bluuebunny/crossref_metadata_2025 huggingface dataset:
Cranial ultrasound screening of preterm and term neonates
Authors: PERRY R. N. , BOWMAN E. D. , MURTON L. J. , ROY R. N. D. , CRESPIGNY L. DE
Published: March 2008

Abstract A cranial ultrasound examination was performed between 48 and 96 h of age on 580 neonates of 25–42 weeks gestation. The incidence of cerebroventricular haemorrhage (CVH) in infants less than 32 weeks gestation was 37%, compared with an incidence of 2.7% in infants of 32 weeks or more. The incidence of CVH in unselected healthy term infants (between 37 and 42 weeks) was only 1.1%.

Of the 13 infants of 32 weeks or more who were found to have a haemorrhage, nine had a small (Grade I) haemorrhage (69%) and none of these infants had abnormal neurological signs in the neonatal period. The remaining four infants with Grade II, III or IV haemorrhage developed either seizures or episodes of apnoea. Two of the 13 infants of 32 weeks or more with a haemorrhage died, one during the newborn period and the other at 5.5 months of age.

CVH in asymptomatic infants of 32 weeks or more gestation is uncommon and does not justify routine cranial ultrasound scanning.
Injuries in the tenth and eleventh years of life
Authors: LANGLEY J. D. , CECCHI J. , SILVA P. A.
Published: March 2008

Abstract From a sample of 803 children, 307 were involved in 413 separate incidents which resulted in injuries requiring medical attention. The most common injuries were lacerations, fractures, abrasions, and sprains. The majority of injuries were of minor severity. The most common incident resulting in an injury was a fall, followed by incidents where a child was struck by a person or object. A fifth of all falls was from bicycles. Sporting and playground equipment were associated with a large number of injuries, particularly at school. The study serves to highlight shortcomings in national injury data bases, in particular the absence of injury severity indices, codes for sports and recreation, and inadequate codes for falls. A case is made for integrating injury prevention within the school syllabus. The importance of bicycle injuries and the need for an injury surveillance based on accident and emergency centres is stressed.
Acute inflammation and distension of the gall bladder in infancy
Authors: ZIV Y. , FEIGENBERG Z. , DINTSMAN M.
Published: March 2008

Abstract Acute cholecystitis in children is a rare disease which has been associated with haemolytic anaemias, intercurrent illness and congenital anomalies. Acute inflammation and distension of the gall bladder in infancy is very rare and the underlying cause is usually not identified. This study describes two infants presenting with acute acalculous cholecystitis with marked distension of the gall bladder. It is stressed that this entity must be taken into account in the differential diagnosis when there is a palpable mass and/or tenderness in the right abdomen, particularly in the presence of intercurrent illness. Early operation is recommended and cholecystectomy is the preferred procedure.
SZ phenotype alpha‐1‐antitrypsin deficiency with paucity of the interlobular bile ducts
Authors: DORNEY S.F. A. , HASSALL E. G. , ARBUCKLE S. M. , VARGAS J. H. , BERQUIST W. E.
Published: March 2008

Abstract A child is reported whose alpha‐1 ‐antitrypsin phenotype is SZ and who has chronic cholestatic liver disease that began in the neonatal period. Liver biopsy demonstrated paucity of the interlobular bile ducts, marked hepatocellular deposition in periportal areas of PAS‐positive, diastase‐resistant granules, and bridging portal fibrosis. The association of paucity of the interlobular bile ducts with SZ phenotype alpha‐1‐antitrypsin deficiency has not been reported previously.
Spinal cord dysfunction with quadriplegia complicating pneumococcal meningitis
Authors: PHELAN M. , MANSON J. I.
Published: March 2008

Abstract A case of pneumococcal meningitis complicated by brain‐stem herniation and flaccid quadriplegia is described, from which the patient, an 11 year old boy, made a partial recovery. The patient had suffered a head injury with skull fracture some years previously; this was his third episode of meningitis. The aetiology of the quadriplegia has not been fully established, but is presumed to be of vascular nature at spinal cord level, associated with an acute hypotensive episode. Preventative aspects of recurrent bacterial meningitis and brain‐stem herniation following lumbar puncture are stressed.
A study of 111 children with recurrent abdominal pain
Authors: BURY R. G.
Published: March 2008

Abstract One hundred and eleven children with recurrent abdominal pain were studied to determine the clinical features in a group of unselected children presenting in a general paediatric practice. Organic disease was found in four children and was easy to recognize. There were characteristic clinical features in children with no apparent organic cause for pain which suggest that detailed investigations are inappropriate. A simple psychosomatic approach showed an immediate and sustained improvement in symptoms in 70% of children studied.
Advanced necrotizing enterocolitis: An indication for emergency separation of omphalopagus conjoined twins
Authors: SAING H. , TAM P.K.H. , LAU J.T.K. , WONG J.
Published: March 2008

Abstract Emergency separation was considered the treatment of choice when one omphalopagus twin developed advanced necrotizing enterocolitis (NEC). Twin B who developed advanced NEC died postoperatively but Twin A recovered satisfactorily.
Familial renal abnormalities associated with the oligohydramnios tetrad secondary to renal agenesis and dysgenesis
Authors: MOORE D. , TUDEHOPE D. , LEWIS B. , MASEL J.
Published: March 2008

Abstract Thirty‐four families of index cases with the oligohydramnios tetrad secondary to renal agenesis/dysgenesis were screened for renal abnormalities using Real Time ultrasonography. The index cases were separated into two groups. Group 1 consisted of cases of perinatally lethal renal disease and Group 2 of cases of renal dysgenesis secondary to the urethal obstruction malformation. Renal ultrasound screenings of 23 families in Group 1 demonstrated two previously unidentified cases of unilateral renal agenesis in siblings. Screening of 11 families in Group 2 revealed one sibling with a hydronephrotic kidney and one parent with an ectopic pelvic kidney.

There is a recurrence risk of 3.5–5% in families with perinatal lethal renal disease and an increased risk of silent renal anomalies in first degree family members. The recurrence risk is low in families of infants with renal dysgenesis secondary to the urethral obstruction malformation, but immediate family members are at increased risk of structural and functional urinary anomalies. Routine renal ultrasound screening of first degree relatives of infants with lethal renal agenesis and dysgenesis is recommended.
Serum and salivary antibody responses to non‐capsular Haemophilus influenzae antigens in children with meningitis and epiglottitis
Authors: SLY P. D. , McFARLANE P. , MERMELSTEIN N. , CRIPPS A. W. , ROBERTON D. M.
Published: March 2008

Serum IgG, IgA and IgM antibody and salivary IgA antibody concentrations to non‐capsular Haemophilus influenzae antigens were measured in 13 children with H. influenzae type b meningitis and in 15 children with epiglottitis. Most had detectable serum IgG and IgM antibody at presentation but significantly fewer patients with meningitis had serum IgA antibody at presentation (P<0.05). Serum antibody concentrations had risen significantly by 3 weeks after presentation in patients with epiglottitis only. Convalescent serum IgG antibody concentrations against these antigens were higher in younger children with epiglottitis.

Salivary IgA antibody to H. influenzae was detectable at presentation in all children with epiglottitis and in 12 of 13 with meningitis. Salivary antibody concentrations did not differ significantly between the two patient groups at presentation, although patients with meningitis had higher salivary IgA antibody concentrations than 10 children of similar age with bronchiolitis (P<0.02). There was no association between the presence of salivary antibody and low concentrations of convalescent serum antibody.

The rise in convalescent serum antibody concentrations to non‐capsular H. influenzae antigens only in children with epiglottitis is similar to findings for antibody to capsular polysaccharide. However, this rise was greater for IgG in younger patients, and the low titre of convalescent serum antibody in patients with meningitis was not associated with higher titres of IgA antibody in secretions as described by others for polysaccharide antibody. These findings suggest that the poor serum antibody response to these antigens in patients with meningitis is independent of age and is not due to mucosal induction of systemic tolerance.
Factors affecting the selection of doctor of first contact in the Western Region of Melbourne: An interview study of parents of sick children
Authors: DUNT D. R. , OBERKLAID F. , TEMPLE‐SMITH M. J.
Published: March 2008

An interview study investigating attitudinal and other factors influencing the selection of primary medical care (PMC) is described. It focuses on parents of sick children, excluding those with trauma or medical/surgical emergencies, and was conducted in part of the Western Region (WR) of Melbourne in late 1983, the period immediately prior to the introduction of Medicare. It is based on a cross‐sectional survey of in‐hours attenders of eight general practices (GP), the Western Region Community Health Centre (WRCHC), the general clinic of the casualty departments at the Western General Hospital (WGH), and the Royal Children's Hospital (RCH), a teaching hospital outside the region.

The most commonly stated reasons for attendance at services generally were ‘closeness to home/work’, ‘recommendation’ and ‘good service’. ‘Cheap/economic reasons’ were given less frequently overall than the above reasons. There were however some differences in reasons given by attenders at different places of care. ‘Cheap/economic reasons’ was offered significantly more often and ‘recommendation’ significantly less often by WGH attenders compared with other attenders. ‘Specialists available’ and ‘dissatisfaction with other doctors’ was offered significantly more frequently and ‘close to home’ and ‘no other doctor’ significantly less frequently by RCH attenders than other attenders.

Health insurance status did not differ significantly at the different places of care. Attenders of the RCH were significantly more knowledgeable about community health centres than GP or WGH attenders. Non‐GP attenders had more often used other than their current place of care for treatment in the recent past than GP attenders had.

It is concluded that non‐economic as well as economic factors are important in the selection of PMC. A pluralist model recognizing the legitimacy of different PMC arrangements including multiple use of services best reflects community usage of PMC services. This is likely to be even more true under Medicare.

The further development of specialist paediatric services at the WGH is necessary both for improved local service delivery and ongoing paediatric education of local doctors in the WR.
Synthetic food colourings and ‘hyperactivity’: A double‐blind crossover study
Authors: ROWE K. S.
Published: March 2008

Of 220 children referred for suspected ‘hyperactivity’, 55 were subjected to a 6 week trial of the Feingold diet. Forty (72.7%) demonstrated improved behaviour and 26 (47.3%) remained improved following liberalization of the diet over a period of 3–6 months. The parents of 14 children claimed that a particular cluster of behaviours was associated with the ingestion of foods containing synthetic colourings. A double‐blind crossover study, employing a single‐subject repeated measures design was conducted, using eight of these children. Subjects were maintained on a diet free from synthetic additives and were challenged daily for 18 weeks with either placebo (during lead‐in and washout periods) or 50 mg of either tartrazine or carmoisine, each for 2 separate weeks. Two significant reactors were identified whose behavioural pattern featured extreme irritability, restlessness and sleep disturbance. One of the reactors did not have inattention as a feature. The findings raise the issue of whether the strict criteria for inclusion in studies concerned with ‘hyperactivity’ based on ‘attention deficit disorder’ may miss children who indicate behavioural changes associated with the ingestion of food colourings. Moreover, for further studies, the need to construct a behavioural rating instrument specifically validated for dye challenge is suggested.
Use of methylprednisolone as prophylaxis for immediate adverse infusion reactions in hypogammaglobulinaemic patients receiving intravenous immunoglobulin: A controlled trial
Authors: ROBERTON D. M. , HOSKING C. S.
Published: March 2008

Ten children and young adults with humoral immunodeficiency disorders were enrolled in a blind crossover study of the effect of intravenous methylprednisolone in preventing immediate adverse infusion reactions to intravenous immunoglobulin. The patients selected had all experienced frequent adverse reactions previously. Each patient received two infusions of intravenous immunoglobulin at least 4 weeks apart. Infusions were of constant volume and rate for each patient. Intravenous methylprednisolone in a dose of 1 mg/kg bodyweight was given 20 min prior to one of the infusions only. A significant decrease in the severity of infusion‐associated immediate adverse reactions was seen following the administration of methylprednisolone (P < 0.01). Interruption of the infusion was necessary for only one patient when methylprednisolone prophylaxis was given, but temporary cessation of the infusion was required for eight of the 10 patients when methylprednisolone was not given (P < 0.05).
Urological anomalies detected on antenatal ultrasound: A 9 year review
Authors: AHMED S. , LeQUESNE G. W.
Published: March 2008

One hundred and forty‐eight patients (107 male, 41 female), in whom a urological anomaly was detected on antenatal ultrasound examination, are reviewed. Postnatal imaging was done primarily by ultrasonography (US) which was often repeated. Depending upon the ultrasound findings, the patients had a renal nuclide scan (RNS) and/or micturating cysto‐urethrogram (MCU), but intravenous urogram (IVU) was not usually considered necessary. A range of urological anomalies was encountered, but renal anomalies were most common. Over half the cases had anomalies which did not require surgery, with non‐obstructive pelvicalyceal dilatation being frequent. Almost half the operated cases had features which should have allowed a clinical diagnosis without the knowledge of the antenatal findings. A fifth of the cases were occult in that they would not have been diagnosed early in life but for the antenatal detection. The majority had congenital pelviureteric junction obstruction and results of early reconstructive surgery were satisfactory.
Maternal determinants of birthweight in normal pregnancy
Authors: FUNG K. P. , Ngan H. Y. S. , WOO J. S. K. , WONG T. W.
Published: March 2008

Partial and multiple regression analysis was performed to find out the correlation between birthweight and maternal anthropometric variables. Pearson regression analysis revealed significant dependence of birthweight on gestation of pregnancy, maternal weight, symphysis‐sternal distance and height, but not on armspan and skin thickness. However, the only maternal variable bearing significant influence on birthweight in partial regression analysis was bodyweight. The effects of maternal determinants on birthweight, though some of them were statistically significant, were clinically unimportant.
Effect of family break‐up and parent divorce on children
Authors: CONNELL H. M.
Published: March 2008

Abstract Family break‐up is a common experience in childhood today, yet reports of its effects on children vary considerably. Variables to be considered are the age, sex and previous experiences of the child as well as the observer's viewpoint (clinician compared with social scientist): the need for well founded research is obvious. Divorce is a process affecting all family members: parent disharmony and quarrels prior to the divorce appear to be more detrimental to a child's adjustment than the separation itself which may represent a relief of tension. Behaviour and emotional problems following divorce relate to litigation regarding custody and access (accusations of sexual abuse during access are not uncommon), and a diminution of living standards. Feelings of rejection, depression, anger and guilt are frequent in the immediate post‐divorce period, but settle during the ensuing year. Family counselling, individual work with children (especially explanations for younger ones) and social support in the post‐divorce period are suggested as a means of combating long‐term, sometimes lifelong, sequelae.
Practical aspects of advanced paediatric cardiopulmonary resuscitation
Authors: TIBBALLS J.
Published: March 2008

Abstract Successful cardiopulmonary resuscitation in the paediatric age group necessitates the acquisition of technical skills for rapid tracheal intubation, external cardiac compression and access to the circulation. Skills and equipment must be adapted to each age group. For optimal mechanical ventilation and the avoidance of complications, correct selection of endotracheal tube diameter and length is necessary. New techniques in resuscitation incorporate an understanding of the mechanism of blood flow during cardiac compression, the use of the intratracheal route for drug administration, and a revision of the use of catecholamines, sodium bicarbonate and calcium solutions in the treatment of asystole‐bradycardia, electromechanical dissociation, ventricular fibrillation and tachycardia. Early intubation, adequate ventilation with oxygen, well performed external cardiac compression, prompt defibrillation and administration of adrenaline remain the cornerstones of advanced cardiopulmonary resuscitation.
Birthweight/gestational age charts revisited
Authors: HUGHES P. F.
Published: March 2008

Abstract Intra‐uterine growth charts are widely used, but the data from which they are generated are imprecise and the (mis)use made of them is in danger of acceptance through repetition. To an obstetrician they have little use and the description ‘intra‐uterine growth chart’is misleading. This traditional analysis is reported to emphasize that a new approach to judging the normality or otherwise of intra‐uterine development is needed, particularly to aid the clinician involved in management of the high risk pregnancy and preterm labour and delivery.
The use of bronchodilators in the young infant
Authors: Henry R. L.
Published: March 2008

When it was first proposed to establish laboratories at Cambridge, Todhunter, the mathematician, objected that it was unnecessary for students to see experiments performed, since the results could be vouched for by their teachers, all of them men of the highest character, and many of them clergymen of the Church of England. (Bertrand Russell, 1872–1970.)
Giardia carriage in Aboriginal and non‐Aboriginal children attending urban day‐care centres in South Australia
Authors: GRIMMOND T. R. , RADFORD A. J. , BROWNRIDGE T. , FARSHID A. , HARRIS C. , TURTON P. , WORDSWORTH K.
Published: March 2008

Abstract A survey of Giardia lamblia prevalence was carried out in Adelaide, South Australia, among Aboriginal and non‐Aboriginal children attending day‐care centres. A single‐stool examination in 178 children aged 6 years and under revealed an overall prevalence rate of 10.7% with all carriers being 1‐4 years of age. Within this age group, Giardia prevalence among Aboriginal children (11/32) was significantly higher than that among non‐Aboriginal children (eight of 99) (Chi‐square analysis, P> 0.001). Furthermore, among Aboriginal children, a significant association (P> 0.05) was found between giardia carriage and the family's contact with rural Aboriginal settlements or people from these areas. Aboriginal children with no rural contact had a giardia prevalence similar to non‐Aboriginal children.
A mesoblastic nephroma with hypercalcaemia
Authors: WOOLFIELD N. F. , ABBOTT G. D. , McRAE C. U.
Published: March 2008

Abstract A 14 week old female infant who presented with a mesoblastic nephroma was found to be hypercalcaemic. This was corrected prior to removal of the tumour and serum calcium concentrations remained within the normal range postoperatively. Hypercalcaemia is a life threatening complication of mesoblastic nephromas and should be investigated in all cases.
Micro‐angiopathic haemolysis, thrombocytopenia and nephrotic syndrome associated with membranous nephropathy in a Vietnamese boy
Authors: McDONALD D. T. , ROY L. P.
Published: March 2008

Abstract The unique association of idiopathic diffuse membranous nephropathy and micro‐angiopathic haemolyi anaemia and thrombocytopenia is described. A 7 year old Vietnamese boy with a 1‐month history of anaemia resistant to oral iron supplements presented with acute onset of nephrotic syndrome. Investigations revealed a micro‐angiopath haemolytic anaemia and thrombocytopenia. There was no associated oliguria or uraemia. Diffuse membranous nephropathy was diagnosed by renal biopsy. Apart from a fourfold rise in enterovirus titres, no underlying cause for the haematological or glomerular abnormalities was found. There was an apparent, partial haematological response to fresh frozen plasma infusions, but not to Vitamin E.
Guidelines for the use of pulse oximetry in the non‐invasive estimation of oxygen saturation in oxygen‐dependent newborn infants
Authors: REYNOLDS G. J. , YU V. Y. H.
Published: March 2008

Abstract An Ohmeda Biox 3700 oximeter was evaluated during treatment of 12 patients with respiratory distress. The infants were of 27–33 weeks’gestation and between 2 days and 5 months postnatal age. Blood gases were taken from indwelling arterial catheters and were measured on an ABL 30 blood gas analyser. The study tested the accuracy of the oximeter in detecting hypoxia (Pao2<55 mmHg) and hyperoxia (Pao2>80 mmHg). Results are based on 175 paired observations. Guidelines are suggested for the use of the pulse oximeter under three conditions. In a newborn infant with acute respiratory distress without direct arterial access, the limits should be set at 85% (lower) and 90% (upper). In an older infant with chronic respiratory distress, the upper limit of use should be 95%. In order to avoid oxygen tensions <55 mmHg which would increase the risk of pulmonary vasoconstriction, however, the lower limit should be 87%. Infants with indwelling arterial lines during their first few weeks of treatment should have oxygen tension measurements and simultaneous oxygen saturation readings plotted on a graph at the bedside. The graph should be updated every 48 h to take into account changed levels of 2,3‐diphosphoglycerate, haemoglobin F, and carboxyhaemoglobin and the recommended limits should be changed accordingly.
Prenatal diagnosis and carrier detection by DNA studies in a Duchenne muscular dystrophy family with no living affected male
Authors: CHEN J. D. , DENTON M. J. , SERRAVALLE S. , MORGAN G.
Published: March 2008

Abstract Restriction fragment length polymorphism studies and gene dosage analysis using the intragenic probes pERT87 were used to detect deletions in potential carriers in a family with Duchenne muscular dystrophy in which the only affected male was deceased. Two females were found to have inherited the paternal pERT87 alleles but not the maternal alleles, suggesting that they have inherited the pERT87 deletion from their mothers. The hybridization signals of pERT87 from these two females upon gene dosage analysis also suggested that they had a single copy of pERT87. The chorionic villi of a male fetus from one of these two females was found to be deleted for pERT87, suggesting that it was affected. This result confirmed the carrier status of the mother.
Perforated chronic duodenal ulcer in children with coexistence of acute appendicitis
Authors: TOUBANAKIS G.
Published: March 2008

Abstract Two cases of perforation of duodenal ulcer with coexistence of acute appendicitis are reported. Current concepts regarding this unusual complication of childhood duodenal ulcer are discussed.
Somatostatin analogue SMS 201‐995 in the short‐term management of neonatal hyperinsulinism due to nesidioblastosis
Authors: SULLIVAN M. J. , TAYLOR B. J. , BROADBENT R. S. , YUN K. , LOVELL‐SMITH M. , DONALD R. A.
Published: March 2008

Abstract A neonate with persistent hyperinsulinaemic hypoglycaemia is presented in whom the use of intravenous somatostatin SMS 201‐995 allowed good glycaemic control over 10 days. A 95% pancreatectomy was then performed.
Stage‐related behavioural problems in the 1‐4 year old child: Parental expectations in a child development unit referral group compared with a control group
Authors: TICEHURST R. L. , HENRY R. L.
Published: March 2008

Abstract Behavioural problems in preschool (1‐4 years) children are a common cause of referral to health services. Parents of children presenting to the child development unit with behavioural problems (n= 18) were compared with a control group (n= 45). A questionnaire was utilized to examine the parents’expectations of the children's behaviours.

As might be expected, the parents of children presenting to the Unit rated their children as having more difficult behaviours. These parents had unrealistic expectations, particularly for the ‘negative’behaviours (disobedience, temper tantrums, defiance and whinging). However, they were able to anticipate normal age‐related difficulties in some problem areas (dawdling during mealtimes, masturbating, not sharing toys and being jealous of one's siblings).

Counselling should address the issue of matching the expectations of parents with the individual rates of development of their children.
A survey of 22 individuals with Prader‐Willi Syndrome in New South Wales
Authors: GAVRANICH J. , SELIKOWITZ M.
Published: March 2008

Abstract Twenty‐two individuals with Prader‐Willi Syndrome in New South Wales were surveyed. The results show that males were diagnosed at a significantly earlier age than females and suggest a recent trend towards earlier diagnosis. The advantages of early diagnosis are discussed. In those in whom cytogenetic studies had been performed, 47% were found to have a deletion involving chromosome 15q11–13. Profound neonatal hypotonia had been present in all cases. Obesity became apparent between 1.5 and 10 years (mean = 3.8 years). Facial dysmorphism was reported in 83% and acromicria in 100%. Sixty‐two per cent of subjects were regarded as less pigmented than first degree relatives. Cognitive assessments were performed on nine subjects. Two (22%) were functioning in the normal range of intelligence. Behaviour problems, both food‐related and non‐food‐related, were present in the majority and placed considerable stress on the family caring for the individual with Prader‐Willi Syndrome.
Fetal lung growth in laryngeal atresia and tracheal agenesis
Authors: SCURRY J. P. , ADAMSON T. M. , CUSSEN L. J.
Published: March 2008

Abstract Three cases of airway obstruction in fetuses born at 21, 32 and 40 weeks gestation are reported. The first had laryngeal atresia, cystic dysplastic kidneys, oligohydramnios and immense fluid‐filled lungs. The second had upper tracheal agenesis, a tracheo‐oesophageal fistula, a cystic dysplastic horseshoe kidney, oligohydramnios and normal‐sized lungs. The third had a pin‐hole mucosal tract through an otherwise atretic larynx, normal kidneys, no oligohydramnios and normal‐sized lungs. Lung weight:body weight ratios, radial alveolar or radial canalicular counts and point‐counting of sections of lungs in cases 1 and 2 show that laryngeal or tracheal obstruction may prevent or reduce the pulmonary hypoplasia associated with renal dysplasia, and in cases 2 and 3, that grossly enlarged, hyperplastic lungs may not be seen unless obstruction is complete.
Cost‐analysis of neonatal intensive and special care
Authors: TUDEHOPE D. I. , LEE W. , HARRIS F. , ADDISON C.
Published: March 2008

Abstract In the present economic climate and with increasing expenditure on neonatal intensive care, there has been a demand for economic evaluation and justification of neonatal intensive care programmes. This study assesses the inhospital costs of neonatal intensive care. Fixed and variable costs were calculated for services and uses of an Intensive/Special Care Nursery for the year 1985 and corrected to 1987 Australian dollar equivalents. Establishing a new neonatal intensive care unit of 43 cots in an existing hospital with available floor space including operating costs for a year were estimated in Australian dollars for 1987 at $6 408 000. Daily costs per baby for each level of care were $1282 ventilator, $481 intensive, $293 transitional and $287 recovery, respectively. The cost per survivor managed in the Intensive/Special Care Nursery in 1985 showed the expected inverse relationship to birthweight being $2400 for > 2500 g, $4050 for 2000–2500 g, $9200 for 1500–1999 g, $23 900 for 1000–1499 g and $63 450 for < 1000 g. Further analysis for extremely low birthweight infants managed in 1986 and 1987 demonstrated costs per survivor of $128 400 for infants < 800 g birthweight and $43 950 for those 800–999 g. This methodology might serve as a basis for further accounting and cost‐evaluation exercises.
Development of hydrogen excretion between feeds in breast and artificially fed full‐term normal neonates
Authors: DAVIES A. G. , FITZGERALD A. , ROBB T. A. , DAVIDSON G. P.
Published: March 2008

Abstract The breath hydrogen test for carbohydrate malabsorption has been proved to be sensitive, specific and non‐invasive. This study was performed to determine its applicability in the newborn period. Postprandial hydrogen excretion in the first 5 days of life was measured in 105 full‐term normal newborns, who were either artificially or breast fed. Samples of expired air were collected via a nasopharyngeal catheter at 30 min intervals between feeds. Some babies showed no hydrogen production after 5 days, while others produced high (200 parts/106) levels. The incidence of hydrogen production increased postnatally—more than 80% of babies produced hydrogen by 5 days of age. None of the babies was unwell or developed frequent or loose stools suggestive of clinical carbohydrate malabsorption. It is therefore postulated that these high hydrogen levels reflect biochemical evidence of clinically insignificant carbohydrate malabsorption in this age group. This study shows clearly that an interfeed interval of 4 h in these babies is insufficient to cause breath hydrogen levels to fall in a predictable way. The ethical and practical difficulties in fasting these infants for longer periods suggest that conventional carbohydrate challenges with breath hydrogen estimations will be difficult in the neonate.
Urinary calculi in children in Western Australia: 1972–86
Authors: JONES T. W. , HENDERSON T. R.
Published: March 2008

Abstract Records of all children presenting with urinary calculi in the period 1972–86 were reviewed in order to detail clinical features, laboratory and radiographic findings and treatment. Of a total of 85 children, 59 were Aboriginal and 26 were Caucasian. The features of urolithiasis differed between these groups. In the Aboriginal patients, calculi consisted mainly of uric acid and urates. Important clinical characteristics of this group included a young age at presentation (median = 2.1 years) and frequent presentation with failure to thrive. Calculi were commonly located in the upper urinary tract and most required surgical removal. Documented sequelae included renal scarring and hypertension. Caucasian children presented at a later age (median = 10.5 years), frequently with abdominal pain, and most calculi were associated with an underlying urological or metabolic abnormality.
Pompe's disease presenting as supraventricular tachycardia
Authors: FUNG K. P. , S. R. N. , C. H.
Published: March 2008

Abstract A Chinese infant with Pompe's disease (type II glygogenosis) had an unusual presentation of supraventricular tachycardia. The patient subsequently died of ventricular fibrillation. The clinical presentation and the mechanism of the arrhythmia are discussed.
Correction of developmental and intelligence test scores for premature birth
Authors: RICKARDS A. L. , KITCHEN W. H. , DOYLE L. W. , KELLY E. A.
Published: March 2008

Abstract When using tests of infant development and intelligence in children born prematurely, the subject's age is commonly corrected for the degree of prematurity. However, there is disagreement: first, on whether this correction should ever be applied, and second, at what age to discontinue the adjustment.

In a theoretical model, the difference between corrected and uncorrected scores in early infancy was massive and the difference remained clinically important until the age of 8.5 years in children who were born extremely prematurely. The clinical implications of using corrected or uncorrected scores were then evaluated in 174 very low birthweight children without severe sensorineural disabilities and with paired Bayley Mental Development Index (MDI) and Wechsler Preschool and Primary Scales of Intelligence (WPPSI) full scale scores. Failure to correct for prematurity reduced the mean MDI by 12.1 points but reduced the mean WPPSI by only 4.1 points. The disparity between individual MDI and WPPSI scores increased significantly with decreasing gestational age if uncorrected scores were used (P= 0.015) but not if scores were corrected. Using corrected scores, the MDI correctly predicted the WPPSI category in 86.1% of children (P < 0.001) but in only 54.6% using uncorrected scores (the difference was not significant).

It is suggested that a practical solution to the dilemma is to correct test scores for prematurity in the age range 2–8.5 years recognizing that only in extremely immature infants will uncorrected scores be substantially lower than corrected ones at a later age.
A longitudinal study of the interactive effects of perinatal complications and early family adversity on cognitive ability
Authors: STANTON W. R. , McGEE R. O. , SILVA P. A.
Published: March 2008

Abstract The effects of high, medium and low levels of perinatal complications and family adversity on intelligence quotient (IQ) scores were examined in a large sample of Dunedin children tested every second year in the age group 3–13 years. The aim was to test the hypothesis that favourable environmental circumstances attenuate the effects of perinatal complications on later cognitive ability. The results did not support this hypothesis but rather suggested that perinatal complications and family adversity have independent adverse effects on the development of children's cognitive ability.
Morbidity from acquired cytomegalovirus infection in a neonatal intensive care unit
Authors: WESTON P. J. , FARMER K. , CROXSON M. C. , RAMIREZ A. M.
Published: March 2008

Abstract In a prospective study of transfused neonates, 32 of 262 infants were viruric at greater than 20 days of life. Of 212 neonates whose early status was known, postnatally acquired infection was proven in 21, two of whom were seronegative at birth and were thought to have transfusion‐acquired cytomegalovirus (CMV). Maternal transmission of CMV is important in this population as there was 91% seropositivity for CMV at birth among the 21 babies who acquired CMV compared with 55% positivity among 150 babies who did not shed CMV (P < 0.01). Significantly increased morbidity (increased length of stay in hospital, increased use of antibiotics, and longer duration of antibiotic administration) was found in babies with acquired CMV compared with matched controls who did not become viruric. Significant morbidity and mortality was not restricted to the two seronegative babies with transfusion‐acquired CMV. The cost of providing CMV antibody negative blood for this neonatal unit would be less than the cost of providing the extended hospital care needed by the two babies with transfusion‐acquired CMV found during this 3 year study.
Evaluation of a children's hospital medical peer review programme
Authors: SMITH A. , NOLAN T.
Published: March 2008

Abstract The records of medical peer review meetings at the Royal Children's Hospital, Melbourne, were audited for the period 1983‐87. This investigation focused on the peer review process, but also evaluated the extent to which recommended changes in medical practice were carried out. The results showed that few recommendations arose from the meetings despite the clear recognition of a number of problem areas. In the instances where firm recommendations were made, few appeared to have been implemented. The main reasons for this failure were: (i) the review was not an integrated part of the medical management structure of the hospital; (ii) recommendations were frequently not made despite clear expressions of the need for action; (iii) the absence of a designated individual to ensure that recommended actions were implemented, together with the lack of a feedback or internal review process to monitor effectiveness; and (iv) a relatively low profile of the peer review. Despite these shortcomings, the peer review is widely perceived to be a valuable exercise, especially as a general educational tool. However, its potential is far greater, and a model is proposed for a more effective medical peer review programme.
Mechanism of the suddent infant death syndrome?
Authors: NEWMAN N. M. , TRINDER J. A. , PHILLIPS K. A. , JORDAN K. , CRUICKSHANK J.
Published: March 2008

Abstract Polygraphic tracings of 13 normal infants were recorded in a morning sleep at 1 and 2 weeks of age and 1, 2, 3, 4, and 6 months of age. A vibrotactile stimulus graded at 25, 50 and 100 Hz (frequency) and amplitudes of 1, 2 and 3 mm (intensity) was used, each combination being applied twice at 30 s intervals to the hand of the sleeping infant during active sleep (AS) and quiet sleep (QS). The results were analysed as percentages of failure to arouse (FTA) in relation to the number of stimulus trials, the criteria for FTA being the absence of a response in heart or respiratory rate, electroencephalogram, or chin electromyogram. The percentages of FTA from QS did not change significantly from 1 week to 6 months of age, irrespective of frequency or intensity. The percentages of FTA from AS fell sharply and significantly from 1 week to 2 months of age (P< 0.001). At 3 months of age there was a significant increase followed by a significant decrease at 4 months of age, both changes showing a significant difference at P< 0.05. Apart from the first week of age, the numbers of FTA from QS were greater than from AS for all stimulus trials. It is concluded that there is an arousal deficit in QS from 1 week to 6 months of age and the temporary deficit in AS at 3 months of age could explain the peak incidence of SIDS at this time.
Audit of drug usage in a regional neonatal intensive care unit
Authors: DANIELL A. J. , DARLOW B. A.
Published: March 2008

Abstract Drug utilization has been audited prospectively for all infants cared for in a regional neonatal intensive care unit for a 3‐month period. Twenty‐five infants had a birthweight less than 1500 g and 54 had a birthweight greater than 1500 g. The total number of different drugs used was 76 and the mean number received was 8.6 with a range of 0‐30. Infants with birthweights less than 1500 g received a mean of 14.5 drugs and infants with birthweights greater than 1500 g received a mean of 4.8 drugs. Almost two‐thirds (63%) of doses were given orally, 20% intravenously and 10% via an umbilical artery catheter. Three drugs, one of which was received by 13% of infants, carried manufacturers’inserts advising against use in premature infants or the newborn.
Hospital admissions for infections of Aboriginal and non‐Aboriginal infants and children in Western Australia, 1981‐86
Authors: GRACEY M. , ANDERSON C. M.
Published: March 2008

Abstract Rates of hospital admissions and bed usage for infections by Aborigines up to 15 years of age were much higher in Western Australia during 1981‐86 than they were for the rest of the population. These rates for Aboriginal infants for gastroenteritis, for example, were 20‐25 times and 40‐50 times those for other infants. The rates mostly declined over the 6 years except for gastrointestinal and respiratory infections in Aboriginal infants and young children in rural and remote areas. Hospitalization rates reflect many factors which include disease incidence and severity but also distance, climate and access to medical and nursing care and their utilization. Preventative health programmes must be maintained to help improve the health of young Aborigines.
Selective epilepsy surgery in tuberous sclerosis
Authors: BYE A. M. , MATHESON J. M. , TOBIAS V. H. , MACKENZIE R. A.
Published: March 2008

Abstract A patient with tuberous sclerosis diagnosed at the age of 5 years developed an intractable seizure disorder characterized by complex partial seizures numbering 10‐20/day. Interictal electroencephalograms (EEG) showed a right frontal epileptogenic focus. A computerized tomography scan demonstrated calcification in the right frontal region at two sites, periventricular calcification and multiple low density lesions. Neuropsychological assessment showed a verbal intelligence quotient (IQ) of 69 and a performance IQ of 88. Telemetry and video monitoring recorded 10 seizures during which the EEG showed flattening of ongoing sharp wave activity in the right frontal region. Electrocorticography further identified and localized epileptogenic tissue in the right frontal cortex and surgical removal of involved tissue and the adjacent two tubers was carried out. Twelve months after surgery the patient has had only two brief seizures.
Current issues in the nutritional management of children with cystic fibrosis
Authors: DANIELS L. A. , DAVIDSON G. P.
Published: March 2008

Abstract Recent evidence suggests that malnutrition has a negative impact on pulmonary function in children with cystic fibrosis. In the past, dietary management has aimed at high energy low fat intake, but this has recently been shown to fall far short of the 120‐150% of the recommended daily allowance for energy cystic fibrosis patients require.

This paper outlines the current principles of nutritional management for children with cystic fibrosis. These include a high energy, high fat containing diet (within limits of individual tolerance); high carbohydrate intake; high salt intake; replacement of fat‐soluble vitamins; appropriate use of pancreatic enzyme preparations; and supplemental feeding when indicated.

It is vital that a nutrition education programme be established for each child and his or her family so that the emphasis shifts from treatment of malnutrition to prevention. The long‐term aim must be to promote an independent, healthy lifestyle which incorporates good nutrition and other healthy pursuits such as exercise.
Selective improvement in cognitive test scores of extremely low birthweight infants aged between 2 and 5 years
Authors: KITCHEN W. H. , RICKARDS A. L. , FORD G. W. , DOYLE L. W. , KELLY E. A. , RYAN M. M.
Published: March 2008

Abstract The cognitive development at 2 and 5 years of a cohort of extremely low birthweight (ELBW) children (birthweight 500‐999 g) was compared with that of cohorts of larger very low birthweight (VLBW) children (birthweight 1000‐1500 g) and normal birthweight (NBW) children (birthweight > 2500 g) to determine whether the improvements in cognitive function of ELBW infants between 2 and 5 years are apparent or real.

At 2 years of age, ELBW children had a mean Mental Developmental Index (MDI) on the Bayley Scales of 90.4, significantly lower than the means of 100.3 for the larger VLBW children (P= 0.006), and 107.8 for the NBW children (P= 0.0002). However by 5 years the mean scores on the Wechsler Preschool and Primary Scales of Intelligence (WPPSI) full‐scale for the ELBW and larger VLBW children were virtually identical (105.9 and 106.0 respectively)—but still lower than the mean WPPSI full‐scale of 114.6 for the NBW children. After standardizing the MDI and WPPSI scores relative to the NBW children, the ELBW children improved between 2 and 5 years (paired t‐test, t= 3.2, P= 0.004) whereas the larger VLBW infants did not.

We postulate that ELBW children require more time than larger VLBW children after birth to compensate for perinatal and other stresses, and that developmental delay at 2 years may not always persist to 5 years.
Rotavirus vaccines: Science and politics
Authors: BARNES G. L.
Published: March 2008

Development of a successful rotavirus vaccine is a major aim of the WHO Diarrhoea1 Diseases Control Programme1. Results of epidemiological studies and estimates of the cost‐effectiveness of a successful vaccine in both developed and developing countries have shown that it is appropriate to devote resources to this objective.
Neonatal sepsis and infection control policies in Australia
Authors: YU V. Y. H.
Published: March 2008

The pattern of neonatal bacterial infection, its management and the types of infection control policy were ascertained in 20 neonatal intensive care units (NICU) in Australia by questionnaire survey. Group B Streptococcus and Escherichia coli were the predominant organisms responsible for perinatally acquired infection for which the most common antibiotic combination used was Penicillin and Gentamicin. Staphylococcus epidermidis and aureus (majority Methicillin resistant) were the predominant organisms responsible for nosocomial infection for which the most common antibiotic combination used was Vancomycin and Cefotaxime. A Serratia epidemic was experienced in four NICU. Lumbar and suprapubic punctures were frequently done as part of the diagnostic workup in nosocomial infections but not with perinatally acquired infections. Haematological indices considered useful as a diagnostic aid varied between NICU and acute phase reactants were rarely relied upon for diagnosis or for monitoring treatment response. Granulocyte transfusion and intravenous immunoglobulins were infrequently used in therapy. No consensus was found on infection control policies. Eight NICU required routine gowning on entry, two restricted sibling visiting and four restricted visiting by relatives and friends. Although routine bacteriological surveillance on staff or equipment was uncommon, serial cultures were carried out in infants from the body surface in six NICU and from the endotracheal aspirate in 17 NICU. Antiseptics used with technical procedures included iodine, chlorhexidine and alcohol used singly or in combination. Skin and umbilical cord care also varied between NICU. The literature was reviewed to determine the effectiveness or otherwise of some of the existing policies in the prevention or management of neonatal infection to encourage consensus towards a more rational approach to neonatal infection in Australia.