bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resource allocation in contemporary paediatrics: The case against high technology
Authors: VIMPANI G. V. 
Published: March 2008

ABSTRACTHigh technology has introduced a new dimension to medical treatment. There are inevitable social costs as well as benefits, and the allocation of resources to high technology, as opposed to other areas of health care, is a contentious issue. The current balance in health service funding between high technology and low technology is not appropriate. It is driven by the technological imperative and only offers solutions to a limited number of problems. There is a scarcity of health resources left to develop intersectoral responses and provide adequate funding for research into person‐intensive interventions suitable for many problems. Arguments against allocating too many resources to high technology in paediatrics are examined in this paper.
Intravenous Indomethacin therapy in preterm neonates with patent ductus arteriosus
Authors: RAJADURAI V. S. , YU V. Y. H. 
Published: March 2008

ABSTRACTThis study examined the response of the patent ductus arteriosus (PDA) to intravenous Indomethacin using serial two dimensional and Doppler echocardiography and documented the complications associated with therapy. Thirty‐six preterm neonates who were oxygen and ventilator dependent were studied when they were aged 3‐7 days. The PDA initially closed in 22 (61%) and constricted in seven (19%) of the infants. It was non‐responsive in five (14%) and the treatment was stopped because of complications in two (6%). Only three (43%) of seven neonates given a second course had PDA closure. In the 25 instances where there was PDA closure following Indomethacin, re‐opening was documented echocardiographically on three (12%) occasions. Overall, Indomethacin therapy was successful in 29 (81%) neonates, PDA ligation was required in four (11%) and three died from unrelated causes. Three (8%) neonates developed major complications: multiple gastric perforations in the first, focal ileal perforation in the second, and necrotizing enterocolitis in the third. Treatment failure. PDA ligation and major complications occurred exclusively in neonates <28 weeks gestation. In view of the relatively low efficacy and high major complication rate in these extremely preterm infants, a randomized clinical trial needs to be conducted using two dimensional and Doppler echocardiography to allow accurate assessment of the PDA response to intravenous Indomethacin.
Glucose‐6‐phosphate dehydrogenase enzyme activity in normal, hemizygote and heterozygote Kelantanese Malays
Authors: NORMAH J. , CHOO K. E. , OPPENHEIMER S. J. , SELAMAH G. 
Published: March 2008

ABSTRACTThis prospective study was performed to quantify glucose‐6‐phosphate dehydrogenase (G6PD) enzyme activity in deficient males and female heterozygotes. The methods used in the study were the fluorescent spot test, G6PD enzyme electrophoresis on cellulose acetate and quantitative assays. Forty‐seven children who had been detected as spot screen deficient at birth were rescreened. Their first degree relatives were also included in the study. The mean enzyme activity of deficient males was 0.74 iu/g Hb (s.d. ± 0.8), of female heterozygotes was 6.5 iu/g Hb (s.d. ± 3.2) and of normal males was 12.1 iu/g Hb (s.d. ± 3.5). The mean activity in deficient males was 6.1% of normal males. Most (35 of 47) of these fell into class 2 in Beutler's classification of G6PD variants. This indicates a population which may be susceptible to favism. Female heterozygotes had an intermediate enzyme activity with a wide scatter. Using a cut off point of enzyme activity of below 9.0 iu/g Hb gave sensitivity and specificity respectively of 87% and 84% in detecting female heterozygotes. This group could be defined more accurately by combining quantitative assays with family studies.
Insulin dependent diabetes in pregnancy: Impact of maternal blood glucose control on the offspring
Authors: PERSSON B. , HANSON U. 
Published: March 2008

AbstractDefinition of optimal glycaemic control in diabetic pregnancy may still be debated. Measures of glucose control (based on 4–6 daily glucose and frequent HbA1c values) were recorded in two series of diabetic pregnancies; one multicentre study (n= 92, 1979–82), and one study from our own institution (n= 113, 1983–85). The average pregnancy glucose levels were 5.9 mmol/L (third trimester only) and 6.5 mmol/L (all trimesters), respectively. Discriminant analysis (including pregnancy glucose, HbA1c, gestational age, diabetes duration and hypertension) revealed that gestational age only (first series) and gestational age and HbA1c independently of each other (second series) were significantly associated with the occurrence of severe neonatal morbidity present among 30 and 16.8% of the infants, respectively. The overall outcome was favourable. The findings of no perinatal mortality, normal premature delivery rate (8.9%) and a very low rate of severe maternal hypoglycaemia (4.4%) in series two support the feasibility of a strict but individualized management programme.
Paediatric management practices in Down syndrome: A follow‐up survey
Authors: FOREMAN P. J. , MANNING E. 
Published: March 2008

AbstractIn a follow‐up survey to a 1984 study, 339 paediatricians in Australia were invited to complete a brief questionnaire in 1990, in which they indicated their usual recommendations, practices and advice when managing children with Down syndrome. The response rate was 67%. The results indicated that the most frequent paediatrician‐initiated referrals were for early intervention and for discussion with other parents; these options were selected more frequently in 1990 than in 1984. While referral to a social worker was the next most frequent choice, it occurred less in 1990 than in 1984. Other increases in referrals were for physiotherapy and speech therapy. Paediatricians were more likely to support referral to a geneticist, speech therapist or cosmetic surgeon in response to a specific parental enquiry, and less likely to support referral to a social worker or to full‐time care. There had been significant increases since 1984 in the likelihood that paediatricians would order audiology and investigation of thyroid and cardiac function. There was less opposition to the use of sedatives, and virtual cessation of the use of tryptophan. Paediatricians were more optimistic about the likelihood of persons with Down syndrome living independently, caring for their own finances, and marrying, but not about other developmental areas.
Combined therapy with growth hormone and oxandrolone in adolescent girls with Turner syndrome
Authors: LU P. W. , COWELL C. T. 
Published: March 2008

AbstractFive adolescent girls with Turner syndrome (mean age 13.9 years, mean bone age 12.0 years) were treated with both recombinant human growth hormone (rhGH) and oxandrolone for 2 years with an average increment in height of 13.4 cm. The mean bone age advanced by only 1.2 years, providing an increase in the mean estimated mature height of 9.2 cm. We conclude that rhGH and oxandrolone benefit older teenagers with Turner syndrome because of an increased growth rate with slow progression of skeletal maturation.
Mood disorders among mothers of infants admitted to a mothercraft hospital
Authors: BARNETT B. , LOCKHART K. , BERNARD D. , MANICAVASAGAR V. , DUDLEY M. 
Published: March 2008

AbstractThe mothers (n= 100) of consecutive infants admitted to a mothercraft residential facility were asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Only one of the women had been identified prior to the infant's admission as having postnatal depression, but 39% scored above the cut‐off point for likely major depressive disorder. No specific infant problem correlated significantly with a higher depression score. The extent of serious mood disorders in the post‐partum population has remained generally unacknowledged despite an upsurge of recent research activity in the field. Nevertheless, this problem has considerable public health significance, impinging as it does on the health of all members of the family. Possible screening and intervention strategies are discussed.
17‐Hydroxyprogesterone rhythms and growth velocity in congenital adrenal hyperplasia
Authors: PINCUS D. R. , KELNAR C. J. H. , WALLACE A. M. 
Published: March 2008

AbstractSix patients on steroid replacement therapy for congenital adrenal hyperplasia provided capillary blood samples collected at 0800, 1200, 1700, and 2200h, on to filter paper for 17‐hydroxyprogesterone analysis. There was a strong correlation between 17‐hydroxyprogesterone day profiles and height velocity over a 4 year period of study. Steroid over‐replacement, identified by significantly decreased height velocity (Standard Deviation Score [SDS] 1.92), caused suppression of 17‐hydroxyprogesterone concentrations to below 10 nmol/L throughout the day. Near average height velocity (Standard Deviation Score 0.245) was accompanied by suppression of 17‐hydroxyprogesterone concentrations below 40 nmol/L but with significant diurnal variation. Under‐replacement with rapid height velocity and bone maturation was accompanied by non‐suppression of 17‐hydroxyprogesterone concentrations (i.e. > 40 nmol/L). These results suggest that serial blood spot 17‐hydroxyprogesterone measurements are a convenient and helpful supplement to measurements of height velocity and bone age maturation to monitor steroid replacement therapy in congenital adrenal hyperplasia. These measurements may be useful particularly in differentiating between over‐replacement and appropriate replacement, and should allow adjustments in dose before abnormal growth patterns are established.
The incidence of congenital heart defects in the first year of life
Authors: KIDD S. A. , LANCASTER P. A. L. , McCREDIE R. M. 
Published: March 2008

AbstractData on the incidence of congenital heart defects (CHD) in the first year of life were collected on a cohort of infants born between 1981 and 1984 in New South Wales and the Australian Capital Territory. There was a total of 1479 cases among 343521 births, an incidence of 4.3 per 1000 livebirths. The following results were obtained after restricting the analysis to cases diagnosed definitively by echocardiography, cardiac catheterization, operation or autopsy. A significant association was found between older maternal age and having an infant with CHD, both before (RR = 1.27, CI = 1.13,1.44) and after (RR = 1.17, CI = 1.02, 1.33) excluding chromosomally related cases. Significant associations were found between having an infant with ventricular septal defect and Italian parentage (RR = 2.50, CI = 1.11, 5.65), and for having an infant with coarctation of the aorta and Lebanese parentage (RR = 3.82, CI = 1.71, 8.52). The incidence of CHD in this Australian population is similar to overseas studies that used comparable diagnostic criteria and ascertainment. An active surveillance system for CHD is recommended as is further investigation of the factors associated with having an infant with CHD.
A prospective study of the psychological adjustment of parents and families of children with cancer
Authors: SAWYER M. G. , ANTONIOU G. , TOOGOOD I. , RICE M. , BAGHURST P. A. 
Published: March 2008

AbstractThis study compared the psychological adjustment of parents and families of children with cancer, with the adjustment of parents and families in the community. In the weeks after their children's diagnoses, the mothers of children with cancer reported significantly more anxiety and insomnia, somatic symptoms and social dysfunction than mothers in the community. These problems had declined by the time of a 1 year follow‐up assessment However, at the follow‐up assessment the mothers of children with cancer reported significantly more symptoms of depression and somatic symptoms than mothers in the community. A similar pattern of findings was evident among the fathers although the fathers generally reported less distress than was reported by the mothers. The results also suggest that a year after the children's diagnoses, the families in which there was a child with cancer were functioning less effectively than the families in the community.
Infant onset subacute necrotizing encephalomyelopathy (Leigh's disease)
Authors: MORRIS S. A. , HARBORD M. G. 
Published: March 2008

AbstractWe reviewed six cases of proven or probable subacute necrotizing encephalomyelopathy with an onset under 12 months of age. All children had been investigated at the Adelaide Children's Hospital in the period 1975‐90. Seizures (five of six) and cortical blindness (five of six) were more prominent clinical features at presentation than the literature would suggest while respiratory abnormalities and developmental delay were also frequent. Flash visual evoked responses, brain‐stem auditory evoked responses, and the interictal electroencephalogram did not contribute to diagnosis. Computerized tomography brain scans were abnormal in three of four cases with typical basal ganglia lesions in one case and brain atrophy in two cases. The diagnosis was suspected in four cases with raised blood or cerebrospinal fluid lactate concentrations. The importance of obtaining a blood or cerebrospinal fluid lactate in all infants with unexplained seizures, cortical blindness or apnoea is emphasized.
Eucalyptus oil poisoning in childhood: 41 cases in south‐east Queensland
Authors: WEBB N. J. A. , PITT W. R. 
Published: March 2008

AbstractForty‐two cases of oral eucalyptus oil poisoning in children under 14 years of age were identified in a defined population between 1 July 1984 and 30 June 1991, and 41 were subjected to retrospective case note analysis. Thirty‐three children (80%) were entirely asymptomatic. This group included all of the four children reported to have ingested more than 30 mL of eucalyptus oil. Only two of the remaining children had symptoms or clinical signs on presentation to hospital. No child required advanced life‐support. There was no correlation between the amount of eucalyptus oil taken and the presence of symptoms. If the estimated volume ingested is large, or symptoms are evident, on presentation at hospital gastrointestinal decontamination should lead to a good outcome with few clinical problems. Eucalyptus oil may be a less toxic compound than has previously been believed.
The epidemiology of incomplete childhood immunization: An analysis of reported immunization status in outer western Sydney
Authors: BELL J. C. , WHITEHEAD P. , CHEY T. , SMITH W. , CAPON A. G. , JALALUDIN B. 
Published: March 2008

AbstractWe surveyed parents of children enrolled in kindergarten in 1992 in outer western Sydney and the Blue Mountains. Using parents' reports, we determined the prevalence of immunization uptake for children starting school, compared the prevalence of immunization uptake among Catholic, government and independent schools, and identified immunization providers. We also documented parental beliefs about immunization and their influence on immunization status, and identified risk factors for incomplete immunization. Nearly 89% of children were reported to be fully immunized. Immunization status did not vary significantly among the different types of school. General practitioners provided 84% of all immunizations and local councils 11%. Incomplete immunization was associated with more negative beliefs in immunization, with post‐secondary education and with families who do not speak English at home. Reminder letters had little effect on immunization status.
Double‐barrelled tubular duplication of the ileum
Authors: SUE K. , HIRATA T. , KAMIMURA T. , TANAKA N. 
Published: March 2008

AbstractA three year old boy with a 10 cm double‐barrelled tubular duplication of the distal ileum is reported. He presented with a small bowel obstruction after a large meal of mandarin oranges. At laparotomy an obstruction of both lumens was found which communicated at both ends with the normal ileal lumen. Although cystic duplications of the small intestine are common, tubular duplications are relatively rare, especially an obstruction with impacted undigested foods.
Autism: Fifty years on from Kanner
Authors: TONGE B. J. , DISSANAYAKE C. , BRERETON A. V. 
Published: March 2008

AbstractIt is now 50 years since Leo Kanner first described autism as a distinctive pattern of symptoms in some children with severe developmental problems. Since then the assessment and diagnosis of children with pervasive disorders of development has been refined and much is known about the phenomenology and epidemiology. Autism is a biological disorder of the central nervous system (CNS) of unknown cause. It is associated with a number of organic disorders such as epilepsy and has comorbidity with other psychiatric disorders such as tic disorder. Cognitive abnormalities in social interactions, affect and language are present but there is still debate regarding which of these, if any, is the primary cognitive deficit. Special education and behavioural management has led to modest but important developmental improvement in many children with autism. Autism remains a life‐long condition but patterns of symptoms change and skills develop from childhood into adult life.
Child injury in Brisbane South 1985‐91: Implications for future injury surveillance
Authors: PITT W. R. , BALANDA K. P. , NIXON J. 
Published: March 2008

AbstractSpecific childhood injury types are ranked by occurrence rate for mortality, hospital admission and emergency department attendance. Cases are drawn from the resident population of Brisbane South, 0‐13 years of age, for the period 1 July 1985 to 30 June 1991. A total of 47244 injuries, 7056 admissions and 99 deaths were analysed. The overall mortality rate was 12.6/100 000 per year (95% confidence interval (Cl), 10.2‐15.3), the overall admission rate was 911/100 000 per year (95% Cl, 890‐932) and the overall hospital attendance rate was 6013/100000 per year (95% Cl, 5958‐6067). A fall was the most frequent injury mechanism for admissions and 65% of attendances involved injury in the child's own home. The surveillance data establish regional variation for childhood injury risk within Australia and identify an unexplained downward trend in head injury that requires further investigation. The future development of injury surveillance in Australia requires simplified coding which can be integrated into new computerized patient management information systems.
Outcome of resuscitated apparently stillborn infants: A ten year review
Authors: YEO C. L , TUDEHOPE D. I. 
Published: March 2008

AbstractThis study addresses the dilemma of whether to attempt resuscitation of the previously undiagnosed fresh stillborn infant and evaluates factors predictive of survival and long‐term outcome. We reviewed the clinical spectrum, immediate complications and long‐term outcome of 45 successfully resuscitated apparently stillborn infants (34 term, 11 preterm) who were admitted to the Intensive Care Nursery. Significant obstetric and intrapartum events were identified in 34 (75%) infants while 11 (25%) had no apparent risk factors. Of the 39 infants with neonatal complications, 37 had hypoxic‐ischaemic encephalopathy (HIE; Sarnat stage 1 in 5, stage 2 in 15, stage 3 in 17); 12 (27%) had oliguria, 10 (22%) had hypotension, 7 (16%) experienced hypoglycaemia, 4 (9%) had disseminated intravascular coagulopathy (DIC) and 1 (2%) had persistent pulmonary hypertension of the newborn (PPHN). Fourteen infants (31%) died in the neonatal period and four (9%) died during infancy. Risks of death and adverse neurodevelopment were significantly increased in infants with stage 2 or 3 HIE (P<0.005). Follow‐up assessment of 24 of the 27 surviving infants revealed a normal outcome in 15 (63%), severe disability in six (25%), moderate disability in two (8%) and mild disability in one (4%) infant. The positive predictive value of stage 2 or 3 HIE was 70% for mortality and 80% for morbidity. One‐third (15/45) of successfully resuscitated apparently stillborn infants were normal at follow‐up assessment and the outcome for these infants was predicted with complete accuracy by the stage of HIE present during the neonatal period.
Hypothermia in children with severe neurological disabilities
Authors: TOBIN J. , REDDIHOUGH D. 
Published: March 2008

AbstractFour severely disabled children who developed hypothermia during acute illness are described. A central defect in thermoregulation in the hypothalamus is likely, based on clinical observation and limited investigations, as well as similarities to sporadic cases reported in the literature. Disturbance of temperature regulation appears to be a rare complication of major brain injury in children, without necessarily occurring in association with pituitary dysfunction. It is of clinical importance because subnormal temperature may indicate severe sepsis.
Pedestrian exposure and the risk of child pedestrian injury
Authors: ROBERTS I. G. , KEALL M. D. , FRITH W. J. 
Published: March 2008

AbstractThe authors used data from the New Zealand Household Travel Survey to examine the extent to which children's pedestrian exposure varies with age, sex and household income. Pedestrian injury morbidity data were combined with pedestrian exposure data to examine age‐specific pedestrian injury risk. The annual number of road crossings for girls was greater than that for boys. Pedestrian exposure increased with increasing age. Children aged 5‐9 years in the lowest household income bracket crossed approximately 50% more roads than those in the middle and upper income brackets. However, for children aged 10‐14 years there was little variation with household income. Sex differences in pedestrian injury rates cannot be explained by differences in exposure although increased exposure may partly explain the increased injury rates for children in lower socio‐economic groups. Prevention strategies might aim to reduce pedestrian exposure or alternatively to reduce pedestrian injury risk per unit of exposure by making safer urban living environments.
Sudden infant death syndrome in Aboriginal and non‐Aboriginal infants
Authors: ALESSANDRI L. M. , READ A. W. , STANLEY F. J. , BURTON P. R. , DAWES V. P. 
Published: March 2008

AbstractThis study, based on routinely recorded data, was designed to compare the epidemiology of sudden infant death syndrome (SIDS) in Aboriginal and non‐Aboriginal infants in Western Australia (WA). All cases of SIDS occurring in infants born in WA from 1980 to 1988 were included in the study. There were 66 Aboriginal (6.1 per 1000 live births) and 337 non‐Aboriginal (1.7 per 1000 live births) infants who died from SIDS. It was found that there was a significant linear increase in the Aboriginal SIDS rate over the study period while the non‐Aboriginal rate remained relatively constant. For non‐Aboriginal infants, there was an elevated risk of SIDS for young maternal age, single marital status and male gender but this was not found for Aboriginal infants. There was a significant difference in the age at death distribution for the two populations. Low birthweight and preterm birth were risk factors for both Aboriginal and non‐Aboriginal infants. There may be differences in the aetiology and/or classification of SIDS between the two populations.