bluuebunny/crossref_metadata_2025_split huggingface dataset:
A national study of risk factors associated with mortality in very low birthweight infants in the Malaysian neonatal intensive care units
Authors:   MALAYSIAN VERY LOW BIRTH WEIGHT STUDY GROUP
Published: March 2008

Objective:To determine the risk factors associated with mortality in very low birthweight (VLBW) infants admitted to the neonatal intensive care units (NIUC) in Malaysia.Method:A prospective observational study of outcome of all VLBW infants born between 1 January 1993 and 30 June 1993 and admitted to the NICU.Results:Data of 868 VLBW neonates from 18 centres in Malaysia were collected. Their mean birthweight was 1223 g (95% confidence intervals: 1208–1238 g). Thirty‐seven point four per cent (325/868) of these infants died before discharge. After exclusion of all infants with congenital anomalies (n=66, and nine of them also had incomplete records) and incomplete records (n=82), stepwise logistic regression analysis of the remaining 720 infants showed that the risk factors that were significantly associated with increased mortality before discharge were: delivery in district hospitals, Chinese race, lower birthweight, lower gestation age, persistent pulmonary hypertension of the newborn, pulmonary airleak, necrotizing enterocolitis of stage 2 or 3, confirmed sepsis, hypotension, hypothermia, acute renal failure, intermittent positive pressure ventilation, and umbilical arterial catheterization. Factors that were significantly associated with lower risk of mortality were: use of antenatal steroid, oxygen therapy, surfactant therapy and blood transfusion.Conclusion:The mortality of VLBW infants admitted to the Malaysian NICU was high and was also associated with a number of preventable risk factors.
Extreme sodium derangement in a paediatric inpatient population
Authors: DUNN K , BUTT W 
Published: March 2008

Objective:To determine the aetiology, symptoms and outcome of extreme sodium derangement in a paediatric inpatient population.Methodology:A retrospective study of children with extreme disturbance of their plasma sodium (≥ 165 mmol/L or ≤ 115 mmol/L) admitted to a tertiary referral centre during a 72‐month period.Results:Twenty‐seven cases of hypernatraemia and 21 of hyponatraemia were reviewed. Sodium disturbance developed after hospital admission in 27/57 cases (57%). Gastroenteritis was the most common cause of hypernatraemia (8/27; 30%), four of 27 (15%) had iatrogenic hypernatraemia. Water overload accounted for 8/21 (38%) cases of hyponatraemia. Neurologic symptoms occurred in 19/24 (79%) with hypernatraemia and in 11/19 (58%) with hyponatraemia. Ten (37%) with hypernatraemia and four (19%) with hyponatraemia died. A deterioration in functional status was seen in two patients with hypernatraemia. There was no apparent deterioration in the survivors with hyponatraemia.Conclusion:Extreme sodium disturbance often develops after admission to hospital and is caused by a variety of diseases and interventions. Neurologic symptoms are common and the mortality rate is high. The outcome in survivors is most likely to be dependent on the underlying disease process.
Prospective study of New Zealand very low birthweight infants: Outcome at 7–8 years
Authors: DARLOW BA , HORWOOD LJ , MOGRIDGE N , CLEMETT RS 
Published: March 2008

Objective:To determine the survival and sensorineural outcome at 7–8 years in very low birthweight (VLBW) infants born in New Zealand in 1986.Methodology:In 1986 all VLBW New Zealand infants admitted to neonatal units were enrolled in a prospective study of acute retinopathy of prematurity. Surviving infants were traced and were assessed at a home visit. Parents were asked a comprehensive questionnaire, and children underwent a visual assessment including photorefraction and were tested with the Revised Wechsler Intelligence Scale for Children (WISC‐R).Results:Four hundred and thirteen VLBW infants were admitted to neonatal units in 1986, 338 (81.8%) surviving to discharge. 12 children died after discharge, 17 were traced to overseas, seven declined to participate and four were untraced, leaving 298 (96% survivors resident in New Zealand) who were assessed at a mean age of 7.6 (± 0.4 years. 15 children (5.0%) had severe disability, 14 (4.7%) moderate disability, and 46 (15.4%) mild disability. Blindness (vision worse than 6/60) occurred in eight children (2.7%), deafness requiring aids in four (1.3%), any form of cerebral palsy in 17 (5.7%), and an IQ score on the WISC‐R>1 SD below the mean in 62 (20.8%). There was no significant difference in outcome for children with birthweight <1000 g and 1000–1499 g.Conclusions:Long‐term (7–8 year) survival and disability rates in this national cohort of VLBW infants is comparable with that reported from other populations. Although a majority of children have no disability a sizeable proportion do perform poorly on the WISC‐R. This may relate in part to problems such as a short attention span and poor visual‐motor integration.
The use of breastmilk in a neonatal unit and its relationship to protein and energy intake and growth
Authors: SIMMER K , METCALF R , DANIELS L 
Published: March 2008

Objective:A nutritional audit was performed to determine whether current feeding regimes were achieving nutritional goals and to evaluate the use of breastmilk (BM) in a neonatal unit (NNU).Methods:All fluid consumed or infused daily was documented with daily weight and weekly length and head circumference measurements in 90 preterm infants (gestational age 30.1 ± 2.6 weeks) while in the NNU for 60 ± 27 days. Daily protein and energy intakes were calculated using values for South Australian preterm BM.Results:Parenteral nutrition provided 85% of the daily energy in week 1 falling to 11% by week 6. Ninety per cent of infants received some of their mother's BM and 62% were discharged at least partially breastfed. Protein and energy intakes were 1.03 ± 0.35 g and 55 ± 10 kcal/kg/day in week 1, increasing to 2.52 ± 0.60 g and 109 ± 15 kcal/kg per day by week 4. Protein intake correlated with weight gain (r2=0.39). Weight gain was 14.0 ± 2.0 g/kg per day and z‐scores for weight declined from 0.25 on admission to 1.22 on discharge, P<0.0001.When infants were divided into two groups comprising those who received BM or formula as their predominant enteral feed, growth and protein intake (but not energy intake) were lower in the BM‐fed infants. However, enteral feeds were tolerated earlier and more quickly in those infants receiving predominantly BM.Conclusion:Energy requirements were readily met using current feeding regimes for preterm infants but protein intakes were marginal. Mothers of preterm infants had similar breastfeeding rates to mothers of term infants in South Australia. The long‐term effects of the lower growth rates of preterm infants fed predominantly BM compared with those fed predominatly formula are unknown and need be balanced against the benefits of BM.
Further observations on the immune response to recombinant hepatitis B vaccine after administration to Aboriginal and Torres Strait Island children
Authors: HANNA JN , FAOAGALI JL , BUDA PJ , SHERIDAN JW 
Published: March 2008

Objective:To determine the prevalence of markers of hepatitis B virus (HBV) immunity and infection at 5 years of age in Aboriginal and Torres Strait Island children who were fully vaccinated in infancy, and to examine the response to a booster dose of hepatitis B vaccine in those children who had no detectable immunity despite vaccination.Methodology:A cross‐sectional study of serological markers to HBV in a sample of 239 Aboriginal and Torres Strait Island children, with a mean age of 5.7 years, who were fully vaccinated in infancy. The antibody response to a booster dose of hepatitis B vaccine was determined in those children in the sample who had no markers of either immunity to HBV or infection with HBV.Results:Of the 239 children, 6% (95% Cl 4–10%) had been infected and, of these, four were HBV surface antigen (HBsAg) positive. Of the remaining 224 children, only 41% (95% Cl 35–48%) had evidence of immunity (i.e. an antibody to HBV surface antigen (anti‐HBs) level of ≥10 miu/mL) to HBV. Of the children with no detectable immunity (i.e. anti‐HBs < 10 miu/mL), 113 were followed up after receiving a booster dose of hepatitis B vaccine. Of these, 84% (95% Cl 76–90%) had an anamnestic response (i.e. anti‐HBs <10 miu/mL following the booster dose). Therefore 16% (95% Cl 10–24%) still had no detectable immunity following the booster dose.Conclusions:This study provides further evidence that Aboriginal and Torres Strait Island children have a suboptimal response to recombinant hepatitis B vaccine. It also indicates that a considerable number of Aboriginal and Torres Strait Island children in the study age cohort have been exposed to HBV. However, despite these concerns, this study and historical data provide strong evidence that there has been a marked reduction in the prevalence of HBV infection and carriage in previously ‘high risk’ Aboriginal and Torres Strait Island children since the introduction of hepatitis B vaccines. Aboriginal and Torres Strait Island children who have been fully vaccinated in infancy do not require a booster dose of hepatitis B vaccine at school entry.
Craniosynostosis in X‐linked hypophosphataemic rickets
Authors: WILLIS FR , BEATTIE TJ 
Published: March 2008

Abstract:A report of three cases of craniosynostosis in X‐linked hypophosphataemic rickets (XLH) is presented. The literature is reviewed, suggesting that craniosynostosis is relatively common in XLH and that boys may be more at risk than girls. It is recommended that radiological screening be offered to all patients with XLH.
Chronic illness perception in adolescence: Implications for the doctor‐patient relationship
Authors: LEUNG SS , STEINBECK KS , MORRIS SL , KOHN MR , TOWNS SJ , BENNETT DL 
Published: March 2008

Objective:To describe the inter‐relationship of chronic illness severity as perceived by adolescents with both psychosocial well‐being and objective measures of illness severity. Additionally to compare the adolescents' perception of illness severity with how their physicians believe that the adolescents perceive their illness severity.Methods:The psychological well‐being of 48 adolescents with either cystic fibrosis (CF) or insulin‐dependent diabetes mellitus (IDDM) was measured by four standardized questionnaires. The adolescents' perception of severity of illness was measured using an original instrument (PSCI), and this measure was compared to their physicians' estimates of how the adolescents perceived the severity of their illness and clinical illness.Results:There were 24 patients in both the CF and IDDM groups. Both groups were found to function well psychosocially; although, there were more patients with low self image compared to normative values. Depression and low self image were associated with a greater adolescent perception of illness severity. For both chronic illness groups, physicians' assessment of assumed adolescent perception of disease severity correlated with clinical indices of disease severity and was higher than the perception of illness severity reported by the adolescents. For adolescents with CF, but not with IDDM, perception of severity of chronic illness correlated with clinical indices.Conclusions:For adolescents with chronic illness, their perception of illness severity is an important indicator of psychosocial well‐being. Physicians do not accurately infer their patients' perception of illness severity.
Thyroid function in a population of children with attention deficit hyperactivity disorder
Authors: VALENTINE J , ROSSI E , O'LEARY P , PARRY TS , KURINCZUK JJ , SLY P 
Published: March 2008

Objective:To determine the prevalence of thyroid hormone abnormalities and generalized resistance to thyroid hormone in a population of children with attention deficit hyperactivity disorder (ADHD) as compared to reference ranges determined from a control population and hence to determine if routine thyroid hormone screening in children with non‐familial ADHD is indicated.Method:Children attending the State Child Development Centre in Perth, Western Australia with ADHD, as defined by the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) provided the study population. The control population consisted of 353 normal children with a history of allergy in whom radioallergosorbent (RAST) testing was being performed.Results:The prevalence of thyroid hormone abnormalities in the study population was 2.3% (95% CI 0.6%, 5.7%). There were no cases of generalized resistance to thyroid hormone. The prevalence of thyroid hormone abnormalities in the general population of children and adolescents has been reported to vary between 1 and 3.7%.Conclusion:Routine thyroid hormone screening is not indicated in children with non‐familial ADHD.
Vigabatrin as first line therapy in infantile spasms: Review of seven patients
Authors: KWONG L 
Published: March 2008

Objective:To study the efficacy of vigabatrin as initial therapy in infantile spasms.Methodology:We reviewed seven patients with newly diagnosed infantile spasms referred to Tuen Mun Hospital, Hong Kong from 1994 to 1995. Vigabatrin was given as the initial monotherapy at therapeutic dose of 50–100 mg/kg. Efficacy was evaluated at the end of second week of treatment.Results:Significant improvement was observed in four patients, 50–75% seizure reduction in two and no response in one patient. Efficacy was noted within the first week of treatment in five of the six patients who responded. No adverse effects were observed. Vigabatrin monotherapy could be continued in five patients.Conclusion:Vigabatrin could be considered as the first line treatment in infantile spasms. A period of 2 weeks may be sufficient to evaluate its efficacy.
Fat gram target to achieve high energy intake in cystic fibrosis
Authors: COLLINS CE , O'LOUGHLIN EV , HENRY RL 
Published: March 2008

Objective:Higher fat and energy intakes confer a survival advantage in cystic fibrosis (CF). There is a need to develop effective nutrition programmes that ensure optimal energy intake in CF.Methodology:A cross‐sectional measurement of clinical characteristics and energy and fat intakes in patients attending the CF outpatients clinic of the John Hunter Hospital, Newcastle was undertaken. Twenty‐nine subjects, mean age 12 years (range 4.3–20.2), completed weighed food records to determine the contribution of fat to the percentage of the recommended energy intake obtained and to document use of pancreatic enzyme replacement therapy.Results:Diets with a high percentage of energy derived from fat did not guarantee that individuals with CF met their energy requirements. Subjects with total fat intakes of 100 g per day or greater, however, achieved in excess of 110% recommended daily intake (RDI) for energy. Up to 47% of subjects consumed more pancreatic enzyme replacement capsules than shown to give maximum effectiveness.Conclusion:Setting a 100 g daily fat target is a realistic way of ensuring high energy intakes in CF. Fat ready reckoners would identify the fat content of food and prescribe specific numbers of pancreatic enzyme replacement capsules to be consumed with each meal or food item.
Erythromycin treatment for gastrointestinal dysmotility in preterm infants
Authors: NG PC , FOK TF , LEE CH , WONG W , CHEUNG KL 
Published: March 2008

Objective:To report our clinical experience on the use of oral erythromycin for the treatment of severe gastrointestinal dysmotility in preterm infants.Methodology:A case series study of seven preterm infants (six were very low birthweight) with severe intestinal dysmotility in a tertiary neonatal centre.Results:All responded favourably without adverse effects and tolerated full enteral feeding within 1–2 weeks of the commencement of the drug.Conclusions:As prolonged total parenteral nutrition carries significant risk of complications, this therapy could be considered in selected preterm infants who fail to establish enteral feeding after an extended period, and in whom an anatomically obstructive lesion of the gastrointestinal tract has been excluded. Meanwhile, we would caution against the widespread implementation of this therapeutic approach until formal evaluation by randomized controlled trials have established the exact role of erythromycin, or its analogues, in the treatment of intestinal dysmotility in preterm infants.
Developmental dysplasia of the hip in South Australia in 1991: Prevalence and risk factors
Authors: YIV BC , SAIDIN R , CUNDY PJ , TGETGEL JD , AGUILAR J , McCAUL KA , KEANE RJ , CHAN A , SCOTT H 
Published: March 2008

Objectives:To determine the prevalence of developmental dysplasia of the hip (DDH) in South Australia (SA) in 1991, the proportion of cases detected in the neonatal period and the perinatal risk factors for DDH.Methodology:Cases of DDH born in SA in 1991 were identified from multiple sources and their clinical data linked to perinatal data provided by midwives; five controls per case were obtained randomly from SA livebirths without congenital abnormalities and adjusted odds ratios (OR) for potential risk factors obtained by logistic regression analysis. South Australia perinatal data were also used to estimate numbers of births with perinatal risk factors for targeted screening.Results:Two hundred and six cases of isolated DDH were identified, giving a prevalence of 10.5 per 1000 births. Of these, 173 (84%) had been detected in the neonatal period. The perinatal risk factors for DDH were identified as breech presentation (OR 9.65), female babies (OR 4.04), first births (OR 1.91) and maternal age of 25 years or more (OR 1.53). Screening breech and firstborn female babies (23% of births) would yield approximately 51% of cases of DDH.Conclusions:Isolated DDH had a prevalence of 10.5 per 1000 births and 84% of cases had been detected in the neonatal period in SA. Repeated screening during infancy of ‘at risk’ groups of babies is recommended.
Longitudinal study of rotavirus infection in child‐care centres
Authors: FERSON MJ , STRINGFELLOW S , McPHIE K , McIVER CJ , SIMOS A 
Published: March 2008

Objective:To describe the epidemiology of symptomatic and asymptomatic rotavirus infection among young children attending Sydney child‐care centres during the 1994 rotavirus season.Methods:Children aged 0–36 months in 11 child‐care centres participated in the study. A weekly stool specimen was collected from each subject and tested for rotavirus antigen by commercial enzyme immunoassay.Results:One hundred and seventy‐eight children (76 girls and 102 boys) with a mean age of 18.2 ± 6.5 (SD) months were enrolled for a total of 2249 child‐weeks. Of 1653 weekly faecal specimens, 59 (3.6%) were positive for rotavirus antigen. Positivity for rotavirus antigen peaked at 8.0% and 7.4% of specimens in weeks 6 and 7, respectively. The 59 positive specimens were obtained from 44 children in eight of the 11 study centres. One child appeared to suffer a second episode. Eighty‐two per cent of episodes were associated with symptoms of gastroenteritis. Overall, 32% of the children in the eight affected centres were infected; 52% of those <12 months were infected compared to 26% of older children. Secondary spread to household contacts was also documented.Conclusions:Rotavirus infection poses a significant health problem in under‐3‐year‐old children attending child‐care centres in Sydney. We believe that these results are applicable to all Australian children of this age attending group child care.
Outcome at 2 years of children 23–27 weeks' gestation born in Victoria in 1991–92
Authors:   THE VICTORIAN INFANT COLLABORATIVE STUDY GROUP
Published: March 2008

Objective:To determine the survival and sensorineural disability rates in very preterm infants born in 1991–92, and to compare the results with contemporaneous normal birthweight controls and with preterm infants born in 1985–87.Methodology:This was a geographically determined cohort study in the state of Victoria, Australia of consecutive livebirths 23–27 weeks' gestational age born during 1991–92, and randomly selected contemporaneous normal birthweight (NBW) controls born during 1991–92 in the three level‐III perinatal centres in the State. Consecutive livebirths 24–26 weeks gestational age born in the State during 1985–87 comprised another comparison group. The main outcome measures were survival and sensorineural disability rates at 2 years of age.Results:Of the 401 livebirths 23–27 weeks in 1991–92, 225 (56.1%) survived to 2 years of age. The survival rate for those 24–26 weeks was 57.4% (143/249), a statistically significant increase on the regional survival rate of 30.1% (95/316) in 1985–87. In 1991–92 births, the survival rate rose significantly with increasing gestational age, and was significantly higher than in 1985–87 at each of 24, 25, and 26 weeks. Of sensorineural impairments in preterm survivors at 2 years of age, the rate of blindness was significantly lower in 1991–92 (2.3%) compared with 1985–87 (8.4%), and the overall rates of sensorineural disability were not statistically different in 1991–92 compared with 1985–87. In 1991–92 preterm survivors, the survival rate free of disability rose significantly with increasing gestational age, and as a percentage of survivors the rate of disability overall fell with increasing gestational age. However, the rate of disability overall was much higher in preterm infants than NBW controls.Conclusions:Survival rates of very preterm infants in this regional cohort have improved in the 1990s after the introduction of exogenous surfactant. Blindness at 2 years of age was significantly lower than in an earlier preterm cohort, but the rates of sensorineural disability still remain higher in very preterm survivors than for NBW controls. Although survival rates are lower and disability rates are higher with diminishing maturity, there is no obvious gestational age below which adverse neurological outcome in survivors would preclude active management on the basis of gestational age alone.
V‐shaped pillows and unsafe infant sleeping
Authors: BYARD RW , BEAL SM 
Published: March 2008

Objective:To investigate the possibility that adult size V‐shaped pillows may be associated with accidental asphyxial deaths in infants.Methodology:Review was undertaken of all cases of sudden infant death presenting to the Women's and Children's Hospital in Adelaide involving infants who had been found on adult size V‐shaped pillows.Results:Four cases of sudden infant death were found in which infants were found sleeping on V‐shaped pillows. All of the deaths had occurred in 1995. In two of the cases the pillows were considered to be implicated in the cause of death as the potential for obstruction of the infants' airways could be demonstrated on death scene reconstruction.Conclusion:Adult size V‐shaped pillows may be unsafe for use in small infants who may accidentally suffocate if trapped between the two arms, or under, the pillow. The use of such pillows to maintain the body position of sleeping infants should be discouraged.