bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with anterior cricoid split for infantile subglottic stenosis
Authors: BERKOWITZ R. G.
Published: March 2008

A retrospective study of infants undergoing anterior cricoid split (ACS) from 1989 to 1993 was performed to evaluate our unit's experience with ACS in the management of infantile subglottic stenosis (SGS). Twelve children were identified ranging in age from 10 to 30 weeks and weighing between 1200 and 6500 g. Nine were born at or less than 30 weeks' gestation. Indications for surgery were endotracheal tube dependency, nasopharyngeal continuous positive airway pressure dependency and recurrent croup. All had varying degrees of SGS. Eleven of the 12 patients were extubated successfully following surgery. Two of these required subsequent repeat ACS 6 and 9 months later with one patient eventually requiring tracheostomy. These results suggest that ACS can be safely employed as an alternative to tracheostomy for a variety of clinical presentations of infantile SGS, with a relatively high rate of successful extubation.
Erythropoietin in very preterm infants
Authors: FERNANDES C. J. , HAGAN R. , FRIEBERG A. , GRAUAUG A. , KOHAN R.
Published: March 2008

Three neonates (a male and two females of gestational ages 27, 27 and 29 weeks with birthweight 985,660 and 1130 g), born to parents who are Jehovah's Witnesses, were admitted to our neonatal intensive care unit over a 2 month period in 1992. Human recombinant erythropoietin (rHuEpo, 200 u/kg sc. on alternate days for 6‐8 weeks) was started early in conjunction with strict control of blood sampling in an attempt to avoid the need for blood transfusion. The lowest haemoglobin recorded was 95 g/L at 35 days of age in the first infant. The amount of blood withdrawn for sampling was 21.4 mL, 20.7 mL and 5.5 mL, respectively. All were discharged near their expected birthdate, never having received a blood transfusion in the Nursery. It is possible to manage sick, very preterm, very low birthweight neonates in a neonatal intensive care setting without the use of blood transfusions by the early use of rHuEpo in conjunction with strict control of blood sampling.
Anticardiolipin and acquired protein S deficiency in early childhood
Authors: COUPER R. T. L. , MAXWELL F. C.
Published: March 2008

A 27 month old child presented with left hemiplegia and was found to have deep cerebral venous thrombosis. The deep cerebral venous thrombosis resolved on warfarin. Elevated and fluctuating anticardiolipin antibodies as well as protein S deficiency were detected.
Transient global amnesia in a young child
Authors: SILBERSTEIN E. P.
Published: March 2008

Unprovoked and unexplained sudden loss of memory and inappropriate behaviour in a 5 year old child is described as fitting into the clinical picture of ‘transient global amnesia’. The likely pathophysiology of this condition is discussed with some support for Fisher's suggestion of ‘hippocampal‐fornical’ dysfunction.
Acute scrotal swelling: A sign of neonatal adrenal haemorrhage
Authors: LIU K. W. , KU K. W. , CHEUNG K. L. , CHAN Y. L.
Published: March 2008

Two neonates presented with acute scrotal swelling suggestive of testicular torsion. Surgical exploration in one patient revealed an infected haematoma. Subsequent investigations including ultrasonography and urinary catecholamine determination disclosed adrenal haemorrhage as the cause of the scrotal haematoma. A second patient in whom a purplish discolouration of the right hemiscrotum was noted was also investigated with ultrasonography, which revealed a normal right testis and a right adrenal haematoma. Both cases of adrenal haemorrhage resolved spontaneously on conservative treatment. Adrenal haemorrhage should be considered as a possible cause of acute scrotal swelling in neonates. Ultrasonography assessment should be performed in such cases to examine the intra‐abdominal organs especially the adrenal glands.
Prevalence, severity and medical management of asthma in European school children in 1985 and 1991
Authors: MITCHELL E. A. , ASHER M. I.
Published: March 2008

This present study, conducted in 1991, examined trends in the prevalence, severity and medical management of asthma in European school children by repeating the protocol of a study performed in 1985, using the same schools and questionnaire. One thousand, nine hundred and one children in 1991 were compared with 1084 children in 1985. The prevalence of respiratory symptoms increased significantly by approximately one‐third, although the increase in the diagnostic label ‘asthma’ did not increase significantly. Asthma severity indices (< 12 asthma attacks in the last 12 months and symptoms in the last month) were not significantly increased, except for night cough in the last month (1985 7.0%, 1991 9.9%, P= 0.008). In 1991, children with wheeze in the last 12 months were more likely to be diagnosed as having asthma and treated with bronchodilators and prophylactic drugs than in 1985. We conclude that the prevalence of asthma symptoms has increased from 1985 to 1991, but the two indices of severity of asthma are mostly unchanged. Diagnosis of asthma in children with symptoms has improved but asthma still appears underrecognized. Drug treatment of asthma has increased.
Vitamin A status in preterm neonates with and without chronic lung disease
Authors: CHABRA S. , ARNOLD J. D. , LESLIE G. I. , BOWEN J. R. , EARL J. , WOOD F.
Published: March 2008

It has been proposed that there is an association between vitamin A (VA) deficiency and the development of chronic lung disease (CLD) in preterm infants. This study was designed to measure the VA status in preterm infants and to compare the results in the group of babies who developed CLD with the group who did not. Vitamin A status was assessed by measuring plasma VA, retinol binding protein (RBP) and the plasma VA:RBP molar ratio in 25 infants of less than 31 weeks gestation during the first 28 days of life. Eleven babies developed CLD and 14 did not. There was no significant difference in plasma VA levels between the CLD and non CLD groups during the first 28 days. The majority of infants had adequate VA status, with a subgroup being deficient.
Primary hyperparathyroidism in a 14 year old girl presenting with bone deformities
Authors: MENON P. S. N. , MADHAVI N. , MUKHOPADHYAYA S. , PADHY A. K. , BAL C. S. , SHARMA L. K.
Published: March 2008

A 14 year old girl with bilateral genu valgum of 6 years duration was brought for evaluation of primary hyperparathyroidism. She had clinical features of rickets such as frontal bossing, rachitic rosary, lumbar lordosis and fixed adduction deformity of the left leg. She had undergone osteotomy earlier for correction of these deformities without benefit. Laboratory investigations showed hypercalcaemia and hypophosphataemia, with elevated alkaline phosphatase and parathyroid hormone levels. A skeletal survey showed generalized decreased density of bone and brown tumours and, coincidentally, a right renal calculus. A computerized tomography scan of the neck and thallium‐technetium subtraction scan delineated an adenoma of the left superior parathyroid gland, which was surgically removed. Parathyroid adenoma manifesting with bone deformities, especially genu valgum, is very rare in children. Early diagnosis and prompt treatment is essential to prevent such deformities.
Reduction of craniofacial and palatal narrowing in very low birthweight infants
Authors: MORRIS K. M. , BURNS Y. R.
Published: March 2008

Many infants born preterm have positional moulding of the head and palate. This study investigates whether specially designed, foam pressure dispersing pads (PDP) worn throughout the neonatal hospital course, were not only effective in reducing craniofacial flattening, but also in lessening palatal narrowing in very low birthweight (VLBW) infants. The study was conducted in two phases. Twenty‐three consecutively born VLBW infants were randomly selected to act as a comparative group. The next 31 VLBW infants born comprised the intervention group, and wore PDP during hospitalization. The two groups were similar in birthweight and gestational age. The groups were compared for changes in craniofacial and palatal parameters at three time intervals during hospitalization. Results indicated a significant increase in growth of craniofacial width, palatal width and palatal area of infants wearing PDP compared to those infants not wearing them. These findings suggest that craniofacial and palatal narrowing observed in VLBW infants may be reduced by the wearing of PDP during hospitalizaton.
Post‐transfusion chronic hepatitis C in children
Authors: MATSUOKA S. , TATARA K. , HAYABUCHI Y. , NII M. , MORI K. , KURODA Y.
Published: March 2008

Two hundred and twenty‐six patients who received blood products for open‐heart surgery in childhood were screened by a second‐generation enzyme‐linked immunosorbent assay and with surrogate markers for hepatitis C virus (HCV) infection, such as alanine aminotransferase (ALT). Twenty‐two (14%) of the 161 recipients who received blood products before 1989 and none of the subjects who had received blood products after 1990 (the year that the blood bank began to screen for HCV antibody) were HCV seropositive. Virologic and histologic studies showed that 10 (45%) of 24 seropositive patients had persistent hepatitis C virus infection, many with ongoing hepatitis. The remaining 12 seropositive patients with absent HCV RNA had normal ALT levels, indicating resolved hepatitis C infection. Enrolment in screening is important to detect chronic hepatitis C in children who received blood products prior to screening of blood donors for HCV antibody.
Trends in the use of fundoplication in children with gastro‐oesophageal reflux
Authors: VEIT F. , SCHWAGTEN K. , AULDIST A. W. , BEASLEY S. W.
Published: March 2008

Objectives: To document changing trends in the indications for fundoplication in children with gastro‐oesophageal reflux and to identify the main shortcomings and complications of the procedure.

Methodology: Retrospective review of 405 consecutive children undergoing fundoplication between 1978 and 1992 inclusive.

Results: Trends in the indications for fundoplication related to broadening of its use in those with severe neurological impairment and uncontrolled reflux, and to changes in the management of patients in the neonatal period. Complications included unwrapping with recurrence of reflux, hiatal hernia, adhesive small bowel obstruction, dumping syndrome, postoperative persistence of oesophageal stricture, excessively tight wrap and poor oesophageal clearance (mostly in oesophageal atresia patients).

Conclusions: This study identified those patients most likely to develop complications following fundoplication. This may assist in the pre‐operative assessment of the likely benefit of fundoplication in children who often have other complex problems.
Home‐based management of children hospitalized with acute gastroenteritis
Authors: O'LOUGHLIN E. V. , NOTARAS E. , McCULLOUGH C. , HALLIDAY J. , HENRY R. L
Published: March 2008

Objective: To determine the source of medical advice to parents and treatment administred at home for children admitted to hospital with acute gastroenteritis.

Methodology A questionnaire was completed by the parents of 231 children admitted during a 12 month period.

Results The majority of children had seen their family doctor or an after‐hours doctor prior to admission. Clear fluids were used for two‐thirds but an oral rehydration solution (ORS) was used in only one‐third of children. Medications were used for half, including antibiotics (19%), antidiarrhoeals (9%), antiemetics (7%) and paracetamol (27%). Inpatient assessment suggested that the majority of children had no or mild dehydration.

Conclusions Appropriate oral rehydration is underutilized and medications are overprescribed for the treatment of acute gastroenteritis. Family doctors continue to be the major source of advice for parents. Increased use of ORS at home may reduce hospitalization rates but attempts to change these practices should be directed at parents and family doctors.
A profile of heart disease risk factors and their relation to parents' education, fathers' occupation and family history of heart disease in 843 South Australian families: The Adelaide Children's WHO Collaborative Study *
Authors: BOULTON T. J. C. , COCKINGTON R. A. , HAMILTON‐CRAIG I. , MAGAREY A. M. , MAZUMDAR J.
Published: March 2008

Objectives: A study was conducted to determine whether the prevalence of risk factors among pre‐adolescent children is associated with their parents' risk factor status and what influence family history of ischaemic heart disease (IHD) and socio‐economic status (SES) had.

Methodology This was a cross‐sectional study of 856 children, mean age 8.6 years, and their parents who underwent the World Health Organization and National Heart Foundation protocols for the study of arteriosclerosis precursors. Historical, demographic, anthropometric, clinical and biochemical outcome measures were used.

Results There was the expected burden of illness reported for the grandparents and parents, with the latter conforming to their expected age group's heart disease risk factor status. The mean serum total cholesterol (TC) level for boys was 4.43 (± 0.79) mmol/L and girls 4.62 (± 0.84) mmol/L, with the 95th percentile for boys and girls combined being 5.88 mmol/L. The level corresponding to two standard deviations above the mean was 6.0 mmol/L. Childrens' IHD risk factor status reflected their parents' with TC, skin fold thickness and body mass index most closely correlated, followed by blood pressure. The greatest correlation was between the childrens' TC and their mothers'. Socio‐economic status as assessed by the parents' education level and fathers' occupational status produced differences in their childrens' risk factors, with mother's level of education having the major influence. There was no impact of family history of IHD.

Conclusions From these results it would appear that screening of the pre‐adolescent may be appropriate but longitudinal study will be important to establish this by documenting persistence of risk factor status. Also, it would appear that a child's future risk from IHD morbidity may be due to environmental influences mediated through differences in SES. As the level of IHD risk factors is reduced within the community, the extent of parent‐child transmission of measurable IHD risk factors in families of high IHD risk may be reduced.
The Adelaide preschool language unit: Results of follow‐up
Authors: STERN L. M. , CONNELL T. M. , LEE M. , GREENWOOD G.
Published: March 2008

Objectives: To determine educational, social and behavioural functioning of children who had been involved in a preschool language intervention programme between 1982 and 1990.

Methodology Fifty children who attended the Unit were available for follow‐up. The children were divided into three groups: (i) language disorder; (ii) speech disorder; and (iii) mixed speech and language disorder. A psychologist administered educational, cognitive and social behavioural tests. Speech, language and articulation were assessed by a speech pathologist.

Results Cognitively, the ‘mixed’ speech and language group obtained lower scores than the speech and language disorder children; results on educational tests were also generally lower. All three groups were significantly underachieving in areas of language, reading, spelling and arithmetic relative to their performance IQ. No socialization problems were found.

Conclusions Severe speech and language disorders in young children, even after periods of intensive intervention, have a significant effect on later educational achievement even when children appear to be ‘coping’ in their educational settings.
Do infants of depressed mothers cry more than other infants?
Authors: MILGROM J. , WESTLEY D. T. , McCLOUD P. I.
Published: March 2008

Objectives: This study compared the crying behaviour of infants of depressed and non‐depressed mothers at 3 and 6 months of age.

Methodology Twenty‐nine depressed and 44 non‐depressed mothers, their infants and partners participated in this study. Mothers were asked to complete 24‐hour diaries of the amount their infants cried for 1 week.

Results The diurnal variations in crying patterns of infants of depressed and non‐depressed mothers were not significantly different. However, infants of depressed mothers were found to cry significantly more in total per day than infants of non‐depressed mothers at 3 months of age, but not at 6 months. The results could not be explained by differences in infant temperament.

Conclusion Maternal depression may be a contributory factor to infant crying at 3 months of age.
Should we estimate liver span in the right mid‐clavicular line or the midline?
Authors: MICHIE C. , ALU S. , WILD K. , HAMPSHEIR R. , CHABONNAUD P. , HARVEY D.
Published: March 2008

Objective: Comparison was made between the accuracy of repeated measurements of liver projection below the costal margin in the right mid‐clavicular line (RMCL) and in the midline (ML).

Methodology: Clinical measurement of liver span was studied in 34 children under 5 years of age by five members of junior ward staff. Three patients were followed longitudinally by the same observers.

Results: The coefficient of reliability between different observers for measurement in the RMCL was 13 mm but for that in the ML was 7 mm. Estimates of liver size in the RMCL were particularly inaccurate when examining larger livers.

Conclusion: More reliable sequential estimates of liver size are likely to be obtained using measurements both in the midline and in a well‐defined and agreed point below the right costal margin.
Neonatal haemochromatosis associated with Down syndrome
Authors: CHEUNG P. C. H. , NG W. F. , CHAN A. K. H.
Published: March 2008

Methodology:The clinical course of a child with neonatal haemochromatosis associated with Down syndrome is described, using case notes and post‐mortem examination.

Results:The patient died of liver failure on day 36. Post‐mortem examination showed siderosis of liver, pancreas, heart, kidney and thyroid.

Conclusions:Neonatal haemochromatosis is a rare paediatric disease, the aetiology of which is unknown. Evidence suggests a disorder of fetoplacental iron handling with implications for recurrence in future pregnancies.
Review Article Neurometrics, dynamic brain imaging and attention deficit hyperactivity disorder
Authors: LEVY F , WARD PB
Published: March 2008

Objective: : The literature on the development of frequency analysis of the electroencephalogram (neurometrics) and functional dynamic brain imaging techiques is reviewed. Clinical applications in the diagnosis and treatment of learning disorders of childhood are discussed.

Conclusions While questions remain about the sensitivity and specificity of the neurometric method in diagnosing attention deficit hyperactivity disorder (ADHD), if the technique proved predictive of medication response, its importance would be established. However, evoked‐potential studies, cerebral blood flow and cerebral glucose metabolic studies promise a better understanding of underlying psychological processes in ADHD.
Inter‐rater reliability in the medical diagnosis of child sexual abuse
Authors: ROBERTS I , MORAN K
Published: March 2008

Objective: To examine inter‐ and intra‐rater reliability in the assessment of genital findings in cases of suspected child sexual abuse.

Methodology Colposcopic photographs of the external genitalia of 70 female children were independently assessed by child sexual abuse teams in Auckland and Sydney. For the Auckland centre, intra‐rater reliability was assessed by making a second independent assessment 6 months following the first. Reliability was quantified using per cent of agreement and Cohen's Kappa statistic.

Results There were high levels of inter‐ and intra‐rater agreement. When photographs were classified as normal/non specific or strongly indicative of child sexual abuse, there was 93% agreement between the Auckland and Sydney teams with a kappa score of 0.70. For the two separate ratings made by the Auckland team there was 94% agreement with a kappa score of 0.75.

Conclusions The high levels of inter‐ and intra‐rater agreement obtained in this study were reassuring. The results obtained compare favourably with the results of reliability studies in other areas of medical practice.
Factors that influence the choice of infant feeding
Authors: TAN JCH , JEFFERY HE
Published: March 2008

Objective

: To consider some of the many factors that influence the choice to initiate and continue breast‐feeding.

Conclusion

: There is increasing recognition of the nutritional value and related health outcomes of breast‐fed infants. Further research is essential to appraise the medical and social determinants of infant feeding practices, particularly the early discontinutation of breast‐feeding. Paediatricians are in an ideal position to foster, encourage and support such research and to accept a wider role in advocacy of the infant's right to obtain optimal nutrition.
Molecular genetics of Wilms' tumour
Authors: TAY JSH
Published: March 2008

Wilms' tumour, or nephroblastoma, is an embryonal malignancy of the kidney with an incidence of approximately 1 in 10000 live births. It occurs in both sporadic and familial forms, but only 1% of Wilms' tumour patients have a positive family history. The molecular genetics of Wilms' tumour have been the subject of extensive research and at least three genes (WT1, WT2, WT3) have been implicated. WT1 has been mapped to 11p13, and it has been suggested that loss or inactivation of a tumour‐suppressor gene at 11p13 might be a primary event in the development of Wilms' tumour. The WT2 gene maps to 11p15 in the region of the Beckwith‐Wiedemann locus. The WT3 locus is likely to be located to chromosome 16q. The understanding of the molecular genetics of Wilms' tumour is reviewed briefly.
A prospective study of nosocomial infection in a neonatal intensive care unit
Authors: KHADILKAR V , TUDEHOPE D , FRASER S
Published: March 2008

Objective:

To determine the incidence of and organisms responsible for neonatal nosocomial infection (after 72 h of age).

Methodology:

A 1‐year evaluation of 321 consecutive septic work‐ups performed on 130 of 1008 babies admitted to a neonatal intensive care unit (NICU) for more than 72 h. Fifty‐seven (89%) of 64 infants of birthweight 500‐999 g, 36 (34%) of 105 infants 100‐1499g, 27 (6%) of 422 infants 1500–2499g and 10 (28%) of 477 infants of birthweight <2500g had at least one septic work‐up.

Results:

In addition to blood culture, the evaluations included haematological score on full blood count in 94.7%, abdominal X‐ray in 48%, endotracheal tube tip culture in 32.7% and lumbar puncture in only 13.1%. Blood culture was positive on 92 occasions in 75 infants (28.7% of work‐ups and 7.4% of all babies admitted). Infection status was classified as definite on 40 occasions in 30 babies, and due to contamination 52 in 45 babies. Twenty of the 30 babies with definite infection were of birthweight 500–999 g. Of the 40 definite infections coagulase‐negative staphylococci (CONS) were cultured from 23 babies, Gram negative bacilli in 14 and Candida spp. in three babies. Sepsis caused or contributed to the deaths of six babies.

Conclusion:

This study identifies infants of birthweight > 1000 g as the highest risk group for nosocomial infection especially CONS. New strategies in prevention, surveillance and treatment are required for extremely low birthweight infants.
Influence of families on the growth of children in an Aboriginal community
Authors: ALSOP‐SHIELDS L , DUGDALE AE
Published: March 2008

Objective:

Some Aboriginal children have poor growth while others grow according to international standards. This study was designed to find whether these differences were related to families.

Methodology:

Data were obtained on 13 families at Cherbourg Aboriginal Community in Queensland. There were data on the growth and hospital admissions of children in these families for at least two generations. Data were taken from records of the Infant Health Clinic and Hospital on the Community. A total of 606 children were considered.

Results:

The growth of a child during infancy is correlated with the growth of his/her mother in infancy, but not with the growth of the father. We have therefore defined families in the matrilineal line. There were marked and highly significant differences between the growth of children in the 13 families. The families with good growth in one generation were likely to have good growth of children in the next generation.

Conclusions:

In spite of the overall improvements in the growth of infants and children at Cherbourg, families tended to maintain their rankings from one generation to the next. It would be cost‐efficient to target health advice to those families who have, in the past, had poor growth among their children.
Status epilepticus in 37 Chinese children: Aetiology and outcome
Authors: KWONG KL , LEE SL , YUNG A , WONG VCN
Published: March 2008

Objective:

The aetiology and clinical features of status epilepticus (SE) are described, with the aim of defining any relationship between risk factors and clinical outcome.

Methodology:

A retrospective review was performed of 37 Chinese children admitted to Queen Mary Hospital, Hong Kong, from 1989 to 1993 with the diagnosis of SE.

Results:

Eighty‐six per cent had onset before 5 years of age; 60% were due to an acute central nervous system (CNS) insult, 11% were idiopathic, 13% had a pre‐existing CNS insult, 5% were febrile and 11% were due to progressive encephalopathy. An abnormal neurological status was present in 24% before the episode of SE, and a history of seizures before the onset of SE was present in 35% of patients. Fifty‐four per cent of the episodes of SE were generalized. The mortality rate was 11% during the period of follow up but no deaths were attributed to SE. Neurological sequelae were observed in 27% of patients and recurrent SE occurred in 12%.

Conclusions:

In those patients with normal neurological status before an episode of SE and without acute CNS insult or progressive encephalopathy, the outcome was favourable.
Growth, development and behaviour in adolescents born small‐for‐gestational‐age
Authors: PRYOR J , SILVA PA , BROOKE M
Published: March 2008

Objective:

To examine the effects on adolescents of being born small‐for‐gestational‐age (SGA).

Methodology:

The sample are members of a cohort longitudinal study in which growth, cognitive development and behaviour are being studied into adulthood, Ninety‐one SGA subjects were available for comparison with the rest of the sample (n= 1037) on measures of height, weight, head circumference, cognitive performance and behavioural variables to the age of 18 years old.

Results:

SGA subjects were shorter and lighter at 18 years of age than their appropriate‐for‐gestational‐age (AGA) counterparts despite age of onset of menarche being the same in both groups. At age 13, SGA subjects scored significantly lower than the AGA group on the WISC‐R scales. They were rated by parents as having more behaviour problems at age of 15.

Conclusions:

SGA birth appears to be a potential problem which extends beyond childhood in its effects on growth, behaviour and cognitive performance.
Higher rates of SIDS persist in low income groups
Authors: FORD RPK , NELSON KP
Published: March 2008

Objective:

To examine how changes in the rates of sudden infant death syndrome (SIDS) have varied in different income groups during a 25 year period.

Methodology:

Census data were obtained for five census periods (1971, 1976, 1981, 1986 and 1991) on the number of SIDS cases and inevitable deaths. Census area units (CAU) were ranked according to the average income earned by adults over the age of 15 years for each census year. The CAU were then divided into three equal income groups: low, middle and high.

Results:

The rates of SIDS differed significantly between the three income groups for the 1991 census period with the low income SIDS rate being 4.6/1000 births compared to 1.2/1000 live births for the higher income groups (Chi‐squared = 18.3, P>0.0001). There was no association between rates of inevitable deaths and income groups.

Conclusion:

Currently, low income groups have three times the rate of SIDS compared to those in higher income groups. The reason for this is probably because the disadvantaged groups carry an overall higher burden of risk factors for SIDS. This must be kept in mind as further SIDS educational programmes are developed and implemented.
Evaluation of an early childhood programme based on principles of conductive education: The Yooralla Project
Authors: CATANESE AA , COLEMAN GJ , KING JA , REDDIHOUGH DS
Published: March 2008

Objective:

To perform an objective evaluation of a programme based on conductive education (CE) for preschool and early school‐aged children with cerebral palsy.

Methodology:

The progress of 17 children participating in a CE‐based programme (the Yooralla programme) was compared with 17 children enrolled in traditional early childhood services. Videotapes of the children performing items from the Vulpe Assessment Battery (VAB) were scored by assessors blind to the treatment group; three standardized tests of cognitive ability were administered; and the questionnaire on resources and stress (QRS‐F) was given to the primary caregiver at the beginning and conclusion of 6 months.

Results:

The Yooralia group improved in motor performance and parental coping variables. Both groups showed improvement on the cognitive measures, with the control group demonstrating slightly greater gains.

Conclusions:

Conductive education may benefit the motor development of children with cerebral palsy and provide greater parental support. A randomized control study with adequate subject numbers is necessary to confirm this tentative conclusion.
Psychological outcome of ECMO‐eligible neonates with severe respiratory failure treated using conventional medical therapy
Authors: MATHIAS JL , CLARK SM , NETTELBECK T , JAMES SL , WHITE DA
Published: March 2008

Objective:

The present study addressed a National Health and Medical Research Council (NHMRC) recommendation that the outcome of neonates who are treated conventionally for respiratory problems be further investigated before setting up additional extracorporeal membrane oxygenation (ECMO) centres in Australia.

Methodology:

The cognitive and behavioural outcome of ECMO eligible infants who received conventional treatment for respiratory problems at birth was assessed in 18 infants aged 1.5–3 years (index group). ECMO was not available at either of the treating hospitals. Index children were compared to a matched control group of children who did not experience any major complications at birth. Children were assessed using either the Bayley or McCarthy scales of infant development and the Child Behavior Checklist.

Results:

Overall, a mortality rate of 19% and a psychological morbidity rate of 18% suggest that children born with severe respiratory failure, who meet existing ECMO eligibility criteria, have a good prognosis when treated using conventional medical therapy.

Conclusions:

Improvements to conventional treatments indicate that ECMO eligibility criteria may need to be revised to identify accurately those infants who are at extreme risk of mortality if treated conventionally.
Factors associated with the age of introduction of solids into the diet of New Zealand infants
Authors: FORD RPK , SCHLUTER PJ , MITCHELL EA ,   NEW ZEALAND COT DEATH STUDY GROUP
Published: March 2008

Objective

: To describe the current timing of the introduction of solids in infancy and the factors influencing the decision to introduce solids.

Methodology

: Eighteen hundred infants were selected randomly as part of the New Zealand Cot Death Study. Of these, 88% of the parent/caregivers were interviewed when their infant was aged between 1 and 12 months. They were asked when solids were first introduced into the diet.

Results

: By 12 weeks of age more than 20% of infants had been given solids; by 16 weeks and by 6 months 50 and 90% of babies, respectively, had been given solids. Maternal smoking, low educational achievement and not being breast‐fed exclusively to 4 weeks of age were factors which were strongly associated with the early introduction of solids.

Conclusion

: Half of New Zealand infants are being started on solids earlier than is presently recommended. More education is needed to promote the later introduction of solid foods into the diet.
Bedwetting and psychopathology in adolescents
Authors: REY JM , BIRD KD , HENSLEY VR
Published: March 2008

Objective

: To ascertain whether nocturnal enuresis in adolescents is associated with depression, hyperactivity, oppositionality, conduct and peer problems.

Methodology

: This was investigated cross‐sectionally in adolescents aged 12‐16 years from a community sample (n= 528) and a clinically referred cohort (n= 2325) using parents' reports.

Results

: Referred adolescents were 7 times more likely to wet the bed than their community counterparts. There was a small but significant association between nocturnal enuresis and hyperactivity. Depressed adolescents were half as likely to wet the bed as those without depression. Bedwetters had more problems relating to peers but were not disliked more often. There was no association between bedwetting, oppositionality, conduct problems and gender. Gender differences disappeared when the effect of hyperactivity was controlled.

Conclusions

: Clinicians need to inquire about symptoms of attention deficit hyperactivity disorder in adolescents who present with enuresis and vice versa.
Health promotion using television in hospital waiting rooms: The Adelaide Children's Parent Education Project
Authors: COCKINGTON RA
Published: March 2008

Objectives:

The Adelaide Children's Hospital Parent Education Project was designed to determine the effect of the screening of health promotion programmes via closed circuit television facilities in hospital waiting rooms on parents' knowledge of child health issues.

Methodology:

A knowledge test was constructed with an internal consistency co‐efficient of 0.95 and used to identify target groups of parents with low knowledge. The education programmes screened were aimed at the knowledge deficits. To assess the effects of the programmes an experiment was conducted using a post‐test only/control group design, including a time delay. Days of the week were assigned randomly to programme days when health education programmes were screened and non‐programme days when normal television programmes were screened. The experimental group was selected randomly from the attendance registers on programme days and the control group from non‐programme days.

Results:

The experimental group of parents gained substantial increases in knowledge with some knowledge scores increasing by nearly 70%. Overall there was a statistically significant difference between the knowledge scores of experimental and control groups. The recall of programme content by parents was notable in view of the fact that because of waiting times most only viewed part of the education programmes. Health‐promoting behaviour changes were also reported.

Conclusions:

The screening of health programmes via hospital waiting room television significantly increases the health knowledge of viewers, although there is a decline over time.
Analgesia for venepuncture in a paediatric surgery centre
Authors: BRISLIN RP , STAYER SA , SCHWARTZ RE , PASQUARIELLO CA
Published: March 2008

Objective:

To establish an effective and efficient method of painless venepuncture in children 8 years and older in an ambulatory paediatric surgery centre.

Methodology:

Sixty patients aged 8‐21 years were randomized to one of three groups: (i) nitrous oxide with EMLA cream; (ii) nitrous oxide with intradermal lidocaine; and (iii) nitrous oxide alone (n= 20 in each group). Patients in all three groups received oral midazolam for pre‐operative anxiolysis. The degree of patient sedation and anxiolysis was noted by two observers before and 2 min after the administration of 50% nitrous oxide. The patient's response to venepuncture or intradermal lidocaine was rated by the two observers using an Observer Response Score. After successful venepuncture, the nitrous oxide was discontinued and the patient was asked to rate the pain of venepuncture using a Patient Response Score.

Results:

There were no differences in the degree of sedation and anxiolysis between the three groups before or after the administration of nitrous oxide. Patients in the control group (nitrous oxide alone) had a higher incidence of withdrawal or vocalization with venepuncture. When the patients rated the pain of venepuncture, there were no differences between the three groups.

Conclusions:

Oral midazolam in combination with 50% nitrous oxide provides adequate analgesia and anxiolysis for venepuncture in patients 8 years and older. The addition of EMLA cream or intradermal lidocaine will decrease the likelihood of patient movement.
Autonomic neuropathy in diabetic children
Authors: VERROTTI A , CHIARELLI F , BLASETTI A , MORGESE G
Published: March 2008

Objective:

Evaluate the presence of cardiovascular autonomic nerve dysfunction in children and adolescents with insulin‐dependent diabetes mellitus.

Methodology:

We studied 110 patients (54 male, 56 female) and 100 healthy sex and age‐matched children. Autonomic nerve function was assessed by standard cardiovascular reflex tests: (1) Fall in systolic blood pressure in response to standing. (2) Heart rate in response to standing. (3) Beat‐to‐beat rate variation during deep breathing. (4) Quotient of heart rate during and after Valsalva manoeuvre. (5) Change in blood pressure response to sustained handgrip. The coefficient of variation of heart rate was determined from 150 systoles using a microcomputer‐based technique. The lower limits of normal were defined according to statistical analysis taking into account the relationship between heart rate variability and age.

Results:

Forty‐seven of the 110 diabetic children and adolescents studied showed one or more abnormal tests for cardiovascular autonomic dysfunction; many patients had an abnormality in more than one test. Twenty‐two patients showed early involvement, 18 patients had definite and 7 severe involvement. No correlation was found between sex, glycaemic control, duration of diabetes or presence of retinopathy and persistent microalbuminuria and the autonomic nerve function.

Conclusions:

In the paediatric age group also, autonomic nerve dysfunction can be present in asymptomatic diabetic patients. Heart rate variation during Valsalva manoeuvre and maximum/minimum 30:15 ratio are the most sensitive indices to detect autonomic abnormalities in children.
Gastroschisis: 13 years' experience at RCH Melbourne
Authors: TAWIL K AL , GILLAM GL
Published: March 2008

Objective:

To review recent experience of gastroschisis at the Royal Children's Hospital, Melbourne.

Methodology:

Retrospective review of admissions over a 13 year period, June 1980‐June 1993 inclusive, including an analysis of those factors influencing mortality, morbidity and complications.

Results:

There were 49 infants, of whom two died (4%), both having an associated bowel atresia. Mode of delivery, age at operative repair, birthweight centile and silo repair had no significant effect on the duration of total parenteral nutrition (TPN) or hospital stay. The presence of short gut and/or gut resection and localized bowel narrowing or bowel atresia resulted in a significant increase in the duration of TPN and hospital stay. The presence of a central venous line was a highly significant risk factor for the development of systemic sepsis.

Conclusion:

Currently gastroschisis has a good outlook with a low mortality. Infants with short gut/resection and bowel atresia have a long duration of TPN and hospitalization, with significant morbidity and complications.
A simple hospital triaging system for infants with acute illness
Authors: HEWSON P. H. , GOLLAN R. A.
Published: March 2008

Objective: To determine the simplest combination of symptoms and signs for use as a triaging procedure in young infants presenting to hospital, and to compare this with the ‘Baby Check’ system.

Methodology: Six hundred and eighty‐two babies were assessed when presenting with acute illness to a children's hospital emergency department. Results of analysis were compared to the results of the Baby Check system, which was derived from the data on the same babies.

Results: The presence of at least one of the following markers: drowsiness on examination, significant chest wall recession, generalized pallor, a history of feeding less than 50% or decreased activity, had a sensitivity of 91%, a specificity of 72%, a positive predictive value of 29% and a negative predictive value of 98% when predicting the need for intervention in hospital. The ‘Baby Check’ system with a score of 13 or more had a sensitivity of 95%, a specificity of 70%, a positive predictive value of 28% and a negative predictive value of 99%. Less common but predictive markers such as bile‐stained vomiting, respiratory grunt, apnoea and convulsions add further to the sensitivity. Based on this data set, if historical variables alone (the presence of either drowsiness, difficult breathing, being more pale than usual, feeding less than 50% or decreased activity) were used (as in telephone screening) 92% of babies needing treatment in hospital would be identified.

Conclusion: A simple five‐marker system is almost as powerful as the 19‐marker Baby Check system and provides a useful basis for a triaging system and educational guidelines when assessing sick babies.
A neonatal early discharge and home support programme: Shifting care into the community
Authors: RIEGER I. D. , HENDERSON‐SMART D. J.
Published: March 2008

Objective: The Neonatal Early Discharge and Family Support Programme (NEDP) was an initiative aimed at providing extended care for families whose infants had required neonatal special care, thereby allowing earlier discharge.

Methodology: Two groups of families were examined; one before and one after the instigation of the NEDP. Hospital and community service usage and psychosocial effects were examined.

Results: Families who received support were able to be discharged earlier and rooming‐in was unnecessary as support was provided at home. Visits to family doctors for mothercraft issues were less frequent. Transport of babies from the Level 3 nursery to other nurseries in order to be closer to home was also provided by the nursing team, saving on ambulance costs and freeing their time for emergencies. There was no increase in maternal anxiety and infants were less difficult in the patient group.

Conclusions: NEDP and family support programme is a worthwhile extension of neonatal intensive care.
The danger of freely rocking cradles
Authors: BEAL S. M. , MOORE L. , COLLETT M. , MONTGOMERY B. , SPROD C. , BEAL A.
Published: March 2008

Objective: To assist the Adelaide State Coroner with his inquest into the death of two infants in South Australia, and to assist the Department of Public and Consumer Affairs develop Australian Standards for rocking cradles.

Methodology: A sample of each brand of new cradle commercially available in South Australia was examined. Videotapes were made of 11 healthy infants in rocking cradles to examine how they moved and how they reacted in different positions.

Results: Many cradles had insecure locking pins. Infants in a cradle tilted at 10d̀ or greater, face down with the side of the face against the bars, and an arm trapped between the body and bars or through the bars, were unable to obtain a clear airway unless a dummy was in the mouth.

Conclusions: Infants should never be left unattended in freely rocking cradles. Australian Standards should recommend locking pins be bolted into place and that cradles cannot tilt to greater than 5d̀.
Do adolescents know where to find help for mental health problems? A brief report
Authors: FOTHERINGHAM M. J. , SAWYER M. G.
Published: March 2008

Objective: Few previous studies have investigated adolescents' knowledge of the services available to provide help with mental health problems. This is an important omission as knowledge about the availability of mental health services may significantly influence the extent to which adolescents with mental health problems receive appropriate help for their difficulties. The purpose of this study was to investigate knowledge of mental health services among socio‐economically disadvantaged adolescents.

Methodology: Students attending the participating high school completed a questionnaire describing mental health services in South Australia.

Results: The results suggest that the adolescents had little knowledge of mental health services and they primarily discussed their problems with other family members or friends. The results also suggest that the adolescents prefer to obtain information about mental health problems from education programmes in schools or on television.

Conclusions: There is a need to make adolescents and their families more aware of the services available to provide help for mental health problems.
Urinary 17α‐hydroxyprogesterone in management of 21 ‐hydroxylase deficiency
Authors: LIM Y. J. , YONG A. B. W. , WARNE G. L. , MONTALTO J.
Published: March 2008

Objectives: The study was designed to assess the reliability of measurement of 24‐hour urinary 17α‐hydroxyprogesterone (17‐OHP) by radio‐immunoassay (RIA) as an alternative biochemical assessment for monitoring the treatment of congenital adrenal hyperplasia (CAH) due to 21 ‐hydroxylase deficiency (21 ‐OHD) and to assess the need for sample purification by column chromatography to improve assay specificity.

Methodology: Morning serum 17‐OHP was measured using RIA and 24‐hour urinary pregnanetriol using gas chromatography. Twenty‐four‐hour urinary 17‐OHP was measured in samples from 17 prepubertal patients with CAH due to 21 ‐OHD, and 20 normal prepubertal children as controls. In 24 urine samples, RIA of 17‐OHP was performed with and without column chromatography.

Results: There was a good correlation between 24‐hour urinary 17‐OHP and 24‐hour urinary pregnanetriol (r = 0.962, P<0.01) and between 24‐hour urinary 17‐OHP and morning serum 17‐OHP (r= 0.955, P<0.01). There was no significant difference in the RIA of the urine samples with and without purification by column chromatography.

Conclusions: The measurement of 24‐hour urinary 17‐OHP is a reliable alternative for the biochemical monitoring of 21‐OHD, and RIA specificity is unaffected by omission of column chromatography.
Cholestatic jaundice and congenital hypopituitarism
Authors: ELLAWAY C. J. , SILINK M. , COWELL C. T. , GASKIN K. J. , KAMATH K. R. , DORNEY S. , DONAGHUE K. C.
Published: March 2008

Objective: The prevalence of cholestatic jaundice as a presenting feature of congenital hypopituitarism is assessed.

Methodology: A retrospective case record analysis of the presenting features in all patients diagnosed as having congenital hypopituitarism between 1973–93.

Results: Seven of the 20 patients with congenital hypopituitarism presented with cholestatic jaundice as the major initial manifestation of the disorder. Liver biopsy findings in three revealed intracellular bile pigment accumulation and variable giant cell formation.

Conclusion: Cholestatic jaundice was the major manifestation of congenital hypopituitarism in 35% of patients presenting in the neonatal or early infancy period.