bluuebunny/crossref_metadata_2025 huggingface dataset:
ECMO in newborn infants: The Melbourne experience
Authors: BUTT W. , MEE R. , McDOUGAL P. , HORTON A. , SHANN F. , HORTON S.
Published: March 2008

Abstract At the Royal Children's Hospital, Melbourne, extracorporeal membrane oxygenation (ECMO) has been used in the treatment of newborn infants with life‐threatening respiratory or cardiac failure since May 1989. The main indications for the use of ECMO are that the disease is reversible, the surviving infant is likely to be normal and there is an 80% likelihood of death without ECMO. Sixteen of 22 (73%) newborn infants have survived at least 6 months after ECMO. Fourteen of 16 (87.5%) infants receiving ECMO (who did not have a congenital diaphragmatic hernia) were functionally normal survivors; the other two infants died. Two of six infants with congenital diaphragmatic hernia who received ECMO were discharged and survived to have normal neurological and respiratory function at 6 month follow up. These results are similar to results from other centres internationally. It would appear that ECMO is a useful therapy for near‐term newborn infants with otherwise fatal cardiorespiratory failure.
ECMO in newborn infants: The New South Wales experience
Authors: KERR S. , CRAWFORD M. , CURRIE B. , PRACY E. , STACEY R. , DUFFY B.
Published: March 2008

Abstract Extracorporeal membrane oxygenation (ECMO) has been used at the Prince of Wales Children's Hospital, Sydney for the treatment of newborn infants with life‐threatening respiratory or cardiac failure since August 1989. The main indications are that the disease is reversible, the surviving infant is likely to be normal and there is an 80% likelihood of death without ECMO. Eighteen of 19 newborn infants have survived at least 2 months after ECMO. The 15 infants receiving ECMO (nine with meconium aspiration, six with persisting pulmonary hypertension) who did not have a congenital diaphragmatic hernia were normal survivors. One death occurred at 5 months of age from chronic lung disease. Three of four infants with congenital diaphragmatic hernia were discharged following ECMO and appeared normal at 6,9 and 18 months of age. These results are similar to results from other centres internationally. It appears that ECMO is a useful therapy for near‐term newborn infants with otherwise fatal cardiorespiratory failure.
Primary staphylococcai pneumonia in childhood: A review of 69 cases
Authors: KNIGHT G. J. , CARMAN P. G.
Published: March 2008

Abstract Primary staphylococcai pneumonia is a rapidly progressive illness with well‐described clinical and radiological features and a significant mortality rate. This retrospective study of cases diagnosed over a 20 year period at a tertiary paediatric hospital was undertaken to document the epidemiology and assess the management and mortality of the disease. The survey demonstrated that far fewer patients are being seen than formerly and confirmed that this is a disease primarily affecting infants and Aboriginal children. The initial radiological features were not diagnostic in the majority of cases but typical changes appeared in most at some time during the illness. The use of surgical drainage was not associated with a decrease in the duration of fever or length of hospital stay. The mortality rate has improved but remains significant.
The epidemiology of acute epiglottitis in children in Western Australia
Authors: HANNA J. N. , WILD B. E. , SLY P. D.
Published: March 2008

Abstract A comprehensive case definition was used to study all cases of epiglottitis that occurred in children under 15 years of age in Western Australia during a 5 year period. There was microbiological evidence of Haemophilus influenzae type b infection in 71% of 103 cases of epiglottitis. Seventy‐five per cent of cases occurred in children under 5 years of age. In this age group, the estimated annual incidence (13.5 episodes per 100000) was significantly lower than that reported in Victoria (22.7 per 100000). The case definition of invasive H. influenzae type b disease used for surveillance purposes in Canada was more sensitive than the definitions used in the United States or England and Wales, yet even the Canadian definition could have detected only 65% of the cases of epiglottitis that occurred in Western Australia. A simple and sensitive surveillance system which could be used to monitor the impact of H. influenzae type b immunization in Western Australia is proposed.
Spondylothoracic dysplasia (Jarcho‐Levin syndrome) in a Chinese baby
Authors: HO N. K.
Published: March 2008

Abstract Spondylothoracic dysplasia (STD) syndrome or the Jarcho‐Levin syndrome has been seen commonly in Puerto Ricans. A case of STD syndrome in a Chinese baby which we believe is the first reported case in an Asian baby is reported. The skeletal disorder syndrome affecting the spine, ribs and thorax is an autosomal recessive disorder with associated non‐skeletal anomalies. It should not be confused with the phenotypically similar skeletal disorder known as spondylocostal dysplasia, which is an autosomal dominant disease.
The New Zealand Cot Death Study: Some legal and ethical issues
Authors: MITCHELL E. A. , HASSALL I. B. , SCRAGG R. , TAYLOR B. J. , FORD R. P. K. , ALLEN E. M.
Published: March 2008

Abstract The New Zealand Cot Death Study is a 3 year multicentre case‐control study aimed at identifying the risk factors for sudden infant death syndrome (SIDS). The paper describes some of the legal and ethical issues which arose in the planning, implementation and analysis of the study.
Four modifiable and other major risk factors for cot death: The New Zealand study
Authors: MITCHELL E. A. , TAYLOR B. J. , FORD R. P. K. , STEWART A. W. , BECROFT D. M. O. , THOMPSON J. M. D. , SCRAGG R. , HASSALL I. B. , BARRY D. M. J. , ALLEN E. M. , ROBERTS A. P.
Published: March 2008

AbstractNew Zealand's high mortality rate from sudden infant death syndrome (SIDS) prompted the development of the New Zealand Cot Death Study. A report of the analysis of the data from the first year has been published. This report now gives the major identified risk factors from the full 3 year data set. In this case‐control study there were 485 infants who died from SIDS in the post‐neonatal age group, and 1800 control infants, who were a representative sample of all hospital births in the study region. Obstetric records were examined and parental interviews were completed in 97.5% and 86.9% of subjects, respectively. As expected many risk factors for SIDS were confirmed including: lower socio‐economic status, unmarried mother, young mother, younger school‐leaving age of mother, younger age of mother at first pregnancy, late attendance at antenatal clinic, non‐attendance at antenatal classes, Maori, greater number of previous pregnancies, the further south the domicile, winter, low birthweight, short gestation, male infant and admission to a special care baby unit. In addition, however, we identified four risk factors that are potentially amenable to modification. These were the prone sleeping position of the baby (odds ratio (OR) = 3.70; 95% confidence interval (Cl) = 2.91, 4.70); bed sharing (OR = 2.70; 95% Cl = 2.02, 3.62); maternal smoking of 1–9 cigarettes per day (OR = 3.47; 95% Cl = 2.50, 4.83), 10–19 cigarettes per day (OR = 3.94; 95% Cl = 2.87, 5.41) or more than 20 cigarettes per day (OR = 5.90; 95% Cl = 4.20, 8.31); and not breast feeding (OR = 2.39; 95% Cl = 1.88, 3.04). After controlling for all of the above variables, the relative risks associated with prone sleeping position (OR = 4.84). sharing bed (OR = 2.02), maternal smoking (OR = 1.79) and not breast feeding (OR = 1.89) were still statistically significant. Population‐attributable risk calculations suggest that these four risk factors may account for 82% of deaths from SIDS. The SIDS mortality rate may fall to less than 0.7/1000 live births if all parents stop putting their infants down to sleep in the prone position, do not sleep with their baby, do not smoke, and breast feed their infants.
Oxygen consumption in the newborn piglet during combined cold face/hot body exposure
Authors: GALLAND B. C. , PEEBLES C. M. , BOLTON D. P. G. , TAYLOR B. J.
Published: March 2008

Abstract There is increasing evidence that hyperthermia can occur in cool climates because of overwrapping and that this practice precedes many deaths labelled as SIDS. We have attempted to test the hypothesis that the interaction of a cold face and a hot body might lead to further hyperthermia in a piglet model. Twelve non‐sedated newborn piglets were studied over the first 10 days of development. Oxygen consumption was measured continuously during sleep. Animals were exposed to cold face conditions initially while the animal's body was kept warm and then while the body was hyperthermic. The results show that stimulation of the face with cool ambient air during conditions of raised metabolic activity (hot body) causes a fall in oxygen consumption towards basal levels. These studies do not, therefore, support the hypothesis that a further increase in metabolic rate occurs during combined cold face and hot body exposure in the piglet model.
Characteristics of the infant thermal environment in the control population of a case—control study of SIDS
Authors: PONSONBY A‐L. , DWYER T. , COCHRANE J. A. , GIBBONS L. E. , JONES M. E.
Published: March 2008

Abstract This report examines the thermal environment during last sleep of a control population to investigate how the thermal environment of the infant's bedroom varies by season, external temperature and by certain maternal and infant characteristics. Two age‐matched control infants were chosen for each case, one of which was also matched on birthweight. The home visits were not pre‐arranged and were matched on climatic conditions, time of year and time period of day for the index case. The initial response rate for controls (n= 108) was 86%. Although there was a large amount of variation in the infant thermal environment, thermal insulation correlated with room temperature (r=−0.44, P= 0.0001) and external temperature (r=− 0.30, P= 0.002). The thermal environment of the infant, as defined by excess thermal insulation for room temperature, did not vary by indoor or outdoor temperature, but higher average values were observed in teenage mothers (mean difference = 2.7 tog [95% Cl = 0.3, 5.2]), infants who slept in an adult bed (mean difference = 2.6 tog [− 0.1, 5.4]) and infants with an illness (mean difference = 0.8 tog [− 0.3,1.9]). There was a tendency for the thermal environment of infants to be higher and more variable during winter, supporting previous hypotheses that paradoxical overheating may occur in some infants during winter. Further work is required to provide a set of recommendations on the optimal thermal conditions for post‐neonatal infants.
Further evidence supporting a causal relationship between prone sleeping position and SIDS
Authors: MITCHELL E. A. , FORD R. P. K. , TAYLOR B. J. , STEWART A. W. , BECROFT D. M. O. , SCRAGG R. , BARRY D. M. J. , ALLEN E. M. , ROBERTS A. P. , HASSALL I. B.
Published: March 2008

Abstract A 3 year case‐control study identifying the risk factors for SIDS was undertaken. Preliminary analysis of the data from the first year suggested that SIDS mortality could fall by 50% if the prevalence of the prone sleeping position changed from 40 to 0%. During the 3 year study the prevalence of the prone sleeping position among infants has fallen from 43% in the first year to 20% in the third year. SIDS mortality has fallen to 3.1/1000 live births, which is very close to that predicted. When considered with other available evidence this strongly supports a causal relationship between the prone sleeping position and SIDS.
Insulin deficiency: Effects on fetal growth and development
Authors: FOWDEN A. L.
Published: March 2008

Insulin deficiency in either the mother or foetus has significant effects on fetal growth and development. In the human, maternal insulin deficiency, or diabetes mellitus, leads to macrosomia and increased adiposity of the foetus, while specific fetal hypo‐insulinaemia is associated with intra‐uterine growth retardation. When maternal diabetes is induced in experimental animals, no consistent increases in fetal bodyweight are observed although the body fat content of the foetus is increased in the majority of species studied. The magnitude of the fetal weight gain during maternal diabetes appears to be determined by the body fat content of the foetus, the severity and duration of the diabetes and by the temporal pattern of maternal hyperglycaemia observed during pregnancy. The latter factors, in particular, influence the level of insulin in the foetus which, in turn, regulates the rate of intra‐uterine growth. By contrast, fetal insulin deficiency has a more uniform effect on fetal growth and leads to impaired growth in both experimental and naturally occurring hypo‐insulinaemic conditions. Fetal insulin deficiency reduces fetal growth by decreasing nutrient uptake and utilization of the fetal tissues and by altering the circulating concentrations of the insulin‐like growth factors. Consequently, deficiencies in either fetal or maternal insulin secretion during pregnancy can alter fetal growth and have important consequences for perinatal survival and postnatal morbidity.
Priorities and practice in tropical paediatrics
Authors: BIDDULPH J.
Published: March 2008

More than 14 million children under 5 years of age die annually in the Third World, mainly due to diarrhoea, pneumonia, malaria and immunizable diseases. The problems of poverty, malnutrition, poor sanitation, illiteracy and high fertility that traditionally are associated with underdevelopment are now being compounded by social disruption due to rapid changes in lifestyle, new diseases such as AIDS and Third World debt.

A vital part of the solution is provision of basic medical and education services to all, with emphasis on female literacy and improving the status of women. Key elements in providing basic medical services are delegation and empowerment. Doctors must delegate the delivery of essential child health services to appropriately trained and adequately supported auxiliaries. Parents, especially mothers, need to be empowered with the knowledge and resources to recognize and manage, or assist in the management of, their children's health problems.
Essential fatty acid deficiency in parenterally fed preterm infants
Authors: LEE E. J. , SIMMER K. , GIBSON R. A.
Published: March 2008

To determine the incidence of essential fatty acid (EFA) deficiency during short term fat‐free parenteral nutrition, the authors investigated prospectively the EFA status of nine low birthweight (1145 ± 343 g) preterm (28.2 ± 1.9 weeks) infants, in whom delivery of dietary fat was delayed postnatally for 2–9 days. Serial determinations of plasma fatty acids showed that during fat‐free alimentation, the major EFA, linoleic acid (LA), decreased rapidly (‐0.75% total fatty acids per day), accompanied by a rise in endogenously produced non‐essential fatty acid, eicosatrienoic acid (Mead acid). Essential fatty acid deficiency was confirmed biochemically by an elevation in the triene‐tetraene ratio in six of the infants, only one of whom developed clinical symptoms. Abnormal fatty acid profiles were corrected within a few days of fat delivery by either intravenous or enteral routes.

Essential fatty acids and their metabolites are involved in a wide range of physiological functions vital to postnatal growth and development. Depletion of these nutrients can be corrected by providing a minimum of 0.25 g LA/kg per day (equivalent to 0.50 g/kg per day of 20% Intralipid or 30–50 mL/kg per day of breast milk).
The cost of improving the outcome for infants of birthweight 500‐999 g in Victoria: THE VICTORIAN INFANT COLLABORATIVE STUDY GROUP
Authors: KITCHEN W. H. , BOWMAN E. , CALLANAN C. , CAMPBELL N. T. , CARSE E. A. , CHARLTON M. , DOYLE L. W. , DREW J. , FORD G. W. , GORE J. , KELLY E. A. , LUMLEY J. , McDOUGALL P. , RICKARDS A. L. , WATKINS A. , WOODS H. , YU V. Y. H.
Published: March 2008

The aim of this study was to conduct an economic evaluation of neonatal intensive care for extremely low birthweight (ELBW) infants born in the state of Victoria. Two distinct eras (1979–80 and 1985–87) were compared. Follow‐up data at 2 years of age were available for all 89 survivors from the 351 live births in 1979–80, and for 211 of 212 survivors from the 560 live births in 1985–87. The overall cost‐effectiveness for ELBW infants during 1985–87 compared with 1979–80 was$104 990 ($A 1987) per additional survivor, or$5390 ($A 1987) per additional life year gained. Cost‐effectiveness improved with increasing birthweight. If the quality of life of the survivors was considered, the economic outlook was more favourable. The cost per quality‐adjusted life year gained was$5090 ($A 1987), approximately one‐tenth of that obtained from the only previous full economic evaluation of neonatal intensive care. Although neonatal intensive care is expensive, it compares favourably with some other health care programmes, particularly as the outcome for ELBW infants continues to improve.
A fatal case of necrotizing enterocolitis in a neonate with polyagglutination of red blood cells
Authors: MARSHALL L. R. , BARR A. L. , FRENCH N. P. , LOWN J. A. , KNOWLES S.
Published: March 2008

An infant of 30 weeks gestation developed necrotizing enterocolitis (NEC) 8 days after birth and died 2 days later after a fulminating course. During her illness she received two blood transfusions, both of which produced sub‐optimal rises in her haemoglobin and were associated with evidence of haemolysis. Retrospective analysis demonstrated T antigen (Tk) polyagglutination of the infant's red blood cells and donor plasma. Although bacterial cultures were negative throughout the course of the illness in this case, T antigen exposure is associated with certain anaerobic infections and with severity of NEC. Infants with NEC should be regularly screened for T antigen exposure and if this test is positive, plasma (immunoglobulin) containing infusions should be avoided.
Flunitrazepam in terminal care
Authors: SMALES O. R. C. , SMALES E. A. , SANDERS H. G.
Published: March 2008

Flunitrazepam is a benzodiazepine of long half‐life with sedative, anxiolytic, muscle relaxant and anticonvulsant properties. It has proved effective in controlling terminal agitation, confusion, restlessness, dystonia and fitting in adults and can be given by subcutaneous infusion in combination with other drugs. Its use in children during their terminal illness is described. Good symptom control without excessive sedation was achieved over the 24 h prior to death.
Distal hypospadias repair with preputiail reconstruction
Authors: DEWAN P. A.
Published: March 2008

Abstract This study reports the results for 27 boys who had their foreskin reconstructed at the time of a distal hypospadias repair. Preservation of the foreskin provides a useful cosmetic alternative for distal hypospadias surgery.
Prevalence of verocytotoxigenic Escherichia coli serotype O157:H7 in children with diarrhoea attending a Sydney hospital
Authors: ONG J. , ZHE L. , ROBINS‐BROWNE R. , GAPES M. , O'LOUGHLIN E. V.
Published: March 2008

Abstract Verotoxin producing Escherichia coli, in particular serotype O157:H7, have been implicated as an important cause of acute gastroenteritis in children. This study was undertaken to determine if E. coli O157:H7 is an important cause of acute gastroenteritis in children in metropolitan Sydney. During the period from October 1990 to September 1991, stools from patients presenting with acute diarrhoea to The Children's Hospital, Camperdown, were examined for the presence of common bacterial pathogens. In addition, stools were grown on sorbitol McConkey agar and sorbitol non‐fermenting organisms were serotyped with O157 antiserum by slide agglutination. The isolates were then tested with H7 antisera and investigated for the production of verocytotoxin and other pathogenic markers including plasmid‐associated EHEC adhesin and chromosomally encoded attachment‐effacement gene. Only two strains (isolated from two different patients, 0.1% of specimens tested) were agglutinated by O157 antiserum and both were non‐motile (H‐). However, both strains produced verotoxin and expressed other virulence markers, suggesting that they were responsible for the diarrhoea. Both patients experienced mild, self limited gastroenteritis. We conclude that E. coli O157:H7 is an uncommon cause of acute gastroenteritis in Sydney children presenting to a children's hospital.
Long‐term complications following bone marrow transplantation in children
Authors: GIRI N. , DAVIS E. A. C. , VOWELS M. R.
Published: March 2008

Abstract Seventeen children who underwent bone marrow transplantation (BMT) between 1975 and 1985 and survived for more than 2 years were evaluated for growth and development. The patients had a follow up of 2.1‐13.1 years. Prior to transplant, children with malignancy had received multi‐agent chemotherapy and nine had also received central nervous system irradiation. Transplant preparation for malignancy (group 1; n= 13) included high‐dose cyclophosphamide (CPA) 120–200 mg/kg and total body irradiation (TBI) 10–13.2 Gy, whereas conditioning for non‐malignant disorders (group 2; n= 4) included high‐dose CPA 200 mg/kg with or without busulphan. Patients in group 1 showed a steady decline in height velocity following initial chemotherapy and cranial irradiation and the decline was even greater following BMT. Growth hormone (GH) deficiency developed in eight of nine children tested, hypergonadotrophic hypogonadism developed in 11 who reached puberty, thyroid hormone abnormalities were encountered in four out of 10 tested and 11 of 13 developed cataracts. Patients in group 2 did not show decline in linear growth rate, thyroid hormone abnormalities or cataracts after BMT. The only child tested had normal GH levels and the two patients who reached puberty showed delayed but complete gonadal recovery. Our data demonstrate that TBI leads to significant late effects on growth and gonadal function. Contrary to previous reports, a high incidence of cataract formation is observed after fractionated TBI. Conditioning regimens without TBI should be considered in children undergoing BMT.
Sensory evoked potentials in inhalant (volatile solvent) abuse
Authors: TENENBEIN M. , PILLAY N.
Published: March 2008

Abstract A study was made to determine whether children with a significant history of inhalant abuse but who lack clinical evidence of neurological abnormality have abnormal visual, auditory or somatosensory evoked potentials. Visual, auditory and somatosensory evoked potential studies were obtained from 15 such children aged 9–17 years. Eight of the children had abnormal visual or auditory evoked potentials. Somatosensory evoked potentials were normal in all. It was concluded that evoked potentials may serve as an objective marker of early neurological damage in children who abuse inhalants and demonstrate potential usefulness for counselling and intervention.
Reported food consumption and dietary habits of New Zealand adolescents
Authors: WORSLEY A. , WORSLEY A. J. , McCONNON S. , SILVA P. A.
Published: March 2008

Abstract Six hundred and sixty‐seven fifteen year old members of the Dunedin Multidisciplinary Health and Development study cohort completed a self‐administered food frequency and dietary habits inventory. The results show that only 14 foods were consumed on a regular basis by more than 80% of the cohort. Statistically significant differences were found between the numbers of boys and girls consuming a variety of foods; generally, more girls consumed fruits and green vegetables and more boys consumed foods rich in fat and sugar. Several differences were observed in the food consumption of three income groups: fewer adolescents in low income families consumed expensive foods such as steak. The implications of these food consumption findings and their associated gender and income differences for nutrition promotion and food policy are discussed.
Retrospective diagnosis of medium chain acyl‐CoA dehydrogenase deficiency
Authors: CHRISTODOULOU J. , CLARKE J. T. R. , RUPAR C. A. , GORDON B. A. , KELLY D. P.
Published: March 2008

Abstract A male infant is reported who died suddenly and who at post‐mortem had pathological evidence suggestive of a genetic defect of fatty acid β‐oxidation. A specific diagnosis could not be made enzymatically because of unavailability of suitable tissue for assay. The diagnosis of medium chain acyl‐CoA dehydrogenase (MCAD) deficiency was made by specific mutation analysis using the polymerase chain reaction and DNA extracted from the newborn screening card of this infant. This powerful new molecular diagnostic technique should prove to be of use in similar circumstances.
Side effects of stimulant use
Authors: LEVY F.
Published: March 2008

The current literature on side effects of central nervous system (CNS) stimulant medications used in the treatment of attention deficit hyperactivity disorder (ADHD) is reviewed, with particular emphasis on dose‐response effects on differing behavioural systems. The reasons for variation in findings may lie in individual differences in children, or in differing responses of target behavioural systems. These may be understood in terms of underlying pharmacological mechanisms. Social, educational and philosophical issues relating to medication use are discussed, and the need for ongoing critical clinical and research approaches, rather than polarization of professional attitudes, is emphasized.
Extremely low birthweight infants at 3 years: A developmental profile
Authors: BOWEN J. R. , STARTE D. R. , ARNOLD J. D. , SIMMONS J. L. , MA P. J. , LESLIE G. I
Published: March 2008

This study documents the neurodevelopmental outcome at 3 years of 52 of 55 extremely low birthweight (ELBW) survivors (survival rate 49%) born in a tertiary maternity centre from July 1985 through December 1988, and examines more closely the developmental profile of the neurologically normal survivors. At 3 years, 6 (12%) children had severe neurodevelopmental impairment (severe cerebral palsy, blindness, deafness or a General Quotient (GQ)<70 on the Griffiths Scales), 11 (21 %) had mild to moderate impairment and 35 (67%) had no neurosensory impairment and normal development (GQ≥ 85). Significant risk factors for severe impairment were stage 3 or 4 retinopathy of prematurity (odds ratio [OR] 21.5), treatment with postnatal steroids (OR 21), grade III or IV intraventricular haemorrhage (OR 11) and supplemental oxygen at ‘term’(OR 6.4). The developmental profile of the 35 neurologically normal children revealed a significant weakness in eye and hand coordination skills and a relative strength in hearing and speech skills. Early recognition of this developmental profile may allow implementation of more appropriate preschool programmes for ELBW children.
Severe thrombocytopenia in extremely low birthweight infants with systemic candidiasis
Authors: DYKE M. P. , OTT K.
Published: March 2008

The clinical, haematological and microbiological features of 12 extremely low birthweight (ELBW) infants with Candida infection were compared with 36 gestational‐age and birthweight matched controls who experienced 42 episodes of bacterial septicaemia. Thrombocytopenia was the feature observed most commonly, occurring in 12 of 12 study infants and 23 of 42 controls (P= 0.004). Minimum platelet counts were below 50 x 109/L in 11 of 12 study patients compared with seven of 42 controls (P < 0.0001). Severe thrombocytopenia may be a useful indicator of systemic Candida infection in ELBW infants.
Pneumomediastinum complicating childhood acute lymphoblastic leukaemia
Authors: COPEMAN M. C. , MOORE P. , SHAW P. J.
Published: March 2008

A case of pneumomediastinum that developed in a 10 year old girl receiving induction chemotherapy for acute lymphoblastic leukaemia is reported. Three factors were identified that may have been associated with this complication: the patient suffered recurrent vomiting during her induction chemotherapy; she had travelled by air the day before the pneumo mediastinum was diagnosed; and was septic with Enferobacter at time of diagnosis. The pneumomediastinum resolved over 2 weeks without specific treatment and without further complications.
Chromosome testing in children with developmental delay in whom the aetiology is not evident clinically
Authors: GRAHAM S. M. , SELIKOWITZ M.
Published: March 2008

A review was carried out to establish the value of chromosome testing in children with significant developmental delay, where the aetiology was not evident clinically. During 1990, 315 children had been assessed at a child development clinic and found to be significantly delayed in one or more areas of development; in 256, the aetiology was not evident clinically. Chromosome testing of these children revealed an abnormality in 10 (3.9%). Thirty children had dysmorphic features; six (20%) of these had an abnormal karyotype. Four (2%) of the 226 who had no dysmorphic features had a chromosome abnormality. One hundred and fifty‐five children had intellectual disability; eight (5%) of these had an abnormal karyotype. Two (2%) of 101 who had a specific delay in their development had a chromosome abnormality. The advantages of chromosome testing in children with developmental delay in whom the aetiology is not evident clinically are discussed.
Immunization status and demographic characteristics of New Zealand infants in the first 6 months of life
Authors: ESSEX C. , COUNSELL A. M. , GEDDIS D. C.
Published: March 2008

In the Royal New Zealand Plunket Society's 1990‐91 cohort study, of 3902 children, 985 (25.2%) had fallen behind the immunization schedule by 6 months of age. These children were more likely to be from lower socio‐economic groups or to have mothers who were older, with high or low education, or of higher parity. The infants were also more likely to be from non‐European families, or to have unemployed fathers. Eight hundred and ten (82.2%) of the incompletely immunized children at that age could be brought up‐to‐date with their immunizations by a single visit to the doctor. The most common reason for delaying immunization was that the baby was sick. This was a false contraindication in 69.2, 79.0 and 78.4% of these children at the 6 week, 3 month and 5 month immunization, respectively.
In utero repair of diaphragmatic hernia
Authors: MACMAHON R. A. , YARDLEY R. W. , SHEKLETON P. A. , RENOU P. M.
Published: March 2008

This report describes the first in utero repair of diaphragmatic hernia in Australia. The patient was a 32 year old woman with major infertility problems who was diagnosed at 15 weeks gestation as having an infant with diaphragmatic hernia. After extensive consideration and counselling the parents requested in utero repair. This was performed at 28 weeks gestation and was technically successful, but the infant was found to be dead after uterine closure. The mother has subsequently been delivered of normal twins at term by Caesarean section.

in utero repair of diaphragmatic hernia requires a high degree of team work, is technically demanding and has major ethical implications. It should be restricted to nationally designated units.
Erroneous measurement of arterial oxygen saturation
Authors: NACHMAN J. A. , SCHWARTZ R. E.
Published: March 2008

This case report describes measures of arterial oxygen saturation from pulse oximetry during blood transfusion.
Interdisciplinary education in adolescent health
Authors: BEARINGER L H. , GEPHART J.
Published: March 2008

AbstractTo date, evidence suggests that, across disciplines, the educational preparation of health professionals has not kept pace. Those involved in the education of clinicians, researchers, and educators in adolescent health are currently faced with the need to rethink traditional educational strategies. Concurrent with a shift in the primary causes of morbidity and mortality in adolescence, from infectious to social aetiologies, is an emerging clarity about the success of integrated comprehensive service settings in addressing adolescents' health needs. One approach for better preparing health providers to work in multiservice settings is to provide training in interdisciplinary programmes. Various models for interdisciplinary education in adolescent health exist; characteristics common to all are delineated. Whereas obstacles to the creation and implementation of interdisciplinary programmes, including institutional, financial, and educational barriers, are great, the need to overcome them is critical if we are to keep pace with the changing needs of the adolescent population.
Warning! Schools can damage your health: Alienation from school and its impact on health behaviour
Authors: NUTBEAM D. , SMITH C. , MOORE L , BAUMAN A.
Published: March 2008

Abstract An international study of health behaviour among school‐age children was co‐ordinated by the World Health Organization (WHO). The data were obtained from a self‐completion questionnaire examining key health behaviours and associated psycho‐social variables obtained from representative samples of young people in school aged 11.5, 13.5, and 15.5 years. The analysis focuses on the relationship between older (15.5 years) students' attitudes towards school and health behaviours such as regular smoking, alcohol use, physical activity and food choices. The data show a strong and progressive relationship between indicators of ‘alienation’ from school, and health compromising behaviours among school students from Australia and Wales. This relationship is most obvious with the ‘abusive’ behaviours of smoking and alcohol misuse. Summary data for nine other countries in the WHO study indicate that this relationship is found consistently across all countries in the study. This substantial minority of students (approximately 30% varying between countries) represents an important target population for efforts to promote healthy lifestyles. Traditional school health education is seen as insufficient to tackle this task and recommendations are made concerning change to the school environment and ethos, and the need to reach young people in their home and community settings.
Issues of transition to adult care
Authors: COURT J. M.
Published: March 2008

Abstract A survey was carried out on adolescents with insulin dependent diabetes mellitus, aged 15 to 18 years, to elicit their views on the process of transfer from paediatric to adult care. The survey provided information on what they expected from a health service during this period of their life, their views on the role of specialist physicians and other health professionals and their preferred age for transfer from a paediatric to an adult service. Young people value continuity of care by a physician whom they trust. They expect confidentiality and privacy, some degree of informality and optimal waiting room conditions when they attend for consultation. Almost all suggested that transfer of care should be after the age of 17 years. An understanding of the views and expectations of young people with a chronic illness such as diabetes should assist those who are responsible for the development of health care. It is recommended that transition services for young people with a chronic illness be developed at those children's and adult hospitals that provide specialist care for them.
Epstein‐Barr virus associated aplastic anaemia and hepatitis
Authors: LAU Y‐L. , SRIVASTAVA G. , LEE C‐W. , KWONG K‐Y. , YEUNG C‐Y.
Published: March 2008

Abstract We report a Chinese girl with Epstein‐Barr virus (EBV) associated aplastic anaemia and hepatitis. Epstein‐Barr virus genome was demonstrated in her bone marrow cells and EBV‐specific serology suggested reactivation of EBV infection. She was initially treated with anti‐thymocyte globulin (ATG) and methylprednisolone but with no haematologic response, and liver function continued to deteriorate. She was then treated with acyclovir. Her aplastic anaemia improved and hepatitis resolved, and there was eradication of EBV genome from her bone marrow cells.
A medium term follow‐up study of patients with hypertrophic pyloric stenosis
Authors: ZHANG A‐L , CASS D. T. , DAWSON K. P. , CARTMILL T.
Published: March 2008

A structured questionnaire was sent to the parents of 120 children from a cohort 192, who had undergone a pyloromyotomy for pyloric stenosis at Westmead Hospital during the years 1984‐91. Information was gained from 85 children in 82 families regarding gastrointestinal complaints and family history of pyloric stenosis. There were few gastrointestinal problems, no reports of recurrent abdominal pain, but two reports of clinically significant vomiting (2.3%) and one of infantile colic. Of the 85 individuals studied, 21 (24.7%) had a positive family history of pyloric stenosis, a higher frequency than previously reported.
The micro‐environment of the sleeping newborn piglet covered by bedclothes: Gas exchange and temperature
Authors: GALLAND B. C. , PEEBLES C. M. , BOLTON D. P. G. , TAYLOR B. J.
Published: March 2008

This study followed the thermal and gaseous micro‐environment of the newborn piglet sleeping under two levels of bedding insulation. After 1 h in the piglet's thermal comfort zone, the head of each piglet was covered for 2h with bedding either 12 mm or 21 mm thick. Body temperature rose rapidly, but the arterial gases showed no change in the direction of asphyxia; with the thicker covering Pao2 was unchanged and Pao2 fell and pH rose. These changes were despite a small rise in environmental Pao2 and fall in Pao2 but were also minimized by the piglet's ability to avoid profound hypocapnia by panting at a very low tidal volume. No significant changes in blood gases occurred with the thinner bedding; the temperature rose markedly but more slowly. It is suggested that human babies submerged under bedclothes for any length of time would be more likely to succumb to the effects of hyperthermia than of asphyxia.
A practical intervention to address ear and lung disease in Aboriginal primary school children of central Australia
Authors: BARKER R. N. , THOMAS D. P.
Published: March 2008

Australian Aboriginal populations have an extremely high prevalence of lung disease and ear disease. In addition to an improvement in socio‐economic conditions, implementation of strategies to address the problem, within the limitations of present conditions, is needed. A 5 month trial was conducted to investigate the effectiveness of a school‐based intervention programme involving nose blowing, deep breathing and coughing combined with exercise performed daily. This was a community‐based trial, designed to give priority to cultural and ethical considerations, to be non‐intrusive and to utilize local skills and resources. Results of the trial showed that signs of upper and lower respiratory tract disease and pulmonary function measurements were statistically significantly improved. Hearing levels showed no statistically significant change. The programme met with a good response from children and teachers. This study does suggest that this strategy may help address the existing problems of lung and ear disease in Aboriginal primary school children, providing some immediate benefits within the limitations of the present socio‐economic conditions.
Neonatal renal candidiasis
Authors: MORRIS S. A. , BAILEY C. J. , CARTLEDGE J. McP.
Published: March 2008

A case is presented of renal candidiasis complicated by obstructive uropathy in a 4 month old infant. Management was successful with surgical decompression combined with peri‐operative amphotericin B, followed by 3 weeks of oral ketoconazole and subsequently 6 weeks of oral fluconazole. Fluconazole was substituted for ketoconazole owing to persistant candiduria, and achieved rapid urinary sterilization. Fluconazole is an effective and less toxic alternative to prolonged courses of amphotericin B in the treatment of neonatal renal candidiasis.
Glucose‐6‐phosphate dehydrogenase enzyme activity of normal term Malaysian neonates of different ethnic origins
Authors: BOO N. Y. , AINOON B. O. , OOI L H. , CHEONG S. K. , HALIZA B. M. S.
Published: March 2008

The cord blood glucose‐6‐phosphate dehydrogenase (G6PD) enzyme activity of 262 normal term Malaysian neonates (92 Malays, 96 Chinese and 74 Indians) was quantitatively determined by the World Health Organisation method. Analysis of variance for the levels of G6PD enzyme activity by ethnic origin and sex showed that there was a significant difference between mean levels of enzyme activity in the three ethnic groups (P= 0.03) but no difference between the sexes (P= 0.36). Multiple range analysis showed that Malays had significantly higher mean levels of G6PD enzyme activity than those of Chinese (P= 0.01). There was no significant difference between the mean levels of G6PD enzyme activity of Chinese and Indians (P= 0.52), nor was there any difference between those of Malays and Indians (P= 0.08). The difference in levels of G6PD enzyme activity among the different ethnic groups could be due to the existence of different G6PD variants.
Acute myeloid leukaemia in patients with trisomy 21 (Down syndrome) treated by bone marrow transplantation
Authors: GOLETA‐DY A. , POZZA L. DALLA , SHAW P. J. , STEVENS M. M.
Published: March 2008

Patients with trisomy 21 have an increased incidence of haematological disorders, including neonatal ‘leukaemoid reaction’(transient myeloproliferative disorder [TMD]) and acute leukaemias. In the past it has been felt that patients with trisomy 21 and acute leukaemia do not tolerate, and hence may not warrant, therapy as intensive as those without the syndrome. The present authors' experience and the current literature do not support this view. Two cases are reported of acute myeloid leukaemia in children with trisomy 21, successfully treated with intensive chemotherapy and bone marrow transplantation.
Fludrocortisone induced heart failure in Addison's disease
Authors: WILLIS F. R. , BYRNE G. C. , JONES T. W.
Published: March 2008

The first reported case of congestive cardiac failure in a child with Addison's disease secondary to fludrocortisone therapy is presented. A renal adaptation to compensate for chronic salt and water deprivation is suggested as a possible mechanism for the development of congestive cardiac failure in this patient.
Recognition and crisis management of asthma in schools
Authors: SHAH S. , GIBSON P. G. , WACHINGER S.
Published: March 2008

Under‐reporting of asthma and inappropriate management at school can hamper a child's academic progress. The aim of this study was to assess asthma reporting and crisis management, following implementation of a Primary School Asthma Programme.

The intervention covered 12 primary schools with 5093 students in an area of high unemployment with a large proportion of the community from a non‐English background. The programme included School Asthma First Aid Kits, training workshops for school staff and individual Crisis Management Plans for students with asthma. Registration of students with asthma at school increased from 6.2% before the intervention in 1989 to 12.7% in 1992. School Asthma Crisis Plans were completed appropriately by the child's doctor and parents and returned by 68% of the students with asthma. Teachers' asthma knowledge and confidence with the management of acute asthma at school improved following asthma education workshops. It was concluded that asthma reporting and acute crisis management of asthma at school can be achieved by a programme undertaken by school medical services.
Allogeneic and autologous bone marrow transplantation for acute non‐lymphoblastic leukaemia
Authors: VOWELS M. R. , LAM‐PO‐TANG R. , FORD D. , TRICKETT A. , MAMEGHAN H.
Published: March 2008

Bone marrow transplantation (BMT) has had an increasing role in the treatment of acute nonlymphoblastic leukaemia (ANLL). A review of patients transplanted between May 1975 and August 1991 was undertaken in order to evaluate problems and outcome, and examine the role of both autologous and allogeneic BMT at various stages in the treatment of ANLL. Forty‐seven patients received either an allogeneic (n= 24) if a suitable donor was identified or autologous (n= 23) BMT if there was no allogeneic donor. Conditioning therapy consisted of total body irradiation (TBI) and cyclophosphamide (n= 14) or busulfan and cyclophosphamide (n= 33) with or without melphalan. Graft‐versus‐host disease prevention was with methotrexate (n= 9), methotrexate and cyclosporin (n= 10) or T cell depletion (n= 5). Minimum follow‐up for surviving patients was 24 months (median 65 months). For patients transplanted in first remission there was a 0% and 9±6% transplant‐related mortality, a 37±11% and 33±12% relapse risk and a 63±11% and 63±12% event‐free survival for autologous and allogeneic BMT, respectively. In second remission, there was a 14% mortality, 50±20% relapse risk and 43±19% event‐free survival for allogeneic BMT. No patient transplanted in relapse survived. In patients who survived greater than 24 months, late side effects were noted in all 8 (100%) patients given TBI and in 2 of 19 (10.5%) given busulfan. These data indicate that both allogeneic and autologous BMT are associated with significant event‐free survival when used both as initial therapy after complete remission has been achieved with conventional chemotherapy or in second remission. Allogeneic and autologous BMT would appear to be similarly effective.
A comparison of the growth patterns of Chinese infants in Chengdu and Hong Kong: 0‐2 years
Authors: YANG M. , LEUNG S. S. F.
Published: March 2008

Factors affecting geographical differences in the growth of Chinese infants were examined by comparing data obtained from longitudinal growth studies on growth and feeding practices performed in two Chinese populations: Chengdu and Hong Kong infants from birth to 2 years. Their mean growth curves were fitted by the Reed model for the first year and the Count model for the second year. Chengdu mothers were significantly taller than Hong Kong mothers. Chengdu infants grew more rapidly than the Hong Kong infants during the first 6 months; it is likely that this is related to genetic differences in growth potential and earlier introduction of solids in Chengdu infants.
Perhaps vigintiphobia should only apply to infants with Rhesus erythroblastosis
Authors: EBERHARD B. A. , DREW J. H.
Published: March 2008

Forty‐two children who sustained a serum bilirubin (SBR) level above 339 μmol/L as newborn infants were assessed at our Growth and Development Clinic to determine presence of sequelae. Only one child (2.3%) had mild sensorineural deafness and one child (2.3%) performed below age‐matched standards on psychological testing. As the SBR level rose the psychological scores were lower. Three infants had sepsis associated with the hyperbilirubinaemia. Two (maximum SBR levels of 371 and 366 μmol/L) children were normal (General Cognitive Index (GCI) 117 and 119, respectively) and one child (maximum SBR level 556 μmol/L) was borderline abnormal (GCI 74) on psychological testing; he also suffered from Rhesus erythroblastosis. Premature infants recorded a mean GCI of 109.9 (±33.4) and for term infants mean GCI was 110.3 (±17.3; NS); however, the youngest premature infant was 32 weeks' gestation. When maximum SBR level was correlated with GCI and Motor Index (MI) the only significant correlation (r= ‐0.7445; P= 0.03) occurred in infants with Rhesus erythroblastosis and GCI. Since exchange transfusion has a mortality of between 0.3 and 5.3% and an associated morbidity incidence of 5.2% we suggest that the standard indication for its use (SBR level of 342 μmol/L) should only apply to infants with Rhesus erythroblastosis. The actual SBR level which places a newborn infant at significant risk of bilirubin encephalopathy, where the cause of jaundice is other than Rhesus erythroblastosis, cannot be determined by this study. However, it is above 342 μmol/L and our results suggest that a re‐evaluation should occur of a SBR level of 342 μmol/L in a term infant, being the indicator for exchange transfusion where the cause of jaundice is other than Rhesus erythroblastosis.