bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of an asthma knowledge questionnaire
Authors: FITZCLARENCE C. A. B. , HENRY R. L.
Published: March 2008

Abstract Asthma is responsible for much morbidity and mortality, which might be decreased by increasing parental and patient knowledge about asthma. This report describes the development and validation of an asthma knowledge questionnaire for use in the assessment of asthma knowledge. Two groups of respondents were examined. One group was designated ‘high knowledge’ and the other ‘low knowledge’. The questionnaire had a maximum possible score of 31. The mean score of 69 ‘high’ knowledge parents was 25.3 (median 25, range 18–31). By contrast, the mean score of 69 ‘low’ knowledge parents was 13.0 (median 13, range 0–21). The difference between the two groups was statistically significant (P < 0.0001). The questionnaire results were reproducible (r= 0.94, P < 0.01). Demographic characteristics such as education and socio‐economic status were not important confounding variables. Face and content validity of the questionnaire were based on reference to published experience. Concurrent validity was demonstrated by the ability of the questionnaire to distinguish low from high knowledge parents. The questionnaire should prove to be a valuable research tool for the assessment of asthma knowledge either as part of an educational intervention or in a clinical situation.
Injuries in the 14th and 15th years of life
Authors: LODGE J. F. , LANGLEY J. D. , BEGG D. J.
Published: March 2008

Abstract From a sample of 849 adolescents studied at age 15, 429 had been involved in 657 separate incidents, which resulted in 705 acute injuries requiring medical attention during their 14th and 15th years of life. The most common injuries were sprains, strains, fractures and lacerations, and the most common body site was the finger. The majority of injuries were of minor severity. Striking against an object or person was the most common incident resulting in injury, followed by being struck by an object or person, and ovarexertion or strenuous movement. Approximately half of the injuries were incurred during sport or a similar physical activity. Sporting injuries are examined in detail and preventive measures discussed.
Unintentional injuries to students at school
Authors: LANGLEY J. D. , CHALMERS D. , COLLINS B.
Published: March 2008

Abstract Unintentional injuries at school have been identified as a significant public health problem. A major barrier to the development of injury prevention policy has been the absence of national data on the circumstances of injuries to students which occur at school. This study sought to determine the incidence, nature, and circumstances of injuries which resulted in death or hospitalization. Fatalities were identified from national mortality data for 1977‐86 inclusive. Coroners' files were then examined to obtain details of the circumstances of injury. Hospitalization cases were identified from the national hospital discharge summary for 1986.

Fifteen fatalities were identified. The circumstances of the deaths were diverse with the most frequent event being a fall (n= 4). A total of 1013 first admissions to hospital were identified, giving an overall incidence rate of 152/100000 students/year. Injury rates declined with increasing age, and males had higher rates than females for all ages. Fractures of the upper and lower limbs and intracranial injury represented more than three‐quarters of all injury. The two leading causes of injury, falls, and incidents involving striking against or being struck by a person or object, represented 89% of all incidents. The use of playground equipment and involvement in sporting activity were two of the more common aspects of many injury events.

The results suggest that prevention policy should place emphasis on those in their first 2 years of schooling, falls from playground equipment, provision of protective equipment for sporting activities, sporting activities designed to minimize physical contact, establishment of standardized injury referral procedures, first‐aid training, and a standardized injury reporting system.
Epidemiology of playground equipment injuries resulting in hospitalization
Authors: CHALMERS D. J. , LANGLEY J. D.
Published: March 2008

Abstract Preparation of the New Zealand Playground Standard was seriously hampered by a lack of published information on the incidence, nature, and circumstances of playground equipment‐related injuries. The present study was aimed at redressing this lack of information. Examination of all discharges from New Zealand public hospitals for 1984 identified 1125 children less than 15 years of age who had been admitted for the treatment of playground equipment‐related injury. This gave an incidence rate of 137/100000 children per year. The mean age was 7.2 years. The commonest injury was fracture of the upper limb (48%), followed by intracranial injury (26%). One‐third occurred at school, climbing apparatus (40%) was most often involved, and the great majority involved falls (93%). With this study it has been possible for the first time in any country to report an incidence rate for all causes of playground equipment‐related injuries resulting in hospitalization, based on data for an entire population. The findings support the emphasis placed on falls in the Standard.
Mechanical ventilation of paediatric patients with asthma: Short and long term outcome
Authors: SHUGG A. W. , KERR S. , BUTT W. W.
Published: March 2008

Abstract In the 7 years from 1982 to 1988, 10639 children with acute asthma were admitted to the Royal Children's Hospital, Melbourne. Of these, 262 children (2%) were treated in the Intensive Care Unit. Twenty‐seven required mechanical ventilation on 34 occasions, being 0.3% of hospital asthma admissions. Five patients died, four due to brain death following respiratory arrest prior to intubation. The main complications were (i) barotrauma, which occurred in five patients on seven occasions (20%); (ii) a reversible myopathy which occurred in three patients treated with high dose corticosteroids and muscle relaxants. Follow‐up of patients ventilated in intensive care revealed that all but one of the initial survivors was alive 1–5 years later, all patients required subsequent readmission to hospital for treatment of acute asthma and 78% had persistent rather than episodic asthma. Although uncommon, an episode of ventilation has a major impact on the family's understanding and future management of acute asthma.
The spectral analysis of cough sounds in childhood respiratory illness
Authors: DAWSON K. P. , THORPE C. W. , TOOP L. J.
Published: March 2008

Cough is the commonest symptom of childhood respiratory disease and at times may be the predominant feature. The characteristic sound of the cough is often considered by the clinician as a useful diagnostic feature in such conditions as croup and whooping cough. This has prompted a closer study of the physical basis of the cough sounds and their relationship to the pathological processes in the airway.1 Keleman et al.2 have demonstrated that there are at least three phases to any particular cough, that is, an initial burst due to air turbulence and tissue vibration, followed by a noisy phase, and the final vocalic burst as the glottis forcefully cuts off the air flow. These studies have led to the development of computer assisted methods of evaluation of cough.3 In turn, sound spectral analysis techniques, which have been used extensively to study lung sounds in asthma,4 have been applied to cough sounds.5,6 A microcomputer‐based system which allows rapid performance of such analyses has been devised and described recently.6
Antinuclear antibodies using HEp‐2 cells in normal children and in children with common infections
Authors: ALLEN R. C. , DEWEZ P. , STUART L. , GATENBY P. A. , STURGESS A.
Published: March 2008

Antinuclear antibody (ANA) immunofluorescence tests, using HEp‐2 cells, were performed on 100 children without a history of connective tissue disease. Eighteen (18%) were positive at titres < 1:40, nine (9%) being greater than 1:160. Interlaboratory variability was demonstrated with some specimens. No association with possible intercurrent infection was found to account for positive results. Of 44 children with proven infections five (11%) were positive. Antinuclear antibody may be found in some normal children when using the sensitive HEp‐2 cell substrate, and in the absence of clinical features should not necessarily suggest the presence of a connective tissue disease.
Assessment of cardiac function by M‐mode echocardiography in selenium‐deficient phenylketonuric children
Authors: GORDON S. J. , LATHAM S. C. , SPINK J. D. , GALBRAITH A. J.
Published: March 2008

Selenium (Se) deficiency is associated with cardiac and skeletal muscle dysfunction. Twenty well children aged 2‐16 years (10 male) attending the Phenylketonuria (PKU) Clinic at the Royal Children's Hospital, Brisbane, had low Se levels (mean 0.29±0.02 s.e.m. μmol/L; normal range 0.56‐1.16 μmol/L). Their myocardial function was assessed at rest and after exercise provocation by M‐mode echocardiography in order to exclude occult left ventricular dysfunction. At rest, fractional shortening (FS) was normal (mean 38.1±1.1 s.e.m.%, n= 20). After exercise, FS increased significantly (P <0.001) from 37.6±1.4% to 44.3±1.2%, n= 12). This was associated with a significant rise (P <0.001) in heart rate (HR) from 77.3±3.1 beats/min to 125.8±5.2 beats/min (n= 12). The normal resting FS and normal increase in FS and HR with exercise is evidence against significant cardiac impairment in this group of Se‐deficient children.
What do medical students know about childhood asthma?
Authors: FITZCLARENCE C. A. B. , HENRY R. L.
Published: March 2008

A questionnaire designed to measure knowledge about childhood asthma was completed by 216 of the 311 (69%) undergraduate medical students at the University of Newcastle. First year students had a mean score of 16.2 (maximum possible score was 31) which was similar to the background community score of 13.0 obtained in a group of parents with no close contact with asthma. Knowledge about asthma increased over each of the 5 years of the medical course. Final‐year students had a mean score of 28.7 (range: 25‐31) which was similar to a group of parents thought by their paediatricians to have a high level of knowledge about asthma (mean: 25.3, range: 18‐31).

The progression of knowledge over the 5 years of the course provided interesting information about the learning process. Although second year students completed the questionnaire after a term devoted to coursework in respiratory medicine, only 26% were able to name two preventive agents and 21% named three agents useful during acute attacks of asthma. Third year students gave correct responses in 39 and 45% of cases, respectively, and the correct response rates rose to 78 and 97% in the fifth year. This was probably because the theoretical knowledge needed to be acquired and tested against a clinical scenario before it could be used.

The study demonstrated an increase in knowledge about asthma throughout the problem‐based medical course. In addition to providing information about the educational process, it provided information about the questionnaire which was able to measure a range of knowledge and not just extremes of asthma knowledge.
The amniotic band syndrome
Authors: KNOWLES S.
Published: March 2008

Paediatricians, ophthalmologists, plastic and orthopaedic surgeons, pathologists and other dysmorphological fringe‐dwellers should all be familiar with the amniotic band syndrome, even if they call it by another name—amniotic bands, constriction rings, Streeter syndrome, amniotic‐deformity‐adhesions–mutilations (ADAM) complex, amongst many.
Depression in mothers and behaviour problems with their preschool children
Authors: WILLIAMS H. , CARMICHAEL A.
Published: March 2008

A follow‐up study of 224 families of a birth cohort of 272 families in a multi‐ethnic poor socio‐economic municipality in Melbourne when the children were 4 years old showed that 27% of the mothers were depressed. There was no difference in the depression rate between Australian‐born and immigrant mothers, a finding in marked contrast to the first year of the study when the depression rate was significantly higher in those immigrant mothers who had been in Australia for less than 3 years, were unable to speak English and who did not have an extended family or close friends. Depression in this group of mothers was attributed to resettlement problems, which over a period of three years had ameliorated.

At 4 years the most important factor associated with depression in both Australian‐born and immigrant mothers was the quality of marital relationships. Lack of an intimate support relationship made mothers more vulnerable to the stresses of child care and rearing, home‐making and life events. In Australian‐born mothers only, another significant factor in vulnerability to depression, was their early childhood experiences of being reared in a disruptive home or in an institution and of being unwanted. In immigrant mothers, but not in Australian‐born mothers, life events were significantly correlated with depression.

The depressed mothers, both Australian‐born and immigrant, perceived their 4 year old children to have significantly more behavioural problems than mothers who were not depressed.
Methadone levels and neonatal withdrawal
Authors: MACK G. , THOMAS D. , GILES W. , BUCHANAN N.
Published: March 2008

The purpose of this study was to observe the effects of methadone exposure in utero, with special reference to maternal and neonatal methadone concentrations and neonatal withdrawal. Two groups of mother‐infant pairs were studied. In the first group, serum methadone concentrations were determined in infants at 1, 6 and 24 h after delivery. In the second group, blood was obtained at 24, 48, 72 and 96 h after birth. There was no correlation between neonatal serum levels and the intensity of withdrawal symptoms. There was no relationship between maternal methadone dose at delivery or maternal serum levels and neonatal methadone levels. The results of this study may be complicated by the prenatal exposure of the neonates to other drugs of abuse apart from methadone.
Progressive hearing loss in children with congenital cytomegalovirus
Authors: HICKSON L. M. H. , ALCOCK D.
Published: March 2008

Case studies of five children with congenital cytomegalovirus (CMV) who were referred for audiological evaluation are presented. Significant deterioration of hearing was noted in all cases within the first 4 years of life. It is essential that neonates with congenital CMV be referred for hearing assessment and that the child's hearing be monitored on a long‐term basis. Early intervention is vital for the speech and language development of hearing‐impaired child.
Duration of hospitalization in extremely preterm infants
Authors: YU V. Y. H. , SHAH V. , GOMEZ J. M. , McCLOUD P. I.
Published: March 2008

This study reports the age at hospital discharge of 233 survivors and age at death of 209 infants who were born at 23‐28 weeks gestation over a 10 year period, 1977‐86. The mean duration of hospitalization of survivors was 95 days and was inversely related to maturity at birth; those born at 23‐25 weeks remained in hospital on average 1‐2 weeks beyond term while those born at 26‐28 weeks went home on average at term or 1 week before term. The mean age at death was 12 days: 53% within 1 day, 23% between 2 and 7 days, 15% between 8 and 28 days and 9% between 28 days and 1 year. The proportions of death in the post‐neonatal period for infants born at 23‐24 weeks, 25‐26 weeks and 27‐28 weeks were 2, 9 and 16% respectively. There was no significant trend in prolonged hospitalization of survivors or postponement of neonatal deaths to the post‐neonatal period over the 1977‐86 period. Nevertheless, both neonatal and post‐neonatal mortality should continually be monitored in this extremely preterm group.
Hepatitis A and B infections in transfusion‐dependent thalassaemia from endemic areas
Authors: LI A. M. C. , CHANG W. K.
Published: March 2008

Abstract The aim of this study was to determine the prevalence of previous hepatitis A virus (HAV) and B virus (HBV) infection which is in 64 transfusion‐dependent (TD) patients with thalassaemia including 26 patients who were transfused before blood donors were screened for HBV. Serial blood samples taken from these 64 patients and 10 non‐TD β‐thalassaemia intermedia patients during a 3 year period, were tested for antibody to HAV (anti‐HAV), hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti‐HBs), antibody to core antigen (anti‐HBc) and when indicated, antibody to Delta virus (anti‐Delta) and HBV DNA. Liver function tests were performed also. Similar tests were conducted on 50 donor blood units. None of the 64 TD patients had evidence of past HAV infection but 50% of blood donors had evidence of past infection (P <0.001). Only 2 brothers and their mother were positive for HBsAg, and 38 patients (59.4%) had persisting HBV antibodies compared with 26% of blood donors (P <0.001). Our TD thalassaemic patients acquired passive immunity from donor plasma, which protected them against HAV and possibly modified the outcome of HBV infection.
Suppression of adrenal function in children on inhaled steroids
Authors: CHANG C. C. C. , TAM A. Y. C.
Published: March 2008

Abstract Inhaled steroid therapy is one of the mainstays of treatment of asthma in children. Side effects, including suppression of the hypothalamic‐pituitary‐adrenal (HPA) axis, have been noted with high doses of inhaled steroids. Most studies concerning side effects have been done with mechanical nebulization devices or hand‐held metered‐dose inhalers. The present study attempts to ascertain if dry powder inhalation of beclomethasone diproprionate is associated with any significant suppression of the HPA axis. Fifteen children (10 male and 5 female) between the ages of 4 and 14 years were followed for several years in our outpatient department. They were on inhaled beclomethasone diproprionate at dosages ranging from 6.9 to 25 μg/kg per day for 4‐24 months. The short adrenocorticotrophic hormone (ACTH) test was used to evaluate function of the HPA axis. Mild suppression of the HPA axis was noted in one of the cases. The study therefore concludes that at therapeutic doses of dry powder beclomethasone diproprionate, suppression of the HPA axis can occur. However, the extent of this complication does not appear to be greater than with hand‐held or mechanical nebulization devices.
An analysis of trends in the incidence of sudden infant death in The Netherlands 1969–89
Authors: ENGELBERTS A. C. , de JONGE G. A. , KOSTENSE P. J.
Published: March 2008

There is considerable interest in the relationship between sleeping position and the occurrence of sudden infant death syndrome (SIDS). As changes have been reported in The Netherlands in the position infants have been placed to sleep, the national Dutch sudden infant death rates were analysed over the time that such changes have taken place.

The overall post‐perinatal death rate (1 week <1 year) was around 4‐4.5 per 1000 live births from 1969 until 1985. From 1985 until 1989 the rate fell from 4.1 to 2.9 per 1000 live births. During the same period the cot death/SIDS rate rose from 0.44 per 1000 in 1969 to between 1.08 and 1.31 per 1000 in 1977‐87, and subsequently fell to 0.7 per 1000 in 1989. These trends coincided with changes in prone sleeping position demonstrated in national surveys.

The problems of interpreting such national data, with only 50‐60% of infant deaths being autopsied and with the possibilities of misclassification over time, are fully discussed. The data are supportive of the relationship between prone sleeping position and cot death.
An overview of retrospective case‐control studies investigating the relationship between prone sleeping position and SIDS
Authors: BEAL S. M. , FINCH C. F.
Published: March 2008

A critical overview of 19 case‐control studies that have investigated the relationship between prone sleeping position and sudden infant death syndrome (SIDS) is presented. Issues relating to the non‐comparability of the studies are described in terms of: (i) case definition; (ii) selection of controls; (iii) quality of the sleeping position data; (iv) recall bias; and (v) adjustment for confounding factors. All studies showed a positive association (2 out of the 19 studies were not significant) between prone sleeping position and SIDS. Meta‐analysis techniques applied to six of these studies, based on ‘usual’ sleeping position in cases and population representative controls, has confirmed an overall higher risk of SIDS in infants who usually sleep prone. The most common odds ratio for an association between prone sleeping position and SIDS was 2.72 (95% confidence interval 2.27‐3.26). The extent to which the methodological problems of retrospective case‐control studies interfere with our interpretations of this association are discussed.
Prone sleeping position and SIDS: Evidence from recent case‐control and cohort studies in Tasmania
Authors: DWYER T. , PONSONBY A‐L. , GIBBONS L. E. , NEWMAN N. M.
Published: March 2008

The most recent data from the cohort and case‐control studies of SIDS and prone position recently reported from Tasmania are reviewed. The cohort analysis was based on 4103 infants born between 1 January 1988 and 1 December 1990 assessed as being at high risk at birth, of whom 29 later died of SIDS. A matched analysis which controlled for infant birthweight and maternal age indicated that prone sleeping position was associated with an increased risk of SIDS (OR 3.92, 95% Cl [1.37‐11.24]). The case‐control study was based on all (n= 55) Tasmanian SIDS deaths from October 1989 to April 1991 and matched live controls. The unadjusted odds ratio for prone position and SIDS was 5.04 (95% Cl [2.29‐11.11]). The population attributable risk percentage, based on the high risk cohort data, was 0.38 (95% Cl [0.35‐0.41]), suggesting that a significant reduction in SIDS incidence might occur if the prevalence of the prone sleeping position in the infant population were reduced. Other factors which may be important for the development of any public health interventions to reduce SIDS based on these findings are discussed.
Resource allocation in contemporary paediatrics: The case against high technology
Authors: VIMPANI G. V.
Published: March 2008

High technology has introduced a new dimension to medical treatment. There are inevitable social costs as well as benefits, and the allocation of resources to high technology, as opposed to other areas of health care, is a contentious issue. The current balance in health service funding between high technology and low technology is not appropriate. It is driven by the technological imperative and only offers solutions to a limited number of problems. There is a scarcity of health resources left to develop intersectoral responses and provide adequate funding for research into person‐intensive interventions suitable for many problems. Arguments against allocating too many resources to high technology in paediatrics are examined in this paper.
Intravenous Indomethacin therapy in preterm neonates with patent ductus arteriosus
Authors: RAJADURAI V. S. , YU V. Y. H.
Published: March 2008

This study examined the response of the patent ductus arteriosus (PDA) to intravenous Indomethacin using serial two dimensional and Doppler echocardiography and documented the complications associated with therapy. Thirty‐six preterm neonates who were oxygen and ventilator dependent were studied when they were aged 3‐7 days. The PDA initially closed in 22 (61%) and constricted in seven (19%) of the infants. It was non‐responsive in five (14%) and the treatment was stopped because of complications in two (6%). Only three (43%) of seven neonates given a second course had PDA closure. In the 25 instances where there was PDA closure following Indomethacin, re‐opening was documented echocardiographically on three (12%) occasions. Overall, Indomethacin therapy was successful in 29 (81%) neonates, PDA ligation was required in four (11%) and three died from unrelated causes. Three (8%) neonates developed major complications: multiple gastric perforations in the first, focal ileal perforation in the second, and necrotizing enterocolitis in the third. Treatment failure. PDA ligation and major complications occurred exclusively in neonates <28 weeks gestation. In view of the relatively low efficacy and high major complication rate in these extremely preterm infants, a randomized clinical trial needs to be conducted using two dimensional and Doppler echocardiography to allow accurate assessment of the PDA response to intravenous Indomethacin.
Glucose‐6‐phosphate dehydrogenase enzyme activity in normal, hemizygote and heterozygote Kelantanese Malays
Authors: NORMAH J. , CHOO K. E. , OPPENHEIMER S. J. , SELAMAH G.
Published: March 2008

This prospective study was performed to quantify glucose‐6‐phosphate dehydrogenase (G6PD) enzyme activity in deficient males and female heterozygotes. The methods used in the study were the fluorescent spot test, G6PD enzyme electrophoresis on cellulose acetate and quantitative assays. Forty‐seven children who had been detected as spot screen deficient at birth were rescreened. Their first degree relatives were also included in the study. The mean enzyme activity of deficient males was 0.74 iu/g Hb (s.d. ± 0.8), of female heterozygotes was 6.5 iu/g Hb (s.d. ± 3.2) and of normal males was 12.1 iu/g Hb (s.d. ± 3.5). The mean activity in deficient males was 6.1% of normal males. Most (35 of 47) of these fell into class 2 in Beutler's classification of G6PD variants. This indicates a population which may be susceptible to favism. Female heterozygotes had an intermediate enzyme activity with a wide scatter. Using a cut off point of enzyme activity of below 9.0 iu/g Hb gave sensitivity and specificity respectively of 87% and 84% in detecting female heterozygotes. This group could be defined more accurately by combining quantitative assays with family studies.
The health effects of day care
Authors: JARMAN F. C. , KOHLENBERG T. M.
Published: March 2008

Recent decades have ushered in the most substantial shifts in the composition and structure of Australian families seen in this country's history. Fertility rates have declined dramatically, from an average of 3.4 children per woman in 1960, to 1.8 children per woman in 1990. Twelve per cent of children are now raised in single parent homes, and the labour force participation of women with children has increased significantly. Thirty‐two per cent of mothers with children under 5 years of age now work outside the home, and this has resulted in a growing demand for supplemental child care.
Retinal haemorrhage in accidental head trauma in childhood
Authors: ELDER J. E. , TAYLOR R. G. , KLUG G. L.
Published: March 2008

Abstract  Twenty‐five children (age range 1.2–14.5 years) who sustained accidental head injury requiring admission to hospital were prospectively examined for evidence of retinal haemorrhage. In no case were retinal haemorrhages detected. It is suggested that accidental head injury seldom results in retinal haemorrhage and that the finding of retinal haemorrhage in a child with a head injury should prompt suspicion of abuse.
The relationship between children's treatment‐related behaviour problems, age and clinical status in cystic fibrosis
Authors: SANDERS M. R. , GRAVESTOCK F. M. , WANSTALL K. , DUNNE M.
Published: March 2008

Abstract  This study examined the relationship between parents' and physicians' reports of treatment‐related behaviour and adjustment problems of children with cystic fibrosis (CF), and children's clinical status as assessed by measures of pulmonary functioning and global ratings of clinical status. Parents completed a Cystic Fibrosis Problem Checklist which measures the extent to which children experience behaviour and adjustment difficulties with different aspects of treatment, including chest physiotherapy, medication taking and diet. A high proportion of parents in each age group reported at least some treatment‐related behaviour difficulties, with significantly more problems being reported with younger children. There was no significant relationship, however, between the child's age, sex and clinicians' ratings of compliance. A stepwise multiple regression showed that the only variables which significantly predicted clinicians' ratings of the severity of the child's disease were forced expired volume and height. Clinicians' ratings of compliance explained a small amount of extra variance (2.4%). It was found that parental reports of treatment‐related behaviour problems were not related to clinical status. The implications of the findings for clinical practice are discussed.
Birth asphyxia associated oliguria: Relationship to outcome at 1 year
Authors: BOURCHIER D.
Published: March 2008

Abstract  The relationship between the degree of oliguria following severe birth asphyxia and outcome at 12 months was examined in 31 infants. All 31 infants developed encephalopathy following severe birth asphyxia and 25 had oliguria for 24 h or more following delivery. Eighteen had persistent oliguria (i.e. >48 h) and the remaining seven had transient oliguria (between 24 and 48 h). Poor outcome (death or neurological abnormality at 12 months) was significantly associated with the degree of oliguria. Encephalopathy, however, was found to be more closely correlated with poor outcome rather than duration of oliguria and a stepwise regression model confirmed that encephalopathy was the more powerful predictor of poor outcome. In those situations where an infant's degree of encephalopathy can not be assessed accurately (e.g. muscle relaxant use) the duration of oliguria may prove a useful prognostic indicator.
Effects of social interaction on distress and recovery from minor surgery in elective paediatric patients
Authors: FIELDING R. , TAM F. S. H. , SAING H.
Published: March 2008

Abstract Thirty‐six children aged 2–10 years, the majority of whom were males admitted for urogenital surgery, were observed for level and frequency of distress and type of social interaction over the duration of hospitalization. The results indicate that high levels of observed distress were associated with longer post‐operative hospital stays. Staff interactions were associated with higher levels of distress while peer caretaking interactions were associated with lower levels of distress. We tested the hypothesis that social interaction lowered distress, leading to a briefer hospital stay. Using path analysis, we found peer caretaking interactions accounted for a small but significant percentage of the observed variance in duration of post‐operative hospital stay. These data illustrate the potential importance of social environments in the maintenance or reduction of distress before and after paediatric surgery. This raises the expectation that certain types of social environments could facilitate recovery from surgery.
The cost and availability of devices for preventing childhood injuries
Authors: PAUL C. L. , REDMAN S. , EVANS D.
Published: March 2008

Abstract Accidental injury is the major cause of death among Australian children. Many childhood injuries are preventable through the use of safety devices such as those recommended by the Child Accident Prevention Foundation of Australia (CAPFA). It has been suggested that poor availability and the high cost of obtaining and installing safety devices may contribute to their low rates of use among families with young children. This paper assesses the availability and cost of recommended safety devices in a medium sized city in Australia. Of the 17 devices recommended by the CAPFA only 10 were readily available in Newcastle. The cost of purchasing and installing all the devices recommended by CAPFA amounted to $1516, or 21.4% of the annual disposable income, after the purchase of necessities, of families with children and 75.5% of the annual disposable income, after purchase of necessities, of single parents. It is argued that the cost of safety devices may be prohibitively expensive, particularly for those most at risk of suffering from injury.
Epidemiology of non‐intentional injuries in an Australian urban region: Results from injury surveillance
Authors: NOLAN T. , PENNY M.
Published: March 2008

Abstract Injury surveillance provides an opportunity to determine non‐intentional injury rates for those injuries which are treated in hospital accident and emergency departments. The first full calendar year of injury surveillance in north‐western greater Melbourne was used to calculate incidence rates of a wide range of injury types and causes for 1989. In a population at risk estimated to number 150604 children aged 0–14 years, the all‐cause injury mortality was 10.6/100000 per year (95% confidence interval [Cl], 5.4–15.8). There were 8207 attendances by children from the denominator area for non‐intentional injury at the three hospitals participating in surveillance, representing rates of 6437/100000 per year (95% Cl, 6258–6616) and 4406/100000 per year (95% Cl, 4254–4558) for boys and girls respectively, while the rates for admission to hospital were 957/100000 per year (95% Cl, 888–1025) and 649/100000 per year (95% Cl, 590–707). The leading causes of hospital attendance were related to injuries involving sports, play equipment, bicycles and poisoning. These rates are substantially lower than those reported from other countries. The possible reasons for this include differences in health care utilization, under‐ascertainment of cases, and a real difference in injury risk. Injury Surveillance Information System codes are defined for a standard set of injuries and injury causes which may be used for future comparative studies. Problems related to assessing the reliability of injury ascertainment are discussed, and the importance of integrating injury surveillance into routine hospital information systems is emphasized.
The infant mortality rate at Cherbourg Aboriginal Community: An update
Authors: PRATT J. , MULLER M. , BLAKE T. , MUSGRAVE I. A. , ALSOP‐SHIELDS L. , DUGDALE A. E.
Published: March 2008

Abstract The infant mortality rate (IMR) at Cherbourg Aboriginal Community in south‐eastern Queensland remained high from 1906 to about 1955–60, but since then has dropped from over 200/1000 live births in 1956–60 to 16/1000 live births in 1986–90, compared with the 1987 rate for Queensland (9.2/1000) and Australia (8.6/1000). The rapid improvement in the IMR was associated with the installation of a piped and chlorinated water supply, sewerage and an intensive campaign to eradicate intestinal worms. There has also been a change in community attitudes towards routine health practices and it is likely that this has been a major factor in the changes.
Pneumothorax secondary to foreign body inhalation in a 20 month old child
Authors: WILKINSON K. A. , BECKETT W. , BROWN T. C. K.
Published: March 2008

Abstract A 20 month old child presented with acute onset of respiratory embarrassment as a result of a left‐sided tension pneumothorax. This proved to be caused by inhalation of an unusual foreign body: the hair from a rag doll.
Apparent life threatening events with serious sequelae in infants and young children
Authors: BEAL S.
Published: March 2008

ABSTRACT Between January 1982 and June 1989 in South Australia 19 infants under 2 years of age have hadserious sequelae following an apparent life threatening event (ALTE) for which no cause could be identified. Thirteen of these children have died, four survive with severe hypoxic damage, one has normal psycho‐motor development and epilepsy, and another has mental retardation and strabismus. Study of these infants suggests heterogeneity in the cause of both sudden infant death syndrome (SIDS) and ALTE, and occasional links between the two.
Clostridium botulinum and sudden infant death syndrome: A 10 year prospective study
Authors: BYARD R. W. , MOORE L. , BOURNE A. J. , LAWRENCE A. J. , GOLDWATER P. N.
Published: March 2008

ABSTRACT It has been proposed that sudden and unexpected death in infants due to intestinal infection with Clostridium botulinum may mimic the clinicopathological features of sudden infant deathsyndrome. Between 3.3 and 3.8% of infants in some series have had this neurotoxin‐producing bacterium isolated on faecal culture. Prospective screening of 248 infants presenting with the sudden infant death syndrome to the Adelaide Children's Hospital over a 10 year period from 1981to 1990 was conducted. Faecal samples were obtained from both small and large intestines and cultured specifically for C. botulinum. No samples were positive. The results of this study suggest that routine post‐mortem culture of faeces for C. botulinum has been of limited use within the South Australian infant population over the last decade, and that occult botulism has not been a significant factor in the causation of sudden death.
Physical and developmental status of preschool small‐for‐gestational‐age children: A comparative study
Authors: PRYOR J. E.
Published: March 2008

ABSTRACT This study aimed to assess the current developmental and physical status of preschool children identified from hospital records as being small‐for‐gestational‐age (SGA)at birth. Sixty‐seven children were compared with a matched group of appropriately grown (AGA) children. Mothers of SGA children were more likely to have smoked during pregnancy, to have suffered pre‐eclamptic toxaemia (PET), and to have had shorter labours than the AGA group. They were less likely to have breast‐fed their babies, and reported higher incidences of eating problems and visits' to the general practitioner. On physical and developmental parameters the AGA group was significantly ahead of the SGA group. For all subjects breast feeding was correlated with higher Stanford Binet scores, and environmental factors appeared more salient for the progress of the SGA children at this age than biological factors. The results are discussed with regard to possible amelioration of the effects of being born small for gestational age.
Stenosis of pulmonary veins in Down syndrome
Authors: STEWART A. D. , CALDER A. L. , NEUTZE J. M. , JAMES A. H. , BRANDT P. W. T.
Published: March 2008

ABSTRACT Two patients with Down syndrome, intracardiac communications and elevated pulmonary arteriolar resistance presented early in life. Both patients had significant stenosis of pulmonary veins. The progressive nature of the stenosis is illustrated in one patient. Pulmonary venous stenosis in Down syndrome has been recorded only twice before in the literature, and may play a part in the early onset of pulmonary vascular occlusive disease in some patients.
Tachyarrhythmia, cardiac rhabdomyomata and fetal hydrops in a premature infant with tuberous sclerosis
Authors: SCURRY J. , WATKINS A. , ACTON C. , DREW J.
Published: March 2008

Abstract An hydropic infant was delivered at 32 weeks gestation by emergency Caesarean section for acute polyhydramnios. A diagnosis of cardiac rhabdomyomata was made on echocardiography. The baby survived 10 days, during which time repeated episodes of supraventricular tachycardia occurred. She eventually died of cardiac failure following an episode of septicaemia, convulsions and aspiration pneumonia. Necropsy showed multiple cardiac rhabdomyomata and numerous cerebral germinal layer and periventricular white matter nodules. This case stresses the importance of clinical investigations and perinatal necropsy in non‐immune hydrops fetalis (NIHF) in determining the causes of clinical presentation and the underlying pathology.
Health problems and service use by parents of normal infants in the first 6 months of life
Authors: HORT K. P.
Published: March 2008

Abstract A retrospective descriptive study was carried out on residents of the northern Sydney health area who delivered normal, full term, singleton infants at three large maternity units. A sample population of 1199 was sent a postal questionnaire when their infants reached the age of 6 months, and a 65% response rate was obtained. Problems encountered, with ratings of severity and difficulty of management, were reported in five categories: acute and persistent or recurrent illness, daytime and night‐time behaviour problems and feeding problems. Forty‐seven per cent of parents reported at least one problem which they rated severe or very difficult to manage, and 19.7% reported two or more, particularly in the areas of behaviour and feeding difficulties. Traditional services such as those provided by general practitioners and specialists were not often helpful for these problems, while baby health services and specialized support services were more helpful. However, a significant number of respondents found no service helpful, representing an area of unmet need.
A review of chest physiotherapy in neonatal intensive care units in Australia
Authors: LEWIS J. A. , LACEY J. L. , HENDERSON‐SMART D. J.
Published: March 2008

Abstract Clinical techniques and protocols for chest physiotherapy vary greatly from one Neonatal Intensive Care Unit to another. In 1988 a questionnaire designed to investigate differing techniques used was distributed to Neonatal Intensive Care Units (NICU) around Australia. Fourteen of the 15 questionnaires were completed and returned. The results revealed that the methods of chest treatment and the indicators for commencing chest treatment were similar throughout NICU. Both physiotherapists and nursing staff played a role in the performance of chest treatment in all but one unit where it was the responsibility of nursing staff. However, the area in which there was most variability between NICU was the individual treatment protocols employed pre‐ and postextubation of the neonate. A review of literature over the past 10 years also demonstrates variability in chest physiotherapy. It was concluded that further well‐controlled studies with larger sample sizes are needed to validate the use of chest physiotherapy for the neonate, especially in relation to the techniques and specific protocols employed.
An evaluation of three methods used to assess the gestational age of Aboriginal neonates
Authors: SAYERS S. M. , POWERS J. R.
Published: March 2008

Abstract Many Aboriginal women do not recall their last menstrual period date, so alternative methods of estimating gestational age are necessary for optimal obstetric and neonatal care. In this retrospective review of 605 Aboriginal infants born at the Royal Darwin Hospital, the gestational age was estimated by the Dubowitz method and compared with available gestational age estimates from first fundal height and first ultrasound measurement. There was good agreement between the Dubowitz and ultrasound estimates of gestational age with best agreement occurring when ultrasound was done in the first trimester and worst agreement in the third trimester. Agreement between fundal height and Dubowitz estimates was poor but the measurement of fundal height was not standardized. When accurate last menstrual period information is absent, these findings suggest that good estimates of gestational age in Aboriginal neonates can be determined from the Dubowitz assessment at birth and from ultrasound measurements taken in the first trimester.
The prehospital management of children with acute asthma
Authors: DAWSON K. P. , JANDERA E. , PENNA A. C.
Published: March 2008

Abstract Parents of 100 children admitted sequentially to hospital with acute asthma were interviewed in order to determine the frequency of the use of asthma action plans and the intensity of prehospital treatment. The results revealed that 51% of the parents possessed some form of action plan and 84% of this group used their plan prior to the child's admission to hospital. However 79% of those children with more than two prior hospital admissions for asthma had an action plan. Bronchodilator therapy was widely used, with widespread possession of nebulizer units, but tended to be given infrequently prior to hospital admission. Steroid use in the acute attack was inadequate. Despite a concurrent national asthma campaign prehospital management was considered to be suboptimal.
Partial sacral agenesis with constipation: A report of one family
Authors: HARDW R. J. , ONIKUL E. , DE SILVA M. , GLASSON M. J. , GASKIN K. J.
Published: March 2008

Abstract Seven first degree relatives in three generations of a family with partial sacral agenesis are reported. Anterior sacral meningoceles were found in five cases, four of whom had severe constipation, one with urinary voiding dysfunction, and another without constipation who had low pressure headaches and dyspareunia. The anomalad was transmitted in an autosomal dominant fashion with incomplete penetrance and variable expression. This entity should be considered in all children and adults with severe constipation from birth, a family history of constipation and/or where constipation is refractory to medical therapy.
Factors influencing parental compliance following school entry health screening
Authors: VOLKMER R. E. , WIGG N. R. , MAVROMATIS C. E.
Published: March 2008

Abstract This study investigated the factors influencing parental action on behalf of their child following a school entry health screening failure. It was predicted that compliance with recommendations to seek further assessment would be related to the screening process variables and the number of barriers to compliance parents faced and that these barriers, and hence compliance, would be influenced by the socio‐economic status of the family. It was also expected that when schools were differentiated on adversity factors, the type of school attended would be related to compliance. Results from a sample of parents (n= 1231) showed that the parental non‐compliance rate to a referral of their child for further assessment following health screening was 26.1%. Non‐compliance was related to both screening process knowledge and satisfaction and the type of barriers to compliance parents experienced. Although the type and number of barriers experienced by parents was related to socio‐economic status, the results of correlational and discriminant function analyses indicated that the barriers most strongly related to compliance (e.g. partner's views, time pressure, more serious problems to worry about) were not related to socio‐economic status nor type of school attended. These findings provide valuable information for child health service providers as well as those involved in policy making and planning in the general area of community health services.
Searches for matched and closely matched related and unrelated bone marrow donors undertaken in a single paediatric unit
Authors: VOWELS M. R. , HONEYMAN M. , ZIEGLER J. B. , WHITE L. , DORAN T. , LAM‐PO‐TANG R.
Published: March 2008

Abstract Information regarding the likelihood of finding suitable marrow donors is limited. In order to determine this potential, all patients who received their primary care at a single paediatric institution over a 9 year period and in whom tissue typing studies were initiated are reviewed. Forty‐five (31.3%) of 144 patients had a sibling who was human leucocyte antigen (HLA) identical. A further 16 (11.2%) patients had immediate or more distant relatives who were either HLA identical (2.7%) or matched for five of six HLA antigens (8.3%). The possibility that a parent was closely matched with the patient was suggestive from the typing of siblings alone in only half the cases. Unrelated HLA matched donors were identified in four (27%) of 17 bone marrow bank searches. Overall, a potential related donor was identified within the family for 42% of patients and this figure rose to 45% when successful marrow bank searches were included. It can be concluded that initial typing should include both the parents and siblings. If a suitable donor is not found then an extended family and/or bone marrow bank search will identify additional suitable donors in a significant number of families.