bluuebunny/crossref_metadata_2025 huggingface dataset:
Energy and nutrient intake at age 6 and its relationship to body size and fatness
Authors: MAGAREY A. , BOULTON J.
Published: March 2008

Abstract The values for macro‐ and micronutrients and food energy intake are reported from a sample of 154 healthy children aged 6 years who have been prospectively studied since birth. The daily food energy intake in absolute terms and adjusted for body mass was lower than reported previously, and lower than the current recommended daily intake (RDI) but consistent with values derived from predictive equations based on other studies of preschool children. The carbohydrate intake was similar, but the protein intake was slightly lower and the fat intake also less than that reported in previous studies of children of a similar age. Micronutrient intake was greater than the RDI for each. The intake of potassium was adequate, but that of sodium was high in relation to the recommended K:Na ratio of > 1, resulting in a value of 0.66.

Stature was positively correlated with energy and fat intake, but there was an inverse correlation between fatness and energy intake, and intake of unrefined carbohydrate. These results are discussed in relation to the effect of different nutritional planes on growth rate.
Recurrent abdominal pain in childhood. Relationship to psychological adjustment of children and families: A preliminary study
Authors: SAWYER M. G. , DAVIDSON G. P. , GOODWIN D. , CRETTENDEN A. D.
Published: March 2008

Abstract The study investigated the prevalence of emotional and behavioural problems in children with recurrent abdominal pain (RAP), the sensitivity of RAP children to a painful stimulus, and the attitudes shown by RAP mothers to issues of health and illness. Three groups of children were compared including two groups with RAP, one in which an organic cause for the pain was found, and one where no organic cause was identified. The third group consisted of pain‐free children from the general community. No consistent patterns of differences was identified between the groups on the measures used. Possible reasons for the findings are discussed and recommendations made for further research in this area.
Assessment of obesity in early childhood
Authors: STORLIEN L. H. , BIRD J. E. , SILVA P. A.
Published: March 2008

Abstract Measures of physical development were gathered at birth and at ages 3, 5 and 7 years on a sample of over 800 children as part of a multidisciplinary development study. Direct measures of obesity (skinfolds, visual estimate and calculated fat body mass) were correlated with a range of indices based on height and weight (Eid, Ponderal, Quetelet's or Body Mass Index [BMI] and a modified BMI) to determine a valid and reliable index of obesity. Quetelet's or BMI (weight divided by height squared) was found to be the best index of obesity, correlating between 0.88 and 0.96 with percentage fat body mass at ages 5 and 7 years. The BMI also correlated consistently higher indices with all direct measures of body fat than did the other indices. The results indicate that in children, as in adults, BMI can be used to assess obesity simply. It has several advantages, being easy to collect, non‐invasive, objective, and requires no special equipment or highly trained personnel. Finally, the BMI, involving as it does only height and weight, can be used to assess obesity retrospectively in the numerous populations which have records of height and weight.
Urinary sodium excretion in young infants: Role of gestational and postnatal ages
Authors: KOO W. W. K. , SUCCOP P. , GUPTA J. M.
Published: March 2008

Fractional urinary sodium excretion (FENa) and urinary sodium excretion (UNaE) were determined 88 times in 42 healthy, appropriate weight‐for‐gestational age infants. Gestational ages (GA) were 28–41 weeks; birthweights were 930–4135 g. Nineteen preterm infants were studied serially a total of 59 times between 1 and 55 days after birth. During the first 4 days after birth, multiple hierarchical regression analyses showed that FENa and UNaE were inversely related to GA (P < 0.001). Postnatal age (PN) was not significantly related to FENa or UNaE. However the effect of GA on FENa and UNaE was not significantly greater than the effect due to postnatal age (PA) (P= 0.31 and P= 0.80, respectively). UNaE (1.6 ± 0.2 mmol/kg per day) was significantly greater than sodium intake (1.1 ± 0.2 mmol/kg per day) at 2.6 ± 0.2 days (P < 0.05). Longitudinal studies extending beyond 4 days indicated that GA and PA had interactive effects on FENa and UNaE; hence the contribution for a given GA was dependent on PA (and vice versa). Sodium intake remained stable (average 1.8 mmol/kg per day) beyond 7 days after birth and was consistently greater than UNAE (P < 0.01). It is suggested that in healthy preterm infants beyond 2 weeks PA, a sodium intake of 2–3 mol/kg per day may be adequate to meet the renal sodium losses.
Patent ductus arteriosus and retinopathy of prematurity in infants below 27 weeks gestation
Authors: MD E. JOHN , TODD D. A.
Published: March 2008

Retrospective study of infants who survived the neonatal period after delivery at 24–26 weeks gestation revealed patency of the ductus arteriosus (PDA) in 44%. The mean birthweight of infants who developed PDA was lower. Retinopathy of prematurity (ROP) was seen in 79% of survivors with 24% having grade III or IV involvement. All but one of the more severe grades of ROP occurred among infants with PDA. Infants with PDA required more prolonged ventilatory support. Perinatal factors did not have a significant role in the development of these complications.
False negative HIV serology in a case of congenital/perinatal AIDS
Authors: GOLDWATER P. N. , KERNICK C. G. , MARTIN A. J. , DELBRIDGE R. G. , MATTHEWS N. T.
Published: March 2008

A case of congenital or perinatal Acquired Immunodeficiency Syndrome (AIDS), the first recognized case of mother to child human immunodeficiency virus (HIV) infection resulting in the full‐blown syndrome in Australia, is reported. The baby who died in November 1985 was diagnosed retrospectively after the child's father had presented with Category A disease (Pneumocystis carinii pneumonia) in May 1987. This case illustrates some of the difficulties that may be experienced in the serological diagnosis of HIV in young children and foreshadows the effects of spread of HIV in the heterosexual community.
Early behaviour, development and parenting in a very low birthweight infant group
Authors: ENGLISH B. J. , PARRY T. S. , DONOVAN M.
Published: March 2008

Abstract Thirty‐seven mothers, their very low birthweight infants and a matched group of term infants of normal birth‐weight and their mothers were seen when the infants were 12 months old (corrected for prematurity). Data were collected about infant behaviour and development, mother‐infant interaction in a free‐play situation, and parenting behaviour indicating child‐centred care. Findings for the mother‐infant dyads in the two birthweight groups were compared to determine the extent to which the data supported possible outcomes of: differences in behaviour/development only, differences in behaviour/development compounded by disturbances of interaction or parenting, or interaction/parenting disturbances despite apparently normal behaviour and development. Results of this analysis indicated significantly poorer scores for the very low birthweight infants on measures of behaviour and development only. Recent reports that interactional problems, which commonly exist early on, resolve through a process of mother‐infant adaptation are discussed in light of the findings of this study. The need to consider developmental problems and interactive failure jointly if early intervention is to be offered is also examined.
The tip of the iceberg: A validation study of the Victorian Congenital Malformations/Birth Defects Register
Authors: LUMLEY J. , PALMA S. , FISCHER M. , ROBERTSON H.
Published: March 2008

Abstract Among 1500 children under 4 years of age admitted consecutively to two paediatric teaching hospitals in Victoria in 1985 the prevalence of birth defects was 20%. Fewer than half of these defects had been notified to the Victorian Congenital Malformations Register. Only chromosomal anomalies and, to a lesser extent, major structural malformations present at birth were adequately ascertained. The implications for birth defects monitoring and for service planning are discussed.
Adrenal hypoplasia and pituitary agenesis in a normocephalic infant, with a review of the literature
Authors: NEWMAN N. M. , WELCH E. , CHALLIS D. R.
Published: March 2008

Abstract A case of adrenal hypoplasia and pituitary agenesis in a normocephalic female infant is described. Twenty‐eight other cases from the world literature were reviewed. There were 18 females and 11 males. More than one affected infant was described in five families, suggesting autosomal recessive inheritance. The mode of presentation, subsequent course, pathology and possible pathogenesis are discussed.
Temperament in Australian toddlers
Authors: SEWELL J. , OBERKLAID F. , PRIOR M. , SANSON A. , KYRIOS M.
Published: March 2008

Abstract A revised validated version of the Toddler Temperament Scale (TTS) was used to develop normative data for temperament in Australian toddlers. Results confirm the accepted practice of dividing the group into younger and older toddlers, with normative data reported for those younger and older than 24 months. The TTS can be used above the normal cut‐off age of 36 months. Care must be taken with interpretation of temperament scores, especially when comparing children of different backgrounds.
Persistent pulmonary hypertension of the newborn treated with hyperventilation: Clinical features and outcome
Authors: JOHN E. , ROBERTS V. , BURNARD E. D.
Published: March 2008

Abstract Twenty‐seven infants with severe persistent pulmonary hypertension of the newborn were seen in 33 months. Asphyxia with or without meconium aspiration was the cause in the majority of cases. Other causes were group B streptococcal sepsis and acute fetal blood loss. The mortality rate was 11%. Twenty‐three of the 24 survivors were followed. Their age at follow‐up ranged 12–37 months. The mean score for mental development was within the normal range while that for psychomotor development was 1 standard deviation below normal. Seven infants were judged to be at risk of attention deficit disorder. Predictor variables related to these outcomes were cardiotocography, meconium aspiration, first pH, highest Paco2 after resuscitation and mother's education. All infants except one were perceived as normal by their parents.
A key to effective control of childhood injuries
Authors: VIMPANI G.
Published: March 2008

Abstract Injuries account for 50% of deaths in Australian children aged 1‐14 years, and are a major cause of hospital admission and disability. Injury surveillance systems involving the establishment of ongoing, systematic collection and analysis of data relevant to injury prevention and trauma management have a critical role in the effective control of the injury pandemic. Contemporary Australian initiatives including the establishment of the National Injury Surveillance and Prevention Project, new national public health programmes and research initiatives have the potential to establish a new wave of injury control programmes on a firm scientific base.
Readability of health care literature
Authors: OATES M. S. , OATES R. K.
Published: March 2008

Abstract A sample of health care literature produced for parents was analysed, using the Flesch method, for readability and human interest. As a comparison, the readability and human interest scores were also calculated for Sydney daily newspapers. It was found that the pamphlets produced by government agencies were more readable than those produced by non‐government agencies. Those pamphlets written with input from parents were the most readable of all. Similar results were found for the human interest level of the pamphlets. The readability and the human interest scores of the government‐produced pamphlets were similar to those of the larger circulation daily newspapers. Health care literature for parents needs to be of good quality and easily understood. The involvement of parents in their production may improve the effectiveness of these leaflets.
Depressed mothers and their children
Authors: EISENBRUCH M.
Published: March 2008

Abstract This paper reviews the current state of research on the relationship between depressed mothers and their children. Several issues are considered: how depressed women function as mothers; the possible origins of depression in the childhood experiences of the mothers; the impact of maternal depression upon the child; the potential consequences for the child's ultimate development; the induction in the child of a depression and the causes of depression in children; the interaction between depressed mothers and their children; and the question of whether there are certain children invulnerable to their mothers’depression. Based on the author's intensive case‐design study of 10 mother‐child dyads, a model of the interaction between the depressed mother and her child is described. The implications are considered in terms of the need for further research on outcome, risk, and vulnerability, the application to paediatrics, and the broader social and cultural considerations.
Growth and catch‐up growth of Australian infants of low birthweight
Authors: HITCHCOCK N. E. , COY J. F.
Published: March 2008

Abstract The growth of 90 infants of low birthweight (1500–2499 g) has been studied longitudinally from birth to 2 years of age. Seventy‐five per cent of those infants were of birthweight that was appropriate‐for‐gestational age (AGA) and of mean gestational age 33.6 weeks (boys) and 34.5 weeks (girls). Twenty‐four per cent were small‐for‐gestational age (SGA) and of mean gestational age 39.4 weeks (boys) and 38.5 weeks (girls). The data showed that, when gestational age was considered, the growth of AGA infants was similar to that of full‐term infants of normal birthweight; SGA infants displayed accelerated growth (‘catch‐up’), particularly in the first months of life with upward percentile crossing from below the 5th toward the 50th. These results provide further evidence of the need to consider gestational age and whether AGA or SGA when assessing the growth of low birthweight infants.
Experience with neonatal screening for cystic fibrosis in New Zealand using measurement of immunoreactive trypsinogen
Authors: WESLEY A. W. , SMITH P. A. , ELLIOTT R. B.
Published: March 2008

Abstract Neonatal cystic fibrosis (CF) screening has been performed in New Zealand for a total of 7 years. This study reports the experience with this procedure in New Zealand over a 4 year period and compares it with 2 years when diagnoses of CF were suggested by clinical features only. A total of 72 infants were confirmed as having CF during 4 years of screening. Twenty‐eight infants were found to have CF during 2 years in which screening was not performed. There were 29 false positive diagnoses during the screening years and six false negative diagnoses. Three of the false negative diagnoses occurred because of laboratory error, but three occurred because either the first or second measurement of immunoreactive trypsinogen (IRT) was normal. Faecal chymotrypsin was measured in samples from 434 infants at the time of the second IRT and assisted with the diagnosis for one infant which might otherwise have been missed. Only 42.5% of infants were asymptomatic at the time of the confirmatory sweat test. Significant morbidity and mortality was associated with meconium ileus which occurred in 24% of infants with CF. Improved ascertainment of cases of CF has occurred since screening began. Further follow‐up is required to determine other benefits of newborn screening.
Supplemental nasogastric feeding in cystic fibrosis patients during treatment for acute exacerbation of chest disease
Authors: DANIELS L. , DAVIDSON G. P. , MARTIN A. J. , POURAS T.
Published: March 2008

Abstract The use of overnight, nasogastric, nutritional supplementation during hospitalization of children with cystic fibrosis (CF) receiving antibiotic therapy for acute exacerbations of respiratory disease was evaluated in 11 children (mean age = 7.75 years). Supplementary feeding significantly increased inpatient energy intake from 116 ± 30% to 165 ± 30% (P < 0.001) of recommended dietary allowance with minimal effect on oral intake. It also resulted in significantly improved weight gains but neither increased energy intakes nor weights were sustained at short‐term (mean = 5.7 weeks) or long‐term (mean = 21.6 weeks) follow‐up. The notion that short bursts of nasogastric feeding for inpatients with CF improve growth status is not supported. However, the study did show that treatment of chest infections alone does not positively affect spontaneous oral energy intake.
Variability of Doppler flow velocity and cerebral perfusion pressure is reduced in the neonate by sedation and neuromuscular blockade
Authors: COLDITZ P. B. , WILLIAMS G. L. , BERRY A. B. , SYMONDS P. J.
Published: March 2008

Abstract Doppler flow velocity (DFV) in the anterior cerebral artery was recorded every 12 h and cerebral perfusion pressure (CPP) continuously in 21 sick, ventilated preterm neonates for 48 h from shortly after birth. Ten received a neuromuscular blocker, seven were sedated with morphine infusions and five received neither of these treatments. Variability of DFV and CPP was assessed by the coefficient of variation (CV) and the autocorrelation function (ACF).

Variability of both signals was lowest in the group treated by neuromuscular blockade (DFV CV 3, s.d. = 0.8; CPP CV 9, s.d. = 2.2; CPP ACF 37, s.d. = 19.2), intermediate in the group receiving sedation by morphine infusion (DFV CV 3.4, s.d = 0.7; CPP CV 11, s.d. = 2.2; CPP ACF 31, s.d. = 21.6) and highest in the group receiving neither treatment (DFV CV 5, s.d. = 1.8; CPP CV 14, s.d. = 2.3; CPP ACF 27, s.d. = 16.7).

Variability also increased with decreasing gestational age, suggesting that immature cerebrovascular regulatory mechanisms were present in the least mature neonates.
Treatment of precocious puberty using an intranasal luteinizing hormone‐releasing hormone analogue: Buserelin
Authors: LOW L. C. K. , WANG C. , CHEUNG P. T. , CHAN F. L.
Published: March 2008

Abstract Fourteen patients with precocious puberty were treated for 1‐3 years with 900‐1800 μg/day of intranasal (i.n.) Buserelin. The peak luteinizing hormone and follicle‐stimulating hormone responses to intravenous luteinizing hormone‐releasing hormone were reduced significantly 4 weeks after starting treatment and remained suppressed while the patients were on treatment. Two patients were withdrawn because of drug non‐compliance. Three patients showed regression of pubertal changes, four patients showed no progression and five patients showed progression of breast size or pubic hair staging after 1.5‐2 years of treatment.

Treatment was changed to the subcutaneous route in two patients because of hormonal escape and accelerated skeletal maturation. The mean growth velocity decreased from 10.78 cm/year (s.e.m. = 0.64) to 7.06 cm/year (s.e.m. = 0.85) after 1 year of treatment (P< 0.005). After an increase in dosage (from 900 μg/day to 1800 μg/day) in most patients, further significant falls in growth velocity to 5.29 cm/year (s.e.m. = 0.45), 4.63 cm/year (s.e.m. = 0.8) and 5.06 cm/year (s.e.m. = 0.5) were observed at 18, 24 and 30 months, respectively, compared with the pretreatment value (P< 0.001). With treatment, the increased rate of skeletal maturation normalized. In 10 patients who had completed 2 years of treatment, the height standard deviation score for bone age improved from a pretreatment value of ‐2.42 ± 0.42 to ‐1.6 ± 0.42 after 2 years of treatment (P< 0.01), indicating an improvement in height prognosis. It is concluded that i.n. Buserelin at a dose of 1800 μg/day is effective in the treatment of most but not all patients with precocious puberty.
Low birthweight and impaired growth to 5 years in Australian Aborigines
Authors: GRACEY M. , ANDERSON C. M. , BROOKS B.
Published: March 2008

Abstract Twelve per cent of Aboriginal infants born in the Kimberley region of Western Australia in 1980 were of low birthweight; this is more than twice the incidence in the non‐Aboriginal population of Western Australia. There was widespread faltering of growth (weight and height) after 6 months of age in Aboriginal children whether they were of normal or low birthweight. Growth retardation was more marked in low birthweight babies who showed little evidence of ‘catch‐up’growth in the first 5 years of life.
Fifth day fits in the newborn
Authors: NORTH K. N. , STOREY G. N. B. , HENDERSON‐SMART D. J.
Published: March 2008

Abstract During the 1970s, there was an epidemic of neonatal convulsions occurring in apparently normal babies during the fourth and fifth days of life. This syndrome was noted in France as well as in Australia. A study was undertaken to review the King George V Hospital (KGV) experience with these ‘fifth day fitters'. All cases of neonatal convulsions at KGV during the years 1972‐85 were reviewed. A total of 94 cases of fifth day fits occurred during this period, accounting for 57% of all neonatal convulsions occurring during 1972‐79.

The fits occurred in healthy term infants after an uncomplicated pregnancy. They appeared on the fourth and fifth days of life. The seizures lasted an average of 24 h, were refractory to drug therapy and, despite extensive investigation, no cause was found. The infants were assessed as normal at the time of discharge from hospital. Follow‐up of these infants was incomplete. However, from the data available, it cannot be assumed to be a benign entity.

The ‘fifth day fit’ syndrome reached epidemic proportions at a number of maternity units during the 1970s. At KGV, no case has been observed since 1982.
Noonan syndrome with spontaneous chylothorax at birth
Authors: CHAN D. K‐L. , HO N‐K.
Published: March 2008

Abstract A female Chinese infant having the features of Noonan syndrome presented with acute respiratory distress at birth, secondary to a large spontaneous left‐sided chylothorax. This condition must be recognized early in such infants, as prompt thoracentesis is life‐saving.
Gastric retention of a swallowed coin after surgical treatment of pyloric stenosis
Authors: CASS D. T.
Published: March 2008

Abstract In patients with a past history of pyloric stenosis, swallowed foreign bodies may not pass out of the stomach. Not only is this clinically relevant, but it also suggests that, even after apparently successful surgery, pyloric function may not be completely normal. A case history is presented and the literature is reviewed.
Extracorporeal membrane oxygenation (ECMO) for non‐ECMO intensive care nurseries
Authors: THAMBAPILLAI E. , DOYLE L. W. , MURTON L. J.
Published: March 2008

An extracorporeal membrane oxygenation (ECMO) centre has been established in the sole outborn‐only level 3 nursery in Melbourne. In the absence of other guidelines, an infant may qualify for ECMO if the expected mortality, based on assessment of the severity of hypoxia, exceeds 80%. However, for a non‐ECMO centre, this involves the additional hazard of transport for an already critically‐ill infant. The aim of this study was to determine the predictors of at least 80% mortality in babies who might have qualified for ECMO but who were cared for in a non‐ECMO level 3 nursery. Regardless of the severity or duration of hypoxia, we were unable to identify a group of infants whose mortality exceeded 80%. Since outborn infants were disproportionately over‐represented amongst those who might qualify for ECMO, it would be advisable to admit preferentially those born outside the level 3 perinatal centres who might qualify for ECMO directly to the ECMO centre. For infants born within our level 3 perinatal centre, it is recommended not to transfer those who might qualify based on data from other centres until the exact role of ECMO is determined. Alternatively, a randomized controlled trial of transfer versus non‐transfer to the ECMO centre for severely hypoxic infants cared for in non‐ECMO level 3 nurseries could be considered.
Luteinizing hormone‐releasing hormone analogue (Buserelin) treatment for central precocious puberty: A multi‐centre trial
Authors: WERTHER G.A. , WARNE G.L. , ENNIS G. , GOLD H. , SILINK M. , COWELL C.T. , QUIGLEY C. , HOWARD N. , ANTONY G. , BYRNE G.C. , THOMSETT M. , EPSTEIN M.T. , PULLAN P.T. , PERRY‐KEANE D.A. , CLARKE A.L. , WILSON F. , HUDSON I.
Published: March 2008

Abstract A multi‐centre open trial of Buserelin, a luteinizing hormone‐releasing hormone (LHRH) analogue, was conducted in 13 children with central precocious puberty. Eleven children (eight girls and three boys), aged 3.4–10.2 years at commencement, completed the required 12 month period of treatment. Initially all patients received the drug by intranasal spray in a dose of 1200 μg/day, but by the end of the 12 month period two were having daily subcutaneous injections and three were receiving an increased dose intranasally. The first month of treatment was associated in one boy with increased aggression and masturbation, and in the girls with an increase in the prevalence of vaginal bleeding. Thereafter, however, both behavioural abnormalities and menstruation were suppressed. Median bone age increased significantly during the study, but without any significant change in the ratio of height age to bone age. The median predicted adult height for the group therefore did not alter significantly over the twelve months of the study. Buserelin treatment caused a reduction in the peak luteinizing hormone and follicle‐stimulating hormone (FSH) responses to LHRH, mostly to prepubertal levels, and also suppressed basal FSH. In the first weeks of treatment, the girls' serum oestradiol levels rose significantly and then fell to prepubertal or early pubertal levels. A similar pattern was seen for serum testosterone levels. Serum somatomedin‐C levels, however, showed little fluctuation over the course of the study. Buserelin treatment was safe and well accepted, and offers the promise of improved linear growth potential in precocious puberty.
Sexually abused adolescents: A distinct group among sexually abused children presenting to a children's hospital
Authors: GARDNER J.J. , CABRAL D.A.
Published: March 2008

Abstract Case records were retrospectively reviewed for 40 adolescents presenting to a paediatric sexual abuse service with a history of acute (23 cases) or chronic (17 cases) abuse. The chronic cases disclosed the abuse to a family member, the abuse was intrafamilial, and they had similarities to the chronically abused younger child. The acute cases disclosed the abuse outside the family, and were abused by strangers or acquaintances. Some acutely abused adolescents had similarities to child victims of stranger assault; however a larger sub‐group was identified (14 of 23; 35% of total) whose indescriminate behaviour may have placed them at increased risk of abuse. They were characterized by previous contact with police and welfare agencies, alcohol/drug abuse, voluntary sexual activity, contraceptive use, genital infections and apparent indifference to the abuse. Half the total group felt emotionally unsupported, and four subsequently attempted suicide. This study identifies unique problems of sexually abused adolescents, and recognizes potential multiple problems in those acutely abused.
Regional cerebral blood flow velocity patterns in newborn infants
Authors: LUI K. , HELLMANN J. , SOTO G. , DONOGHUE V. , DANEMAN A.
Published: March 2008

Abstract Using range‐gated pulsed Doppler sonography, cerebral blood flow velocity (CBFV) waveforms from the anterior cerebral artery (ACA), middle cerebral artery (MCA) and circle of Willis artery (CW) were examined in a total of 34 newborn infants. We compared the pulsatility index (PI) from the three cerebral arteries sampled in 10 term and 10 preterm (29 ± 2 weeks) newborn infants without a history of perinatal asphyxia or intracranial pathology. The PI in the ACA ranged from 0.60 to 1.03. There were no significant differences in PI between the three vessels by paired comparisons. The PI of the MCA differed from that of the ACA by 0.00 ± 0.05. The variation coefficient (CV) was 7%. For CW wih ACA, the difference was 0.00 ± 0.04 and CV was 6%. Both intra‐ and interexaminer variation in PI measurements were studied in another 14 infants. The variation coefficients were 5–8% for all three cerebral arteries.

We showed that CBFV waveform patterns were similar in regional cerebral arteries, with PI being a consistent CBFV index. In normal cerebral circulation, the intervessel PI differences were within observer variations. Deviation from this may suggest abnormal regional cerebral haemodynamics.
Incessant ventricular tachycardia in infancy
Authors: LAU K‐C. , McGUIRE M. A. , ROSS D. L. , NUNN G. R. , KNIGHT W. B. , UTHER J. B.
Published: March 2008

Abstract Two infants with incessant tachycardia uncontrolled by multiple drug treatment were thought initially to have supraventricular tachycardia. Careful examination of the 12‐lead electrocardiogram suggested ventricular tachycardia, which was confirmed by electrophysiological studies. Intra‐operative mapping showed that the arrhythmia arose from the posterior left ventricular free wall in one infant and at the left ventricular apex in the other. Cryoablation of these foci led to cessation of ventricular tachycardia. Myocardial biopsy showed hamartomatous involvement in the first infant and normal tissue in the other. In the first infant the incessant arrhythmia was cured but in the other it recurred 4 months later. The origin of the recurrent tachycardia was adjacent to the previously cryoablated arrhythmogenic area. This area was also cryoablated, leading to disappearance of the ventricular tachycardia. Both patients are free of arrhythmia 10 months and 3 months after their surgery. Surgically ablatable lesions are common in infants with incessant ventricular tachycardia. Early diagnosis and prompt surgical treatment usually can effect ‘cure’ of this potentially fatal problem in childhood.
Cystic fibrosis: An inborn error of cellular electrolyte transport?
Authors: O'LOUGHLIN E. V.
Published: March 2008

Abnormal epithelial transport in cystic fibrosis (CF) appears to provide a unifying hypothesis to explain the varying clinical manifestations of CF. The major abnormality is the cell regulation of epithelial Cl‐ secretion; however, a number of other abnormalities of electrolyte transport has been observed. A description of the normal physiology of secretion and the current state of our knowledge of the abnormalities of epithelial secretion is discussed.
Diagnosis and treatment of antenatal uropathies
Authors: GRUENEWALD S. M. , COHEN R. C. , ANTICO V. F. , FARLOW D C. , CASS D. T.
Published: March 2008

Abstract Thirty‐five patients with significant fetal hydronephrosis detected on antenatal ultrasound had postnatal investigations which included ultrasound, 99mtechnetium diethylenetriamine pentacetic acid (99mTcDTPA) renal scans and micturating cysto‐urethrograms. Antenatal and postnatal ultrasound were unable to determine reliably the level of obstruction causing the hydronephrosis. The 99mTcDTPA renal scan was useful in determining the necessity and timing of surgery, but could not exclude vesico‐ureteric reflux. Seven patients required surgery in the neonatal period and a further seven children had surgery because of deterioration of the scan appearance on follow‐up studies performed at 3, 6 and 12 months of age and then at longer time intervals. Twenty patients (almost 60%) have been managed conservatively for a mean of 28 months (range: 12 months‐7 years) with no deterioration in renal function.
The chest radiograph in acute bronchiolitis
Authors: DAWSON K. P. , LONG A. , KENNEDY J. , MOGRIDGE N.
Published: March 2008

Abstract The relationship between clinical severity, as judged by a clinical scoring method, and the degree of radiological change on a chest X‐ray, was assessed in 153 children with acute bronchiolitis. There was no statistical correlation between clinical severity and the degree of radiological change. The majority of radiographs were requested on the assumption that it was a useful routine investigation. We suggest that the request for a chest X‐ray in acute bronchiolitis should be made only when the need for intensive care is being considered, where there has been an unexpected deterioration in the child's condition or the child has an underlying cardiac or pulmonary disorder.
Inhaled therapy in paediatrics
Authors: SLY P. D. , SOUËF P. N. LE
Published: March 2008

In this review the technical aspects of inhaled therapy will be considered, as well as the more common uses of inhaled therapy in paediatrics.
Sensorineural hearing loss
Authors: JARMAN F. C.
Published: March 2008

Hearing losses in children are disabling and frequently unrecognized. Children with persistent uncorrected hearing impairment are at high risk for speech and language delays, behavioural problems, and socialization and learning difficulties. Although most hearing impairment in childhood is conductive in type. about 1 in 1000 Australian children have significant sensorineural hearing losses (SNHL) of mild to profound degree.
Outcome to 8 years of infants <1000 g birthweight: Relationship with neonatal ventilator and oxygen therapy
Authors: DOYLE L. W. , KITCHEN W. H. , FORD G. W. , RICKARDS A. L. , KELLY E. A. , CALLANAN C. , RAVEN J. , OLINSKY A.
Published: March 2008

The study involved a cohort of 59 consecutive survivors with birthweights < 1000 g, born between 1977 and 1980, to 8 years of age. The aim of the report was to determine if those survivors who had received more oxygen and ventilator therapy differed in their outcome compared with those who had received less oxygen and ventilation. Children were graded into four groups, characterized by decreasing durations of oxygen and ventilation. Children who had received less oxygen and ventilation were more likely to be below the third percentile for weight at 2, 5 and 8 years but the trends were significant only at 2 and 5 years (P= 0.006, P= 0.013 and P= 0.19 respectively). The rate of cerebral palsy was 8% at 8 years; the only children with severe or moderate disabilities from their cerebral palsy were in the lowest oxygen and ventilation group (n= 4, P <0.02). The frequency of hospital re‐admission and the duration of re‐hospitalization did not vary significantly between the four groups at any age. The rates of recurrent wheezing episodes or asthma did not vary significantly between the groups. Although the cohort as a whole had some impairment of lung function compared with healthy full‐term controls, there was no significant difference between the four groups. Contrary to expectations, our findings suggest lower rates of poor growth and adverse neurological outcomes with increasing durations of oxygen and ventilation in the newborn period.
Audiological evaluation of very low birthweight infants
Authors: TUDEHOPE D. , SMYTH V. , SCOTT J. , ROGERS Y.
Published: March 2008

ABSTRACT A population of consecutively surviving very low birthweight (VLBW) infants comprising 41 infants (24 female) birthweight <1000 g and 108 infants (63 female) birthweight 1000–1500 g received detailed audiological evaluation. The audiological test battery comprised auditory brainstem evoked response (ABR) prior to hospital discharge, behavioural audiometry and tympanometry at 8–12 months and monitoring as necessary. The ABR results were interpreted with reference to a normative group of 36 full‐term infants (birthweight 2.4–4.5 kg). Of the 142 VLBW infants completing audiological evaluation, one (0.7%) had evidence of moderate‐severe high frequency sensorineural hearing loss, 83 (58.5%) evidence of conductive dysfunction (18 severe, 42 moderate and 23 mild) and only 58 (40.8%) normal hearing. The 19 infants with severe auditory impairment were more likely to have suffered moderate‐severe apnoea, two courses of mechanical ventilation, prolonged oxygen therapy and recurrent upper respiratory tract infections in the first year of life than infants without severe impairment (P<0.05). Because of the incidence of conductive pathology, difficulties occurred when attempting to compare ABR status at 36–42 weeks postmenstrual age with peripheral hearing status at 8–12 months as assessed by visual reinforcement orientation audiometry (VROA) and impedance audiometry. The most useful ABR test parameters as screening measures of peripheral auditory status were Wave I‐III‐V morphology, wave V threshold levels and wave V absolute latency values when used in combination as a test battery. Auditory brainstem evoked response performed at 36–42 weeks postmenstrual age combined with follow‐up tympanometry, may be regarded as a viable method of monitoring at risk VLBW infants that can be used before behavioural testing in isolation is reliable.
Drug errors in intensive care
Authors: BORDUN L. A. , BUTT W.
Published: March 2008

Abstract Errors in prescription, administration, delivery and interaction of drugs are likely in children in intensive care units because of the large number of often unfamiliar medications these children receive. We evaluated prospectively the frequency and consequence of drug errors in a large multidisciplinary intensive care unit. There was a mistake in drug prescription, administration, delivery or drug interaction in 2% of medication orders, with 12% of these mistakes causing actual harm to the patient. The frequency of drug errors must be appreciated and due care must be taken in checking and delivering drugs to children in an intensive care unit.
Case studies in adolescent deliberate self‐harm
Authors: SHUGG A. W. , MENAHEM S.
Published: March 2008

Abstract Four adolescents admitted to a general paediatric ward at a teaching hospital with deliberate self‐harm were reviewed. Their initial psychosocial assessment was noted together with their subsequent course 12 months later. Despite an extensive assessment by a multidisciplinary team during the initial admission, follow‐up 12 months later revealed that each subject appeared to have ongoing problems. This outcome raised doubts as to the appropriateness and effectiveness of a prolonged hospital admission in their initial assessment. The difficulties encountered with their management are highlighted.
What do health care professionals know about childhood asthma?
Authors: HENRY R. L. , FITZCLARENCE C. A. B. , HENRY D. A. , CRUICKSHANK D.
Published: March 2008

The aim of this study was to examine the level of knowledge about childhood asthma in paediatric nurses, pharmacists and general practitioners to assess their potential value as sources of accurate information for patients with asthma. The main outcome measure was the score obtained on an asthma knowledge questionnaire which had been validated previously. The maximum possible score was 31. Eighty‐three general practitioners had a mean score of 28.1 (range 14–31); 82 pharmacists scored a mean of 24.2 (range 15–30) and 30 paediatric nurses had a mean score of 25.5 (range 16–30). General practitioners scored well in most questions but had some worrying deficiencies, particularly in distinguishing preventive therapy from symptom relieving medication. Pharmacists and paediatric nurses had a number of problems in certain important areas. In particular pharmacists as a group were unaware of many of the clinical features of asthma, had misconceptions, such as the need to avoid cow's milk, and recorded incorrect responses to clinical scenarios of acute treatment. Paediatric nurses tended to overestimate the side effects of inhaled medications, and also the value of auscultation. They had poor knowledge of exercise‐induced asthma.

The data overall suggest that specific educational strategies should be devised for different groups of health professionals who manage children with asthma and suggest that poor knowledge on the part of health care providers may contribute to morbidity.
Oesophageal perforation caused by a coin
Authors: CASS D. T. , LAI B.
Published: March 2008

Abstract An unusual consequence of an initially asymptomatic coin ingestion is described to alert paediatricians that coins are not always innocuous. The case illustrates the need to investigate subtle but persistent symptoms, and also describes the surgical approach to coins that erode through the oesophageal wall.
Ureaplasma urealyticum in a neonatal intensive care population
Authors: DYKE M. P. , GRAUAUG A. , KOHAN R. , OTT K. , ANDREWS R.
Published: March 2008

The incidence of Ureaplasma colonization at birth and its effect on the development of chronic lung disease (CLD) and on mortality was studied in a neonatal intensive care population. Ureaplasma colonization was associated with a birthweight < 1000 g (odds ratio [OR] 3.45 confidence intervals [CI] 2.13‐5.60) and a gestational age < 30 weeks (OR 2.54 CI 1.71–3.79). In a case‐controlled study of 112 infants, significant associations with Ureaplasma colonization were maternal pyrexia in labour (n= 38 vs 21; P= 0.015), the requirement for antibiotics in labour (n= 39 vs 16; P= 0.0005) and vaginal delivery (n= 78 vs 58; P= 0.009). Risk factors associated with the development of CLD were birthweight < 1000 g (OR 3.77 CI 2.53–5.62) and delivery by Caesarean section (OR 1.65 CI 1.11–2.43). Within the group delivered by Caesarean section. Ureaplasma colonization was also associated with an increased risk of CLD (OR 1.97 CI 1.08–3.62). Ureaplasma colonization of infants at birth is associated with factors suggestive of maternal chorioamnionitis as well as preterm birth and low birthweight. In infants delivered by Caesarean section, Ureaplasma colonization is associated with an increased risk of chronic lung disease.
Cardiac arrhythmias as a manifestation of acquired heart disease in association with paediatric respiratory syncitial virus infection
Authors: ARMSTRONG D. S. , MENAHEM S.
Published: March 2008

Respiratory syncitial virus (RSV) is a common cause of upper and lower respiratory tract infection in infants. An association between RSV bronchiolitis and cardiac arrhythmias has been described but is rare. A further case of an infant with supraventricular tachycardia in association with culture‐positive respiratory syncitial virus bronchiolitis is reported. This case prompted a review of the two other cases of arrhythmia associated with RSV infection seen at this institution and a review of all other published cases.
Oesophageal duplication cyst: Another cause of neonatal respiratory distress
Authors: STEWART R. J. , BRUCE J. , BEASLEY S. W.
Published: March 2008

Oesophageal duplication cysts in infants (usually males) should be recognized as a cause of respiratory distress which worsens during the neonatal period, and which is associated with feeding difficulties. Their radiological appearance is that of a right‐sided posterior mediastinal mass, which is shown to be cystic on ultrasound. Excision is curative.
Future challenges for behavioural research in adolescent health
Authors: COLLINS J. K.
Published: March 2008

AbstractRisk to health during adolescence is more likely due to behaviour than disease. Problems arise because behaviour is distally removed from its consequences and negative reinforcement is not contiguous with it. The paper reviews recent research and the problems faced by health workers in devising educational programmes when behaviour, in the cultural value system of adolescents, is present‐oriented and outcomes are future‐oriented. The challenge to the behavioural scientist is to develop health education programmes which have personal meaning to adolescents. Working against this aim are such processes as adolescent taboos, locus of control, the personal fable, risk behaviours and social‐cognitive immaturity. Suggestions are made for research scientists to devise and evaluate programmes to change the operational liberalism of adolescent behaviour by installing more ideologically conservative attitudes in the hope that behavioural change will follow.
Plasma fibronectin levels in extremely preterm infants in the first 8 weeks of life
Authors: DYKE M. P. , FORSYTH K. D.
Published: March 2008

Abstract Fibronectin has in the past been considered to function simply as a non‐specific plasma opsonin. However, recent studies have demonstrated that this molecule plays an important role in fundamental components of the immune response, for example, neutrophil adhesion, T cell activation and endothelial function. Additionally, fibronectin is important in lung homeostasis where it contributes to alveolar epithelial integrity. In this study plasma fibronectin levels were measured longitudinally in a group of extremely preterm infants, mean gestational age 27 weeks.

Plasma fibronectin levels at birth were significantly lower in the preterm study group than in term controls (mean 91±33 μg/mL compared with 214±62 μg/mL in the term controls, P<0.0001). The preterm cohort demonstrated a more than two‐fold rise in plasma fibronectin on days one and two; levels fell almost to baseline values by day three with a subsequent slow rise to a plateau by day 28. No further increase was seen by day 56. This sequence of early changes in fibronectin levels mirrored closely the time course of respiratory distress syndrome. Infants of mothers with pre‐eclampsia had significantly lower peak fibronectin levels than in those without (P= 0.016), and those infants with bronchopulmonary dysplasia showed a trend towards lower basal fibronectin levels (P= 0.07) and a greater difference between peak and basal levels (P= 0.05).

Neonates, particularly those born preterm, have blunted immunological responses to infection. Fibronectin plays a key role in immunological responsiveness. The significant changes in fibronectin levels after birth in the preterm neonate are likely to have important pathophysiological consequences. The relationship between alterations in fibronectin after birth, endothelial and epithelial cell function, and respiratory distress syndrome (RDS) remain to be explored.
A review of venovenous haemofiltration in seriously ill infants
Authors: REEVES J. H. , BUTT W. B. , SATHE A. S.
Published: March 2008

Abstract Between April 1989 and October 1991,13 severely ill infants, median age 13 days (range 1‐180 days), median weight 3.5 kg (range 2.5‐4.8 kg), received continuous venovenous haemofiltration (CVVH) for a median duration of 39 h (range 5‐234 h). Filtration was performed through a double lumen catheter inserted into a central vein. The indications for filtration included acute renal failure (8), fluid overload (5), inborn errors of metabolism (3) and sepsis (1). Some infants had more than one indication. The median Paediatric Risk of Mortality (PRISM) score on the day of admission to the intensive care unit was 27 (range 8‐42). No change in the level of respiratory support was required following the commencement of CVVH. Serum electrolyte concentrations and plasma osmolality remained normal throughout. Serum creatinine fell from a mean of 0.11 mmol/L (95% Cl 0.058‐0.168) to 0.07 mmol/L (Cl 0.034‐0.112). Urea fell from a mean of 9.5 mmol/L (Cl 4.4‐14.6) to 6.5 mmol/L (Cl 2.7‐10.3). Platelet counts fell by 40‐50% from a mean of 126x106/mm3 (Cl 72‐180) to 69x 106/mm3 (Cl 36‐103) 18 h following commencement of filtration but no bleeding was encountered. The main complication was a thrombosis of the superior and inferior vena cava in one infant. Four infants survived to be discharged from intensive care. Continuous venovenous haemofiltration, with its inherent advantages over arteriovenous haemofiltration, is feasible in small infants using standard paediatric equipment.