bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and aetiology of neurological impairment in extremely low birthweight infants
Authors: WAUGH J , O'CALLAGHAN MJ , TUDEHOPE DI , MOHAY HA , BURNS YR , GRAY PH , ROGERS YM 
Published: March 2008

Abstract Objective: To determine the prevalence and perinatal predictors of cerebral palsy, intellectual impairment, visual impairment and deafness in a cohort of extremely low birthweight (ELBW) infants at two years of age. Methodology: The study population comprised 199 of the 224 (89%) ELBW infants managed at the Mater's Mothers Hospital, Brisbane, between July 1977 and February 1990 and who survived to two years. The prevalence of cerebral palsy, intellectual impairment, blindness and deafness was measured by clinical, psychometric and audiological assessment and the association with 24 risk factors examined. Results: Cerebral palsy occurred in 20 children (10%). Risk of cerebral palsy was associated with ventricular dilatation, intraventricular haemorrhage, necrotizing enterocolitis and multiple birth, though only ventricular dilatation (OR 4.41; 95% Cl 1.32‐14.8) remained significant in the adjusted analysis. Intellectual impairment occurred in 20 children (10%) and was independently associated with ventricular dilatation (OR 15.0; 95% Cl 2.2‐102.8), ventilation FiO2 >80% (OR 3.4; 95% Cl 1.01‐11.5), vaginal delivery (OR 3.5; 95% Cl 1.09‐11.4) and male sex (OR 6.1; 95% Cl 1.67‐22.3). No perinatal predictor was statistically associated with risk of deafness. Retinopathy of prematurity (OR 36.9; 95% Cl 2.8‐495.5) was associated with risk of later visual impairment. Conclusions: Intellectual impairment was associated with a broad range of perinatal variables. Cerebral palsy was associated with fewer variables, all of which were also associated with intellectual impairment. Neurologic injury was associated with male sex and multiple birth, which are not biological insults themselves, but may be markers of susceptibility to injury.
Neurodevelopmental profile of Down syndrome in Chinese children
Authors: KWONG KL , WONG V 
Published: March 2008

Abstract Objective: To give an overall appraisal of the clinical features of Down syndrome (DS) in Chinese children with emphasis on the neurodevelopmental outcome, and to compare the related complications with that of other races. Methodology: The records of 124 Chinese children with DS assessed at the Child Assessment Centre of the University Department of Paediatrics in the Duchess of Kent Children's Hospital from 1985 to 1993 were reviewed. Results: Thirty‐one per cent of patients had microcephaly. Eighty‐five per cent (33/39) when assessed in the first year of life had a developmental quotient (DQ) above 50 but only 29% (2/7) had DQ above 50 when assessed after the age of 5. Only two patients (1.6%) had epilepsy: infantile spasms (1) and Lennox‐Gastaut syndrome (1). Hearing impairment was found in 45% of children with mild conductive hearing impairment being the most common. Conclusions: Chinese children with DS, when compared with other races, were similarly intellectually disabled, but were less likely to develop epilepsy.
Visits to medical practitioners in the first 6 months of life
Authors: GUNN J , LUMLEY J , YOUNG D 
Published: March 2008

Abstract Objective: To assess the use of medical practitioners' services by mothers and their babies in the 6 months following childbirth. Methodology: Aggregated Medicare data detailing medical practitioner services provided to a random sample of 650 Victorian babies born between 1 March and 31 May 1993 and their mothers were obtained from the Health Insurance Commission. This provided data on services provided between March and December of 1993 to the selected cohort. Services provided by the public hospital system to mothers and babies are not included. Results: Mothers and babies in the sample used 6404 medical practitioner services in the 6 months following birth; 57% of services were to babies, 43% to mothers. Of the 6404 medical practitioner services 5042 (79%) were provided by general practitioners (GP), 804 (12%) by paediatricians, 319 (5%) by obstetricians and 239 (4%) by ‘other’ specialists. The mean number of visits to a GP by mothers was 3.5 and by babies was 4.2 in the 6 months following birth. General practitioners were more likely to be vocationally registered and there were differences in the item numbers charged between those who were vocationally registered and those who were not. The length of GP consultation differed significantly between mothers' and babies' visits. Conclusions: A previously undocumented level of postnatal use of medical practitioner services is presented. It suggests a significant level of postnatal maternal and infant morbidity that requires further study.
Haemodynamic effects of differing blood transfusion rates in infants less than 1500 g
Authors: NOSÈ Y , TAMAI H , SHIMADA S , FUNATO M 
Published: March 2008

Abstract Objective: To investigate whether the haemodynamic effects of the standard 2‐3 h blood transfusion increases the risk for intraventricular haemorrhage (IVH) and patent ductus arteriosus (PDA) in very low birthweight infants. Methodology: In a randomized controlled study, haemodynamic changes using slow and rapid transfusion were compared. Twenty‐seven very low birthweight infants were divided between 12 h (n= 14) and 3 h (n= 13) transfusion groups. Blood pressure, ejection fraction (EF), anterior cerebral artery pulsatility index (Pl), blood gases, serum electrolytes and haematocrit were measured pre‐ and post‐transfusion. Infectious status was also monitored. Results: Blood pressure (48.1/25.5 vs 55.7/30.2 mmHg) and EF (0.68 vs 0.73) increased significantly during rapid transfusion (P>0.01) but remained stable with slow transfusion. Serum potassium, base excess and incidence of infection did not increase in either group. Conclusions: Slow transfusion causes less haemodynamic disturbance than rapid transfusion, thereby preventing the potential risk for IVH and PDA.
Cannabis cookies: A cause of coma
Authors: BOROS CA , PARSONS DW , ZOANETTI GD , KETTERIDGE D , KENNEDY D 
Published: March 2008

ABSTRACTDespite the prevalence of cannabis use in the community, reports of adverse effects in young children are rare. Two cases of cannabis‐induced coma are reported following accidental ingestion of cannabis cookies. The possibility of cannabis ingestion should be considered in cases of unexplained coma in a previously well young child if signs of conjunctival hyperaemia, pupillary dilatation and tachycardia are present and other causes such as CNS infection or trauma are unlikely. Specific screening for cannabinoids should be undertaken.
Routine microbiological testing in sudden and unexpected infant death
Authors: CARMICHAEL EM , GOLDWATER PN , BYARD RW 
Published: March 2008

Objective: To evaluate the significance of microbiological test results in a series of infants who had died suddenly and unexpectedly. Methodology: Following a review of all cases of sudden natural death in infants presenting to the Adelaide Children's Hospital (ACH) division of the Women's and Children's Hospital (WCH) over the 10 year period between 1983 and 1992, specific evaluation of microbiological test results was undertaken. Results: There were 329 cases of sudden infant death syndrome (SIDS) and 23 cases in which sudden infant death was either attributed to other conditions or was unclassifiable. Positive microbiological results were recorded in the majority of cases, most being considered to be due to postmortem overgrowth or to contamination at autopsy. Of the remaining cases, microbiological results were essential to the establishment of the diagnosis in three cases, and were a useful adjunct to the diagnosis in a further six cases. Conclusions: Routine microbiological testing in cases presenting as SIDS did not reveal occult sepsis in most instances. Such testing did, however, add support to the diagnosis of SIDS where no pathogens were isolated and, if not undertaken, would have resulted in a small percentage of cases of sudden infant death due to infections remaining undiagnosed.
Effect of phototherapy on thyroid stimulatory hormone and free thyroxine levels
Authors: TAN KL , CHIRINO‐BARCELO Y , AW TC , JOSEPH R 
Published: March 2008

Objective: To study the effect of phototherapy for neonatal hyperbilirubinaemia on thyroid function as neonatal thyroid screening is sometimes performed during exposure to phototherapy. Methodology: Infants with non‐haemolytic hyperbilirubinaemia were sequentially allocated to fibre‐optic phototherapy, conventional daylight phototherapy, or a combination of both. Bilirubin concentration was monitored 12 hourly by capillary blood sampling; venous blood was sampled for thyroid stimulating hormone (TSH) and free thyroxine (fT4) determinations, at start of exposure, at 24 h, end of exposure and 1 day later. Comparable unexposed infants served as controls. Results: All 123 study infants and 25 controls remained well during the study. Bilirubin levels declined during phototherapy, being most rapid in the combination group. The TSH and fT4 values at start of exposure were 3.86 ± 0.41 mU/L (mean ± SEM) and 33.20 ± 1.16 pmol/L, respectively, in the fibre‐optic group, 3.62 ± 0.38 mU/L and 37.22 ± 1.76 pmol/L in the daylight group, and 4.40 ± 0.48 mU/L and 29.91 ± 1.13 pmol/L in the combined group, compared with 5.77 ± 0.40 mU/L and 34.46 ± 1.68 pmol/L in the control group. The TSH and fT4 values declined with increasing age in the phototherapy and control groups with end of exposure values of 2.90 ± 0.28mU/L and 27.71 ± 0.71 pmol/L, 2.77 ± 0.31 mU/L and 33.52 ± 1.22pmol/L, and 3.44 ± 0.30 mU/L and 27.54 ± 0.88 pmol/L, respectively, compared with 4.21 ± 0.61 mU/L and 27.19 ± 2.33 pmol/L (at 72 h) in the control group. The pattern of TSH and fT4 decline in the exposed and control groups was similar, being related to increasing age. Conclusions: The validity of neonatal thyroid screening is not affected by fibre‐optic or conventional phototherapy or by both combined.
Risk‐stratified nosocomial infection surveillance in a neonatal intensive care unit: Report on 24 months of surveillance
Authors: FERGUSON JK , GILL A 
Published: March 2008

Objective: To document the nosocomial infection rate in a single neonatal intensive care unit (NICU) in terms of patient workload and device utilization. Methodology: Nosocomial infections have been identified and documented by the methodology described by the National Nosocomial Infection Surveillance System (NNIS), Centres for Disease Control, Atlanta. In addition, antibiotic usage has been surveyed in the NICU and standardized measures of patient exposure to antibiotics stratified by birthweight and gestational age have been described. Results: Overall nosocomial infection rates compared favourably with the published NNIS figures at 6.2 infections per 100 admissions or 4.8 per 1000 patient days. Infection rates were significantly higher in lower birthweight groups. Device‐related infection rates in each birthweight cohort were also very close to published figures and varied less with birthweight group. Antibiotic exposure averaged 12% of total admission days, less than previously published data. Conclusions: The NNIS system is applicable to Australian NICU and provides an effective tool for monitoring infection episodes.
The prediction of hospital admission in children with acute asthma
Authors: TWADDELL SH , HENRY RL , FRANCIS JL , GIBSON PG 
Published: March 2008

Objective: To determine whether a single assessment of children at the time of presentation to the emergency department would discriminate accurately between those requiring admission and those who could be managed at home and to examine the appropriateness of these decisions. Methodology: Fifty‐three children were assessed using a table recommended by Australian and New Zealand respiratory paediatricians, which categorizes children as probably being able to manage at home (group 1), may need admission to hospital (group 2) and certainly need admission to hospital (group 3) on the basis of oximetry, presence of wheeze and pulsus paradoxus. Results: Nine out of 11 children assigned to group 1 were managed at home and 15/17 who were predicted to require admission were admitted. No individual component of the assessment dominated the decision made. Of the 25 children allocated to group 2, 18 were admitted. Conclusions: The method employed was highly predictive of outcome for half of the children who presented with asthma. However, 25/53 (47%) were assigned by the table to a recommendation for further assessment; this limits its usefulness.
Health care and its costs for children with perinatally acquired HIV infection
Authors: CARLIN JB , LANGDON P , HURLEY SF , ZIEGLER JB , DOHERTY R , CHONDROS P , KALDOR JM 
Published: March 2008

Objective: To describe survival patterns, use of health services and related costs for Australian children with perinatally acquired human immunodeficiency virus (HIV) infection. Methodology: A retrospective cross‐sectional survey was made of 20 children with HIV infection (91% of those diagnosed) and 13 children with maternal antibodies who subsequently seroreverted, treated at 10 medical centres. Details of disease progression and use of health services were obtained from hospital medical records. Monthly costs for three phases of infection were estimated by linking service usage rates with estimates of the unit cost of each service. The average lifetime cost was estimated by combining monthly costs and phase duration estimates from the literature. Results: Patterns of disease progression were similar to those reported internationally, with a median survival of 8 years. Use, of health services increased with severity of illness. Mean monthly costs were $120 per month (1992 Australian dollars) for children with maternal antibodies who subsequently seroreverted, $320 per month for children with HIV infection but no acquired immunodeficiency syndrome (AIDS)‐defining illness, and $1830 per month for children with AIDS. The present value of total lifetime cost for a child with HIV infection was $48174,46% of which was for treatment of AIDS. Discussion: The mean lifetime cost for a perinatally infected child was just over half that for a man with HIV in Australia. Health service usage and costs were lower for Australian than American children with HIV.
Inhaled hypertonic saline increases sputum expectoration in cystic fibrosis
Authors: RIEDLER J , READE T , BUTTON B , ROBERTSON CF 
Published: March 2008

Objective: To determine whether inhalation of hypertonic saline (HS) increases sputum expectoration in patients with cystic fibrosis (CF). Methodology: Ten adolescents with CF, who were receiving inpatient treatment for a pulmonary exacerbation, were enrolled in a controlled cross‐over clinical trial. After inhalation of a beta adrenergic drug to prevent possible broncho‐constriction, each patient inhaled for 10min either 0.9% isotonic saline (IS) or 6% HS prior to routine physiotherapy. The following day the patient received the alternative solution. Seven patients undertook a second block after 1‐5 days. Outcome measures included weight of sputum, a visual analogue score to assess the subjective feeling of a cleared chest after physiotherapy, and spirometry. Results: Sputum expectoration (median; Q1,Q3) from the beginning of the inhalation of HS or IS to the final spirometry measure 60min post‐physiotherapy was significantly greater after HS than IS [17.2g (11.7, 34.8) vs 11.3g (6.5. 16,1); P— 0.006]. A clinical score of the patient's own judgement of a cleared chest was significantly better after HS than IS. Spirometry results did not change following either of the two inhalations. Conclusions: These data show that the inhalation of 6% HS prior to physiotherapy can increase sputum expectoration in patients with CF and suggest that HS might be an effective, safe and cheap adjunct to regular physiotherapy in patients with CF.
Accelerated schedule of hepatitis B vaccination in high‐risk youth
Authors: WILKINSON SE , MORATH M , BENNETT DL , BURGESS MA , ISAACS D 
Published: March 2008

Objective: To perform a feasibility and immunogenicity study of an accelerated schedule of hepatitis B immunization for high‐risk youth. Methodology: High‐risk adolescents attending a youth health centre and nearby youth refuges were immunized with Engerix‐B recombinant vaccine, 20 μg intramuscularly, at 0,2 and 6 weeks. Serology was performed prior to immunization and 3 months after the third dose. Results: Forty‐two subjects (27 female) aged 13‐20 years entered the study. Two (4.8%), already hepatitis B virus (HBV) seropositive, were excluded. Thirty‐six of 40 subjects had one or more risk factors for HBV. Participants were often elusive, needing multiple attempts to establish contact. Twenty (50%) of the 40 completed three immunizations and all 14 studied developed anti‐hepatitis B surface titres of > 100mlU/mL (geometric mean titre 630 mIU/mL, 95% confidence intervals 309‐1290). Conclusion: High‐risk youth can be immunized against hepatitis B successfully using an accelerated schedule, but compliance is difficult.
‘On the spot’vaccination: Does it work?
Authors: BURGESS MA , LEVY M , ALPERSTEIN G , MIRA M , BEK M , ISAACS D , KAKAKIOS A , FASHER B , HANSON R , KILHAM H , MALCOLM M 
Published: March 2008

Objective: To trial and evaluate a system of ‘on the spot’vaccination for children up to the age of 15 years in the Early Childhood Centres of the Central Sydney Area Health Service, at the Royal Alexandra Hospital for Children and in a number of general practices in the area. Methodology: A brief questionnaire was used to collect data from parents and health care professionals about the child's vaccination status and vaccines given ‘on the spot’. Results: Over an 8 week period in August‐September 1993, 5162 questionnaires were completed; 71% of children were up to date with their vaccination. If Haemophilus influenzae type b vaccine, which had been introduced only 2 months before commencement of the study, was excluded, 84% of the children were up to date. A total of 441 children were given 663 vaccinations ‘on the spot’. Very few children were too ill to be vaccinated (6%). However, only 30% of those who needed vaccination ‘on the spot’actually received it (441 of 1480), and only 41% (24 of 58) of a subset of those who were not vaccinated were known to have complied 1 month later. Children attending Early Childhood Centres were younger than children attending general practices or the hospital. Conclusions: A high proportion of children who attended for routine or acute health care had vaccinations overdue (30%). If this scheme could be continued and expanded it would have an important impact on vaccination coverage, and hence on the incidence of vaccine‐preventable diseases.
Does intramuscular vitamin K1 act as an unintended depot preparation?
Authors: LOUGHNAN PM , McDOUGALL PN 
Published: March 2008

Objective: To propose a hypothesis that the long duration of effect of intramuscular (i.m.) vitamin K1 in preventing late onset haemorrhagic disease results from a depot effect after i.m. injection. Methodology: Review of scientific literature relating to the pharmacology of vitamin K, and the aetiology of late onset haemorrhagic disease. Results: A single i.m. dose of vitamin K1 is effective for at least 2 months, whereas the duration of effect of a single oral dose is about 3‐4 weeks. The known pharmacological properties of vitamin K1 are seemingly at variance with the long duration of effect of an i.m. dose. Menaquinones (vitamins K2) are absent in the newborn liver, but gradually accumulate after birth. This, together with the low concentrations of vitamin K1 in human breast milk, may explain the peak frequency of late onset haemorrhagic disease at 4‐8 weeks. We hypothesize that after i.m. injection, vitamin K1 acts as a depot preparation by forming a viscous mass in muscle tissue which is slowly absorbed over many weeks. This hypothesis is supported by reports indicating significantly higher plasma vitamin K1 levels several weeks after i.m., as compared to oral vitamin K1. Conclusions: The prolonged efficacy of i.m. vitamin K1, compared to oral preparations may be due to a depot effect New oral preparations of vitamin K1, despite greatly improved bioavailability, may have a shorter duration of effect than i.m. vitamin K1, and therefore be less effective for long‐term prophylaxis.
Improved outcomes following the introduction of surfactant to an Australian neonatal unit
Authors: BEEBY P , CHAN D , HENDERSON‐SMART D 
Published: March 2008

Objective: To study the impact of the introduction of artificial surfactant therapy for hyaline membrane disease (HMD) in an Australian neonatal intensive care unit. Methodology: Infants <32 weeks gestation admitted between June 1991 and Dec 1993 who received treatment with artificial surfactant were compared with infants admitted during the preceding 30 months who would have been candidates for such treatment. Results: For treated infants with gestations in the range 24‐27 weeks, there was a significant reduction in neonatal death (adjusted odds ratio 0.28) and a significant increase in the incidence of chronic lung disease (CLD) (adjusted odds ratio 3.4). With gestations in the range 28‐31 weeks, there was no significant change in neonatal death or CLD, but there was a significant reduction in incidence of pneumothorax (adjusted odds ratio 0.32). Conclusions: A reduced incidence of pneumothorax and neonatal death following the introduction of artificial surfactant. therapy was readily demonstrable in the Australian setting.
Parents' perceptions towards their child's use of inhaled medications for asthma therapy
Authors: LIM SH , GOH DYT , TAN AYS , LEE BW 
Published: March 2008

Objective: Understanding patients' and their parents' perceptions towards asthma medication is important in developing strategies to ensure patient compliance. In this study, parents' perceptions towards their children's use of inhaled medication for asthma treatment were evaluated. Methodology: A questionnaire was administered by interviewing parents of 210 asthmatic children attending the Department of Paediatrics, National University Hospital. Results: Our results showed that 76/210 (36%) of parents either felt opposed to inhaler therapy and/or preferred oral medications. The main reasons for their reluctance to use inhalers were related to fear of dependence, side effects and overdosage, and the child's dislike for inhalers. A third of these parents felt that inhalers were only indicated for very severe asthma. Conclusions: We conclude that a significant proportion of parents have reservations regarding the use of inhalers for the treatment of asthma. These factors should be taken into consideration when planning an effective asthma education programme.