bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic outcome for intensive care of infants of birthweight 500–999 g born in Victoria in the post surfactant era
Authors:   THE VICTORIAN INFANT COLLABORATIVE STUDY GROUP
Published: March 2008

Objective: To determine the incremental cost of improving the outcome for extremely low birthweight (ELBW, birthweight 500–999 g) infants born in Victoria after the introduction of exogenous surfactant (the post surfactant era). Methodology: This was a geographically determined cohort study of ELBW children in Victoria, Australia of consecutive livebirths born in three distinct eras: (i) 1979–80 (n= 351); (ii) 1985–87 (n= 560); and (iii) 1991–92 (n= 429). Exogenous surfactant was first used in Victoria in March, 1991. The consumption of nursery resources per livebirth, and the survival and sensorineural disability rates at 2 years of age for each era were investigated. Utilities were assigned as follows: 0 for dead, 0.4 for severe disability, 0.6 for moderate disability, 0.8 for mild disability, and 1 for no disability. Utilities were multiplied for more than one disability. Dollar costs were assumed to be $1470 ($A 1992) per day of assisted ventilation, and one dose of exogenous surfactant was assumed to be equivalent to one third of a day of assisted ventilation. Cost‐effectiveness (additional costs per additional survivor or life‐year gained) and cost‐utility (additional costs per additional quality‐adjusted survivor or life‐year gained) ratios were calculated for the pre‐surfactant era (1985–87 vs 1979–80), and for the post surfactant era (1991–92 vs 1985–87). Results: Considering only the costs incurred during the primary hospitalization, cost‐effectiveness and cost‐utility ratios were lower (i.e. economically better) in the post surfactant era than in the pre‐surfactant era (pre‐surfactant vs post surfactant; S7040 vs$4040 per life year gained; $6700 vs$5360 per quality‐adjusted life year gained). Both ratios fell with increasing birthweight. In contrast with the pre‐surfactant era, cost‐utility ratios were less favourable than cost‐effectiveness ratios in the post surfactant era. With costs for long‐term care of severely disabled children added, both cost ratios were higher in the post surfactant era. Conclusion: The incremental cost during the primary hospitalization of improving the outcome for ELBW infants has fallen in the post surfactant era.
Calcium intake in children with positive IgG RAST to cow's milk
Authors: MADSEN CD , HENDERSON RC 
Published: March 2008

Objective: This study was made to: (i) identify the prevalence of low calcium intakes in a paediatric population with loosely defined ‘milk allergy’; and (ii) assess long‐term (mean 21 months later) changes in calcium intake following a single nutrition counselling session with those patients initially found to have a low intake. Methodology: Calcium intake was assessed in a cross‐sectional study of 58 patients ages 5–16 years (mean 9.9 years) with IgG radioallergosorbent test (RAST) class II or higher for cow's milk protein. Those 31 patients found to have a low calcium intake were prospectively re‐evaluated 12–30 months later following a single nutrition counselling session. Results: Calcium intake was < recommended dietary allowance (RDA) for 31 of 58 (53%) patients. The patient's perception of their intake was unreliable; 44% of those who rated their calcium intake fair or good did not meet their RDA. Taking a calcium supplement did not ensure adequate intake; 21% of those taking supplements still did not meet their RDA. Milk intake predicted calcium intake; 8% of those who did not drink milk vs 68% of those who did drink at least some milk met their RDA without supplementation. The 31 patients with low intakes received counselling and were re‐evaluated at an average follow‐up of nearly 2 years. Calcium intake was increased a mean of 360 mg/day and use of supplements increased from 10 to 52% of the group. Despite these positive changes, 48% still did not meet their RDA. Conclusion: Limited milk intake is likely to be associated with suboptimal calcium intake. Efforts should be made to educate the family about the importance of calcium and its non‐dairy sources. With many families repeated discussions of this issue may be necessary to influence calcium intake.
Treatment characteristics of congenital heart disease and behaviour problems of patients and healthy siblings
Authors: JANUS M , GOLDBERG S 
Published: March 2008

Objective: To examine behaviour problems of children in families where one child was diagnosed with congenital heart disease (CHD), in relation to the intensity of treatment required for the CHD. Methodology: Treatment intensity was based on patients' hospitalizations, surgical operations, current treatment, frequency of check‐ups and finality of surgical repair. Mothers of 29 patients and 43 healthy siblings (4–14 years old), and a sub‐sample of fathers, reported on behaviour problems of their children and rated the frequency of considering patient's CHD while performing routine child care in nine areas of family life (accommodation of illness). Results: High treatment intensity was associated with high accommodation of illness and elevated behaviour problems among patients. In contrast, siblings in families where treatment intensity was low, but accommodation of illness high were at most risk for behaviour problems. Conclusions: Treatment intensity has a markedly different impact on behaviour problems of patients and healthy siblings. It is important for parents and healthcare professionals to provide both patients and siblings with information about the patient's medical condition, regardless how much treatment that condition may need.
A review of open biopsy for mediastinal masses
Authors: Massie RJH , Asperen PP Van , Mellis CM 
Published: March 2008

Objective: To review the recent experience with biopsied mediastinal lesions in children and to assess the impact of recent advances in imaging and surgical techniques on diagnosis. Methodology: The clinical and radiological features of 55 patients who had mediastinal biopsies at The Royal Alexandra Hospital For Children (RAHC) over 15 years were reviewed. Results: Fifty‐five patients presented to RAHC between 1978 and 1993 with lesions of the mediastinum requiring biopsy of that site. Thirty‐one of the 55 (56%) lesions were malignant. Neurogenic tumours were the most common (40%). In order of frequency the following lesions were found: neuroblastoma (15), teratoma (eight), non‐ Hodgkin's lymphoma (NHL; eight), enteric cyst/duplication (five), ganglioneuroma (five), bronchogenic cyst (three), ganglioneuroblastoma (two), lymphangioma (two), abscess (two), Hodgkin's lymphoma (HL; two), oesophageal granuloma (one), Langerhan's cell histiocytosis (one), congenital fibromatosis (one). Eighty‐two per cent of neurogenic tumours were located in the posterior mediastinum, while 75% of teratomas and 100% lymphoid tumours were located anteriorly. Symptoms were generally unhelpful in establishing a specific diagnosis and in 27% of cases the lesions were discovered incidentally. Physical signs, such as thoracic inlet obstruction and neurological findings, were helpful clinically in localizing lesions within the mediastinum. Chest radiography enabled lesions to be subdivided within the mediastinum. This localization, in combination with the age at presentation, predicted the tissue diagnosis. Computerized tomography (CT) and magnetic resonance imaging (MRI) further defined the lesion and demonstrated involvement of adjacent structures. Histology, however, was essential to distinguish benign from malignant lesions. Conclusions: The clinical presentation of mediastinal masses is often non‐specific or incidental. Despite recent advances in imaging technology and biopsy techniques, full histological examination is required to exclude malignancy.
Acute renal failure in the newborn: Incidence and outcome
Authors: AIREDE A'KI , BELLO M , WEERASINGHE HD 
Published: March 2008

Objective: To describe an experience from a developing country of newborn renal disease particularly those without advanced neonatal care. Methodology: Prospective evaluation from a referral hospital, North‐East of Nigeria between 1 July 1990 and 30 June 1994. Babies admitted for any morbidities who were diagnosed as being in acute renal failure (ARF) during the study period (non‐oliguric inclusive). Onset of ARF; day on which oliguria or anuria detected, or serum urea first exceeded 10 mmol/L. Urine output quantitated from carefully bagged urine and suprapubic bladder aspiration, and venous blood regularly obtained for serum electrolytes, urea and creatinine. Fractional excretion of sodium (FENa) and renal failure index (RFI) were determined on some babies. Results: Forty‐three neonates (M:F; 3.3:1) with ARF, the majority (27) of whom were out‐born, and 14, 26 and three were preterm, full‐term and post term, respectively. Encountered incidence was 3.9/1000 live births with a high prevalence rate; 34.5/1000 admissions. A significantly greater incidence was seen in the latter half of study; 10.7 vs 53.7/1000, P<0.05. Early ARF occurrence (aged; 0–5 days) in 33 (77%) of babies. The aetiology was comprised of perinatal asphyxia, sepsis, obstructive uropathy and miscellaneous in 53.4%, 32.6%, 9.3% and 4.7%, respectively. Twenty‐two (51.2%) deaths occurred; however, the exact causes were indeterminable. Fractional excretion of sodium (FENa and renal failure index (RFI) were of <1.75% and ≤2.0, respectively, significantly differentiated sepsis (intrinsic) from perinatal asphyxial (pre‐renal) ARF; P<0.01. No case of persistent renal failure occurred. Conclusion: Our FENa value (although less than reported in previous literature from affluent societies) remained sensitive (along with RFI) in differentiating aetiological group of ARF. Our data and medical management outcome, despite absence of level‐III care, support the need for good resuscitation, careful monitoring and constant re‐evaluation. The effect of salbutamol on hyperkalaemia is emphasized.
Prediction of obesity in children at 5 years: A cohort study
Authors: O'CALLAGHAN MJ , WILLIAMS GM , ANDERSEN MJ , BOR W , NAJMAN JM 
Published: March 2008

Objective:To examine determinants of moderate and severe obesity in children at 5 years of age.Methodology:A prospective cohort of mothers were enrolled at first antenatal visit, and interviewed shortly after delivery, at 6 months and 5 years. Detailed health, psychological and social questionnaires were completed at each phase by mothers, and child health questionnaires at 6 months and 5 years. At 5 years 4062 children were assessed physically, the Peabody Picture Vocabulary Test administered and mothers completed a modified Child Behaviour Checklist. Moderate obesity was defined as BMI between 85th and 94th percentiles inclusively, and severe obesity as a BMI greater than the 94th percentile.Results:Independent predictors of severe obesity at 5 years were birthweight, female gender, maternal BMI and paternal BMI. Moderate obesity at 5 years was predicted by birthweight, paternal BMI and sleeplessness at 6 months, while small for gestational age (SGA) status and feeding problems at 6 months were protective factors for moderate obesity. Obesity was not associated with problems of language comprehension or behaviour.Conclusions:Findings of this study suggest that biological rather than psychosocial factors are the major determinants of obesity at 5 years.
Haemodynamic responses and population pharmacokinetics of midazolam following administration to ventilated, preterm neonates
Authors: HARTE GJ , GRAY PH , LEE TC , STEER PA , CHARLES BG 
Published: March 2008

Objective: To evaluate the effects of intravenous midazolam on haemodynamic variables and cerebral blood flow velocity (CBFV) and to determine the pharmacokinetics using a population approach in very low birthweight (VLBW) ventilated infants. Methodology: Physiological variables were measured at predetermined times in 10 infants with birthweight ≤1500 g following a bolus dose of intravenous midazolam (0.1 mg/kg). Heart rate, mean arterial blood pressure (MAP) and transcutaneous CO2 (TcPCO2) were recorded and CBFV was assessed by Doppler ultrasound. Midazolam concentrations were also measured and pharmacokinetic parameters determined using a population modelling package. Results: No change in heart rate occurred during the study period, while the MAP decreased by 3 mmHg 5 min after midazolam administration compared to baseline values. A non‐significant fall in TcPCO2 was seen at 20 min. Mean CBFV decreased from the baseline by 12% at 5 min, then returning to predose values. Midazolam concentrations were in the range shown to be effective in sedation of paediatric intensive care infants with the elimination being delayed in comparison to older children. Conclusions: As only minor cerebral and haemodynamic effects were found with the use of midazolam in stable ventilated preterm infants, it appears to be a safe, short‐term sedative agent.
Blood pressure, lipids, lipoproteins, body fat and physical activity of Singapore children
Authors: SCHMIDT GJ , STENSEL DJ , WALKUSKI JJ 
Published: March 2008

Objective: To determine body composition, coronary risk factors and physical activity and the inter‐relationships of these variables in Singaporean school children. Methodology: This study examined 1681 children (784 boys and 897 girls) from eight primary and seven secondary schools to determine percentiles for body stature and composition, blood pressure, lipids/lipoproteins and blood glucose by gender for three age divisions. An exercise and leisure pursuit questionnaire was administered to ascertain self‐reported physical activity patterns. Anthropometric data and blood pressure readings were taken. Capillary blood was drawn from each child via finger prick sampling following an overnight fast. The concentrations of total cholesterol (TCHOL), triglyceride (TG), high‐density lipoprotein cholesterol (HDL‐C) and glucose (GLU) were determined from plasma using a dry chemistry analyser. Low‐density lipoprotein cholesterol (LDL‐C), very low‐density lipoprotein cholesterol (VLDL) and the TCHOL/HDL‐C ratio were determined by calculation. Results: While 47.7% of boys and 22.0% of girls disclosed active lifestyles, differences between the active and non‐active children were found in coronary risk factors TCHOL, LDL‐C, TG, TCHOL/HDL‐C and per cent body fat. No differences were shown between the two groups in HDL‐C, GLU and blood pressure. There was a high correlation between the various measures of body composition with the highest correlation (r=0.806, P < 0.001) found between body mass index (BMI) and waist measurements. Conclusions: Children in this study who reported no activity or relatively little activity were found to have TCHOL, LDL‐C, TG, TCHOL/HDL‐C and per cent body fat that were higher than those who reported moderately high or vigorous physical activity patterns.
Complications of central venous access devices in children with and without cancer
Authors: TOBIANSKY R , LUI K , DALTON DM , SHAW P , MARTIN H , ISAACS D 
Published: March 2008

Objective: Complications of indwelling central venous access devices (CVAD) were assessed in 63 children with cancer and 35 without cancer. Methodology: Central venous access devices placed surgically in 1991 were reviewed for complications. Results: In cancer patients, the median CVAD duration was 211 days (range 9–924), compared to 37 days (range 3–339) in the non‐cancer patients. Although significantly more CVAD, 41 of 72 (57%), were infected in the cancer patients compared to 14 of 40 (35%) CVAD in the non‐cancer patients (OR = 2.46, 95% Cl 1.03–5.93), the rate of line infection in cancer patients was lower: 2.8 per 1000 catheter days compared with 7.6 per 1000 in non‐cancer patients (P= 0.0014). Infection was significantly more common in intensive chemotherapy cancer patients (P= 0.0002). Conclusions: Treating infected CVAD with antibiotics or hydrochloric acid (HCl), clearing occluded lines with streptokinase/HCl and repairing fractured lines, when successful, resulted in a considerable gain in the number of days of use for the CVAD.
Preschool hearing screening: Evaluation of a parental questionnaire
Authors: HAMMOND PD , GOLD MS , WIGG NR , VOLKMER RE 
Published: March 2008

Objective: To evaluate the validity of a parental questionnaire used to screen preschool children for persistent hearing impairment. Methodology: Six‐hundred and eighty‐five children aged 4–5 years from a Metropolitan area of Adelaide, Australia, were enrolled. Each parent completed a questionnaire aimed at detecting parental concerns about hearing impairment. Screening audiometry was then performed. Children who failed the initial audiometry screening underwent repeat audiometry screening 6–8 weeks later. The audiometry and questionnaire data were then compared. Results: Of the 657 children who successfully completed initial audiometry, 544 (83%) passed and 113 (17%) failed. Of the 84 children who had follow‐up audiometry, 64 (76%) passed. Parental concerns were identified on questionnaire in 50% of all children. Neither individual questions nor the number of concerns were found to relate to audiometry results. Compared with audiometry results, the hearing screening questionnaire had a sensitivity of 56% and specificity of 52%. Conclusions: The hearing questionnaire used in this study and in several Australian states is an ineffective screening test for detecting persistent hearing loss.
Methionine loading does not enhance the predictive value of homocysteine serum testing for all‐cause mortality or major adverse cardiac events
Authors: Dunkelgrun M. , Hoeks S. E. , Schouten O. , Feringa H. H. H. , Welten G. M. J. M. , Vidakovic R. , Van Gestel Y. R. B. M. , Van Domburg R. T. , Goei D. , De Jonge R. , Lindemans J. , Poldermans D. 
Published: March 2008

AbstractBackground:  Hyperhomocysteinaemia is independently associated with atherosclerotic disease. Methionine loading could improve the predictive value of hyperhomocysteinaemia by detecting mild disturbances in enzyme activity. The aims of this study were to determine the beneficial effect of methionine loading on the predictive value of homocysteine testing for long‐term mortality and major adverse cardiac events (MACE).Methods:  In an observational study, 1122 patients with suspected or known vascular disease, underwent homocysteine testing, which was measured fasting and again 6 h after methionine loading. Hyperhomocysteinaemia was defined as a fasting level ≥15 μmol/L and post‐methionine loading level ≥45 μmol/L or an increase of ≥30 μmol/L above fasting levels. Primary end‐points were death and MACE. Multivariate Cox regression analysis was used, adjusting for all cardiac risk factors.Results:  During follow up (mean 8.9 ± 3.4 years), 98 patients died (8.7%), 86 had a MACE (7.7%), 579 patients had normal tests, 134 patients had only fasting hyperhomocysteinaemia, 226 only post‐methionine hyperhomocysteinaemia and 183 patients had both. In multivariate analysis, overall survival and MACE‐free survival were significantly worse for those with fasting hyperhomocysteinaemia, with hazard ratios of 1.86 (95% confidence interval (CI) 1.20–2.87) and 2.24 (95%CI 1.41–3.53), respectively. The addition of hyperhomocysteinaemia after methionine loading did not significantly increase the risk of death or MACE, with hazard ratios of 0.97 (95%CI 0.52–1.81) and 0.89 (95%CI 0.47–1.69), respectively.Conclusion:  The presence of post‐methionine hyperhomocysteinaemia did not significantly alter risk of death or MACE in patients with normal or increased fasting homocysteine levels, respectively. In conclusion, methionine loading does not improve the predictive value of homocysteine testing with regard to long‐term mortality or MACE.
Infliximab in severe active ankylosing spondylitis with spinal ankylosis
Authors: Cheung P. P. M. , Tymms K. E. , Wilson B. J. , Shadbolt B. , Brook A. S. , Dorai Raj A. K. , Khoo K. B. K. 
Published: March 2008

AbstractBackground:  Infliximab is an anti‐tumour necrosis factor monoclonal antibody, which significantly improves pain, stiffness and functional disability outcomes in patients with active ankylosing spondylitis. There are limited data available on the efficacy of this treatment for the subgroup with established spinal ankylosis.Aim:  To compare the treatment response of infliximab in active severe ankylosing spondylitis for patients with and without radiographic evidence of spinal ankylosis in the clinical practice setting.Methods:  Twenty‐seven patients with mean Bath Ankylosing Spondylitis Disease Activity Index of 8.7, all HLA‐B27 positive, with 11 (41%) having spinal ankylosis, were studied for 54 weeks. The qualification for initial and ongoing infliximab treatment was defined by the Australian Pharmaceutical Benefit Schedule (PBS), and 5 mg/kg of infliximab was given at 0 week (baseline), repeated at 2 and 6 weeks and every 6 weeks thereafter. At each time point, PBS‐mandated and international consensus response measures were completed. Disease activity and outcome measures for spinal ankylosis subgroup and those who did not have spinal ankylosis were cross‐sectionally compared at baseline and 1 year.Results:  Patients with spinal ankylosis tended to be older (P = 0.01). Although the subgroup with spinal ankylosis had higher baseline activity scores, the only significant difference between the subgroups was the degree of morning stiffness (P = 0.04). By 54 weeks, all patients including the subgroup with spinal ankylosis fulfilled the PBS criteria for continuation of treatment. Majority of patients including the subgroup with spinal ankylosis achieved the various international consensus response measures. Patients with spinal ankylosis also experienced significant improvements in health‐related quality of life, with majority returning to full‐time employment by 1 year.Conclusion:  In real‐life clinical practice, patients with established disease with spinal ankylosis and high levels of inflammation and disease activity can achieve a major clinical response with infliximab.
Sensitization of meningeal nociceptors: inhibition by naproxen
Authors: Levy Dan , Zhang Xi‐Chun , Jakubowski Moshe , Burstein Rami 
Published: March 2008

AbstractMigraine attacks associated with throbbing (manifestation of peripheral sensitization) and cutaneous allodynia (manifestation of central sensitization) are readily terminated by intravenous administration of a non‐selective cyclooxygenase (COX) inhibitor. Evidence that sensitization of rat central trigeminovascular neurons was also terminated in vivo by non‐selective COX inhibition has led us to propose that COX inhibitors may act centrally in the dorsal horn. In the present study, we examined whether COX inhibition can also suppress peripheral sensitization in meningeal nociceptors. Using single‐unit recording in the trigeminal ganglion in vivo, we found that intravenous infusion of naproxen, a non‐selective COX inhibitor, reversed measures of sensitization induced in meningeal nociceptors by prior exposure of the dura to inflammatory soup (IS): ongoing activity of Aδ‐ and C‐units and their response magnitude to mechanical stimulation of the dura, which were enhanced after IS, returned to baseline after naproxen infusion. Topical application of naproxen or the selective COX‐2 inhibitor N‐[2‐(cyclohexyloxy)‐4‐nitrophenyl]‐methanesulfonamide (NS‐398) onto the dural receptive field of Aδ‐ and C‐unit nociceptors also reversed the neuronal hyper‐responsiveness to mechanical stimulation of the dura. The findings suggest that local COX activity in the dura could mediate the peripheral sensitization that underlies migraine headache.