bluuebunny/crossref_metadata_2025 huggingface dataset:
Avoidance of red blood cell transfusion in an extremely preterm infant given recombinant human erythropoietin therapy
Authors: YU V. Y. H. , BACSAIN M. B.
Published: March 2008

To avoid red blood cell (RBC) transfusions, recombinant human erythropoietin (rHuEPO) was given to an infant born at a gestation of 26 weeks and a birthweight of 830 g to parents who were Jehovah's Witnesses. The infant had hyaline membrane disease and required 52 days of assisted ventilation and 19 days of oxygen therapy. He received theophylline therapy for 61 days for recurrent apnoea and bradycardia. He developed bilateral intraventricular haemorrhage (IVH) and left‐sided periventricular leucomalacia (PVL). Intravenous rHuEPO was started on day 1 at 200 U/kg per day for 1 month followed by subcutaneous rHuEPO 400 U/kg three times a week for 6 more weeks, supplemented with Vitamin E, folic acid and iron. Blood sampling was kept to a minimum and non‐invasive blood‐gas monitoring was used consistently. Consequently, the estimated cumulative volume of blood loss from sampling was only 21 mL during his hospital stay. His haemoglobin (Hb) was 150 g / L at birth and this fell to below 100 g / L from day 25 onwards. His lowest leucocyte count was 3.6x109/L. He was discharged on day 83 with a Hb of 95 g/L, Hct of 29%, reticulocyte count of 2.8% and weight of 2400 g. At a postnatal age of 3 months, he had a Hb of 113 g/L. At 6 months, investigations showed: Hb 121 g/L, haematocrit 33%, reticulocyte 1% and a weight of 4.4 kg. He was readmitted to hospital once for an episode of vomiting and follow up to date showed developmental delay. Concerns remained whether the withholding of RBC transfusion in the infant was related to his IVH, PVL, prolonged recurrent apnoea and bradycardia and poor weight gain. Although rHuEPO therapy shows promise in reducing the need for RBC transfusions, its overall efficacy and safety remain to be proven and its routine use in preterm infants has to be weighed up against the potential benefits and risks of RBC transfusions.
Inguinal hernia in extremely preterm infants
Authors: YEO C. L. , GRAY P. H.
Published: March 2008

The prevalence of inguinal hernia during primary hospitalization was determined in 250 infants with gestational age 24–29 weeks. Fourteen per cent developed hernia, with prevalence significantly higher in boys than girls. Infants with respiratory distress syndrome and those requiring prolonged mechanical ventilation were significantly predisposed to the development of hernia. Male infants, especially those who required prolonged ventilatory assistance, were at greatest risk. This information may be used when counselling parents regarding complications of very preterm infants.
Factors adversely associated with breast feeding in New Zealand
Authors: FORD R. P. K. , MITCHELL E. A. , SCRAGG R. , STEWART A. W. , TAYLOR B. J. , ALLEN E. M.
Published: March 2008

Control data from 1529 infants studied in a multicentre case‐control study of sudden infant death in New Zealand were analysed to identify factors that might hinder the establishment and duration of breast feeding. Although 1300 infants (85%) were exclusively breast‐fed at discharge from the obstetric hospital, this fell to 940 (61%) by 4 weeks. Logistic regression was used to identify factors that might adversely influence breast feeding ‘at discharge’,‘at 4 weeks’ and the overall ‘duration’ of breast feeding.

When adjusted for confounding factors, not exclusive breast feeding ‘at discharge’ was significantly associated with: twin pregnancy, being a Pacific Islander, mother not bedsharing, subsequent dummy use, birthweight less than 2500g, heavy maternal smoking, not attending antenatal classes and mother less than 20 years old at first pregnancy. Mothers smoking more than 20 cigarettes a day were nearly twice as likeiy to not exclusively breast feed on discharge compared to those who did not smoke. A ‘dose response’ was apparent with the heaviest smokers having the least likelihood of establishing exclusive breast feeding.

Being exclusively breast‐fed at discharge but not ‘at 4 weeks’ was associated with: twin pregnancy, admission to a neonatal intensive care unit, subsequent dummy use and not being married. A shorter overall ‘duration’ of breast feeding was associated with maternal smoking, subsequent dummy use, mother not bedsharing, twin pregnancy, mother less than 20 years old at first pregnancy, low occupational status and not attending antenatal classes. These effects persisted when social and demographic factors, including birthweight, were taken into account.

This study showed that 31% of New Zealand women had smoked during their pregnancy. A concerted effort to achieve smokefree pregnancies would not only directly improve the health of mother and child but may enhance both the initiation and duration of breast feeding. The influence on the duration of breast feeding of both dummy usage and the mother sharing the bed with her infant needs to be explored further, as a causal relationship cannot be established from these data.
Insulin‐dependent diabetes mellitus in southern Chinese children: An overview
Authors: WONG G. W. K.
Published: March 2008

Thirty‐three southern Chinese children with insulin‐dependent diabetes mellitus (IDDM) were studied. The patients had a mean follow‐up of 5.2 years (range 1.2–8.2). The mean age of onset was 8.3 years (range 1.7–13.5). The mean duration of symptoms before diagnosis was 22 days. Ten patients (30%) presented with diabetic ketoacidosis at diagnosis. Only one patient (3%) was found to have thyroid microsomal antibodies and none was found to have hypothyroidism or hyperthyroidism. Incidence and prevalence were calculated from data recorded retrospectively and prospectively in a population‐based registry of IDDM. The prevalence in 1991 and 1992 was 8.3 per 100000 children under 15 years of age. The age‐standardized incidence of IDDM was 1.7/100 000 per year with the 95% confidence interval of 1.2–2.4/100 000 per year for children under 15 years of age during the years 1986–93. The incidence for males was 1.1/100 000 per year and for females, 2.4/100 000 per year.
integrated health and education input in the development of educational resources about asthma for schools
Authors: HENRY R. L. , GIBSON P. G. , VIMPANI G. V. , HAZELL J. , LEGGATT R. , MOWBRAY C. , THOMPSON S. , PINE J. , VALENTINE M. , JOYCE J.
Published: March 2008

The development of educational packages on health‐related topics has become common in school curricula. This paper describes an integrated health and education input in the development of an educational package about asthma for Year 8 high school students. Ownership and educational relevance of the package (ensuring its appropriateness for inclusion within the Personal Development/Health/Physical Education curriculum) was achieved by collaboration between teachers with an understanding of the principles of curriculum design and health professionals with content knowledge about asthma. The model used for the production of the package about asthma could be extended to other health topics.
Incidence of apnoea and bradycardia in preterm infants following triple antigen immunization
Authors: BOTHAM S. J. , ISAACS D.
Published: March 2008

Ninety‐seven preterm infants were immunized with diphtheria‐tetanus‐pertussis (DTP) prior to discharge from hospital. The mean gestational age at birth was 28.1 weeks (range 24‐34) and the mean age at immunization was 80.6 days (range 44–257). Nineteen (20%) infants developed apnoea or bradycardia within 24 h of immunization. The infants who developed apnoea and/or bradycardia had a younger gestational age at birth than those who did not (P= 0.03), were artificially ventilated for longer (P= 0.01) and were more likely to have a diagnosis of chronic lung disease (P= 0.006). In the majority of infants these events were not clinically significant. Two infants who developed concurrent upper respiratory tract infections required additional oxygen and one of them was treated with oral theophylline. In general, it is safe practice to immunize preterm infants with DTP unless otherwise contraindicated. However, it is recommended that cardiorespiratory function is monitored after immunization in very preterm infants who had prolonged ventilatory support and/or chronic lung disease.
Congenital Candida pneumonia in a preterm infant
Authors: NG P. C. , SIU Y. K. , LEWINDON P. J. , WONG W. , CHEUNG K. L. , DAWKINS R.
Published: March 2008

A 24 week gestation survivor of congenital Candida pneumonia who received prompt antifungal treatment and modern neonatal intensive care is reported. It was an unusual case in that fungal chorioamnionitis occurred without a foreign body in the maternal genital tract. Early diagnosis and treatment of congenital fungal pneumonia was possible because of prior knowledge of the obstetric history. Amphotericin B was successfully used for the treatment of this condition but combination with fluconazole (a fungistatic agent) was unsatisfactory and may be undesirable. Dexamethasone therapy to assist extubation was instituted once the fungal infection had been successfully controlled.
Predicting the outcome of symptomatic congenital cytomegalovirus infection
Authors: JONES C. A. , ISAACS D.
Published: March 2008

Abstract The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. Chorioretinitis occurs in 10–15% of symptomatic babies and almost always indicates significant mental impairment. Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. The mortality of symptomatic congenital CMV infection is about 30%.
Adherence to recommended medical regimens in childhood and adolescence
Authors: FOTHERINGHAM M. J. , SAWYER M. G.
Published: March 2008

Objectives:Factors that appear to influence treatment adherence among adults have been the focus of considerable research in recent years. However, less research has focused on children's treatment adherence. This paper reviews current knowledge about factors that appear to influence adherence among children and adolescents.

Methodology:Factors associated with adherence to medical regimens reviewed here include: (i) the psychosocial characteristics of children and their parents; (ii) the nature of the treatment regimen; and (iii) the relationship between health practitioners, parents and paediatric patients.

Conclusions:Issues for future research include: (i) the adherence of both children and their parents to children's treatment, and the allocation of responsibility for treatment adherence; (ii) the wide range of behaviours involved in regimen adherence should be acknowledged; patients' adherence to one aspect of their regimen should not be considered indicative of their overall adherence; and (iii) longitudinal studies are required to examine the causal relations between patient adherence and its antecedents.
The prevalence of respiratory symptoms in South Australian preschool children. I. Geographic location
Authors: VOLKMER R. E. , RUFFIN R. E. , WIGG N. R. , DAVIES N.
Published: March 2008

Objectives: This study was designed to ascertain the prevalence of respiratory symptoms in South Australian preschool children and to investigate the relationship between prevalence rates and geographic location.

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 State preschool population of that age. At the time of a routine preschool health check, parents completed a questionnaire regarding their child's respiratory health and place of residence (postcode).

Results: Results showed that the prevalence rates were as follows: (i) ever having chest wheezing 38.6%; (ii) chest wheezing within the preceding 12 months 25.2%; (iii) ever having asthma 22.5%; (iv) ever having a dry cough at night 33.7%; (v) ever having bronchitis or cough with sputum 55.3%; (vi) ever having hay fever 29.7%; (vii) prone to excessive head colds 32.6%; and (viii) ever having eczema 18.8%. Over 38% of parents claimed that winter was the season for the most frequent or severe attacks of wheezing and 31.7% claimed no seasonal difference. Winter was the season most associated with episodes of bronchitis (50.9%), with no seasonal difference in episodes for 29.8% of children. Prevalence rates differed by geographic location within South Australia and within the Adelaide metropolitan region.

Conclusion: This population‐based survey shows that over 22% of South Australian 4 to 5 year old preschool children have had (or continue to have) asthma. The study also documented the geographic distribution of respiratory symptom prevalence within South Australia.
Another outcome of neonatal intensive care: First year mortality and hospital morbidity
Authors: NIVEN G. R. , HARDING J. E.
Published: March 2008

Objectives: To determine first year mortality and hospital morbidity after neonatal intensive care.

Methodology: Cohort study of 6077 surviving infants inborn in one regional hospital in 1988. Nine hundred and eighty‐eight received neonatal intensive care and 103 were very low birthweight (VLBW).

Results For infants who required care in the neonatal intensive care unit (NICU), the relative risk of dying before their first birthday was 3.6 (95% confidence intervals [Cl] 1.5‐8.8). This increased risk was associated with low birthweight (LBW) rather than requirement for NICU care. Of all inborn survivors, 10.4% were readmitted to hospital in the first year and 2.4% more than once. The readmission rate was 20% for NICU survivors and 30% for VLBW infants. The risk of hospitalization was independently associated both with NICU admission (odds ratio 2.3, Cl 1.9‐2.9) and with VLBW (OR 1.8, Cl 1.1‐3.0). The NICU survivors also had multiple admissions and prolonged hospital stays.

Conclusions Both low birthweight and neonatal illness requiring intensive care are important indicators of continuing medical vulnerability over the first year of life.
Home oxygen management of neonatal chronic lung disease in Western Australia
Authors: SILVA D. T. , HAGAN R. , SLY P. D.
Published: March 2008

Objective: To describe the course and management of infants with neonatal chronic lung disease who were discharged home on low‐flow supplemental oxygen.

Methodology Retrospective case series in Western Australia.

Results Fifty‐six neonates born in the 6 year period 1987‐92 inclusive were discharged home on supplemental oxygen. The median gestational age was 27 weeks (range 22‐40), median birthweight 865 g (range 450‐3350), median oxygen flow rates 125 mL/min (range 30‐850). The median corrected age at discharge was 1 month (range term‐9.5) and this had decreased throughout the study period. Acute hospital readmissions were common (36 of 56, 64%). The majority of these admissions were for wheezing illnesses. Three infants died. The median corrected age at weaning from day oxygen was 4 months (range term‐33) and from night oxygen was 6 months (range 2‐38). Monitoring of oxygen saturation in air, in low‐flow oxygen and in the overnight sleep study were important non‐invasive guides in deciding when patients were ready for discharge, reducing the oxygen flow rate and when oxygen could be ceased, respectively.

Conclusions The home oxygen programme enables infants with neonatal chronic lung disease to be discharged home earlier, is safe, and well accepted by parents and community health care workers.
Has changing diagnostic preference been responsible for the recent fall in incidence of sudden infant death syndrome in South Australia?
Authors: BYARD R. W. , BEAL S. M.
Published: March 2008

Objective: An apparent decrease in deaths attributed to sudden infant death syndrome (SIDS) has been noted in a number of diverse geographical areas during the past several years. At the same time the definition of SIDS has been in a state of flux and some observers have raised the possibility that the fall in SIDS deaths is due to diagnostic transfer rather than to a genuine decrease in numbers. The present study was undertaken to investigate this possibility.

Methodology: All sudden and unexpected deaths in infants under 1 year of age in South Australia during a 10 year period from 1984 to 1993 were reviewed.

Results: The number of deaths due to SIDS fell from 40 in 1984 to 17 in 1993, with a maximum of 52 cases per year in 1987. In contrast, the number of cases of sudden death not due to SIDS remained under 10 per year. The overall infant death rate also fell, while the total number of births per year remained relatively unchanged.

Conclusions: The lack of major change in sudden infant death rates from other causes, combined with the fall in SIDS deaths, is not supportive of diagnostic transfer being a major determinant of the declining SIDS death rate. Therefore, other factors are likely to be responsible for the falling SIDS rate in this population.
The changing prevalence of asthma‐like respiratory symptoms in South Australian rural schoolchildren
Authors: CROCKETT A. J. , CRANSTON J. M. , ALPERS J. H.
Published: March 2008

Objectives: To describe the changing prevalence of wheezy breathing and doctor‐diagnosed asthma, as obtained by questionnaire data, from the years 1984‐92 in a sample of South Australian rural schoolchildren.

Methodology A cross‐sectional study of three populations of schoolchildren from the South Australian rural towns of Burra (mid‐north), Gladstone (mid‐north) and Kingston (southern, coastal). The cumulative or lifetime prevalences and the 12‐month period prevalence (current) of respiratory symptoms were estimated from questionnaire data obtained from parental responses for 1032 schoolchildren aged from 5 to 18 years, and compared with prevalences obtained from a previous study.

Results The overall cumulative prevalence of wheezy breathing in 1992 was 36.2%, an increase from 24.1% in 1984 with a 12‐month period prevalence of 25.0%. The 1992 cumulative prevalence of doctor‐diagnosed asthma was 23.3%. There was no difference in the prevalence of wheeze between the three rural regions studied. A trend to a higher prevalence of doctor‐diagnosed asthma in one of the three regions was thought to be due to medical specialist input.

Conclusions The cumulative prevalence for wheeze among school‐age children in South Australian rural communities has increased in the period 1984‐92. There were no regional differences in the cumulative prevalence rates. The results confirm previous studies in Victoria and New South Wales.
Adrenal 21‐hydroxylase deficiency in childhood: 25 years' experience
Authors: LIM Y. J. , BATCH J. A. , WARNE G. L.
Published: March 2008

Objective: To review past and present management of congenital adrenal hyperplasia at a single centre, as a guide to best practice.

Methodology The records of 89 patients with congenital adrenal hyperplasia due to 21‐hydroxylase deficiency managed in a children's hospital in Australia over a period of 25 years were reviewed.

Results The diagnosis was made in infancy in 66 patients (37 males and 29 females) and later in 23 (11 males and 12 females). The mean age for genitoplasty in females with ambiguous genitalia was 18 months before 1984 and 3 months thereafter. Significant differences were found between males and females presenting after infancy with regard to virilization, bone age advancement, risk of true precocious puberty and final height. The mean final height standard deviation scores for seven males and seven females treated from infancy were — 1.32 and — 1.26, respectively.

Conclusions The results emphasize the importance of early diagnosis and good control in ensuring a good outcome for patients with 21‐hydroxylase deficiency.
Minicores and congenital fibre type disproportion observed in a family
Authors: JONGPIPUTVANICH S. , WALSH P. J. , KAKULAS B. A.
Published: March 2008

Objective: To report a family in which congenital fibre type disproportion (CFTD) and minicore disease have been observed in members of the same family, and raise the question of the relationship between CFTD and minicores.

Methodology: A follow‐up clinical and biopsy study of a girl who presented to hospital because of marked hypotonia and non‐progressive weakness. She had muscle biopsies at the age of 18 months and again at 4 1/2 years. Her asymptomatic parents were also biopsied. The muscle specimens were processed for histopathological and morphometric studies.

Results: The histopathological findings of the muscle of the daughter were consistent with CFTD. The muscle biopsy of her father was normal whereas her mother's revealed minicore formation.

Conclusions: The findings of CFTD and minicore disease in members of the same family suggest that CFTD and minicore formation may both be the result of a common pathological mechanism rather than each being a distinct clinicopathological entity.
Juvenile myoclonic epilepsy
Authors: BUCHANAN N
Published: March 2008

Abstract Juvenile myoclonic epilepsy is a relatively common, though under diagnosed, form of epilepsy that commences in adolescence. The distinguishing symptoms, diagnosis and medical management are discussed.
Review Article Towards a better understanding of childhood asthma
Authors: van ASPEREN PP
Published: March 2008

Objective: To explore the ways asthma may be defined in childhood and consider the current evidence to support these possible definitions.

Methodology The relationship of symptoms, atopy, bronchial hyperresponsiveness (BHR) and airway inflammation in defining childhood asthma is reviewed.

Results While none of the four proposed methods of defining asthma can stand alone as the ‘gold standard], in childhood asthma, all four, namely clinical symptoms, atopy, BHR and airway inflammation, are intimately related. The degree of atopy and BHR, and the presence of airway inflammation, should be viewed as significant risk factors for persistent wheezing in childhood.

Conclusion At present the clinical diagnosis of asthma in childhood remains largely based on symptoms but it is likely that, with further research, the group of children who are now labelled as having asthma will be subdivided into different subgroups with implications for both treatment and outcome.
The Fremantle Lead Study
Authors: WILLIS FR , ROSSI E , BULSARA M , SLATTERY MJ
Published: March 2008

Objective: To ascertain blood lead levels in a sample of preschool children from Fremantle, Western Australia, and to correlate these with possible risk factors.

Methodology The study was a cross‐sectional prevalence survey of 120 children from day‐care centres and 44 hospital inpatients. Blood lead and ferritin levels were determined and a risk factor questionnaire was completed by parents.

Results Of the 164 children 25.6% had lead levels above the NH&MRC goal (<10μg/dL). Nine of 133 (6.7%) had ferritin levels below 10 μg/L suggesting iron deficiency. Excessive blood lead concentrations as defined by the NH&MRC (>9μg/dL) related to: child's presence during house renovation (OR 3.35, P = 0.007, 95% Cl 1.39‐8.81); Aboriginality (OR 6.4, P = 0.008, 95% Cl 1.6‐24.9), and, in the 9‐24 month age group, inversely to distance between home and a road carrying >7000 vehicles/day (r‐0.56, P = 0.009, n = 24).

Conclusions A group of Fremantle children with unacceptably high blood lead levels has been identified. Renovation of older housing and Aboriginality are important risk factors.
Of colic and rumbling in the guts
Authors: THOMAS DB
Published: March 2008

Infant colic is a common disorder of doubtful aetiology. The known facts have been interpreted in a historical and geographical context The apparent increase in incidence of the condition in the Westernized world during the twentieth century may reflect the technological advances and social changes that have occurred in recent years.
Aminophylline and Doppler time‐averaged mean velocity in the middle cerebral artery in preterm neonates
Authors: GOVAN JJ , OHLSSON A , RYAN ML. , MYHR T , FONG K
Published: March 2008

Objective

: The purpose of this study was to assess the effect of an intravenous loading dose of aminophylline (6 mg/kg) on Doppler time‐averaged mean velocity in the middle cerebral artery in ventilated preterm neonates.

Methodology

: Twenty infants were studied by colour/duplex Doppler technique prior to and at 5, 10, 30 and 60 min after the administration of aminophylline.

Results:

Aminophylline treatment was associated with a statistically significant reduction in time‐averaged mean velocity from baseline (P>0.001) and an increase in heart rate (P>0.001) at all timepoints. The largest reduction in time‐averaged mean velocity of 19% (95% confidence interval ‐ 10 to ‐ 28%) occurred at 10 min post‐dose. There were no statistically significant changes in transcutaneous Pco2 or mean arterial blood pressure.

Conclusions:

The observed reduction of 19% from baseline in time‐averaged mean velocity following treatment with aminophylline alone is unlikely to be of clinical importance. Whether aminophylline in combination with other drugs that decrease central blood flow velocity such as indomethacin and/or dexamethasone could result in a clinically significant reduction deserves further study.
Teacher initiated improvement of asthma policy in schools
Authors: HAZELL J , HENRY RL , FRANCIS JL , HALLIDAY JA
Published: March 2008

Objective:

To assess whether information about asthma acquired by individual teachers, following attendance at an inservice seminar, would be communicated to other school staff, and whether policies about asthma management would be subsequently developed in schools.

Methodology:

A telephone interview was conducted of 50 primary school teachers in the Hunter Region who were selected randomly from those who had represented their school at an inservice seminar about asthma.

Results:

All 48 respondents had provided feedback to their colleagues, mostly at a staff meeting. After the seminar the number of schools with a written policy about the management of asthma had increased from 1 to 20. Initially the school's first aid kits contained a bronchodilator inhaler in 25 schools (increasing to 43 after the seminar), a spacer device in six schools (increasing to 47) and written guidelines for management of an asthma attack in seven schools (increasing to 32). Teachers from four schools indicated that all school staff knew how to recognize an acute attack prior to the seminar compared with 22 schools afterwards. Before the seminar 18 schools asked parents to supply written instructions for the management of their children at school but this increased to 44 after the seminar.

Conclusions:

A programme of one‐off seminars attended by one teacher from each primary school resulted in large increases in the proportion of schools with appropriate policies for the management of asthma in the school environment.
Respiratory mechanics before and after late artificial surfactant rescue
Authors: TODD DA , CHOUKROUN M‐L , FAYON M , KAYS C , GUÉNARD H , GALPÉRINE I , DEMARQUEZ J‐L
Published: March 2008

Objective:

To assess the effect of late administration of synthetic surfactant (Exosurf) on the ventilatory function of premature infants with hyaline membrane disease (HMD).

Methodology:

Prospective non‐randomized study in the Neonatal Intensive Care Unit (NICU) of a major referral hospital. The patients included two groups of premature infants with a birthweight between 750 and 2000 g who developed HMD. In group 1 with moderate to severe HMD, 2x5mL/kg doses of Exosurf were given 12h apart (first dose given at a mean age of 18.7±3.4h [mean ± s.e.m.]). In group 2 with milder HMD, no surfactant was given.

Results:

Significant reductions (P>0.05) in the fraction of inspired oxygen (Flo2) occurred 6 h after surfactant administration (24 h of life) and by 48 h (64 h of life) in group 2. These improvements in gas exchange preceded improvements in passive respiratory compliance which occurred 24 h after surfactant (42 h of life) and by 72 h (88 h of life) in group 2 (P>0.01). In both groups pulmonary resistance increased and was significant (P>0.05) by 48 h (66 h of life) in group 1.

Conclusions:

Synthetic surfactant given as late as a mean age 18.7±3.4 h still improves gas exchange but these early improvements cannot be completely explained by modifications of respiratory compliance.
BiliBlanket phototherapy system versus conventional phototherapy: A randomized controlled trial in preterm infants
Authors: COSTELLO S. A. , NYIKAL J. , YU V. Y. H. , McCLOUD P.
Published: March 2008

Objective: This study compares the use of standard overhead fluorescent phototherapy units with the BiliBlanket a woven fibreoptic pad which delivers high intensity light with no ultraviolet or infrared irradiation in the treatment of jaundice in preterm infants.

Methodology: We chose to study infants between 800 and 2500 g, with strict criteria for commencing and ceasing phototherapy. Serum bilirubin levels were followed at 12–24 h intervals until 24 h after cessation of phototherapy. Infants were allocated at random to receive either conventional phototherapy or the BiliBlanket.

Results: There were 24 infants in the conventional group and 20 in the BiliBlanket group. Mean duration of phototherapy was compared and was 44 h for the conventional group versus 42 h for the BiliBlanket group.

Conclusions: We have shown that the BiliBlanket is as effective as conventional phototherapy and was well accepted by nursing staff and parents.
Enzyme activity of glucose‐6‐phosphate dehydrogenase‐deficient Malaysian neonates during the first 10 days of life
Authors: BOO N. Y. , AINOON O. , ARIF Z. A. ZAINAL , CHEONG S. K. , HALIZA M. S.
Published: March 2008

Objective: The objective of this study was to determine the degree of severity of enzyme deficiency in glucose‐6‐phosphate dehydrogenase (G6PD)‐deficient Malaysian neonates as part of an effort to identify risk factors associated with severe hyperbilirubinaemia in G6PD‐deficient infants.

Methodology: During this study, enzyme activity was measured in 53/59 (89.8%) hospital‐diagnosed G6PD‐deficient neonates (34 Malays, 12 Chinese, and seven other ethnic groups) born consecutively in the Kuala Lumpur Maternity Hospital. All neonates, except one, were males.

Results: The mean level of enzyme activity of the 52 males G6PD‐deficient neonates (0.47 iu/g Hb, 95% confidence intervals: 0.37, 0.57) was less than 10% of that of normal Malaysian male neonates. The enzyme activity of the only female G6PD‐deficient infant, at 1.11 iu/g Hb, was 12.5% of the mean G6PD enzyme activity of normal females.

Conclusion: Our results showed that G6PD deficiency in Malaysian neonates predominantly affects males and is usually severe.
Primary infantile hypomagnesaemia: Report of two cases
Authors: PREBBLE J. J.
Published: March 2008

Objective: To present case reports of two siblings with primary hypomagnesaemia both presenting with seizures, and one also with a cardiac arrhythmia. To briefly review the pathophysiology, clinical features, diagnosis, management and genetics of this disorder.

Methodology: Published literature reports of primary hypomagnesaemia and studies of hypomagnesaemia in humans. Reports of the clinical features and inheritance of primary hypomagnesaemia.

Results: The information is descriptive of the pathophysiology, clinical features, diagnostic criteria, and management Considered modes of inheritance are presented. Two cases of primary hypomagnesaemia in brothers of consanguineous parents are described. Cardiac arrhythmia at presentation has not previously been reported. Diagnosis and adequate magnesium supplementation controls the biochemical disorder and the neurological development is normal.

Conclusions: Primary hypomagnesaemia should be considered in infants with seizures, as failure to identify this metabolic disorder can result in death. Subsequent siblings, particularly male, should be closely monitored.
Nasal inflammation and chronic ear disease in Australian Aboriginal children
Authors: GIBSON PG , STUART JE , WLODARCZYK J , OLSON LG , HENSLEY MJ
Published: March 2008

Objective: Chronic middle ear disease is common in Aboriginal children, and may be linked to nasal inflammation and Eustachian tube dysfunction. The pattern of nasal inflammation is unknown. The study reported here was performed to define the role of allergy and infection in causing nasal inflammation in Aboriginal children with chronic middle ear disease.

Methodology: Thirty‐one Aboriginal children aged between 3 and 7 years underwent clinical assessment, audiometry and allergy skin tests. Nasal swabs for bacterial culture and cytology were performed during the winter and again in spring to identify any seasonal variation. A randomized trial of nasal beclomethasone for 8 weeks was conducted in children with abnormal tympanometry to identify the effect of therapy upon nasal cytology.

Results: Twenty‐six of the 31 children had abnormal tympanograms. Average hearing levels were reduced in nine children. Pathogenic organisms were isolated from most children: Streptococcus pneumoniae (82%), Haemophilus influenzae (79%), Moraxella catarrhalis (39%) and Staphylococcus aureus (29%). Eight of the 31 children (26%) were atopic. Nasal cytology disclosed a marked neutrophil infiltrate (80% of cells) during the winter, which fell significantly in spring to 52% of cells. Only two subjects had nasal eosinophilia of >10%. There was no effect of beclomethasone on nasal cytology.

Conclusions: Chronic ear disease in Aboriginal children is associated with nasal inflammation, neutrophil infiltration and the presence of bacteria. These features suggest respiratory infection as the main cause of chronic nasal inflammation in Aboriginal children with middle ear disease. There is a seasonal variation in the severity of the nasal infiltrate, consistent with increased infections during winter. Despite a high prevalence of atopy, allergic nasal disease was uncommon.
Mental health promotion for young people: A proposal for a tripartite approach
Authors: SAWYER MG , KOSKY RJ
Published: March 2008

ABSTRACT Child and adolescent mental health promotion programmes may be more effective if they include a combination of different approaches to health promotion rather than relying primarily on one approach. A group of complementary approaches that could be combined in a single programme include: (i) a community‐wide media campaign to highlight the harmful effects of family discord on the mental health of young people; (ii) a school‐based social skills programme to improve the social skills of young people; and (iii) a life skills programme to build the competence of young people ‘at risk’ for developing mental health disorders. The potential value of this particular combination of approaches is discussed with the aim of facilitating the development of innovative new child and adolescent mental health promotion programmes in Australia.
Primary hyperparathyroidism in childhood and adolescence
Authors: CRONIN CS , REEVE TS , ROBINSON B , CLIFTON‐BLIGH P , GUINEA A , DELBRIDGE L
Published: March 2008

Objective: The aim of this study was to determine the nature of the presentation and pathology of primary hyperparathyroidism in children and adolescents and to compare these findings with adults.

Methodology: Data were obtained from the Thyroid Surgery Database at Royal North Shore Hospital on all children and adolescents undergoing parathyroid surgery. These results were then compared to data obtained from the last 100 consecutive adult parathyroidectomies.

Results: A total of eight younger patients underwent parathyroidectomy including three children (0–12 years) and five adolescents (13–18 years). A common presentation in the younger age group was hypercalcaemic crisis (50%) with a serum calcium >3.5 mmol/L and clinical signs of calcium intoxication. This compared to the adult age group where only 8% presented with crisis (P <0.05). Eighty‐eight per cent of the younger patients complained of abdominal symptoms compared to only 1% of adults. Seven of eight young patients had sporadic hyperparathyroidism.

Conclusions: Primary hyperparathyroidism, although uncommon in the younger age group, is still most commonly associated with sporadic tumours. Familial syndromes do not constitute a large percentage of patients. Younger patients are more prone to present late with abdominal symptoms, toxicity and hypercalcaemic crisis, presumably due to delayed diagnosis of an uncommon condition in this age group.
Gender differences in food‐related concerns, beliefs and behaviours of North Queensland adolescents
Authors: NOWAK M , SPEARE R
Published: March 2008

Objective: To describe the beliefs, attitudes, behaviours and knowledge of North Queensland adolescents about food and nutrition.

Methodology: A questionnaire surveyed 791 Year 8 students from private schools.

Results: More girls than boys felt guilt about food, sometimes ate from boredom, reported trying to select foods that were good for them and were concerned about the fat content of food; 30% of boys and 17% of girls thought they should be concerned about their food intake only when overweight.

Low daily dietary intakes were reported for: bread, fruit, vegetables and dairy products with only 24% eating at least one fruit, one vegetable, one dairy product and one core cereal food daily. Fat and sugar intake was high: 41% students ate high fat savoury foods and 53% ate high sugar foods at least seven times during the week.

Parents, television and school provided information about food and nutrition to 70‐80% of these students, followed by friends and magazines with doctors and teachers providing information on weight and weight loss to 10% of students.

Conclusions: Doctors should be aware of the low intake of recommended foods as well as the high intakes of fat and sugar among adolescents and the gender differences in food related beliefs and behaviours when treating nutrition related diseases and providing guidance for their prevention.
Prevalence and impact of chronic childhood conditions in Auckland, New Zealand
Authors: VOGEL AM , LENNON D , AMERATUNGA SN , HOLYOAKE J
Published: March 2008

Objective: To establish the prevalence of specific chronic conditions of childhood in the Auckland area and to quantify resource use by these children.

Methodology: Estimates were made from available registry data and published data sources of the population of children with selected chronic conditions resident in the Auckland Area Health Board area. Resource use data were extracted for admissions to Auckland public hospitals and from providers of community based technology services.

Results: The largest community prevalence groups are those with asthma, intellectual handicap, congenital heart disease and epilepsy. Children aged 0‐14 with chronic conditions accounted for at least 14340 hospital days stay in Auckland in 1992 at an estimated minimum cost of $7.9 million. Over 200 children are dependent on technological aids at home.

Conclusions: There are sparse data on the numbers and needs of children with chronic conditions in the population. A non‐categorical approach which crosses disease entities may be the best method of meeting common needs.
Inhaled nitric oxide during emergency neonatal transportation
Authors: TANG SF , MILLER OI
Published: March 2008

ABSTRACT Inhaled nitric oxide is currently being investigated as a selective pulmonary vasodilator for neonates with persistent pulmonary hypertension. The use of continuous inhaled nitric oxide during emergency transportation of three critically ill neonates with meconium aspiration and pulmonary hypertension is described. The successful application of this technique may allow safer transportation of neonates who require high level intensive care including ongoing nitric oxide, high frequency ventilation and/or extracorporeal life support. Regionally based nitric oxide‐equipped retrieval teams may relieve the pressure on smaller neonatal intensive care units to provide inhaled nitric oxide therapy and allow centralization of nitric oxide resources, thus facilitating development of expertise and the completion of meaningful research programs with substantial recruitment.
The use of high doses of adrenaline in paediatric cardiac resuscitation
Authors: HIGGINSON I , MONTGOMERY D , TUCK R
Published: March 2008

Adrenaline has been used in cardiac resuscitation for many years, yet until recently its mechanism of action and optimal dosage remained poorly investigated or understood. Recent guidelines suggest the use of higher doses of adrenaline at an early stage in paediatric resuscitation. This paper examines the use of adrenaline in paediatric resuscitation and studies the arguments in favour of using higher doses than previously accepted.
An unusual congenital dorsal midline thoracic mass
Authors: MACDONALD JMS , LESLIE GI
Published: March 2008

Objective: To describe the presentation and investigation of an unusual form of congenital dorsal midline thoracic mass.

Results: An infant born by emergency Caesarean section at 34 weeks gestation was found to have a large dorsal midline thoracic mass. The infant had normal neurological function in all limbs. Radiological investigation showed no abnormality in the vertebrae. Ultrasonographic investigation suggested the mass to consist of subcutaneous oedema. The mass resolved completely within the first 2 weeks.

Conclusions: The lesion observed in this infant represents a very unusual location for a benign condition caused by cervical pressure on the presenting fetal part. The use of ultrasonography enabled rapid exclusion of the more common, potentially serious, causes of a congenital midline dorsal thoracic mass.
Acyclovir for the prevention and treatment of varicella zoster in children, adolescents and pregnancy
Authors: KESSON AM , GRIMWOOD K , BURGESS MA , FERSON MJ , GILBERT GL , HOGG G , ISAACS D , KAKAKIOS A , McINTYRE P
Published: March 2008

Abstract: Varicella causes a mild, self‐limiting childhood disease that may reactivate years later as shingles. In immuno‐compromised patients with altered cell mediated immunity, and rarely in healthy individuals, varicella results in a life‐threatening infection. The antiviral drug, acyclovir, substantially reduces the mortality and risk of severe disease in these groups of patients. Early commencement of acyclovir is recommended for children with both varicella and altered cell mediated immunity, newborns during the first 2 weeks of life, preterm infants in the neonatal nursery, and severe varicella or shingles (including ocular zoster) in any patient, as well as during pregnancy. Acyclovir may be considered in children with serious cardiopulmonary disease or chronic skin disorders where varicella may exacerbate the underlying disease or increase the risk of secondary bacterial sepsis. Acyclovir, however, is not recommended for healthy individuals without severe disease, as a prophylactic agent against varicella, for asthmatics receiving aerosolized or low‐dose oral steroids and/or as treatment of the post‐varicella syndromes. When acyclovir is prescribed it should be given intravenously to those with severe disease, those at risk of dissemination and in children younger than 2 years of age.
High and low dose initial thyroxine therapy for congenital hypothyroidism
Authors: GUNN AJ , WAKE M , CUTFIELD WS
Published: March 2008

Objective: To assess factors influencing thyroxine (T4 levels 1 month after initiating replacement therapy for congenital primary hypothyroidism.

Methodology: A retrospective review of 41 children with congenital hypothyroidism who received either high or low dose initial T4 therapy. Thyroid scintiscan was performed, and T4 levels determined before starting treatment and after 1 month.

Results: T4 levels at 1 month were correlated (r2=0.38, P<0.001) with the pretreatment T4 level (r= 0.48), as well as with the T4 dose (r= 0.46). Suboptimal treated T4 levels (<130nmol/L) were seen with greater frequency in infants with thyroid agenesis (7/11) rather than ectopia (7/28, P<0.03), despite receiving similar doses of thyroxine. Infants with suboptimal treated T4 levels had lower pretreatment T4 levels than those with optimal levels (21±7 vs 48±34nmol/L, P<0.02). Biochemical hyperthyroidism (T4 >216nmol/L) occurred in six patients: four of six had ectopia.

Conclusions: These data suggest that infants with little residual thyroid function should receive higher initial T4 doses than those with significant ectopia.
Glucose and the newborn baby: Sweet justice?
Authors: KOH THHG
Published: March 2008

Abstract: Neonatal hypoglycaemia remains a controversial issue. Uncertainty surrounds what constitutes the optimal safe blood glucose for newborn babies. There are good reasons and evidence for maintaining blood glucose greater than 2.5mmol/L in newborn babies. Since 1986 neonatal paediatricians have changed in their definition of neonatal hypoglycaemia. Ideally, screening of blood glucose in neonatal intensive care units should be done with an on‐site glucose analyzer.
Definition of neonatal hypoglycaemia: Is there a change?
Authors: KOH THHG , VONG SK
Published: March 2008

Objective: To compare the definitions of neonatal hypoglycaemia in textbooks and among paediatricians in 1992 with those used in 1986.

Methodology: A questionnaire was sent to 420 neonatal paediatricians in the UK and to 88 Australian neonatal paediatricians in 1992 asking for their definition of hypoglycaemia in term babies and preterm/small‐for‐gestational‐age (SGA) babies. Fourteen textbooks on neonatal paediatrics (published since 1990) were also surveyed for the definition of hypoglycaemia used in the text. The UK paediatricians were also asked, ‘Do you believe that a baby who is hypoglycaemic but has no abnormal clinical signs is at less risk of neurological damage than a baby who is hypoglycaemic with abnormal signs?’ The 1992 results were compared with the published results of a similar survey in 1986.

Results: There was a 68% response from neonatal paediatricians both in the UK and Australia. Similar to the 1986 results there continued in 1992 to be a wide range in the definition for hypoglycaemia (<1‐4mmol/L) among neonatal paediatricians and in textbooks. The median of the definition of hypoglycaemia for both term and preterm/SGA babies among paediatricians and in textbooks in 1992 was significantly different from the results in 1986. Compared with 1986 there was a significant increase in 1992 in the number of paediatricians and textbooks defining a safe blood glucose concentration as being at least 2mmol/L. Sixty per cent of UK neonatal paediatricians believe that a baby who is hypoglycaemic but has no abnormal clinical signs is at less risk of neurological damage than a baby who is hypoglycaemic with abnormal signs.

Conclusions: From 1986 to 1992 there was a significant change in the definition of hypoglycaemia both among paediatricians and in neonatal textbooks compared with the definition in use during 1965‐86. The findings suggest that neonatal paediatricians do change in their practice. The changes in the definition of hypoglycaemia may be due to the data available and discussion on hypoglycaemia since 1988. Neonatal paediatricians still attach significance to clinical signs associated with hypoglycaemia.