in two‐week increments from 20 to 43 weeks' gestation as means, with standard deviations.
Congenital labial cyst
Authors: SMITH G. H. H. , COHEN R.
Published: March 2008

Abstract We present the case of a congenital labial cyst in an otherwise normal female infant. This condition is uncommon, with only 30 female congenital external genital cysts previously reported in the English literature. When recognized, these cysts can be treated conservatively with an expectation of spontaneous resolution.
The changing growth of Aboriginal children
Authors: DUGDALE A. E. , MUSGRAVE I. A. , STREATFIELD K.
Published: March 2008

Abstract We have used data from children at an Aboriginal settlement in Queensland to demonstrate the changing patterns of growth over the last 30 years. In cohorts of children born during the early 1950s and 1960s the mean weight‐for‐age value was satisfactory for the first three months of life, but then fell until aged 12 months and remained at about 92% of the NCHS median value until 5 years old. In the cohort born in 1972‐73 there was some improvement and in the 1982‐83 cohort the mean weight‐for‐age value was close to international levels from 1 to 5 years. The decline in weight‐for‐age between 3 and 12 months was still present. Length‐for‐age values were not available in the 1950s and 1960s but the mean value increased from the 1972‐73 cohort to the 1982‐83 cohort, which was close to international levels. The mean weight‐for‐length was close to international levels in the 1972‐73 cohort, but in the 1982‐83 cohort was high from 3 to 12 months and then fell close to the international level. These data indicate that the children at this Aboriginal settlement are now growing satisfactorily. The impaired growth between 3 and 12 months needs further investigation, but most of the earlier concerns about poor growth appear to have been resolved.
Hyperglycaemia complicating haemolytic uraemic syndrome
Authors: CRAWFORD B. A. , ROY L. P. , KNIGHT J. F.
Published: March 2008

Abstract The occurrence of hyperglycaemia and insulin deficiency in a young child receiving peritoneal dialysis during the course of haemolytic uraemic syndrome (HUS) is described. This unusual complication may have been due to microvascular disease involving the pancreas. Plasma glucose should be monitored during HUS, particularly if dialysis with fluids containing high dextrose concentrations is required.
Anaemia and thalassaemia in healthy adolescents from southern Chinese families
Authors: LI A. M. C. , CHENG M. Y.
Published: March 2008

Abstract A study was conducted on 447 healthy high school students of southern Chinese descent to determine the prevalence of anaemia and thalassaemia. Haematological data and serum ferritin levels were determined on all venous blood samples. Haemoglobin (Hb) etectrophoretic study was conducted on 43 students who had anaemia (Hb<12 g/dL), and/or mean corpuscular volume (MCV) less than 80 fL. They were re‐assessed after 1 month of oral iron therapy. Three girls had definite iron deficient anaemia (<1%). Thirty‐nine students had either α or β‐thalassaemia, only seven of whom showed anaemia Since the overwhelming majority of both the thalassaemic students (38 of 39) and the participants (429 of 447) were of Cantonese extraction (native of Guangdong province), the overall incidence of 8.6% (α‐thalassaemia 5.4%, β‐thalassaemia 3.4%) reflected the high frequency of the thalassaemia gene among this group of southern Chinese. MCV measurement rather than Hb, was more useful in its detection.
Aganglionosis: Associated anomalies
Authors: CASS D.
Published: March 2008

Abstract In a series of 21 patients with aganglionosis there were five with associated anomalies (24%). These included trisomy 21, Smith‐Lemli‐Opitz syndrome type II, persistent Müllerian duct syndrome, supernumerary digits and segmental hypopigmentation. This high incidence may be due to sample bias, but clinicians are encouraged to carefully follow their aganglionic patients as there may be under‐reporting of associated anomalies. Knowledge of these anomalies can help in the management of individual patients and subsequent pregnancies. In addition these diverse associated anomalies suggest that as well as sometimes being part of a vagal neural crest deficiency, aganglionosis can be part of a generalized mesenchymal defect in embryonic development. There are probably several genes involved.
Two unusual tumours of the gastrointestinal tract in a patient with tuberous sclerosis
Authors: BYARD R. W. , PHILLIPS G. E. , DARDICK I. , ROBERTSON E. , CARTER R. F. , BOURNE A. J.
Published: March 2008

A 16 year old girl with an established diagnosis of tuberous sclerosis presented with a 1 year history of swelling of the left cheek. A 2 cm diameter tumour was excised which showed histological features of a solid variant of a minor salivary gland basal cell adenoma. One year later during laparotomy and excision of multiple renal angiomyolipomas, a 5 cm diameter subserosal tumour was found at the hepatic flexure of the colon. Examination of biopsy material revealed a leiomyoma. This case is presented to demonstrate two tumours that have not to the authors' knowledge been previously described in a young patient with tuberous sclerosis. Although the association may be coincidental, these tumours could represent two rare associations of tuberous sclerosis.
Childhood obsessive‐compulsive disorder
Authors: KING N. J. , TONGE B. J.
Published: March 2008

Of fascination for many decades, obsessive‐compulsive disorder in adults (OCD) has been subjected to extensive investigation. However, it is also clear that OCD can be experienced by children and adolescents (for convenience we refer to ‘childhood’ OCD). Childhood OCD is a complex clinical syndrome characterized by obsessive ideation, typically accompanied by overt behavioural acts carried out in a ritualistic fashion.1 As obsessive‐compulsive children are notoriously secretive about their aberrant behaviour, it can be sometime before parents and teachers become aware of the actual extent of the child's obsessive‐compulsive behaviour.
An epidemiological survey of dog bites presenting to the Emergency Department of a children's hospital
Authors: GREENHALGH C. , COCKINGTON R. A. , RAFTOS J.
Published: March 2008

German shepherds are the most popular registered breed of dog in South Australia, but are also the most hazardous to children, biting more often and more severely. A study of the victims of dog bites presenting to the Emergency Department of the Adelaide Children's Hospital over an 18 month period revealed that, although many breeds were involved, only German shepherds were implicated more frequently than their prevalence in the community. Attacks occurred most often in a domestic setting involving a friendly dog that was known to the victim. Boys were more often bitten than girls and children aged 1‐6 years most commonly involved. Injuries to the face and scalp were frequent and the usual ones to require admission for suture under general anaesthetic. Some scarring was a common sequel and resulting fear of dogs remained with some children. Most attacks were reported to be unprovoked and a previous biting history on the part of the dog was uncommon. Parents who are contemplating obtaining a dog for a family pet should be made aware of these facts and advised regarding the biting hazards and possible prevention. The German shepherd situation especially should be brought to their attention.
Failure of intravenous infusions in neonates
Authors: HECKER J. F. , DUFFY B. J. , FONG T. , WYER M.
Published: March 2008

The median life expectancy (survival) of 286 peripheral intravenous infusion sites in 105 babies in a children's intensive care unit was 36 h. Unadjusted univariate survival analysis revealed that dextrose infusions and the initial infusions received by a baby had longer survival than total parenteral nutrition (TPN) infusions and later infusions respectively. Also infusions with cloxacillin and penicillin survived for longer than average while infusions with phenytoin had reduced survival. Gestational age, weight, infusion site, other drugs, co‐infusion of Intralipid with TPN solutions and neutralization of TPN did not influence survival of infusions. Multivariate survival analysis confirmed the findings for TPN and penicillin but not for cloxacillin, phenytoin or later Infusions. Multivariate analysis also suggested that survival was improved with ampicillin and aminophylline and worse for leg sites, for older babies and for infusions in which the fluids were given at greater rater. It also indicated that neutralization of TPN improved survival.
Breast feeding practices and severe hyperbilirubinaemia
Authors: TUDEHOPE D. , BAYLEY G. , MUNRO D. , TOWNSEND S.
Published: March 2008

This study establishes the association between early onset severe hyperbilirubinaemia (serum bilirubin (SBR) level ≥ 272 μmol/L) with no assigned cause and breast feeding. The rates of breast feeding at hospital discharge increased from 46.4 to 75.4% in non‐insured (public) women and 58.6 to 89.2% in insured (private) women between 1975 and 1987, and were accompanied by an increase in severe hyperbilirubinamia from 1.6 to 3.1% in public and 0.9 to 3.6% in private babies. The case control study involved 125 term breast feeding infants born between 1 July 1985 and 1 July 1986 with severe hyperbilirubinaemia (SBR level 272 μmol/L) with no assigned cause who were compared with 125 matched controls who had peak SBR levels ≥ 272 μmol/L Severe hyperbilirubinamia was associated with primiparous and non‐Caucasian mothers, non‐smoking and oxytocin usage. Univariate analysis of feeding practice variables revealed that less frequent breast feeds, greater weight loss and less frequent stools over the first 3 days related to severe hyperbilirubinaemia (P <0.05). Multivariate analysis of the eight significant univariate factors revealed that maternal non‐smoking, less frequent breast feeding, less frequent stooling and excessive infant weight loss were the best predictors of severe hyperbilirubinaemia. With the wide promotion of breast feeding, the contribution of individual feeding practices to severe hyperbilirubinaemia demands ongoing analysis and review.
Cord whole blood hyperviscosity: Measurement, definition, incidence and clinical features
Authors: DREW J. H. , GUARAN R. L. , GRAUER S. , HOBBS J. B.
Published: March 2008

Cord whole blood viscosity and haematocrit values (PCV) were determined in 2461 live birth infants. Viscosity measurements were performed on an Australian‐designed coaxial narrow‐gap viscometer. Normal viscosity values were determined for each week of gestation above 34 weeks. Hyperviscosity was defined as a viscosity value above 2 s.d. from the mean for each week of gestation and it occurred in 164 (6.7%) newborn infants. Although a close relationship existed between cord whole blood viscosity and PCV (r= 0.6597, P <0.0001), only 47.4% of polycythaemic infants (PCV>65) were also hyperviscous and only 23.9% of hyperviscous infants were also polycythaemic. Hence, using the haematocrit to select which infants require viscosity studies fails to detect many hyperviscous newborn infants. Hyperviscosity was less common (3.6%, P <0.001) in infants who were born by Caesarean section and more common (16.5%, P <0.001) in those who were growth retarded. Of the hyperviscous infants, 84.5% were not growth retarded, most (87.8%) were term and most (86.6%) were delivered vaginally. Most hyperviscous newborn infants may thus remain undetected unless routine whole blood viscosity studies are performed.
The use of Dexamethasone in full‐term infants with severe respiratory failure and pulmonary barotrauma
Authors: BARR P.
Published: March 2008

Eight full‐term infants (mean gestation 39.9 weeks [range 37‐42] and mean birthweight 3642 g [range 3060‐4200]) with severe respiratory failure (median oxygenation index 28 [range 16‐65] and median arterial/alveolar Po2 ratio (a/APo2) 0.094 [range 0.038‐0.165]) and pulmonary barotrauma were treated with Dexamethasone, 0.5 mg/kg per day, from the median age of 5 days (range 3‐22). Six of the eight (75%) infants survived. They were weaned from mechanical ventilation and extubated a median of 2.5 days after commencing treatment with Dexamethasone. Two infants died and one of them suffered recurrent pneumothoraces. There was a significant improvement in oxygenation in the seven infants who survived the 72 h period of observation. Their median oxygenation index was 24 when Dexamethasone was commenced compared with 8 after 12 h (P <0.05) and 10 after 36 h (P <0.025). Their a/APo2, ratio was 0.095 when Dexamethasone was commenced compared with 0.289 after 12 h (P <0.05) and 0.207 after 36 h (P <0.025). There was a significant increase in the infants' arterial mean blood pressure associated with Dexamethasone therapy and one infant developed Staphylococcus aureus septicaemia. In this uncontrolled study of eight full‐term infants with severe respiratory failure and pulmonary barotrauma, the use of Dexamethasone was associated with significant improvement in oxygenation and rapid weaning from mechanical ventilation.
Nutrition of Australian Aboriginal infants and children
Authors: GRACEY M.
Published: March 2008

Adequate nutrition is essential for normal growth during childhood. This is so important that the United Nations has included ‘provision of adequate nutrition’ in their International Declaration of the Rights of the Child. For paediatricians, satisfactory growth is the most important, practical indicator of adequate nutrition but growth is affected by other genetic and environmental factors, particularly repeated or chronic infection.
Outcome of infants with birthweight 2000 g or less who undergo major cardiac surgery
Authors: NUMA A. , BUTT W. , MEE R. B. B.
Published: March 2008

Abstract A retrospective study of all neonates with birthweight 2000 g or less undergoing major cardiac surgery at the Royal Children's Hospital, Melbourne over the last 5 years was performed in order to determine outcome and identify subgroups within this population that may have a poor prognosis. The mean length of stay in intensive care following surgery was 32 days, with non‐survivors having a significantly longer duration of stay than survivors. Overall mortality was 43%, and for children with congenital heart disease as part of a recognizable syndrome the mortality was 100%. None of the survivors suffered incapacitating cardiac, neurological or respiratory handicap. These children in general have a poor prognosis and utilize significant resources; results of cardiac surgery in this group need to be closely followed in the future.
The association of thyroid dyshormonogenesis and deafness (Pendred syndrome): Experience of the Victorian Neonatal Thyroid Screening Programme
Authors: COAKLEY J. C. , KEIR E. H. , CONNELLY J. F.
Published: March 2008

Abstract Between 1977 and 1989, the Victorian Neonatal Thyroid Screening Programme detected five subjects with thyroid dyshormonogenesis and sensorineural deafness. These patients have been diagnosed as having Pendred syndrome. In two of the children, thyroid function tests which were initially abnormal at birth returned to normal spontaneously without treatment. However, hypothyroidism subsequently recurred and the children required thyroxine therapy. These two children could have been mistakenly diagnosed as having transient hypothyroidism. The detection of five patients with Pendred syndrome illustrates the importance of audiological assessment in all babies with thyroid dyshormonogenesis in whom there is increased uptake of isotope on thyroid scanning. In our experience, hearing loss in patients with Pendred syndrome may be progressive over time, so that repeated audiological assessments are necessary.
Reappraisal of the SIDS enigma: An epidemiological and clinicopathological approach
Authors: GOLDWATER P. N.
Published: March 2008

Abstract The possibility that most cases of sudden infant death syndrome (SIDS) are caused by a transmissible agent is explored. A hypothesis of causation is developed using pathological and epidemiological data and our microbiological findings. The nature and distribution of vascular damage together with the consistent finding of liquid blood, in addition to the epidemiological features of SIDS, form the basis of the hypothesis that a bacterial toxin is a likely single cause of most cases of the syndrome. Future research ideas and a new definition of SIDS are proposed.
Infant botulism: A review in South Australia (1980–89)
Authors: THOMAS D. G.
Published: March 2008

Between March 1980 and March 1989 there were six identified cases of infant botulism. The presenting symptoms were predominantly poor feeding, lethargy and constipation, and the presenting signs were predominantly hypotonia, weak gag reflex and respiratory difficulty. All required intensive care and prolonged hospital stays. Recovery was eventually complete in all cases. Infant botulism is an uncommon condition but early recognition with adequate intensive care usually results in complete recovery.
Usefulness of the Widal test in diagnosing childhood typhoid fever in endemic areas
Authors: CHOO K. E. , RAZIF A. R. , OPPENHEIMER S. J. , ARIFFIN W. A. , LAU J. , ABRAHAM T.
Published: March 2008

Data are presented for 2382 children investigated for fever in a Malaysian hospital between 1984 and 1987 when Widal tests and blood cultures were a routine part of every fever screen. There were 145 children who were culture positive (TYP‐CP) for Salmonella typhi, while 166 were culture negative but were diagnosed as having typhoid (TYP‐CN). Analyses of the sensitivity and specificity of combinations of initial Widal titres in predicting a positive S. typhi culture in a febrile child (culture positive vs the rest) showed the best model to be an O‐ and/or H‐titre of ≥ 1 in 40 (sensitivity 89%; specificity 89%). While the negative predictive value of the model was high (99.2%) the positive predictive value remained below 50% even for very high titres of O and H (> 1 in 640), at which point the specificity was 98.5%, supporting the clinical view that a high proportion of the TYP‐CN patients really were typhoid but were missed by culture. The TYP‐CN patients showed a very similar clinical and age profile to TYP‐CP patients. The length of history of fever did not affect the initial Widal titre in culture positive cases. The Widal test in children remains a sensitive and specific ‘fever screen’ for typhoid although it will not identify all cases. In children, lower cut‐off points for O‐ and H‐titres should be used than are generally recommended.
Cyclosporin therapy in steroid‐dependent nephrotic syndrome
Authors: WEBB K. L. , SARGENT P. , BURKE J. R.
Published: March 2008

Abstract Five children with multiple relapsing steroid‐dependent nephrotic syndrome were treated with continuous cyclosporin for periods ranging from 18 to 48 months. Renal biopsy showed mild mesangial proliferation in three of the children and minimal change in two. All children previously had been treated with cyclophosphamide. Cyclosporin was started during remission at 5 mg/kg per day. If a relapse occurred the dose was increased until a trough blood level of 100–250 ng/mL (HPLC) was achieved. In the initial 12 months of treatment, the mean number of relapses decreased from 6.4±0.54(s.d.) per annum to 1.6±1.3 per annum (P<0.01). Cyclosporin was effective in maintaining long‐term remission in four of the five patients. Side effects included hypertrichosis (5) and gum hyperplasia (1). The mean creatinine clearance decreased from 126±16 to 97=22 mL/min per 1.73 m2 (P = NS). A renal biopsy in all five patients after 12 months therapy showed no nephrotoxicity. A further biopsy in one patient after 4 years therapy showed interstitial fibrosis. Cyclosporin should be considered in children with steroid‐dependent nephrotic syndrome who show signs of steroid toxicity and have only a short remission period after cyclophosphamide. Serial renal biopsies are recommended if prolonged therapy is used.
Serum immunoglobulin G directed against porcine trypsin in the serum of cystic fibrosis children receiving porcine pancreatic enzyme supplements
Authors: QUIRK P. , GREER R. , SHEPHERD R. , CLEGHORN G.
Published: March 2008

Abstract Cystic fibrosis (CF) patients require pancreatic enzyme replacement therapy to correct pancreatic insufficiency. These enzymes are derived from porcine pancreas and are known to be antigenic. To determine the possible clinical consequences, a specific ELISA was developed to detect IgG antibody directed against porcine trypsin (PTAb) in the sera of CF patients. The assay was used to evaluate the occurrence of PTAb in a cross sectional study of 103 CF patients in relation to the introduction of porcine enzyme therapy, clinical status and genotype. Antibodies against porcine trypsin were detected in the sera of 63% of patients unrelated to the age of commencement or the duration of enzyme therapy. No differences were observed in the clinical status of CF patients who had developed PTAb (n= 65) and those who had no detectable PTAb (n= 38) as determined from: the current prescribed dose of porcine pancreatic enzyme capsules; Z scores for height and weight; and respiratory function tests. It is suggested that the PTAb commonly found in the sera of CF patients are of doubtful clinical significance but the prospect of PTAb contributing to immune complex disease should be examined further.
Birth order and risk of sudden infant death syndrome: Is the true relationship negative?
Authors: SPIERS P. S. , LOHMANN R. , GUNTHEROTH W. G.
Published: March 2008

Abstract The risk of SIDS has been reported consistently as being positively related to parity or birth order. However the reports in question have failed to take into account the possible confounding effects of sibship size. In the present study it was reasoned that if this were done the relationship would be negative, not positive. In an analysis of births stratified by sibship size occurring in the years 1975–84 in the state of Oregon, it was found that the risk of SIDS in the age range 7–364 days did indeed tend to decrease with increasing birth order when sibship size was held constant. An expected tendency for SIDS rates to increase with increasing sibship size when birth order was held constant was also confirmed. This tendency is probably explained by a negative correlation between family size and socio‐economic status. Non‐SIDS rates behaved in a similar manner to SIDS rates. The tendency for the risk of SIDS to decrease with increasing birth order was more evident when births following a pregnancy interval of less than 12 months were excluded.
Child day care and home injuries involving playground equipment
Authors: KOTCH J. B. , CHALMERS D. J. , LANGLEY J. D. , MARSHALL S. W.
Published: March 2008

Abstract The increasing number of children attending child day care has led to a corresponding concern for their safety in the absence of parental care. Previous studies have documented that the majority of injuries occurring in child day care involve falls, and that the most common consumer product associated with such falls is playground equipment. This study describes New Zealand children less than 5 years of age admitted to hospital between 1979 and 1988 for injuries associated with playground equipment located at home or a child care facility. There were 528 hospitalized home injuries involving playground equipment, and 145 such day care injuries. Fractures were the most common injury, and the head was the most commonly involved body region. Lower limb injuries were the most severe. Among the differences between home and day care injuries were the type of equipment involved. Swings were disproportionately associated with head injuries.
Do diagnosis related groups separate the case‐mix of a specialist children's hospital and a paediatric unit in a general hospital?
Authors: PHELAN P. D. , BAXTER K. , BISHOP J. , HUDSON I. , HINDLE D.
Published: March 2008

The ability of diagnosis related groups (DRG) and refinement diagnosis related groups (RDRG) to measure differences in case‐mix was investigated using discharge data for patients <18 years of age from three specialist children's hospitals and four district hospitals. While the three children's hospitals each had a greater percentage of RDRG for more complex patients, only one children's hospital had more complex patients based on DRG and RDRG cost weights and on the percentage of diagnoses per discharge. Cost weights based on USA practices may be inappropriate in Australia, and Australian weights will be necessary for firm conclusions. Refinement diagnosis related groups with appropriate cost weights may be acceptable measures of case‐mix in specialist children's hospitals, but they have inherent limitations for paediatric patients in that many complex paediatric patients are ill very seriously with one disorder, whereas complex adult patients usually have secondary diagnoses and secondary procedures. Moreover, no DRG version developed in the US will be suitable for use in Australia unless it takes account of medical costs and transfer practice.
The prevalence of anencephalus and spina bifida in New Zealand
Authors: BORMAN B. , CRYER C.
Published: March 2008

Despite the plethora of epidemiological research conducted on anencephalus and spina bifida, few of the studies have used multiple source case ascertainment and controlled for the effect of possible confounding factors. This paper reports the results from a study of the relationships between various risk factors and the prevalence of anencephalus and spina bifida in New Zealand during 1978‐82, using case data obtained from multiple sources and a national cohort of births as the denominator. The rates of anencephalus and spina bifida in New Zealand were 0.78/1000 and 0.94/1000 total births, respectively. The rate of a neural tube defect (NTD) birth for Maori parents was less than for their non‐Maori counterparts. Paternal ethnic origin and maternal ethnic origin made similar contributions to the model of anencephalus rates, but the results suggest that paternal ethnic origin is a less important risk factor in the prevalence of spina bifida. The rate of both NTD was high among female infants and low among births to women born in countries other than the British Isles and New Zealand. The rate of anencephalus showed a distinct north‐south gradient, but there was no evidence of effects for maternal or paternal age, parity, urban‐rural place of residence, nuptiality, social class or season of birth in the prevalence of either NTD in New Zealand.
C‐Reactive protein as a diagnostic tool of sepsis in very immature babies
Authors: WAGLE S. , GRAUAUG A. , KOHAN R. , EVANS S. F.
Published: March 2008

Abstract Three hundred and nine septic screens were performed on 123 consecutively admitted infants of <30 weeks gestation. As part of the septic screen, serial quantitative measurements of C‐reactive protein (CRP) were performed daily until discontinuation of antibiotic therapy. Complete blood counts were performed daily for the first 2 days of each septic episode.

The babies had a mean birth weight of 1035.8 g s.d. 273.2 and a mean gestational age of 27 weeks s.d. 1.8. A CRP level of 10 mg/L or above was considered abnormal. Subsequently the receiver operator characteristic curve for CRP was constructed to demonstrate the ideal cut off value.

Of the 309 septic screens, there were 51 instances of proven sepsis and 39 instances of deep culture negative sepsis. In the remaining 219, a diagnosis of proven or deep culture negative sepsis could not be made.

On the first day of the septic episode CRP showed a sensitivity of 62.7%, specificity of 87.2% and negative predictive value of 92.2% for proven sepsis. There was a significant increase in the sensitivity (90.2%) and negative predictive value (97.7%) of CRP with a specificity of 80.6 when both day 1 and 2 estimations were combined.

We conclude that when the CRP is elevated on day 1 and/or day 2, the diagnosis of sepsis is extremely likely and when the CRP is within normal limits on days 1 and 2 of the septic episode, neonatal sepsis can be confidently excluded and antibiotic therapy ceased.
Carbon dioxide concentrations in the environment of sleeping infants
Authors: MALCOLM G. , COHEN G. , HENDERSON‐SMART D.
Published: March 2008

Abstract In 22 infants continuous measurements were made of the concentration of carbon dioxide (CO2) in inspired air during sleep. Evidence was found of CO2 enrichment of inspired air in certain environmental conditions. The levels achieved were not sufficiently high to acutely endanger an infant. Carbon dioxide concentrations as high as 2‐3% were observed in the prone position when the infant's head was under a blanket and when the lower face was obscured by bedding. Sleeping prone on a sheepskin also resulted in an increased concentration of CO2 but to a lesser extent than being under a blanket. In awake infants the presence of a pacifier also promoted an excess of CO2 in the inspired air, both in the prone and supine positions. The physiological and clinical implications of these findings, in relation to the Sudden Infant Death Syndrome (SIDS), are unknown and warrant investigation.
CNS Germinomas: Curable tumours in two adolescents
Authors: HILL P. , LEPRE F. , ALLISON R.
Published: March 2008

Abstract Two cases of central nervous system germinoma are described which highlight the various presentations of this tumour in different anatomical locations. The first case is that of a 15 year old boy with a suprasellar germinoma who presented with the classical triad of diabetes insipidus, visual disturbance and hypopituitarism. The need for full hormonal evaluation and replacement therapy is stressed. In the second case a 14 year old boy with pineal germinoma presented with features of raised intracranial pressure, Parinaud's syndrome and normal anterior pituitary function. Both cases were treated with corticospinal irradiation which resulted in regression of the tumours. Follow up has now been for over 4 years with no sign of recurrence.
Adrenal haemorrhage: Presenting as acute scrotal swelling in a neonate
Authors: DORAI C. R. THAMBI , SMITH A. J. , DEWAN P. A.
Published: March 2008

Abstract A case of neonatal adrenal haemorrhage presenting as a unilateral acute scrotum is reported, and the role of ultrasound (US) examination in diagnosis is discussed.
Survival of low birthweight infants in central Queensland
Authors: MERCER H. P. , ROPER P. C. , O'DUFFY J. F. , NESS G. J.
Published: March 2008

The survival of low birthweight infants £2000g born in the central Queensland area during the years 1979 to 1991 was examined. Five hundred and sixty such infants were either delivered at one of the two Rockhampton obstetric units (Rockhampton Base Hospital and the Mater Misericordiae Hospital) or retrieved from outlying central Queensland areas. Both hospitals had intensive care nurseries capable of ventilation and infants were transferred to tertiary centres only for cardiac or surgical treatment. The study involved all liveborn infants', including those with lethal malformations and all deaths up to the time of discharge. Survival rates were as follows: £500 g 0%, 501 £750 g 30%, 751 £1000 g 51%, 1001 ± 1500 g 79%, 1501 £2000g 93%. The survival of Aboriginal infants and outborn infants were found to be essentially the same as the overall group.
Well health care and the sudden infant death syndrome
Authors: FORD R. P. K. , MITCHELL E. A. , TAYLOR B. J.
Published: March 2008

The aim of this study was to examine whether poor attendance at routine antenatal and postnatal ‘well child’ health services was associated with a higher risk of sudden infant death syndrome (SIDS, or cot death). A nationwide case‐control study of SIDS in New Zealand enrolled 485 postneonatal deaths due to SIDS and 1800 control infants who were selected randomly. The risk for SIDS was found to be higher for infants whose mothers attended their first antenatal check later than 3 months into the pregnancy, made fewer antenatal visits, and did not go to antenatal education classes. However, this increased risk was largely explained by high parity, maternal smoking, the mother not being married, mother being <20 years old at the birth of her first child, and delivery during the winter months. Infants not attending a 6 week postnatal check had an almost three‐fold increased risk of SIDS compared with those who did attend (odds ratio [OR] 2.86; 95% confidence interval [Cl] 1.93, 4.24). Similarly, infants not attending well child clinics were at increased risk of SIDS (OR 2.75; 95% Cl 2.09, 3.62). These differences persisted when adjusted for likely confounders. This study demonstrates that infants who miss child health nurse clinics are those most at risk for SIDS and are those who warrant increased surveillance.
Early intervention: The professional views and referral practices of paediatricians in Victoria
Authors: REDDIHOUGH D. S. , TINWORTH S. , MOORE T. G. , IHSEN E. , DENNEHY S.
Published: March 2008

Early intervention services for young children with developmental disabilities have developed considerably in the past decade, yet little information is available about the referral practices and views of Australian paediatricians. During 1991, 100 paediatricians in Victoria completed a postal questionnaire designed to gain information regarding their attitudes to early intervention and referral practices. The results indicated that paediatricians had a positive view of early intervention, and perceived the standard and quality of the services in their region as comprehensive (16%) or adequate (54%). They were likely to make prompt referrals in the presence of an established disability (75%), but with suspected developmental delay, many (45%) were likely to wait until the delay was confirmed. Referrals were more often made for intervention for the child rather than for family support. However, paediatricians felt that early intervention had a beneficial effect on family functioning (81%). In general, the results indicate that there seem to be few barriers between paediatricians and the early intervention field.
Sudden infant death syndrome and infant mortality in Aboriginal and non‐Aboriginal infants
Authors: ALESSANDRI L. M. , READ A. W. , STANLEY F. J. , BURTON P. R. , DAWES V. P.
Published: March 2008

The aim of this study was to investigate sudden infant death syndrome (SIDS) in the context of total infant mortality for Aboriginal and non‐Aboriginal infants. Deaths for infants born in Western Australia from 1980 to 1988 inclusive were ascertained from a total population data base. Infant mortality rates and rates by period and cause of death were calculated for both populations. Aboriginal infants had a mortality rate three times that for non‐Aboriginal infants (23.6 cf. 7.9 per 1000 live births) and both populations showed a similar rate of decline in mortality over the study period. There were differences in the proportion of deaths occurring neonatally and postneonatally in the two populations. In terms of SIDS, 21% of the deaths in Aboriginal infants occurred neonatally compared with 7% for non‐Aboriginal infants. The overall cause of infant death distribution differed significantly between the two populations (P < 0.001). During the study period, Aboriginal infants showed a significant increase in deaths due to SIDS and a significant decrease in those due to birth defects and low birthweight. These results suggest it would be useful to review the pathology and diagnosis of sudden unexplained death in infancy.
Headache and asthma
Authors: WILKINSON I. A. , HALLIDAY J. A. , HENRY R. L , HANKIN R. G. , HENSLEY M. J.
Published: March 2008

The aim of this study was to investigate the association between headache and asthma, bronchodilators and atopy in school children. A cross‐sectional survey of all primary school children was conducted in two towns near Newcastle, New South Wales, Australia; one in the vicinity of two coal‐fired power stations, the other free of outdoor industrial air pollution. The main outcome measures were frequent headache, wheezing, bronchial reactivity, use of bronchodilators and atopy. Eight hundred and fifty‐one primary school children aged 5‐12 years participated (92% response rate). Twenty‐three per cent of the children were reported to have had a history of frequent headache. Crude odds ratios indicated that the odds of frequent headache was significantly higher in children with asthma and atopy and where there was a smoker in the home, but that there was no association between frequent headache and use of bronchodilators or the sex of the child or socio‐economic status measured as father's occupation. Stepwise logistic regression with frequent headache as the outcome of interest showed that, after adjusting for age and smoking in the home, the odds ratio for asthma (defined as current wheeze) was 3.24 (95% confidence interval [CI] 2.19‐4.77). The similarly adjusted odds ratio for asthma defined as bronchial hyperreactivity (BHR).was 1.60 (95% Cl 1.09‐2.37). Atopy was not statistically significantly associated with headache for either model. Asthma (defined as wheeze or BHR) is an independent risk factor for frequent headache. The relationship between headache and asthma is an association with bronchial hyperresponsiveness rather than atopy.
Coagulopathy with piperacillin administration in cystic fibrosis: Two case reports
Authors: RYE P. J. , ROBERTS G. , STAUGAS R. E. M. , MARTIN A. J.
Published: March 2008

Two cases are reported of coagulopathy in association with the administration of piperacillin to patients with cystic fibrosis. In both cases the coagulopathy was associated with the development of a serum sickness‐like illness with fever, rash and abnormal liver function tests occurring on day 12 and day 16 of treatment, respectively. On withdrawal of the piperacillin, both the serum sickness and the coagulopathy resolved rapidly, without sequelae.
Screening test for growth hormone deficiency: Usefulness of L‐dopa‐propranolol provocative test
Authors: LIM Y. J. , KWAN E. , LOW L. C. K.
Published: March 2008

This is a retrospective review of 185 short children who were tested for growth hormone (GH) secretion using the L‐dopa‐propranolol provocative test. One hundred and thirty‐three children were deemed to have passed the screening test when a GH concentration of greater than 15 miu/L was elicited after stimulation. Fifty‐two failed the screening test, of which 33 were diagnosed as having growth hormone deficiency (GHD) when they had inadequate growth hormone response to insulin‐induced hypoglycaemia. The other 19 were low‐responders since they showed adequate GH response to insulin tolerance test (ITT). The low‐responder rate to L‐dopa‐propranolol provocative test among short children who are not GH deficient was 12.5%. The low cost of L‐dopa and propranolol, the simplicity and safety of the test, and the acceptable rate of low‐responders make the test an effective screening test for GHD.