bluuebunny/crossref_metadata_2025 huggingface dataset:
Emotional and behavioural problems experienced by children living in single‐parent families: A pilot study
Authors: CLARK J. J. , SAWYER M. G. , NGUYEN A‐M. T. , BAGHURST P. A.
Published: March 2008

This study compared the prevalence of emotional and behavioural problems experienced by 10‐11 year old and 14‐15 year old children living in single‐parent and two‐parent families in South Australia. The 10‐11 year old male children living in single‐parent families were found to have significantly more emotional and behavioural problems than 10‐11 year old male children living in two‐parent families. In particular, the younger male children living in single‐parent families experienced more externalizing behaviour problems than younger male children living in two‐parent families. It is suggested that paediatricians and general practitioners need to be aware of children who are at particular risk for developing emotional and behavioural problems, and the approaches which may be employed to provide help.
The use of developmental screening and assessment instruments by paediatricians in Australia
Authors: ROSSITER E. J. R.
Published: March 2008

Two hundred and seven Australian paediatricians were sent a questionnaire to determine whether they undertook developmental screening and/or assessment. Replies were received from 140(68%) paediatricians of whom 115 (82%) stated they did developmental screening and 58 (41%) said they did developmental assessment The Denver Developmental Screening Test was the most widely used (74%), but several other tests were used, not all correctly. There was greater confusion in the area of developmental assessment and appropriate tests, although 37 (26%) used the Griffiths.

The results are described in detail and some of the current concerns about developmental screening and assessment are discussed.
Infantile hypertrophic pyloric stenosis: A clinical review from a general hospital
Authors: ZHANG A‐L. , CASS D. T. , DUBOIS R. S. , CARTMILL T.
Published: March 2008

A review of 212 cases of infantile hypertrophic pyloric stenosis (IHPS) in a general hospital during an 8.5 year period documents clinical features and suggests refinement of treatment. Features such as sex, age at onset and presentation were similar to other studies. There was a preponderance of infants born in the summer. Premature infants represented 10% of the series, and the most premature (<33 weeks gestation) presented later after birth (40 vs 25 days). Diagnosis was clinical in 65% of cases, but 4% presented before physical examination and diagnostic tests were positive. At the time of admission only 15% had significant abnormalities of serum electrolytes (chloride <85 mmol/L). The periumbilical incision resulted in a hidden scar. Duodenal perforation (3.3%) and wound dehiscence (1.4%) are related to technical factors and can be avoided. The timing of commencement of postoperative feeds did not influence the rate of vomiting. The average length of stay was 3.5 days. These results are discussed with suggestions about how to minimize diagnostic tests and length of hospital stay.
Adolescent resilience: The potential impact of personal development in schools
Authors: RAPHAEL B.
Published: March 2008

Abstract The challenges and stresses faced by adolescents include entry into secondary school, the development of adolescent sexuality, family conflicts, parental mental illness, socio‐cultural factors, substance use and abuse, work and career abuse, social and antisocial behaviour, and the carry‐over of problems from childhood. The ways in which programmes through schools can address these issues, enhance resilience and promote adolescent mental health are discussed. The potential of personal development programmes could be utilized to this end, with targeted educational and group initiatives and evaluation of outcomes.
Family relationships and the development of social competence in adolescence
Authors: BRENNAN J. L.
Published: March 2008

Abstract Resilient adolescents are notable for their social competence, which enables them to form and maintain close relationships. The evidence is that adolescents' social competence is derived from their experience of close relationships within their family. On the basis of structured interviews, adolescents' working models of attachments can be categorized into secure, dismissive, or pre‐occupied. These attachment styles are associated with very divergent beliefs about the self and others, with differing patterns of emotion regulation and with differing risk profiles for maladjustment. Parenting styles and family relationships appear to have considerable influence on attachment behaviour. Further evidence for the importance of the family comes from research on ego development. Family level behavioural patterns have been discerned from family research interviews which are associated with stagnation or advancement in ego development during adolescence. Though the results suggest causal connections, the direction of effects is far from clear. Longitudinal research underpins the importance of childhood temperament as a contributing factor to the quality of the family environment that the child and then adolescent experiences.
Hospital admission rates for asthma and pneumonia in Fijian and Indian children
Authors: FLYNN M. G. L
Published: March 2008

Abstract To confirm the clinical impression that Melanesian Fijian and Fiji Indian children differ in their profiles of respiratory morbidity, national hospital admission statistics for respiratory diseases in children aged 5‐14 years were examined for 4 years between 1985 and 1989. The mean annual admission rate for asthma was three‐fold higher in Indians (1.68/1000) than Fijians (0.56/1000); rate ratio (Indian:Fijian) = 3.00, 95% confidence interval 2.54‐3.55. Conversely, the mean annual admission rate for pneumonia was three‐fold higher in Fijians (1.70/1000) than Indians (0.50/1000); rate ratio (Fijian:Indian) = 3.39 (2.85‐4.03). Admission rates for influenza, tuberculosis and bronchiectasis were also higher in Fijian children. Fijian and Indian children differ in hospital admission rates for respiratory diseases, possibly due to differences in incidence, prevalence or severity.
Infant weaning practices in Adelaide: The results of a shopping complex survey
Authors: RETALLACK S. J. , SIMMER K. , MAKRIDES M. , GIBSON R. A.
Published: March 2008

Abstract The results are presented of a survey of infant weaning practices carried out in shopping complexes in the Adelaide metropolitan area. The types of foods and fluids currently being consumed by the sample of 258 healthy infants was documented, and a comparison made between the feeding practices of breast and artificially fed infants and with respect to socio‐economic status. While the majority of weaning diets were compatible with the South Australian guidelines, 40% of infants under 4 months of age were having solid foods and a greater percentage of these infants were artificially fed. Iron intake may not be optimal after six months of age with the increasing use of cow's milk and non‐fortified adult cereals. There is an increasing awareness of the inappropriateness of adding sugar and salt to infant foods; however, foods high in sugar and salt are still being used. The results suggest that parents may not always be aware of or understand the rationale behind recommendations for weaning and that dietary guidelines for adults and children may not always be appropriate for infants. Consistent guidelines for infants, modified to consider current food trends, would be useful for parents.
Cotside plasma rather than whole blood estimates of blood glucose in the newborn
Authors: REYNOLDS G. J. , KIAGI G.
Published: March 2008

Abstract An evaluation of the use of a glucose reflectance meter for the cotside measurement of plasma rather than whole blood glucose was undertaken. Three hundred and twelve samples were obtained for examination. There is a closer correlation between plasma glucose than whole blood glucose to laboratory values. Confidence and prediction intervals show that even separating plasma from whole blood at the cotside does not improve the reliability of glucose reflectance meters when predicting blood glucose values in the context of managing high risk newborn infants. The cotside measurement of blood glucose using glucose reflectance meters should be abandoned and improved methods for quickly obtaining accurate laboratory data should be instituted.
Patterns of weight growth in Aboriginal children on Queensland communities
Authors: DUGDALE A. E. , MULLER M. , ALSOP‐SHIELDS L.
Published: March 2008

Abstract We have used data from existing health records to study the birthweights and percentage weights for age (%W/A) of children in five Aboriginal communities in Queensland. The data are from cohorts of children born in the 1950s‐80s at Cherbourg, the 1960s‐80s at Yarrabah and the 1970s‐80s in Woorabinda, Palm Island and Doomadgee. Birthweights have not changed significantly in any of the communities and generally remain below the international level. The weights for 1 and 5 year old children have improved significantly at Cherbourg and Palm Island, but have dropped significantly at Doomadgee. The overall pattern is for children on remote communities to have a lower %W/A and less improvement in %W/A than those closer to population centres. Other workers have found the same pattern elsewhere. These patterns of growth are probably not directly related to the level of general health services, but rather to other facilities available and attitudes of mothers to child care. The results also show that Aboriginal children can reach international levels of %W/A, so the poor growth in many communities is potentially preventable.
Aerosol deposition in cystic fibrosis using an aerosol conservation device and a conventional jet nebulizer
Authors: MARSHALL L. M. , FRANCIS P. W. , KHAFAGI F. A.
Published: March 2008

Abstract The deposition of technetium radiolabelled aerosol within the lungs of 12 stable cystic fibrosis patients (mean age 12.7 years) was compared using the Acorn nebulizer and mouthpiece alone, and the Acorn nebulizer attached to the Mizer Aerosol Conservation Device (MACD). The total activity delivered to the patient using the MACD was 11.1% (\pm7.8% s.d.) of the initial dose, compared to 5.8% (\pm4.2% s.d.) with the nebulizer and mouthpiece alone (P<0.05). With the MACD, 84% of the intrapulmonary dose was delivered to the peripheral regions, compared to 76.5% with the nebulizer and mouthpiece (P<0.05). No significant correlation was found between aerosol deposition and pulmonary function. The Mizer Aerosol Conservation Device significantly increases both total intrapulmonary aerosol deposition and peripheral aerosol distribution.
Aminophylline therapy and cerebral blood flow velocity in preterm infants
Authors: CHANG J. , GRAY P. H.
Published: March 2008

Pulsed Doppler ultrasound was used to evaluate the cerebral blood flow velocity (CBFV), in the middle and anterior cerebral arteries in 10 infants before and after the administration of aminophylline (7.5 mg/kg). Mean CBFV, heart rate, blood pressure, oxygen and carbon dioxide tensions were recorded before the loading dose, and then at 1, 2, 6 and 24 h after completion of the infusion. Mean CBFV in the middle and anterior cerebral arteries were 16.8 cm/s and 10.8 cm/s respectively prior to the infusion. There was a significant decrease (P<0.05) in velocities in both arteries at 1 and 2 h post drug therapy, which returned to base values by 6h, and remained as such at 24h. The heart rate increased (P<0.05) after the infusion, while no consistent changes were observed in blood pressure or oxygen tension. Carbon dioxide levels were significantly reduced (P<0.05) at 2h. The reduction in CBFV, however, was more than would be expected on the basis of the change in carbon dioxide levels alone, suggesting that other factors may be exerting an influence. While no adverse effects were noted in the infants studied, it is suggested that aminophyiline should be used judiciously in sick preterm infants at highest risk from ischaemic brain injury.
Communicable disease outbreaks in long day care centres in western Sydney: Occurrence and risk factors
Authors: JORM L. R. , CAPON A. G.
Published: March 2008

We surveyed the directors of all 92 long day care centres in western Sydney to document the occurrence of communicable disease outbreaks during 1992 and to identify risk factors for the occurrence of these outbreaks. A total of 6092 children were enrolled at the centres, of whom 530 (8.7%) were less than 3 years old. Most centres (80.4%) reported at least one outbreak of communicable disease. Diarrhoea was the most commonly reported outbreak type (60 outbreaks), followed by conjunctivitis, head louse infestation and chicken pox (46, 44 and 24 outbreaks, respectively). Chicken pox outbreaks had the largest mean number of cases per outbreak (9.6) and the longest mean outbreak duration (4.4 weeks). Centres with a large total enrolment (50 or more children), those that were open for 12 or more hours each day and those which had commenced operating in 1990 or more recently were generally more likely to report outbreaks, particularly of diarrhoea. The vast majority of communicable disease outbreaks (92.1%) were handled by day‐care staff without seeking outside assistance. Day‐care centre directors may be unaware of the health services that could help them. We need to work more closely with long day care centres, and to focus preventative efforts on large centres, those open for long hours, and newly opened centres.
Lumbar punctures in suspected bacterial meningitis: Too many or too few?
Authors: SELBY A. , ISAACS D. , GILLIS J. , HANSON R. , O'CONNELL A. , SCHELL D. , MAI T. VAN
Published: March 2008

Children aged 1 month to 14 years admitted to the Royal Alexandra Hospital for Children during a 10 month period with suspected meningitis were studied prospectively. The aims were to determine how often lumbar puncture (LP) was delayed or never done, in relation to the outcome of all children, in order to determine the risks of LP and the risks of not doing LP. Of 218 children with suspected meningitis, LP was performed immediately in 195 (89.4%). Meningitis was diagnosed in 49 of these (bacterial 18, viral 31). No child developed cerebral herniation due to immediate LP. There were 11 traumatic taps and two children required repeated attempts. Lumbar puncture was delayed, but performed at a later time in 17 children, of whom three had proven bacterial meningitis, 1 had presumed bacterial meningitis but no organism was detected and 13 had alternative diagnoses. Six children never had an LP, although ventricular cerebrospinal fluid was obtained from two Four of these six children had presumptive bacterial meningitis, one had tuberculous meningitis presenting with acute hydrocephaius and diagnosed post‐mortem, and one had a very poor neurological outcome and no final diagnosis was reached. Of the 27 children with bacterial meningitis, LP was performed immediately in 18, or two‐thirds. There were only minor adverse effects of immediate LP. Delayed LP probably resulted in failure to identify the organism in one child with bacterial meningitis, but did not adversely affect outcome in any child. Of the six children in whom LP was never performed, in only one was no final diagnosis reached. There was no evidence of excessive morbidity attributable to performing too many or too few lumbar punctures.
Impaired increase of prostaglandin E2 in gastric juice during steroid therapy in children
Authors: SHIMIZU T. , YAMASHIRO Y. , YABUTA K.
Published: March 2008

To investigate the aetiology of steroid‐induced peptic ulcers in children, prostaglandin E2 (PGE2) release and acid secretion into gastric juice was evaluated in 10 children receiving a corticosteroid before and after injection of pentagastrin. The concentration of luminal PGE2 was measured by radio‐immunoassay. The basal levels of PGE2 concentration and acid secretion in gastric juice did not differ significantly between the steroid therapy group and control group. After stimulation with pentagastrin, acid secretion increased significantly (P>0.01) in both groups and PGE2 concentration increased significantly (P>0.01) only in the control group. Prostaglandin E2 concentration was significantly lower in the steroid therapy group than in the control group 20‐40 and 40‐60 min after pentagastrin stimulation (P>0.01 and P>0.05, respectively). Since PGE2 has a cytoprotective effect on the gastric mucosa, the results of impaired increase of PGE2 in response to increased acid secretion during steroid therapy may indicate causality with the development of steroid‐induced peptic ulcers.
An outbreak of Pneumocystis carinii pneumonia in children with malignancy
Authors: CHEUNG Y. F. , CHAN C. F. , LEE C. W. , LAU Y. L.
Published: March 2008

An outbreak of Pneumocystis carinii pneumonia (PCP) in three patients within a 6 week period was reported. Two patients had acute lymphoblastic leukaemia and one had brain‐stem glioma. They shared common features of immuno‐suppression and absence of cotrimoxazole prophylaxis and had been nursed in the same room. The severity of PCP and its response to treatment may be related to the degree of immunosuppression. Because of the morbidity and mortality of PCP, chemoprophylaxis should be given to all at‐risk cases. Furthermore, isolation of patients with PCP should be considered in view of increasing evidence of nosocomial transmission.
Dumping syndrome after Nissen fundoplication
Authors: VEIT F. , HEINE R. G. , CATTO‐SMITH A. G.
Published: March 2008

Dumping syndrome is infrequently reported in children, but has significant morbidity. It may be difficult both to diagnose and manage. Two children are reported who developed dumping syndrome after Nissen fundoplication. Symptoms occurred soon after the operation and included post‐prandial pallor, sweating, lethargy and diarrhoea. Failure to thrive was a prominent feature. Typical biochemical changes included hyperglycaemia shortly after meals, followed by hyperinsulinaemia and reactive hypoglycaemia. Effective treatment was only achieved with continuous enteral feeding. Children undergoing fundoplication should be closely monitored for episodes of hypoglycaemia and unresponsiveness. The incidence of dumping syndrome after fundoplication may be underestimated, particularly in children.
The effect of growth hormone on growth and blood urea levels in children with chronic renal failure
Authors: McMAHON K. A. , POWELL H. R. , WALKER R. G. , JONES C. L.
Published: March 2008

It has been claimed that low protein diets slow deterioration of chronic renal failure (CRF) by reducing renal solute load. The anabolic effect of recombinant human growth hormone (rhGH) also has potential to reduce renal solute load and thereby slow progression of renal failure. The aim of this study was to determine the effect of rhGH on growth, renal solute load and renal function in children with CRF.

Seven prepubertal children, aged 2‐14 years, with moderately severe CRF (creatinine clearance 7.7‐23.4 mL/min per 1.73 m2) were treated with daily subcutaneous rhGH, 1 U/kg per week for 10‐12 months. As expected, mean height velocity standard deviation scores (SDS) increased, from ‐ 2.87 before treatment to + 3.39 on rhGH, and mean height increased from ‐ 3.1 to ‐ 2.4 SDS. Serum urea concentrations decreased in most patients during the first month of growth hormone treatment from a mean of 20.0pm7.7 mmol/L to 14.8pm5.8 mmol/L (P= 0.006). The serum urea then returned to pretreatment levels over the next few months.

In the 12 months before treatment with growth hormone, mean creatinine clearance decreased from 19.3 mL/min per 1.73 m2 to 16.7 mL/min per 1.73 m2. In the next 12 months on rhGH mean creatinine clearance decreased further to 13.5 mL/min per 1.73 m2. Therefore the rate of deterioration of renal function was unaffected during treatment with growth hormone. Initial treatment with rhGH is associated with decrease in serum urea concentrations in children with CRF, probably mediated by stimulation of anabolic incorporation of dietary nitrogen into body protein. Despite this reduction in renal solute load, renal function deterioration continued unchanged in most children.
Retention and use of personal health records: A population‐based study
Authors: JEFFS D. , NOSSAR V. , BAILEY F. , SMITH W. , CHEY T.
Published: March 2008

A parent‐held record has been issued to all children born in New South Wales (NSW), Australia since 1988. Five years after its introduction, an evaluation was undertaken to determine its retention rate over time, rate of documentation of immunization status and other important child health information, and its perceived usefulness to parents. The cross‐sectional study comprised an interviewer administered questionnaire to 622 households derived from a stratified random sample of 25 local government areas, representative of 73% of all households containing children under 5 years of age in NSW. A concurrent postal survey assessed the attitudes and use of the Personal Health Record (PHR) among a stratified random sample of 911 health care providers.

Results showed that the PHR was well retained, with 89% claimed retention at 4 years, and over 78% of parents able to produce the record for inspection at interview. Of the records examined, 91% had at least one immunization recorded while 68% had a complete regimen documented by age 4 years. Overall, 93% of parents expressed satisfaction with the PHR, while 64% of all health care providers also felt that the PHR was ‘beneficial to the health care children received’, although only 53% of these used it regularly to record their findings. It is concluded that the PHR currently issued in NSW is well retained and valued by parents, and used by and useful to a range of health professionals.
Day care and asthma morbidity
Authors: CONNETT G. J. , CONNETT C. J. , QUEK S. C. , LEE B. W.
Published: March 2008

An association between attendance at day care centres and lower respiratory symptoms among pre‐school asthmatic children who were attending follow‐up appointments at a specialist respiratory outpatient clinic was studied. Parents of 69 children completed a questionnaire. Because of the variation in the age distribution of the two groups, analysis was restricted to children aged 2‐4 years old; results from 49 children were analysed. Cough, wheeze at night and wheeze on waking occurred significantly more frequently in the two weeks prior to clinic visits among asthmatics attending day care. Among asthmatic children requiring specialist outpatient follow up, those attending day care are more likely to be troubled by lower respiratory symptoms than those looked after at home.
Smoking in pregnancy and child development to age 9 years
Authors: McGEE R. , STANTON W. R.
Published: March 2008

This study examined the association between women's retrospective reports of smoking during pregnancy and subsequent language, cognitive, behavioural and physical development in their children up to age 9 years. While there was a strong association between maternal smoking and an index of disadvantageous child rearing, maternal smoking was not associated with more general family disadvantage. After controlling for levels of background disadvantage, no relationship was found between reports of smoking and language, cognitive or physical development. However, smoking was related to maternal reports of behaviour problems at age of school entry. Possible explanations for this relationship are discussed.
Is cow's milk protein intolerance a cause of gastro‐oesophageal reflux in infancy?
Authors: McLAIN B. I. , CAMERON D. J. S. , BARNES G. L
Published: March 2008

To test the hypothesis that cow's milk protein intolerance (CMPI) might cause or contribute to gastro‐oesophageal reflux (GOR), 10 of 14 infants with abnormal GOR on prolonged oesophageal pH monitoring who had failed to respond to conventional antireflux therapy were placed on a hypo‐allergenic diet for 1 month. In no child was there significant improvement in pH monitoring indices, and only two showed any symptomatic improvement. Therefore, in these children, CMPI did not appear to contribute to GOR. It is probable that CMPI is rare as a cause of passive GOR, although our results do not exclude CMPI as a cause of active vomiting.
Risk factors and outcomes associated with low birthweight delivery in the Australian Capital Territory 1989‐90
Authors: HERCEG A. , SIMPSON J. M. , THOMPSON J. F.
Published: March 2008

: The objectives of this study were to describe outcomes of low birthweight (LBW; >2500g) babies born in the Australian Capital Territory (ACT) and to identify risk factors associated with LBW in the ACT. A cohort study was conducted involving all births recorded in the ACT Maternal and Perinatal Data Collection sets for 1989‐90.

Status at discharge is presented for 9373 births each weighing more than 499 g born in the ACT in 1989 and 1990, classified by birthweight. Other outcomes are given for live births (n = 9309) only. Adjusted odds ratios for significant risk factors for LBW are given for 9084 singleton births whose computer records contained all relevant information.

Perinatal mortality rates for LBW babies are consistent with other States, apart from 500‐999 and 1500‐1999g babies which have higher rates. Eighteen per cent of LBW babies are transferred to other hospitals. Low birthweight babies are more likely than normal birthweight babies to have 1 and 5 min Apgar scores less than 7, to need resuscitation and to take more than 5 min to establish respiration. Risk of LBW is associated with maternal primiparity, age 35 years or more in primiparous women, history of one or more spontaneous abortions, induced abortions or perinatal deaths, chronic illness, public health insurance and single marital status, and with fetal female sex and congenital anomalies.

Babies born weighing less than 2500 g in the ACT have more adverse outcomes and are much more likely to be transferred than normal birthweight babies. Modifiable risk factors for LBW relate to lower maternal socio‐economic status. Measures to decrease the incidence of LBW and its subsequent costs will have greatest gains in this group of women.
Sequelae of Haemophilus influenzae type b meningitis in Aboriginal and non‐Aboriginal children under 5 years of age
Authors: BOWER C. , PAYNE J. , CONDON R. , HENDRIE D. , HARRIS A. , HENDERSON R.
Published: March 2008

Between 1984 and 1990, 257 cases of Haemophilus influenzae type b (Hib) meningitis occurred in children under five years of age in Western Australia. We obtained information on possible sequelae in 131 cases (all non‐Aboriginal) by medical record review and parental interview, and in a further 116 cases (60 non‐Aboriginal, 56 Aboriginal) by medical record review only; no follow‐up information was available for ten children (nine non‐Aboriginal, 1 Aboriginal). The incidence of Hib meningitis in children under five years of age was 26.3 per 100000 for non‐Aboriginal and 152.2 per 100000 for Aboriginal children. The case fatality rate was 3.5% for non‐Aboriginal children and 14.0% for Aboriginal children. Sequelae were recorded for 17.1% of non‐Aboriginal and 22.4% of Aboriginal children who survived Hib meningitis. Surviving Aboriginal children experienced severe sequelae following Hib meningitis almost three times more frequently than surviving non‐Aboriginal children (10.5%vs 3.6%), although mild and moderate sequelae were not more common in Aboriginal children. The information on incidence and severity of sequelae in this study was obtained by chart review and parental interview, and hence may be subject to error or bias, particularly for mild and moderate disabilities. Outcomes like death and severe sequelae, such as cerebral palsy and profound intellectual and physical disability, are less subject to bias. Of Aboriginal children who contracted Hib meningitis in Western Australia over the study period, 22.8% either died or had severe sequelae, while only 7.0% of non‐Aboriginal children experienced these severe outcomes.
Two hour seminar improves knowledge about childhood asthma in school staff
Authors: HENRY R. L. , HAZELL J. , HALLIDAY J. A.
Published: March 2008

Teachers and support staff are often called upon to manage asthma at school but may have little knowledge and understanding of the condition. The aim of this study was to determine whether a short seminar would improve knowledge in non‐health professionals. Seventy school staff attended one of five 2 h seminars presented by an asthma educator. Participants completed the Newcastle Asthma Knowledge Questionnaire (AKQ) before, and 2 months after, the seminar. The mean initial score (maximum possible 31) was 16.4 (range 4–26), increasing to 23 (range 13–29, P= 0.0001). There was a large increase in knowledge about symptoms, pathophysiology, preventive medications and side effects of medications. Initially almost all of the participants had deficiencies in knowledge about reliever medications and the management of exercise‐induced asthma. After the seminar, knowledge in these areas was still poor, with only one‐third of the participants answering them correctly. The results have been used to modify the content of the 2 h seminar with increased emphasis on those areas in which deficiencies in knowledge were demonstrated. No data are available yet as to whether this improved knowledge has improved management.
Congenital heart disease: A 10 year cohort
Authors: BOWER C. , RAMSAY J. M.
Published: March 2008

In order to describe the epidemiology of congenital heart disease in Western Australia, a retrospective, population‐based cohort study was conducted using data collected from multiple sources of ascertainment by the Western Australian Birth Defects Registry. The prevalence of congenital heart disease was 7.65 per 1000 total births. Nine per cent of all cases had a chromosomal disorder, another 17% had extracardiac defects in addition to congenital heart disease, and 75% had isolated congenital heart disease. Congenital heart disease was more common in Aboriginal compared with non‐Aboriginal infants, and in multiple births compared with singletons. Compared with infants weighing 3000 to 3499 g, infants of lower birthweight were more likely to have congenital heart disease, and infants in the heaviest category (£3500 g) were less likely to have congenital heart disease. Three per cent of all stillbirths were known to have a cardiac defect, as were 15.2% of neonatal deaths and 10.8% of post‐neonatal deaths.
Death in neonatal intensive care
Authors: KELLY N. P. , ROWLEY S. R. , HARDING J. E.
Published: March 2008

The aim of this study was to review the frequency of decisions to withdraw treatment from neonates who had died in a large neonatal intensive care unit the reasons for these decisions, and the procedures followed. A 12 month retrospective review of medical and nursing records was undertaken. There were 67 deaths; treatment was withdrawn from 52 infants who were dead or dying, from 9 infants on the basis of a severe congenital abnormality, and from 6 infants with severe acquired brain damage. The decision‐making process and the management of treatment withdrawal are reviewed. It is concluded that withdrawal of treatment resulting in death occurs frequently in the neonatal intensive care service of National Women's Hospital, Auckland, New Zealand, but is usually a recognition of the inevitable. Truly elective withdrawal of treatment is uncommon in the immature infant, but does occur in the context of multiple abnormalities or severe birth asphyxia, where it follows a formal procedure.
A comparative study of the growth of South‐East Asian children in south‐west Sydney born in Australia and overseas
Authors: LOKA P. , NOSSAR V. , BAUMAN A. E.
Published: March 2008

The height and weight of two groups of South‐East Asian children between the ages of 1 and 10 years living in south‐west Sydney were compared to determine the effects of environment on growth and development. One group of these children was born overseas and the other in Australia. The children who were born in Australia were found to be significantly taller (1–2%) and heavier (10%) than those born overseas. This would suggest that ecological factors including health and nutrition contribute to these differences.
Breast feeding in neonatal alloimmune thrombocytopenia
Authors: REESE J. , RAGHUVEER T. S. , DENNINGTON P. M. , BARFIELD C. P.
Published: March 2008

Infants with neonatal alloimmune thrombocytopenia are at risk of severe intracranial haemorrhage. Placental transfer of maternal immunoglobulin G (IgG) directed against fetal platelet antigens is known to be the underlying mechanism. Since breast milk contains IgG it is theoretically possible that breast feeding of these infants could cause thrombocytopenia. The following case report shows that an infant with neonatal alloimmune thrombocytopenia may be safely breast fed, even when the breast milk contains the platelet specific antibody (HPA‐1a).
Rare disease surveillance
Authors: ELLIOTT E. J. , CHANT K. G.
Published: March 2008

Rare diseases in children account for disproportionate morbidity and mortality and are particularly demanding of both families and health resources. Surveillance may provide data on their epidemiology, aetiology, management and outcome and on the support requirements of affected children. Existing methods for rare disease surveillance include mandatory and voluntary notification schemes, which may be active or passive, hospital discharge databases and death certification data. The recent establishment of the Australian Paediatric Surveillance Unit has facilitated active, prospective, national case ascertainment by voluntary notification of selected rare conditions. Information obtained should enable estimation of incidence rates, evaluation of prevention and management strategies, extend data collected by existing methods and help estimate future health needs.
Hospitalization of infants for infections in Western Australia, 1980–91
Authors: GRACEY M. , GEE V.
Published: March 2008

Rates of hospitalization of Aboriginal infants in Western Australia from 1980 through 1991 for infections were much higher than for other infants and were consistently higher in rural areas than in metropolitan areas. There were substantial declines in rates of hospital admissions and bed occupancy of rural Aboriginal infants for respiratory and gastrointestinal infections during the study period; changes in rates for other infections were less marked and less consistent. Despite recent improvements, Aboriginal infants are hospitalized much more frequently and for longer than other infants because of these diseases. Hospitalization rates reflect many factors including disease incidence and severity but also are affected by isolation, climatic and physical conditions, and access to medical and nursing care. Preventive health programmes need to be maintained and intensified in order to improve health standards of young Aborigines and to lessen their need for hospital care.
Clothing and bedding and its relevance to sudden infant death syndrome: Further results from the New Zealand Cot Death Study
Authors: WILSON C. A. , TAYLOR B. J. , LAING R. M. , WILLIAMS S. M. , MITCHELL E. A. ,   the NEW ZEALAND COT DEATH STUDY GROUP
Published: March 2008

As part of a large nationwide case‐control study covering a region with 78% of all births in New Zealand during 1987–90, the clothing and bedding of infants dying of sudden infant death syndrome (SIDS) and that of an appropriate control group were recorded. Cases consisted of 81% (n= 393) of all cases of SIDS in the study area and 88.4% (n= 1592) of 1800 control infants randomly selected from the hospital births and who completed a home interview.

Use of a wool ‘waterproof’ underblanket was associated with a significantly reduced risk of SIDS (adjusted OR 0.44; 95% CI: 0.26‐0.73) while sheepskin use was not. Firm tucking was identified as contributing to a reduced risk of SIDS even after adjusting for potentially confounding variables (adjusted OR 0.63, 95% CI: 0.46–0.86).

Sixty case infants (15.6% of cases) were found dead with the head covered but there were no equivalent data for controls. Having been found previously completely covered by bedding was equally common in cases and controls (28.8% cases and 30.6% of control infants). Other differences of bedding and clothing between cases and controls were small; mattress characteristics were not studied.

The exact methods in which babies are cared for are important and this study suggests that infants are at lower risk of SIDS when firmly tucked in and when sleeping on a ‘waterproof wool underblanket.
Application of capture—recapture methodology to estimate the completeness of child injury surveillance
Authors: ROBERTS I. , SCRAGG R.
Published: March 2008

This paper describes the use of the two sample capture‐recapture method to estimate the completeness of ascertainment of injury events in both routine public hospital discharge statistics and in an active injury surveillance system. For all child pedestrian injuries public hospital discharge statistics were 90% complete and the active surveillance system 77% complete. For non‐traffic child pedestrian injuries public hospital discharge statistics were 66% complete, the active surveillance system being 79% complete. Capture‐recapture methods have the potential to improve the accuracy of traditional childhood injury surveillance systems.
Sole parenthood and the risk of child pedestrian injury
Authors: ROBERTS I.
Published: March 2008

Children of sole parents have the worst mortality record of all social groups. Road vehicle related injuries account for a large part of their excess mortality. In this case‐control study the association between sole parent status and the risk of child pedestrian injury was examined. Cases (n= 258) were children killed or hospitalized as a result of a pedestrian injury in the Auckland region over a period of 2 years and 2 months. Controls were a random sample of the child population. The children of sole parents were at a significantly increased risk of injury (odds ratio = 1.57; 95% confidence interval (CI) 1.09, 2.27). However, there was a striking difference in the effect of sole parent status according to ethnic group. Among European families, sole parenthood was associated with a greatly increased risk of injury (OR = 3.13; 95%CI 1.84, 5.31), whereas in Pacific Island families sole parenthood was associated with a significant protective effect (OR = 0.40; 95%CI 0.18, 0.89). The protective effect of sole parent stalus in Pacific Island families may reflect the beneficial effects of the social support provided by extended family networks. Children of sole parents in the context of the nuclear family may be particularly vulnerable.
Genetic predisposition to hypertension (as detected by Na+/Li+ countertransport) and risk of diabetic nephropathy in childhood diabetes
Authors: CHIARELLI F. , VERROTTI A. , KALTER‐LEIBOVICI O. , LARON Z. , MORGESE G.
Published: March 2008

In order to evaluate whether insulin‐dependent diabetes mellitus patients with incipient nephropathy have an overactivity of erythrocyte sodium‐lithium countertransport (Na+/Li+ CT), 82 diabetic children and 38 healthy age‐matched control subjects and their parents and grandparents were studied. The children were divided into two groups according to the presence of persistent microalbuminuria (MA). Diabetic children with MA had Na+/Li+ CT activity higher than normoalbuminuric diabetics and healthy controls. The parents and grandparents of microalbuminuric patients showed higher Na+/Li+ CT than parents and grandparents of normoalbuminuric diabetics and of the controls. This study demonstrates that predisposition to hypertension, as indicated by increased Na+/Li+ CT activity in erythrocytes, is more frequently detectable in patients with persistent microalbuminuria than in diabetics without persistent microalbuminuria or in healthy controls. Overactivity of Na+/Li+ CT is present also in parents and grandparents of diabetic children with MA. This study suggests that genetic predisposition to hypertension is more frequent in patients at risk of developing diabetic nephropathy, as well as in their parents and grandparents.
Cyclical vomiting syndrome
Authors: FORBES D.
Published: March 2008

Abstract Cyclical vomiting syndrome is an uncommon, disabling symptom complex of unknown cause, with features in common with migraine. It affects principally children and adolescents. Differential diagnosis and theories of pathogenesis are discussed. Therapy should be aimed at prophylaxis of vomiting bouts, 'switching off’ episodes once they commence and preventing complications of established vomiting episodes. Families need rapid access to care to minimize morbidity and disruption to functioning.
A cross‐sectional study of growth, puberty and endocrine function in patients with thalassaemia major in Hong Kong
Authors: KWAN E. Y. W. , LEE A. C. W. , LI A. M. C. , TAM S. C. F. , CHAN C. F. , LAU Y. L. , LOW L. C. K.
Published: March 2008

Methodology: A cross‐sectional study of growth, puberty and endocrine function was performed on 35 girls and 33 boys with thalassaemia major.

Results Despite regular transfusion and chelation therapy, 75% of the girls and 62% of the boys over the age of 12 years were below the third percentile for height. Hypogonadotropic hypogonadism was found in a similar percentage of patients. Moderate to marked zinc deficiency secondary to chelation therapy was considered unlikely because normal serum zinc levels were found in all but three of our patients, but we could not exclude the possibility of a marginal status of zinc nutrition causing growth failure. Growth hormone deficiency and diabetes mellitus were sometimes encountered but hypothyroidism, hypoparathyroidism and adrenal insufficiency were rare among our patients. Most of the patients with growth failure had normal growth hormone (GH) response to insulin induced hypoglycaemia. The serum insulin‐like growth factor‐1 (IGF‐1) levels were low in our patients and no significant difference in the serum IGF‐1 levels was found between prepubertal children with or without growth failure (0.4±0.1 mU/mL vs 0.37±0.11 mU/mL, P = 0.39). Similarly, no difference in the serum IGF‐1 levels was found between pubertal children with or without growth failure (0.48 ± 0.2 U/mL vs 0.56 ±0.14 U/mL, P= 0.26).

Conclusions Delayed sexual maturation and a possible defect in growth unrelated to the GH‐IGF‐1 axis may be responsible for the growth failure in adolescent children with thalassaemia major.
Efficacy of phototherapy for hyperbilirubinaemia in infants with the respiratory distress syndrome
Authors: TAN K. L. , LIM G. C. , BOEY K. W.
Published: March 2008

Objectives: To evaluate the efficacy of phototherapy for hyperbilirubinaemia in preterm infants with and without the respiratory distress syndrome (RDS).

Methodology: Prospective cohort study of preterm infants cared for at Kandang Kerbau Hospital, Singapore: 170 with RDS and 477 without RDS, sepsis or other complications (control group) presenting with non‐haemolytic hyperbilirubinaemia at about the same time were exposed to daylight phototherapy when bilirubin concentrations exceeded 255 μmol/L or 222 μmol/L if <48h of age. Bilirubin values were monitored 6‐hourly during exposure, and daily for at least 2 days postphototherapy.

Results The infants were comparable in birthweight, gestational age, postnatal age, haemoglobin, haematocrit and bilirubin values, at start. The response to phototherapy of the infants with RDS was comparable to that of the well preterm infants; the duration of exposure was 50.1 ± 1.6 (mean ± s.e.m.) versus 50.1 ± 1.4 h, 24‐hour decline rate 25.71 ± 1.29% versus 26.32 ± 0.65, and overall decline rate 0.96± 0.03%/h versus 0.95±0.02%/h.

Conclusion The presence of RDS did not affect the efficacy of phototherapy for neonatal hyperbilirubinaemia in preterm infants.
Retinopathy of prematurity in infants weighing 1000‐1499 g at birth
Authors: KEITH C. G. , DOYLE L. W.
Published: March 2008

Objectives: To review the incidence and severity of retinopathy of prematurity (ROP) in infants with birthweights 1000‐1249 g and 1250‐1499 g, to establish whether the upper weight limit for routine ophthalmological examination might safely be lowered.

Methodology Prospective cohort study of infants born between 1 January 1977 and 31 December 1992 cared for in the neonatal nurseries at the Royal Women's Hospital, Melbourne. Data were retrieved on 1373 infants who survived their initial hospitalization. They comprised 657 with birthweights 1000‐1249g (group 1) and 716 with birthweights 1250‐1499g (group 2). There were 76 outborn infants in group 1 and 97 in group 2; the remaining infants were all born at the Royal Women's Hospital. Ocular examinations commenced at 2 weeks of age, when possible, and at 2‐weekly intervals after that.

Results In group 1, ROP was detected in 14.6% (96/657) and severe ROP (bilateral stage 3‐5) in 5.0% (33/657). Five (0.8%) children required surgical intervention (reaching threshold disease); following surgery, one was legally blind, one had severely impaired vision, and the other three had near‐normal vision. Another child was blind; he was born at 28 weeks gestational age with a birthweight of 1170g, and was transferred to a Level II hospital at 9 weeks chronological age with no detectable retinopathy. He returned 1 year later totally blind with detached retinae (grade 5 ROP). The prevalence of bilateral blindness in this group was 0.3% (2/657). In group 2, ROP was detected in 6.4% (46/716) and severe ROP in 0.8% (6/716). No children required surgery; three were found to be myopic at follow up but the corrected visual acuity was normal. No children in group 2 were blind. No significant difference was found between the rates of ROP in inborn and outborn infants.

Conclusion In neonatal units with similar rates of ROP and visual outcome, routine ophthalmological examination in the neonatal nursery of infants weighing more than 1249g at birth is probably unnecessary.
Delayed diagnosis of cystic fibrosis in children with a rare genotype (ΔF508/R117H)
Authors: FITZGERALD D. , van ASPEREN P. , HENRY R. , WATERS D. , FREELANDER M. , WILSON M. , WILCKEN B. , GASKIN K.
Published: March 2008

Objectives: In neonatal screening for cystic fibrosis (CF), infants recognised as ΔF508 heterozygotes require a sweat test to confirm the diagnosis. However, compound heterozygotes with ΔF508 and the R117H mutation are known to have non‐diagnostic sweat chlorides (<60 mmol/L) at an early age. As genotyping for rare mutations is not readily available in Australia, there is a need to determine whether quantitative pancreatic stimulation tests could facilitate the diagnosis of CF in three infants with the ΔF508/R117H mutation.

Methodology Formal sweat testing, genotyping and pancreatic stimulation tests were performed in three subjects heterozygous for ΔF508 who initially had non‐diagnostic sweat chloride results (40‐60 mmol/L) but presented later with persisting chest symptoms and/or signs consistent with CF.

Results All three patients were shown to have the ΔF508/R117H genotype with initial sweat chloride results ranging from 40 to 58 mmol/L. Pancreatic stimulation tests demonstrated reduced enzyme secretion in two and decreased fluid, bicarbonate and chloride secretion in all three patients.

Conclusions In infants recognized as ΔF508 heterozygotes by the newborn screening programme, the presence of an equivocal sweat chloride does not exclude the diagnosis of CF. If such patients with an initially equivocal sweat chloride subsequently develop symptoms suggestive of CF and have a persisting non‐diagnostic sweat chloride then the diagnosis of CF can be confirmed by more extensive genotyping if available or by pancreatic stimulation testing.