bluuebunny/crossref_metadata_2025 huggingface dataset:
Ventricular septal defect and sudden death in early childhood
Authors: BYARD R. W.
Published: March 2008

A 21/2 year old boy collapsed at home and was taken immediately to the local hospital in cardiorespiratory arrest where attempted resuscitation was unsuccessful. At autopsy, massive cardiomegaly was found associated with a large membranous ventricular septal defect. There was also an early acute bronchopneumonia. Although growth parameters indicated failure to thrive, no specific health problems had been noted by the family apart from an apparent mild ‘upper respiratory infection’ prior to death. While the occurrence of sudden and unexpected death in cases of undiagnosed isolated ventricular septal defect has not been emphasized in the literature, this case demonstrates that sudden death may be a problem in early childhood. This is particularly so in cases of untreated large defects with cardiomegaly when additional stresses such as acute infection occur.
Hydrocephalus ex vacuo and clasp thumb deformity due to congenital cytomegalovirus infection
Authors: FRASER S. H. , O'KEEFE R. J. , SCURRY J. P. , WATKINS A. M. C. , DREW J. H. , CHOW C. W.
Published: March 2008

A case of congenital hydrocephalus in a male infant with flexion deformity of the thumbs and great toes is reported. A maternal uncle had undefined intellectual impairment and X‐linked hydrocephalus was considered among the differential diagnoses. However, this diagnosis was considered unlikely as the pyramids were preserved at autopsy. In addition, postmortem histopathology and viral culture established cytomegalovirus (CMV) infection as the underlying cause of the hydrocephalus. Although CMV infection is a well recognized cause of congenital hydrocephalus, the associated flexion deformities of the thumbs and great toes have not been previously described and may reflect injury to the corticospinal tracts.
Survey on developmental‐behavioural training experiences of Australian paediatric advanced trainees
Authors: CHEE K. Y. , SIMPSON J. M. , HUTCHINS P.
Published: March 2008

In order to monitor whether paediatric education has adapted to meet modern practice 91 paediatric advanced trainees were surveyed to elicit their satisfaction with developmental‐behavioural (DB) training. A response of 69% was obtained to a postal questionnaire. The traditional imbalance persists, with trainees considering themselves significantly better informed in the medical disciplines (P>0.001). Satisfaction with training in the 14 developmental disciplines surveyed is less (P>0.001) and significantly more variable compared with 11 traditional medical disciplines (P>0.01). Formal rotations in DB disciplines had been received by all respondents by the 7th year of training. However, 46–67% consider themselves ill‐informed in learning/school problems, attention‐deficit hyperactivity disorder, adolescent problems, paediatric rehabilitation and language impairment. Thirty‐seven per cent found formal postgraduate instruction unhelpful. Paediatric advanced training gives exposure to, but unsatisfactory formal education, in developmental and behavioural paediatrics. Current initiatives for mandatory DB training have serious implications for achieving adequate resources and standards to meet clinical and training demands.
Myoclonic encephalopathy of infancy: A 10 year review
Authors: NISSEN M. D. , APPLETON D. B.
Published: March 2008

Myoclonic encephalopathy of infancy (MEI) is a unique cause of acute ataxia in infants and is a rare presentation of neuroblastoma. Five cases presenting to a tertiary referral children's hospital during a 10 year period are reviewed. Two cases were associated with a neuroblastoma. All children were treated with intramuscular injections of adrenocorticotropic hormone, with symptomatic improvement. One child died from an opportunistic infection following chemotherapy for neuroblastoma. The four survivors have mild to moderate clinical and intellectual deficits. Investigation and continuing observation for occult neural crest tumours is emphasized for all cases of MEI, though no underlying cause was found in 60% of children in this study.
Analysis of paediatric tumour types associated with hemihyperplasia in childhood
Authors: SMITH P. J. , SULLIVAN M. , ALGAR E. , SHAPIRO D. N.
Published: March 2008

In order to further explore the relationship between hemihyperplasia in children and the occurrence of embryonal tumours of childhood, the records at St Jude Children's Research Hospital were examined for patients who presented with a malignant tumour and hemihyperplasia. Of 27 evaluable patients, 19 had Wilms' tumour and one had massive bilateral nephroblastomatosis. The tumours were more likely to occur on the side affected by hemihyperplasia than to be found contralaterally. All but five of these patients developed the tumours before, the age of six. Twenty‐two of the 27 patients developed tumours associated with allelic loss on chromosome band 11p15, suggesting that the locus associated with hemihyperplasia may be also located at chromosome band 11p15.
Urinary N‐acetyl‐beta‐D‐glucosaminidase excretion in term and preterm neonates
Authors: TSUKAHARA H. , HORI C. , TSUCHIDA S. , HIRAOKA M. , SUDO M. , HARUKI S. , SUEHIRO F.
Published: March 2008

Urinary N‐acetyl‐beta‐D‐glucosaminidase (NAG) excretion was measured in term and preterm neonates on days 1, 4, 7, 14 and 28 of life. Urinary NAG showed a peak level on day 4 or 7 in these infants. In addition, it tended to be higher with the degree of prematurity. In sick preterms who were depressed at birth and had respiratory failure, the NAG activity was further elevated during the first 2 weeks, suggesting the presence of renal tubular injury in this period. These observations thus suggest that urinary NAG may be a sensitive measure of renal maturation or damage in neonates.
Pulmonary thromboembolism and unexpected death in infancy
Authors: CHAMP C. , BYARD R. W.
Published: March 2008

Review of the Department of Histopathology autopsy files over a 30 year period from 1962 to 1991 revealed only three cases in which unexpected death occurred in infants under 1 year of age due to massive pulmonary thromboemboli. Predisposing factors included necrotizing enterocolitis with gut perforation and sepsis, a ventriculoatrial shunt and idiopathic arterial calcification. Diagnosis of the latter autosomal recessive condition was only made at autopsy. These cases demonstrate that pulmonary thromboembolism is a possible, although exceedingly rare, cause of sudden infant death, that some predisposing factors are unique to infancy and that the source of the pulmonary thromboembolus may be difficult to determine at autopsy. Massive pulmonary thromboembolism in infancy may point to the presence of other significant clinically‐unsuspected, disorders.
Effects of nasal continuous positive airway pressure on apnoea index and sleep in infants
Authors: McNAMARA F. , HARRIS M‐A. , SULLIVAN C. E.
Published: March 2008

Objectives: We examined the effectiveness of nasal continuous positive airway pressure (CPAP) for treatment of sleep apnoea in infants.

Methodology: We studied five infants who all had significant central and mixed apnoea and severe sleep fragmentation. Polysomnographic recordings were performed on 2 consecutive nights in these infants. One night was used as a control study and during the second night nasal CPAP was applied throughout the night

Results: Nasal CPAP significantly reduced apnoea in each infant, with the apnoea index (apnoeas/h) decreasing from 65.6± 14.6 during the control study to 10.5± 14.6 during CPAP in non‐rapid eye movement (non‐REM) sleep, and from 106± 13.9 during the control study to 26.6± 13.9 during CPAP in REM sleep. Nasal CPAP also improved the sleep fragmentation markedly; REM sleep increased from 14.2± 1.2% of sleep during the control study to 27.1 ± 1.2% of sleep during CPAP.

Conclusions: We conclude that nasal CPAP is an effective treatment for infantile apnoea. Sleep apnoea in these infants is associated with profound sleep fragmentation, which is reversed by nasal CPAP.
Parental asthma knowledge: Its association with readmission of children to hospital
Authors: HENRY R. L , COOPER D. M. , HALLIDAY J. A.
Published: March 2008

Objectives: To assess whether poor parental knowledge about asthma was a risk factor for readmission of their children to hospital.

Methodology: Parents of children who were admitted to the paediatric facility at Newcastle Mater and John Hunter Hospitals were administered a previously validated asthma knowledge questionnaire with a maximum possible score of 31.

Results: The mean parental knowledge scores for three groups of children were determined: those with a previous diagnosis of asthma being readmitted to hospital (170 children, mean score 18.3); those with a previous diagnosis of asthma being admitted for the first time (114 children, mean score 17.2); and children being admitted with their first attack of asthma (65 children, mean score 15.6). There was a significant difference in parental asthma knowledge between the first and third group (P<0.001) but not between the first and second group. A linear regression model with knowledge score as an outcome found that increased knowledge was associated with previously diagnosed asthma, higher parental occupation and no smoker in the home.

Conclusions: Knowledge was poor in all groups. Readmission rate was related to the severity of the child's asthma.
Clinical manifestations and outcome of Haemophilus influenzae type b disease
Authors: GILBERT G. L. , JOHNSON P. D. R. , CLEMENTS D. A.
Published: March 2008

Objectives: To document clinical manifestations, laboratory findings and outcome of childhood Haemophilus influenzae type b (Hib) infections.

Methodology: Medical records of 235 children with Hib disease admitted to hospital during a 2 year period were reviewed; additional information was obtained by questionnaire and follow up 6 weeks after discharge.

Results: Three‐quarters of patients presented with either meningitis or epiglottitis. Children with epiglottitis were older, had shorter illnesses and were less likely to have had antibiotics before admission than those with meningitis; 38% of the latter had been given some antibiotic therapy, with no apparent effect on the outcome. Fever persisted for 7 days or more in 23% of patients with meningitis. Death from meningitis occurred in 3.8% of patients and was due to fulminating disease.

Conclusions: These data will assist in recognition and appropriate management of Hib disease as the clinical manifestations become less familiar following the introduction of immunization. Specific laboratory diagnosis is required for accurate surveillance, which should be maintained in order to ensure high immunization rates.
The prevalence of respiratory symptoms in South Australian preschool children. II. Factors associated with indoor air quality
Authors: VOLKMER R. E. , RUFFIN R. E. , WIGG N. R. , DAVIES N.
Published: March 2008

Objectives: This study investigated the relationship between indoor air quality and the prevalence of respiratory symptoms in South Australian preschool children.

Methodology: Data were collected from 14124 families with a child aged 4 years 3 months to 5 years of age. This sample represents 73% of the targeted State preschool population. At the time of a routine preschool health check, parents completed a questionnaire regarding: their child's respiratory health and place of residence (postcode), parental smoking, type of fuel used for cooking and heating and method used for home cooling.

Results: For preschool children residing in the greater Adelaide region, logistic regression analyses found that having a natural gas stove compared to an electric stove was significantly associated with increased prevalence rates for: (i) asthma (odds ratio [OR] 1.24); (ii) wheezing in the preceding 12 months (OR 1.16); excessive colds (OR 1.14); and hay fever (OR 1.13). The use of a liquid petroleum gas stove compared to an electric stove was not associated with any respiratory symptoms‐ The use of a flueless gas heater compared to other forms of heating was significantly associated with increased prevalence rates for dry cough (OR 1.26), ever having wheezed (OR 1.15) and wheezing in the preceding 12 months (OR 1.18). The use of a wood fire/heater compared to other forms of heating was significantly associated with a reduced prevalence rate for dry cough (OR 0.84) and ever having wheezed (OR 0.82). Parental smoking was significantly associated with increased prevalence rates for bronchitis (OR 1.21) and ever having wheezed (OR 1.24). The form of home cooling used was not associated with prevalence rates, after accounting for geographic location. Socio‐economic status (postcode level) was not generally associated with prevalence rates.

Conclusions: These results suggest that respiratory symptom prevalence is related to the fuel used for cooking and heating and parental smoking. Prospective investigation regarding indoor air quality and respiratory symptoms is required.
Improving asthma documentation in a paediatric emergency department
Authors: TEO S. , HANSON R. , van ASPEREN P. , GILES H. , FASHER B. , DAVIS A. M. , KRISTIDIS P.
Published: March 2008

Objectives: To improve documentation for children presenting to the Emergency Department (ED) of The Children's Hospital with acute asthma.

Methodology: In phase I, the documentation process was analysed using a standard total quality management (TQM) approach to identify specific problems leading to poor documentation. Fifty‐two medical records of children presenting over a 3 week period were reviewed for nursing and medical documentation. A set of minimum criteria, consistent with the Paediatric Asthma Management Plan, were established for documentation by both medical and nursing staff. Following dissemination and education, compliance with documentation was evaluated and compared to an asthma survey performed in the ED in 1991. In phase II, a specific proforma for medical assessment was developed and 80 medical records of children presenting over a 3 week period were reviewed. Fifty‐two (65%) with completed proformas were evaluated. The outcome measure was the documentation rate for minimum criteria established by TQM process.

Results In phase I, nursing compliance with documentation ranged from 46% for signs of respiratory distress to 83% for a past history of asthma and 100% for pulse rate. Doctors were similarly poor at documenting essential elements such as severity (31%), palpable pulsus paradoxus (29%), the child's usual doctor (46%) and follow‐up arrangements (21–56%). In phase II, the documentation of the severity of acute asthma (42%) and of the child's usual doctor (42%) remained poor but there were statistically significant improvements in documentation of interval medications, palpable pulsus paradoxus, respiratory rate, pre‐treatment oximetry, education, follow‐up arrangements and communication letters.

Conclusion The process of TQM has proved valuable in improving some aspects of documentation of children presenting to ED with acute asthma. It remains to be shown whether improved documentation will result in improved outcome.
Recommended body mass index cutoff values for overweight screening programmes in Australian children and adolescents: Comparisons with North American values
Authors: LAZARUS R. , BAUR L. , WEBB K. , BLYTH F. , GLIKSMAN M.
Published: March 2008

Objectives: Guidelines for screening children and adolescents for overweight have recently been published by a North American Expert Committee. As Australian clinicians might uncritically adopt these recommendations, we explore the consequences of applying North American body mass index (BMI) cutoff values to an Australian population.

Methodology The Australian BMI cutoffs were calculated using the methods recommended from height and weight data for 8492 schoolchildren aged 7‐15 years old.

Results Smoothed Australian BMI cutoffs were similar to those derived from the first United States National Health and Nutrition Examination Survey (NHANES‐I) values for whites. However, the NHANES‐I cutoffs would result in systematic misclassification. Among 7 year olds, the NHANES‐I 85th percentile cutoff would wrongly classify 4.6% of normal males and 9.1% of normal females as ‘at risk of overweight’. At age 14 years, the NHANES‐I 95th percentile cutoff would misclassify 3.5% of children as ‘overweight’ instead of ‘at risk of overweight’.

Conclusion Australian screening programmes should use BMI cutoffs appropriately derived from local measurements, and these are given for Australian children.
Somatosensory evoked potentials predict neurologic outcome in full‐term neonates with asphyxia
Authors: HARBORD M. G. , WESTON P. F.
Published: March 2008

Objectives: To investigate the ability of somatosensory evoked potentials (SSEP) to predict neurologic outcome in term neonates with birth asphyxia.

Methodology Upper limb SSEP were performed on nine infants of 1‐7 weeks of age who had perinatal asphyxia and an encephalopathy still present at 7 days of age. Comparison was made between the cranial ultrasound, electroencephalogram (EEG), SSEP and neurologic outcome at 9‐36 months.

Results Normal SSEP were found in four infants, all of whom were normal on neurologic follow up at 9‐12 months. Neonatal EEG performed on two out of four of these infants were also normal, while cerebral oedema was seen on cranial ultrasound in three of the four studies. No SSEP response was seen initially in three infants, all of whom had adverse outcomes (one death, two with spastic diplegia). In contrast, their neonatal EEG had shown normal background rhythms, while two of the three cranial ultrasounds revealed oedema. For two infants the initial SSEP was absent over one hemisphere and just present over the other. Both children were abnormal on follow up at 10‐12 months but did not have a hemiparesis.

Conclusions Upper limb SSEP appear more sensitive than EEG or cranial ultrasounds in predicting the short term neurologic outcome of neonates with asphyxia.
Upper and lower gastrointestinal complications with dexamethasone despite H2 antagonists
Authors: McDONNELL M. , EVANS N.
Published: March 2008

Objectives: To describe three preterm babies who developed gastrointestinal complications during treatment with dexamethasone for chronic lung disease, during a 10 month period.

Methodology Case reports in a tertiary neonatal intensive care unit.

Results All three babies had received intravenous cimetidine since the commencement of steroid therapy, and developed gastrointestinal complications. There was no evidence of necrotizing enterocolitis in either of the two babies with gastrointestinal perforation. This is the first report of lower gastrointestinal complications associated with dexamethasone therapy.

Conclusion Recommendation of concomitant use of H2 antagonists with steroid therapy may be premature, and requires testing with a randomized controlled trial.
Behavioural effects of hospitalization in children
Authors: WRIGHT M. C.
Published: March 2008

Hospitalization is a common occurrence in childhood. The behaviour of most children is affected during and/or after hospitalization. This annotation lists factors that have been found to be associated with adverse behavioural outcomes as a result of hospitalization. Ways in which these behavioural effects may be minimized are discussed, concluding with an indication of areas for further research.
Vitamin D deficiency in infants and young children born to migrant parents
Authors: PILLOW J. J. , FORREST P. J. , RODDA C. P.
Published: March 2008

Objectives: To determine the current modes of presentation for the development of nutritional vitamin D deficiency in Melbourne children.

Methodology A retrospective descriptive review was undertaken of the case records of children less than 5 years of age discharged from three Melbourne hospitals with a diagnosis of vitamin D deficiency or hypocalcaemia from January 1992 to January 1994.

Results The study identified 13 infants and young children whose hospital admission was related to nutritional vitamin D deficiency. Significant morbidity and a broad spectrum of biochemical and clinical features were noted at presentation. All children had migrant parents and were either exclusively or predominantly breast fed. Ten infants (77%) were less than 1 year at presentation. Associated deficiencies of iron and B12 were present in five cases. Of the five mothers tested, serum 25‐hydroxy vitamin D3 was low in four.

Conclusion Nutritional vitamin D deficiency is a continuing health problem in infants and young children born to migrant parents living in Melbourne. Paediatricians, obstetricians and general practitioners, particularly those managing women and infants from migrant communities, should be aware of this condition. Vitamin D supplementation to high‐risk women during pregnancy and to their infants should be considered.
Video‐assisted thoracoscopic surgery in the paediatric population
Authors: YIM A. P. C. , LOW J. M. , NG S. K. , HO J. K. S. , LIU K. K. W.
Published: March 2008

Objective: Video‐assisted thoracoscopic surgery (VATS) is now widely practised in adults but there are few publications on its application in the paediatric population.

Methodology: Retrospective review of the authors' experience with VATS in children under 16 years old during an 18 month period in a university teaching hospital.

Results: From September 1993 to March 1994, VATS was attempted in 14 patients. Five were unsuccessful because of pleural symphysis or inability to collapse the upper lung. Ten cases of VATS were successfully performed in the remaining nine patients (eight males, one female; age range from 22 days to 15 years old). These included two drainages and limited decortications for loculated pleural effusion, one guided drainage of pericardial effusion, one thymectomy for thymic hyperplasia, three wedge resections for metastatic pulmonary osteosarcoma and three bleb excisions and pleurodesis for primary spontaneous pneumothoraces. There were no intra‐operative complications. There was one death from dysrhythmia following an uneventful wedge resection. The mean duration of chest tube drainage was 1.4 days and postoperative hospital stay 2.6 days excluding two patients who stayed for further medical treatment.

Conclusion: VATS is a useful approach in selected cases but further development of this approach awaits refinement of anaesthetic technique and endoscopic instrumentation.
An epidemic of acute post‐streptococcal glomerulonephritis among Aboriginal children
Authors: STREETON C. L. , HANNA J. N. , MESSER R. D. , MERIANOS A.
Published: March 2008

Objective: To describe an epidemic of acute post‐streptococcal glomerulonephritis (APSGN) that occurred in Aboriginal children in three remote Aboriginal communities in Far North Queensland between July and October, 1993.

Methodology: Children at the communities aged between 2 and 14 years were screened so as to identify all cases of APSGN. Parenteral penicillin was administered to all 583 children who presented for the screening procedure.

Results: APSGN was diagnosed in 58 (10%) of the 583 children. A further 142 (24%) children had microscopic haematuria. Children aged 5‐8 years had the highest APSGN attack rate, and the highest prevalence of microscopic haematuria. Of all 583 children, 34% had skin sores, and group A streptococci (GAS) were isolated from 71% of the skin swabs. The prevalence of both skin sores and GAS were greater in the children with APSGN, and in those with microscopic haematuria, than in children with normal urine. A marked decline in the number of cases of APSGN occurred after the mass administration of penicillin.

Conclusions: The epidemic of APSGN was associated with GAS skin infections. The mass use of penicillin may have had an effect in reducing the transmission of the nephritogenic strain of GAS. Microscopic haematuria was a significant finding in many of the children, and further prospective studies are required to understand the significance of this finding.
Annotation Accidental death or sudden infant death syndrome?
Authors: BEAL SM , BYARD RW
Published: March 2008

Objective: To describe the reasons why it is difficult to decide whether to attribute some infant deaths to accidents or to SIDS.

Methodology To extract from infant deaths data in South Australia those where the cause of death is debatable.

Results The risks associated with rocking cradles, bed sharing, bedclothes, couch sleeping, unsafe cots or beds and the prone position are presented.

Conclusions : Uniform worldwide death scene investigations for all infant deaths should help identify unsafe sleeping conditions for infants.
Review Article Tongue‐tie
Authors: WRIGHT JE
Published: March 2008

Objective: To review the presenting features of tongue‐tie in childhood and indications for frenulotomy, drawing conclusions from a retrospective study of patients encountered in paediatric surgical practice and from the literature.

Methodology A disease index was kept enabling histories to be selected for analysis. All patients were seen by the author and all operations performed by the author or a registrar under supervision in a standard manner. Patients were reviewed 2 weeks after operation.

Results During 18 years of practice, 287 patients with simple tongue‐tie were encountered (two others with true ankyloglossia were not included in this study) and 158 frenulotomies were performed. The presenting symptoms were related to sucking or swallowing (13%), speech (32%), mechanical problems related to restricted tongue movements (14%) and to other problems (3%). In 38% the asymptomatic tongue‐tie was noted incidentally.

Conclusion It is concluded that there is no place for division of tongue‐tie without anaesthesia in the newborn. Speech difficulties related to tongue‐tie are over‐rated and mechanical problems are underestimated. The indications for frenulotomy include articulation difficulties confirmed by a speech pathologist, mechanical limitations such as inability to lick the lips, to perform internal oral toilet or play a wind instrument. There may be rare instances in infancy where problems with feeding and suction can be helped by frenulotomy but evidence for this is anecdotal. Operation requires general anaesthesia except in older, co‐operative teenagers in whom local anaesthetic is appropriate.
High frequency oscillatory ventilation: Initial experience in 22 patients
Authors: JOHNSTON D , HOCHMANN M , TIMMS B
Published: March 2008

Objectives: To report the outcome of a consecutive cohort of neonates treated with high frequency oscillatory ventilation (HFOV).

Methodology Prospective cohort study of 22 neonates failing conventional mechanical ventilation (CMV) between October 1992 and August 1993. Outcomes evaluated were in‐hospital survival rate, comorbidities including patent ductus arteriosus (PDA), cerebroventricular haemorrhages (CVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), and acute changes in respiratory status.

Results Eighteen of 22 (81.8%) survived. Of the four children who died, one did not respond to HFOV and died within 24 h of treatment. Two died of respiratory failure complicated by pulmonary haemorrhage. The remaining infant responded to HFOV but later developed severe NEC while on minimal CMV and died at 2 weeks of age.

Three subjects were ≥34 weeks' gestation; each responded well to HFOV with no substantial comorbidity. Of the remaining 19 infants <34 weeks' gestation, six (31.6%) had a PDA, and seven (36.8%) had a CVH. One infant developed cystic periventricular leucomalacia. Three infants (15.8%) had NEC. Respiratory failure in the 15 survivors with gestational ages <34 weeks improved dramatically with HFOV. Ten (66.7%) survivors <34 weeks developed BPD and 10 (66.7%) ROP.

Conclusion High frequency oscillatory ventilation was associated with a survival rate of 81.8%, but with significant comorbidity.
Risk factors for sensorineural hearing loss in extremely premature infants
Authors: LESLIE GI , KALAW MB , BOWEN JR , ARNOLD JD
Published: March 2008

Objective: To identify potentially preventable risk factors for sensorineural hearing loss (SNHL) in extremely premature infants.

Methodology A case control study of survivors with gestational age (GA) <28 weeks or birthweight (BW) <1000 g using data collected prospectively in our Neonatal Intensive Care Unit database. Each subject with bilateral SNHL >40dB was matched according to GA, BW and sex with two controls who had neither sensorineural nor conductive hearing loss.

Results Infants with SNHL had increased mean (±s.d.) days ventilated (53 ± 21 vs 37±23 days, P= 0.006) and in oxygen (107±44 vs 69±28 days, P= 0.02) compared with controls. The risk for SNHL was increased for infants who spent >90 days in oxygen (OR 4.0 [95% Cl 1.1‐15.6]), had maximum FiO2 >0.90 (5.6 [1.2‐26.9]), minimum plasma Na <125mmol/L (5.6 [1.1‐27.8] or maximum pH >7.60 (5.6 [1.1‐89.0]). Neither maximum serum bilirubin nor exposure to ototoxic drugs was associated with SNHL.

Conclusions: Avoidance of severe hyponatraemia and extreme alkalosis, as well as use of surfactant to minimize the severity of hyaline membrane disease, may result in a decreased incidence of SNHL in extremely premature infants.
Effect of a postural support nappy on ‘flattened posture’ of the lower extremeties in very preterm infants
Authors: MONTEROSSO L , COENEN A , PERCIVAL P , EVANS S
Published: March 2008

Objectives: To determine whether the use of a postural support nappy (PSN) would reduce the features of ‘flattened posture’ in the lower extremities of infants <31 weeks gestation who are nursed prone.

Methodology: Randomized, observer blind, controlled trial conducted at King Edward Memorial Hospital for Women, Perth, Western Australia. Infants were randomly assigned and stratified by gestational age to be nursed in a conventional nappy (n= 29) or a PSN (n= 31) when in the prone position. The features of ‘flattened posture’ were measured as angles and assessed by blinded observers prior to commencement of the intervention, 4 weeks post intervention, then bi‐weekly until discharge.

Results A significant reduction in the features of ‘flattened posture’ occurred in the PSN group after 4‐6 weeks of intervention and stabilized by 8 weeks until discharge. No changes were detected in the control group. No significant difference was observed between infants <29 weeks gestation compared to infants of 29‐30 weeks gestation in either treatment group.

Conclusions: Use of the PSN in infants <31 weeks gestation who are nursed in the prone position significantly reduces the features of ‘flattened posture’ in the lower extremities. This is of benefit in the short term, and follow up of these infants into childhood will demonstrate whether the long‐term effects of ‘flattened posture’ can be prevented.
Agnathia (severe microghathia), aglossia and choanal atresia in an infant
Authors: WALKER PJ , EDWARDS MJ , PETROFF V , WILSON I , TEMPERLEY AD , SEABROOK J
Published: March 2008

A neonate is reported here, who was born with severe mandibular hypoplasia, complete absence of the tongue, unilateral choanal atresia, contralateral choanal stenosis and developed severe airway obstruction at birth. Arrested development of the ventral first branchial arch most likely underlies the clinical deficits. Most reported cases of agnathia have been lethal but the infant reported here has survived into infancy with a tracheostomy and feeding gastrostomy. Her clinical features, assessment and management are discussed.
Health status of Victorian special school children
Authors: ACKLAND MJ , WADE RW
Published: March 2008

Objective

: This study sought to determine the health status and health needs of a sample of students attending special schools for the intellectually disabled in Victoria, Australia.

Methodology:

Two hundred and forty‐nine students not previously seen by a Community Child Health Medical Officer (CCHMO) were assessed at school. Data on student, parent and staff needs were obtained through personal interviews and documented on a standard questionnaire. Health status was documented using data obtained from parents and teachers as well as the clinical assessment.

Results:

Comparison of the number of problems reported by parents with the number confirmed at examination showed significant underreporting of vision, hearing and general medical problems. However, behaviour problems were nearly all reported. Many students had multiple problems with 63% having 2–4 problems and 11% having 5–8 problems. Ninety‐nine (40%) of the 249 children seen had newly detected problems; vision (24), hearing (24) and obesity (9) were the most common. Two hundred and forty‐four (98%) had known problems and 27% of these had insufficient information available from parents or staff to completely ascertain their health status. In 115 cases the primary problem was intellectual impairment of unknown cause. Down's syndrome was the next most common underlying diagnosis (30) followed by autism (24), epilepsy (21) and cerebral palsy (15). The most common secondary diagnoses were asthma (16), congenital heart defects (12), seizures (8) and skin problems (8). Many students required referral for further management both for newly detected problems (64%) and known problems (18%). Parents required counselling and/or discussion on a number of issues for both newly detected problems (66%) and known problems (39%); when counselling had taken place parent and staff concerns had reduced significantly by the time of the follow‐up assessment.

Conclusions:

This study demonstrates that in those students with known intellectual impairment there were many with other unrecognized health problems and unmet needs. These findings have implications for health services provided to children attending special schools.
Incomplete catch‐up growth in low birthweight Chinese infants in Hong Kong
Authors: LAM B , KARLBERG J , LOW LCK , YEUNG CY
Published: March 2008

Objective:

To describe the early catch‐up growth in length in Chinese low birthweight (>2500g) infants.

Methodology:

The infants (n= 181) were delivered between 1988 and 1993 and followed up at Queen Mary and Tsan Yuk Hospitals, Hong Kong. One third had a birthweight below ‐2SDS, most of whom were term or close‐to‐term babies small‐for‐gestational‐age (SGA). The remaining babies were appropriate‐for‐gestational‐age (AGA) in birthweight, but frequently born prematurely.

Results:

The SGA group did not show a catch‐up growth in height comparable to that reported on other recent studies, as 33–35% of the patients were still short at 6 and 12 months (7–12% for the AGA group). When comparing the postnatal mean growth curve of the SGA group with the mean curve of the AGA group there was little sign of catch‐up growth.

Conclusions:

The results showed that Hong Kong SGA infants have an incomplete catch‐up growth and for successful intervention the causative mechanisms have to be identified.
Perinatal mortality trends among South Australian Aboriginal births 1981–92
Authors: RODER D , CHAN A , PRIEST K
Published: March 2008

Objective:

To assess changes in perinatal mortality and risk factors for births to Aboriginal mothers in South Australia in 1981–92.

Methodology:

All 4013 singleton Aboriginal births in the South Australian perinatal data collection were included. Trends in proportions with specific maternal and infant characteristics, and perinatal mortality by year of birth, were investigated by logistic regression analysis.

Results:

Changes found included an increase in the proportions of mothers aged 35 years and over, preterm births and births of very low birthweight (>1500 g), but a decrease in the proportions of births to women under 20 years of age, and of births with a birth defect. There was no statistically significant change in the crude perinatal mortality rate nor in the risk of perinatal death after adjusting for risk factors.

Conclusions:

The perinatal mortality rate among Aboriginal births, which is three times higher than the rate for all South Australian births, is not declining, in contrast to the State rate overall. This highlights the need for a concerted approach to Aboriginal perinatal health.
Changing patterns of survival and outcome at 4 years of children who weighed 500–999 g at birth
Authors: TUDEHOPE DI , BURNS YR , GRAY PH , MOHAY HA , O'CALLAGHAN MJ , ROGERS YM
Published: March 2008

Objective:

To evaluate the impact of changing perinatal practices on survival rates and 4 year neurodevelopmental outcome for infants of birthweight 500–999 g.

Methodology:

The study was a tertiary hospital‐based prospective cohort study that compared survival, impairment and handicap rates between two eras, July 1977 to December 1982 (era 1) and January 1983 to June 1988 (era 2). All 348 live, inborn infants and 49 outborn infants of birthweight 500–999 g were prospectively enrolled in a study of survival and outcome. Rates of survival, neurodevelopmental impairment and functional handicap at 4 years were compared between eras. Perinatal risk factors for handicap were also compared between eras.

Results:

Four year survival rates for inborn infants 500‐999 g improved from 32.6% in era 1 to 49.2% in era 2 (OR 2.1, 95% CI 1.26‐3.48) but for outborn infants the improvement between 31.8% and 53.6% was not significant. There were significant improvements in survival for inborn infants in birthweights 800‐899 g and 900–999 g between study periods. The rates of functional handicap between the first and second eras (mild 10 vs 7%; severe or multiply severe 14 vs 16%) were not significantly different. Although the rate of cerebral palsy increased from 0 to 12% (P>0.01) other rates of impairment such as blindness 0 vs 3%, deafness 2 vs 2% and developmental delay 12 vs 11% did not change. The chance of a survivor being free of handicap remained unchanged at 78% and 76% for the two eras, respectively. Although the absolute number of intact survivors more than doubled (41 vs 83) so too did the number of severe or multiply severe handicapped survivors (7 vs 17). Multivariate logistic regression analysis for the entire study cohort revealed male gender, multiple birth, prolonged mechanical ventilation and cerebral ventricular dilatation but not birthweight or gestational age to be independently associated with severe or multiply severe handicap.

Conclusions:

The advances in neonatal intensive care for extremely low birthweight infants between July 1977 and December 1982 and January 1983‐June 1988 resulted in an increased number of non‐disabled survivors but had no impact on incidence of severe disability. The application of prediction of mortality or severe handicap to clinical practice has the potential to reduce the proportion and absolute number of severely handicapped survivors.
Use of simple clinical parameters to assess severity of bronchiolitis
Authors: MAI TV , SELBY AM , SIMPSON JM , ISAACS D
Published: March 2008

Objective

: To determine whether simple clinical parameters could be used to predict the severity of acute bronchiolitis and the need for supplemental oxygen therapy.

Methodology

: A prospective study, performed in a tertiary care paediatric hospital. Seventy‐one infants under 15 months of age with a clinical diagnosis of acute bronchiolitis were examined on admission. Clinical parameters were recorded, and each infant was re‐examined after approximately 12 and 24h. All infants were examined by one medical student and, when possible, by a doctor, the two being unaware of each other's findings. Parameters recorded included respiratory and heart rates and presence of wheeze, crackles, intercostal recession, sternal retraction and/or cyanosis. The outcome measure was the need for supplemental oxygen, as determined by the independent caring medical team, on the basis of pulse oximetry and clinical judgement.

Results

: Forty (56%) of the 71 babies required supplemental oxygen. All cyanosed babies required supplemental oxygen, but only 9 (21%) were cyanosed on admission. Intercostal recession (relative risk RR 2.55; 95% CI 1.28, 5.08) and sternal retraction (RR 1.60; 95% CI 1.06, 2.42) predicted the need for supplemental oxygen with moderate accuracy. Interobserver agreement was only fair for most parameters, but was poor for intercostal recession and good for cyanosis.

Conclusions

: Simple clinical parameters may help predict the need for oxygen therapy in acute bronchiolitis, although further studies are required to define suitable clinical criteria. Such criteria are extremely important in developing countries where oxygen is a scarce resource.
Antenatal and intrapartum factors associated with Sudden Infant Death Syndrome in the New Zealand Cot Death Study
Authors: STEWART AJ , WILLIAMS SM , MITCHELL EA , TAYLOR BJ , FORD RPK , ALLEN EM ,   NEW ZEALAND COT DEATH STUDY GROUP
Published: March 2008

Objective

: To describe the relationship between antenatal and intrapartum factors and sudden infant death syndrome (SIDS).

Methodology

: The New Zealand Cot Death Study was a 3 year case‐control study, with 485 infants who died from SIDS in the postneonatal period and 1800 randomly selected control infants. Data were obtained from obstetric records, parental interview and community nursing records.

Results

: This study confirms many of the antenatal and intrapartum risk factors for SIDS noted in studies from both the southern and northern hemispheres. After controlling for potential confounders, such as occupational group and marital status, significant inverse effects were noted for interpregnancy interval, birthweight and gestation. Other factors that retained a significantly increased risk of SIDS were: increasing parity, bacteriological evidence of urinary tract infection (UTI) (adjusted odds ratio 1.73, 95% CI 1.10–2.73); smoking antenatally (AdjOR 2.14, 95% CI 1.61–2.84); less than six antenatal checks attended (AdjOR 1.84, 95% CI 1.19–2.84); second stage of labour less than 16 min (AdjOR 2.06, 95% CI 1.35–3.14) and multiple birth (AdjOR 3.23, 95% CI 1.70–6.02). No interaction was observed between maternal haemoglobin and antenatal smoking. Interactions were tested for and not found between antenatal smoking and three antenatal risk factors (UTI, short second stage of labour and number of antenatal appointments). The only significant interaction between these three factors and three modifiable postnatal risk factors (prone sleeping, bed sharing and bottle feeding) was between bed sharing and fewer antenatal appointments. The risk of SIDS associated with bed sharing was greater among those whose mothers had fewer antenatal appointments.

Conclusions

: Although many of the previously identified antenatal and intrapartum risk factors for SIDS are confirmed, the risks of SIDS associated with obstetric factors are in general considerably lower than the risks associated with the four modifiable postnatal risk factors.
Prevention of early onset group B streptococcal sepsis in the newborn
Authors: VIGNESWARAN R , O'LOUGHLIN JA , McDONALD HM
Published: March 2008

: There is an urgent need for strategies to prevent early onset group B streptococcal sepsis in the newborn. The most effective mechanism is the identification of maternal carriers of the organism and interruption of transmission during labour. Vaginal culture is currently the most reliable method for the identification of carriers. Antibiotic prophylaxis for known carriers in labour has been demonstrated to be effective as standard management practice in a number of Australian institutions and is the best available strategy at this stage.
The epidemiology, mortality and morbidity of tuberculosis in Australia: 1850‐94
Authors: WILLIAMS HE , PHELAN PD
Published: March 2008

: The review covers the four major changes in the history of tuberculosis in Australia from 1850 to 1994. During the first 100 years there was no significant effective treatment. Mass miniature radiological chest screening and effective bacteriological examination of World War II army recruits resulted in reliable diagnosis. The Australian Tuberculosis Campaign 1948‐76 utilized the army experience for detection, and the use of specific treatment virtually eliminated the disease. Failure to maintain strict screening of high‐risk groups, especially immigrants, has led to a resurgence of tuberculosis as shown by an increase in notifications in adults and prevalence rates in secondary school children.
Play position is influenced by knowledge of SIDS sleep position recommendations
Authors: MILDRED J , BEARD K , DALLWITZ A , UNWIN J
Published: March 2008

Objective

: This study determined whether knowledge of sleeping in the prone position as a risk factor for sudden infant death syndrome (SIDS) influences caregivers' positioning of their infants for play and sleep.

Methodology

: One hundred caregivers attending Adelaide metropolitan Child Adolescent and Family Health Services (CAFHS) were surveyed by self‐administered questionnaire.

Results

: Ninety‐three per cent of parents reported that their knowledge of SIDS influenced infant positioning for sleep and 84% reported they never put their infant in the prone position for sleep. Thirty‐seven per cent reported that SIDS knowledge did influence play positioning and 26% reported never placing their infant prone for play. There was a significant association (P= 0.002) between the influence of SIDS knowledge on play positioning and avoidance of the prone position for play.

Conclusions

: Community educators may need to clarify that prone positioning for play is not a risk factor for SIDS and that it is desirable for infants to spend supervised wakeful time in the prone position.
Prevalence of Helicobacter pylori infection in asymptomatic children
Authors: HARDIKAR W , GRIMWOOD K
Published: March 2008

Objective:

To determine the prevalence of Helicobacter pylori infection in a sample of asymptomatic Australian children.

Methodology:

A prospective observational study, during a 3 month period, of consecutive children aged 0 to 14 years undergoing minor elective surgical procedures in a Day Surgical Unit at a Melbourne paediatric hospital. Subjects without gastrointestinal symptoms or a family history of peptic ulcers had sociodemographic data recorded and serum collected. Serum anti‐H. pylori immunoglobulin G antibodies were measured by an enzyme immunoabsorbent assay previously validated in children from the same population.

Results:

H. pylori antibodies were present in 21/147 (14.3%) children aged 3 months to 14 years. Prevalence was not influenced by age or sex, but was greatest in children whose parents migrated from developing nations and lowest in children with Caucasian Australian or Western European parents (25.8 vs5.9%; P>0.001). An inverse relationship between social class and infection was also observed (P= 0.02). Multivariate analysis demonstrated the father's ethnic background as the only significant independent risk factor for H. pylori infection (P= 0.002).

Conclusions:

Although seroprevalence of H. pylori appears to be lower in Australian children than in developing countries there are some ethnic groups at substantially greater risk for the acquisition of H. pylori infection and its complications.
Neonatal cholestasis in two siblings: A variant of Dubin‐Johnson syndrome?
Authors: KIMURA A , YUGE K , KOSAI K‐l , KAGE M , FUJISAWA T , INOUE T , YAMASHITA Y , NAKASHIMA E , KATO H
Published: March 2008

Objective

: Two Japanese brothers with neonatal cholestasis associated with pigment granules in the hepatocytes and hepatosteatosis were evaluated for the possible role of hepatosteatosis in the Dubin‐Johnson syndrome.

Methodology and results

The morphology of pigment accumulation and the laboratory data in these cases were examined. The elevation of urinary coproporphrin isomer I to more than 90% and the presence cholestasis resembled that in the Dubin‐Johnson syndrome, but the hypertriglyceridaemia (<1.13mmol/L as triolein) and the hepatosteatosis differed. Both infants were thought to have familial hypertriglyceridaemia. However, this diagnosis was difficult to confirm in the absence of data on the normal values of apolipoprotein and lipoprotein isomer for infants.

Conclusions

: A neonatal variant of the Dubin‐Johnson syndrome may account for the unusual findings in these infants.