bluuebunny/crossref_metadata_2025 huggingface dataset:
Takayasu's arteritis associated with Wiskott‐Aldrich syndrome
Authors: LAU Y‐L , WONG S‐N. , LAWTON W. M.
Published: March 2008

Abstract A unique case of a Chinese boy with Wiskott‐Aldrich syndrome (WAS) associated with Takayasu's arteritis is reported. He had eczema, epistaxis and recurrent infections since early infancy and was found to have thrombocytopenia, negative delayed‐type skin hypersensitivity, low T cell number and impaired lymphocyte proliferation to phytohaemagglutinin and concanavalin A. He had high normal serum immunoglobulin (Ig)G and IgA with low IgM and isohaemagglutinin. He presented with hypertensive encephalopathy at 5.5 years of age and an aortogram demonstrated abdominal aortic aneurysm with bilateral stenosis of renal arteries resulting in renovascular hypertension. His hypertension was difficult to control medically and autotransplant of his kidneys to the iliac arteries was performed, but he died in the immediate postoperative period. The relationship between immunodeficiency and collagen‐vascular disease was discussed.
Serum osteocalcin in normal and short Chinese children
Authors: LOW L. C. K. , LAU Y. L.
Published: March 2008

Abstract Serum osteocalcin was measured by radioimmunoassay in 200 normal children and adolescents, and seven growth hormone (GH) deficient and seven non‐growth hormone deficient (NGHD) short children. There was a sex‐ and age‐dependent change in the serum osteocalcin concentrations in normal children and adolescents with a pattern similar to the childhood height velocity curves. The serum osteocalcin concentration was in the low normal range in most patients with GH deficiency and NGHD short stature. GH therapy significantly increased the growth velocity in both groups of short children. GH treatment resulted in a significant rise in serum osteocalcin concentrations after 6 and 12 months in NGHD children but a more variable change was observed in GH‐deficient children. Although osteocalcin levels may give some biochemical indication of growth, these measurements should be used together with auxological and other biochemical measurements to assess growth reliably.
The KEMH method for securing umbilical catheters
Authors: GRAUAUG A. A. , TOMPKINS J. R.
Published: March 2008

Abstract A new method of fixation of umbilical catheters is described. This method utilizes a purse‐string suture around the cord stump, which is then secured through the umbilical skin and fixed to the catheter with adhesive tape. This method avoids damage to the fragile skin, particularly of the preterm newborn, caused by the use of T piece strapping.
An area analysis of child injury morbidity in Auckland
Authors: ROBERTS I. , MARSHALL R. , NORTON R. , BORMAN B.
Published: March 2008

Abstract The geographical distribution of child injury morbidity in Auckland between 1982 and 1987 was examined. Analysis of total injury, pedestrian injury and vehicle occupant injury, with the census area unit as the basic spatial entity revealed distinct variations in child injury morbidity by census area unit. Morbidity rates were above average in parts of the central urban area and South Auckland and below average on the North Shore. Total injury morbidity and pedestrian injury morbidity rates were strongly correlated with census area unit unemployment rates, which were used as a measure of socio‐economic deprivation. Geographical areas with high rates of child injury morbidity, to which injury prevention resources can be directed, were identified. In particular, the results suggest that injury prevention programmes should be targeted at socio‐economically disadvantaged communities.
Lafora disease: A progressive myoclonus epilepsy
Authors: ELLIOTT E. J. , TALBOT I. C. , PYE I. F. , HODGES S. , SWIFT P. G. F. , TANNER M. S.
Published: March 2008

Abstract Lafora disease is a rare inborn error of metabolism resulting in storage of a polyglucosan in tissues including the brain, skin and liver. Four children are described with progressive myoclonus epilepsy and intellectual deterioration in whom this diagnosis was made. In two the diagnosis was confirmed by the presence of periodic acid schiff (PAS) positive, diastase resistant, colloidal iron staining inclusion material in the liver when they were referred to a paediatric gastroenterologist with abnormal liver function tests. In one, the diagnosis was made from cerebellar biopsy, although on retrospective review the liver biopsy performed at this time was abnormal. In a fourth child, whose sibling was affected, histological diagnosis was confirmed by skin biopsy, although clinical and EEG findings had been highly suggestive for several years. The disease has autosomal recessive inheritance, is progressive and the prognosis is poor. Paediatricians should be aware of this diagnosis, which is often delayed, as early histological diagnosis allows prognostic and genetic counselling and optimal treatment Although the diagnosis was made by liver or brain biopsy in three cases, skin biopsy offers a reliable, less invasive means of diagnosis.
Postnatal depression and SIDS: A prospective study
Authors: MITCHELL E. A. , THOMPSON J. M. D. , STEWART A. W. , WEBSTER M. L. , TAYLOR B. J. , HASSALL I. B. , FORD R. P. K. , ALLEN E. M. , SCRAGG R. , BECROFT D. M. O.
Published: March 2008

Abstract This study was carried out in response to reports from nurses to a post‐neonatal mortality review committee that a number of mothers of infants dying from sudden infant death syndrome (SIDS) appeared to be depressed before the child's death. The New Zealand Cot Death Study was a 3 year multicentre case‐control study for SIDS. There were 485 SIDS cases in the post‐neonatal age group in the study regions, and these were compared with 1800 control infants. Infants of mothers with either a self‐reported use of medication for psychiatric disorders, a history of hospitalization for psychiatric illness or a family history of postnatal depression had a significantly increased risk of SIDS compared with infants of mothers who were either not using medication (odds ratio (OR) = 1.45; 95% confidence interval (Cl) = 1.03, 2.04) or were without a history of hospitalization for psychiatric illness (OR = 1.80; 95% Cl = 1.03, 3.11) or a family history of postnatal depression (OR = 1.61; 95% Cl = 1.06, 2.43). All mothers of infants born in the study areas over a 1 year period were eligible to complete a questionnaire measuring maternal depression when the infant was 4 weeks of age. Thirty‐three infants subsequently died from SIDS, and they were compared with 174 controls. Fifteen (45.5%) of the mothers of cases were depressed, compared with 28 (16.1%) of the mothers of controls. This prospective study found that the infants of those mothers that were depressed were more likely to die from SIDS than those of the non‐depressed mothers (OR = 4.35; 95% Cl = 1.82, 10.37) and postnatal depression as a risk factor for SIDS was still significant after controlling for possible confounding variables (OR = 3.37; 95% Cl = 1.24, 9.12). We conclude that postnatal depression is a risk factor for SIDS.
Insulin dependent diabetes in pregnancy: Impact of maternal blood glucose control on the offspring
Authors: PERSSON B. , HANSON U.
Published: March 2008

Definition of optimal glycaemic control in diabetic pregnancy may still be debated. Measures of glucose control (based on 4–6 daily glucose and frequent HbA1c values) were recorded in two series of diabetic pregnancies; one multicentre study (n= 92, 1979–82), and one study from our own institution (n= 113, 1983–85). The average pregnancy glucose levels were 5.9 mmol/L (third trimester only) and 6.5 mmol/L (all trimesters), respectively. Discriminant analysis (including pregnancy glucose, HbA1c, gestational age, diabetes duration and hypertension) revealed that gestational age only (first series) and gestational age and HbA1c independently of each other (second series) were significantly associated with the occurrence of severe neonatal morbidity present among 30 and 16.8% of the infants, respectively. The overall outcome was favourable. The findings of no perinatal mortality, normal premature delivery rate (8.9%) and a very low rate of severe maternal hypoglycaemia (4.4%) in series two support the feasibility of a strict but individualized management programme.
Paediatric management practices in Down syndrome: A follow‐up survey
Authors: FOREMAN P. J. , MANNING E.
Published: March 2008

In a follow‐up survey to a 1984 study, 339 paediatricians in Australia were invited to complete a brief questionnaire in 1990, in which they indicated their usual recommendations, practices and advice when managing children with Down syndrome. The response rate was 67%. The results indicated that the most frequent paediatrician‐initiated referrals were for early intervention and for discussion with other parents; these options were selected more frequently in 1990 than in 1984. While referral to a social worker was the next most frequent choice, it occurred less in 1990 than in 1984. Other increases in referrals were for physiotherapy and speech therapy. Paediatricians were more likely to support referral to a geneticist, speech therapist or cosmetic surgeon in response to a specific parental enquiry, and less likely to support referral to a social worker or to full‐time care. There had been significant increases since 1984 in the likelihood that paediatricians would order audiology and investigation of thyroid and cardiac function. There was less opposition to the use of sedatives, and virtual cessation of the use of tryptophan. Paediatricians were more optimistic about the likelihood of persons with Down syndrome living independently, caring for their own finances, and marrying, but not about other developmental areas.
Combined therapy with growth hormone and oxandrolone in adolescent girls with Turner syndrome
Authors: LU P. W. , COWELL C. T.
Published: March 2008

Five adolescent girls with Turner syndrome (mean age 13.9 years, mean bone age 12.0 years) were treated with both recombinant human growth hormone (rhGH) and oxandrolone for 2 years with an average increment in height of 13.4 cm. The mean bone age advanced by only 1.2 years, providing an increase in the mean estimated mature height of 9.2 cm. We conclude that rhGH and oxandrolone benefit older teenagers with Turner syndrome because of an increased growth rate with slow progression of skeletal maturation.
Splenic injury in children: A 10 year experience
Authors: CHOONG R. K. C. , GRATTAN‐SMITH T. M. , COHEN R. C. , CASS D. T.
Published: March 2008

Abstract The aim of this report was to review retrospectively the management of splenic trauma at a major Australian tertiary referral centre (Westmead Hospital) over a 10 year period. Forty‐nine patients (0‐15 years of age) with documented blunt splenic trauma were identified. The causes of splenic injury were road trauma (73%) and falls (27%). There were 22 minor injuries (Injury severity score [ISS] <16) and 27 severe injuries (ISS ≥16). All nine deaths were related to road trauma (mean ISS = 59). The investigation most commonly used was CT scanning (47%). Peritoneal lavage was performed in six patients (12%). Management involved non‐operative care in 29 patients (57%), exploratory laparotomy alone in 5 (10%), splenic salvage in 2 (4%) and splenectomy in 13 (26%). This experience supports the view that non‐operative management of splenic injury in haemodynamically stable children is safe and is the preferred treatment. Experienced assessment and meticulous observation is necessary. Laparotomy is indicated if there is continuing haemodynamic instability despite resuscitation. Operative management is aimed at splenic salvage with splenectomy being reserved for uncontrolled haemorrhage.
Rotavirus gastroenteritis in infants aged 0–6 months in Melbourne, Australia: Implications for vaccination
Authors: CRAWLEY J. M. S. , BISHOP R. F. , BARNES G. L.
Published: March 2008

Abstract The aim of this study was to determine the occurrence of rotavirus infection in infants under 6 months of age who were admitted to hospital in a developed country for treatment of gastroenteritis. Between April 1980 and April 1990, 595 such infants were admitted to the infectious diseases ward at the Royal Children's Hospital, Melbourne, Australia. Faecal specimens were collected within 6h of admission and were tested for viral, bacterial and protozoal enteric pathogens. Rotaviruses of several serotypes were found in specimens from 15.1% of the infants, adenoviruses in 12.4% and other pathogens in 10.8%. Rotaviruses were found equally often in infants in each 1 month age group. No pathogens were able to be identified in 61.7% of cases. These results show that rotavirus is an important pathogen in infants under 6 months of age who are admitted to hospital with gastroenteritis. Rotavirus vaccination will need to be given during the first 1–3 months of life in developed countries, as is recommended for developing countries. The large group in whom no pathogens were isolated requires further consideration.
The use of child safety restraints with nursery furniture
Authors: WATSON W. L. , OZANNE‐SMITH J.
Published: March 2008

Abstract In Australia, nursery furniture is associated with just over 6% of all injuries to children between birth and 3 years of age and 19% (or almost one in five) of all injuries in the first year of life. In the case of injury associated with prams or strollers and high chairs, the vast majority of injuries occur as the result of falls (75 and 83% respectively). Interviews with parents whose children suffered an injury as a result of a fall from a pram or stroller or from a high chair indicate that only a small proportion of the children (28 and 25% respectively) were wearing any form of safety restraint prior to their injury despite the fact that, in both samples, the percentage of safety restraints fitted was about 80%. The potential for serious injury from such falls is great as most injuries in both groups (96 and 75% respectively) were to the head. One death associated with a stroller and one death as the result of a fall from a high chair have been recorded for Victoria between 1985 and 1988. In the absence of mandatory requirements for the design and manufacture of nursery furniture, there is a need to provide information about nursery furniture safety to parents and care‐givers through nursery furniture retailers and through maternity hospitals and child health centres. In particular, the promotion of the correct use of an appropriate and effective child restraint is a relatively simple and inexpensive measure that could prevent up to 80% of all injuries associated with the three items of nursery furniture most often related to injury: strollers or prams, high chairs and change tables.
The incidence of labial fusion in children
Authors: LEUNG A. K. C. , ROBSON W. L. M. , TAY‐UYBOCO J.
Published: March 2008

Abstract A retrospective study of 9070 female infants born at the Foothills Provincial Hospital was conducted to determine the incidence of labial fusion at birth. A prospective study was also conducted on 1970 female patients assessed through a paediatric outpatient clinic to determine the incidence of labial fusion in this population. None of the newborn infants had labial fusion. Thirty‐five children (1.8%) assessed at the paediatric outpatient clinic were found to have labial fusion with a peak incidence at 13–23 months of age (3.3%).
Mood disorders among mothers of infants admitted to a mothercraft hospital
Authors: BARNETT B. , LOCKHART K. , BERNARD D. , MANICAVASAGAR V. , DUDLEY M.
Published: March 2008

The mothers (n= 100) of consecutive infants admitted to a mothercraft residential facility were asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Only one of the women had been identified prior to the infant's admission as having postnatal depression, but 39% scored above the cut‐off point for likely major depressive disorder. No specific infant problem correlated significantly with a higher depression score. The extent of serious mood disorders in the post‐partum population has remained generally unacknowledged despite an upsurge of recent research activity in the field. Nevertheless, this problem has considerable public health significance, impinging as it does on the health of all members of the family. Possible screening and intervention strategies are discussed.
17‐Hydroxyprogesterone rhythms and growth velocity in congenital adrenal hyperplasia
Authors: PINCUS D. R. , KELNAR C. J. H. , WALLACE A. M.
Published: March 2008

Six patients on steroid replacement therapy for congenital adrenal hyperplasia provided capillary blood samples collected at 0800, 1200, 1700, and 2200h, on to filter paper for 17‐hydroxyprogesterone analysis. There was a strong correlation between 17‐hydroxyprogesterone day profiles and height velocity over a 4 year period of study. Steroid over‐replacement, identified by significantly decreased height velocity (Standard Deviation Score [SDS] 1.92), caused suppression of 17‐hydroxyprogesterone concentrations to below 10 nmol/L throughout the day. Near average height velocity (Standard Deviation Score 0.245) was accompanied by suppression of 17‐hydroxyprogesterone concentrations below 40 nmol/L but with significant diurnal variation. Under‐replacement with rapid height velocity and bone maturation was accompanied by non‐suppression of 17‐hydroxyprogesterone concentrations (i.e. > 40 nmol/L). These results suggest that serial blood spot 17‐hydroxyprogesterone measurements are a convenient and helpful supplement to measurements of height velocity and bone age maturation to monitor steroid replacement therapy in congenital adrenal hyperplasia. These measurements may be useful particularly in differentiating between over‐replacement and appropriate replacement, and should allow adjustments in dose before abnormal growth patterns are established.
The incidence of congenital heart defects in the first year of life
Authors: KIDD S. A. , LANCASTER P. A. L. , McCREDIE R. M.
Published: March 2008

Data on the incidence of congenital heart defects (CHD) in the first year of life were collected on a cohort of infants born between 1981 and 1984 in New South Wales and the Australian Capital Territory. There was a total of 1479 cases among 343521 births, an incidence of 4.3 per 1000 livebirths. The following results were obtained after restricting the analysis to cases diagnosed definitively by echocardiography, cardiac catheterization, operation or autopsy. A significant association was found between older maternal age and having an infant with CHD, both before (RR = 1.27, CI = 1.13,1.44) and after (RR = 1.17, CI = 1.02, 1.33) excluding chromosomally related cases. Significant associations were found between having an infant with ventricular septal defect and Italian parentage (RR = 2.50, CI = 1.11, 5.65), and for having an infant with coarctation of the aorta and Lebanese parentage (RR = 3.82, CI = 1.71, 8.52). The incidence of CHD in this Australian population is similar to overseas studies that used comparable diagnostic criteria and ascertainment. An active surveillance system for CHD is recommended as is further investigation of the factors associated with having an infant with CHD.
A prospective study of the psychological adjustment of parents and families of children with cancer
Authors: SAWYER M. G. , ANTONIOU G. , TOOGOOD I. , RICE M. , BAGHURST P. A.
Published: March 2008

This study compared the psychological adjustment of parents and families of children with cancer, with the adjustment of parents and families in the community. In the weeks after their children's diagnoses, the mothers of children with cancer reported significantly more anxiety and insomnia, somatic symptoms and social dysfunction than mothers in the community. These problems had declined by the time of a 1 year follow‐up assessment However, at the follow‐up assessment the mothers of children with cancer reported significantly more symptoms of depression and somatic symptoms than mothers in the community. A similar pattern of findings was evident among the fathers although the fathers generally reported less distress than was reported by the mothers. The results also suggest that a year after the children's diagnoses, the families in which there was a child with cancer were functioning less effectively than the families in the community.
Infant onset subacute necrotizing encephalomyelopathy (Leigh's disease)
Authors: MORRIS S. A. , HARBORD M. G.
Published: March 2008

We reviewed six cases of proven or probable subacute necrotizing encephalomyelopathy with an onset under 12 months of age. All children had been investigated at the Adelaide Children's Hospital in the period 1975‐90. Seizures (five of six) and cortical blindness (five of six) were more prominent clinical features at presentation than the literature would suggest while respiratory abnormalities and developmental delay were also frequent. Flash visual evoked responses, brain‐stem auditory evoked responses, and the interictal electroencephalogram did not contribute to diagnosis. Computerized tomography brain scans were abnormal in three of four cases with typical basal ganglia lesions in one case and brain atrophy in two cases. The diagnosis was suspected in four cases with raised blood or cerebrospinal fluid lactate concentrations. The importance of obtaining a blood or cerebrospinal fluid lactate in all infants with unexplained seizures, cortical blindness or apnoea is emphasized.
Eucalyptus oil poisoning in childhood: 41 cases in south‐east Queensland
Authors: WEBB N. J. A. , PITT W. R.
Published: March 2008

Forty‐two cases of oral eucalyptus oil poisoning in children under 14 years of age were identified in a defined population between 1 July 1984 and 30 June 1991, and 41 were subjected to retrospective case note analysis. Thirty‐three children (80%) were entirely asymptomatic. This group included all of the four children reported to have ingested more than 30 mL of eucalyptus oil. Only two of the remaining children had symptoms or clinical signs on presentation to hospital. No child required advanced life‐support. There was no correlation between the amount of eucalyptus oil taken and the presence of symptoms. If the estimated volume ingested is large, or symptoms are evident, on presentation at hospital gastrointestinal decontamination should lead to a good outcome with few clinical problems. Eucalyptus oil may be a less toxic compound than has previously been believed.
The epidemiology of incomplete childhood immunization: An analysis of reported immunization status in outer western Sydney
Authors: BELL J. C. , WHITEHEAD P. , CHEY T. , SMITH W. , CAPON A. G. , JALALUDIN B.
Published: March 2008

We surveyed parents of children enrolled in kindergarten in 1992 in outer western Sydney and the Blue Mountains. Using parents' reports, we determined the prevalence of immunization uptake for children starting school, compared the prevalence of immunization uptake among Catholic, government and independent schools, and identified immunization providers. We also documented parental beliefs about immunization and their influence on immunization status, and identified risk factors for incomplete immunization. Nearly 89% of children were reported to be fully immunized. Immunization status did not vary significantly among the different types of school. General practitioners provided 84% of all immunizations and local councils 11%. Incomplete immunization was associated with more negative beliefs in immunization, with post‐secondary education and with families who do not speak English at home. Reminder letters had little effect on immunization status.
Double‐barrelled tubular duplication of the ileum
Authors: SUE K. , HIRATA T. , KAMIMURA T. , TANAKA N.
Published: March 2008

A three year old boy with a 10 cm double‐barrelled tubular duplication of the distal ileum is reported. He presented with a small bowel obstruction after a large meal of mandarin oranges. At laparotomy an obstruction of both lumens was found which communicated at both ends with the normal ileal lumen. Although cystic duplications of the small intestine are common, tubular duplications are relatively rare, especially an obstruction with impacted undigested foods.
Failing a generation: The impact of culture on the health and well‐being of youth
Authors: ECKERSLEY R.
Published: March 2008

Abstract Trends in suicide, mental disorders, drug abuse and crime suggest western industrial societies are becoming increasingly harmful to psychological and social well‐being. These trends are usually explained in personal, social and economic terms; problems in personal relationships, poverty, family conflict and breakdown, unemployment, homelessness, education pressures and demographic changes. The contribution of the culture of western societies to our worsening predicament, most evident among our youth, may be seriously under‐estimated because it is more difficult to assess. Yet modern western culture arguably fails to meet the most fundamental requirements of any culture: to provide a sense of belonging and purpose, and so a sense of meaning and self‐worth, and a moral framework to guide our conduct. This cultural failing may be more apparent in Australia, and other ‘new’ western nations because they are young, heterogeneous peoples. without a long, shared cultural heritage or a strong sense of identity.
Suicidal adolescents: Lessons to be learned from early intervention
Authors: ALVIN P.
Published: March 2008

Abstract In France as in most developed countries, suicide is the second leading cause of adolescent deaths. Suicide attempts are estimated to be at least 30 times more common than completed suicides. Adolescent suicidal behaviours are a most sensitive subject. Fear, defensive attitudes, and lack of consensus as to management are detrimental to a good understanding of and an appropriate approach to the problems involved. Our adolescent medicine experience with several hundred adolescent victims of suicide attempt shows that most come from troubled or abusive environments, most did not clearly intend to die and are asking for some help. Only a minority appear to be mentally ill and need inpatient psychiatric care. These patients are best approached when hospitalized like any other adolescent and offered a thorough health screening, within an integrated and multidisciplinary framework which allows working with both the patient and his family.
The impact of caring and connectedness on adolescent health and well‐being
Authors: RESNICK M. D. , HARRIS L J. , BLUM R. W.
Published: March 2008

Abstract This study of over 36000 7th‐12th grade students focused on protective factors against the quietly disturbed and acting out behaviours, which together represent the major social morbidities of adolescence. Multivariate models developed separately for girls and boys repeatedly demonstrated the protective function of caring and connectedness in the lives of youth, particularly a sense of connectedness to family and to school. A sense of spirituality, as well as low family stress (referring to poverty, unemployment, substance use and domestic violence) also functioned as protective factors. Measures of caring and connectedness surpassed demographic variables such as two parent vs single parent family structure as protective factors against high risk behaviours. Interventions for youth at‐risk must critically examine the ways in which opportunities for a sense of belonging may be fostered, particularly among youth who do not report any significant caring relationships in their lives with adults.
Street youth: Social imbalance and health risks
Authors: EISENSTEIN E.
Published: March 2008

Abstract Street youth are children and adolescents who express, through their bodies and lives, misery and social abandonment. Paradoxically, they are also the embodiment of resistance and survival strategies in a very unfavourable environment. The current deterioration of citizens' rights and the social inequalities reflect the consequences of vicious cycles of economic and political crises in Brazil. Poverty conditions reach levels of misery and create strategies of survival that create multiple high‐risk health situations. Many other factors make up the complex dynamics of these conflicts in which the limit of rejection and social abandonment are expressed in the violence of extermination. The proposals and solutions cannot be dissociated from the reality of this country and of the street youth lifestyle. Effective health education within this social context is difficult, but possible with the development of appropriate audio‐visual material and the dissemination of preventive health information. A commitment to action must permeate all levels of decision making within the health system and in our society, for it is the essence of democracy and human rights.
Suicide in the young
Authors: GOLDNEY R. D.
Published: March 2008

Abstract Suicide in the young is not a new phenomenon. There have been increases in young males but not young females, and the geographic distribution varies. Although sociological issues are of importance, there are substantial data attesting to the presence of psychiatric illness in the overwhelming majority of those who commit suicide. While such illness may not be a sufficient cause for suicide to occur, it would appear to be a necessary one. Treatments are available.
Health issues for Aboriginal youth: Social and cultural factors associated with resilience
Authors: BRADY M. A.
Published: March 2008

Abstract Research into Aboriginal health has tended to focus on the morbidity of babies and young children, or on the chronic illnesses of adults. Adolescent Aborigines are rarely the target of health research. While health services for Aboriginal people, even in remote areas, have improved enormously over the last few years with the provision of Aboriginal‐controlled organizations, health services alone do not prevent the major causes of morbidity. In any case, young people, particularly adolescent boys, are poor users of these facilities. The major causes of adolescent Aboriginal morbidity and mortality are preventable: they have to do with ways of living, with the social, cultural and physical environments which surround adolescents. The paper draws on anthropological fieldwork which pays close attention to these issues. The paper examines the concept of ‘adolescence’ among Aboriginal groups, and explores the reasons for the resilience of some populations to a particular health problem, that of petrol sniffing among the young.
Taking a chance on love: Risk behaviour of Sydney street youth
Authors: HOWARD J.
Published: March 2008

Abstract Two samples of street youth from the inner city area of Sydney, ranging in age from 13 to 20, with a mean of 17, were surveyed via a lengthy questionnaire. The first survey in 1989/90 (n= 92: 66 males, 26 females) revealed high levels of physical and sexual abuse; violence and negative relationships as major factors in leaving home; safe sexual practice not common (other than for those prostituting); polydrug use widespread and heavier for females; some needle sharing by injecting drug users (IDU). Second survey, 1990/91 (n= 100: 70 males, 30 females), confirmed previous picture, but found changes in immunodeficiency virus (HIV) risk behaviours: needle sharing reduced; for those prostituting an increase in safe sexual practices with clients; reduction in regular safe sexual practices with non‐paying partners. IDU was significantly linked to prostitution as was needle sharing. Some changes are in an encouraging direction, but more preventive work is needed focusing on safe behaviours with non‐paying partners and how to initiate and negotiate these. More qualitative or ethnographic research could better inform such efforts and, indigenous strategies deserve recognition.
Six year trend of neonatal septicaemia in a large Malaysian maternity hospital
Authors: BOO N. Y. , CHOR C. Y.
Published: March 2008

Abstract A study carried out in the Maternity Hospital, Kuala Lumpur over a 6 year period from 1986 to 1991, showed that the annual rates of septicaeia ranged from 5.2 to 10.2/100 admissions. Septicaemia accounted for between 11.0 to 30.4% of all neonatal deaths. The case fatality ratios ranged from 23.0 to 52.2%, being highest in 1989 when basic facilities were compromised. Low birthweight neonates accounted for 55.5% of those with septicaemia. The most common causative organisms were Staphylococcus epidermidis and Staphylococcus aureus in 1986 and 1987, but from 1988 Klebsiella species became the most common. More than 50% of neonatal septicaemia occurred after the age of 2 days. The results of the study demonstrated the dynamism of infection control: when control measures introduced earlier were not sustained, outbreaks of nosocomial infection recurred or worsened.
Elimination of methicillin‐resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan
Authors: WEBSTER J. , FAOAGALI J. L. , CARTWRIGHT D.
Published: March 2008

Abstract Evaluating hand wash products in terms of user acceptability and effectiveness against methicillin‐resistant Staphylococcus aureus (MRSA) has been part of a long‐term strategy to eliminate endemic MRSA from the neonatal intensive care unit at the Royal Women's Hospital (Brisbane). Following the introduction of a new hand wash disinfectant (triclosan 1% wt/vol), new cases of MRSA colonization were monitored for 12 months. In addition, the use of antibiotics, the incidence of multi‐resistant Gram‐negative cultures and neonatal infections were noted. No changes were made to any procedures or protocols during the trial. All babies colonized with MRSA had been discharged from the nursery within 7 months of the introduction of triclosan and in the subsequent 9 months no new MRSA isolates had been reported. Reduction in the use of vancomycin has resulted in a cost saving of approximately $A17000. The total number of Gram‐negative isolates has not increased, although Pseudomonas aeruginosa is now reported more often. Compared with the previous 12 months. fewer antibiotics were prescribed and fewer nosocomial infections recorded (P<0.05).
Cyanoacrylate‐assisted foreign body removal from the ear and nose in children
Authors: HANSON R. M. , STEPHENS M.
Published: March 2008

Abstract Two cases of foreign body removal using cyanoacrylate (Histoacryl blue, B.Braun Australia Pty. Ltd., Sydney, NSW) or tissue glue are described. Both cases involved children with beads, one in the external auditory meatus and the other in the nostril. The benefits of this technique are discussed.
Autism: Fifty years on from Kanner
Authors: TONGE B. J. , DISSANAYAKE C. , BRERETON A. V.
Published: March 2008

It is now 50 years since Leo Kanner first described autism as a distinctive pattern of symptoms in some children with severe developmental problems. Since then the assessment and diagnosis of children with pervasive disorders of development has been refined and much is known about the phenomenology and epidemiology. Autism is a biological disorder of the central nervous system (CNS) of unknown cause. It is associated with a number of organic disorders such as epilepsy and has comorbidity with other psychiatric disorders such as tic disorder. Cognitive abnormalities in social interactions, affect and language are present but there is still debate regarding which of these, if any, is the primary cognitive deficit. Special education and behavioural management has led to modest but important developmental improvement in many children with autism. Autism remains a life‐long condition but patterns of symptoms change and skills develop from childhood into adult life.
Child injury in Brisbane South 1985‐91: Implications for future injury surveillance
Authors: PITT W. R. , BALANDA K. P. , NIXON J.
Published: March 2008

Specific childhood injury types are ranked by occurrence rate for mortality, hospital admission and emergency department attendance. Cases are drawn from the resident population of Brisbane South, 0‐13 years of age, for the period 1 July 1985 to 30 June 1991. A total of 47244 injuries, 7056 admissions and 99 deaths were analysed. The overall mortality rate was 12.6/100 000 per year (95% confidence interval (Cl), 10.2‐15.3), the overall admission rate was 911/100 000 per year (95% Cl, 890‐932) and the overall hospital attendance rate was 6013/100000 per year (95% Cl, 5958‐6067). A fall was the most frequent injury mechanism for admissions and 65% of attendances involved injury in the child's own home. The surveillance data establish regional variation for childhood injury risk within Australia and identify an unexplained downward trend in head injury that requires further investigation. The future development of injury surveillance in Australia requires simplified coding which can be integrated into new computerized patient management information systems.
Outcome of resuscitated apparently stillborn infants: A ten year review
Authors: YEO C. L , TUDEHOPE D. I.
Published: March 2008

This study addresses the dilemma of whether to attempt resuscitation of the previously undiagnosed fresh stillborn infant and evaluates factors predictive of survival and long‐term outcome. We reviewed the clinical spectrum, immediate complications and long‐term outcome of 45 successfully resuscitated apparently stillborn infants (34 term, 11 preterm) who were admitted to the Intensive Care Nursery. Significant obstetric and intrapartum events were identified in 34 (75%) infants while 11 (25%) had no apparent risk factors. Of the 39 infants with neonatal complications, 37 had hypoxic‐ischaemic encephalopathy (HIE; Sarnat stage 1 in 5, stage 2 in 15, stage 3 in 17); 12 (27%) had oliguria, 10 (22%) had hypotension, 7 (16%) experienced hypoglycaemia, 4 (9%) had disseminated intravascular coagulopathy (DIC) and 1 (2%) had persistent pulmonary hypertension of the newborn (PPHN). Fourteen infants (31%) died in the neonatal period and four (9%) died during infancy. Risks of death and adverse neurodevelopment were significantly increased in infants with stage 2 or 3 HIE (P<0.005). Follow‐up assessment of 24 of the 27 surviving infants revealed a normal outcome in 15 (63%), severe disability in six (25%), moderate disability in two (8%) and mild disability in one (4%) infant. The positive predictive value of stage 2 or 3 HIE was 70% for mortality and 80% for morbidity. One‐third (15/45) of successfully resuscitated apparently stillborn infants were normal at follow‐up assessment and the outcome for these infants was predicted with complete accuracy by the stage of HIE present during the neonatal period.
Hypothermia in children with severe neurological disabilities
Authors: TOBIN J. , REDDIHOUGH D.
Published: March 2008

Four severely disabled children who developed hypothermia during acute illness are described. A central defect in thermoregulation in the hypothalamus is likely, based on clinical observation and limited investigations, as well as similarities to sporadic cases reported in the literature. Disturbance of temperature regulation appears to be a rare complication of major brain injury in children, without necessarily occurring in association with pituitary dysfunction. It is of clinical importance because subnormal temperature may indicate severe sepsis.
Pedestrian exposure and the risk of child pedestrian injury
Authors: ROBERTS I. G. , KEALL M. D. , FRITH W. J.
Published: March 2008

The authors used data from the New Zealand Household Travel Survey to examine the extent to which children's pedestrian exposure varies with age, sex and household income. Pedestrian injury morbidity data were combined with pedestrian exposure data to examine age‐specific pedestrian injury risk. The annual number of road crossings for girls was greater than that for boys. Pedestrian exposure increased with increasing age. Children aged 5‐9 years in the lowest household income bracket crossed approximately 50% more roads than those in the middle and upper income brackets. However, for children aged 10‐14 years there was little variation with household income. Sex differences in pedestrian injury rates cannot be explained by differences in exposure although increased exposure may partly explain the increased injury rates for children in lower socio‐economic groups. Prevention strategies might aim to reduce pedestrian exposure or alternatively to reduce pedestrian injury risk per unit of exposure by making safer urban living environments.
Sudden infant death syndrome in Aboriginal and non‐Aboriginal infants
Authors: ALESSANDRI L. M. , READ A. W. , STANLEY F. J. , BURTON P. R. , DAWES V. P.
Published: March 2008

This study, based on routinely recorded data, was designed to compare the epidemiology of sudden infant death syndrome (SIDS) in Aboriginal and non‐Aboriginal infants in Western Australia (WA). All cases of SIDS occurring in infants born in WA from 1980 to 1988 were included in the study. There were 66 Aboriginal (6.1 per 1000 live births) and 337 non‐Aboriginal (1.7 per 1000 live births) infants who died from SIDS. It was found that there was a significant linear increase in the Aboriginal SIDS rate over the study period while the non‐Aboriginal rate remained relatively constant. For non‐Aboriginal infants, there was an elevated risk of SIDS for young maternal age, single marital status and male gender but this was not found for Aboriginal infants. There was a significant difference in the age at death distribution for the two populations. Low birthweight and preterm birth were risk factors for both Aboriginal and non‐Aboriginal infants. There may be differences in the aetiology and/or classification of SIDS between the two populations.
Normal early infant behaviour patterns
Authors: WALKER A. M. , MENAHEM S.
Published: March 2008

As part of a wider study, infant behaviour was reviewed prospectively, using a 24 h diary completed by the mother. Infants' sleep, awake, fussing, crying and feeding behaviour were recorded at 1,2,4,6 and 8 weeks. Completed records were obtained from 21 infants. As expected most time was spent asleep, with a mean of 16.2 h at 1 week and 15.5 h at 8 weeks. Most sleeping occurred between midnight and 4 a.m. even by week 1 and there was a progressive fall in the average duration of feeding during that time interval over the 8 week period. Fussing and crying were mostly noted between 4 and 8 p.m. with an additional peak between 8 a.m. and noon, the latter disappearing by week 4. There was also a progressive drop in both the average feeding and fussing/crying times by week 8, reflecting increased settled and awake periods. It is against a background of normal early infant behaviour patterns that one can evaluate interventions aimed at altering such behaviour and dealing with the vexed problem of ‘colic’.
Alcohol and drug usage in parents soon after stillbirth, neonatal death or SIDS
Authors: VANCE J. C. , NAJMAN J. M. , BOYLE F. M. , EMBELTON G. , FOSTER W. J. , THEARLE M. J.
Published: March 2008

The behaviour of bereaved parents with respect to their drug and alcohol ingestion was examined 2 months following the loss of an infant from stillbirth (SB) neonatal death (NND) or sudden infant death syndrome (SIDS). Responses from bereaved families (99 SB, 109 NND, 52 SIDS) were compared with 252 control families (who had a liveborn infant). There was no difference in self‐medication using aspirin as the example. The use of sedative drugs was significantly higher in all bereaved mothers (but especially the SIDS group). Use of sedatives by fathers was significantly higher only in the SIDS group. There was also a greater frequency of heavy drinking of mothers in all the bereaved groups and fathers in the SIDS group. These results have implications for the understanding and care of families following infant loss.
Subureteric Polytef injection in the management of vesico‐ureteric reflux in children
Authors: DEWAN P. A. , GOH D. W.
Published: March 2008

Subureteric Polytef injection is one of the alternatives now available for the management of vesico‐ureteric reflux in children. The results of the treatment by one surgeon, over a 2 year period, were studied prospectively in 47 children (60 refluxing units). Following a single injection, reflux was abolished in 49 (82%) ureters and of the 11 failures, 10 ureters showed a reduction of the grade of reflux while one remained unchanged. A repeat injection was performed in nine of these ureters with success in five, persistence in two, and two children are awaiting a follow‐up cystogram. The conservative success, with the addition of a second injection, was 90% (54/60). Of the four with unresolved reflux, two have low grade reflux and are free of infection, and two have had a ureteric reimplant, one of which was after a single injection, at the request of the parents. There were no instances of ureteric obstruction. These results show a viable, minimally invasive alternative to open ureteric reimplantation in the management of vesico‐ureteric reflux in children.
Outcome of neonates transported between Level III centres depends upon centre of care
Authors: HARDING J. E. , MORTON S. M.
Published: March 2008

This study aimed to clarify whether the adverse outcomes seen in babies transported between New Zealand Level III intensive care nurseries were due to the transport itself or to possible differences in care in different centres. The outcomes of 34 infants inborn at National Women's Hospital, Auckland but transported to other centres were compared with those of 68 matched controls inborn at the receiving centres and with 68 controls inborn and cared for at National Women's Hospital.

Transport was associated with a transient (non‐significant) deterioration in respiratory status but no increase in chronic lung disease. However, infants cared for elsewhere, whether transported or control, had more periventricular haemorrhage than Auckland babies (23% and 29%vs 15%, P= 0.03) and worse neurodevelopmental outcome (70% and 66%vs 88% of those whose outcomes were known were normal at follow up, P= 0.002).

We conclude that differences in care between centres may be more important than the transport itself in determining the long‐term outcome of transported neonates.
A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus
Authors: SKELTON R. , EVANS N. , SMYTHE J.
Published: March 2008

The accuracy of the characteristic physical signs of a patent ductus arteriosus (PDA), that is, a systolic murmur, increased volume of pulses and increased praecordial activity, in diagnosing a haemodynamically significant PDA in ventilated premature infants was prospectively evaluated. Fifty‐five ventilated preterm infants (birthweight >1500g) had daily echocardiographic and clinical evaluation for a PDA for the first 7 days of life. The examiners were blinded to each other's findings. Probability analysis was performed for the accuracy of each clinical sign in detecting a haemodynamically significant PDA as defined by echocardiographic criteria. Clinical signs were poor at detecting a significant PDA in the first 4 days of life. On day 1, none of the 10 infants with a significant PDA had a murmur. By day 4, clinical signs were better at detecting a significant PDA, but specificity remained poor with many false positive signs. Six infants had murmurs with a closed duct. The development of echocardiographic haemodynamic significance preceded the development of physical signs by a mean of 1.8 days. Significant ductal shunts often occurred silently, but the development of a murmur often marked an increase in the velocity of the flow through the duct rather than an increase in the size of a shunt. This study confirms that echocardiography is required for the reliable early diagnosis of a PDA in ventilated preterm infants.