bluuebunny/crossref_metadata_2025_split huggingface dataset:
Somatosensory evoked potentials predict neurologic outcome in full‐term neonates with asphyxia
Authors: HARBORD M. G. , WESTON P. F. 
Published: March 2008

Objectives: To investigate the ability of somatosensory evoked potentials (SSEP) to predict neurologic outcome in term neonates with birth asphyxia.Methodology Upper limb SSEP were performed on nine infants of 1‐7 weeks of age who had perinatal asphyxia and an encephalopathy still present at 7 days of age. Comparison was made between the cranial ultrasound, electroencephalogram (EEG), SSEP and neurologic outcome at 9‐36 months.Results Normal SSEP were found in four infants, all of whom were normal on neurologic follow up at 9‐12 months. Neonatal EEG performed on two out of four of these infants were also normal, while cerebral oedema was seen on cranial ultrasound in three of the four studies. No SSEP response was seen initially in three infants, all of whom had adverse outcomes (one death, two with spastic diplegia). In contrast, their neonatal EEG had shown normal background rhythms, while two of the three cranial ultrasounds revealed oedema. For two infants the initial SSEP was absent over one hemisphere and just present over the other. Both children were abnormal on follow up at 10‐12 months but did not have a hemiparesis.Conclusions Upper limb SSEP appear more sensitive than EEG or cranial ultrasounds in predicting the short term neurologic outcome of neonates with asphyxia.
Upper and lower gastrointestinal complications with dexamethasone despite H2 antagonists
Authors: McDONNELL M. , EVANS N. 
Published: March 2008

Objectives: To describe three preterm babies who developed gastrointestinal complications during treatment with dexamethasone for chronic lung disease, during a 10 month period.Methodology Case reports in a tertiary neonatal intensive care unit.Results All three babies had received intravenous cimetidine since the commencement of steroid therapy, and developed gastrointestinal complications. There was no evidence of necrotizing enterocolitis in either of the two babies with gastrointestinal perforation. This is the first report of lower gastrointestinal complications associated with dexamethasone therapy.Conclusion Recommendation of concomitant use of H2 antagonists with steroid therapy may be premature, and requires testing with a randomized controlled trial.
Vitamin D deficiency in infants and young children born to migrant parents
Authors: PILLOW J. J. , FORREST P. J. , RODDA C. P. 
Published: March 2008

Objectives: To determine the current modes of presentation for the development of nutritional vitamin D deficiency in Melbourne children.Methodology A retrospective descriptive review was undertaken of the case records of children less than 5 years of age discharged from three Melbourne hospitals with a diagnosis of vitamin D deficiency or hypocalcaemia from January 1992 to January 1994.Results The study identified 13 infants and young children whose hospital admission was related to nutritional vitamin D deficiency. Significant morbidity and a broad spectrum of biochemical and clinical features were noted at presentation. All children had migrant parents and were either exclusively or predominantly breast fed. Ten infants (77%) were less than 1 year at presentation. Associated deficiencies of iron and B12 were present in five cases. Of the five mothers tested, serum 25‐hydroxy vitamin D3 was low in four.Conclusion Nutritional vitamin D deficiency is a continuing health problem in infants and young children born to migrant parents living in Melbourne. Paediatricians, obstetricians and general practitioners, particularly those managing women and infants from migrant communities, should be aware of this condition. Vitamin D supplementation to high‐risk women during pregnancy and to their infants should be considered.
Video‐assisted thoracoscopic surgery in the paediatric population
Authors: YIM A. P. C. , LOW J. M. , NG S. K. , HO J. K. S. , LIU K. K. W. 
Published: March 2008

Objective: Video‐assisted thoracoscopic surgery (VATS) is now widely practised in adults but there are few publications on its application in the paediatric population.Methodology: Retrospective review of the authors' experience with VATS in children under 16 years old during an 18 month period in a university teaching hospital.Results: From September 1993 to March 1994, VATS was attempted in 14 patients. Five were unsuccessful because of pleural symphysis or inability to collapse the upper lung. Ten cases of VATS were successfully performed in the remaining nine patients (eight males, one female; age range from 22 days to 15 years old). These included two drainages and limited decortications for loculated pleural effusion, one guided drainage of pericardial effusion, one thymectomy for thymic hyperplasia, three wedge resections for metastatic pulmonary osteosarcoma and three bleb excisions and pleurodesis for primary spontaneous pneumothoraces. There were no intra‐operative complications. There was one death from dysrhythmia following an uneventful wedge resection. The mean duration of chest tube drainage was 1.4 days and postoperative hospital stay 2.6 days excluding two patients who stayed for further medical treatment.Conclusion: VATS is a useful approach in selected cases but further development of this approach awaits refinement of anaesthetic technique and endoscopic instrumentation.
An epidemic of acute post‐streptococcal glomerulonephritis among Aboriginal children
Authors: STREETON C. L. , HANNA J. N. , MESSER R. D. , MERIANOS A. 
Published: March 2008

Objective: To describe an epidemic of acute post‐streptococcal glomerulonephritis (APSGN) that occurred in Aboriginal children in three remote Aboriginal communities in Far North Queensland between July and October, 1993.Methodology: Children at the communities aged between 2 and 14 years were screened so as to identify all cases of APSGN. Parenteral penicillin was administered to all 583 children who presented for the screening procedure.Results: APSGN was diagnosed in 58 (10%) of the 583 children. A further 142 (24%) children had microscopic haematuria. Children aged 5‐8 years had the highest APSGN attack rate, and the highest prevalence of microscopic haematuria. Of all 583 children, 34% had skin sores, and group A streptococci (GAS) were isolated from 71% of the skin swabs. The prevalence of both skin sores and GAS were greater in the children with APSGN, and in those with microscopic haematuria, than in children with normal urine. A marked decline in the number of cases of APSGN occurred after the mass administration of penicillin.Conclusions: The epidemic of APSGN was associated with GAS skin infections. The mass use of penicillin may have had an effect in reducing the transmission of the nephritogenic strain of GAS. Microscopic haematuria was a significant finding in many of the children, and further prospective studies are required to understand the significance of this finding.
Annotation Accidental death or sudden infant death syndrome?
Authors: BEAL SM , BYARD RW 
Published: March 2008

Objective: To describe the reasons why it is difficult to decide whether to attribute some infant deaths to accidents or to SIDS.Methodology To extract from infant deaths data in South Australia those where the cause of death is debatable.Results The risks associated with rocking cradles, bed sharing, bedclothes, couch sleeping, unsafe cots or beds and the prone position are presented.Conclusions : Uniform worldwide death scene investigations for all infant deaths should help identify unsafe sleeping conditions for infants.
Review Article Tongue‐tie
Authors: WRIGHT JE 
Published: March 2008

Objective: To review the presenting features of tongue‐tie in childhood and indications for frenulotomy, drawing conclusions from a retrospective study of patients encountered in paediatric surgical practice and from the literature.Methodology A disease index was kept enabling histories to be selected for analysis. All patients were seen by the author and all operations performed by the author or a registrar under supervision in a standard manner. Patients were reviewed 2 weeks after operation.Results During 18 years of practice, 287 patients with simple tongue‐tie were encountered (two others with true ankyloglossia were not included in this study) and 158 frenulotomies were performed. The presenting symptoms were related to sucking or swallowing (13%), speech (32%), mechanical problems related to restricted tongue movements (14%) and to other problems (3%). In 38% the asymptomatic tongue‐tie was noted incidentally.Conclusion It is concluded that there is no place for division of tongue‐tie without anaesthesia in the newborn. Speech difficulties related to tongue‐tie are over‐rated and mechanical problems are underestimated. The indications for frenulotomy include articulation difficulties confirmed by a speech pathologist, mechanical limitations such as inability to lick the lips, to perform internal oral toilet or play a wind instrument. There may be rare instances in infancy where problems with feeding and suction can be helped by frenulotomy but evidence for this is anecdotal. Operation requires general anaesthesia except in older, co‐operative teenagers in whom local anaesthetic is appropriate.
High frequency oscillatory ventilation: Initial experience in 22 patients
Authors: JOHNSTON D , HOCHMANN M , TIMMS B 
Published: March 2008

Objectives: To report the outcome of a consecutive cohort of neonates treated with high frequency oscillatory ventilation (HFOV).Methodology Prospective cohort study of 22 neonates failing conventional mechanical ventilation (CMV) between October 1992 and August 1993. Outcomes evaluated were in‐hospital survival rate, comorbidities including patent ductus arteriosus (PDA), cerebroventricular haemorrhages (CVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), and acute changes in respiratory status.Results Eighteen of 22 (81.8%) survived. Of the four children who died, one did not respond to HFOV and died within 24 h of treatment. Two died of respiratory failure complicated by pulmonary haemorrhage. The remaining infant responded to HFOV but later developed severe NEC while on minimal CMV and died at 2 weeks of age.Three subjects were ≥34 weeks' gestation; each responded well to HFOV with no substantial comorbidity. Of the remaining 19 infants <34 weeks' gestation, six (31.6%) had a PDA, and seven (36.8%) had a CVH. One infant developed cystic periventricular leucomalacia. Three infants (15.8%) had NEC. Respiratory failure in the 15 survivors with gestational ages <34 weeks improved dramatically with HFOV. Ten (66.7%) survivors <34 weeks developed BPD and 10 (66.7%) ROP.Conclusion High frequency oscillatory ventilation was associated with a survival rate of 81.8%, but with significant comorbidity.
Risk factors for sensorineural hearing loss in extremely premature infants
Authors: LESLIE GI , KALAW MB , BOWEN JR , ARNOLD JD 
Published: March 2008

Objective: To identify potentially preventable risk factors for sensorineural hearing loss (SNHL) in extremely premature infants.Methodology A case control study of survivors with gestational age (GA) <28 weeks or birthweight (BW) <1000 g using data collected prospectively in our Neonatal Intensive Care Unit database. Each subject with bilateral SNHL >40dB was matched according to GA, BW and sex with two controls who had neither sensorineural nor conductive hearing loss.Results Infants with SNHL had increased mean (±s.d.) days ventilated (53 ± 21 vs 37±23 days, P= 0.006) and in oxygen (107±44 vs 69±28 days, P= 0.02) compared with controls. The risk for SNHL was increased for infants who spent >90 days in oxygen (OR 4.0 [95% Cl 1.1‐15.6]), had maximum FiO2 >0.90 (5.6 [1.2‐26.9]), minimum plasma Na <125mmol/L (5.6 [1.1‐27.8] or maximum pH >7.60 (5.6 [1.1‐89.0]). Neither maximum serum bilirubin nor exposure to ototoxic drugs was associated with SNHL.Conclusions: Avoidance of severe hyponatraemia and extreme alkalosis, as well as use of surfactant to minimize the severity of hyaline membrane disease, may result in a decreased incidence of SNHL in extremely premature infants.
Effect of a postural support nappy on ‘flattened posture’ of the lower extremeties in very preterm infants
Authors: MONTEROSSO L , COENEN A , PERCIVAL P , EVANS S 
Published: March 2008

Objectives: To determine whether the use of a postural support nappy (PSN) would reduce the features of ‘flattened posture’ in the lower extremities of infants <31 weeks gestation who are nursed prone.Methodology: Randomized, observer blind, controlled trial conducted at King Edward Memorial Hospital for Women, Perth, Western Australia. Infants were randomly assigned and stratified by gestational age to be nursed in a conventional nappy (n= 29) or a PSN (n= 31) when in the prone position. The features of ‘flattened posture’ were measured as angles and assessed by blinded observers prior to commencement of the intervention, 4 weeks post intervention, then bi‐weekly until discharge.Results A significant reduction in the features of ‘flattened posture’ occurred in the PSN group after 4‐6 weeks of intervention and stabilized by 8 weeks until discharge. No changes were detected in the control group. No significant difference was observed between infants <29 weeks gestation compared to infants of 29‐30 weeks gestation in either treatment group.Conclusions: Use of the PSN in infants <31 weeks gestation who are nursed in the prone position significantly reduces the features of ‘flattened posture’ in the lower extremities. This is of benefit in the short term, and follow up of these infants into childhood will demonstrate whether the long‐term effects of ‘flattened posture’ can be prevented.
Health status of Victorian special school children
Authors: ACKLAND MJ , WADE RW 
Published: March 2008

Objective: This study sought to determine the health status and health needs of a sample of students attending special schools for the intellectually disabled in Victoria, Australia.Methodology:Two hundred and forty‐nine students not previously seen by a Community Child Health Medical Officer (CCHMO) were assessed at school. Data on student, parent and staff needs were obtained through personal interviews and documented on a standard questionnaire. Health status was documented using data obtained from parents and teachers as well as the clinical assessment.Results:Comparison of the number of problems reported by parents with the number confirmed at examination showed significant underreporting of vision, hearing and general medical problems. However, behaviour problems were nearly all reported. Many students had multiple problems with 63% having 2–4 problems and 11% having 5–8 problems. Ninety‐nine (40%) of the 249 children seen had newly detected problems; vision (24), hearing (24) and obesity (9) were the most common. Two hundred and forty‐four (98%) had known problems and 27% of these had insufficient information available from parents or staff to completely ascertain their health status. In 115 cases the primary problem was intellectual impairment of unknown cause. Down's syndrome was the next most common underlying diagnosis (30) followed by autism (24), epilepsy (21) and cerebral palsy (15). The most common secondary diagnoses were asthma (16), congenital heart defects (12), seizures (8) and skin problems (8). Many students required referral for further management both for newly detected problems (64%) and known problems (18%). Parents required counselling and/or discussion on a number of issues for both newly detected problems (66%) and known problems (39%); when counselling had taken place parent and staff concerns had reduced significantly by the time of the follow‐up assessment.Conclusions:This study demonstrates that in those students with known intellectual impairment there were many with other unrecognized health problems and unmet needs. These findings have implications for health services provided to children attending special schools.
Incomplete catch‐up growth in low birthweight Chinese infants in Hong Kong
Authors: LAM B , KARLBERG J , LOW LCK , YEUNG CY 
Published: March 2008

Objective:To describe the early catch‐up growth in length in Chinese low birthweight (>2500g) infants.Methodology:The infants (n= 181) were delivered between 1988 and 1993 and followed up at Queen Mary and Tsan Yuk Hospitals, Hong Kong. One third had a birthweight below ‐2SDS, most of whom were term or close‐to‐term babies small‐for‐gestational‐age (SGA). The remaining babies were appropriate‐for‐gestational‐age (AGA) in birthweight, but frequently born prematurely.Results:The SGA group did not show a catch‐up growth in height comparable to that reported on other recent studies, as 33–35% of the patients were still short at 6 and 12 months (7–12% for the AGA group). When comparing the postnatal mean growth curve of the SGA group with the mean curve of the AGA group there was little sign of catch‐up growth.Conclusions:The results showed that Hong Kong SGA infants have an incomplete catch‐up growth and for successful intervention the causative mechanisms have to be identified.
Perinatal mortality trends among South Australian Aboriginal births 1981–92
Authors: RODER D , CHAN A , PRIEST K 
Published: March 2008

Objective:To assess changes in perinatal mortality and risk factors for births to Aboriginal mothers in South Australia in 1981–92.Methodology:All 4013 singleton Aboriginal births in the South Australian perinatal data collection were included. Trends in proportions with specific maternal and infant characteristics, and perinatal mortality by year of birth, were investigated by logistic regression analysis.Results:Changes found included an increase in the proportions of mothers aged 35 years and over, preterm births and births of very low birthweight (>1500 g), but a decrease in the proportions of births to women under 20 years of age, and of births with a birth defect. There was no statistically significant change in the crude perinatal mortality rate nor in the risk of perinatal death after adjusting for risk factors.Conclusions:The perinatal mortality rate among Aboriginal births, which is three times higher than the rate for all South Australian births, is not declining, in contrast to the State rate overall. This highlights the need for a concerted approach to Aboriginal perinatal health.
Changing patterns of survival and outcome at 4 years of children who weighed 500–999 g at birth
Authors: TUDEHOPE DI , BURNS YR , GRAY PH , MOHAY HA , O'CALLAGHAN MJ , ROGERS YM 
Published: March 2008

Objective:To evaluate the impact of changing perinatal practices on survival rates and 4 year neurodevelopmental outcome for infants of birthweight 500–999 g.Methodology:The study was a tertiary hospital‐based prospective cohort study that compared survival, impairment and handicap rates between two eras, July 1977 to December 1982 (era 1) and January 1983 to June 1988 (era 2). All 348 live, inborn infants and 49 outborn infants of birthweight 500–999 g were prospectively enrolled in a study of survival and outcome. Rates of survival, neurodevelopmental impairment and functional handicap at 4 years were compared between eras. Perinatal risk factors for handicap were also compared between eras.Results:Four year survival rates for inborn infants 500‐999 g improved from 32.6% in era 1 to 49.2% in era 2 (OR 2.1, 95% CI 1.26‐3.48) but for outborn infants the improvement between 31.8% and 53.6% was not significant. There were significant improvements in survival for inborn infants in birthweights 800‐899 g and 900–999 g between study periods. The rates of functional handicap between the first and second eras (mild 10 vs 7%; severe or multiply severe 14 vs 16%) were not significantly different. Although the rate of cerebral palsy increased from 0 to 12% (P>0.01) other rates of impairment such as blindness 0 vs 3%, deafness 2 vs 2% and developmental delay 12 vs 11% did not change. The chance of a survivor being free of handicap remained unchanged at 78% and 76% for the two eras, respectively. Although the absolute number of intact survivors more than doubled (41 vs 83) so too did the number of severe or multiply severe handicapped survivors (7 vs 17). Multivariate logistic regression analysis for the entire study cohort revealed male gender, multiple birth, prolonged mechanical ventilation and cerebral ventricular dilatation but not birthweight or gestational age to be independently associated with severe or multiply severe handicap.Conclusions:The advances in neonatal intensive care for extremely low birthweight infants between July 1977 and December 1982 and January 1983‐June 1988 resulted in an increased number of non‐disabled survivors but had no impact on incidence of severe disability. The application of prediction of mortality or severe handicap to clinical practice has the potential to reduce the proportion and absolute number of severely handicapped survivors.
Use of simple clinical parameters to assess severity of bronchiolitis
Authors: MAI TV , SELBY AM , SIMPSON JM , ISAACS D 
Published: March 2008

Objective: To determine whether simple clinical parameters could be used to predict the severity of acute bronchiolitis and the need for supplemental oxygen therapy.Methodology: A prospective study, performed in a tertiary care paediatric hospital. Seventy‐one infants under 15 months of age with a clinical diagnosis of acute bronchiolitis were examined on admission. Clinical parameters were recorded, and each infant was re‐examined after approximately 12 and 24h. All infants were examined by one medical student and, when possible, by a doctor, the two being unaware of each other's findings. Parameters recorded included respiratory and heart rates and presence of wheeze, crackles, intercostal recession, sternal retraction and/or cyanosis. The outcome measure was the need for supplemental oxygen, as determined by the independent caring medical team, on the basis of pulse oximetry and clinical judgement.Results: Forty (56%) of the 71 babies required supplemental oxygen. All cyanosed babies required supplemental oxygen, but only 9 (21%) were cyanosed on admission. Intercostal recession (relative risk RR 2.55; 95% CI 1.28, 5.08) and sternal retraction (RR 1.60; 95% CI 1.06, 2.42) predicted the need for supplemental oxygen with moderate accuracy. Interobserver agreement was only fair for most parameters, but was poor for intercostal recession and good for cyanosis.Conclusions: Simple clinical parameters may help predict the need for oxygen therapy in acute bronchiolitis, although further studies are required to define suitable clinical criteria. Such criteria are extremely important in developing countries where oxygen is a scarce resource.