bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of routine school entrant health assessments in Christchurch
Authors: BARNETT P. , FORD R. P. K.
Published: March 2008

The School Entrant Health Assessment (SEHA) programme was established in New Zealand to ensure that every child entering school was assessed by a nurse. This type of service has come under a lot of criticism and so we investigated the scheme in Christchurch, looking at the outcome of the physical examination. We did not explore the health promotion aspect of the nurses' work. We traced the path of 1281 new entrants. The nurses identified problems in 459 (35.8%) children and nearly half were given further appointments or referred on. However, it was judged that only 21 (1.6%) children might have actually received a significant long‐term benefit. We feel that a non‐selective approach to school entry health assessments is inefficient. Nevertheless, the opportunity to fully audit the health of new school entrants is most important and could be a valuable opportunity for health promotion.
Haemophilus influenzae septicaemia in the neonate: Report of two cases and review of the English literature
Authors: WONG S‐N. , NG T‐L
Published: March 2008

Two neonates with early onset respiratory illness were found to have Haemophilus influenzae septicaemia. One of them died. A review of the English literature showed that Haemophilus influenzae septicaemia is increasing in incidence. Almost all cases presented with respiratory distress in the first 2 days. Other associated features included meningitis, arthritis, conjunctivitis and cellulitis. The mortality, which averaged 52%, was high, especially in premature bables. The septicaemia was caused by ascending infection from the colonized maternal birth canal, and most cases were caused by nontypable strains of Haemophilus influenzae. Because of the occurrence of ampicillin or chloramphenicol resistance, a third generation cephalosporin is the treatment of choice for known cases of serious infection.
Two decades of change: Cot deaths and birth score items in Canterbury, New Zealand
Authors: FORD R. P. K. , McCORMICK H. E. , SCHLUTER P. J. , HARNETT P. M.
Published: March 2008

The individual items of two birth scores and the scores themselves were examined for a sample of 2065 mothers and infants pairs for any changes between 1968 and 1986. About 100 births were randomly sampled for each year. The scoring systems used were the Sheffield risk score and the Christchurch‐Invercargill‐Dunedin score. A total of eight items from these scores was examined. The purpose was to discover whether the increasing cot death rate in Canterbury could be attributed to an increasing proportion of vulnerable infants, as determined by the items in the risk scores. No such relationship was uniformly found.
Assessment and treatment of childhood asthma
Authors: HENRY R. , SLY P. , GODFREY S. , VAN ASPEREN P. , STAUGAS R. , SOUEF P. LE , SMITH G. , ROBERTSON I. , ROBERTSON C. , PHELAN P. , OLINSKY A. , MORTON J. , MITCHELL E. , MELLIS C. , MASTERS B. , MARTIN J. , LANDAU L. , KEMP A. , ISLES A. , HARRIS M. , FRANCIS P. , DAWSON K. , COOPER P. , COOPER D. , ASHER I. , ALLEN H.
Published: March 2008

Abstract In June 1990 a meeting of Paediatric Respiratory Physicians was held near Adelaide. The guidelines for assessing and treating asthma as prepared by the Thoracic Society of Australia and New Zealand for the management of patients with asthma was considered. Although not explicitly stated, these guidelines were designed for adult asthmatics. There was complete agreement that a companion statement was needed to take into account differences between the management of children and adults. This document fulfils that role. Further recommendations are found in a statement prepared by Australian and New Zealand respiratory paediatricians following a workshop in June 1989. This present statement should be read in association with the previous documents.1,2
Late adolescent outcome of early onset anorexia nervosa
Authors: JARMAN F. C. , RICKARDS W. S. , HUDSON I. L.
Published: March 2008

Abstract Forty‐three young female patients admitted consecutively to hospital with anorexia nervosa (AN) were reevaluated in late adolescence an average of 4.3 years following initial presentation. Follow‐up interviews were conducted individually by a paediatrician and a psychiatrist on 32 of the original 43 patients (mean age 18.3 years) with outcome assessed by multidimensional physical, menstrual, eating behaviour, psychosocial and global outcome criteria. Physical outcome, as assessed by validated indices of body adiposity, was within the normal range (3‐97th percentiles) in 94% of the 32 patients seen at follow‐up, although only 56% reported regular cyclical menstrual function. Good physical outcome, however, was not necessarily predictive of successful adjustment in other areas. Eating behaviour was unequivocally normal in only 25% of patients, with a majority still dieting, bingeing or vomiting with meals, Psychosocial adjustment was satisfactory in the majority of cases but varied widely. Univariate and multivariate statistical analysis identified higher premorbid and admission body mass index (BMI) percentiles, a family history of obesity and shorter duration of illness on admission as significant prognostic indicators of favourable physical outcome. Although girls who develop AN in early adolescence are generally thought to have a favourable long‐term prognosis, health professionals need to be aware that these patients form a heterogeneous group and may have considerable ongoing physiologic and psychologic disturbance despite normalization of body mass.
Chronic granulomatous disease: A different pattern in Hong Kong?
Authors: LAU Y. L. , WONG S. N. , LAWTON J. W. M. , CHOW C. B.
Published: March 2008

Abstract From July 1988 to December 1989, six boys with chronic granulomatous disease were diagnosed in our institutions. Their clinical features were reviewed in order to delineate the pattern of infections which seems to have both similarities and differences when compared with published reports of Caucasian patients. The most striking difference was the lack of skin sepsis and chronic lymphadenitis in our six patients. Gram‐negative organisms were the commonest pathogens while Staphylococci sp. were not isolated. Clinical features which should alert one to the diagnosis were also highlighted. Prophylactic co‐trimoxazole was effective in reducing the frequency of bacterial infections. Early diagnosis is not only essential for optimal patient management but also for genetic counselling for the extended family.
A review of epidemiological studies of sudden infant death syndrome in Southern New Zealand
Authors: TAYLOR B. J.
Published: March 2008

The rate of sudden infant death syndrome (SIDS) in Southern New Zealand has been very high with an apparent real increase in incidence from the early 1970s. Recent research is reviewed and the results of specific interventions aimed at preventing SIDS summarized. The intervention consisted of strongly advising new parents that their babies sleep on their back or side and that they avoid over‐heating, especially during infections. For the Otago area, child‐care practice has been documented and prone sleeping of 1 month old babies has declined from 41.8% in 1986 to 2.4% in 1989‐90. There is also evidence that parental control of infants' thermal environment has improved, maternal smoking during pregnancy has slightly decreased and the number of babies breast fed at 1 month of age has increased by 11%. In Southern NZ there has been a decline in post‐neonatal SIDS mortality from 6.3 deaths per 1000 live births 1979‐84 to 1.3 per 1000 live births in 1990. There are grounds for supposing that the intervention has been causative of this change, a possibility being addressed by on‐going studies.
The pneumographic and medical investigation of infants suffering apparent life threatening episodes
Authors: RAHILLY P. M.
Published: March 2008

Investigation of 340 babies who suffered from apparent life threatening episodes (ALTE) was performed using pneumographic studies and a variety of medical investigations. A number of medical abnormalities were demonstrated by history or investigation, including gastro‐oesophageal reflux (211), airways pathology (17), evidence of fits (25), brain‐stem tumour (2), hypoglycaemia (2), respiratory syncytial virus (8) and possible Munchausen by proxy (5). Pneumographic abnormalities were detected in 27 of the 340 infants. Home monitors were used for 135 infants. Future central apnoeas occurred in 20 of the 26 infants on home monitors that had had an abnormal pneumogram, compared with one of the 109 infants on home monitors after a normal pneumogram. Thus pneumograms have a sensitivity and specificity of 95% for predicting central apnoeas in babies who have already suffered an ALTE. The effect of eyeball pressure on the heart rate was measured in 65 babies and was found to cause a brisk drop in heart rate in 32 babies. Twenty‐two of the 32 babies had future white apnoeas (usually associated with gastro‐oesophageal reflux), compared with five of the 33 babies who had no drop in heart rate in response to eyeball pressure. Thus this test has a sensitivity of 81% and a specificity of 74% at predicting white apnoeas in babies who have already suffered an ALTE.
Herpes simplex virus type 1 infections presenting at birth
Authors: GARLAND S. M. , DOYLE L. , KITCHEN W.
Published: March 2008

Two cases of intra‐uterine acquired neonatal herpes simplex type I presented with atypical skin lesions apparent at or shortly after birth; the timing and appearance of the lesions meant that herpes virus infections were not considered to be the most likely diagnosis. Once herpes simplex was diagnosed, both infants were treated with acyclovir. Prompt diagnosis and institution of acyclovir are imperative for a favourable outcome from neonatal herpes infections.
Inguinal hernia in very low birthweight children: A continuing risk to age 8 years
Authors: KITCHEN W. H. , DOYLE L. W. , FORD G. W.
Published: March 2008

Abstract  The prevalence of inguinal hernia repair up to 8 years of age was determined in 205 inborn children of birthweight < 1500 g who had survived to the age of 8 years; 37 (18.0%) of the children required surgery for inguinal hernia, significantly more frequently for boys than girls (32.0% and 3.9% respectively). The cumulative percentage of inguinal hernia operations in boys was 8.7% during primary hospitalization, 20.4% by 2 years, 30.1% by 5 years and 32.0% by 8 years; and 36.4% (12 of 33) hernias in boys occurred beyond 2 years of age. The risk of hernia in boys was only marginally higher in those who required assisted ventilation and in those of birthweight <1000 g. Very low birthweight infants, particularly boys, are at risk of developing an inguinal hernia not only in infancy but also to at least 8 years of age.
Impact of influenza on morbidity in children with cystic fibrosis
Authors: FERSON M. J. , MORTON J. R. , ROBERTSON P. W.
Published: March 2008

Abstract  Recommendations concerning annual influenza vaccination in children suffering from cystic fibrosis (CF) are not uniform. Previous studies have shown that influenza causes a small proportion of episodes of episodes of acute respiratory deterioration in CF patients. During the 1989 Australian winter, we studied the association between serologically proven influenza infection and acute respiratory morbidity in 20 children with CF. Six children were shown to have influenza infection, four with type A and two with type B. Four of five children requiring hospital admission were shown to have influenza, but only 2 of 15 did not need admission (P≤0.025). As well, influenza was diagnosed in 6 of 12 children who suffered acute respiratory illness leading to school absenteeism (including hospitalization), but diagnosed in no children without this degree of illness (P≤0.25). Influenza significantly increases the incidence of hospitalization and of less serious respiratory illness in children with CF, a finding which suggests that influenza vaccine efficacy studies are necessary in this group.
Effect of fetal haemoglobin on the accuracy of pulse oximetry in preterm infants
Authors: RAJADURAI V. S. , WALKER A. M. , YU V. Y. H. , OATES A.
Published: March 2008

Abstract Pulse oximeters are programmed with a calibration curve derived from studies done in adults. Whether fetal haemoglobin levels affect their reliability is unclear. This study reports the accuracy of pulse oximetry in 22 preterm infants (mean 31 weeks, range 25–36 weeks gestation) between 1 h and 73 days of age. Oxygen saturation obtained from a Nellcor N‐200 pulse oximeter (SpO2) was compared with simultaneous arterial values (functional SaO2) measured by a Radiometer OSM3 Hemoximeter over a SpO2 range of 83–99%. Fetal haemoglobin (HbF), carboxyhaemoglobin (HbCO) and methaemoglobin (HbMet) measured by the hemoximeter ranged between 0–100%, 0–3.5% and 0–0.8% respectively. Linear regression analysis revealed a close correlation between SpO2 and functional SaO2 (SpO2= 0.75 SaO2+ 24.43, r = 0.88, (P<0.001) over a wide range of values for PCV, heart rate, blood pressure, PaO2. PaCO2 and pH. The mean SpO2‐SaO2 difference of 1.3, (s.d. 2.5%, P(0.001) was unaffected by HgF, HbCO or HbMet but was increased in infants receiving inotropic support. We conclude that the Nellcor N‐200 pulse oximeter gives reliable oxygen saturation measurements unaffected by the HbF level in preterm infants.
Association of N‐myc amplification with neuroblastoma: The Australian and New Zealand experience
Authors: TELFORD D. J. , KAVALLARIS M. , WHITE L. , NORRIS M. D. , BRIAN M. J. , STEWART B. W.
Published: March 2008

Abstract Tumour samples from 38 patients with neuroblastoma were analysed for the presence of N‐myc amplification. N‐myc gene copy number in tumour DNA was determined by Southern blotting, and by dilution analysis where appropriate. Available clinical data, obtained at tissue collection and by subsequent questionnaire included patient age at diagnosis, catecholamine, ferritin and neuron‐specific enolase levels, treatment and disease status. This study was designed to investigate the use of N‐myc amplification data as an additional indicator for determination of prognosis. Patients with amplified N‐myc had more rapid disease progression than those without amplification (P<0.005). Stratification of Stage III and IV patients using N‐myc amplification permitted identification of a subgroup with poorer prognosis. The results demonstrate that determination of N‐myc amplification is important in assessment of prognosis and subsequent treatment in patients with neuroblastoma.
Tracking relative weight in subjects studied longitudinally from ages 3 to 13 years
Authors: KELLY J. L. , STANTON W. R. , McGEE R. , SILVA P. A.
Published: March 2008

ABSTRACT Heights and weights of a large sample of subjects studied longitudinally from ages 3 and 13 years were used to calculate relative weight, using a Body Mass Index score (BMI) which estimates adiposity. Males and females differed significantly in BMI scores only at ages 3 and 13 years. The correlations between BMI scores at all ages were positive and significant. The subjects were divided at each age into a ‘light’, an ‘average’ and a ‘heavy’ group based on the position of their BMI score relative to the 25th and 75th percentiles. Subjects were ‘tracked’ from ages 3,7 and 11 years to determine whether they had remained in the same BMI group by age 13 years relative to their peers. Slightly fewer than half of the 3 year old subjects but the majority of 7 and 11 year old subjects remained in the same relative weight group by age 13 years. Only 1% of 7 and 11 year old subjects in the top and the bottom quartiles for BMI scores shifted from one extreme group to the other. Relative weight at 3, 7 and 11 years was more persistent for subjects with extreme bodyweights than subjects with bodyweights in the middle range. Consistent with the pattern of correlations, the tracking pattern for all 3 groups showed that subjects' BMI scores remained more stable as the subjects grew older.
Normalization of Vitamin B12 absorption after ileal resection in children
Authors: OOI B. C. , BARNES G. L. , TAURO G. P.
Published: March 2008

ABSTRACT Impaired Vitamin B12 absorption after significant ileal resection has been reported to be permanent, although partial recovery after ileal bypass can occur. Three children are presented in whomVitamin B12 malabsorption returned to normal 6–8 years after ileal resection. This was due probably to adaptation of the remaining small bowel, although spontaneous resolution of bacterial overgrowth is a possible explanation. An abnormal Schilling test after ileal resection does not automatically imply the need for life‐long Vitamin B12 injections.
Breath hydrogen excretion in healthy premature infants
Authors: NICHOLSON L. M. , MITCHELL J. D. , GUPTA J. M.
Published: March 2008

ABSTRACT Breath hydrogen excretion during the neonatal period was studied on 84 occasions in 44 well premature infants of 27–37 weeks gestational age who all received lactose‐containing feeds. Only one of 15 infants studied during the first 24 h excreted hydrogen. Thereafter, the proportion of infants excreting hydrogen increased daily. From day 5 onwards all the infants studied were found to be excreting hydrogen. The concentration and the volume of hydrogen exhaled by infants ranged from 10–230 parts/106 and 2.6–107 μL/min, respectively. Breath hydrogen excretion was variable and showed no relationship to birth weight, gestation period, volume of feed or the time of last feed though there was an increase with the age of the infant. Breath hydrogen excretion appears to be a normal phenomenon in premature infants and is probably related to gut colonization with lactose fermenting organisms.
Immunodeficiency in methylmalonic acidaemia
Authors: WONG S‐N. , LOW L. C‐K. , LAU Y‐L. , NICHOLLS J. , CHAN M. Y‐P.
Published: March 2008

ABSTRACT Three Chinese infants with methylmalonic acidaemia were described. They presented in the neonatal period with recurrent episodes of poor feeding, lethargy, apnoea and severe acidosis. The diagnosis was established by increased methylmalonic acid concentration in the plasma and/or urine. Pancytopenia was a prominent feature in all three patients. Only patient three had assessment of lymphocyte subsets and it showed diminished population of B‐lymphocytes and a reversed CD4/CD8 ratio. All three patients were unresponsive to vitamin B12. They experienced severe infections including Gramnegative septicaemia, candidiasis and Pneumocystis carinii pneumonia which caused their deaths. Patients with this disease should be regarded as having severe immunodeficiency, and in addition to optimal metabolic control, they should be treated aggressively for any suspected infective episodes.
Report on the X‐linked lymphoproliferative disease in an Australian family
Authors: TURNER A. M. , BERDOUKAS V. A. , TOBIAS V. H. , ZIEGLER J. B. , TOOGOOD I. R. , MULLEY J. C. , SKARE J. , PURTILO D. T.
Published: March 2008

ABSTRACT X‐linked lymphoproliferative disease is characterized by immune deficiency, particularly to the Epstein‐Barr virus and by a tendency to develop fatal infectious mononucleosis, acquired hypogammaglobulinaemia or malignant lymphoma. This disorder has been diagnosed in three boys, two brothers and a maternally related cousin, residing in Australia. The proband presented at 6 years of age with fulminating infectious mononucleosis. His 9 year old male cousin had developed an ileal Burkitt lymphoma one year earlier. Immunological and molecular genetic evidence is presented to support our view that his younger sibling is also affected with this condition. DNA linkage studies using probes to DXS10 and DXS37 provide confirmatory evidence for the diagnosis in the proband's brother and information on carrier status in female family members.
Single daily dose ceftriaxone therapy in epiglottitis
Authors: KNIGHT G. J. , HARRIS M. A. , PARBARI M. , O'CALLAGHAN M. J. , MASTERS I. B.
Published: March 2008

Abstract Ceftriaxone as a single daily intravenous dose for 5 days was used to treat seven patients with proven Haemophilus influenzae epiglottitis. All children responded favourably. The serum levels achieved exceeded the MIC by up to 1500 times at the trough level during and for up to 24 h after the completion of the treatment. Side effects were mild and transient and did not disrupt the continuity of the treatment. Ceftriaxone potentially offers a number of clinical and economic advantages in the management of epiglottitis.
Motorcycling attitudes and behaviours. I. 12 and 13 year old adolescents
Authors: REEDER A. I. , CHALMERS D. J. , LANGLEY J. D.
Published: March 2008

Abstract The death and serious injury of adolescent motorcyclists is a major public health problem. Effective preventive strategies depend on knowledge about target populations. The attitudes and patterns of exposure to motorcycling of 730 13 year old New Zealand adolescents are described. Fifty‐two per cent could ride a motorcycle, a further 13% intended to learn, 22% had driven on‐road, and 60% had ridden as pillion passengers on‐road. Significantly more males than females were riders (P<0.001) and had ridden as pillion passengers (<P<0.05). More male than female non‐riders intended to learn (P< 0.001). Eighty per cent of the sample recognized road ‘accidents’ as the main cause of death for their peers, and 31% had known a motorcyclist killed or injured. Seventeen per cent of on‐road riders had not worn a helmet when last riding. Few statistically significant differences in risk perception were obtained between males and females or riders and non‐riders. Preventive options are discussed.
Cycling health beliefs, crash experiences and night cycling behaviour of 13 year olds
Authors: LANGLEY J. D. , WILLIAMS S. M.
Published: March 2008

Abstract The relationship of selected health beliefs to self‐reported crash experiences, cycling at night and the use of tail‐lights at night was examined for a sample of 730 13 year olds. The questions relating to cycling health beliefs were similar to those asked by Weinstein10 in his study of unrealistic optimism about susceptibility to a range of health problems. They included: vulnerability, worry, controllability, chance, barriers, seriousness, apprehension and safety. The majority of 13 year olds interviewed did not exhibit a strong optimistic bias regarding their vulnerability and skills as safe cyclists. In general the majority considered a crash involving a car would most likely be serious and only a minority said they were not worried about being involved in such a crash. In addition, the majority did not consider that crashes are a matter of chance or that there are significant barriers to adopting safety measures. They tended to consider the chances of being apprehended by a traffic officer for failure to use a tail‐light at night as being low. Overall the univariate analyses failed to show a consistent pattern of relationships between health beliefs and the two cycling behaviours. The same was true for crash experiences. The joint effects of beliefs and crash experience on the use of a light at night were examined using logistic regression. The results suggest that the health beliefs work in an additive way as far as boys are concerned, but that they have very little influence on the behaviour of girls. The model for boys suggests that the variables have a relatively small influence on behaviour.
Organ weight/bodyweight ratios: Growth rates of fetal organs in the latter half of pregnancy with a simple method for calculating mean organ weights
Authors: MITROPOULOS G. , SCURRY J. , CUSSEN L.
Published: March 2008

Abstract Ratios for major organ weights compared with bodyweights of 1023 stillborn and liveborn babies who lived less than 72 h are presented. The ratios were calculated for 2 week increments of gestational age from 20 to 43 weeks and clearly depict the relative growth of fetal organs during the last half of pregnancy. The ratios for heart and for kidneys were virtually constant for the whole period of gestation examined. The ratios for thymus and spleen increased between 20 and 30 weeks gestation and then became constant, although the ratio for the spleen dropped slightly during the last 6 weeks. The ratios for liver, lungs and adrenals decreased between 20 and 30 weeks gestation, and then steadied. The ratio for brain declined very slowly throughout the period examined. An observation of practical importance was that all organ weight/bodyweight ratios were virtually constant after 30 weeks gestation. Approximate mean organ weight/bodyweight ratios between 30 and 43 weeks gestation were: heart 0.007, lungs 0.02, spleen 0.003, liver 0.04, kidneys 0.01, adrenals 0.003, thymus 0.004 and brain 0.13. By multiplying the mean ratio by the total bodyweight, the approximate mean weight for a particular fetal organ can be calculated in situations where charts of normal organ weights are not at hand.
High cervical cord injury: Medical, nursing and psychosocial aspects of rehabilitation
Authors: STERN L. M. , CAMPBELL D. A. , HARTLEY E. W. , HOMAN S. R.
Published: March 2008

Abstract Two patients with traumatic high cervical cord injury are described. Both patients required long‐term ventilatory support. Diaphragmatic pacing has been successful in meeting their ventilatory requirements and improving their quality of life. Both patients are now living in their own homes. Their medical, nursing and psychosocial needs have been met by multi‐disciplinary team involvement and their ongoing support in the community.
A review of therapeutic monitoring of chloramphenicol in patients with Haemophilus influenzae meningitis
Authors: COAKLEY J. C. , HUDSON I. , SHANN F. , CONNELLY J. F.
Published: March 2008

Abstract Two hundred and seventy‐seven serum chloramphenicol concentrations in 90 patients with Haemophilus influenzae type b meningitis were analysed retrospectively. Most patients were given chloramphenicol 25 mg/kg 6 hourly initially. Chloramphenicol concentrations were categorized as pre‐dose (‘trough’) or post‐dose (‘peak’). Twenty‐six per cent of the results were in the potentially toxic range (above 30 mg/L), and 18% were below 10mg/L. Analysis of 46 pre‐ and post‐dose measurements showed that for the intravenous (i.v.) route of administration, 23% of the pre‐dose concentrations were higher than the corresponding post‐dose levels and, for the oral route, 42% of the pre‐dose levels were higher. Multivariate analysis of covariance demonstrated that chloramphenicol concentrations decreased significantly with increasing number of days of treatment and that the decline was steeper with i.v. administration. The results of this study emphasize the need for therapeutic monitoring of chloramphenicol concentrations, and suggest that chloramphenicol should be given as a loading dose of 40 mg/kg, followed by 25 mg/kg per dose 8 hourly for 3–4 days and then 6 hourly.
Familial cyanotic breath‐holding spells
Authors: SILBERT P. L. , GUBBAY S. S.
Published: March 2008

Abstract Breath‐holding spells can be a source of considerable parental anxiety and are a frequent cause of referral to paediatric services. This report is of a family of seven siblings all of whom have suffered breath‐holding spells, including three who developed breath‐holding spells within the neonatal period, with the other four developing them at 3–4 months of age. All of the children have on occasions exhibited convulsive activity at the termination of the episode. All had normal initial electroencephalogram's (EEG) and one had centrotemporal spikes on his EEG when repeated at age 6 years. Anticonvulsant therapy resulted in a reduced frequency of breath‐holding spells. The epidemiology, pathophysiology and therapy of breath‐holding spells is discussed with reference to this unique family. This report gives further credence to the notion that there often may be a familial predisposition to breath‐holding spells.
Aluminium absorption and antacid therapy in infancy
Authors: WOODARD‐KNIGHT L. , FUDGE A. , TEUBNER J. , SIMMER K.
Published: March 2008

Abstract The aim of this study was to determine whether infants absorb aluminium from antacid therapy. The study was conducted at Torrens House, a service provided by Child and Adolescent Health Services (CAFHS) for feeding and settling problems. Over an 11 week period, all patients receiving antacid therapy were studied. Patients not receiving antacids but of similar age acted as controls. Plasma and urine levels of aluminium were measured. The 15 infants receiving antacids had higher aluminium levels than the 17 controls (plasma 3.3±2.2 μmol/L vs 1.5±1.5 μmol/L, P<0.01; urine 25.1 ± 27.6 μmol/L vs 1.1 ±1.8 μmol/L, P<0.004). The response was variable with 50% of infants receiving antacids recording plasma aluminium levels previously associated with toxicity in patients with renal failure after chronic exposure to aluminium. We conclude that infants absorb aluminium from antacids and suggest that patients receiving antacids have their plasma levels monitored to identify those at possible risk of toxicity.
Service needs of children with disabilities and their families
Authors: HOLLINGSWORTH J.
Published: March 2008

Abstract A survey of 1527 families receiving the Child Disability Allowance was undertaken. There were substantial unmet needs for home help services, respite care and equipment. Satisfaction with services, particularly therapy, and respite care facilities was less than optimal. Many families also lacked knowledge about resources available to them. Improvement in the quality and availability of services is essential as is dissemination of information about available facilities.
Pathogenesis of Duchenne muscular dystrophy: The calcium hypothesis revisited
Authors: TAY J. S. H. , LAI P. S. , LOW P. S. , LEE W. L. , GAN G. C.
Published: March 2008

Abstract Rapid advances in the molecular genetics of Duchenne muscular dystrophy (DMD) and the discovery and localization of the gene product dystrophin has brought new hope that successful treatment for this disease may not be too far away. Dystrophin has been postulated to have a mechanical function, helping to resist stress associated with muscle contraction. The presence of dystrophin in low concentrations in muscle cells, its expression in nervous tissue and the observation that hypercontraction of the sarcomeres precedes membrane rupture make the hypothesis unlikely. On the basis of an analogy with a cytoskeletal protein ankyrin, which is associated with the sodium/potassium adenosine triphosphatase (ATPase) in the kidney, it is possible that dystrophin deficiency leads initially to an increased but inefficient calcium‐ATPase activity, which pumps calcium out of the cell. Partial failure of the pump would result in intracellular accumulation of calcium, hypercontractions of the sarcomeres, rupture of the cell membrane, massive influx of calcium and cell necrosis.
Parental perception of the effect of venepuncture in preschool children in non‐therapeutic research
Authors: LAU Y‐L. , YEUNG C‐Y.
Published: March 2008

Abstract Non‐therapeutic research in children is said to be justified in part if the risk involved is no more than minimal, but there is little information on the risk of venepuncture to make that judgement. This prospective study was carried out to assess the effect of venepuncture on 425 healthy children aged between 3.6 and 6.6 years old who participated in a non‐therapeutic research project. A parental questionnaire was sent out 1 month after the blood was taken. Three hundred and ninety‐one parents (92%) returned the questionnaires. Parental responses indicated the risk of complications was of the order considered to be minimal. A large majority of parents (78%) felt this experience would be helpful for the child if blood had to be taken again and a significant proportion (40%) felt the child would be more confident when going to see a doctor or dentist afterwards. Venepuncture in preschool children causes minimal harm and might even have some positive effects.
Alcohol burns in the neonate
Authors: WATKINS A. M. C. , KEOGH E. J.
Published: March 2008

Abstract The case histories of two infants who sustained chemical burns due to contact with alcoholic skin preparation solutions are presented. The skin permeability of the extremely low birthweight infant renders them susceptible to major burns following relatively brief exposure to such solutions. Care is needed in the selection and use of skin disinfection solutions in the neonatal nursery.
Itraconazole therapy for disseminated candidiasis in a very low birthweight neonate
Authors: BHANDARI V. , NARANG A. , KUMAR B. , SINGH M. , NAIR P. M. C. , BHAKOO O. N.
Published: March 2008

Abstract The management of a preterm neonate with systemic candidiasis using oral itraconazole is described. Oral itraconazole was well tolerated and effected a clinical and mycological cure.
Failure of allogeneic bone marrow transplantation to benefit HIV infection
Authors: GIRI N. , VOWELS M. R. , ZIEGLER J. B.
Published: March 2008

Abstract A 16 year old boy underwent allogeneic bone marrow transplantation (BMT) from an human leukocyte antigen (HLA)‐identical sibling for severe aplastic anaemia. He was symptomatic for 7 years before transplantation and had received multiple red blood cell and platelet transfusions. Conditioning for BMT consisted of cyclophosphamide, antilymphocyte globulin and total lymphoid irradiation. Engraftment was rapid, there was no evidence of rejection despite the history of multiple blood product transfusions and he did not develop acute or chronic graft versus host disease. He was well for the first 8 months after transplantation but then developed fevers, interstital pneumonia, herpes simplex infections and cytomegalovirus enteritis. Serological studies revealed antibodies to human immunodeficiency virus (HIV) and he was considered to have acquired immune deficiency syndrome (AIDS). Retrospective analysis of the serum samples showed that he was seronegative for HIV until approximately 10 months before transplantation when his serum became HIV positive. Lymphocyte function studies done after transplantation suggested immunologic recovery at 3 months post‐transplant with a brisk though subnormal response to phytohaemagglutinin stimulation. T cell subset analysis performed subsequently showed complete absence of CD4 positive cells indicating immune incompetence which was associated with clinical features of AIDS. Bone marrow transplantation had failed to produce sustained immunologic reconstitution and prevent the progression of HIV to which he ultimately succumbed.
The role of a saliva control clinic in the management of drooling
Authors: REDDIHOUGH D. , JOHNSON H. , FERGUSON E.
Published: March 2008

Abstract This paper describes a saliva control clinic which has been established at the Royal Children's Hospital, Melbourne. A team involving two speech pathologists, a paediatrician, a plastic surgeon and a dentist has assessed and managed 68 young people over a period of 2 years. Treatment options have included behavioural programmes, trial of oral appliances, medication and surgery. This multidisciplinary approach has been useful in developing assessment techniques and formulating recommendations.
A multicentre randomized placebo‐controlled double‐blind study on the efficacy of Ketotifen in infants with chronic cough or wheeze
Authors: VAN ASPEREN P. P. , McKAY K. O. , MELLIS C. M. , LOH R. K. S. , HARTH S. C. , THONG Y. H. , HARRIS M. , ROBERTSON I. F. , GIBBESON M. , RHODES L. , ZIEGLER J. B.
Published: March 2008

Abstract The efficacy of Ketotifen was examined in the treatment of 113 infants between 6 and 36 months of age presenting with a history of cough and/or wheeze in a multicentre randomized placebo‐controlled double‐blind study. A 4 week no‐medication baseline phase preceded the 16 week treatment phase in which infants took 2.5 mL twice daily of either placebo or Ketotifen (0.5 mg) syrup; this was followed by a 4 week wash‐out phase. Diary card evaluation was performed by the parent or guardian for the duration of the study and recorded wheeze and cough twice daily as well as medication used. The percentage of symptom‐free days decreased significantly in both groups (P<0.005) with placebo‐treated infants experiencing significantly more symptom‐free days compared with the Ketotifen group (P<0.01), although this difference was never more than 10% in any 4 week treatment period. Symptom severity scores and use of β‐agonist medication were also less in the placebo‐treated infants but did not reach statistical significance. This study was unable to show a therapeutic advantage of Ketotifen over placebo in this group of infants with chronic cough and/or wheeze and the apparent statistical advantage of placebo is not a clinically relevant finding.
Immunization status of Casualty attenders: Risk factors for non‐compliance and attitudes to ‘on the spot’ immunization
Authors: JONES K. , FASHER B. , HANSON R. , BURGESS M. , ISAACS D. , JOSHI P. , BLANCH R. , BYRNE J.
Published: March 2008

Abstract Outbreaks of vaccine preventable infections have focused attention on ‘missed opportunities’ for immunizing children. The immunization status of 520 consecutive children attending Casualty during a 10 day period was studied. Only 70% of children had received their diphtheria, tetanus, pertussis (DTP) and poliomyelitis immunization at the appropriate time, 13% had completed the schedule later than recommended and 17% had immunizations overdue by 4 weeks or more. For measles (mumps/rubella) vaccine (MM or MMR) 75% were up to date, 10% were given late and 15% were overdue.

A subset of 171 families was interviewed to evaluate factors affecting compliance. Families possessing a Social Security ‘Health Care Card’, whose father was unemployed, who spoke poor English or who had lived in Australia for 5 years or less were significantly more likely (P<0.02) to be inadequately immunized. There were 84 children whose immunization was overdue and who were well enough to be immunized. The parents of 70 (83%) of these 84 said that they would agree to ‘on the spot’ immunization if it were available; 14 (17%) parents refused, the commonest reason for refusal being that the parents felt that the child was too sick at the time to be immunized.
HomeLog: Long‐term recording of infant temperature, respiratory and cardiac signals in the home environment
Authors: FORD R. P. K. , BROWN P. J. , DOVE R. A. , TUFFNELL C. S. , MACEY P. M.
Published: March 2008

Abstract There is increasing evidence that overheating is a contributing factor for some cot deaths. The authors' hypothesis is that infant thermoregulation is closely related to respiratory control. HomeLog is a system built to investigate the developing thermal, respiratory and cardiac behaviour of infants in the home environment over several weeks. HomeLong is based on a modified laptop computer. Signals recorded include body temperature (from rectal and various skin sites), ambient temperature, thoracic impedance, abdominal movement and electrocardiogram (ECG). Continuous night‐time recordings have been made for up to 6 weeks from infants between 1 and 4 months of age, in their own cots, in their own homes. Various time and frequency domain analyses of the breathing and temperature data have been developed. Analysis of breath rate variability and of body temperature fluctuations has confirmed sleep/weke changes. In addition, a periodic oscillation of body temperature every 1–2 h has been found, which closely matches oscillations of breath rate variability.
Stillbirths, neonatal and post‐neonatal mortality by race, birthweight and gestational age
Authors: KLIEWER E. V. , STANLEY F. J.
Published: March 2008

The birthweight and gestational age specific mortality of singleton Aboriginal and White infants born in Western Australia during the period 1980–86 is described. The analyses are based on the approximately 8000 Aboriginal and 143000 White births notified through the Western Australia Midwives' system, which were linked to perinatal and infant death records. Overall, stillbirth, neonatal and post‐neonatal mortality risks were significantly higher (P<0.01) for Aboriginals than Whites. However, for specific birthweights and gestational ages, particularly for infants of lower birthweight and shorter gestations, Aboriginals had lower mortality risks than Whites. The ratio of Aboriginal to White mortality risks tended to increase with advancing age of death, suggesting that longer exposure to the well‐documented poorer social and environmental conditions of Aboriginal infants increased the mortality risk.
Chronic diaphragmatic pacing in a quadriplegic boy
Authors: GORTON S. , BURKE C. , APPLETON D. B.
Published: March 2008

Diaphragmatic pacing is a method of long‐term artificial ventilation that is preferable to other forms of ventilation in suitable patients. Its use is described in a 14 year old quadriplegic boy who was previously hospital dependent and required continuous positive pressure ventilation.
Non‐traffic child pedestrian injuries
Authors: ROBERTS I. , KOLBE A. , WHITE J.
Published: March 2008

Abstract All non‐traffic child pedestrian deaths and injuries resulting in hospitalization in the Auckland region over a 5 year period were identified from coroner's and hospital records. There were eight deaths (0.77/100000 children per year) and 91 hospital admissions (8.7/100000 children per year). Close to half (48%) of the non‐traffic pedestrian injury admissions had been misclassified as traffic pedestrian injuries. Eighty‐seven per cent of the non‐traffic pedestrian injury deaths and 93% of the injuries occurred in residential driveways, most often involving a child run over by a reversing vehicle. Further studies are required to determine the most effective strategies for the prevention of non‐traffic child pedestrian injuries.
A clinical audit of cotside blood glucose measurement in the detection of neonatal hypoglycaemia
Authors: REYNOLDS G. J. , DAVIES S.
Published: March 2008

An evaluation of the use of cotside blood glucose measurement by BM Reflolux was undertaken as part of a unit audit programme. During the study period, 383 paired samples were obtained for both cotside and laboratory analysis. There were 328 results from the cotside which were less than 4 mmol/L. Cotside measurements consistently underestimated laboratory measurements but the differences were not related to age, gestation, weight or haematocrit. The difference between cotside measurements and laboratory results was greater at lower blood glucose values. Confidence and prediction intervals of blood glucose values from cotside measurement suggest that this technique is not reliable for the diagnosis of hypoglycaemia in the newborn. Indiscriminate and uncontrolled use of cotside glucose monitoring should not be relied upon for clinical management.
An old traditional herbal remedy for neonatal jaundice with a newly identified risk
Authors: YEUNG C. Y. , LEUNG C. S. , CHEN Y. Z.
Published: March 2008

Yin‐chen (Artemisia scoparia) is a very popular intravenous herbal preparation used for the treatment of neonatal jaundice in China. Bilirubin‐protein titration studies with the horse radish peroxidase method have shown that the herb is highly effective in displacing bilirubin from its protein binding. Free bilirubin is liberated in this process and this could increase the risk of brain damage in jaundiced infants. With the present state of knowledge, the use of traditional herbal therapies should be strongly discouraged in neonates.
Red‐back spider bites to Perth children, 1979‐1988
Authors: MEAD H. J. , JELINEK G. A.
Published: March 2008

The aim of this study was to describe the pattern of illness caused by red‐back spider bites to children in Perth, Western Australia, over a 10 year period, and to compare it with that in adults. The case‐notes of 241 (89%) of the 271 children admitted to Princess Margaret Hospital and Fremantle Hospital with suspected red‐back spider bite from 1979 to 1988 were available for analysis. A definite bite was defined as a definite bite by a positively identified red‐back spider, positive identification of a red‐back spider with no definite bite but the later development of typical symptoms or no definite history of red‐back spider bite but strong clinical evidence and complete recovery after administration of antivenom. Systemic envenomation was accepted if there were symptoms of vomiting, generalized pain or sweating, or abdominal pain.

Sixty‐five per cent of children were definitely bitten. As found in previous adult and mixed studies, there was a peak incidence in the warmer months with a male preponderance (68%); 81% of bites were to the extremities and 83% of bites occurred in the daytime. The syndrome produced in children was usually similar to that seen in adults.

Twenty‐one per cent of children received antivenom, a rate comparable to previous studies in older age groups; however, no child received more than one ampoule. Compared with data extracted from a previously published study at Fremantle Hospital, in which 37% of adults treated with antivenom received more than one ampoule, these findings suggest that contrary to current opinion children may not be at an increased risk of morbidity from latrodectism.
Marden‐Walker syndrome in two siblings
Authors: CHIA F. L. , CHIA F.
Published: March 2008

Two siblings are reported who have features of the Marden‐Walker syndrome. They have congenital joint contractures, camptodactyly, talipes equinovarus, abnormal facies, global delay in developmental milestones, hypotonia and failure to thrive. About 20 cases have been reported in the world literature. A summary of some of the cases is presented. This syndrome appears to be an autosomal recessive trait in some families.
Transient congenital hypothyroidism due to maternal thyrotrophin binding inhibiting immunoglobulin
Authors: SCHWINGSHANDL J. , DONAGHUE K. , LUTTRELL B. , COWELL C. , WARD P. , SILINK M.
Published: March 2008

Transient congenital hypothyroidism due to maternal thyrotrophin binding inhibitor immunoglobulin (TBII), a thyroid‐stimulating hormone (TSH)‐receptor blocking antibody, is described in three male siblings born to a mother with autoimmune thyroiditis. These cases are believed to be the first described in Australia. The first child was found to have a serum TSH of 565 mU/L and had a negative thyroid scan when presented for neonatal screening. He was treated with thyroxine but became thyrotoxic at 3 months of age when he was on a dosage of 85 μg/m2 of body surface area. He was euthyroid 6 months after discontinuation of therapy. Nine years later a second hypothyroid sibling was born, with a serum TSH of 709 mU/L on day 4. Both mother and child were demonstrated to be strongly positive for TBIl. Again this child was able to cease therapy by the age of 9 months. A third sibling, also TBIl positive, was born 12 months after the second. His TSH was 90 mU/L and his serum thyroxine (T4) was 169 nmol/L. On this occasion, thyroid stimulation‐blocking antibody was found to be present in the serum of both mother and child. Thyroxine therapy was ceased at 1 month. The family present a picture of varying degrees of transient neonatal hypothyroidism due to the transplacental passage of a maternal receptor blocking antibody. The condition is self‐limiting, resolving when the immunoglobuiin is cleared from the infant's circulation.