bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathophysiology of overheating in a piglet model: Findings compared with sudden infant death syndrome
Authors: ELDER DE , BOLTON DPG , DEMPSTER AG , TAYLOR BJ , BROADBENT RS
Published: March 2008

Objective: To examine the nature of hyperthermia‐induced pathophysiological changes in an animal model including effects on lung compliance.

Methodology: Piglets were randomly assigned to heated or non‐heated groups. Heated animals were warmed to 4°C above normal body temperature while sedated and breathing spontaneously. Cardiorespiratory variables were recorded serially and haematological assessments and blood cultures taken at 0 and 6 h. After 6 h the animals were killed and a limited postmortem was performed. Control animals had all procedures without heating.

Results: Heated piglets developed tachycardia, hypotension and a metabolic acidosis in addition to tachypnoea, hypocapnic alkalosis and a neutrophil leucocytosis. Rectal temperature after death fell at the same rate in both groups. Lung histology revealed an excess of lung haemorrhage and alveolar oedema in the heated group. No significant group differences in dynamic lung compliance were demonstrated.

Conclusions: The pathological changes that occur during hyperthermia are non‐specific but not incompatible with those found in sudden infant death syndrome. There was no confirmation of the thesis that hyperthermia causes death by altering lung compliance.
Prevalence and aetiology of neurological impairment in extremely low birthweight infants
Authors: WAUGH J , O'CALLAGHAN MJ , TUDEHOPE DI , MOHAY HA , BURNS YR , GRAY PH , ROGERS YM
Published: March 2008

Objective: To determine the prevalence and perinatal predictors of cerebral palsy, intellectual impairment, visual impairment and deafness in a cohort of extremely low birthweight (ELBW) infants at two years of age.

Methodology: The study population comprised 199 of the 224 (89%) ELBW infants managed at the Mater's Mothers Hospital, Brisbane, between July 1977 and February 1990 and who survived to two years. The prevalence of cerebral palsy, intellectual impairment, blindness and deafness was measured by clinical, psychometric and audiological assessment and the association with 24 risk factors examined.

Results: Cerebral palsy occurred in 20 children (10%). Risk of cerebral palsy was associated with ventricular dilatation, intraventricular haemorrhage, necrotizing enterocolitis and multiple birth, though only ventricular dilatation (OR 4.41; 95% Cl 1.32‐14.8) remained significant in the adjusted analysis. Intellectual impairment occurred in 20 children (10%) and was independently associated with ventricular dilatation (OR 15.0; 95% Cl 2.2‐102.8), ventilation FiO2 >80% (OR 3.4; 95% Cl 1.01‐11.5), vaginal delivery (OR 3.5; 95% Cl 1.09‐11.4) and male sex (OR 6.1; 95% Cl 1.67‐22.3). No perinatal predictor was statistically associated with risk of deafness. Retinopathy of prematurity (OR 36.9; 95% Cl 2.8‐495.5) was associated with risk of later visual impairment.

Conclusions: Intellectual impairment was associated with a broad range of perinatal variables. Cerebral palsy was associated with fewer variables, all of which were also associated with intellectual impairment. Neurologic injury was associated with male sex and multiple birth, which are not biological insults themselves, but may be markers of susceptibility to injury.
Neurodevelopmental profile of Down syndrome in Chinese children
Authors: KWONG KL , WONG V
Published: March 2008

Objective: To give an overall appraisal of the clinical features of Down syndrome (DS) in Chinese children with emphasis on the neurodevelopmental outcome, and to compare the related complications with that of other races.

Methodology: The records of 124 Chinese children with DS assessed at the Child Assessment Centre of the University Department of Paediatrics in the Duchess of Kent Children's Hospital from 1985 to 1993 were reviewed.

Results: Thirty‐one per cent of patients had microcephaly. Eighty‐five per cent (33/39) when assessed in the first year of life had a developmental quotient (DQ) above 50 but only 29% (2/7) had DQ above 50 when assessed after the age of 5. Only two patients (1.6%) had epilepsy: infantile spasms (1) and Lennox‐Gastaut syndrome (1). Hearing impairment was found in 45% of children with mild conductive hearing impairment being the most common.

Conclusions: Chinese children with DS, when compared with other races, were similarly intellectually disabled, but were less likely to develop epilepsy.
Visits to medical practitioners in the first 6 months of life
Authors: GUNN J , LUMLEY J , YOUNG D
Published: March 2008

Objective: To assess the use of medical practitioners' services by mothers and their babies in the 6 months following childbirth.

Methodology: Aggregated Medicare data detailing medical practitioner services provided to a random sample of 650 Victorian babies born between 1 March and 31 May 1993 and their mothers were obtained from the Health Insurance Commission. This provided data on services provided between March and December of 1993 to the selected cohort. Services provided by the public hospital system to mothers and babies are not included.

Results: Mothers and babies in the sample used 6404 medical practitioner services in the 6 months following birth; 57% of services were to babies, 43% to mothers. Of the 6404 medical practitioner services 5042 (79%) were provided by general practitioners (GP), 804 (12%) by paediatricians, 319 (5%) by obstetricians and 239 (4%) by ‘other’ specialists. The mean number of visits to a GP by mothers was 3.5 and by babies was 4.2 in the 6 months following birth. General practitioners were more likely to be vocationally registered and there were differences in the item numbers charged between those who were vocationally registered and those who were not. The length of GP consultation differed significantly between mothers' and babies' visits.

Conclusions: A previously undocumented level of postnatal use of medical practitioner services is presented. It suggests a significant level of postnatal maternal and infant morbidity that requires further study.
Haemodynamic effects of differing blood transfusion rates in infants less than 1500 g
Authors: NOSÈ Y , TAMAI H , SHIMADA S , FUNATO M
Published: March 2008

Objective: To investigate whether the haemodynamic effects of the standard 2‐3 h blood transfusion increases the risk for intraventricular haemorrhage (IVH) and patent ductus arteriosus (PDA) in very low birthweight infants.

Methodology: In a randomized controlled study, haemodynamic changes using slow and rapid transfusion were compared. Twenty‐seven very low birthweight infants were divided between 12 h (n= 14) and 3 h (n= 13) transfusion groups. Blood pressure, ejection fraction (EF), anterior cerebral artery pulsatility index (Pl), blood gases, serum electrolytes and haematocrit were measured pre‐ and post‐transfusion. Infectious status was also monitored.

Results: Blood pressure (48.1/25.5 vs 55.7/30.2 mmHg) and EF (0.68 vs 0.73) increased significantly during rapid transfusion (P>0.01) but remained stable with slow transfusion. Serum potassium, base excess and incidence of infection did not increase in either group.

Conclusions: Slow transfusion causes less haemodynamic disturbance than rapid transfusion, thereby preventing the potential risk for IVH and PDA.
Lethal kyphomelic dysplasia
Authors: CISARIK F , BAXOVA A , KOZLOWSKI K
Published: March 2008

ABSTRACT A lethal form of kyphomelic dysplasia with severe bowing of the long bones of the lower extremities is reported.
Cannabis cookies: A cause of coma
Authors: BOROS CA , PARSONS DW , ZOANETTI GD , KETTERIDGE D , KENNEDY D
Published: March 2008

Despite the prevalence of cannabis use in the community, reports of adverse effects in young children are rare. Two cases of cannabis‐induced coma are reported following accidental ingestion of cannabis cookies. The possibility of cannabis ingestion should be considered in cases of unexplained coma in a previously well young child if signs of conjunctival hyperaemia, pupillary dilatation and tachycardia are present and other causes such as CNS infection or trauma are unlikely. Specific screening for cannabinoids should be undertaken.
Behavioural assessment and treatment of chronic headaches in children
Authors: King NJ , TONGE BJ
Published: March 2008

ABSTRACT This review explores advances in the behavioural assessment and treatment of childhood headaches. Behavioural assessment procedures are outlined including the behavioural interview, self‐report questionnaires, self‐monitoring and caregiver observations. We conclude that behavioural treatment strategies are effective in the management of childhood headaches, although most of the research support appears to be limited to relaxation training and biofeedback. Nonetheless, the behavioural assessment and treatment of childhood headaches appears to be a promising clinical and research direction.
Routine microbiological testing in sudden and unexpected infant death
Authors: CARMICHAEL EM , GOLDWATER PN , BYARD RW
Published: March 2008

Objective: To evaluate the significance of microbiological test results in a series of infants who had died suddenly and unexpectedly.

Methodology: Following a review of all cases of sudden natural death in infants presenting to the Adelaide Children's Hospital (ACH) division of the Women's and Children's Hospital (WCH) over the 10 year period between 1983 and 1992, specific evaluation of microbiological test results was undertaken.

Results: There were 329 cases of sudden infant death syndrome (SIDS) and 23 cases in which sudden infant death was either attributed to other conditions or was unclassifiable. Positive microbiological results were recorded in the majority of cases, most being considered to be due to postmortem overgrowth or to contamination at autopsy. Of the remaining cases, microbiological results were essential to the establishment of the diagnosis in three cases, and were a useful adjunct to the diagnosis in a further six cases.

Conclusions: Routine microbiological testing in cases presenting as SIDS did not reveal occult sepsis in most instances. Such testing did, however, add support to the diagnosis of SIDS where no pathogens were isolated and, if not undertaken, would have resulted in a small percentage of cases of sudden infant death due to infections remaining undiagnosed.
Effect of phototherapy on thyroid stimulatory hormone and free thyroxine levels
Authors: TAN KL , CHIRINO‐BARCELO Y , AW TC , JOSEPH R
Published: March 2008

Objective: To study the effect of phototherapy for neonatal hyperbilirubinaemia on thyroid function as neonatal thyroid screening is sometimes performed during exposure to phototherapy.

Methodology: Infants with non‐haemolytic hyperbilirubinaemia were sequentially allocated to fibre‐optic phototherapy, conventional daylight phototherapy, or a combination of both. Bilirubin concentration was monitored 12 hourly by capillary blood sampling; venous blood was sampled for thyroid stimulating hormone (TSH) and free thyroxine (fT4) determinations, at start of exposure, at 24 h, end of exposure and 1 day later. Comparable unexposed infants served as controls.

Results: All 123 study infants and 25 controls remained well during the study. Bilirubin levels declined during phototherapy, being most rapid in the combination group. The TSH and fT4 values at start of exposure were 3.86 ± 0.41 mU/L (mean ± SEM) and 33.20 ± 1.16 pmol/L, respectively, in the fibre‐optic group, 3.62 ± 0.38 mU/L and 37.22 ± 1.76 pmol/L in the daylight group, and 4.40 ± 0.48 mU/L and 29.91 ± 1.13 pmol/L in the combined group, compared with 5.77 ± 0.40 mU/L and 34.46 ± 1.68 pmol/L in the control group. The TSH and fT4 values declined with increasing age in the phototherapy and control groups with end of exposure values of 2.90 ± 0.28mU/L and 27.71 ± 0.71 pmol/L, 2.77 ± 0.31 mU/L and 33.52 ± 1.22pmol/L, and 3.44 ± 0.30 mU/L and 27.54 ± 0.88 pmol/L, respectively, compared with 4.21 ± 0.61 mU/L and 27.19 ± 2.33 pmol/L (at 72 h) in the control group. The pattern of TSH and fT4 decline in the exposed and control groups was similar, being related to increasing age.

Conclusions: The validity of neonatal thyroid screening is not affected by fibre‐optic or conventional phototherapy or by both combined.
Risk‐stratified nosocomial infection surveillance in a neonatal intensive care unit: Report on 24 months of surveillance
Authors: FERGUSON JK , GILL A
Published: March 2008

Objective: To document the nosocomial infection rate in a single neonatal intensive care unit (NICU) in terms of patient workload and device utilization.

Methodology: Nosocomial infections have been identified and documented by the methodology described by the National Nosocomial Infection Surveillance System (NNIS), Centres for Disease Control, Atlanta. In addition, antibiotic usage has been surveyed in the NICU and standardized measures of patient exposure to antibiotics stratified by birthweight and gestational age have been described.

Results: Overall nosocomial infection rates compared favourably with the published NNIS figures at 6.2 infections per 100 admissions or 4.8 per 1000 patient days. Infection rates were significantly higher in lower birthweight groups. Device‐related infection rates in each birthweight cohort were also very close to published figures and varied less with birthweight group. Antibiotic exposure averaged 12% of total admission days, less than previously published data.

Conclusions: The NNIS system is applicable to Australian NICU and provides an effective tool for monitoring infection episodes.
The prediction of hospital admission in children with acute asthma
Authors: TWADDELL SH , HENRY RL , FRANCIS JL , GIBSON PG
Published: March 2008

Objective: To determine whether a single assessment of children at the time of presentation to the emergency department would discriminate accurately between those requiring admission and those who could be managed at home and to examine the appropriateness of these decisions.

Methodology: Fifty‐three children were assessed using a table recommended by Australian and New Zealand respiratory paediatricians, which categorizes children as probably being able to manage at home (group 1), may need admission to hospital (group 2) and certainly need admission to hospital (group 3) on the basis of oximetry, presence of wheeze and pulsus paradoxus.

Results: Nine out of 11 children assigned to group 1 were managed at home and 15/17 who were predicted to require admission were admitted. No individual component of the assessment dominated the decision made. Of the 25 children allocated to group 2, 18 were admitted.

Conclusions: The method employed was highly predictive of outcome for half of the children who presented with asthma. However, 25/53 (47%) were assigned by the table to a recommendation for further assessment; this limits its usefulness.
Transcatheter embolization of coronary artery fistula with controlled release coils
Authors: QUEK SC , WONG J , TAY JSH , REIDY J , QURESHI SA
Published: March 2008

ABSTRACT The treatment for large congenital coronary cameral fistulas has been surgical but with advances in interventional catheterization techniques transcatheter embolization of these fistulas with coils or detachable balloons is now possible. This report describes occlusion of a congenital coronary arteriovenous fistula in a 6‐year‐old girl.
Annotation New perspectives on inflammation in atopic dermatitis
Authors: KEMP AS , CAMPBELL DE
Published: March 2008

Recent information implicates the stimulation of T cells by Staphylococcus aureus antigens and exotoxins as a likely factor in provoking the inflammatory response in atopic dermatitis. S. aureus secrets exotoxins called superantigens, which stimulate a large proportion of T cells. In addition, protein A, a component of the cell wall of S. aureus, is a potent B cell mitogen. This understanding provides a rationale for attempting to reduce the staphylococcal skin colonization of patients with severe atopic dermatitis and correlates with the clinical observation in a number of situations of marked improvement in atopic dermatitis following antibiotic treatment.
Health care and its costs for children with perinatally acquired HIV infection
Authors: CARLIN JB , LANGDON P , HURLEY SF , ZIEGLER JB , DOHERTY R , CHONDROS P , KALDOR JM
Published: March 2008

Objective: To describe survival patterns, use of health services and related costs for Australian children with perinatally acquired human immunodeficiency virus (HIV) infection.

Methodology: A retrospective cross‐sectional survey was made of 20 children with HIV infection (91% of those diagnosed) and 13 children with maternal antibodies who subsequently seroreverted, treated at 10 medical centres. Details of disease progression and use of health services were obtained from hospital medical records. Monthly costs for three phases of infection were estimated by linking service usage rates with estimates of the unit cost of each service. The average lifetime cost was estimated by combining monthly costs and phase duration estimates from the literature.

Results: Patterns of disease progression were similar to those reported internationally, with a median survival of 8 years. Use, of health services increased with severity of illness. Mean monthly costs were $120 per month (1992 Australian dollars) for children with maternal antibodies who subsequently seroreverted, $320 per month for children with HIV infection but no acquired immunodeficiency syndrome (AIDS)‐defining illness, and $1830 per month for children with AIDS. The present value of total lifetime cost for a child with HIV infection was $48174,46% of which was for treatment of AIDS.

Discussion: The mean lifetime cost for a perinatally infected child was just over half that for a man with HIV in Australia. Health service usage and costs were lower for Australian than American children with HIV.
Inhaled hypertonic saline increases sputum expectoration in cystic fibrosis
Authors: RIEDLER J , READE T , BUTTON B , ROBERTSON CF
Published: March 2008

Objective: To determine whether inhalation of hypertonic saline (HS) increases sputum expectoration in patients with cystic fibrosis (CF).

Methodology: Ten adolescents with CF, who were receiving inpatient treatment for a pulmonary exacerbation, were enrolled in a controlled cross‐over clinical trial. After inhalation of a beta adrenergic drug to prevent possible broncho‐constriction, each patient inhaled for 10min either 0.9% isotonic saline (IS) or 6% HS prior to routine physiotherapy. The following day the patient received the alternative solution. Seven patients undertook a second block after 1‐5 days. Outcome measures included weight of sputum, a visual analogue score to assess the subjective feeling of a cleared chest after physiotherapy, and spirometry.

Results: Sputum expectoration (median; Q1,Q3) from the beginning of the inhalation of HS or IS to the final spirometry measure 60min post‐physiotherapy was significantly greater after HS than IS [17.2g (11.7, 34.8) vs 11.3g (6.5. 16,1); P— 0.006]. A clinical score of the patient's own judgement of a cleared chest was significantly better after HS than IS. Spirometry results did not change following either of the two inhalations.

Conclusions: These data show that the inhalation of 6% HS prior to physiotherapy can increase sputum expectoration in patients with CF and suggest that HS might be an effective, safe and cheap adjunct to regular physiotherapy in patients with CF.
Accelerated schedule of hepatitis B vaccination in high‐risk youth
Authors: WILKINSON SE , MORATH M , BENNETT DL , BURGESS MA , ISAACS D
Published: March 2008

Objective: To perform a feasibility and immunogenicity study of an accelerated schedule of hepatitis B immunization for high‐risk youth.

Methodology: High‐risk adolescents attending a youth health centre and nearby youth refuges were immunized with Engerix‐B recombinant vaccine, 20 μg intramuscularly, at 0,2 and 6 weeks. Serology was performed prior to immunization and 3 months after the third dose.

Results: Forty‐two subjects (27 female) aged 13‐20 years entered the study. Two (4.8%), already hepatitis B virus (HBV) seropositive, were excluded. Thirty‐six of 40 subjects had one or more risk factors for HBV. Participants were often elusive, needing multiple attempts to establish contact. Twenty (50%) of the 40 completed three immunizations and all 14 studied developed anti‐hepatitis B surface titres of > 100mlU/mL (geometric mean titre 630 mIU/mL, 95% confidence intervals 309‐1290).

Conclusion: High‐risk youth can be immunized against hepatitis B successfully using an accelerated schedule, but compliance is difficult.
‘On the spot’vaccination: Does it work?
Authors: BURGESS MA , LEVY M , ALPERSTEIN G , MIRA M , BEK M , ISAACS D , KAKAKIOS A , FASHER B , HANSON R , KILHAM H , MALCOLM M
Published: March 2008

Objective: To trial and evaluate a system of ‘on the spot’vaccination for children up to the age of 15 years in the Early Childhood Centres of the Central Sydney Area Health Service, at the Royal Alexandra Hospital for Children and in a number of general practices in the area.

Methodology: A brief questionnaire was used to collect data from parents and health care professionals about the child's vaccination status and vaccines given ‘on the spot’.

Results: Over an 8 week period in August‐September 1993, 5162 questionnaires were completed; 71% of children were up to date with their vaccination. If Haemophilus influenzae type b vaccine, which had been introduced only 2 months before commencement of the study, was excluded, 84% of the children were up to date. A total of 441 children were given 663 vaccinations ‘on the spot’. Very few children were too ill to be vaccinated (6%). However, only 30% of those who needed vaccination ‘on the spot’actually received it (441 of 1480), and only 41% (24 of 58) of a subset of those who were not vaccinated were known to have complied 1 month later. Children attending Early Childhood Centres were younger than children attending general practices or the hospital.

Conclusions: A high proportion of children who attended for routine or acute health care had vaccinations overdue (30%). If this scheme could be continued and expanded it would have an important impact on vaccination coverage, and hence on the incidence of vaccine‐preventable diseases.
Does intramuscular vitamin K1 act as an unintended depot preparation?
Authors: LOUGHNAN PM , McDOUGALL PN
Published: March 2008

Objective: To propose a hypothesis that the long duration of effect of intramuscular (i.m.) vitamin K1 in preventing late onset haemorrhagic disease results from a depot effect after i.m. injection.

Methodology: Review of scientific literature relating to the pharmacology of vitamin K, and the aetiology of late onset haemorrhagic disease.

Results: A single i.m. dose of vitamin K1 is effective for at least 2 months, whereas the duration of effect of a single oral dose is about 3‐4 weeks. The known pharmacological properties of vitamin K1 are seemingly at variance with the long duration of effect of an i.m. dose. Menaquinones (vitamins K2) are absent in the newborn liver, but gradually accumulate after birth. This, together with the low concentrations of vitamin K1 in human breast milk, may explain the peak frequency of late onset haemorrhagic disease at 4‐8 weeks. We hypothesize that after i.m. injection, vitamin K1 acts as a depot preparation by forming a viscous mass in muscle tissue which is slowly absorbed over many weeks. This hypothesis is supported by reports indicating significantly higher plasma vitamin K1 levels several weeks after i.m., as compared to oral vitamin K1.

Conclusions: The prolonged efficacy of i.m. vitamin K1, compared to oral preparations may be due to a depot effect New oral preparations of vitamin K1, despite greatly improved bioavailability, may have a shorter duration of effect than i.m. vitamin K1, and therefore be less effective for long‐term prophylaxis.
Improved outcomes following the introduction of surfactant to an Australian neonatal unit
Authors: BEEBY P , CHAN D , HENDERSON‐SMART D
Published: March 2008

Objective: To study the impact of the introduction of artificial surfactant therapy for hyaline membrane disease (HMD) in an Australian neonatal intensive care unit.

Methodology: Infants <32 weeks gestation admitted between June 1991 and Dec 1993 who received treatment with artificial surfactant were compared with infants admitted during the preceding 30 months who would have been candidates for such treatment.

Results: For treated infants with gestations in the range 24‐27 weeks, there was a significant reduction in neonatal death (adjusted odds ratio 0.28) and a significant increase in the incidence of chronic lung disease (CLD) (adjusted odds ratio 3.4). With gestations in the range 28‐31 weeks, there was no significant change in neonatal death or CLD, but there was a significant reduction in incidence of pneumothorax (adjusted odds ratio 0.32).

Conclusions: A reduced incidence of pneumothorax and neonatal death following the introduction of artificial surfactant. therapy was readily demonstrable in the Australian setting.
Which milk for the preterm infant?
Authors: TUDEHOPE DI , STEER PA
Published: March 2008

Abstract: The optimal diet for the low birthweight infant is one that supports a growth rate approximating that of the third trimester of intra‐uterine life without imposing stress on the developing metabolic or excretory systems. Although preterm human milk does not meet the energy and nutrient needs of developing preterm infants, the benefits such as contributions to host defence and gastrointestinal trophic aspects, and the psychological benefits of maternal‐infant bonding, make it the preferred diet.
War zone paediatrics in Rwanda
Authors: PEARN J.
Published: March 2008

Abstract: Children are particularly vulnerable to injury and death in two types of 20th century conflicts: terrorist attack and civil war. This account describes some first‐hand experiences of the aftermath of the Rwandan Civil War of 1994. Events leading to the conflict are described, eye witness accounts of child trauma during the war are recorded and the medical problems (currently ongoing) affecting children are described. Over a period of 3 months from April to June 1994, between half and one million Rwandese, a significant proportion of them women and children, were murdered in brutal hand‐to‐hand killing, dying from close‐quarter gunshot and machete slaughter. Nearly half of the population became refugees in neighbouring countries or displaced persons in their own land. UNAMIR II, the United Nations Emergency Humanitarian Response, grew to some 7000 persons by May 1995. Medical aid was provided by emergency medical contingents from the United Kingdom, Canada and Australia, the latter through its Australian Medical Support Force, providing the definitive emergency medical infrastructure from August 1994. In the consequent post‐war civil and social disruption, children suffered from burns, cholera and from motor vehicle trauma. Ongoing landmine blasts continue to affect children and adolescents especially. A new international humanitarian code to build a time‐expiry device into landmines and other similar ordinance is urgently required as the post‐conflict ongoing disasters in Rwanda, Afghanistan and Cambodia illustrate. Current problems affecting children include an increasing risk of HIV infection, trauma and the special humanitarian needs of thousands of orphans.
Parents' perceptions towards their child's use of inhaled medications for asthma therapy
Authors: LIM SH , GOH DYT , TAN AYS , LEE BW
Published: March 2008

Objective: Understanding patients' and their parents' perceptions towards asthma medication is important in developing strategies to ensure patient compliance. In this study, parents' perceptions towards their children's use of inhaled medication for asthma treatment were evaluated.

Methodology: A questionnaire was administered by interviewing parents of 210 asthmatic children attending the Department of Paediatrics, National University Hospital.

Results: Our results showed that 76/210 (36%) of parents either felt opposed to inhaler therapy and/or preferred oral medications. The main reasons for their reluctance to use inhalers were related to fear of dependence, side effects and overdosage, and the child's dislike for inhalers. A third of these parents felt that inhalers were only indicated for very severe asthma.

Conclusions: We conclude that a significant proportion of parents have reservations regarding the use of inhalers for the treatment of asthma. These factors should be taken into consideration when planning an effective asthma education programme.
Neonatal bacterial sepsis in a neonatal intensive care unit: A 5 year analysis
Authors: SANGHVI KP , TUDEHOPE DI
Published: March 2008

Objective: To study the pattern of neonatal sepsis in a neonatal intensive care unit (NICU) during a 5 year period and assess the relationship between maternal risk factors and early onset sepsis (EOS).

Methodology: The study reported here was a retrospective analysis of 209 episodes of septicaemia and 5 episodes of bacterial meningitis in 198 newborn infants, 22 of whom died. Eighty‐one infants had EOS (≤72h) and 117 infants had late onset sepsis (LOS >72 h). All infants had clinical evidence of sepsis, a computerized haematological score for sepsis of 4 or greater, and either treatment with antibiotics for 7 days or more or had earlier death due to sepsis. The organisms causing neonatal sepsis were analyzed according to the day of onset, gestational age, birthweight and year of infection.

Results: Sepsis occurred in 5.6 per 1000 live births and 3.8% of NICU admissions. There were 81 episodes of EOS and 128 of LOS. Coagulase negative staphylococci (CONS) 38.8%, group B Streptococcus (GBS) 20.1% and Gram‐negative bacilli (GNB) 20.1% were the common causes of sepsis; and GBS (50.6%) and CONS (60.9%) were the most common organisms in EOS and LOS, respectively. The mean gestational age and birthweight were heigher in babies with EOS than compared with LOS. The higher likelihood of probable rather than definite infection in infants with EOS was related to more mothers in the EOS group receiving intrapartum antibiotics. GNB infection was more common in their babies.

Conclusions: GBS and CONS were the most common causes of EOS and LOS, respectively. The use of maternal intrapartum antibiotics interferes with neonatal blood culture results. Because blood cultures are not always positive in neonatal septicaemia, a combination of clinical, haematological and other microbiological evidence should be used when diagnosing neonatal septicaemia.
Partnership in chronic health care: Care management as an integral part of the paediatric hospital system
Authors: O'NEILL C , CONTOLE J , BRYAN D , SCHWARZ R , MINOGUE C
Published: March 2008

Care management for children with complex care needs in the hospital setting is not just about care managers developing and maintaining partnerships between hospital and community professionals, children and their families. It also requires organizational commitment to a system which is patient centred, recognizes parental expertise and offers clinical skills which are co‐ordinated across specialty areas.
Prevalence of maternal depression and its relationship to ADL skills in children with developmental delay
Authors: HARVEY JM , O'CALLAGHAN MJ , VINES B
Published: March 2008

Objective:

To determine the prevalence of maternal affective symptoms in children with developmental problems compared to a control group, and to examine their relationship to the child's Activities of Daily Living (ADL), socialization skills and behaviour.

Methodology:

This study examined prospectively the prevalence of symptoms of maternal depression, maternal anxiety, stress and adverse life events in 65 mothers whose children were attending a Child Development Clinic. ADL and socialization skills were measured using the Vinelands Adaptive Behaviour Scales, and behaviour using a checklist.

Results:

Symptoms of maternal depression (P=0.04), maternal anxiety (P=0.01) and number of adverse life events (P=0.03) were increased in the study compared to control mothers. Presence of maternal symptoms was unrelated to ADL or socialization skills though was associated with increased behavioural symptoms in the child.

Conclusion:

Affective disturbance in mothers of children with developmental problems are common and should be addressed as part of a comprehensive assessment of such children.
Cutis marmorata telangiectatica congenita: An unusual presentation with monoatrophy in two Chinese children
Authors: WONG V
Published: March 2008

Cutis marmorata telangiectatica congenita (CMCT) is a rare cutaneous vascular anomaly. Two children with monoatrophy of one limb referred for neurological assessment were found to have a segmental form of CMTC. The paediatrician and paediatric neurologist should be alerted to this rare disease in children referred for cutaneous lesion with associated limb asymmetries as distinguished from other neurocutaneous syndromes.
Chronic illness in adolescents: Transfer or transition to adult services?
Authors: SAWYER SM , BLAIR S , BOWES G
Published: March 2008

It is widely believed that the improved survival of young people with chronic diseases will be associated with the development of appropriate services within the adult healthcare domain. There is, however, little evidence to suggest that this is happening at a rate commensurate with clinical requirements. This paper highlights the multiplicity of barriers that impede the development of transition services to facilitate the transfer of medical care from the paediatric to the adult domain. Different models of transition care are described, and the terms ‘transfer’ and ‘transition’ are differentiated. The clinical demand for service development is highlighted, as well as the need for specific research in this area of healthcare delivery.
Progressive myoclonic epilepsies: Recent genetic advances
Authors: ELLAWAY CJ , ELLIOTT EJ , CHRISTODOULOU J
Published: March 2008

The progressive myoclonic epilepsies are a rare group of debilitating epileptic encephalopathies characterized by myoclonic seizures, progressive neurological dysfunction and dementia. In the past year advances in gene mapping have isolated gene loci for the majority of progressive myoclonic disorders, paving the way for specific diagnosis, more accurate prognosis and risk calculation, as well as opening the potential for prenatal and pre‐symptomatic diagnosis in at risk families.
Emergency management skills of South Australian paediatric trainees
Authors: BRADY RM , RAFTOS J
Published: March 2008

Objective:

This article describes a theoretical and practical assessment of the emergency management skills of South Australian paediatric trainees. The aim was to identify strengths and weaknesses so as to optimally orientate future training in this area, and to provide a baseline that could be used to assess effectiveness of future interventions.

Methodology:

Thirty‐four paediatric trainee medical officers responsible for after hours emergency care in Adelaide were asked to anonymously complete a 24 question theory assessment based on recognized emergency management training programmes, and to perform a mock clinical resuscitation. Response rate was 90% for the theoretical section and 69% for the practical.

Results:

The average trainee was found to be deficient in one quarter to one third of the theoretical precepts, and required an average of 2 min to establish effective bag‐valve‐mask ventilation with an infant manikin.

Conclusions:

There is a range of theoretical and practical resuscitation deficits that may currently hinder effective emergency management by paediatric trainees.
The overlap of attention deficit hyperactivity disorder with other common mental disorders
Authors: HAZELL P
Published: March 2008

Objective:

The literature on the overlap (co‐morbidity) of attention deficit hyperactivity disorder (ADHD) with conduct disorder, specific learning disability, and anxiety disorders was reviewed to examine: (i) the evidence for ADHD being a syndrome distinct from the other conditions; and (ii) the evidence for co‐morbid patterns representing meaningful subtypes of ADHD.

Methodology:

Narrative review of the literature.

Conclusions:

Conduct disorder is distinguished from ADHD by prognosis, patterns of association and familial aggregation. ‘Pure’ disorders are uncommon, however, and there is little evidence to support a distinct co‐morbid subtype. There are few data that reliably distinguish ADHD from specific learning disabilities, but there are weaknesses in research to date. A specific ADHD + learning disabled subtype may exist, but as yet the implications for treatment are not known. Attention deficit hyperactivity disorder is distinguished from anxiety by symptom discrimination, factor analysis, patterns of association, familial aggregation and treatment response. There is evidence for a distinct ADHD + anxiety subtype.
The immunogenicity of Haemophilus influenzae: Meningococcal protein conjugate vaccine in Polynesian and non‐Polynesian New Zealand infants
Authors: AMERATUNGA SN , LENNON DR , ENTWISTLE B , ROBINSON E , AMERATUNGA RV
Published: March 2008

Objective:

To examine the comparative immunogenicity of the Haemophilus influenzae type b‐meningococcal protein (PRP‐OMP) conjugate vaccine in Polynesian and non‐Polynesian New Zealand infants.

Methodology:

Fifty‐six Polynesian and 53 non‐Polynesian infants aged 2–7 months recruited from primary health care settings in Auckland received a two‐dose primary series of PRP‐OMP. A sub‐sample of 83 participants received a booster dose of PRP‐OMP at 12–16 months of age. Anti‐PRP antibody concentrations were measured in pre‐ and post‐vaccination blood samples.

Results:

Antibody responses consistent with long‐term protection (≥1.00 μg/mL) were observed in 72, 85 and 95% of children following the first, second and booster doses.

Conclusions:

Despite differences in disease epidemiology, PRP‐OMP was highly immunogenic in Polynesian and non‐Polynesian infants.
The role of diet and behaviour in childhood
Authors: BREAKEY J
Published: March 2008

Abstract: This short review summarizes the most important research, particularly that from 1985 to 1995, on the relationship between diet and behaviour. Relevant studies particularly those using double‐blind placebo controlled food challenge methodology were selected, and are presented within a historical context. Summary tables of the early development of concepts and later pertinent studies are provided. The research has shown that diet definitely affects some children. Rather than becoming simpler the issue has become demonstrably more complex. The range of suspect food items has broadened, and some nonfood items are relevant. Symptoms which may change include those seen in attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), sleep problems and physical symptoms, with later research emphasizing particularly changes in mood. The reports also show the range of individual differences both in the food substances producing reactions and in the areas of change.
Sunburn and sun protection among young children
Authors: McGee R , Williams S , Glasgow H
Published: March 2008

Objective: To examine the extent of sun exposure, sun protection and experience of sunburn among young New Zealand children on summer weekends.

Methods: In a telephone survey of 1243 respondents, those with children in the household were asked about sun exposure and protection for the youngest child in the family. Information was obtained for 285 children aged from infancy to 10 years.

Results: Over 90% of the children were reported to be outside on the preceding Saturday and/or Sunday; 7% of those outside experienced some degree of sunburn. The worst burning was on the face, head, neck or ears. On either day about half the children were wearing sunscreen and 60% were wearing a hat. Parental use of sun protection was the strongest predictor of sun protection among the children.

Conclusions: While reports of sun protection among young children were encouraging, many children in the community are still at high risk of sunburn. Efforts to promote sun protection as a family responsibility may reduce the experience of burning among the young.
Subperiosteal orbital haematoma presenting as proptosis at birth
Authors: SKULL SA , SULLIVAN TJ
Published: March 2008

Abstract: We present a case report of a neonate with congenital subperiosteal orbital haematoma presenting with unilateral proptosis with review of current literature. The baby made an uneventful recovery following surgical drainage of the haematoma. This is the second report of orbital haematoma presenting at birth. Orbital haematoma should be considered in the newborn with unilateral proptosis. Early detection with computed tomography (CT) or magnetic resonance imaging (MRI) is required to determine the need for surgical drainage.
Meningitis in Hong Kong children, with special reference to the infrequency of haemophilus and meningococcal infection
Authors: SUNG RYT , SENOK AC , HO A , OPPENHEIMER SJ , DAVIES DP
Published: March 2008

Objective: To study the epidemiologic and aetiologic features of meningitis in children in Hong Kong.

Methodology: A retrospective study of 85 children resident in the New Territory East region of Hong Kong admitted to a teaching Hospital because of meningitis during a 9 year period.

Results:
Mycobacterium tuberculosis was the most common aetiological agent accounting for 13 cases (15.3%). Other bacteria accounted for 41 cases (48%); among these one fifth were caused by Haemophilus influenzae type b. The overall admission rates for tuberculous meningitis in Chinese children were 0.76/100 000 (95% CI 0.25‐1.78) and 0.42/100 000 (CI 0.19‐0.8) per year, respectively, for under 5 year olds and under 15 year olds. The overall annual incidence rates of bacterial meningitis other than tuberculous were 5.2/100 000 (CI 3.72‐7.43) and 1.6/100 000 (CI 1.14‐2.29) for Chinese children under 5 years and under 15 years, respectively. The annual incidence of H. influenzae meningitis in Chinese children under 5 years old was low at 1.1/100 000 (0.43‐2.2). All five cases of meningococcal meningitis were in Vietnamese children (under 5 years of age incidence: 13.0/100 000 per year, CI 4.2‐30.3). There were no cases of meningococcal meningitis in Chinese children during the 9 year period.

Conclusion:
M. tuberculosis was the most common aetiological agent of meningitis in Hong Kong children. The incidence of haemophilus or meningococcal meningitis was very low.
Usefulness of stable microbubble test of tracheal aspirate for the diagnosis of neonatal respiratory distress syndrome
Authors: BOO N‐Y , CHEONG K‐B , CHEONG S‐K , LYE M‐S , ZULFIQAR MA
Published: March 2008

Objectives: To compare the overall accuracy of the stable microbubble test (SM test) with measurement of level of surfactant protein A (SP‐A) of tracheal aspirate for the diagnosis of respiratory distress syndrome (RDS).

Methodology: Tracheal aspirates were obtained from neonates on ventilatory support. The SM test was carried out on specimens of tracheal aspirate immediately after collection. Levels of SP‐A in tracheal aspirates were determined by enzyme‐linked immunosorbent assay (ELISA) method. The results of the SM test and SP‐A level of the tracheal aspirates were compared against the clinical diagnosis of RDS based on clinical, radiological and bacteriological findings.

Results: Both the median microbubble counts (6 microbubbles/mm,2 range = 0–90) and median SP‐A levels (100μg/L, range = 0–67 447) of infants with RDS were significantly lower than those of infants with no obvious lung pathology (P<0.0001), and pneumonia (P<0.0001). The SM test of tracheal aspirates had higher overall accuracy for the diagnosis of RDS than measurement of SP‐A levels (94.6%vs 82.4%). When the receiver operating characteristic (ROC) curves of both tests for RDS were compared, the area under the ROC curve of the SM test was larger (0.9689) than that of the SP‐A method (0.8965).

Conclusions: This study showed that the SM test of tracheal aspirate was a useful bedside diagnostic test for RDS. It could be carried out at any time after birth on infants requiring ventilatory support.
Ocular sequelae in extremely premature infants at 5 years of age
Authors: HEBBANDI SB , BOWEN JR , HIPWELL GC , MA PJ , LESLIE GI , ARNOLD JD
Published: March 2008

Objective To report long‐term ophthalmological sequelae in extremely premature infants at 5 years and to determine the relationship between neonatal variables (including retinopathy of prematurity; ROP) and the 5 year ophthalmological outcome of these infants.

Methodology The study cohort comprised 84 surviving infants born with a birthweight <1000 g or gestational age <28 weeks from June 1985 to December 1989. All infants had an ophthalmological assessment between 34 and 40 weeks post conceptional age to document grade of ROP and were assessed at 5 years of age for fundoscopy, visual acuity, refractive error and ocular mobility.

Results Of the 84 long‐term survivors 69 (82%) were formally assessed at 5 years. Overall, 30 (43%) had some form of ocular disorder. Nineteen (27%) had reduced visual acuity of <6/6 and three of these were blind. Myopia > −0.5 dioptre was noted in eight (12%), hypermetropia ≥2.0 dioptre in five (8%), astigmatism in seven (11%) and strabismus was present in nine (14%) of the cohort. There was a significant relationship (P<0.0001) between the incidence of ocular disorders and ROP. However, even those premature children without ROP had a 31% incidence of ocular disorder at 5 years.

Conclusion Long‐term ophthalmological follow‐up is recommended in all extremely premature infants regardless of the presence of ROP in the neonatal period.
Issues in diagnosis following the sudden infant death syndrome intervention campaigns
Authors: BYARD RW
Published: March 2008

Abstract: The fall in numbers of sudden infant death syndrome (SIDS) deaths in recent years has resulted in questions being asked as to whether changes in the pathological assessment and diagnosis of such cases have influenced reported death rates. Specific concerns have been raised about possible changes in diagnostic criteria, differences in the evaluation of these infants and the possibility of changes in the pathological findings at autopsy. However, no major changes in either diagnostic criteria or in pathological features appear to have occurred, despite some changes in the epidemiological characteristics of cases.
Biological predictors and co‐morbidity of attention deficit and hyperactivity disorder in extremely low birthweight infants at school
Authors: O'CALLAGHAN M J , HARVEY J M
Published: March 2008

Objective: To examine biological predictors and co‐morbidity of Attention Deficit Hyperactivity Disorder (ADHD) and associated academic and social impairment in a cohort of extremely low birthweight of (ELBW) children attending school.

Methodology: Eight seven (70%) of 125 ELBW children born between 1977 and 1986 were followed prospectively. Neonatal and biological data including cranial ultrasound for 62% of children, formal developmental assessment at 4 or 6 years of age, teacher and parent ADHD questionnaire, parental rating of health status and social impairment and school teacher rating of academic performance was recorded.

Results: Apart from grades 3 or 4 intraventricular haemorrhage in a minority of children, there was no evidence to suggest an association between ADHD and perinatal adversity in ELBW children. Social impairment, academic difficulty and atopic symptoms were significantly related to ADHD.

Conclusions: Extremely low birthweight children presenting with symptoms of ADHD are likely to suffer social and learning impairment and these, rather than perinatal risk factors, should be the focus of clinical attention.