bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antenatal and intrapartum factors associated with Sudden Infant Death Syndrome in the New Zealand Cot Death Study
Authors: STEWART AJ , WILLIAMS SM , MITCHELL EA , TAYLOR BJ , FORD RPK , ALLEN EM ,   NEW ZEALAND COT DEATH STUDY GROUP
Published: March 2008

Objective: To describe the relationship between antenatal and intrapartum factors and sudden infant death syndrome (SIDS).Methodology: The New Zealand Cot Death Study was a 3 year case‐control study, with 485 infants who died from SIDS in the postneonatal period and 1800 randomly selected control infants. Data were obtained from obstetric records, parental interview and community nursing records.Results: This study confirms many of the antenatal and intrapartum risk factors for SIDS noted in studies from both the southern and northern hemispheres. After controlling for potential confounders, such as occupational group and marital status, significant inverse effects were noted for interpregnancy interval, birthweight and gestation. Other factors that retained a significantly increased risk of SIDS were: increasing parity, bacteriological evidence of urinary tract infection (UTI) (adjusted odds ratio 1.73, 95% CI 1.10–2.73); smoking antenatally (AdjOR 2.14, 95% CI 1.61–2.84); less than six antenatal checks attended (AdjOR 1.84, 95% CI 1.19–2.84); second stage of labour less than 16 min (AdjOR 2.06, 95% CI 1.35–3.14) and multiple birth (AdjOR 3.23, 95% CI 1.70–6.02). No interaction was observed between maternal haemoglobin and antenatal smoking. Interactions were tested for and not found between antenatal smoking and three antenatal risk factors (UTI, short second stage of labour and number of antenatal appointments). The only significant interaction between these three factors and three modifiable postnatal risk factors (prone sleeping, bed sharing and bottle feeding) was between bed sharing and fewer antenatal appointments. The risk of SIDS associated with bed sharing was greater among those whose mothers had fewer antenatal appointments.Conclusions: Although many of the previously identified antenatal and intrapartum risk factors for SIDS are confirmed, the risks of SIDS associated with obstetric factors are in general considerably lower than the risks associated with the four modifiable postnatal risk factors.
Prevention of early onset group B streptococcal sepsis in the newborn
Authors: VIGNESWARAN R , O'LOUGHLIN JA , McDONALD HM 
Published: March 2008

Abstract: There is an urgent need for strategies to prevent early onset group B streptococcal sepsis in the newborn. The most effective mechanism is the identification of maternal carriers of the organism and interruption of transmission during labour. Vaginal culture is currently the most reliable method for the identification of carriers. Antibiotic prophylaxis for known carriers in labour has been demonstrated to be effective as standard management practice in a number of Australian institutions and is the best available strategy at this stage.
The epidemiology, mortality and morbidity of tuberculosis in Australia: 1850‐94
Authors: WILLIAMS HE , PHELAN PD 
Published: March 2008

Abstract: The review covers the four major changes in the history of tuberculosis in Australia from 1850 to 1994. During the first 100 years there was no significant effective treatment. Mass miniature radiological chest screening and effective bacteriological examination of World War II army recruits resulted in reliable diagnosis. The Australian Tuberculosis Campaign 1948‐76 utilized the army experience for detection, and the use of specific treatment virtually eliminated the disease. Failure to maintain strict screening of high‐risk groups, especially immigrants, has led to a resurgence of tuberculosis as shown by an increase in notifications in adults and prevalence rates in secondary school children.
Play position is influenced by knowledge of SIDS sleep position recommendations
Authors: MILDRED J , BEARD K , DALLWITZ A , UNWIN J 
Published: March 2008

Objective: This study determined whether knowledge of sleeping in the prone position as a risk factor for sudden infant death syndrome (SIDS) influences caregivers' positioning of their infants for play and sleep.Methodology: One hundred caregivers attending Adelaide metropolitan Child Adolescent and Family Health Services (CAFHS) were surveyed by self‐administered questionnaire.Results: Ninety‐three per cent of parents reported that their knowledge of SIDS influenced infant positioning for sleep and 84% reported they never put their infant in the prone position for sleep. Thirty‐seven per cent reported that SIDS knowledge did influence play positioning and 26% reported never placing their infant prone for play. There was a significant association (P= 0.002) between the influence of SIDS knowledge on play positioning and avoidance of the prone position for play.Conclusions: Community educators may need to clarify that prone positioning for play is not a risk factor for SIDS and that it is desirable for infants to spend supervised wakeful time in the prone position.
Prevalence of Helicobacter pylori infection in asymptomatic children
Authors: HARDIKAR W , GRIMWOOD K 
Published: March 2008

Objective:To determine the prevalence of Helicobacter pylori infection in a sample of asymptomatic Australian children.Methodology:A prospective observational study, during a 3 month period, of consecutive children aged 0 to 14 years undergoing minor elective surgical procedures in a Day Surgical Unit at a Melbourne paediatric hospital. Subjects without gastrointestinal symptoms or a family history of peptic ulcers had sociodemographic data recorded and serum collected. Serum anti‐H. pylori immunoglobulin G antibodies were measured by an enzyme immunoabsorbent assay previously validated in children from the same population.Results: H. pylori antibodies were present in 21/147 (14.3%) children aged 3 months to 14 years. Prevalence was not influenced by age or sex, but was greatest in children whose parents migrated from developing nations and lowest in children with Caucasian Australian or Western European parents (25.8 vs5.9%; P>0.001). An inverse relationship between social class and infection was also observed (P= 0.02). Multivariate analysis demonstrated the father's ethnic background as the only significant independent risk factor for H. pylori infection (P= 0.002).Conclusions:Although seroprevalence of H. pylori appears to be lower in Australian children than in developing countries there are some ethnic groups at substantially greater risk for the acquisition of H. pylori infection and its complications.
Neonatal cholestasis in two siblings: A variant of Dubin‐Johnson syndrome?
Authors: KIMURA A , YUGE K , KOSAI K‐l , KAGE M , FUJISAWA T , INOUE T , YAMASHITA Y , NAKASHIMA E , KATO H 
Published: March 2008

Objective: Two Japanese brothers with neonatal cholestasis associated with pigment granules in the hepatocytes and hepatosteatosis were evaluated for the possible role of hepatosteatosis in the Dubin‐Johnson syndrome.Methodology and resultsThe morphology of pigment accumulation and the laboratory data in these cases were examined. The elevation of urinary coproporphrin isomer I to more than 90% and the presence cholestasis resembled that in the Dubin‐Johnson syndrome, but the hypertriglyceridaemia (<1.13mmol/L as triolein) and the hepatosteatosis differed. Both infants were thought to have familial hypertriglyceridaemia. However, this diagnosis was difficult to confirm in the absence of data on the normal values of apolipoprotein and lipoprotein isomer for infants.Conclusions: A neonatal variant of the Dubin‐Johnson syndrome may account for the unusual findings in these infants.
Benign transient hyperphosphatasaemia associated with adenovirus infection
Authors: NG PC , CHEUNG CK , TAM JS , LI CK 
Published: March 2008

Abstract: Benign transient hyperphosphatasaemia in early childhood is a harmless biochemical abnormality which is not commonly known to paediatricians. We describe a typical case in a young child and provide further evidence to support a viral aetiology.
Another vaccine, another treadmill?
Authors: FERSON M. J. 
Published: March 2008

Objective: Attention is drawn to possible disadvantages arising from the introduction of universal varicella vaccination in infancy. Methodology: Comparisons are made between universal infant varicella vaccination and the current measles immunization programme, and a review of current literature on age‐specific complications of varicella and cost‐benefit analyses of varicella vaccination. Results: Universal infant vaccination will cause a greater proportion of varicella cases to occur in adults, including pregnant women, who are at greater risk of serious complications compared to children. Although economic costs resulting from lost time from work will fall dramatically, health costs may rise. Conclusions: Universal infant vaccination should only be considered if measles is first controlled, and then only if more information on duration of protection becomes available and combined measles‐mumps‐rubella‐varicella vaccines are approved.
Role of routine lumbar puncture in neonatal sepsis
Authors: KUMAR P. , SARKAR S. , NARANG A. 
Published: March 2008

Objective: To evaluate the utility of lumbar puncture done routinely as part of complete workup in neonatal sepsis. Methodology: Two hundred and nine consecutive lumbar punctures performed in 169 neonates were prospectively evaluated for the diagnosis of meningitis over a 6 month period in a tertiary care referral neonatal unit. Results: Among babies with ‘suspected clinical sepsis’, five (3.3%) were diagnosed to have meningitis. None of the clinically normal babies with high risk obstetric factors alone had meningitis. The lumbar puncture was traumatic in 22.9%, and in 26.3% the fluid obtained was inadequate for complete analysis. The results were inconclusive in 37% of the cases. Conclusion: Based on this study, routine lumbar puncture may not be required in clinically normal newborns with adverse obstetric factors. In babies with clinical sepsis, though the yield is not very high; there are no reliable clinical or laboratory markers to predict which babies will have meningitis and hence these babies would warrant a lumbar puncture.
Incidence and outcome of diabetic cerebral oedema in childhood: Are there predictors?
Authors: MEL J. M. , WERTHER G. A. 
Published: March 2008

Objective: Information regarding cerebral oedema in diabetic children with ketoacidosis does not point to any causal factor or any predictor of outcome. Cases of diabetic ketoacidosis resulting in cerebral oedema at Royal Children's Hospital, Melbourne, over the last 20 years were reviewed. Methodology: The study was divided into two 10‐year periods during which different fluid protocols were used. During the earlier period dehydration was corrected rapidly (over six h) with a fluid isotonic for sodium. During the latter period rehydration was over 24 h using half‐normal saline. Results: A similar number of patients developed cerebral oedema in the two periods (six of 3134 vs six of 3373). Only half of the patients (six) developed cerebral oedema during their initial presentation of diabetes mellitus. The age range was similar (1 to 15 years) with eight males and four females. Survival from cerebral oedema (four of 12) was not predicted by demographic or biochemical findings, including initial biochemistry, age, duration of ketoacidosis and the management protocols. Conclusions: This study suggests that the rate of salt and water replacement in diabetic ketoacidosis are not key determinants of the appearance of cerebral oedema. No factors predictive of survival from cerebral oedema have been identified, though this is a rare entity and case numbers were small. Nevertheless, current protocols at Royal Children's Hospital and most other centres utilize slow rates of rehydration with isotonic saline fluids. Further review in 5–10 years may determine whether this protocol is effective in reducing rates of cerebral oedema complicating diabetic ketoacidosis.
Growth hormone therapy for 3 years: The OZGROW experience
Authors: COWELL CT , DIETSCH S , GREENACRE P 
Published: March 2008

Abstract Objective: To examine the growth response over 3 years of growth hormone deficient (GHD) and non‐GHD children who have received growth hormone (GH) in Australia. Methodology: A retrospective study of a group of patients (1362 children) who commenced GH prior to 1 September 1990. Data were collected at 12 growth centres located in major cities throughout Australia. The data were transferred after informed consent to the national OZGROW database located at the Royal Alexandra Hospital for Children, Sydney, NSW. Of the 1362 children, 898 had received 3 years or more GH therapy and were eligible for this analysis. This cohort was then categorized by diagnosis. Growth response was assessed using height standard deviation score, estimated mature height, growth velocity (GV), GH dose and bone age (years). Results: For children who completed 3 years therapy, the baseline characteristics among diagnostic groups were similar with mean height standard deviation score (SDS) less than – 3 SDS (except for the malignancy group) and mean GV ranging from 3.5 to 4.4 cm/year. The GV during the first year improved in all groups (7.7‐9.4 cm/year) followed by an attenuated response during the second and third years of therapy. After 3 years GH therapy the GHD group with peak levels <10 mU/L demonstrated the greatest change in estimated mature height and height SDS. The GHD group with peak levels between £10 but <20 mU/L had a growth response similar to the non‐GHD children for all outcome parameters. Change in bone age ranged from 3.1 to 3.8 years with no differences being noted between the diagnostic groups, nor consistently with pubertal status. Conclusions: Australian GH guidelines have targeted very short children when compared to other series. This large cohort of non‐GHD children has demonstrated short‐term benefits of GH therapy; however, the long‐term benefit remains unclear until these children reach final adult height.
An Angelman syndrome clinic: Report on 24 patients
Authors: LEITNER RP , SMITH A 
Published: March 2008

Abstract Objective: Angelman syndrome (AS) is a rare congenital neurodevelopmental disorder with complex genetic aetiology. Diagnosis may be difficult and there is severe life‐long disability. An AS clinic was commenced in Sydney, Australia, in 1993 with the aim of gathering information about the natural history of AS, management issues and parental concerns. Methodology: Patients were referred from metropolitan Sydney, rural New South Wales and interstate. A questionnaire, history, physical examination and diagnostic tests were undertaken. Results: In the first year, 24 patients with AS were assessed. There were 11 males and 13 females, whose ages ranged from 3 to 30 years. The mean age of diagnosis was 12.8 years. The diagnosis was made by neurologists in four cases, by clinical geneticists in three cases, by paediatricians in two cases and 15 cases were diagnosed at the AS clinic. A clear history of epilepsy was obtained in 19 (79%) and in 15 of these patients the age of onset was during the first 4 years of life. An EEG had been performed in 21 patients, and in two the EEG was reported as normal. Fifteen of the patients (62.5%) could walk independently and in this cohort there was a significant sex difference in walking: 10/11 males compared to 5/13 females (P >0.01). Five patients (21%) were in full‐time permanent care. Genetic testing with appropriate DNA probes from chromosome 15(q11‐13), complete in 20 families, showed deletion in 12 patients (60%), uniparental disomy in 1 (5%) and no detectable abnormality in 7 (35%). Conclusions: The diagnosis of AS should be considered in any patient with severe developmental disability particularly if there is a movement disorder and lack of speech. The control of epilepsy is a major management problem. Further research is needed to establish the frequency and type of seizures, the reponse to anticonvulsants and to determine if improvement can be expected with age. The mobility of patients should be assessed regularly, to determine the most appropriate options for intervention.
Weight‐for‐age and weight‐for‐height references for Hong Kong children from birth to 18 years
Authors: LEUNG SSF , LAU JTF , TSE LY , OPPENHEIMER SJ 
Published: March 2008

Abstract Objective: Childhood obesity is an emerging problem in Asia. Sequential monitoring of the growth of an individual can detect a change in body fatness, provided there are ethnically appropriate growth references. Methodology: A territory wide cross‐sectional growth survey of Hong Kong on 24 709 individuals from the age of newborn to 18 years was performed in 1993. Weight‐for‐age and weight‐for‐height percentile charts were prepared separately for boys and girls. Results: There was an average increase of 8.5 kg and 5.1 kg in the 18 year old boys and girls, respectively, compared to those surveyed 30 years ago. The percentile curves between 6 and 18 years were similar to those of Singapore. Weight‐for‐height percentile curves were close to those of America in the prepubertal years. Conclusions: These Hong Kong growth standards for weight‐for‐age and weight‐for‐height are important tools for the assessment of nutritional status of an individual and for monitoring changes in nutritional status of the population.
An evaluation of 1994 school entry immunization certificates on the Central Coast of New South Wales
Authors: WATT PD 
Published: March 2008

Abstract Objective: To evaluate school entry immunization certificates and document the immunization status of children enrolled during 1994 in kindergartens on the NSW Central Coast. Methodology: Immunization certificates and non‐statutory documentation of immunization for school entry presented by parents were evaluated during visits to 68 NSW Central Coast schools in May and June 1994. Results: Immunization information for 3741 kindergarten enrolments was reviewed. Of these enrolments, 79% presented immunization certificates of which 10% were incomplete, 14% presented non‐statutory documentation and 7% had no certificate or non‐statutory documentation. It was considered that 19% of children were incompletely immunized; 8% of certificates presented were incorrectly completed. Conclusions: The study found that about 80% of Central Coast school entrants were fully immunized. Reliance on immunization certificates as evidence of immunization may overestimate vaccination completion rates, as some certificates may be incorrectly completed. Education of parents, school staff and certificate providers should help to improve both immunization completion and documentation.
Assisted ventilation and survival of extremely low birthweight infants
Authors: DOYLE LW , DAVIS P , DHARMALINGAM A , BOWMAN E 
Published: March 2008

Abstract Objective: To determine the incremental consumption of ventilator resources associated with the improving survival rate of extremely low birthweight (ELBW, birthweight 500–999 g) infants, from the time assisted ventilation was introduced. Methodology: Cohort study of ELBW infants born in one tertiary perinatal centre (The Royal Women's Hospital, Melbourne). All ELBW infants born from 1971 to 1993 were included in the study. Inhospital survival rates and patient‐days of assisted ventilation were the main outcome measures. Discrete eras of relatively stable survival rate and consumption of ventilator resources were identified. These comprised the years 1971–74, 1977–83, 1985–90, and 1992–93. Cost‐effectiveness ratios (the incremental consumption of ventilator resources per additional survivor) were calculated between adjacent eras by dividing the increment in the consumption of ventilator resources by the increment in the survival rate. Results: The survival rates rose progressively between eras (6.2, 33.9, 49.1, 68.8%, respectively, as did the consumption of ventilator resources (0.1, 6.6, 16.2, 24.7 patient‐days of assisted ventilation per livebirth, respectively). The cost‐effectiveness ratio deteriorated initially, increasing from 23.2 to 63.5 additional patient‐days of assisted ventilation per additional survivor, but then improved, falling to 43.1 additional patient‐days of assisted ventilation per additional survivor in the last era. These changes were even more marked for those of birthweight 750‐999 g (20.0, 63.2 to 35.9 additional patient‐days of assisted ventilation per additional survivor, respectively). In contrast, the cost‐effectiveness ratio was initially worse for those of birthweight 500‐749 g, being three‐fold higher than for the larger infants, and only improved substantially in the last era (59.8, 58.3 to 44.1 additional patient‐days of assisted ventilation per additional survivor, respectively). Conclusions: The initial deterioration in cost‐effectiveness ratios between successive eras probably reflected the increased availability of resources for assisted ventilation, without any other major advances in perinatal care. The improvement in cost‐effectiveness in the last era reflected, in part, the increased use of antenatal steroid therapy and the introduction of exogenous surfactant to neonatal intensive care.
Early post‐traumatic seizures in children: Clinical and radiological aspects of injury
Authors: ONG LC , DHILLON MK , SELLADURAI BM , MAIMUNAH A , LYE MS 
Published: March 2008

Abstract Objective: To determine the type and outcome of early post‐traumatic seizures in children and the factors associated with it. Methodology: A prospective observational study on all consecutive children with head injuries at the General Hospital Kuala Lumpur between November 1993 and December 1994. The onset, type and frequency of seizures occurring within the first week of injury were documented. Using inpatients as a cohort, logistic regression analysis was used to determine clinical and radiological variables significantly associated with seizures. The outcome 6 months post‐injury was assessed using the Glasgow Outcome Scale. Results: Fifty‐three of 966 children (5.5%) developed seizures within the first week of trauma. Seven (13.2%) occurred within 1 h of injury, 30 (56.6%) between 1 and 24 h and 16 (30.2%) after 24 h. Factors significantly associated with early post‐traumatic seizures were female sex, age less than 2 years, loss of consciousness for more than 24 h and acute subdural haematoma (P <0.01). Children with seizures had a poorer outcome (death or severe disability) man inpatients without seizures (21/53 vs 19/182, P <0.001). The outcome was worst in children with recurrent partial seizures, who had a longer injury‐seizure interval and were more likely to have focal neurologic deficits compared to those with sporadic or generalized seizures. Conclusions: Anticonvulsant prophylaxis to minimize the adverse effects of early seizures in head injury should be considered for young children (less than 2 years old) with subdural haematoma and a prolonged duration of coma. Prompt and effective control of recurrent seizures is recommended.