bluuebunny/crossref_metadata_2025 huggingface dataset:
Corrigendum*
Authors: FERGUSSON D. M. , DIMOND M. E. , SHANNON F. T.
Published: March 2008

Abstract The prevalence of illness was studied in a birth cohort of Christchurch children during the period from birth to 5 years. By 5 years children had made an average of 18.0 family doctor consultations for morbidity and a further 4.7 for preventive health care procedures; 38% had been admitted to hospital on at least one occasion and 62% had made one or more attendances at a hospital outpatient department. The majority of general practitioner consultations involved four major groups of conditions: respiratory illness; integumental lesions; gastrointestinal illness and accidents. Hospital admissions were dominated by six groups of conditions: respiratory illness, minor surgery, accidents, feeding and management problems, admissions relating to the child's home environment and gastrointestinal illness. Two thirds of hospital outpatient attendances were accounted for by five groups of conditions: accidents; musculoskeletal conditions; respiratory illness; vision problems and congenital heart murmur.
Diuresis and natriuresis following acute pneumothorax in very low birthweight infants
Authors: LESLIE GARTH I. , III JOSEPH B. PHILIPS , WORK JACK , CASSADY GEORGE
Published: March 2008

Seven tension pneumothoraces developed in six very low birthweight infants receiving assisted ventilation for hyaline membrane disease. Mean values for blood pressure and creatinine clearance (Ccr) tended to increase following pneumothorax decompression, although neither increase was statistically significant. Urine volume, osmolar clearance and urine sodium excretion all increased significantly in the 8 h following diagnosis and decompression of pneumothoraces. However, when expressed as a percentage of Ccr, none of these ariables changed, significantly. Mean sodium balance changed from positive to negative despite a significant increase in urine aldosterone excretion. It is suggested that the increases in osmolar clearance and sodium excretion were consequences of the increases in Ccr following pneumothorax decompression. Development immaturity in the renal tubular response to aldosterone might also have contributed to development of negative sodium balance.
The significance of fat‐filled macrophages in the diagnosis of aspiration associated with gastro‐oesophageal reflux
Authors: STAUGAS R. , MARTIN A. J. , BINNS G. , STEVEN I. M.
Published: March 2008

Tracheal aspirates from 46 children were examined for the presence of fat‐filled macrophages. They had no history suggestive of gastro‐oesophageal reflux. The number of positive results from this group (46%) was compared with the number of positive results (73%) in a group of 40 children with proven gastro‐oesophageal reflux. The difference in proportion of positive results between the two groups was statistically significant (P<0.05). In addition, subgroups of subjects, negative for gastro‐oesophageal reflux and lower respiratory tract disease, were compared with children who had both conditions. A slightly greater difference, although at a similar level of significance, was found. The fact that 42% of subjects without lower respiratory tract disease or gastro‐oesophageal reflux had tracheal aspirates positive for fat‐filled macrophages would, however, suggest that this test is of limited clinical value and may need better quantitation before it can be recommended for widespread clinical use.
Pulmonary sequestration in a newborn mimicking cardiac disease: A trap for diagnosis
Authors: SHOLLER GARY F. , WHIGHT CHRISTOPHER M. , NUNN GRAHAM R.
Published: March 2008

A case of pulmonary sequestration in a neonate presenting with hyperdynamic circulation and a murmur is reported. Clinical, radiographic and echocardiographic data suggested the diagnosis and this was confirmed by angiography. The surgical findings were those of sequestration of the right lower lobe, in conjunction with an accessory right lung complete with bronchial and vascular supply arising from the region of the lower oesophagus. Pulmonary sequestration may mimic primary cardiovascular disease in the neonate.
A multidisciplinary approach to the management of psychosocial admissions to a general paediatric ward
Authors: MENAHEM SAMUEL , LUBITZ LIONEL
Published: March 2008

Abstract This study investigated the cheracteristics of all new in‐patients with major psychological and/or social problems admitted to a medical ward over a 4‐week period. Fifteen successive patients were studied prospectively. The professional time spent by the medical and paramedical personnel involved in the initial assessment and management was reviewed, and the children followed‐up 6 months later.

The study found that the patients readily fell into two major groups. Group I were infants and children who had been maltreated or were at risk for child abuse. Group II were older children who presented with psychosomatic symptoms arising from disturbed family or environmental backgrounds. The medical, psychiatric and social work input was considerable for both groups (19 vs 27 h per patient respectively). Their hospital stay was prolonged (15 vs 21 days respectively; the hospital average was 4.4 days). The outcome differed in the two groups. Patients in Group I failed to attend follow‐up appointments in most cases unless such attendance was legally mandatory. In contrast, Group II patients usually kept their follow‐up appointments, the intervention generally being successful.
Indomethacin therapy of patent ductus in preterm infants controlled by plasma levels
Authors: LEWIS IVOR G. , HARVEY DIANNE P. , MAXWELL GEORGE M.
Published: March 2008

Abstract Indomethacin was given by suppository to 18 neonates for the treatment of patent ductus arteriosus. The plasma levels of the drug were measured by high pressure liquid chromatography. Permanent closure of the ductus was achieved in 12 of 21 treatments and took up to 48 h. Successful treatment was strongly associated with a plasma indomethacin level >0.5 μg/ml in the 8 h after a dose. Decreased urinary output was more likely at the same level, but was also found with substantially lower figures. It is suggested that indomethacin therapy for patent ductus should be rationalized by measurement of the plasma level.
Pyloric stenosis: A postoperative ultrasonic study
Authors: BOURCHIER D. , DAWSON K. P. , KENNEDY J. C.
Published: March 2008

Abstract Six infants with hypertrophic pyloric stenosis and 20 control infants were studied ultrasonically on four occasions during the first year of life. At each examination the total diameter and muscle wall thickness of the pylorus were measured. Initially the pylorus was significantly (P <0.05) larger in the hypertrophic pyloric stenosis group but returned to normal values by 6 months postoperation. The control group showed a small increase in size of the pylorus over the 12 month period.
Progressive diaphyseal dysplasia mimicking childhood myopathy: Clinical and biochemical response to prednisolone
Authors: LOW L. C. K. , STEPHENSON J. B. P. , STUART‐SMITH D. A.
Published: March 2008

Abstract Two siblings presented with symptoms suggestive of myopethy: the true diagnosis of Engelmaann's disease was delayed until X‐rays revealed the characteristic sclerosis and widening of long bone diaphyses. Dominant inheritance from their father had not been suspected because of his lack of symptoms. Biochemical studies of bone metabolism did not elucidate the underlying mechanism. Prednisolone dramatically improved the clinical condition, particularly in the more severely affected child. While research into the biochemical basis must continue, paediatricians should remeber to X‐ray the long bones of ‘myopathic’ children, and offer steroids when the clinical condition warrants.
The health of Aboriginal children: The case for change and community control
Authors: DEBELLE GEOFF
Published: March 2008

The health of Aboriginal Australians remains poor despite improvements over the past decade. Aboriginal life expectancy is at least 20 years less than that of the Australian population overall. The wastage of fetal and infant life is three times that of non‐Aborigines.1 Available data on Aboriginal childhood morbidity indicates a seemingly unchanging pattern of ill‐health; poor growth performance with widespread mild‐to‐moderate protein‐energy malnutrition2 and high prevalance rates for infections of the upper and lower respiratory tract,3,4 gastrointestinal tract,5 eyes6 and skin.7 We may have reached a state of diminished returns where blind expenditure on health delivery will not secure any major improvements.
Chlamydial infections in infancy
Authors: GILBERT GWENDOLYN L.
Published: March 2008

Non‐gonococcal ophthalmia neonatorum was the first recognized manifestation of sexually transmitted chlamydial infection and for many years it was thought to be the only manifestation in infants born to infected mothers. In the 20 years since techniques for isolation of Chlamydia trachomatis in cell culture were described, many important effects of chlamydial infection, including afebrile pneumonia in infants, have been established. Prospective studies have determined the incidence of chlamydial infection in pregnant women and the risk of transmission of infection to their infants. They have shown that these are among the commonest perinatal infections. It is estimated that at least 1% of infants in this community have chlamydial conjunctivitis and up to 5/1000 will develop pneumonia. Chlamydial infections are characterized by a subacute onset and, without appropriate treatment, a prolonged course. Although they are rarely fatal, symptoms are sometimes severe and there may be long‐term sequelae. The recent development of rapid and relatively inexpensive methods for direct detection of chlamydiae in clinical specimens will facilitate the diagnosis and treatment of infections in infants.
Mothers' knowledge of first aid — An exploratory study
Authors: LANGLEY JOHN , SILVA PHIL
Published: March 2008

Mothers' knowledge of first aid was assessed using a questionnaire comprising 13 multiple choice questions. The results showed that approximately three‐quarters of the mothers correctly answered 70% of the questions. Whilst higher intelligence and previous training in first aid were shown to be associated with better scores, the effects were small. Some aspects of first aid which deserve more emphasis in training courses were identified.
Preduodenal portal vein with situs inversus and duodenal atresia
Authors: ZIV YECHIEL , LOMBROZO RAPHAEL , DINTSMAN MOSHE
Published: March 2008

In a 7‐day‐old infant referred because of bile‐stained vomiting, jaundice and lack of meconium, radiological examination revealed the ‘double‐bubble’ sign of duodenal atresia as well as dextrocardia. This infant also had a strawberry haemangioma on the right shoulder. Operation disclosed situs inversus and a preduodenal portal vein as well as duodenal atresia. A side‐to‐side duodeno‐jejunostomy was performed successfully without damage to the anomalous vein. The history of polyhydramnion during gestation, the presence of other anomalies, the rapid onset of bile‐stained vomiting and the classic ‘double‐bubble’ sign, together appeared to indicate that the duodenal atresia was intrinsic and not due to the external pressure of the anomalous vein on the duodenum.
Emotional and social effects of congenital heart disease in Singapore
Authors: KONG S. G. , TAY J. S. H. , YIP W. C. L. , CHAY S. O.
Published: March 2008

A cohort of patients with congenital heart disease (n=29) who had undergone corrective cardiac surgery was studied and compared with normal controls. The mean age of cardiac patients was 10.3 years with a range of 6 years to 16 years. Their emotional maladjustment as measured on a behavioural checklist was significantly higher (P < 0.01) than controls, and their social adjustment was also similarly less satisfactory (P < 0.05). Regression analysis indicated that emotional maladjustment in the child was related to maternal maladjustment (P < 0.01), maternal guilt (P < 0.01) and maternal anxiety (P < 0.05). Social maladjustment in the child was significantly related to maternal guilt (P < 0.05) and pampering (P < 0.02). It was considered that the child with heart disease was perceived and ‘labelled’ by the mother as abnormal even after surgery and was therefore the object and focus of maternal guilt and anxiety. Hence, the child's emotional and social maladjustment is probably the result of maternal factors rather than the physical handicaps of the illness.
Body build and the desire for slenderness in young people
Authors: CARROLL DENISE , GLEESON CAROL , RIBSBY BARBARA , DUGDALE A. E.
Published: March 2008

The median weight‐for‐height of young people in Brisbane are below the ‘standard’ values. In most groups the weight‐for‐height are symmetrically distributed, suggesting that this is the range of normal variation. Only among girls aged 15‐19 years was there an excess of ‘obese’ subjects.

Almost all girls and young women say they want to lose weight, even though many are already well below the ‘standard’. This trend is also present, but is less marked, among boys and young men. In these young people the desire for slenderness is causing unhappiness that seems out of proportion to the possible benefits of change. Health professionals should encourage a more balanced attitude to physiological variations in weight‐for‐height among young people.
Stosstherapy: A fresh look at some principles of therapy — especially chemotherapy
Authors: KEIPERT JAMES A.
Published: March 2008

Stosstherapy is the treatment of disease by a single or short‐term, large and sometimes massive, dose of a therapeutic agent. It was most commonly used after the discovery of sulphonamides and penicillin, but has been revived with the recent use of single‐dose chemotherapy. It is effective in many disorders, and these are documented, together with the dosage ranges which can be used. Stosstherapy has a rational basis, is safe, effective, has many advantages compared with long‐term therapy, and could be used much more frequently. Reasons are given why stosstherapy conforms with accepted principles of chemotherapy, but it is given for a much shorter period because the time for an infection to be overcome may be much shorter than has been assumed. It is postulated that the duration of chemotherapy could be shortened in many diseases.
Apnoea in very low birthweight infants: Outcome at 2 years
Authors: TUDEHOPE DAVID I. , ROGERS YVONNE M. , BURNS YVONNE R. , MOHAY HEATHER , O'CALLAGHAN MICHAEL J.
Published: March 2008

Follow‐up data to 2 years are reported for 164 of an initial cohort of 172 consecutively, surviving very low birthweight infants. The 13 infants who suffered apnoeic episodes at home were not predicted at discharge from hospital. The mean (s.d.) general developmental quotient at 2 years for the total group was 97.3(12.0), compared with 99.0 (10.2) for the 72 infants who had nil‐mild apnoea in the newborn period and 96.0 (13.4) for the 92 infants with moderate‐severe apnoea (P<0.1). All six infants with general quotients <76 had sustained moderate‐severe apnoea (P<0.05). Multivariate analysis to assess the influence of confounding variables showed that the presence of chronic lung disease decreased the general quotient by 4.0 units, birthweight <1000 g 3.3 units, mechanical ventilation 2.2 units and moderate‐severe apnoea only 0.1 unit. Moderate‐severe apnoea occurred in six of eight babies with neurological handicap and all eight with sensory handicaps (P<0.01). Overall, of the 12 (7.3%) handicapped children, two had no apnoea and 10 moderate‐severe apnoea (P= 0.07).

Moderate or severe apnoea occurred in 58% of very low birthweight infants and was associated with the smallest and sickest infants who had the most handicaps at 2 years. However, when correction for birthweight <1000 g, mechanical ventilation and chronic lung disease is made, apnoea per se, as it was detected and managed between 1978‐80, had no additional deleterious effect on average intellectual performance though it may have been an important causative factor in functional handicap.
Triose phosphate isomerase deficiency: Report of a family
Authors: CLARK ARTHUR C. L. , SZOBOLOTZKY MARGARET A.
Published: March 2008

Triose phosphate isomerase (TPI) deficiency is associated with a syndrome of congenital non‐spherocytic haemolytic anaemia, mental subnormality, motor impairment, growth failure and cardiac failure. The deficiency state is characterized by moderately reduced red cell TPI activity, and marked instability of the abnormal enzyme to heat. The clinical features of an affected child are described, and some problems in the laboratory diagnosis delineated.
Cushiongoid adrenal hyperplasia in infancy
Authors: PULIYEL JACOB M. , KOMARANCHATH AUGUSTINE , KUMAR K. RAMESH
Published: March 2008

Cushing's syndrome, a characteristic pattern of obesity with hypertension due to the hyperfunction of the adrenal cortex, is relatively rare in infancy. Thirty‐six infants have been reported in world literature,1,2 most of whom have had adrenal tumours. There are only eight reported cases of infants under the age of 1 year with adrenal hyperplasia responsible for Cushing's syndrome. This is a report of an 8 month old child with bilateral nodular adrenal hyperplasia.
Colonoscopy in the diagnosis of abdominal tuberculosis in children
Authors: TAM P. K. H. , SAING H. , Lee J. M. H.
Published: March 2008

Childhood abdominal tuberculosis has protean manifestations and remains a difficult diagnosis problem, often requiring surgery for pathological confirmation. Colonoscopy, however, can now be performed with safety in children and appears to offer a new and better alternative to surgery. An earlier experience confirmed its value in the management of ileocaecal tuberculosis as it provided histological proof and bacteriological information to guide chemotherapy, avoiding the need for anaesthesia and laparotomy. However, colonoscopy hasn't been helpful in the diagnosis of the ‘exudative’ type of abdominal tuberculosis.
Congenital renal salt‐losing syndrome and failure to thrive in infancy
Authors: CHUA HOCK LENG , HEWITT IAN K. , HOBDAY JOHN D.
Published: March 2008

An infant with congenital renal salt‐losing syndrome is reported. The importance of recognizing this rare disorder is emphasized because early detection, and treatment with sodium supplementation, results in marked growth improvement and may prevent volume depletion, electrolyte disturbance, and cardiovascular collapse. The clinical features and biochemical abnormalities seen in the congenital renal salt‐losing syndrome are described. In this condition, natriuresis occurs in the face of normal renal and adrenal function and, as the child gets older, spontaneous resolution occurs. Other causes of hyponatraemia in infancy are discussed.
Why children drown
Authors: PEARN J.
Published: March 2008

Child drowning, especially among the preschool population, remains a significant cause of death in all countries from which statistics are available. A reduction in drowning rates in childhood remains a top priority for preventive paediatrics. Identification of antecedent causes and baseline predispositions (immigrant families, large families, older than average parents, specific high‐risk family lifestyles, attitudes to child rearing and socio‐economic status) has illustrated the complex themes that make it likely a child might enter the drowning sequence.

Children drown as the end result of a sequence which is a longitudinal chain composed of many links.1 Some of the links in the drowning sequence are weak, but others are forged with great resilience. The difficulty of doing anything effective to reduce drownings is illustrated by the data in Table 1. The latest available National figures show that for preschool children, the situation has not improved since 1970.
Congenital hypothyroidism
Authors: CONNELLY J.
Published: March 2008

The 1980s have seen widespread growth in the screening of newborn infants for congenital hypothyroidism (CH). By 1982 it was estimated that 7‐9 million infants were screened annually.1 There has been further expansion since 1982, not only in communities with highly developed public health programmes, but also in less developed centres.2 Experience from Hong Kong is reported in a previous issue of this journal.3
The anatomical and physiological characteristics of pre‐adolescent males and females
Authors: BLANKSBY B. A. , BLOOMFIELD J. , ELLIOT B.C. , ACKLAND T. R. , MORTON A. R.
Published: March 2008

Two hundred and two pre‐adolescent subjects aged 7‐12 years were examined on a battery of anatomical and physiological tests. The total sample comprised non‐competitive children, and those involved in training for swimming or tennis.

A series of analyses of variance were applied to the data to determine whether any differences existed between preadolescent males and females. No significant interaction between age, sex and sporting involvement was found which indicated sex differences to be independent of age and training group. The results revealed that males were superior to females in physical exercise capacity, PWC170, forced vital capacity, and hand grip strength. Males also demonstrated a lesser proportion of body fat than females but were more mesomorphic. No significant differences existed in any of the other tests.
Neonatal jaundice: Its prevalance in Chinese babies and associating factors
Authors: FOK T. F. , LAU S. P. , HUI C. W.
Published: March 2008

A prospective study of 1238 full‐term Chinese newborn infants was conducted to determine the incidence of neonatal jaundice and associated factors. A significantly more severe degree of hyperbilirubinaemia was present in infants whose ABO blood group was incompatible with that of their mothers and those who were deficient in the enzyme glucose‐6‐phosphate dehydrogenase (G6PD). Among the remainder, clinical jaundice was present in 87% and 23.9% had a peak serum bilirubin (SB) concentration greater than 204 mol/l. Factors that were found to have an association with a higher peak SB concentration included: male infants; elder siblings who had a history of neonatal jaundice; and breast‐fed infants with or without supplementation with formula feed. Factors that were found to have no significant association with the peak SB concentration were: gestational age; birthweight; the mode of delivery of the infants; maternal consumption of Chinese herbs and syntocinon induction or augmentation of labour.
Petrol abuse at Elcho Island: An attempted intervention
Authors: WATSON D. S.
Published: March 2008

AbstractAn attempt to contain juvenile petrol abuse at Elcho Island in the Northern Territory of Australia is described. Ethyl mercaptan (skunk juice) was introduced as an additive to the petrol to discourage petrol sniffing. Reasons for the failure of the programme are discussed.
The children of IVF pregnancies: A cohort study
Authors: SPENSLEY J. C. , MUSHIN D. , BARREDA‐HANSON M.
Published: March 2008

Abstract A number of concerns have been publicly expressed concerning children conceived by in vitro fertilization (IVF). For this reason the first 52 infants in the Monash University IVF Programme were seen for paediatric follow‐up. Forty‐nine children completed the Programme with one child dying at 4 months and one set of twins being withdrawn from the study. Assessment was by general paediatric interview and examination. A sub‐group comprising 33 of the children and their parents received psychosocial assessment including developmental assessment. Results revealed no particular areas of concern related to the IVF conception itself. Problems found appeared to be related to the high incidence of preterm delivery (21%), twinning (21%), and Caesarean delivery (37%). The limitations of this preliminary study are noted and a longer term controlled study is planned.
A 10 year review of systemic lupus erythematosus in Singapore children
Authors: LEE B. W. , YAP H. K. , YIP W. C. L. , LOW P. S. , SAW A. H. , TAY J. S. H. , WONG H. B.
Published: March 2008

A 10 year retrospective analysis of the clinical features and survival of 24 Singapore children with systemic lupus erythematosus was made. The female to male sex ratio was 11:1. The median age at diagnosis was 9.3 years (range: 3.5–17.6 years), and the median duration of follow‐up was 3.6 years (range: 3 months ‐ 10 years). The common modes of presentation were prolonged fever and malar rash (both 46%). Renal involvement (71 %) was frequent. There were six deaths, three from chronic renal failure, two from infection, and one from carditis. The overall survival at 5 years was 0.800 (s.e.m. = 0.090), and at 10 years 0.698 (s.e.m. = 0.103). The survival for lupus nephritis was 0.727 at 5 years (s.e.m. = 0.116), and 0.586 at 10 years (s.e.m. = 0.130). Although the 5 year survival rate is comparable with other series, there were more deaths after the first 5 years, and morbidity from the disease as well as from therapy was considerable.
Effect of ipratropium bromide on respiratory mechanics in infants with acute bronchiolitis
Authors: SEIDENBERG J. , MASTERS I. B. , HUDSON I. , OLINSKY A. , PHELAN P. D.
Published: March 2008

The effect of nebulized ipratropium bromide in 14 infants (mean age:20 weeks, range:4–41) with acute respiratory syncytial virus bronchiolitis was examined. A modified rapid chest compression technique was used to obtain partial expiratory flow‐volume curves and maximum flow at functional residual capacity. Passive respiratory mechanics were assessed by brief occlusion at end inspiration. Thoracic gas volume was measured in a body plethysmograph. No significant difference was found in forced and passive respiratory mechanics pre‐ and post‐ipratropium bromide. No subgroups could be identified. These results do not support the use of ipratropium bromide in acute viral bronchiolitis.
Food intake at age 8 2. Frequency, company and place of meals
Authors: MAGAREY A. , NICHOLS J. , BOULTON J.
Published: March 2008

In a sample of 141 healthy 8 year old children, over 95% had three main meals on each of the 4 days of the food record. Two‐thirds had an afternoon snack and nearly one‐half a morning snack on each of the 4 days, but only one‐quarter had supper on each day.

Seventy‐one per cent of all meals were eaten at home with the family, 20% at school with friends, and less than 1% of meals were eaten at a restaurant or fast food outlet. These data show that amongst children of primary school age, take away sources of food make a very small contribution to the diet, and that eating habits at home are of greatest importance to the child's diet.
Neonatal jaundice in ‘healthy’ very low birthweight infants
Authors: TAN K. L.
Published: March 2008

The daily bilirubin levels during the first week of life in 94 premature very low birthweight (VLBW, < 1500g) relatively ‘healthy’ infants were determined. Mean daily bilirubin values peaked on the fourth day of life at 188.1 μmol/l (s.e.m. = 5.3). Twenty‐eight infants developed hyperbilirubinaemia (bilirubin > 260 μmol/l), at which time they were exposed to phototherapy. When individual peak bilirubin values were evaluated, the overall peak value was 213.9 μmol/l (s.e.m. = 5.1) occurring at 4.81 days (s.e.m. = 0.11), although the value is most likely an underestimate, since the 28 pre‐phototherapy values were not truly peak values. Seventy‐six (81%) infants experienced bilirubin levels > 170 μmol/l. The method of delivery apparently had no impact on the bilirubin levels.

All the infants remained well and progressed satisfactorily.‘Healthy’ VLBW infants experience a much greater incidence and severity of neonatal jaundice than mature infants with the same clinical status.
The neonatal recognition of partial 11q trisomy (previously ‘Trisomy 22′)
Authors: PATTEMORE P. K. , SHAW R. L , GUNN T. R.
Published: March 2008

The recognition of chromosomal abnormalities in the neonatal period is important. Paediatricians should be aware that the partial Trisomy 22’(now partial 11 q trisomy) syndrome has a recognizable phenotypic expression and is relatively common. The distinctive fades with a long philtrum, micrognathia, beaked nose and deft palate, associated with hypotonia and other congenital abnormalities, should make early postnatal diagnosis possible so that parental counselling can be given without delay.
Attitudes of Australian neonatal paediatricians to the treatment of extremely preterm infants
Authors: GARIS C. DE , KUHSE H. , SINGER P. , YU V. Y. H.
Published: March 2008

A questionnaire survey was carried out to identify areas of consensus or disagreement in the attitudes and practices of Australian neonatal paediatricians with regard to the treatment of extremely preterm infants. Considerable variation was found in the estimated chances of survival and disability among respondents. The majority of neonatal paediatricians advocated prompt resuscitation and initiation of neonatal intensive care at birth, although all believed life‐support treatment should be withdrawn in those instances where medical complications develop resulting in near certainty of death or life with total incapacity. The predominant view was for parents to be involved in the decision‐making process for withdrawal of life‐support and for the neonatal intensive care policy to be made known to the parents. Information from this survey which raised concerns included the variability in the estimate of the potential for survival, the lack of relevance of the law to everyday practices in the neonatal intensive care units, the small minority of respondents who felt that life‐and‐death decisions should be made by medical staff alone, and the reluctance of some neonatal paediatricians to inform parents about the policies of their unit.
Pattern of glomerulonephritis in Chinese population: The effect of renal biopsy on the therapeutic decision
Authors: LAI K. N. , LAI F. M. , CHAN K. W. , AU T. C. , TAM A. , LEUNG N. K.
Published: March 2008

A retrospective analysis of 190 consecutive renal biopsies was undertaken to assess the pattern of glomerulonephritis in Chinese, and the role of renal biopsy in paediatric nephrology. Minimal change nephropathy, IgA nephropathy and membranous nephropathy comprised 41%, 16% and 13% of primary glomerular diseases, respectively. Minimal change nephropathy accounted for only 61% of patients with idiopathic nephrotic syndrome. In 76 patients the provisional clinicopathological diagnosis was shown to be incorrect or uncertain, and correct diagnosis was made solely on histologtcal examination. In 47 cases a substantial change in therapy occurred on the basis of biopsy results. These data suggest that the practice of renal biopsy in paediatric nephrology performed appropriately in carefully selected patients is a useful procedure.
The contribution of the paediatrician and psychiatrist to the management of the child, adolescent and his family — A paediatrician's viewpoint
Authors: MENAHEM S.
Published: March 2008

An overview highlighting the important contribution of the paediatrician to the psychological care of his patients and their families is presented. He is expected to be competent in his role of diagnosing and managing the physical disorders of his patients; in addition, the complete paediatrician needs to acquire skills in assessing and treating primary developmental and behavioural disorders, and in preventing and managing secondary emotional difficulties which may arise because of minor or major physical illness.

The paediatrician may work in collaboration with the psychiatrist in managing children with psychosomatic disorders, and refer directly to the psychiatrist those children with psychoses and conduct disorders. For the rest, especially those who present with somatic symptomatology without organic findings, the psychologically minded paediatrician needs to understand the symptom and the child within the context of his family. Such an understanding may enable the paediatrician to treat the child himself or alternatively prepare his patient for a psychiatric referral, if appropriate.

Issues of training of the paediatrician in the acquisition of these listening skills are discussed, emphasizing the additional need for self‐directed independent learning. The important preventive role of the paediatrician is emphasized.
Children's understanding of cystic fibrosis
Authors: HARBORD M. G. , CROSS D. G. , BOTICA F. , MARTIN A. J.
Published: March 2008

Sixty‐one children aged 4–18 years with cystic fibrosis were interviewed about their understanding of the illness and their attitude towards it. Responses were compared across three age groups: 4–6 years, 7–11 years and 12–18 years, corresponding to Piagetian stages of cognitive development. While there was an obvious progression in knowledge with advancing age, the children's attitude to their illness and therapy varied remarkably between age groups. Those in the 4–6 year group were more positive about themselves and about the effect of therapy than those in the older groups. More than half knew that they were bom with the illness, in contrast to published reports of healthy children's concepts of illness causation for this age group. Children in the 7–11 year group were least likely to feel better after therapy and were least likely to mention anything positive about having cystic fibrosis, despite having a higher mean Schwachman clinical score than those in the oldest group.
Control of nephroblastoma: Associated hypertension and polydipsia by captopril
Authors: SUTHERS G. K. , ROY L. P. , STEVENS M.
Published: March 2008

A child with nephroblastoma, severe hypertension, polydipsia, and polyuria is presented. Previous reports of this association describe great difficulty in controlling the hypertension by medical means. Captopril provided prompt and continuing control of this child's hypertension and allowed for optimal preparation prior to surgery.
Neonatal hypertrophic cardiomyopathy: A case report and family study
Authors: WEINTRAUB R. G. , SWINBURN M. J. , LEE L.
Published: March 2008

An infant of a diabetic mother is described with severe neonatal hypertrophic obstructive cardiomyopathy. Commencement of regular intravenous propranolol was associated with marked clinical improvement. Long‐term oral propranolol was continued and at 12 months of age there was complete resolution of the cardiomyopathy.

Familial hypertrophic cardiomyopathy hypertrophy was present in two other generations of this family. The results of family screening and tissue typing are presented, with the suggestion that tissue typing may be a useful tool in the assessment of doubtful cases in certain affected families.
Wilms' tumour with acquired von Willebrand's disease
Authors: HAN P. , LOU J. , WONG H. B.
Published: March 2008

A young infant with Wilms' tumour was found to have acquired von Willebrand's syndrome but no bleeding symptoms. Neither parent of the infant had evidence of von Willebrand's syndrome. Postoperatively, after removal of the tumour, factor VIII complex levels returned to normal. The mechanism of the acquired von Willebrand's syndrome was unclear. No evidence was found of an inhibitor of factor VIII complex or entrapment of factor VIII in the tumour.
Parenteral absorption of insulin from the lung in diabetic children
Authors: ELLIOTT R. B. , EDGAR B. W. , PILCHER C. C. , QUESTED C. , McMASTER J.
Published: March 2008

Semi‐synthetic human insulin was delivered via a novel nebulizer to the respiratory tracts of six diabetic children. Blood glucose control obtained was at least as good as a control day when they received their usual dose of subcutaneous insulin.
Temporal clustering of transient erythroblastopenia (cytopenia) of childhoood
Authors: BERESFORD C. H. , MACFARLANE S. D.
Published: March 2008

A temporal cluster of four cases of transient childhood erythroblastopenia is described. In all cases there was an associated transient neutropenia and in one case a transient mild thrombocytopenia. In all cases reticulo‐endothelial iron overload was a prominent feature but there was no evidence of a pre‐existing chronic haemolytic state. All children made a full recovery with only supportive treatment, although in three cases blood transfusion was necessary.
Hypereosinophilia syndrome with pneumonia in acute lymphoblastic leukaemia
Authors: TAN AH MOY , DOWNIE P. J. , EKERT H.
Published: March 2008

Eosinophilic pneumonia in association with acute lymphoblastic leukaemia (ALL) is very rare. A teenage boy is described with eosinophilic pneumonia which preceded by several months the onset of ALL. Prior to establishment of the diagnosis he had been treated with corticosteroids with a transient response only. This delayed his final diagnosis until there were haematologic features of leukaemia. The teukaemic blasts were cALLA (CD10) positive and had a normal chromosome number with no translocations on banding studies. The pneumonia remitted rapidly when his leukaemia responded to chemotherapy.
Uptake of 99mTc Pertechnetate in a partial volvulus of the proximal jejunal loop
Authors: JOST G. M. , FOWLER R. , ANDREWS J. T. , LICHTENSTEIN M.
Published: March 2008

High uptake of Technetium‐99m Pertechnetate (99mTcO4) in situations unrelated to the presence of acid‐secreting gastric cells has attracted recent attention. A 10 year old white girl, investigated for the possible presence of a Meckel's diverticulum, was found to have a partial volvulus of the proximal jejunal loop that exhibited intense localization of Technetium‐99rn Pertechnetate.
Hypoplastic lungs and abnormal phospholipids in asphyxiating thoracic dystrophy
Authors: FORREST P. , HARKES A. , D'SOUZA S. W.
Published: March 2008

Abstract The respiratory impairment of asphyxiating thoracic dystrophy previously has been attributed to slower growth of the ribs which reduces chest size and limits chest expansion during breathing. Two siblings with this condition are described. One was found to have an abnormally low crying vital capacity; in the other the peak flow rate was reduced markedly. Chest X‐rays and ventilation‐perfusion nuclear scans were suggestive of hypoplastic lungs. Nasopharyngeal aspirates of airway secretions were found to contain significantly less total phospholipids and differences in phospholipid composition in comparison with a normal control group. These findings raise the possibility that the lungs are hypoplastic and have an abnormal phospholipid content in asphyxiating thoracic dystrophy.
Setting up a clinical audit of paediatric morbidity in Hong Kong: Some early experiences
Authors: LEUNG D.T.Y. , TSENG R.Y.M. , DAVIES D.P.
Published: March 2008

Abstract A method of clinical audit was devised to document paediatric morbidity patterns at the Prince of Wales Hospital, a new 1428 bed general hospital serving the eastern part of the Hong Kong New Territories (with a current population of about 750 000). The applicability of the method is illustrated by considering morbidity in 1654 children aged from 1 month to 12 years admitted to the hospital over a 13 month period in 1984–85.
Peptic ulceration in leukaemia
Authors: SCOTT B. , HUTSON J. M.
Published: March 2008

Abstract Two children with leukaemia are described who successfully underwent oversewing of perforated duodenal ulcers which probably were secondary to immunosuppression and steroid therapy. This is only the second report of ulceration in childhood leukaemia. Stress ulceration in children responds favourably to conservative surgery and removal of the insult. Ulcer prophylaxis with antacids or Cimetidine Should be initiated in patients being subjected to combined immunosuppression and high‐dose steroids, particularly during bone marrow transplantation.
Vietnamese child health in a Hong Kong closed camp
Authors: SAMUDA G. M. , CHAN S. P. , YEUNG C. Y.
Published: March 2008

Vietnamese refugees arriving in Hong Kong since 1982 have been confined to restricted areas. In this study, 241 children in one of these areas were screened to identify their health status. Using NCHS standards, 48% were found to be below the fifth percentile for both weight‐for‐age and height‐for‐age. Anaemia was found in 8% and hepatitis B antigenaemia in 25%. Intestinal parasites were identified in 62% of faecal specimens and 26% of these contained more than one parasite. Although all children had received BCG, 41% had a negative PPD skin test. Chronic bacterial skin infections, lice and otitis media with perforation were identified as other common problems. Screening of this population revealed a high prevalence of health problems, some of which would respond to appropriate public health measures.
Long‐term study on T lymphocyte subsets in newly diagnosed type 1 diabetes mellitus
Authors: CHIARELLI F. , BLASETTI A. , VERROTTI A. , ANICHINI M. , MORGESE G.
Published: March 2008

T lymphocyte subsets in peripheral blood from 16 newly diagnosed type 1 diabetic children were studied prospectively at four time intervals: as soon as possible after diagnosis and 1, 4 and 12 months later. T lymphocyte subsets were analysed using monoclonal antibodies and counted by cytofluorimetry. The percentage of T lymphocytes (OKT3+ cells) did not change at the four study times. The percentage of helper/inducer T cells (OKT4+ cells) was high at the diagnosis (43.1 ± 2.1%), but decreased after 1 and 4 months with no difference in the control values. The percentage of suppressor/cytotoxic T lymphocytes (OKT8+ cells) was low at the diagnosis, but increased after 1 and 4 months. The OKT4/OKT8 ratio was 2.31 ± 0.22 at the diagnosis study, decreasing to 1.83 after 1 month, compared with 16 sex‐ and age‐matched control children. The high percentage of helper/inducer T lymphocytes and low number of suppressor/cytotoxic T cells at onset of diabetes favour immune reactions that lead to β‐cell damage.
The selenium status of children with phenylketonuria: Results of selenium supplementation
Authors: LIPSON A. , MASTERS H. , O'HALLORAN M. , THOMPSON S. , COVENEY J. , YU J.
Published: March 2008

The selenium status of children with phenylketonuria on a synthetic low phenylalanine diet was assessed. Correlation between blood selenium and red cell glutathione peroxidase was unsatisfactory (r= 0.65) due to the poor discrimination of red cell glutathione peroxidase with a low selenium diet. No symptoms of deficiency were observed. Supplementation with 50 μg per week of selenium as brewers yeast tablets over a period of 6 months significantly increased the blood selenium of the phenylketonuric children. Plasma Vitamin E levels were within normal limits. The supplementation effectively doubled their selenium intake to 15–17 μg per day, which is probably sufficient for this group with an adequate Vitamin E status, though considerably lower than the recommended minimum intake of 50 μg per day.
A better guideline on milk requirements for babies below 6 months
Authors: LEUNG S. S. F. , LUI S. , LO L. , DAVIES D. P.
Published: March 2008

The volume of infant formula required for babies below the age of 6 months continues to pose problems both for parents and child health care workers. To investigate this, about 150 bottle‐fed babies were studied every 2 months from birth for their milk intake and weight gain. They were fed on demand with full strength infant formula and weaning was started at about 4 months. Weight gain was normal, with growth patterns comparable to Cambridge babies. The mean (s.d.) daily milk volumes in millilitres consumed were: 582 (144), 847 (163), 851 (176), 812 (219) at 7 days, 2, 4 and 6 months, respectively. With such a wide range of milk intake at each age, it would be inappropriate and misleading to provide a single mean recommended volume. Thus, percentile values are suggested as a better guideline for recommended intake. Estimation was made for the volume of milk required if milk was the sole source of energy for the first 6 months.
A case of cardiovascular collapse due to adrenal insufficiency
Authors: WALKER C. , BUTT W.
Published: March 2008

A 6 year old boy presented with cardiogenic shock following a mild gastroenteritis‐like illness. He was subsequently found to have adrenal failure secondary to adrenoleucodystrophy. Despite adequate corticosteroid replacement and intensive cardiorespiratory support, progressive cardiac failure occurred and the patient died. High levels of endogenous catecholamines may be toxic to the myocardium in the absence of sufficient corticosteroid.
Australian paediatricians and the new morbidity: A national survey of changing paediatric practice patterns
Authors: OBERKLAID F.
Published: March 2008

Abstract General paediatricians across Australia were surveyed to determine whether their practice reflected the commonly held assumption that paediatrics was changing, with an increased emphasis on ambulatory and community care and involvement with conditions comprising the new morbidity. A 10 page questionnaire was mailed to every paediatrician in the Australian College of Paediatrics directory of members considered to be practising general paediatrics. Of a total of 287 questionnaires distributed, 224 were returned (response rate 80.9%). Two‐thirds of respondents practised in a capital city, while the remaining third were divided equally between isolated paediatricians and those who practised in a provincial city. Only 15 paediatricians (6.8%) spent more than half their time involved in inpatient care, while 60% spent less than one‐fifth of their time with inpatients. There was no correlation between inpatient involvement and length of paediatric practice, but surprisingly there was a significant trend (P= 0.007) for paediatricians practising in a capital city to do more inpatient work. Respondents were provided with a list of eight conditions held commonly to comprise the new morbidity, and there was a strong response indicating an increase in children seen with these conditions over the past 5 years, as well as a decrease in children with clearly identifiable organic disease. Furthermore, respondents indicated in absolute terms the numbers of patients seen in the past month with each of the conditions. Results confirmed the significant numbers of children seen with conditions comprising the new morbidity, their increased presentation to paediatricians in the past 5 years and the predominance of non‐inpatient work in consultant paediatric practice in Australia.
‘Normal’disaccharidase levels in children
Authors: BARNES G. L. , FORD R. P. K. , DAWSON S. , LAWRANCE S.
Published: March 2008

Abstract Results of disaccharidase assays in small bowel biopsies from 887 children over a 3 year period were analysed to establish normal values. Abnormal histology, the presence of giardia trophozoites or total absence of sucrase and isomaltase were found in 307 cases and these were excluded from further consideration. The results for maltase, sucrase and lactase from the remaining 580 children have been graphed as percentiles at various ages. They represent results which are as close to normal as it is possible ethically to obtain.
Is admission to hospital with stridor and acute viral croup influenced by time?
Authors: DAWSON K. P.
Published: March 2008

Abstract Study of the records of 100 children admitted sequentially to hospital with viral croup suggested that they were more likely to be admitted at night than during the day when compared with other common conditions. The actual day of the week was unimportant, suggesting that medical availability was not a factor.