bluuebunny/crossref_metadata_2025 huggingface dataset:
Extreme sodium derangement in a paediatric inpatient population
Authors: DUNN K , BUTT W
Published: March 2008

Objective:

To determine the aetiology, symptoms and outcome of extreme sodium derangement in a paediatric inpatient population.

Methodology:

A retrospective study of children with extreme disturbance of their plasma sodium (≥ 165 mmol/L or ≤ 115 mmol/L) admitted to a tertiary referral centre during a 72‐month period.

Results:

Twenty‐seven cases of hypernatraemia and 21 of hyponatraemia were reviewed. Sodium disturbance developed after hospital admission in 27/57 cases (57%). Gastroenteritis was the most common cause of hypernatraemia (8/27; 30%), four of 27 (15%) had iatrogenic hypernatraemia. Water overload accounted for 8/21 (38%) cases of hyponatraemia. Neurologic symptoms occurred in 19/24 (79%) with hypernatraemia and in 11/19 (58%) with hyponatraemia. Ten (37%) with hypernatraemia and four (19%) with hyponatraemia died. A deterioration in functional status was seen in two patients with hypernatraemia. There was no apparent deterioration in the survivors with hyponatraemia.

Conclusion:

Extreme sodium disturbance often develops after admission to hospital and is caused by a variety of diseases and interventions. Neurologic symptoms are common and the mortality rate is high. The outcome in survivors is most likely to be dependent on the underlying disease process.
Prospective study of New Zealand very low birthweight infants: Outcome at 7–8 years
Authors: DARLOW BA , HORWOOD LJ , MOGRIDGE N , CLEMETT RS
Published: March 2008

Objective:

To determine the survival and sensorineural outcome at 7–8 years in very low birthweight (VLBW) infants born in New Zealand in 1986.

Methodology:

In 1986 all VLBW New Zealand infants admitted to neonatal units were enrolled in a prospective study of acute retinopathy of prematurity. Surviving infants were traced and were assessed at a home visit. Parents were asked a comprehensive questionnaire, and children underwent a visual assessment including photorefraction and were tested with the Revised Wechsler Intelligence Scale for Children (WISC‐R).

Results:

Four hundred and thirteen VLBW infants were admitted to neonatal units in 1986, 338 (81.8%) surviving to discharge. 12 children died after discharge, 17 were traced to overseas, seven declined to participate and four were untraced, leaving 298 (96% survivors resident in New Zealand) who were assessed at a mean age of 7.6 (± 0.4 years. 15 children (5.0%) had severe disability, 14 (4.7%) moderate disability, and 46 (15.4%) mild disability. Blindness (vision worse than 6/60) occurred in eight children (2.7%), deafness requiring aids in four (1.3%), any form of cerebral palsy in 17 (5.7%), and an IQ score on the WISC‐R>1 SD below the mean in 62 (20.8%). There was no significant difference in outcome for children with birthweight <1000 g and 1000–1499 g.

Conclusions:

Long‐term (7–8 year) survival and disability rates in this national cohort of VLBW infants is comparable with that reported from other populations. Although a majority of children have no disability a sizeable proportion do perform poorly on the WISC‐R. This may relate in part to problems such as a short attention span and poor visual‐motor integration.
The use of breastmilk in a neonatal unit and its relationship to protein and energy intake and growth
Authors: SIMMER K , METCALF R , DANIELS L
Published: March 2008

Objective:

A nutritional audit was performed to determine whether current feeding regimes were achieving nutritional goals and to evaluate the use of breastmilk (BM) in a neonatal unit (NNU).

Methods:

All fluid consumed or infused daily was documented with daily weight and weekly length and head circumference measurements in 90 preterm infants (gestational age 30.1 ± 2.6 weeks) while in the NNU for 60 ± 27 days. Daily protein and energy intakes were calculated using values for South Australian preterm BM.

Results:

Parenteral nutrition provided 85% of the daily energy in week 1 falling to 11% by week 6. Ninety per cent of infants received some of their mother's BM and 62% were discharged at least partially breastfed. Protein and energy intakes were 1.03 ± 0.35 g and 55 ± 10 kcal/kg/day in week 1, increasing to 2.52 ± 0.60 g and 109 ± 15 kcal/kg per day by week 4. Protein intake correlated with weight gain (r2=0.39). Weight gain was 14.0 ± 2.0 g/kg per day and z‐scores for weight declined from 0.25 on admission to 1.22 on discharge, P<0.0001.

When infants were divided into two groups comprising those who received BM or formula as their predominant enteral feed, growth and protein intake (but not energy intake) were lower in the BM‐fed infants. However, enteral feeds were tolerated earlier and more quickly in those infants receiving predominantly BM.

Conclusion:

Energy requirements were readily met using current feeding regimes for preterm infants but protein intakes were marginal. Mothers of preterm infants had similar breastfeeding rates to mothers of term infants in South Australia. The long‐term effects of the lower growth rates of preterm infants fed predominantly BM compared with those fed predominatly formula are unknown and need be balanced against the benefits of BM.
Further observations on the immune response to recombinant hepatitis B vaccine after administration to Aboriginal and Torres Strait Island children
Authors: HANNA JN , FAOAGALI JL , BUDA PJ , SHERIDAN JW
Published: March 2008

Objective:

To determine the prevalence of markers of hepatitis B virus (HBV) immunity and infection at 5 years of age in Aboriginal and Torres Strait Island children who were fully vaccinated in infancy, and to examine the response to a booster dose of hepatitis B vaccine in those children who had no detectable immunity despite vaccination.

Methodology:

A cross‐sectional study of serological markers to HBV in a sample of 239 Aboriginal and Torres Strait Island children, with a mean age of 5.7 years, who were fully vaccinated in infancy. The antibody response to a booster dose of hepatitis B vaccine was determined in those children in the sample who had no markers of either immunity to HBV or infection with HBV.

Results:

Of the 239 children, 6% (95% Cl 4–10%) had been infected and, of these, four were HBV surface antigen (HBsAg) positive. Of the remaining 224 children, only 41% (95% Cl 35–48%) had evidence of immunity (i.e. an antibody to HBV surface antigen (anti‐HBs) level of ≥10 miu/mL) to HBV. Of the children with no detectable immunity (i.e. anti‐HBs < 10 miu/mL), 113 were followed up after receiving a booster dose of hepatitis B vaccine. Of these, 84% (95% Cl 76–90%) had an anamnestic response (i.e. anti‐HBs <10 miu/mL following the booster dose). Therefore 16% (95% Cl 10–24%) still had no detectable immunity following the booster dose.

Conclusions:

This study provides further evidence that Aboriginal and Torres Strait Island children have a suboptimal response to recombinant hepatitis B vaccine. It also indicates that a considerable number of Aboriginal and Torres Strait Island children in the study age cohort have been exposed to HBV. However, despite these concerns, this study and historical data provide strong evidence that there has been a marked reduction in the prevalence of HBV infection and carriage in previously ‘high risk’ Aboriginal and Torres Strait Island children since the introduction of hepatitis B vaccines. Aboriginal and Torres Strait Island children who have been fully vaccinated in infancy do not require a booster dose of hepatitis B vaccine at school entry.
Craniosynostosis in X‐linked hypophosphataemic rickets
Authors: WILLIS FR , BEATTIE TJ
Published: March 2008

A report of three cases of craniosynostosis in X‐linked hypophosphataemic rickets (XLH) is presented. The literature is reviewed, suggesting that craniosynostosis is relatively common in XLH and that boys may be more at risk than girls. It is recommended that radiological screening be offered to all patients with XLH.
Chronic illness perception in adolescence: Implications for the doctor‐patient relationship
Authors: LEUNG SS , STEINBECK KS , MORRIS SL , KOHN MR , TOWNS SJ , BENNETT DL
Published: March 2008

Objective:

To describe the inter‐relationship of chronic illness severity as perceived by adolescents with both psychosocial well‐being and objective measures of illness severity. Additionally to compare the adolescents' perception of illness severity with how their physicians believe that the adolescents perceive their illness severity.

Methods:

The psychological well‐being of 48 adolescents with either cystic fibrosis (CF) or insulin‐dependent diabetes mellitus (IDDM) was measured by four standardized questionnaires. The adolescents' perception of severity of illness was measured using an original instrument (PSCI), and this measure was compared to their physicians' estimates of how the adolescents perceived the severity of their illness and clinical illness.

Results:

There were 24 patients in both the CF and IDDM groups. Both groups were found to function well psychosocially; although, there were more patients with low self image compared to normative values. Depression and low self image were associated with a greater adolescent perception of illness severity. For both chronic illness groups, physicians' assessment of assumed adolescent perception of disease severity correlated with clinical indices of disease severity and was higher than the perception of illness severity reported by the adolescents. For adolescents with CF, but not with IDDM, perception of severity of chronic illness correlated with clinical indices.

Conclusions:

For adolescents with chronic illness, their perception of illness severity is an important indicator of psychosocial well‐being. Physicians do not accurately infer their patients' perception of illness severity.
Thyroid function in a population of children with attention deficit hyperactivity disorder
Authors: VALENTINE J , ROSSI E , O'LEARY P , PARRY TS , KURINCZUK JJ , SLY P
Published: March 2008

Objective:

To determine the prevalence of thyroid hormone abnormalities and generalized resistance to thyroid hormone in a population of children with attention deficit hyperactivity disorder (ADHD) as compared to reference ranges determined from a control population and hence to determine if routine thyroid hormone screening in children with non‐familial ADHD is indicated.

Method:

Children attending the State Child Development Centre in Perth, Western Australia with ADHD, as defined by the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) provided the study population. The control population consisted of 353 normal children with a history of allergy in whom radioallergosorbent (RAST) testing was being performed.

Results:

The prevalence of thyroid hormone abnormalities in the study population was 2.3% (95% CI 0.6%, 5.7%). There were no cases of generalized resistance to thyroid hormone. The prevalence of thyroid hormone abnormalities in the general population of children and adolescents has been reported to vary between 1 and 3.7%.

Conclusion:

Routine thyroid hormone screening is not indicated in children with non‐familial ADHD.
Vigabatrin as first line therapy in infantile spasms: Review of seven patients
Authors: KWONG L
Published: March 2008

Objective:

To study the efficacy of vigabatrin as initial therapy in infantile spasms.

Methodology:

We reviewed seven patients with newly diagnosed infantile spasms referred to Tuen Mun Hospital, Hong Kong from 1994 to 1995. Vigabatrin was given as the initial monotherapy at therapeutic dose of 50–100 mg/kg. Efficacy was evaluated at the end of second week of treatment.

Results:

Significant improvement was observed in four patients, 50–75% seizure reduction in two and no response in one patient. Efficacy was noted within the first week of treatment in five of the six patients who responded. No adverse effects were observed. Vigabatrin monotherapy could be continued in five patients.

Conclusion:

Vigabatrin could be considered as the first line treatment in infantile spasms. A period of 2 weeks may be sufficient to evaluate its efficacy.
Fat gram target to achieve high energy intake in cystic fibrosis
Authors: COLLINS CE , O'LOUGHLIN EV , HENRY RL
Published: March 2008

Objective:

Higher fat and energy intakes confer a survival advantage in cystic fibrosis (CF). There is a need to develop effective nutrition programmes that ensure optimal energy intake in CF.

Methodology:

A cross‐sectional measurement of clinical characteristics and energy and fat intakes in patients attending the CF outpatients clinic of the John Hunter Hospital, Newcastle was undertaken. Twenty‐nine subjects, mean age 12 years (range 4.3–20.2), completed weighed food records to determine the contribution of fat to the percentage of the recommended energy intake obtained and to document use of pancreatic enzyme replacement therapy.

Results:

Diets with a high percentage of energy derived from fat did not guarantee that individuals with CF met their energy requirements. Subjects with total fat intakes of 100 g per day or greater, however, achieved in excess of 110% recommended daily intake (RDI) for energy. Up to 47% of subjects consumed more pancreatic enzyme replacement capsules than shown to give maximum effectiveness.

Conclusion:

Setting a 100 g daily fat target is a realistic way of ensuring high energy intakes in CF. Fat ready reckoners would identify the fat content of food and prescribe specific numbers of pancreatic enzyme replacement capsules to be consumed with each meal or food item.
Erythromycin treatment for gastrointestinal dysmotility in preterm infants
Authors: NG PC , FOK TF , LEE CH , WONG W , CHEUNG KL
Published: March 2008

Objective:

To report our clinical experience on the use of oral erythromycin for the treatment of severe gastrointestinal dysmotility in preterm infants.

Methodology:

A case series study of seven preterm infants (six were very low birthweight) with severe intestinal dysmotility in a tertiary neonatal centre.

Results:

All responded favourably without adverse effects and tolerated full enteral feeding within 1–2 weeks of the commencement of the drug.

Conclusions:

As prolonged total parenteral nutrition carries significant risk of complications, this therapy could be considered in selected preterm infants who fail to establish enteral feeding after an extended period, and in whom an anatomically obstructive lesion of the gastrointestinal tract has been excluded. Meanwhile, we would caution against the widespread implementation of this therapeutic approach until formal evaluation by randomized controlled trials have established the exact role of erythromycin, or its analogues, in the treatment of intestinal dysmotility in preterm infants.
Developmental dysplasia of the hip in South Australia in 1991: Prevalence and risk factors
Authors: YIV BC , SAIDIN R , CUNDY PJ , TGETGEL JD , AGUILAR J , McCAUL KA , KEANE RJ , CHAN A , SCOTT H
Published: March 2008

Objectives:

To determine the prevalence of developmental dysplasia of the hip (DDH) in South Australia (SA) in 1991, the proportion of cases detected in the neonatal period and the perinatal risk factors for DDH.

Methodology:

Cases of DDH born in SA in 1991 were identified from multiple sources and their clinical data linked to perinatal data provided by midwives; five controls per case were obtained randomly from SA livebirths without congenital abnormalities and adjusted odds ratios (OR) for potential risk factors obtained by logistic regression analysis. South Australia perinatal data were also used to estimate numbers of births with perinatal risk factors for targeted screening.

Results:

Two hundred and six cases of isolated DDH were identified, giving a prevalence of 10.5 per 1000 births. Of these, 173 (84%) had been detected in the neonatal period. The perinatal risk factors for DDH were identified as breech presentation (OR 9.65), female babies (OR 4.04), first births (OR 1.91) and maternal age of 25 years or more (OR 1.53). Screening breech and firstborn female babies (23% of births) would yield approximately 51% of cases of DDH.

Conclusions:

Isolated DDH had a prevalence of 10.5 per 1000 births and 84% of cases had been detected in the neonatal period in SA. Repeated screening during infancy of ‘at risk’ groups of babies is recommended.
Longitudinal study of rotavirus infection in child‐care centres
Authors: FERSON MJ , STRINGFELLOW S , McPHIE K , McIVER CJ , SIMOS A
Published: March 2008

Objective:

To describe the epidemiology of symptomatic and asymptomatic rotavirus infection among young children attending Sydney child‐care centres during the 1994 rotavirus season.

Methods:

Children aged 0–36 months in 11 child‐care centres participated in the study. A weekly stool specimen was collected from each subject and tested for rotavirus antigen by commercial enzyme immunoassay.

Results:

One hundred and seventy‐eight children (76 girls and 102 boys) with a mean age of 18.2 ± 6.5 (SD) months were enrolled for a total of 2249 child‐weeks. Of 1653 weekly faecal specimens, 59 (3.6%) were positive for rotavirus antigen. Positivity for rotavirus antigen peaked at 8.0% and 7.4% of specimens in weeks 6 and 7, respectively. The 59 positive specimens were obtained from 44 children in eight of the 11 study centres. One child appeared to suffer a second episode. Eighty‐two per cent of episodes were associated with symptoms of gastroenteritis. Overall, 32% of the children in the eight affected centres were infected; 52% of those <12 months were infected compared to 26% of older children. Secondary spread to household contacts was also documented.

Conclusions:

Rotavirus infection poses a significant health problem in under‐3‐year‐old children attending child‐care centres in Sydney. We believe that these results are applicable to all Australian children of this age attending group child care.
Outcome at 2 years of children 23–27 weeks' gestation born in Victoria in 1991–92
Authors:   THE VICTORIAN INFANT COLLABORATIVE STUDY GROUP
Published: March 2008

Objective:

To determine the survival and sensorineural disability rates in very preterm infants born in 1991–92, and to compare the results with contemporaneous normal birthweight controls and with preterm infants born in 1985–87.

Methodology:

This was a geographically determined cohort study in the state of Victoria, Australia of consecutive livebirths 23–27 weeks' gestational age born during 1991–92, and randomly selected contemporaneous normal birthweight (NBW) controls born during 1991–92 in the three level‐III perinatal centres in the State. Consecutive livebirths 24–26 weeks gestational age born in the State during 1985–87 comprised another comparison group. The main outcome measures were survival and sensorineural disability rates at 2 years of age.

Results:

Of the 401 livebirths 23–27 weeks in 1991–92, 225 (56.1%) survived to 2 years of age. The survival rate for those 24–26 weeks was 57.4% (143/249), a statistically significant increase on the regional survival rate of 30.1% (95/316) in 1985–87. In 1991–92 births, the survival rate rose significantly with increasing gestational age, and was significantly higher than in 1985–87 at each of 24, 25, and 26 weeks. Of sensorineural impairments in preterm survivors at 2 years of age, the rate of blindness was significantly lower in 1991–92 (2.3%) compared with 1985–87 (8.4%), and the overall rates of sensorineural disability were not statistically different in 1991–92 compared with 1985–87. In 1991–92 preterm survivors, the survival rate free of disability rose significantly with increasing gestational age, and as a percentage of survivors the rate of disability overall fell with increasing gestational age. However, the rate of disability overall was much higher in preterm infants than NBW controls.

Conclusions:

Survival rates of very preterm infants in this regional cohort have improved in the 1990s after the introduction of exogenous surfactant. Blindness at 2 years of age was significantly lower than in an earlier preterm cohort, but the rates of sensorineural disability still remain higher in very preterm survivors than for NBW controls. Although survival rates are lower and disability rates are higher with diminishing maturity, there is no obvious gestational age below which adverse neurological outcome in survivors would preclude active management on the basis of gestational age alone.
V‐shaped pillows and unsafe infant sleeping
Authors: BYARD RW , BEAL SM
Published: March 2008

Objective:

To investigate the possibility that adult size V‐shaped pillows may be associated with accidental asphyxial deaths in infants.

Methodology:

Review was undertaken of all cases of sudden infant death presenting to the Women's and Children's Hospital in Adelaide involving infants who had been found on adult size V‐shaped pillows.

Results:

Four cases of sudden infant death were found in which infants were found sleeping on V‐shaped pillows. All of the deaths had occurred in 1995. In two of the cases the pillows were considered to be implicated in the cause of death as the potential for obstruction of the infants' airways could be demonstrated on death scene reconstruction.

Conclusion:

Adult size V‐shaped pillows may be unsafe for use in small infants who may accidentally suffocate if trapped between the two arms, or under, the pillow. The use of such pillows to maintain the body position of sleeping infants should be discouraged.
Recent advances in diagnosis of the childhood muscular dystrophies
Authors: JONES KJ , NORTH KN
Published: March 2008

Abstract: Recent advances in molecular genetics research have revolutionised our understanding of the childhood muscular dystrophies. The first breakthrough came in 1987 with the identification of the gene for dystrophin, the protein that is abnormal in X‐linked Duchenne muscular dystrophy. Dystrophin is bound to a complex of proteins in the muscle membrane, and primary abnormalities of these protein have now been identified as the cause of some autosomally inherited forms of muscular dystrophy. A group of transmembrane proteins known as α‐ (adhalin) β‐, γ‐ and δ‐sarcoglycan are deficient in autosomal recessive limb‐girdle muscular dystrophy, and the extracellular matrix protein merosin (α2‐laminin), is deficient in a subset of patients with congenital muscular dystrophy. Identification of primary deficiencies in these ‘dystrophin associated proteins' will result in improved diagnostic accuracy, more accurate genetic counselling and, in some cases, the availability of prenatal diagnosis.
Economic outcome for intensive care of infants of birthweight 500–999 g born in Victoria in the post surfactant era
Authors:   THE VICTORIAN INFANT COLLABORATIVE STUDY GROUP
Published: March 2008

Objective: To determine the incremental cost of improving the outcome for extremely low birthweight (ELBW, birthweight 500–999 g) infants born in Victoria after the introduction of exogenous surfactant (the post surfactant era).

Methodology: This was a geographically determined cohort study of ELBW children in Victoria, Australia of consecutive livebirths born in three distinct eras: (i) 1979–80 (n= 351); (ii) 1985–87 (n= 560); and (iii) 1991–92 (n= 429). Exogenous surfactant was first used in Victoria in March, 1991. The consumption of nursery resources per livebirth, and the survival and sensorineural disability rates at 2 years of age for each era were investigated. Utilities were assigned as follows: 0 for dead, 0.4 for severe disability, 0.6 for moderate disability, 0.8 for mild disability, and 1 for no disability. Utilities were multiplied for more than one disability. Dollar costs were assumed to be $1470 ($A 1992) per day of assisted ventilation, and one dose of exogenous surfactant was assumed to be equivalent to one third of a day of assisted ventilation. Cost‐effectiveness (additional costs per additional survivor or life‐year gained) and cost‐utility (additional costs per additional quality‐adjusted survivor or life‐year gained) ratios were calculated for the pre‐surfactant era (1985–87 vs 1979–80), and for the post surfactant era (1991–92 vs 1985–87).

Results: Considering only the costs incurred during the primary hospitalization, cost‐effectiveness and cost‐utility ratios were lower (i.e. economically better) in the post surfactant era than in the pre‐surfactant era (pre‐surfactant vs post surfactant; S7040 vs$4040 per life year gained; $6700 vs$5360 per quality‐adjusted life year gained). Both ratios fell with increasing birthweight. In contrast with the pre‐surfactant era, cost‐utility ratios were less favourable than cost‐effectiveness ratios in the post surfactant era. With costs for long‐term care of severely disabled children added, both cost ratios were higher in the post surfactant era.

Conclusion: The incremental cost during the primary hospitalization of improving the outcome for ELBW infants has fallen in the post surfactant era.
Calcium intake in children with positive IgG RAST to cow's milk
Authors: MADSEN CD , HENDERSON RC
Published: March 2008

Objective: This study was made to: (i) identify the prevalence of low calcium intakes in a paediatric population with loosely defined ‘milk allergy’; and (ii) assess long‐term (mean 21 months later) changes in calcium intake following a single nutrition counselling session with those patients initially found to have a low intake.

Methodology: Calcium intake was assessed in a cross‐sectional study of 58 patients ages 5–16 years (mean 9.9 years) with IgG radioallergosorbent test (RAST) class II or higher for cow's milk protein. Those 31 patients found to have a low calcium intake were prospectively re‐evaluated 12–30 months later following a single nutrition counselling session.

Results: Calcium intake was < recommended dietary allowance (RDA) for 31 of 58 (53%) patients. The patient's perception of their intake was unreliable; 44% of those who rated their calcium intake fair or good did not meet their RDA. Taking a calcium supplement did not ensure adequate intake; 21% of those taking supplements still did not meet their RDA. Milk intake predicted calcium intake; 8% of those who did not drink milk vs 68% of those who did drink at least some milk met their RDA without supplementation. The 31 patients with low intakes received counselling and were re‐evaluated at an average follow‐up of nearly 2 years. Calcium intake was increased a mean of 360 mg/day and use of supplements increased from 10 to 52% of the group. Despite these positive changes, 48% still did not meet their RDA.

Conclusion: Limited milk intake is likely to be associated with suboptimal calcium intake. Efforts should be made to educate the family about the importance of calcium and its non‐dairy sources. With many families repeated discussions of this issue may be necessary to influence calcium intake.
Treatment characteristics of congenital heart disease and behaviour problems of patients and healthy siblings
Authors: JANUS M , GOLDBERG S
Published: March 2008

Objective: To examine behaviour problems of children in families where one child was diagnosed with congenital heart disease (CHD), in relation to the intensity of treatment required for the CHD.

Methodology: Treatment intensity was based on patients' hospitalizations, surgical operations, current treatment, frequency of check‐ups and finality of surgical repair. Mothers of 29 patients and 43 healthy siblings (4–14 years old), and a sub‐sample of fathers, reported on behaviour problems of their children and rated the frequency of considering patient's CHD while performing routine child care in nine areas of family life (accommodation of illness).

Results: High treatment intensity was associated with high accommodation of illness and elevated behaviour problems among patients. In contrast, siblings in families where treatment intensity was low, but accommodation of illness high were at most risk for behaviour problems.

Conclusions: Treatment intensity has a markedly different impact on behaviour problems of patients and healthy siblings. It is important for parents and healthcare professionals to provide both patients and siblings with information about the patient's medical condition, regardless how much treatment that condition may need.
A review of open biopsy for mediastinal masses
Authors: Massie RJH , Asperen PP Van , Mellis CM
Published: March 2008

Objective: To review the recent experience with biopsied mediastinal lesions in children and to assess the impact of recent advances in imaging and surgical techniques on diagnosis.

Methodology: The clinical and radiological features of 55 patients who had mediastinal biopsies at The Royal Alexandra Hospital For Children (RAHC) over 15 years were reviewed.

Results: Fifty‐five patients presented to RAHC between 1978 and 1993 with lesions of the mediastinum requiring biopsy of that site. Thirty‐one of the 55 (56%) lesions were malignant. Neurogenic tumours were the most common (40%). In order of frequency the following lesions were found: neuroblastoma (15), teratoma (eight), non‐ Hodgkin's lymphoma (NHL; eight), enteric cyst/duplication (five), ganglioneuroma (five), bronchogenic cyst (three), ganglioneuroblastoma (two), lymphangioma (two), abscess (two), Hodgkin's lymphoma (HL; two), oesophageal granuloma (one), Langerhan's cell histiocytosis (one), congenital fibromatosis (one). Eighty‐two per cent of neurogenic tumours were located in the posterior mediastinum, while 75% of teratomas and 100% lymphoid tumours were located anteriorly. Symptoms were generally unhelpful in establishing a specific diagnosis and in 27% of cases the lesions were discovered incidentally. Physical signs, such as thoracic inlet obstruction and neurological findings, were helpful clinically in localizing lesions within the mediastinum. Chest radiography enabled lesions to be subdivided within the mediastinum. This localization, in combination with the age at presentation, predicted the tissue diagnosis. Computerized tomography (CT) and magnetic resonance imaging (MRI) further defined the lesion and demonstrated involvement of adjacent structures. Histology, however, was essential to distinguish benign from malignant lesions.

Conclusions: The clinical presentation of mediastinal masses is often non‐specific or incidental. Despite recent advances in imaging technology and biopsy techniques, full histological examination is required to exclude malignancy.
Acute renal failure in the newborn: Incidence and outcome
Authors: AIREDE A'KI , BELLO M , WEERASINGHE HD
Published: March 2008

Objective: To describe an experience from a developing country of newborn renal disease particularly those without advanced neonatal care.

Methodology: Prospective evaluation from a referral hospital, North‐East of Nigeria between 1 July 1990 and 30 June 1994. Babies admitted for any morbidities who were diagnosed as being in acute renal failure (ARF) during the study period (non‐oliguric inclusive). Onset of ARF; day on which oliguria or anuria detected, or serum urea first exceeded 10 mmol/L. Urine output quantitated from carefully bagged urine and suprapubic bladder aspiration, and venous blood regularly obtained for serum electrolytes, urea and creatinine. Fractional excretion of sodium (FENa) and renal failure index (RFI) were determined on some babies.

Results: Forty‐three neonates (M:F; 3.3:1) with ARF, the majority (27) of whom were out‐born, and 14, 26 and three were preterm, full‐term and post term, respectively. Encountered incidence was 3.9/1000 live births with a high prevalence rate; 34.5/1000 admissions. A significantly greater incidence was seen in the latter half of study; 10.7 vs 53.7/1000, P<0.05. Early ARF occurrence (aged; 0–5 days) in 33 (77%) of babies. The aetiology was comprised of perinatal asphyxia, sepsis, obstructive uropathy and miscellaneous in 53.4%, 32.6%, 9.3% and 4.7%, respectively. Twenty‐two (51.2%) deaths occurred; however, the exact causes were indeterminable. Fractional excretion of sodium (FENa and renal failure index (RFI) were of <1.75% and ≤2.0, respectively, significantly differentiated sepsis (intrinsic) from perinatal asphyxial (pre‐renal) ARF; P<0.01. No case of persistent renal failure occurred.

Conclusion: Our FENa value (although less than reported in previous literature from affluent societies) remained sensitive (along with RFI) in differentiating aetiological group of ARF. Our data and medical management outcome, despite absence of level‐III care, support the need for good resuscitation, careful monitoring and constant re‐evaluation. The effect of salbutamol on hyperkalaemia is emphasized.
Human milk oligosaccharides: Only the breast
Authors: McVEAGH P , MILLER J BRAND
Published: March 2008

Abstract: Over 100 years ago it was first deduced that a major component of human milk must be an unidentified carbohydrate that was not found in cows milk. At first this was thought to be a form of lactose and was called gynolactose. We now know that this was not a single carbohydrate but a complex mixture of approximately 130 different oligosaccharides. Although small amounts of a few oligosaccharides have been found in the milk of other mammals, this rich diversity of sugars is unique to human milk. The oligosaccharide content of human milk varies with the infant's gestation, the duration of lactation, diurnally and with the genetic makeup of the mother. Milk oligosaccharides have a number of functions that may protect the health of the breast fed infant. As they are not digested in the small intestine, they form the ‘soluble’ fibre of breast milk and their intact structure is available to act as competitive ligands protecting the breast‐fed infant from pathogens. There is a growing list of pathogens for which a specific oligosaccharide ligand has been described in human milk. They are likely to form the model for future therapeutic and prophylactic anti‐microbials. They provide substrates for bacteria in the infant colon and thereby contribute to the difference in faecal pH and faecal flora between breast and formula‐fed infants. They may also be important as a source of sialic acid, essential for brain development.
Prediction of obesity in children at 5 years: A cohort study
Authors: O'CALLAGHAN MJ , WILLIAMS GM , ANDERSEN MJ , BOR W , NAJMAN JM
Published: March 2008

Objective:To examine determinants of moderate and severe obesity in children at 5 years of age.

Methodology:A prospective cohort of mothers were enrolled at first antenatal visit, and interviewed shortly after delivery, at 6 months and 5 years. Detailed health, psychological and social questionnaires were completed at each phase by mothers, and child health questionnaires at 6 months and 5 years. At 5 years 4062 children were assessed physically, the Peabody Picture Vocabulary Test administered and mothers completed a modified Child Behaviour Checklist. Moderate obesity was defined as BMI between 85th and 94th percentiles inclusively, and severe obesity as a BMI greater than the 94th percentile.

Results:Independent predictors of severe obesity at 5 years were birthweight, female gender, maternal BMI and paternal BMI. Moderate obesity at 5 years was predicted by birthweight, paternal BMI and sleeplessness at 6 months, while small for gestational age (SGA) status and feeding problems at 6 months were protective factors for moderate obesity. Obesity was not associated with problems of language comprehension or behaviour.

Conclusions:Findings of this study suggest that biological rather than psychosocial factors are the major determinants of obesity at 5 years.
Haemodynamic responses and population pharmacokinetics of midazolam following administration to ventilated, preterm neonates
Authors: HARTE GJ , GRAY PH , LEE TC , STEER PA , CHARLES BG
Published: March 2008

Objective: To evaluate the effects of intravenous midazolam on haemodynamic variables and cerebral blood flow velocity (CBFV) and to determine the pharmacokinetics using a population approach in very low birthweight (VLBW) ventilated infants.

Methodology: Physiological variables were measured at predetermined times in 10 infants with birthweight ≤1500 g following a bolus dose of intravenous midazolam (0.1 mg/kg). Heart rate, mean arterial blood pressure (MAP) and transcutaneous CO2 (TcPCO2) were recorded and CBFV was assessed by Doppler ultrasound. Midazolam concentrations were also measured and pharmacokinetic parameters determined using a population modelling package.

Results: No change in heart rate occurred during the study period, while the MAP decreased by 3 mmHg 5 min after midazolam administration compared to baseline values. A non‐significant fall in TcPCO2 was seen at 20 min. Mean CBFV decreased from the baseline by 12% at 5 min, then returning to predose values. Midazolam concentrations were in the range shown to be effective in sedation of paediatric intensive care infants with the elimination being delayed in comparison to older children.

Conclusions: As only minor cerebral and haemodynamic effects were found with the use of midazolam in stable ventilated preterm infants, it appears to be a safe, short‐term sedative agent.
Thyroglossal duct cyst or ectopic thyroid gland?
Authors: HOLLAND AJA , SPARNON AL , LeQUESNE GW
Published: March 2008

Abstract: We report a 16‐year‐old boy with an anterior midline neck mass clinically diagnosed as a thyroglossal duct cyst. An ultrasound scan performed prior to surgery suggested a normally located thyroid gland. Following surgical excision of the presumed thyroglossal duct cyst the patient became hypothyroid. A radioisotope scan confirmed no active thyroid tissue. A pitfall in the ultrasonographic identification of the thyroid gland is discussed.
The effect of 12 months' treatment with eicosapentaenoic acid in five children with cystic fibrosis
Authors: THIES NH
Published: March 2008

Abstract: Five children with cystic fibrosis (CF) and chronic suppurative lung disease had eicosapentaenoic acid (EPA) supplementation for 12 months. Outcome was measured by the change in frequency of admissions/bed days while taking EPA compared to the previous 2 years. Although no significant changes occurred, there is an indication that this treatment may benefit children who don't have end‐stage disease. Further studies are indicated in the use of this neglected mode of treatment.
Helicobacter pylori: challenges for the paediatrician
Authors: WALSH D , DRUMM B
Published: March 2008

Abstract: During the last 15 years, a great body of knowledge about Helicobacter pylori has been accumulated. Much, however, remains to be studied, particularly in relation to children. The vast majority of infections occur in childhood. It is towards children that any widespread screening, prevention or treatment strategies would need to be aimed. In this annotation, we discuss the epidemiology, symptomatology, diagnosis and treatment of H. pylori in children.
How does surfactant really work?
Authors: HILLS BA
Published: March 2008

Abstract: Although administration of exogenous surfactant to the neonate with RDS often relieves hypoxia rapidly, it is events occurring some 18–48 h later that determine the ultimate clinical outcome, indicating a vital second stage to ‘rescue’. It is proposed that, whereas a reduction in surface tension facilitates the initial penetration of the lungs by air, the second stage is provided by surface‐active phospholipid (SAPL) slowly adsorbing (binding) to alveolar epithelium to displace water in the same way that surfactants are widely used industrially as ‘de‐watering’ agents. In the normal newborn, this de‐watering lining of SAPL is already in place, explaining the extremely rapid expulsion of fluid from the lungs at birth. The selection or formulation of a surfactant for rescue should thus take both stages into consideration.
Blood pressure, lipids, lipoproteins, body fat and physical activity of Singapore children
Authors: SCHMIDT GJ , STENSEL DJ , WALKUSKI JJ
Published: March 2008

Objective: To determine body composition, coronary risk factors and physical activity and the inter‐relationships of these variables in Singaporean school children.

Methodology: This study examined 1681 children (784 boys and 897 girls) from eight primary and seven secondary schools to determine percentiles for body stature and composition, blood pressure, lipids/lipoproteins and blood glucose by gender for three age divisions. An exercise and leisure pursuit questionnaire was administered to ascertain self‐reported physical activity patterns. Anthropometric data and blood pressure readings were taken. Capillary blood was drawn from each child via finger prick sampling following an overnight fast. The concentrations of total cholesterol (TCHOL), triglyceride (TG), high‐density lipoprotein cholesterol (HDL‐C) and glucose (GLU) were determined from plasma using a dry chemistry analyser. Low‐density lipoprotein cholesterol (LDL‐C), very low‐density lipoprotein cholesterol (VLDL) and the TCHOL/HDL‐C ratio were determined by calculation.

Results: While 47.7% of boys and 22.0% of girls disclosed active lifestyles, differences between the active and non‐active children were found in coronary risk factors TCHOL, LDL‐C, TG, TCHOL/HDL‐C and per cent body fat. No differences were shown between the two groups in HDL‐C, GLU and blood pressure. There was a high correlation between the various measures of body composition with the highest correlation (r=0.806, P < 0.001) found between body mass index (BMI) and waist measurements.

Conclusions: Children in this study who reported no activity or relatively little activity were found to have TCHOL, LDL‐C, TG, TCHOL/HDL‐C and per cent body fat that were higher than those who reported moderately high or vigorous physical activity patterns.
Complications of central venous access devices in children with and without cancer
Authors: TOBIANSKY R , LUI K , DALTON DM , SHAW P , MARTIN H , ISAACS D
Published: March 2008

Objective: Complications of indwelling central venous access devices (CVAD) were assessed in 63 children with cancer and 35 without cancer.

Methodology: Central venous access devices placed surgically in 1991 were reviewed for complications.

Results: In cancer patients, the median CVAD duration was 211 days (range 9–924), compared to 37 days (range 3–339) in the non‐cancer patients. Although significantly more CVAD, 41 of 72 (57%), were infected in the cancer patients compared to 14 of 40 (35%) CVAD in the non‐cancer patients (OR = 2.46, 95% Cl 1.03–5.93), the rate of line infection in cancer patients was lower: 2.8 per 1000 catheter days compared with 7.6 per 1000 in non‐cancer patients (P= 0.0014). Infection was significantly more common in intensive chemotherapy cancer patients (P= 0.0002).

Conclusions: Treating infected CVAD with antibiotics or hydrochloric acid (HCl), clearing occluded lines with streptokinase/HCl and repairing fractured lines, when successful, resulted in a considerable gain in the number of days of use for the CVAD.
Preschool hearing screening: Evaluation of a parental questionnaire
Authors: HAMMOND PD , GOLD MS , WIGG NR , VOLKMER RE
Published: March 2008

Objective: To evaluate the validity of a parental questionnaire used to screen preschool children for persistent hearing impairment.

Methodology: Six‐hundred and eighty‐five children aged 4–5 years from a Metropolitan area of Adelaide, Australia, were enrolled. Each parent completed a questionnaire aimed at detecting parental concerns about hearing impairment. Screening audiometry was then performed. Children who failed the initial audiometry screening underwent repeat audiometry screening 6–8 weeks later. The audiometry and questionnaire data were then compared.

Results: Of the 657 children who successfully completed initial audiometry, 544 (83%) passed and 113 (17%) failed. Of the 84 children who had follow‐up audiometry, 64 (76%) passed. Parental concerns were identified on questionnaire in 50% of all children. Neither individual questions nor the number of concerns were found to relate to audiometry results. Compared with audiometry results, the hearing screening questionnaire had a sensitivity of 56% and specificity of 52%.

Conclusions: The hearing questionnaire used in this study and in several Australian states is an ineffective screening test for detecting persistent hearing loss.
Salmonella meningitis in children in Far North Queensland
Authors: MESSER RD , WARNOCK TH , HEAZLEWOOD RJ , HANNA JN
Published: March 2008

Abstract: Seven cases of Salmonella meningitis have occurred in infants in Far North Queensland since 1982. The mean age of onset was 2.8 months, and at least five of the cases were caused by Salmonella virchow. Five of the cases had significant complications during the acute illness: all required prolonged (median 34 days) inpatient management, and four developed permanent neurological sequelae. S. virchow is the serovar most frequently isolated from infants in Far North Queensland. The source of S. virchow infections in these infants remains uncertain, but transmission may occur through cross‐infection and person‐to‐person transmission in the home.
Methionine loading does not enhance the predictive value of homocysteine serum testing for all‐cause mortality or major adverse cardiac events
Authors: Dunkelgrun M. , Hoeks S. E. , Schouten O. , Feringa H. H. H. , Welten G. M. J. M. , Vidakovic R. , Van Gestel Y. R. B. M. , Van Domburg R. T. , Goei D. , De Jonge R. , Lindemans J. , Poldermans D.
Published: March 2008

Background:  Hyperhomocysteinaemia is independently associated with atherosclerotic disease. Methionine loading could improve the predictive value of hyperhomocysteinaemia by detecting mild disturbances in enzyme activity. The aims of this study were to determine the beneficial effect of methionine loading on the predictive value of homocysteine testing for long‐term mortality and major adverse cardiac events (MACE).

Methods:  In an observational study, 1122 patients with suspected or known vascular disease, underwent homocysteine testing, which was measured fasting and again 6 h after methionine loading. Hyperhomocysteinaemia was defined as a fasting level ≥15 μmol/L and post‐methionine loading level ≥45 μmol/L or an increase of ≥30 μmol/L above fasting levels. Primary end‐points were death and MACE. Multivariate Cox regression analysis was used, adjusting for all cardiac risk factors.

Results:  During follow up (mean 8.9 ± 3.4 years), 98 patients died (8.7%), 86 had a MACE (7.7%), 579 patients had normal tests, 134 patients had only fasting hyperhomocysteinaemia, 226 only post‐methionine hyperhomocysteinaemia and 183 patients had both. In multivariate analysis, overall survival and MACE‐free survival were significantly worse for those with fasting hyperhomocysteinaemia, with hazard ratios of 1.86 (95% confidence interval (CI) 1.20–2.87) and 2.24 (95%CI 1.41–3.53), respectively. The addition of hyperhomocysteinaemia after methionine loading did not significantly increase the risk of death or MACE, with hazard ratios of 0.97 (95%CI 0.52–1.81) and 0.89 (95%CI 0.47–1.69), respectively.

Conclusion:  The presence of post‐methionine hyperhomocysteinaemia did not significantly alter risk of death or MACE in patients with normal or increased fasting homocysteine levels, respectively. In conclusion, methionine loading does not improve the predictive value of homocysteine testing with regard to long‐term mortality or MACE.