bluuebunny/crossref_metadata_2025 huggingface dataset:
Infectious diarrhoea in children: Controlling transmission in the child care setting
Authors: THOMPSON S. C.
Published: March 2008

An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce. Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person‐to‐person transmission within group care. This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings. The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non‐toilet‐trained children, staff combining nappy changing and food preparation duties, large enrolment, low staff‐to‐child ratio, and poor hygiene and child handling practices. Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents. Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories. Finding a pathogen in these circumstances needs to be interpreted with caution. Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.
Study of hemiplegic cerebral palsy with a review of the literature
Authors: KHAW C. W. H. , TIDEMANN A. J. , STERN L. M.
Published: March 2008

Details of 66 children with hemiplegic cerebral palsy seen over a 20 year period are presented, with comparisons between right and left hemiplegia. There were slightly more right hemiplegics than left hemiplegics. There were minor differences in the frequency of associated problems, but overall there were no major differences between right and left hemiplegics. It is likely that this is due to the greater plasticity of the immature brain. The results of this study are compared with earlier studies of hemiplegic cerebral palsy.
How appropriate are commercially available human milk fortifiers?
Authors: METCALF R. , DILENA B. , GIBSON R. , MARSHALL P. , SIMMER K.
Published: March 2008

A preliminary investigation was made into the effectiveness of two breastmilk fortifiers on the Australian market (FM‐85 [Nestle, Vevey, Switzerland] and Enfamil Human Milk Fortifier [EHMF; Mead Johnson, Evansville, IN, USA]). Infants < 1800 g and < 34 weeks gestation at birth, who were receiving breast milk, were randomized to receive either of the fortifiers (n= 14 for FM‐85, n= 10 for EHMF), until a weight of 2 kg was reached. Infants not receiving breast milk (n= 9) were fed a preterm formula (Prenan, Nestlé). The two fortifier groups were similar in most parameters examined: (i) weight gain (17.9 ± 3.0 vs 17.4 ± 3.5g/kg per day); (ii) head circumference growth (1.02 ± 0.28 vs 1.03 ± 0.25 cm/week); (iii) arm muscle area growth (32.6 ± 20.0 vs 33.5 ± 13.7 mm2/week); (iv) arm fat area growth (14.3 ± 6.1 vs 14.0 ± 8.7 mm2/week); (v) plasma calcium (2.52 ± 0.08 vs 2.58 ± 0.15 mmol/L); (vi) plasma phosphate (2.02 ± 0.21 vs 2.13 ± 0.32 mmol/L); (vii) plasma copper (5.28 ± 2.83 vs 5.66 ± 3.07 pmol/L); and (vii) plasma zinc (13.3 ± 5.5 vs 15.8 ± 9.2 μmol/L). The FM‐85 group had a higher alkaline phosphatase level (355 ± 110 vs 231 ± 70 iu/L) than the EHMF group; however, no values were outside the normal range. The Prenan group had a higher rate of weight gain (23.6 ± 3.3 g/kg per day) and higher arm fat area growth rate (25.2 ± 7.6 mm2/week) than the fortifier groups, while all other parameters were similar. The incidence of feed intolerance was considered high in both fortifier groups. The addition of many of the components of breastmilk fortifiers has not been well validated and it is proposed that a simplified fortifier composed of protein and phosphate may be better tolerated and equally effective at optimizing growth and bone mineralization. The specific needs of extremely low birthweight infants (>1000 g) have not been addressed.
Age‐related changes in oxygen saturation over the first year of life: A longitudinal study
Authors: MASTERS I. B. , GOES A. M. , HEALY L. , O'NEIL M. , STEPHENS D. , HARRIS M. A.
Published: March 2008

Stability of oxygen saturation depends on maturation and function of individual components of the respiratory system. The aim of this study was to record and analyse comprehensive oxygen saturation data in a longitudinal study over the first year of life. Detailed sleep studies were performed on 15 normal infants eight times in the first year of life. The accrued oxygen saturation data were analysed on a computerized oximetry data analysis system. Results show the mean sleep saturation levels trending upwards and stabilizing by 185 days. There was an inverse curvilinear relationship between mean age and median desaturation time and the median number of desaturations at ≥95, ≥92 and ≥90% saturation. The mean cumulative desaturation time ≥90% in the first 4 months was 11.08 min (range 2.5–36.57 min). This study demonstrates monotonic patterns of increasing saturation and decreasing number and time of desaturations ≥95% and ≥90% but a random pattern of desaturations ≥85% occurs across the first 6 months of life. Cumulative desaturation times over the first 4 months of life were high and could be important to the development of maturity of the respiratory system. After 6 months, all indices of saturation and desaturation point to a stable and mature respiratory system.
The effect of halothane on neonatal ciliary beat frequency
Authors: O'CALLAGHAN C. , ATHERTON M. , KARIM K. , GYI A. , LANGTON J. A. , ZAMUDIO I. , BARRY P.
Published: March 2008

The effect of a commonly used anaesthetic agent, halothane, on neonatal cilial function was determined. A nasal cilial sample was taken from 13 healthy, term, newborn infants. For 1 h, half of each sample was exposed to halothane and half to air. Cilial function was assessed by measuring beat frequency with a modified light transmission method. Cilial beat frequency was significantly slower in the cilia exposed to halothane, 9(s.d. 2.5)Hz, than to air, 12.9(s.d. 1.5)Hz. Decreased mucociliary clearance following halothane anaesthesia is due, at least in part, to a directly depressant effect of halothane on ciliated cells.
Oral calcium treatment in vitamin D‐dependent rickets type II
Authors: WONG G. W. K. , LEUNG S. S. F. , LAW W. Y. , CHEUNG N. K. H. , OPPENHEIMER S. J.
Published: March 2008

Vitamin D‐dependent rickets type II is a rare hereditary disease that results from target organ resistance to the action of 1,25‐dihydroxyvitamin D3. There is a great heterogeneity in the clinical presentation of this condition. The affected patients usually present early in childhood with clinical and biochemical evidence of rickets. Physiological replacement dosage of 1,25‐dihydroxyvitamin D3 has no therapeutic effect. Responses to pharmacological doses of vitamin D metabolites or long‐term calcium infusion have been variable. A case is reported here of an 8 year old girl, of consanguineous parents with vitamin D‐dependent rickets, type II, in whom treatment with high dose oral calcium resulted in marked biochemical and radiological improvement. It is concluded that high dose oral calcium treatment is an effective treatment option for patients with vitamin D‐dependent rickets type II.
Antimicrobial factors and microbial contaminants in human milk: Recent studies
Authors: MAY J. T.
Published: March 2008

An overview of recent studies of antimicrobial factors and microbial contaminants found in human milk is presented. The incidence of gastrointestinal and respiratory infections in infants receiving human milk continues to be lower than in those not breast‐fed due to the presence of specific antibody and possibly anti‐adhesion factors in the milk. Whether the many other antimicrobial factors, which have been shown to be active in vitro or in animal model systems, have any influence on infant infections is still not clear. Microbial contaminants in human milk are rare, as are associated infant infections from the milk. However, some contaminants such as cytomegalovirus are commonly transferred to infants from the milk of seropositive mothers, fortunately without any adverse effects in the infants. Human T‐lymphotropic virus type 1 is transferred via human milk in endemic areas, human milk being the main source of mother‐to‐infant transmission. While some reports suggest human immunodeficiency virus type 1 transfer may occur through human milk, this is not the predominant mode of transmission to infants.
Health beliefs among New Zealand adolescents
Authors: NADA‐RAJA S. , McGEE R. , WILLIAMS S.
Published: March 2008

A modified version of the Multidimensional Health Locus of Control (MHLC) scale was administered to 837 adolescents, aged 15 years, to assess their beliefs about health. There were significant sex differences on the total scores of the internal and powerful others dimensions of the scale. MHLC beliefs were not significantly associated with self‐reported ratings of general health or mental health. Significantly more distress due to the experience of negative life events was reported by females with a strong internal locus of control. Maternal health beliefs showed stronger associations with daughters' health beliefs than sons'. For males, strong beliefs in an internal locus of control and weak beliefs in chance were significantly associated with aspects of attachment, social support and self‐perceived strengths. There were weak correlations for the majority of associations between health beliefs and health measures and most of the adolescents reported either good or very good health. The findings suggest that adolescents' health beliefs may be quite different from those of adults.
Plant sources of acid stable lipases: Potential therapy for cystic fibrosis
Authors: TURSI J. M. , PHAIR P. G. , BARNES G. L.
Published: March 2008

Exogenous lipase used in the treatment of pancreatic insufficiency may be destroyed by stomach acid. This study was undertaken to search for a readily available source of acid stable lipase. Eleven plant sources (avocado, walnut, pinenut, coconut, lupin, lentils, chickpea, mungbean, oats, castor beans and eggplant) were screened for lipolytic activity using a newly developed radio‐isotopic labelled substrate method. The results obtained by this method were confirmed by thin layer chromatography. Two of the sources (castor bean and dehulled oats) showed significant lipolytic activity at pH 5.6, castor beans containing 1.5 U/mg of extracted solid and oats 400–1200 U/mg of extracted solid. Castor beans are difficult to obtain and so may be an impractical commercial source of lipase; however, oats are abundant. If simple methods of enzyme purification and concentration can be developed, oats may prove to be a practical source of acid stable lipase for use in the treatment of patients with pancreatic insufficiency, especially those who have cystic fibrosis.
Rehospitalization and growth of infants with bronchopulmonary dysplasia: A matched control study
Authors: CHYE J. K. , GRAY P. H.
Published: March 2008

Objectives: To determine the risk of hospitalization and the growth during the first year of life in infants with bronchopulmonary dysplasia (BPD) and birthweight matched controls.

Methodology: The study population consists of 78 infants of 26 to 33 weeks gestation with BPD of whom 20 were discharged on home oxygen therapy. The 78 control infants were matched with the study infants for broad based birthweight categories. Infants were reviewed at 4,8 and 12 months corrected for prematurity at which time the history of rehospitalization was recorded and growth parameters were measured.

Results: Infants with BPD were found to have a higher overall rate of rehospitalization (58 vs 35%, relative risk (RR) 1.7,95% confidence interval (Cl) 1.2‐2.4) and were more likely to be readmitted for respiratory illnesses (39 vs 20%, RR 1.9, 95% Cl 1.1‐3.2) and for poor growth (14 vs 1%, RR 14, 95% Cl 1.7‐82) than the control group. Many infants, both study and control, remained below the 10th percentile at 1 year of age. More BPD infants were below the 10th percentile in weight at the 4 month visit than the control infants (30 vs 15%, P= 0.034). This difference was neither present at subsequent visits nor in the other major growth parameters. The 20 BPD infants who were on home oxygen therapy were more frequently hospitalized for concerns with failure to thrive (30 vs 9%, RR 3.3,95% Cl 1.2‐8.9) than the remaining 58 BPD infants. No significant differences were detected in the overall rate of rehospitalization. Poor growth at the corrected age of 1 year was similar in the two subgroups of infants.

Conclusions: BPD infants are at increased for risk rehospitalization during the first year of life. While many infants with BPD have growth failure, it is suggested that the provision of appropriate supplemental oxygen at home may result in those infants having similar growth patterns when compared to birthweight matched preterm infants without BPD.
Clinical features of neonatal seizures
Authors: O'MEARA M. W. , BYE A. M. E. , FLANAGAN D.
Published: March 2008

Objectives: Identification of seizures in neonates is difficult. This study analyses the clinical features of seizures in a cohort of neonates.

Methodology: The clinical events of 41 neonates referred for investigation of suspected seizures were studied with prolonged video/electroencephalographic (EEG) telemetry.

Results: Sixteen neonates had no seizures recorded; 25 had confirmed seizures, 13 with clinical correlates. Each neonate with electroclinical seizures had paroxysms of abnormal movements in stereotyped patterns. These patterns were consistently found to have electrical correlates. Focal clonic movements were seen most frequently. Multiple clinical features characterized the seizure repertoire in six neonates. In five neonates the clinical features became less evident during monitoring and these seizures were difficult to recognize. This change was associated with anticonvulsant administration in three cases.

Conclusions: Electroclinical seizures are characterized by abnormal paroxysmal stereotyped behaviour, often with multiple clinical features. Recommendations for the management of abnormal neonatal events are proposed.
Neonatal herpes simplex infection: Keys to early diagnosis
Authors: ELDER DE , MINUTILLO C , PEMBERTON P J
Published: March 2008

Objective: To highlight the clinical features of neonatal herpes simplex (HSV) infection that might facilitate earlier diagnosis.

Methodology Fifteen year retrospective review of proven neonatal HSV cases from a regional neonatal referral unit.

Results Fifteen cases reviewed: 10 with central nervous system (CNS) disease, three with skin, eyes or mouth (SEM) disease and two with disseminated disease (DIS). A median 4 day delay occurred between symptom onset and hospital admission. All cases presented after maternity hospital discharge, most commonly with feeding problems and lethargy. Six patients presented with skin lesions; parental genital herpes was reported in three (20%) cases. Seven infants died, four without acyclovir treatment and three of 11 treated cases. Three of five CNS disease survivors and all infants with SEM disease were normal at follow up.

Conclusions Acyclovir improves outcome in neonatal HSV infection. To improve outcome further earlier recognition of the non‐specific presenting features of the disease is required.
Kawasaki disease associated with streptococcal infection within a family
Authors: ANDERSON DG , WARNER G , BARLOW E
Published: March 2008

Objective: To describe the illness occurring in four members of a family, which had clinical and laboratory features of Kawasaki disease and streptococcal infection.

Methodology: A retrospective report of three siblings and an adult male living in one household. The children had serology, blood counts, cultures and echocardiography performed and were treated with antibiotics and gammaglobulin infusions.

Results: The patients developed clinical, and exhibited laboratory, features suggesting streptococcal infection and 4/5 criteria suggesting the diagnosis of Kawasaki disease. All made a good clinical recovery but the youngest developed a coronary artery aneurysm.

Conclusions: It may be difficult to distinguish streptococcal infection and Kawasaki disease. It is possible that some cases of Kawasaki disease are precipitated by streptococcal infection.
A pilot evaluation of conductive education‐based intervention for children with cerebral palsy: The Tongala Project
Authors: COLEMAN GJ , KING JA , REDDIHOUGH DS
Published: March 2008

Objective:

To perform an objective evaluation of a programme based on conductive education (CE).

Methodology:

Two groups of children with cerebral palsy were studied over 6 months. Eleven children participated in a CE‐based programme and nine children received traditional early intervention programmes. Videotapes of the children performing items from the Vulpe Assessment Battery (VAB) were scored by assessors blind to the treatment group. The questionnaire on resources and stress (QRS‐F) was administered to the primary caregiver.

Results:

Few statistically significant results were obtained. There was a trend for the conductive education‐based group to make slightly greater gains. The videotaped measures yielded high Chronbach coefficients and high interrater correlation coefficients suggesting that this is a useful method to evaluate progress.

Conclusions:

The study was limited by small sample size, the nature of the control group and the lack of random assignment to CE and control groups. It did provide a basis for the development of further research in the area.
Parent satisfaction with services in an emergency department located at a paediatric teaching hospital
Authors: BROWN K , SHEEHAN E , SAWYER M , RAFTOS J , SMYTH V
Published: March 2008

Objective:

To evaluate parents' satisfaction with the services provided in an emergency department located at a paediatric hospital.

Methodology:

A descriptive study in which the parents of children with non‐life‐threatening illnesses attending an emergency department completed a questionnaire describing their satisfaction with services in the department.

Results:

The majority of parents were satisfied with the services provided. However, less satisfied parents reported having to wait significantly longer before receiving medical attention than satisfied parents. Consistent with this finding, 77% of less satisfied parents reported that staff did not attend to their children's needs quickly enough and 62% felt that there were insufficient staff available to provide help. Twenty‐nine per cent of the less satisfied parents reported that they did not know what was required for the ongoing care of their children after their discharge from the emergency department.

Conclusions:

In order to address the concerns of less satisfied parents, emergency departments need to give careful attention to the maintenance of reasonable waiting times, the provision of adequate staffing, and the quality of staff‐parent communication. Addressing these issues may improve the ongoing care of children after their discharge from emergency departments.
Cleft palate, mortality and morbidity in infants of substance abusing mothers
Authors: THOMAS DB
Published: March 2008

Objective

: To investigate a high incidence of congenital malformations, morbidity and mortality in infants of drug abusing mothers.

Methodology

: In a 10 and a half year period from 1984–95, 497 such babies were reviewed whose mothers had abused a variety of drugs.

Results

: Thirty babies died or had serious disability. There were five cases of SIDS and 19 babies had major malformations, including seven with cleft lip/palate. Six babies had significant gastrointestinal disorders or feeding difficulties.

Conclusion

: The incidence of clefting was 10 times the normal rate and SIDS five times the expected incidence. In a group of mainly socially disadvantaged women, the abuse of narcotics, amphetamines and other substances, with possible sub‐optimal nutrition, may have been contributory to this high morbidity and mortality. No specific drug could be implicated.
Hydrometrocolpos and segmental colonic dilatation in a girl with megacystis‐microcolon‐intestinal hypoperistalsis syndrome
Authors: DEWAN PA , BROWN N , MURTHY DP , DANGA‐CHRISTIAN B , HAAN E , BYARD RW , WATTERS DAK
Published: March 2008

Objective

: To report a case of a newborn female infant noted to have features of the megacystis‐microcolon‐intestinal hypoperistalsis syndrome (MMIHS) with the additional features of hydrometrocolpos and segmental colonic dilatation and review the literature.

Methodology

: The details of the case were collated and compared with the previous published experience with this condition.

Results:

Thus far there have been 58 previous cases of MMIHS described, only four of which have had colonic dilatation. A number of concurrent anomalies have been described, but not the hydrometrocolpos or dysmorphic features seen in this patient.

Conclusion

: This case appears to be MMIHS with additional features not previously recorded.
Electroencephalograms, clinical observations and the monitoring of neonatal seizures
Authors: BYE AME , FLANAGAN D
Published: March 2008

Objective

: To identify neonatal seizures and evaluate the efficiency of clinical observations and short duration electroencephalograms (EEG).

Methodology

: Sixty‐three neonates were investigated using prolonged video/EEG monitoring. Patients with confirmed seizures were treated with sequential doses of phenobarbitone and, if seizures persisted, phenytoin. The likelihood of correct management if short duration EEG and clinical observations had been employed was determined.

Results

: Thirty‐two patients had confirmed seizures. After administration of anticonvulsants, clinical observations identified seizures in a mean of 66% (s.d. 7.3%) of the cohort. A 60 min EEG after each stage of phenobarbitone therapy would guarantee electrographic seizure capture in a mean of 76% (s.d. 10%) of the cohort. A 60 min EEG after addition of phenytoin would guarantee capture in 50%.

Conclusions

: An EEG would avoid misdiagnoses in most patients with ambiguous clinical signs. After anticonvulsant infusions, EEG add substantial information to that gained by clinical observations.
Pattern of preschool behaviour problems in New Zealand, using the Behaviour Check List
Authors: PAVULURI MN , LUK S‐L
Published: March 2008

Objective: The main aim of the study was to identify the pattern of behaviour problems in preschool children to enable early recognition and intervention.

Methodology: Three hundred and twenty children, in eight randomly selected preschool centres, aged between 2.5 and 5 years, were included in the study. Parents completed the Behaviour Check List (BCL), a screening measure for preschool behaviour problems.

Results: Dependency, temper tantrums, and being difficult to manage were the commonly rated symptoms when moderate‐severe problems were examined. Developmental problems decreased with increasing age, while relationship problems and worries that were cognitively mediated worsened. There were no major differences in the patterns between boys and girls. On cross‐cultural comparison, parents in New Zealand rated their children lower on the BCL compared to those in the UK. Factor analysis of the BCL yielded seven factors. The two main factors ‘predominantly conduct’ and ‘predominantly emotional’ consisted of a mixture of conduct (difficulty in managing, temper tantrums, sibling rivalry) and emotional (unhappy mood, worry, fears) problems. The other five factors were related to developmental problems.

Conclusions: These results help clinicians identify the emerging pattern of preschool behaviour problems that change with increasing age and vary with differing cultures. Categorical presentation of preschool behaviour problems support the view that they should be included in a classification system.
Bacterial colonization of indwelling vascular catheters in newborn infants
Authors: NARENDRAN V , GUPTA G , TODD DA , JOHN E
Published: March 2008

Objective: To determine the incidence of bacterial colonization of intravascular catheters, to compare the incidence of colonization of intra‐arterial (IA), intravenous (IV) and central venous catheters (CVC), and to determine the association, if any, between catheter withdrawal and bacterial sepsis.

Methodology: A prospective observational study was carried out at the neonatal intensive care unit of a university‐affiliated regional referral centre. A total of 155 catheters (45 IA, 54 IV and 56 CVC) were obtained from 96 infants admitted to the unit and the distal 0.75 cm studied under the scanning electron microscope. The adjoining 0.75 cm was cultured for bacteria.

Results: Scanning electron microscopy revealed that 46% of catheters had bacteria on the internal surface and 13% had bacteria on the outer surface. Greater numbers of CVC were colonized with bacteria compared to IA and IV catheters (P < 0.01). Bacterial colonization of intravascular catheters was not significantly associated with the duration the catheter remained in situ or local reaction at the site of entry of the catheter. Colonization of the external surface of the catheter was significantly associated with bacterial septicaemia (P= 0.0466). Eighty‐three per cent of 155 catheters studied had coagulum on the inner or outer surface. Only 53% of these were colonized with bacteria. Bacterial colonization occurred in the absence of a coagulum in only three instances. Catheter withdrawal was not associated with bacterial sepsis. Lack of coagulum on the internal surface of the catheter was strongly associated with septicaemia during the 7 days after catheter withdrawal.

Conclusions: Although significant numbers of intravascular catheters were colonized with bacteria, only colonization with the external surface was associated with catheter‐related sepsis.
Genotype of the cystic fibrosis population of the Hunter Region of New South Wales
Authors: HENRY RL , HETTIARACHCHI LC , COLLEY P , COLLLINS C , O'LOUGHLIN EV , COOPER DM
Published: March 2008

Objective: To determine the genotype of patients attending the cystic fibrosis clinic at John Hunter Hospital, Newcastle, Australia.

Methodology: Seventy‐five of the 76 patients attending the clinic over a 6 month period had blood collected for genetic analysis of 17 of the cystic fibrosis (CF) gene mutations.

Results: Sixty‐one per cent of the patients were homozygous for the ΔF508 mutation and all except one child had at least one ΔF508 mutation.

Discussion: Nearly 80% of the CF genes were the ΔF508 mutation. This prevalence suggests that the obligatory false negative rate of a newborn screening programme for CF based on a combination of immunoreactive trypsin and the ΔF508 gene may be as low as 4‐5%.
Serum lipid profiles in Malay mothers and neonates: A cross‐sectional study
Authors: CHOO KE , DAVIS TME , MANSUR MA , AZMAN E , ACHANA S
Published: March 2008

Objective: Preliminary epidemiological data suggest that dyslipidaemia contributes significantly to rising mortality due to atherosclerosis in Peninsular Malays. The aim of this study was to determine whether abnormal serum lipid profiles are present at birth in this population.

Methodology: The patents were 487 non‐diabetic Malay women who had an uncomplicated antenatal course and delivered healthy singleton babies at term. Cord blood and maternal post‐partum venous blood samples were taken for assay of serum cholesterol and triglyceride concentrations using standard enzymatic methods.

Results: Maternal total serum cholesterol concentrations (mean±SD; 7.5±2.5 mmol/L) were higher than in other reported series (range of published means 5.2‐6.5 mmol/L) with a correspondingly low high‐density lipoprotein (HDL):total cholesterol ratio. The mean cord blood total serum cholesterol (1.7±1.0 mmol/L) was consistent with previously reported population means (1.5‐1.9 mmol/L) but there was a relatively high low‐density lipoprotein (LDL)‐cholesterol and depressed HDL: cholesterol ratio. Significant correlations between maternal and neonatal serum total (P= 0.038) and especially HDL‐cholesterol (P <0.001) were observed. Maternal and cord blood serum triglyceride levels were comparable to those in other series.

Conclusions: These cross‐sectional data provide evidence that abnormal serum cholesterol profiles are found in pregnant Malay women and their neonates which may have implications for the prevalence of macrovascular disease in the Malay population.
New South Wales population‐based birthweight percentile charts
Authors: BEEBY PJ , BHUTAP T , TAYLOR LK
Published: March 2008

Objective: To derive newborn percentile charts using NSW population and hospital‐based data.

Methodology: Birthweight data for liveborn singleton infants were obtained from the New South Wales Midwives Data Collection (MDC) from 1990 to 1994 inclusive (n= 422139). Data were also collected from King George V Hospital (KGV) for liveborn singleton infants less than 35 weeks of gestation for 1982‐89 inclusive, and for all gestations for 1990‐95 inclusive (n= 30 610). Birthweight percentiles were derived using the MDC data separately for mates and females. Head circumference (n= 29 090) and birth length percentiles (n= 26 973) were derived from the KGV data.

Results: The charts derived from MDC data had generally higher percentiles than previously published charts. These represent the largest Australian population‐based study published to date.

Conclusions: Periodic review of newborn growth charts is recommended because of changing ethnic and socio‐economic factors.
Isolated congenital tricuspid valve dysplasia: A rare condition mimicking persistent pulmonary hypertension of the newborn
Authors: YAM MC , NG PC , FOK TF
Published: March 2008

ABSTRACT Isolated congenital tricuspid valve dysplasia is a rare and potentially lethal congenital heart disease that can be easily confused with persistent pulmonary hypertension of the newborn. We describe a neonate with isolated congenital tricuspid valve dysplasia who did not respond to mechanical ventilation but improved by tolazoline. Clinicians should be aware that the initial fulminant course of this condition may be reversed by reducing the pulmonary vascular resistance, thereby allowing time for spontaneous recovery.
Aortic aneurysm complicating bacterial endocarditis in childhood
Authors: DAVIS EA , VALENTINE JP , D'ORSOGNA L
Published: March 2008

Bacterial endocarditis is an uncommon diagnosis in childhood with significant morbidity and mortality. Aortic aneurysm as a complication is well described in adults but there are few reports in the paediatric literature. Two children with bacterial endocarditis are described, whose illnesses were complicated by aortic aneurysm formation requiring surgical intervention.
Phimosis: Is circumcision necessary?
Authors: DEWAN PA , TIEU HC , CHIENG BS
Published: March 2008

Abstract: Circumcision has been the traditional treatment for phimosis, but now is not the only management option, the best of which appears to be topical steroid application. Importantly, the literature suggests that phimosis probably is over‐diagnosed, indicating that a prospective, randomized controlled study is needed to compare the non‐circumcision options. Such a study would require consensus on the diagnostic criteria for phimosis; therefore, a more exacting definition would be needed and is suggested. Despite the non‐controlled data on medical treatment of true phimosis, there seems little doubt that surgical intervention is not needed for all male infants with adherence of the foreskin to the glans, a non‐retractable foreskin or, indeed, true phimosis.
Urinary uric acid excretion in term and premature infants
Authors: TSUKAHARA H. , HIRAOKA M. , HORI C. , TSUCHIDA S. , UCHIDA H. , FUJISAWA K. , KONISH Y. , SUDO M.
Published: March 2008

Objective: To clarify postnatal changes in urinary uric acid (UA) excretion in normal term infants and to examine the effects of prematurity or illness on the UA excretion.

Methodology: Measurements of urinary UA were performed in term and premature infants at the ages of 1 and 7 days and at 1 and 4 months, as well as at 7 months in term infants.

Results: Urinary UA levels were lowest on day 7 in term infants. The levels were highest on day 1 in premature infants and remained significantly higher compared to term babies during the first month of life. Respiratory failure requiring ventilation and oxygen supply resulted in further significant elevation of urinary UA in premature infants.

Conclusions: With the reference values obtained in the study reported here, urinary UA can now be used for the diagnosis and monitoring of inherited disorders of purine metabolism and for the assessment of oxygen radical insult to sick infants.
Cytochrome P450 2D6 and glutathione S‐transferase genotype in sudden infant death syndrome
Authors: CHEN CL , LIU Q , EVANS WE , SANDER CH , RELLING MV
Published: March 2008

Objectives:

The risk of sudden infant death syndrome (SIDS) has been linked with xenobiotic exposures, race and inheritance. Because cytochrome P450 2D6 (CYP2D6) and glutathione S‐transferases (GSTM1 and GSTT1) are genetically regulated, polymorphically distributed, and responsible for detoxification of many centrally acting exogenous and endogenous bioactive compounds, our objective was to determine whether the prevalences of deficiencies in CYP2D6, GSTM1, and GSTT1 differ in SIDS victims compared to healthy controls.

Methods:

CYP2D6 mutations (deletion, A, B, and T alleles) and GSTM1 and GSTT1 null genotypes were assessed in DNA from 50 SIDS victims. CYP2D6 phenotype, assigned using dextromethorphan urinary ratios, was assessed in 25 unrelated parents of SIDS victims.

Results:

The CYP2D6B mutation was the only mutant CYP2D6 allele found in SIDS victims, present in 26.2% of patients (11/42) and 13.1% (11/84) of alleles. Adjusting for race, the prevalence of wild‐type CYP2D6 alleles and of homozygous wild‐type CYP2D6 phenotype was not different in SIDS victims compared to controls (P= 0.585 and 0.224, respectively). Among the 25 parents of SIDS victims, all subjects were extensive metabolizers, a prevalence not different from controls (P= 0.243). The prevalence of the null genotype for GSTM1, GSTT1 and double‐null for GSTM1 and GSTT1 was 33.3%, 21.4% and 9.5%, respectively, among SIDS victims, and was not different than controls (P=0.61, 0.1, 0.28, respectively). The combination of CYP2D6 homozygous wild‐type genotype and the null genotype for GSTM1, GSTT1, or both GSTM1 + GSTT1 also did not differ in SIDS victims and controls.

Conclusions:

The frequencies of CYP2D6 mutant genotypes and the null genotypes for GSTM1 and GSTT1 were not different among SIDS victims compared to normal controls, and thus these polymorphisms are unlikely to identify families with a high risk of SIDS.
Prolonged low‐dose indomethacin therapy for patent ductus arteriosus in very low birthweight infants
Authors: KUMAR RK , YU VYH
Published: March 2008

Objective:

To determine the efficacy and side‐effects of prolonged low‐dose indomethacin therapy in very low birthweight (VLBW; <1500 g) infants with a haemodynamically significant patent ductus arteriosus (hsPDA).

Methodology:

Very low birthweight infants admitted over a 16 month period were studied (6 months, retrospectively and 10 months, prospectively). Cross‐sectional and M‐Mode echocardiograms with pulsed‐wave and colour Doppler were performed to assess the significance of ductal patency.

Results:

Forty‐one (28%) of 148 VLBW infants were diagnosed to have hsPDA. Indomethacin therapy was successful in 90% after the first course, increasing to 95% after the second course. The recurrence rate after the first course was 3%. Minor and transient complications included oliguria, urea retention, hyponatraemia and thrombocytopenia. Although three infants had focal bowel perforation and the fourth had bowel perforation associated with necrotizing enterocolitis, the incidence of gastrointenstinal pathology was not significantly different from infants without hsPDA and not given indomethacin.

Conclusions:

Very low birthweight infants with hsPDA have a high response rate and low recurrence rate to prolonged lowdose indomethacin therapy. Side‐effects were mild and transient. However, it is prudent to be cautious when administering indomethacin in critically ill infants <1000 g with hsPDA who manifest clinical features of bowel ischaemia.
Abnormalities in surfactant in sudden infant death syndrome as a postmortem marker and possible test of risk
Authors: HILLS BA , MASTERS IB , VANCE JC , HILLS YC
Published: March 2008

Objective:

To determine whether physical abnormalities in lung surfactant, particularly inversion of the hysteresis between surface tension and surface area, are an effective postmortem marker for sudden infant death syndrome (SIDS).

Methodology:

Bronchoalveolar lavage (BAL) was employed to obtain lung rinsings from 55 infants under 24 months of age at autopsy, comprising 34 index cases and 21 controls. Folch reagent was used to extract the lipoid content which was then applied at two surface concentrations, fixed and BAL‐determined (BALD), to the pool of a Langmuir trough in which surface tension (γ) was measured continuously by the Wilhelmy method as surface area (A) was cycled.

Results:

The γ:A loops from SIDS samples were inverted relative to controls (i.e. they were hysteresis reversed, this inversion being quantified by an empirical surface tension:area reversal (STAR) score). There was a wide scatter of STAR scores, but a critical value was found which offered a significant (P= 0.017) separation of SIDS cases from controls for a fixed surface concentration and a highly significant separation (P= 1.0 × 10‐4) for BALD surface concentrations. Differences in the yields of phospholipid and proteolipid, or their correlation to STAR scores, did not reach statistical significance.

Conclusions:

Inversion of the γ:A loops (i.e. hysteresis inversion) would appear to offer a better postmortem marker of SIDS than any reported previously, the procedure having potential for development as a prospective test indicating the risk of this disease.
A follow‐up study of infants ≤ 2000 g birthweight treated in central Queensland
Authors: MERCER HP , ROPER PC
Published: March 2008

Objective:

This follow‐up study was undertaken in an effort to ascertain the morbidity in the survivors of infants ≤2000 g birthweight cared for in the two Rockhampton intensive care nurseries.

Methodology:

The records of all infants ≤2000 g delivered in or transferred to Rockhampton during the 11 year period 1979 through 1989 inclusive were extracted. Efforts were made to contact and examine all of these children. Those found to be disabled were assessed as being mildly, moderately or severely affected.

Results:

Of the 482 infants of birthweight ≤2000 g treated in the period under review, 393 survived to be discharged from hospital. Eight were known to have died subsequently. Of the remaining 385 children, 288 (74.8%) were able to be contacted and their health status determined. A total of 36 infants were found to have significant disabilities. Twenty‐four were mildly affected, five moderately and seven severely affected. Severe disability in infants of ≤1000 g was 16% (3/19).

Conclusions:

The incidence of disability was established in 74.8% of the surviving population, It was not dissimilar to the incidence of disability in similar birthweight groups in some Australian tertiary centres for the years under study. It is emphasized that the follow‐up was incomplete and recognized that the survival rates and incidence of disability in survivors has improved in tertiary centres since the time frame of this study.
Chronic lung disease in very low birthweight infants: A 5‐year review
Authors: YEO CL , CHOO S , HO LY
Published: March 2008

Objectives:

To determine the incidence, clinical spectrum and outcome of very low birthweight (VLBW) infants with chronic lung disease (CLD), and evaluate associated factors.

Methodology:

Retrospective review of 265 VLBW infants managed in the NICU from January 1988 to December 1992.

Results:

The overall neonatal survival rate for VLBW infants was 83%. Sixty‐five (25%) infants had CLD, of whom 42% had severe CLD. Mortality in infants with CLD was 11%. In contrast with infants without CLD, CLD infants had significantly higher risk of adverse neurodevelopment with cerebral palsy documented in 13.5% and functional disability recorded in 34.6% at 2 years corrected age. Factors associated with the development of CLD included; decreasing birthweight (OR 0.98, Cl 0.97–0.99), septicaemia (OR 4.96, Cl 1.57–15.65), necrotizing enterocolitis (OR 119.07, Cl 4.98–2845.04), hyaline membrane disease (OR 5.34, Cl 1.83–15.55), patent ductus arteriosus (OR 4.46, CI 1.75–11.36) and increasing fraction of inspired oxygen concentration in the first week of life (OR 1.09, Cl 1.04–1.14).

Conclusions:

Chronic lung disease occurs frequently in VLBW infants and is associated with a high incidence of adverse neurodevelopment. Further studies to clarify the role of non‐respiratory factors such as patent ductus arteriosus (PDA) and sepsis in the pathogenesis of CLD may reduce the incidence or prevent the development of CLD in these preterm infants.
Perinatal outcome following conservative management of mid‐trimester pre‐labour rupture of the membranes
Authors: NOURSE CB , STEER PA
Published: March 2008

Objective:

To assess perinatal outcome and the effect of antenatal steroid use following conservative management of 86 consecutive singleton pregnancies complicated by pre‐labour rupture of membranes (ROM) in the mid‐trimester (13–26 weeks; mean 22.8 weeks).

Methodology:

Review of obstetric and neonatal case notes between 1 January 1990 and 31 December 1993.

Results:

The duration of ruptured membranes (latent period) ranged from 1.25 to 105 days (mean 23.8 days; median 14 days) and was inversely related to gestational age at ROM. There was clinical evidence of chorioamnionitis in 39.5% with placental histological changes consistent with chorioamnionitis in 76.6%. All infants were delivered before 33 weeks gestation (mean 26 weeks). Overall, the mortality rate was 43.0% but 62.5% in infants with ROM before 24 completed weeks gestation. Adverse outcome (defined as death, severe intraventricular haemorrhage (IVH) or periventricular leucomalacia (PVL)) occurred in 46.5% and was significantly related to both gestation at delivery and gestation at ROM. In the group (n= 40) with ROM before 24 weeks gestation, adverse outcome occurred in 65% and was inversely related to gestation at ROM independent of gestation at delivery. Antenatal steroid administration resulted in less adverse outcome independent of gestation at delivery (OR 0.31; 95% CI (0.09–0.98; P= 0.046)).

Conclusion:

From the neonatal perspective conservative management is justified for pregnancies with ROM at or after 24 weeks gestation; in this group the use of antenatal steroids prior to delivery may improve perinatal outcome. A poor outcome is associated with ROM that occurs before 24 weeks gestation.
Megaloblastic anaemia and pancytopenia secondary to prophylactic cotrimoxazole therapy
Authors: TAPP H , SAVARIRAYAN R
Published: March 2008

A case of megaloblastic anaemia and pancytopenia associated with prophylactic cotrimoxazole therapy is reported and discussed.
Changes in serum lipids and lipoproteins in epileptic children treated with anticonvulsants
Authors: VERROTTI A , DOMIZIO S , ANGELOZZI B , SABATINO G , MORGESE G , CHIARELLI F
Published: March 2008

Objective: To assess the effect of long‐term treatment of phenobarbital, carbamazepine and sodium valproate on serum lipids and lipoproteins in epileptic children.

Methodology: One hundred and fourteen (55 male, 59 female) children and adolescents suffering from various types of epilepsy who received different antiepileptic drugs were studied. The patients were subdivided into three groups according to their therapy: (i) carbamazepine (35 patients); (ii) phenobarbital (34 patients); and (iii) sodium valproate (45 patients). One‐hundred healthy sex‐ and age‐matched children served as controls. Lipids and lipoprotein profile were evaluated before the beginning of the anticonvulsant therapy and after at least 2.5 years. In the patients receiving phenobarbital, we re‐evaluated 12 children (seven male, five female) at the end of therapy.

Results: The children receiving phenobarbital showed high levels of serum total cholesterol and low‐density lipoprotein (LDL) cholesterol and low levels of triglycerides, while children treated with carbamazepine had high levels of total cholesterol, triglycerides, LDL and high‐density lipoprotein (HDL) cholesterol. Children treated with valproate had low triglycerides and LDL cholesterol levels with high levels of HDL cholesterol. The patients treated with phenobarbital showed a normalization of all parameters after the end of therapy.

Conclusions: Anticonvulsant drugs significantly modify serum lipids and lipoproteins in epileptic children. The changes due to phenobarbital seem to be transient.
Minimal haemolysis in blood co‐infused with amino acid and dextrose solutions in vitro
Authors: JANKOV RP , ROY RND
Published: March 2008

Objective: To examine the haemolytic effects of amino acid and dextrose solutions on co‐infused packed red blood cells.

Methodology: An in vitro study of packed cells co‐infused at various rates with dextrose 5%, 10%, 15% and intravenous amino acid solution (Vamin; Kabi‐Pharmacia, Baxter Healthcare Pty Ltd) in dextrose 5%, 10% and 15%. The degree of haemolysis was measured as free oxyhaemoglobin by spectrophotometer. Co‐infused 0.9% saline and water were used as 0% and 100% haemolysis controls.

Results: Only minimal haemolysis was observed with the solutions tested. The greatest observed amount of haemolysis was 0.14%.

Conclusions: Co‐infusion of packed red blood cells with dextrose and amino acid solutions at the concentrations and infusion rates commonly used, in neonatal care, does not cause clinically important haemolysis.
Steroid 17α‐hydroxylase deficiency: First Australian case report
Authors: CAMERON FJ , MONTALTO J , YONG ABW , WARNE GL
Published: March 2008

Abstract: 17α‐hyroxylase deficiency is a rare form of congenital adrenal hyperplasia (CAM) that affects both glucocorticoid and sex hormone biosynthesis. We report a case of an unambiguous female with testes and hypertension. She was found to have deficient 17α‐hydroxylase activity. The diagnosis was not made easily, the condition being unexpected due to its rarity. The discriminating feature of this form of sex‐reversal is the presence of hypertension due to the elevated serum deoxycorticosterone levels. A failure to detect this will inappropriately focus attention on other, more common causes of sex reversal such as androgen insensitivity and gonadal dysgenesis, and expose the patient to the long‐term sequelae of uncontrolled arterial hypertension.
Penicillium marneffei infection in a non‐HIV infected child
Authors: KWAN EYW , LAU YL , YUEN KY , JONES BM , LOW LCK
Published: March 2008

We report a case of Penicillium marneffei infection in a previously healthy 3.5 years‐old Chinese boy and review the literature. The details of the case are described with emphasis on his immune function and treatment outcome. This boy had transient immunodeficiency involving phagocytic and NK cells due to P. marneffei infection which resolved after treatment with gamma interferon and amphotericin B. A prolonged course of fluconazole of 1 year was successful in preventing relapse. Gamma interferon, amphotericin B and a prolonged course of fluconazole may be useful in the treatment of life‐threatening infection by P. marneffei.