bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstructive sleep apnoea presenting as failure to thrive in infancy
Authors: FREEZER N. J. , BUCENS I. K. , ROBERTSON C. F.
Published: March 2008

Objectives: To study the postoperative outcome of infants under the age of 18 months in whom an adenotonsillectomy had been performed, with particular emphasis on the pre‐ and postoperative weight gain and linear growth velocities, and the resolution of symptoms of obstructive sleep apnoea (OSA).

Methodology A retrospective study of all infants in whom an adenotonsillectomy had been performed during the 5 year period to January 1990. Details of pre‐ and postoperative outcome variables were obtained by review of hospital and office records and by telephone calls to the parents.

Results Complete data were available for 29 (76%) of the 38 infants in whom an adenotonsillectomy had been performed. The data from these infants are reported. Pre‐operatively, all infants had clinical symptoms of OSA, and 52% of infants also presented with failure to thrive (FIT). Seven infants were dysmorphic: three had Down syndrome, three had a craniofacial anomaly and one infant had Mobius syndrome. Following adenotonsillectomy, 23 infants (79%) had complete resolution of their OSA symptoms. Two infants with Down syndrome required a tracheostomy to relieve persistent upper airway obstruction. Eighty‐seven per cent of the infants with pre‐operative FTT had a significant increase in weight gain velocity postoperatively (mean 195.1 ± 80.8 s.d. vs 509.8± 249.1 g/month; P<0.001), including the infants with mild persistent symptoms of OSA. The weight gain velocity of infants who were not failing to thrive pre‐operatively did not change significantly following adenotonsillectomy (328.1 ± 106.9 vs 333.2±146.4 g/month; P= 0.82). The linear growth velocity of all infants did not change significantly postoperatively.

Conclusions: SA should be considered in infants with FTT, as adenotonsillectomy is an effective treatment for OSA in infancy, and the weight gain velocity of these infants may increase significantly postoperatively. Overnight oximetry or other physiological studies may be required if the clinical signs and symptoms of OSA are equivocal.
Morphine increases synchronous ventilation in preterm infants
Authors: DYKE M. P. , KOHAN R. , EVANS S.
Published: March 2008

Objectives: To examine the short‐term cardiorespiratory effects of intravenous morphine infusion in ventilated preterm infants.

Methodology A randomized double‐blind placebo‐controlled trial in a neonatal intensive care unit. Twenty‐six preterm infants (29‐36 weeks gestation) with hyaline membrane disease requiring ventilatory assistance on the first day after birth were included in the study. A loading dose of morphine 100 μg/kg over 30 min followed by a continuous intravenous infusion at 10 μg/kg per hour was given. Primary measures were heart rate, blood pressure, respiratory rate and interaction of spontaneous respiration with mechanical ventilation. Secondary measures were durations of oxygen therapy, ventilator therapy and hospitalization as well as incidence of bronchopuimonary dysplasia, periventricular haemorrhage and pneumothorax.

Results Morphine‐treated infants spent a significantly greater percentage of total ventilated time breathing in synchrony with their ventilators (median [IQ]= 72[58‐87]vs 31 [17‐51]%; P= 0.0008). Heart rate and respiratory rate, but not blood pressure, were reduced in morphine‐treated infants. Duration of oxygen therapy was reduced (median [IQ]= 4.5[3‐7]vs 8[4.75‐12.5] days; P= 0.046).

Conclusions Intravenous morphine infusion increases synchronicity of spontaneous and ventilator‐delivered breaths in preterm infants. Morphine reduces heart rate and respiratory rate without reducing blood pressure, and may help to reduce duration of oxygen therapy in preterm infants with hyaline membrane disease.
Clinical signs associated with Triple Antigen (DTP) vaccination in infants
Authors: HARRIS G. , NOLAN T. , HARTMAN L.
Published: March 2008

Objective: The perceived reactogenicity of pertussis‐containing vaccines is of considerable public health importance. The purpose of this study was to establish prospectively the incidence of systemic and local clinical signs associated with the first three doses of the diphtheria‐tetanus‐pertussis vaccine (DTP) currently used in Australia. In addition, in order to determine whether variability in reporting of such phenomena might be associated with variation in DTP batches, infant behaviour was studied with three batches for the first of the three DTP vaccinations.

Methodology : Double blind, randomized controlled trial. There were 591 eligible infants who were recruited sequentially from centres for vaccination in three large Melbourne municipalities, of whom 531 (mean age 10 weeks, 45% female) were randomized and immunized. Of 181 subjects who received DTP from batch 1, 151 were studied at the time of their second DTP dose, and 98 at the third. Infants were assigned randomly to receive one of three batches of DTP vaccine. Parents were provided with a thermometer and a clinical sign diary. Research nurses visited the home 24 h after vaccination, and telephoned 7 days after vaccination to record local and systemic signs.

Results There was no significant variation between DTP batches in rates of local or systemic signs. At the time of the first vaccination, the rates of local signs were: redness 16%, induration 29%, swelling 46%, and tenderness 54%. Systemic signs included: irritability 93%, intermittent inconsolable crying 43%, and persistent crying 12%. An axillary temperature of greater than 38°C was recorded in 13% (Cl 9–19%) of babies following the first immunization, 20% (Cl 14–27%) following the second, and 14% (Cl 8–23%) following the third immunization. There were significant reductions in the rates of observed signs over the immunization course for diarrhoea, irritability, intermittent inconsolable crying and persistent crying.

Conclusions There is little difference in the rates of clinical signs or presumed minor adverse effects associated with the DTP vaccine used in Australia today compared to that used 10 years ago, despite increases in the diphtheria and tetanus toxoid concentration, and the addition of aluminium phosphate adjuvant. Rates are comparable to those for other DTP vaccines manufactured in North America and Europe.
Neurodevelopmental outcome in very low birthweight infants with necrotizing enterocolitis requiring surgery
Authors: TOBIANSKY R. , LUI K. , ROBERTS S. , VEDDOVI M.
Published: March 2008

Objective: To assess the effect of necrotizing enterocolitis (NEC) on neurodevelopmental outcome.

Methodology: Neurodevelopmental outcome of 20 very low birthweight (VLBW) infants who developed NEC requiring surgery was compared with 40 matched infants controlled for gestation, birthweight, and year of admission. Twenty‐nine VLBW infants who developed NEC and did not require surgery were also compared.

Results: Infants with NEC needing surgery were of 26±2 weeks gestation and weighed 892±192 g at birth. Infants with NEC managed medically were of higher gestation (27±2 weeks) but similar birthweights. More infants with NEC requiring surgery required inotropic support. At follow up, NEC surgery infants had a significantly higher incidence of developmental morbidity, 11 of 20 compared with 11 of 40 matched controls (Fisher's exact test P= 0.0493), and six of 29 infants with NEC managed medically (Fisher's exact test P= 0.0174).

Conclusions: These findings stress the importance for close follow up for neurodevelopmental sequelae in VLBW infants who have had NEC requiring surgery.
High frequency oscillation in newborn infants with respiratory failure
Authors: McDOUGALL PN , LOUGHNAN PM , CAMPBELL NT , HOCHMANN M , TIMMS BJ , BUTT WW
Published: March 2008

Objective: To report ventilation strategies, survival and complications in 39 outborn infants treated with high frequency oscillatory ventilation (HFOV).

Methodology Data were collected prospectively between 1 May 1992 and 31 December 1993 on all infants treated with HFOV who had severe respiratory failure despite optimal conventional ventilation.

Results Twenty‐eight out of 39 (72%) survived. Of the 15 infants with birthweights <1500g, eight survived. Best survival rates were for infants with pulmonary interstitial emphysema with air leak (4/5) and for infants of birthweight >1500g with hyaline membrane disease (8/8), and meconium aspiration syndrome (7/7). Three infants deteriorated while on HFOV and required extracorporeal membrane oxygenation. Complications were: (i) development of pulmonary interstitial emphysema (1); (ii) recurrence of pneumothorax (3); (iii) hypotension (2); and (iv) bronchopulmonary dysplasia (9). One of the eight infants weighing <1500g who received HFOV in the first week of life developed periventricular haemorrhage.

Conclusion The initial results of HFOV for severe respiratory failure were encouraging although a learning curve was encountered with its introduction.
Technology seduction: Lost opportunities in child health?
Authors: STANLEY FJ , KURINCZUK J J
Published: March 2008

This report examines the extent to which illness‐based individual care and expensive, often unevaluated, technologies in paediatrics have seduced practitioners away from more cost‐effective, population‐based child health activities and examples of new and unevaluated technologies in perinatology and paediatrics are given. The way in which these technologies are introduced and taken up, by ‘creeping incrementalism], is described and a plea is made to implement only those aspects of paediatric care that have been demonstrated to be effective. This would result in only appropriate technologies being used, avoid harm being done to children and ensure that money is available for other effective population‐based activities that improve child health.
Invasive pneumococcal infection in children, 1981‐92: A hospital‐based study
Authors: DAVIS CWC , McINTYRE PB
Published: March 2008

Objective: To document the pattern and sequelae of invasive pneumococcal infection in hospitalized children.

Methodology Retrospective review of Streptococcus pneumoniae (Sp) isolates from normally sterile sites from 1981 to 1992 at three paediatric centres in Sydney for demographic data, spectrum of disease, predisposing conditions, mortality, and sequelae from meningitis.

Results: Four hundred and thirty‐one episodes in 417 patients were identified. Foci of infection were: meningitis, 34%; pneumonia, 29%; bacteraemia without apparent focus, 30%; and other foci, 7%. Sixty‐one per cent of all cases and 64% of cases with meningitis were less than 2 years old. Predisposing conditions were present in 37%, were significantly more common in patients over age 2 years and were more common with foci other than meningitis. Overall mortality was 6.6% whereas the mortality for those with meningitis was 8%. Neurological sequelae were identified in 34% of previously normal children, and severe hearing loss occurred in 11.5%.

Conclusions The high morbidity and mortality from invasive pneumococcal infection in children justifies further evaluation of preventive strategies.
Follow‐up validation study of the Victorian Congenital Malformations Register
Authors: KILKENNY M , RILEY M , LUMLEY J
Published: March 2008

Objective: To determine whether there has been an improvement in ascertainment of malformations in the Victorian Congenital Malformations Register (VCMR).

Methodology The medical records of 500 children under 4 years of age admitted consecutively to two paediatric teaching hospitals in Victoria in 1992 were viewed to determine whether these cases had been notified to the Register.

Results Over three‐quarters of the defects recorded had been notified to VCMR. There was 100% ascertainment of chromosomal anomalies and a high proportion of major structural malformations were notified.

Conclusion This study repeats the validation study completed in 1986 and shows marked improvement in ascertainment of malformations in the VCMR by 1992.
Herpes simplex virus infections in the neonate
Authors: MALOUF DJ , OATES RK
Published: March 2008

Objectives: To review the experience of the Camperdown Children's Hospital with neonatal herpes simplex viral (HSV) infections between 1960 and 1992.

Design: A retrospective record review of all cases of HSV infection.

Results: Fifteen proven HSV infections were found. Only three cases had a definite history of HSV infection during pregnancy. Six were delivered at 36 weeks gestation or earlier. Seven weighed 2500 g or less. Forty‐three per cent developed physical signs within 7 days of birth. Three cases were confined to skin, eyes and mouth, five were generalized, six had encephalitis with or without skin lesions, and one had pneumonitis. The mortality rate comprising the five with generalized infection was 47%, one with encephalitis and the one with pneumonitis. Four of the eight survivors have persisting neurological impairment. Those with disseminated infection and encephalitis did poorly regardless of antiviral treatment.

Conclusion A high index of suspicion of HSV infection is important so that antiviral treatment can be commenced early, particularly for those infections localized to skin, eye and mouth where there may be a good prognosis.
Anti‐neutrophil cytoplasmic antibodies in Japanese children with ulcerative colitis
Authors: KANEKO K , SUZUKI Y , SHIMIZU T , YAMASHIRO Y , YABUTA K , LIFSCHITZ CH
Published: March 2008

Objective: To investigate the diagnostic value of anti‐neutrophil cytoplasmic antibodies (ANCA) in the diagnosis of ulcerative colitis (UC) in Japanese children.

Methodology Serum samples from 23 children with UC (17 Japanese, 6 non‐Japanese), 27 children with Crohn's disease (CD) (10 Japanese, 17 non‐Japanese), 10 children with other diarrhoeal diseases, and 33 normal, healthy adult volunteers were assayed for ANCA using an indirect immunofluorescence technique.

Results ANCA were detected in 6/17 (35%) UC patients and 0/10 (0%) CD patients in Japanese children, and in 3/6 (50%) UC patients and 3/17 (18%) CD patients in non‐Japanese children. The difference in prevalence between Japanese and non‐Japanese children with UC was not statistically significant (P>0.05). ANCA were not found in other diarrhoeal patients and volunteers.

Conclusions Although ANCA have been reported to be useful in the diagnosis of UC in adults, they may be of limited use in Japanese children. This might reflect the heterogeneity of UC.
Selenium status of New Zealand infants fed either a selenium supplemented or a standard formula
Authors: DARLOW BA , INDER TE , SLUIS KB , NUTHALL G , MOGRIDGE N , WINTERBOURN CC
Published: March 2008

Objective: New Zealand soils are deficient in the essential micronutrient, selenium. New Zealand infants have low selenium levels at birth and experience a further decline if fed cows milk based formula. This study examined the selenium status of infants fed with a new commercially available selenium supplemented formula.

Methodology Forty‐four newborn infants, whose mothers wished to formula feed, were randomized in an open controlled trial to be fed a commercially available selenium supplemented cows milk formula (containing 17 μg Se/L) or an unsupplemented formula (containing 4.6 μg Se/L). Cord, 1 and 3 month blood samples were obtained for selenium status (plasma and red cell selenium and glutathione peroxidase) and thyroid function.

Results Mean plasma selenium and glutathione peroxidase values were significantly higher in supplemented than unsupplemented infants at 1 month (unpaired t‐tests; P<0.0001 and P= 0.001 respectively) and 3 months (P<0.0001 and P= 0.0005). Analysis within treatment groups between time points (paired t‐tests) showed that selenium supplementation prevented the fall in plasma selenium from birth to 1 month seen in unsupplemented infants and was associated with a rise in levels between 1 and 3 months (P= 0.002).

Conclusions Supplementing cows milk formula with selenium to replicate the levels found in breast milk is nutritionally sound. Feeding from a few days of age with a formula containing 17 μg Se/L in infants with low selenium status at birth is sufficient to cause a rise to 80% of adult levels at 3 months of age.
Immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children
Authors: HANNA JN , SEXTON WL , FAOAGALI JL , BUDA PJ , KENNETT ML , BRUSSEN KA
Published: March 2008

Objective: To determine the immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children in north Queensland.

Methodology: A cross‐sectional survey of immunity in a sample of children; 101 fully vaccinated Aboriginal and Torres Strait Island children, with a median age of 24.5 months, from 10 communities in North Queensland participated in this study. The main outcome measures were the prevalence of adequate antibody levels against hepatitis B, poliomyelitis and measles.

Results: Only 54% (95% Cl 44–63%) of the children had adequate immunity (10 m iu/mL) to hepatitis B, and one child had been infected despite vaccination. Although all the children (95% Cl 96–100%) had adequate immunity (i.e. neutralizing antibodies at a dilution of 1:8) to poliovirus 2, only 93% (95% Cl 86–96%) and 60% (95% Cl 50–69%) had adequate immunity to polioviruses 1 and 3, respectively. Nearly all (96%; 95% Cl 90–98%) of the children had adequate immunity (i.e. detectable IgG antibody) to measles.

Conclusions: Although a relatively low proportion of the children had adequate antibody levels against hepatitis B the clinical significance of this observation is uncertain. Further studies are needed to determine whether fully vaccinated Torres Strait Island children have been adequately protected and whether they require a booster dose of hepatitis B vaccine. A substantial proportion of fully vaccinated Aboriginal and Torres Strait Island children are inadequately protected against poliomyelitis, and therefore any such child with acute flaccid paralysis should be investigated fully for poliomyelitis. Vaccinated Aboriginal and Torres Strait Island children are well protected against measles, as are other Australian children.
Fetal echocardiography
Authors: PENNY DJ , WEINTRAUB RG
Published: March 2008

: Fetal echocardiography has provided a means for the detailed assessment of cardiac structure and function from early prenatal life. Indications for a fetal echocardiographic examination and the potential implications for individuals caring for newborns with cardiac malformations are discussed.
Inferior vena cava pressure as an estimate of central venous pressure
Authors: YUNG M , BUTT W
Published: March 2008

Objective:

To determine whether pressure in the inferior vena cava (IVC) is similar to central venous pressure.

Methodology:

Prospective measurement of both central venous pressure (CVP) and inferior vena cava pressure (IVCP) in the same child; each child had to have both catheters in situ. Two measurements of each pressure in reverse order (IVCP then CVP, and CVP then IVCP) were done and the mean of each was recorded. Comparison of the pressures was performed using the method of Bland and Altman.

Results:

Thirty‐nine children had pressures recorded. The CVP ranged from 3 to 17 mmHg. In 22 of 39 measurements IVCP was equal to CVP; in 33 of 39 measurements IVCP was different from CVP by 1 mm or less and in 37 of 39 measurements IVCP was different from CVP by 2 mm or less. The mean difference between IVCP and CVP was + 0.33 mmHg, the 95% confidence interval was 2.26 to + 2.93 mmHg.

Conclusion:

Measurement of IVCP is a good approximation to CVP and can be routinely used in clinical care of children who do not have raised intra‐abdominal pressure.
Neonatal systemic candidiasis
Authors: McDONNELL M , ISAACS D
Published: March 2008

: Systemic candidiasis is notoriously difficult to diagnose in neonates; however, it is frequently described and has a high mortality and morbidity. It is particularly likely to occur in extremely low birthweight babies, especially those receiving long‐term parenteral nutrition and antibiotics. The clinical features are non‐specific. Thrombocytopenia occurs in almost all cases of systemic candidiasis, but also in about half the cases of bacterial sepsis. Empirical antifungal therapy should be considered more readily for high‐risk, clinically septic, thrombocytopenic babies.
A case‐control study examining risk factors for invasive Haemophilus influenzae type b disease in Victoria, Australia 1988‐90
Authors: CLEMENTS DA , WEIGLE† KA , GILBERT‡ GL
Published: March 2008

Objective

: To determine whether day‐care attendance was a risk factor for Haemophilus influenzae type b (Hib) disease, particularly for epiglottitis.

Methodology

: A case‐control analysis of risk factors for invasive Hib disease was performed in Victoria, Australia between February 1988 and February 1990 prior to the introduction of immunization for Hib. A total of 210 cases and 367 day surgery hospital controls were enrolled prospectively. Data were collected by questionnaire at the time of admission.

Results

: Logistic regression analysis showed that risk factors for meningitis were day‐care attendance, household crowding and recent illness in a sibling. Risk factors for epiglottitis were day‐care attendance and mother's birthplace in Australia or New Zealand.

Conclusions

: This study confirms that day‐care attendance is a risk factor for Hib epiglottitis as well as meningitis. In addition, the mother's birthplace in Australia or New Zealand is a risk factor for epiglottitis in these data. The reason for this latter observation is unclear.
Obsessive‐compulsive behaviour in children and adolescents: A cross‐sectional Australian study
Authors: KING NJ , MYERSON NN , INGLIS S , JENKINS M , OLLENDICK TH
Published: March 2008

Objective:

To examine the reliability of the survey form of the Leyton Obsessional Inventory‐Child Version (LOI‐CV), ascertain the prevalence of self‐reported obsessive‐compulsive behaviour together with age and sex differences and identify the most common obsessive‐compulsive behaviours and their associated level of interference.

Methodology:

The survey form of the LOI‐CV was administered to a large sample of children and adolescents attending regular schools. Participants were aged between 8 and 16 years (n= 1602).

Results:

We found the survey instrument to have adequate internal consistency and test‐retest reliability. There was an age‐related decline in self‐reported obsessive‐compulsive behaviour and girls reported a higher level of obsessive‐compulsive behaviour than boys. The most common obsessive‐compulsive behaviours included: repeated thoughts or words, having trouble making decisions, having to do certain things and doing things in the exact manner and having a bad conscience. For the most part, these behaviours were associated with low levels of interference. However, for a significant minority of youth (5 to 14%), these behaviours did cause problems and significantly interfered with their lives.

Conclusions:

Although many obsessive‐compulsive behaviours are part of normal development, they may still be problematic for some children and adolescents.
Neonatal outcome in a randomized, controlled trial of low‐dose aspirin in high‐risk pregnancies
Authors: LESLIE GI , GALLERY EDM , ARNOLD JD , ROSS MR , GYORY AZ
Published: March 2008

Objective:

To determine the value of low‐dose aspirin in high‐risk pregnancies, and assess its impact on fetal growth, as well as on perinatal mortality and morbidity.

Methodology:

One hundred and eight women with singleton pregnancies were enrolled in a randomized, double‐blind, placebo‐controlled trial of 100 mg/day aspirin from 17 to 19 week gestation. Enrolment criteria included pre‐existing chronic essential hypertension or renal disease, or a history of previous early, severe pre‐eclampsia.

Results:

There were four stillbirths (all aspirin) and two neonatal deaths (both placebo), to yield respective perinatal mortality rates of 69/1000 and 40/1000 (P=0.499). Liveborn infants in the aspirin group were significantly more mature (P= 0.017) and of heavier birthweight (P= 0.034) but had similar length (P= 0.091) and head circumference (P= 0.257). Fewer infants in the aspirin group were liveborn prematurely (5/54 vs 14/50; P= 0.016) or were of low birthweight (3/54 vs9/50; P= 0.052). There were no significant between‐group differences for standard deviation (Z) scores for weight, length or head circumference, or for skinfold thickness measurements. There was no significant difference in occurrence of low Apgar scores or in neonatal intensive care unit use between the groups.

Conclusions:

Low‐dose aspirin does not appear to have a significant effect on perinatal morbidity. The increase in weight at birth associated with low‐dose aspirin therapy is due to prolongation of pregnancy rather than prevention of intra‐uterine growth retardation.
Health status of Victorian special school children
Authors: ACKLAND MJ , WADE RW
Published: March 2008

Objective

: This study sought to determine the health status and health needs of a sample of students attending special schools for the intellectually disabled in Victoria, Australia.

Methodology

: Two hundred and forty‐nine students not previously seen by a Community Child Health Medical Officer (CCHMO) were assessed at school. Data on student, parent and staff needs were obtained through personal interviews and documented on a standard questionnaire. Health status was documented using data obtained from parents and teachers as well as the clinical assessment.

Results

: Comparison of the number of problems reported by parents with the number confirmed at examination showed significant underreporting of vision, hearing and general medical problems. However, behaviour problems were nearly all reported. Many students had multiple problems with 63% having 2‐4 problems and 11% having 5‐8 problems. Ninety‐nine (40%) of the 249 children seen had newly detected problems; vision (24), hearing (24) and obesity (9) were the most common. Two hundred and forty‐four (98%) had known problems and 27% of these had insufficient information available from parents or staff to completely ascertain their health status. In 115 cases the primary problem was intellectual impairment of unknown cause. Down syndrome was the next most common underlying diagnosis (30) followed by autism (24), epilepsy (21) and cerebral palsy (15). The most common secondary diagnoses were asthma (16), congenital heart defects (12), seizures (8) and skin problems (8). Many students required referral for further management both for newly detected problems (64%) and known problems (18%). Parents required counselling and/or discussion on a number of issues for both newly detected problems (66%) and known problems (39%); when counselling had taken place parent and staff concerns had reduced significantly by the time of the follow‐up assessment.

Conclusions

: This study demonstrated that in those students with known intellectual impairment there were many with other unrecognized health problems and unmet needs. These findings have implications for health services provided to children attending special schools.
Lumbar puncture in suspected neonatal sepsis
Authors: McINTYRE P. , ISAACS D.
Published: March 2008

Objective: The importance of lumbar puncture (LP) as part of the evaluation of suspected neonatal sepsis is assessed, as it may be the only positive diagnostic test in about 10% of septic babies with meningitis but negative blood cultures. However, LP may compromise respiratory function, and the interpretation of cerebrospinal fluid (CSF) may not be straightforward.

Conclusion: The clinical setting and the probability of meningitis are important determinants of the likely value of LP. For asymptomatic neonates with obstetric risk factors for sepsis, and for babies with early‐onset respiratory distress alone, LP may be delayed and only performed later if blood cultures are positive. This is because hundreds of LP will be needed to diagnose a single case. However, infants with suspected late‐onset sepsis should have an immediate LP because finding Gram‐negative bacilli or fungi in the CSF will affect treatment choices.
Sudden infant death syndrome: Effect of breast and formula feeding on frontal cortex and brainstem lipid composition
Authors: BYARD R. W. , MAKRIDES M. , NEED M. , NEUMANN M. A. , GIBSON R. A.
Published: March 2008

Methodology: Docosahexaenoic acid levels were measured by gas chromatography in samples of frontal lobe and brain‐stem taken from 28 and 26 infants, respectively, who had died of sudden infant death syndrome (SIDS).

Results: Significantly higher levels of docosahexaenoic acid were present in the frontal lobe tissues derived from the 13 breast fed infants (age range = 3.3–36.3 weeks; mean 15.9 ± 11.3 weeks) compared to the 15 formula fed infants (age range = 6.9–47.7 weeks; mean 19.3 ± 10.6 weeks); mean (± s.d.) levels were 8.5 ± 1.1% and 7.6 ± 0.8% of total fatty acids (P= 0.019). There was, however, no significant difference in brainstem docosahexaenoic acid levels between breast and formula fed infants.

Conclusions: Given these variable findings, further investigation of the relationship between dietary fatty acid intake and cerebral lipid levels may help to clarify whether different modes of feeding have a role in the pathogenesis of SIDS.
An evaluation of the action plans of children with asthma
Authors: DAWSON K. P. , VAN ASPEREN P. , HIGGINS C. , SHARPE C. , DAVIS A.
Published: March 2008

Objective: To assess the provision and use of action plans in children attending hospital because of asthma.

Methodology: An interviewer administered a structured questionnaire to the parents of 279 children attending the Casualty Department, Outpatient clinics or admitted to hospital because of asthma, at two Level 3 teaching hospitals.

Results: Only 82 (29%) of the children attending hospital had a written action plan. The majority (57%) were devised by paediatricians and covered the salient aspects of care. However, indications for steroid use were included in only 28% of plans and only 37% of the action plans in children over 5 years incorporated the use of peak flow meters.

Conclusion: Action plans are still under‐utilized in children with asthma. General practitioners should be encouraged to consider the use of action plans for the group of children not already covered.
Therapy methods for cerebral palsy
Authors: GRAVES P.
Published: March 2008

Objective:Current approaches to therapy for cerebral palsy tend to be child‐focussed and claim functional improvements. Such approaches lead to demands for more therapy and more services as the solution for problems associated with cerebral palsy. This report suggests an alternative approach.

Methodology:The literature on therapy methods for cerebral palsy is reviewed and compared with the literature on early intervention for children with intellectual disabilities.

Results:The claims for functional improvements resulting from therapy methods cannot be substantiated. The literature on early intervention for children with cognitive impairments indicates a shift in emphasis from the child's impairments to the whole child, the family and the wider community.

Conclusions:Demands for more and better therapy are, at best, simplistic and tend to detract from the real needs of the child and family. An ongoing ecological approach is more likely to produce positive outcomes.
Annotation New rapid microbiological diagnostic techniques
Authors: BURGNER D , ISAACS D , GIVNEY R
Published: March 2008

Objective: To briefly and critically review the role of new, rapid techniques, especially PCR, in the diagnosis of infectious diseases.

Methodology: Review of the literature.

Results: New diagnostic techniques show great promise but many techniques are still in their infancy and the relative roles of the various methods remain uncertain.

Conclusions: It seems likely that different techniques will continue to be useful in a number of different contexts. No one technique is likely to become ‘diagnostically dominant’ in the foreseeable future.
The social and educational outcome of a cohort of rural children in relation to the racial and socio‐economic groupings of their parents
Authors: COX JW
Published: March 2008

Objective: To evaluate the outcome after a generation of extra health and educational intervention among children whose antenatal and perinatal characteristics appeared influenced by racial origin and socio‐economic status.

Methodology: Sixty‐five of an original cohort of 103 children born in Cunnamulla, Queensland, 1974‐75, remained in the area allowing educational and social outcomes to be assessed: 40 were Aboriginal, 25 were children of unemployed Caucasians and 38 were children of employed Caucasians. The criteria for a successful outcome on leaving school were progression to further education or finding paid employment.

Results: Fifty‐three of the children who had left school were assessed (the remaining 12 were still at school). Only four of the 30 assessed Aborigines had successful outcomes compared with 10 of the 13 employed Caucasians and three of the 10 unemployed Caucasians. Gender influenced success, with females under‐represented such that among the 23 Aboriginal and unemployed Caucasian girls only one had a successful outcome; 13 of these 23 girls were pregnant before finishing secondary education.

Conclusions: The educational and social success of Aborigines is poor compared with the children of employed Caucasians. Outcomes for children of unemployed Caucasians are similar to those of Aborigines, suggesting failure of a range of government and community intervention programmes.
The management of acute abdominal pain in children
Authors: SIMPSON ET , SMITH A
Published: March 2008

Objective: Acute abdominal pain is a common problem in childhood, and appendicitis is frequently diagnosed by general practitioners and doctors working in emergency departments. The objective of the present report was to determine the frequency of appendicitis in a group of children with acute abdominal pain presenting to the emergency department of a general hospital, as well as attempting to analyse the manner in which these patients were managed.

Methodology: The initial assessment in hospital (by resident hospital staff) of the study group of patients was analysed and their subsequent clinical progress documented.

Results: The present report shows that the vast majority of children with acute abdominal pain do not have appendicitis and that appendicitis is significantly over‐diagnosed by junior hospital doctors.

Conclusions: Appendicitis is a clinical diagnosis, best made by an experienced member of the paediatric surgical team. Frequent review, with a minimum of investigations, provides the best means of making a rational decision regarding surgery.
Gender differences in adolescent weight and shape‐related beliefs and behaviours
Authors: NOWAK M , SPEARE R , CRAWFORD D
Published: March 2008

Objective: To describe the beliefs, attitudes and behaviours of North Queensland adolescents about weight, weight loss and body shape, and to examine the influence of gender.

Methodology: A questionnaire was used to survey 791 year 8 adolescents from private schools in north Queensland.

Results: Only 41% of the girls and 54% of the boys were satisfied with their weight; 52% of the girls and 27% of the boys wanted to lose weight, 52% of the girls thought their thighs were too fat and 26% of the boys thought their stomachs were too fat. When surveyed, 35% of the girls and 22% of the boys were trying to lose weight.

Conclusions: The weight loss drive, so prevalent in our culture, is already apparent among 12‐14 year old schoolchildren. The challenge is to prevent obesity without encouraging an accompanying obsession with weight loss; however, good information, appropriately delivered, may be insufficient without a change in cultural expectations and assistance from the fashion and advertising industries.
Late‐onset infections of infants in neonatal units
Authors: ISAACS D , BARFIELD C , CLOTHIER T , DARLOW B , DIPLOCK R , EHRLICH J , GRIMWOOD K , HUMPHREY I , JEFFERY H , KOHAN R , McNEIL R , McPHEE A , MINUTILLO C , MOREY F , TUDEHOPE D , WONG M
Published: March 2008

Objective: To examine regional variations in the incidence of late‐onset neonatal infections in Australian and New Zealand neonatal units.

Methodology: A longitudinal, prospective surveillance study of systemic sepsis (septicaemia or meningitis) in 11 neonatal units: 10 in the Australian States of the Northern Territory, New South Wales, Queensland, Victoria and Western Australia, and 1 in Christchurch, New Zealand. The results are reported of late‐onset neonatal infection (defined as sepsis after 48 h) for the second year of prospective surveillance, data being collected from 1 October 1992 to 30 September 1993.

Results: Data were available on 24 535 live births in Australia, representing approximately 10% of all live births in the country. There were 320 episodes of sepsis in Australian units affecting 294 babies. One hundred of these episodes (31%) were earty‐onset; 3.0% of babies admitted to six tertiary care neonatal units attached to maternity hospitals developed late sepsis, and this rate did not differ between units. The proportion of babies infected was inversely related to birthweight: 22.6% of babies under 1000 g, but 0.6% over 2000 g. Coagulase negative staphylococci were the commonest cause of late‐onset sepsis. There were 26 episodes of S. aureus septicaemia, of which only one was due to MRSA. Meningitis occurred in 13 babies (5.9%) with late‐onset sepsis. The mortality from late‐onset sepsis was 7.7%.

Conclusions: Coagulase‐negative staphylococci are the commonest cause of late‐onset sepsis of babies in neonatal units. There were no major regional differences in the incidence of, or the organisms causing, late sepsis.
Childhood asthma complicated by anxiety: An application of cognitive behavioural therapy
Authors: PARK SJ , SAWYER SM , GLAUN DE
Published: March 2008

Objective: To identify characteristics within the patient and the environment that might be instrumental in triggering and maintaining an episode of asthma in children whose objective lung function tests suggested a less severe exacerbation than the subjective report and behaviour indicated, and also to investigate the efficacy of a cognitive behavioural intervention, using the paradigm of a panic anxiety disorder.

Methodology: A retrospective investigation of 23 case records and psychosocial histories, focusing on the characteristics of the sample and the number of presentations and admissions before and after the intervention, which is described.

Results: Children aged 10‐12 years predominated. A precipitating event triggered a fear that their condition had deteriorated in the context of a growing understanding that asthma in a child could be fatal. A reduction in presentations and admissions post‐intervention is shown.

Conclusions: The paradigm of panic disorder is useful to understand the sudden onset of apparent deterioration in the severity of asthma when objective lung function tests do not support the subjective experience.
Congenital dyserythropoietic anaemia: Report of three cases
Authors: ARIFFIN WA , KARNANEEDI S , CHOO KE , NORMAH J
Published: March 2008

Between January 1985 and June 1992, the Paediatric Department of Hospital Universiti Sains Malaysia has diagnosed congenital dyserythropoietic anaemia in three children, two of whom were siblings. The age of onset ranged from 1 to 3 years. All of them became transfusion‐dependent before the age of 4 months. One of them was successfully treated with bone marrow transplantation.
Computer administration of a school‐based adolescent health survey
Authors: HIBBERT ME , HAMILL C , ROSIER M , CAUST J , PATTON G , BOWES G
Published: March 2008

Objective: To examine the utility of notebook computers in the collection of data in large scale surveys.

Methodology: A notebook computer administered survey of health in adolescents was conducted in 1992 using a multi‐instrument questionnaire. Students in school years 7,9 and 11 in private and government schools in Melbourne and rural Victoria participated.

Results: Parental consent was obtained with an 83% response rate. Each student answered questions directly onto the computer taking an average of 68 min to complete the highly branched confidential but not anonymous questionnaire. Students were presented with on average 33% of the 897 possible questions. Over 90% of students reported enjoying using the computer. Those who reported answering the questions honestly all the time ranged from 68 to 85%, increasing with grade level.

Conclusions: The use of computers in survey research provides many advantages in data collection including exposure only to relevant questions and the opportunity of asking sensitive questions.
Antibodies to diphtheria, tetanus and pertussis in infants before and after immunization with DTP (Triple Antigen) vaccine
Authors: STEWART TA , NOLAN TM , HOGG G , McEWEN J
Published: March 2008

Objective: To determine antibody levels to the Australian manufactured combined diphtheria, tetanus and pertussis (DTP) vaccine (Triple Antigen, CSL Ltd) in infante before and after their primary immunization course.

Methodology: Serosurvey (antibody prevalence study) in two groups: infants aged 5‐9 weeks who had not received any immunizations (n= 25), and infants aged 7‐10 months who had received two (n= 25) or three immunizations (n= 57) with DTP, sampled from infants attending the Royal Children's Hospital, Melbourne, either as inpatients or outpatients between February and April 1993. The immunization history for each infant was determined from hospital records, the parent‐held child health record, or the local council or family doctor who immunized the infant.

Results: Enzyme immunoassay (EIA) of antibodies to diphtheria and tetanus showed all infants to have adequate protective levels after two or three vaccinations (£0.01 IU/mL). All subjects who had received all three DTP vaccinations had detectable antibody to at least one pertussis antigen. Antibodies to the pertussis antigens filamentous haemagglutinin and pertussigen (pertussis toxin) were comparable to levels determined for whole cell pertussis vaccines used elsewhere in the world. EIA‐determined antibodies to pertussis agglutinogen type 2 and agglutinogen type 3 showed substantially higher geometric mean titres when results for pre‐immunization and post‐immunization subjects were compared.

Conclusions: These data show that the Australian manufactured DTP vaccine has immunogenic properties similar to those of vaccines used elsewhere, and that antibody concentrations following immunization are at levels consistent with efficacy.
The high morbidity associated with a measles outbreak in a West Australian town
Authors: JEREMIJENKO AM , KELLY H , PATEL M
Published: March 2008

Objective: To determine the effectiveness of the measles vaccine and to record the morbidity during a measles outbreak.

Methodology: A retrospective cohort study was carried out. It was a community‐based study in Bunbury. Western Australia, between February and May 1994, of 53 cases of measles and their household contacts.

Results: Of the 53 cases of measles, 24 were from one high school. Only two cases occurred in the high school class that had received the National Health and Medical Research Council of Australia recommended measles, mumps and rubella (MMR) booster 12 months earlier. Neither had been vaccinated. Vaccine effectiveness was 91% (95% confidence interval 67‐97%). Ten cases had complications of measles and a further five were admitted to hospital. Doctors prescribed antibiotics to 29 cases and metoclopramide to five cases. One month elapsed between the day the index case became ill and the first notification to the community health centre.

Conclusions: The low herd immunity that led to this high school outbreak can be attributed to low vaccine coverage. There was a significant morbidity associated with this outbreak that may have been averted if earlier notification had occurred. The MMR booster dose should be offered to all 10‐16 year olds to prevent high school outbreaks.
Use of an occupational therapy motor performance checklist by a school health service: A pilot study
Authors: GWYNNE K , BLICK B , HUGHES L
Published: March 2008

Objective: The aim of this pilot study was to assess whether the School Health Service could play a role in identifying the children in most need of community occupational therapy services.

Methodology: A two‐tiered referral system, which incorporated a Motor Performance Checklist (MPC) devised by the authors, was used. This checklist consisted of 12 gross and fine motor items and was administered to 123 children in their first year of school. Comparison was made between parent/teacher referrals alone and the two‐tiered referral system as measured against a ‘gold standard’ test (the Bruininks‐Oseretsky Test of Motor Proficiency) in a smaller subgroup.

Results: Results indicated that the two‐tiered referral system incorporating the MPC had a sensitivity of 75% and specificity of 95% while the teacher/parent referrals had a sensitivity of 88% but a low specificity of only 41%. There was no significant difference in sensitivity (z= 0, P < 0.05) but a highly significant difference in specificity (z= 3.56, P > 0.005) between these two systems.

Conclusions: This two‐tiered referral system has the potential to impact significantly on paediatric occupational therapy utilization, service delivery and waiting times in the community health setting.
Patterns of disease among children: A simple and versatile measure of child health in communities
Authors: DUGDALE AE
Published: March 2008

Objective: To derive an indicator of community child health that is simple, stable, cost‐effective and suitable for small communities.

Methodology: Discharge diagnoses of children have been tabulated for hospitals in Australia and other countries and from an Aboriginal community, for up to 40 years. The differences in ratios between main diagnostic groups relate to the child health status in the community.

Results: As we pass from ‘developing’ to ‘developed’ conditions, the proportion of different diagnoses changes with a relative decrease in gastroenteritis and a relative increase in respiratory and other diseases. These changes parallel changes in infant mortality rates and child growth that are independent indicators of community child health.

Conclusions: The ratios of diagnoses of hospital discharges, the ‘disease pyramid’ is a reliable, valid and cost‐effective way of measuring child health in a community while avoiding many of the uncertainties of conventional disease‐specific and age‐specific discharge rate statistics.