bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of pain in the newborn infant
Authors: COLDITZ P. B. 
Published: March 2008

ABSTRACTThe importance of providing adequate analgesia for children in pain was highlighted by a recent annotation in this journal.1 Newborn infants as well as children fare better after surgery if adequate analgesia is provided.2 The sick newborn infant who has not had surgery but who is receiving assisted ventilation and multiple invasive procedures may also fare better with analgesia, but this topic has received little attention despite the large number of babies who receive this treatment in newborn intensive care units. This manuscript reviews the evidence of what constitutes a ‘painful’ stimulus to a newborn infant and details options for analgesic treatment. Some issues are raised that may dictate the direction of necessary future research.
Glucose: A fuel for thought!
Authors: AYNSLEY‐GREEN A. 
Published: March 2008

ABSTRACTIt is a privilege and an honour to deliver this, the Turner Gibson Oration for 1989. I chose the title of my lecture because glucose, as the essential substrate for brain function, is indeed the fuel for our thoughts. Although important at all ages, it has a particular significanice for the young child, since a normal supply of glucose is essential to protect brain development and hence the potential for thought in the child's brain. Thus, glucose should have a high priority in our own thinking as paediatricians. With this in mind, the purpose of my lecture is to fuel your own thoughts on your management of children who have disordered glucose homeostasis by examining controversy, challenging current dogma and providing new information.
Volumetric diffusive respirator use in neonatal respiratory failure
Authors: CAMPBELL P. J. , CHILTON H. W. , GARVEY P. A. , GUPTA† J. M. 
Published: March 2008

AbstractSix very low birthweight neonates with terminal respiratory failure due to severe hyalline membrane disease who failed to respond to conventional ventilation were offered a trial of high frequency jet ventilation using the volumetric diffusive respirator (VDR). All neonates showed improvement in pulmonary function. Two neonates were weaned successfully from high frequency ventilation. The results of this initial trial suggest that the volumetric diffusive respirator is a safe and effective method of ventilation in neonates with respiratory failure and that the survival rate in such neonates might be enhanced if treatment is introduced earlier in the disease.
Bronchopulmonary dysplasia in very low birthweight infants
Authors: YIP Y. Y. , TAN K. L. 
Published: March 2008

AbstractThe incidence, clinical presentation and severity of bronchopulmonary dysplasia (BPD) in 110 consecutive very low birthweight (VLBW) infants admitted to the National University Hospital Neonatal Intensive Care Unit between October 1985 and January 1989 is reviewed. Thirty‐two infants died, giving an overall survival rate of 70.90%. Sixty infants (54.4%) required mechanical ventilation in the first week of life; 24 (40%) of these infants died. Of the 36 survivors, 23 required oxygenation at 28 days of life and 21 fulfilled the criteria for BPD (35% of the 60 ventilated and 58% of the survivors). The incidence of BPD in all VLBW infants is 19% and of VLBW survivors 27%. Birthweight and gestational age appear to be important determinants. All the survivors in the 501‐750 g birthweight group developed BPD compared to 6.25% in those above 1250 g. None of those >30 weeks gestation developed BPD.Two forms of BPD were observed; the ‘severe’ group presented radiologically with chest radiographs characteristic of Stage IV BPD, while the ‘mild’ group with small or normal sized lungs demonstrated irregular strands of radio‐densities alternating with areas of normal or increased lucency. The duration of mechanical ventilation and oxygen dependency were significantly longer in the ‘severe’ group, with the mean maximum peak inspiratory pressure, mean airway pressure, and Fio2 required in the first week of life being also significantly higher.Hyaline membrane disease was the main cause of respiratory failure requiring ventilation. The other causes were persistent pulmonary hypertension (1) and apnoea of prematurity (3); all of the latter developed only mild BPD.Those who developed BPD required a significantly longer period of hospitalization, a longer period to regain their birthweight and attain a weight of 2 kg, and a higher incidence of retinopathy of prematurity compared with those without BPD even after correcting for the earlier gestational age of the BPD group.
Second intracranial neoplasms following treatment of childhood acute lymphoblastic leukaemia
Authors: VOWELS M. R. , TOBIAS V. , MAMEGHAN H. 
Published: March 2008

AbstractWe report a boy with acute lymphoblastic leukaemia (ALL) treated with chemotherapy and prophylactic cranial irradiation to a dose of 24 Gy. Six years after diagnosis he developed a glioma and died. Prior to 1979, four cases of second malignant neoplasm (SMN) of the brain had been reported in children treated for ALL. These SMNs occurred within 2 years of the original diagnosis (median 1.3 years) and at least two of four patients had not received prior radiotherapy. Since 1979. 28 cases of SMN of the brain have been reported including nine of 468 (1.9%) long‐term survivors in one study. All occurred more than 3.7 years from diagnosis (median 6.5 years; range 4‐13 years) and all received cranial irradiation (median 24 Gy; range 20‐48 Gy). These data indicate a change in the pattern of SMNs which is most likely due to the introduction of cranial irradiation. As well, the frequency of SMNs in children treated for ALL appears to have increased, although it is still no greater than the risk of SMNs developing following the treatment of any other primary childhood neoplasm.
Infantile hepatic haemangioma: Investigation and treatment
Authors: KRISTIDIS P. , DE SILVA M. , HOWMAN‐GILES R. , GASKIN K. J. 
Published: March 2008

AbstractInfantile hepatic haemangiomas are benign tumours which tend to regress in late infancy. We describe five infants with hepatic haemangioma, three of whom developed congestive cardiac failure. Technetium‐99m labelled red blood cell scan was useful in the diagnosis and follow‐up of the lesion. The three symptomatic infants were treated with prednisone (2 mg/kg per day) for 2 months in addition to digoxin and diuretics. Significant clinical improvement occurred within 3 weeks in each case. We conclude that the red blood cell scan is a good non‐invasive diagnostic test and recommend corticosteroids as initial management for symptomatic infantile hepatic haemangiomas.
Near miss sudden death in an infant with Wolff‐Parkinson‐White syndrome
Authors: ROSENBERG H. C. , YEE R. , SHARMA A. D. , GOLDBACH M. M. , GUIRAUDON G. M. , LI M. D. 
Published: March 2008

AbstractA 6 month old infant with known Wolff–Parkinson–White syndrome presented with an out of hospital cardiac arrest. An electrocardiogram in the emergency department demonstrated atrial fibrillation with rapid ventricular response. The child subsequently was resuscitated and underwent successful interruption of an accessory connection after failing medical therapy. This case underlines the need to reassess the indications for invasive electrophysiologic testing in young children.
Anthropometry and obesity in myelomeningocele
Authors: ROBERTS D. , SHEPHERD R.W. , SHEPHERD K. 
Published: March 2008

ABSTRACTAnthropometric data on 110 myelomeningocele (MMC) subjects in relation to age, sex, level of lesion and ambulation were studied to investigate growth and the occurrence of obesity in MMC. In 52 subjects, indices of obesity were validated against body composition analysis of total body fat (%BF) using body potassium and body water techniques. Most subjects were short and light compared to reference data and became relatively shorter and heavier with age. Overall trunk growth was not affected by the level of lesion, but sitting height was affected by kyphoscoliosis. Arm spans were similar to reference data, but were significantly greater in wheelchair users. Leg length was greatest in those who walked. Body composition data showed excess adipose in many MMC subjects, this tendency increasing with age. When correlated with %BF determined from body composition analysis, common clinical indices of obesity had variable r values (wt/ht2 0.78; wt/sitting ht2 0.77; upper arm fat area 0.75; triceps skinfold 0.74; wt/arm span2 0.68, with the 4 skinfold method correlating best, 0.82). Anthropometric measures, taken with cognizance of level of disability and mobility, can accurately assess body growth and the occurrence of obesity in MMC. The influence of ambulatory activity in promoting normal growth is emphasized.
The effect of dexamethasone upon platelets and neutrophils of preterm infants with chronic lung disease
Authors: BOURCHIER D. , WESTON P. J. 
Published: March 2008

ABSTRACTThe effect of a 21‐day (reducing dose) course of dexamethasone upon platelet numbers, neutrophil numbers and neutrophil morphology in ventilator‐dependent preterm infants with chronic lung disease is reported. Forty‐one infants, who were sespsis‐free throughout the treatment period, received 46 courses of dexamethasone. In these infants the circulating platelet count increased significantly from 235 ± 157 to 476 ± 208 × 109/L Both total neutrophil numbers (7.94 ± 7.16 to 19.56 ± 12.40 × 109/L) and immature neutrophil numbers (1.19 ± 1.22 to 2.68 ± 2.58 × 109/L) also showed a significant increase reaching a peak on day 7 of treatment and decreasing thereafter. The immature: total (I:T) neutrophil ratio remained essentially unchanged. Eight other infants who developed serious sepsis during the treatment period showed a fall in both platelets (293 ± 236 to 140 ± 170 × 109/L) and total neutrophil numbers (18.61 ± 10.83 to 15.76 ± 10.53 × 109/L), together with an increase in immature neutrophils (2.30 ± 2.80 to 8.22 ± 13.91 × 109/L) and consequent increase in I:T ratio.
Three cases of congenital adrenal hypoplasia: A cause of salt‐wasting and mortality in the neonatal period
Authors: BATCH J. A. , MONTALTO J. , YONG A. B. W. , GOLD H. , GOSS P. , WARNE G. L. 
Published: March 2008

ABSTRACTThree infants with congenital adrenal hypoplasia are described. The two surviving infants were detected and successfully treated in the neonatal period due to a suggestive family history (Case 1) and antenatal maternal oestriol screening (Case 2). The modes of inheritance, diverse clinical presentation, associated conditions, diagnostic work‐up and pathology of congenital adrenal hypoplasia in these three infants is discussed.
Conductive Education
Authors: REDDIHOUGH D. 
Published: March 2008

ABSTRACTOver the past 5 years, there has been increasing interest in the application of principles of Conductive Education, also known as the Peto method, to treat children with cerebral palsy. In 1945 Andras Peto, a Hungarian physician trained in rehabilitation and psychiatry, began his work with motor disordered children.1 In 1952 he opened what was then called the National Motor Therapy Institute in Budapest. By 1963 his work had achieved national recognition. When he died in 1967 his pupil, Dr Mari Hari, continued his work and became director of the Institute, now known as the Andras Peto Institute for Motor Disorders.
Aluminium absorption in infancy
Authors: CHEDID F. , FUDGE A. , TEUBNER J. , JAMES S. L. , SIMMER K. 
Published: March 2008

AbstractThe use of aluminium‐containing medications and aluminium contamination of infant formulae is common. We aimed to determine whether aluminium absorption occurs after antacid ingestion. Plasma and urinary levels of aluminium were measured before and after antacid therapy in seven infants whose mean gestational age was 36 ± 2 weeks and postnatal age 11 ± 5 days. Antacid therapy (400‐800 μmol aluminium) was given with feeds for 2 days.Plasma aluminium levels increased and reached toxic levels (0.64 ± 0.33 μmol/L vs 3.48 ± 2.86 μmol/L, P= 0.029). Urinary aluminium: creatinine ratio also increased. These results demonstrate that infants absorb aluminium from antacids and raise the concern of aluminium toxicity.
Delivery of Vitamin A from parenteral nutrition solutions in neonates
Authors: THOMAS D. G. , JAMES S. L. , FUDGE A. , ODGERS C. , TEUBNER J. , SIMMER K. 
Published: March 2008

AbstractThe delivery of Vitamin A from parenteral nutrition may be suboptimal. To Investigate this sample solutions were prepared and Vitamins A and E concentrations from the solution bags and the efflux from the lines were measured over a 24 h period. The results show that mean Vitamin A levels in the solution bags declined from a range of 57‐66% to 17% of expected over 24 h and at the efflux of the lines from a range of 13‐29% to 4% of expected, giving a calculated delivery of 10% of expected. There is no improvement with light protection or an ethylene vinyl acetate system. Mixing the vitamin preparation in lipid showed less decline (from 92 to 70% of expected over 24 h), but the delivery was variable. When vitamins were added to a lipid‐dextrose‐amino acid solution, there was minimal loss from the solution bag and line with a calculated delivery of 94% of expected. The delivery of Vitamin E from all systems was constant with a mean calculated delivery of 74% of expected.It was concluded that the mixing of multivitamins in dextrose‐amino acid‐electrolyte solutions results in poor delivery of Vitamin A and this is improved by mixing in lipid solution. This is important in preterm infants who are prone to become Vitamin A deficient.
The natural history of untreated phenylketonuria over 20 years
Authors: PITT D. B. , DANKS D. M. 
Published: March 2008

ABSTRACTFifty‐one adult with untreated phenylketonuria (PKU), have been reviewed after a 20 year interval, at ages ranging from 28.8 to 71.8 years. Five died of causes unrelated to PKU. Three severely affected individuals had shown a progressive loss of motor function and three had developed epilepsy, bringing the total with this problem to 12. No loss of abilities was apparent in 41 patients. Other health problems, including cataracts, were not frequent. Serum phenylalanine levels had decreased over the 20 year period. Untreated PKU does not generally cause progressive loss of abilities during adult life.
Reduced mortality in small premature infants treated at birth with a single dose of synthetic surfactant
Authors: CORBET A. J. , LONG W. A. , MURPHY D. J. , GARCIA‐PRATS J. A. , LOMBARDY L. R. , WOLD D. E. 
Published: March 2008

ABSTRACTA randomized controlled trial of Exosurf® Neonatal, a synthetic exogenous surfactant, was performed. Exosurf was given to premature infants weighing 700‐1350 g, by instillation down the endotracheal tube during mechanical ventilation, within 1 h of birth. Control infants were treated with air. Dose administration was performed in secrecy by clinicians who maintained the blind for 2 years. A total of 109 infants received air and 109 received Exosurf; 19 infants with congenital pneumonia or major malformations were excluded from the primary efficacy analysis. By the age of 28 days there were 14 deaths in the air group and 4 deaths in the Exosurf group, a 69% reduction with Exosurf (P= 0.050). Survival without bronchopulmonary dysplasia at the age of 28 days was significantly improved by 15% (P= 0.050). By the age of 1 year post‐term there were 19 deaths in the air group and 10 deaths in the Exosurf group, a 42% reduction with Exosurf (P = 0.104). There were no significant changes in the incidence of bronchopulmonary dysplasia, pulmonary air leaks, intraventricular haemorrhage, patent ductus arteriosus, necrotizing enterocolitis or infection. The reduction in mortality indicates important results in high risk premature infants treated soon after birth with a single dose of Exosurf.
Fundoplication in preterm infants with gastro‐oesophageal reflux
Authors: JUSTO R. N. , GRAY P. H. 
Published: March 2008

ABSTRACTGastro‐oesophageal reflux in preterm infants may result in recurrent pulmonary insult due to aspiration of gastric contents, and intractable obstructive apnoea. Fundoplication is effective in controlling reflux when medical management has failed. Our experience between 1981 and 1990 was reviewed to assess the efficacy of early surgery in the management of 11 such infants. The infants had a median gestational age of 29 weeks and a median birthweight of 1032g. Nine infants had fundoplication for recurrent aspiration pneumonitis and two for intractable apnoea. The median age at the time of surgery was 100 days and the median weight of the infants was 2640 g. Nine infants were oxygen dependent and two were still ventilated at the time of surgery. The operative procedure was well tolerated by 10 of the 11 infants. Surgery failed to control reflux in two infants, although good control was obtained in the one who had subsequent surgery. Three infants required prolonged ventilation postoperatively; two of them died later from pulmonary failure. The median time to discharge was 24 days (8‐113 days). All infants with intractable apnoea were cured by surgery. Fundoplication is an effective method of management when used early in the treatment of chronic gastro‐oesophageal reflux in preterm infants. There is minimal morbidity from the surgical procedure.
Survival, growth and quality of life in children after orthotopic liver transplantation: A 5 year experience
Authors: CHIN S. E. , SHEPHERD R. W. , CLEGHORN G. J. , PATRICK M. K. , JAVORSKY G. , FRANGOULIS E. , ONG T. H. , BALDERSON G. , KOIDO Y. , MATSUNAMI H. , LYNCH S. V. , STRONG R. 
Published: March 2008

ABSTRACTThe aims of this study were to investigate outcome and to evaluate areas of potential ongoing concern after orthotopic liver transplantation (OLT) in children. Actuarial survival in relation to age and degree of undernutrition at the time of OLT was evaluated in 53 children (age 0.58‐14.2 years) undergoing OLT for endstage liver disease. Follow‐up studies of growth and quality of life were undertaken in those with a minimum follow‐up period of 12 months (n= 26). The overall 3 year actuarial survival was 70%. Survival rates did not differ between age groups (actuarial 2 year survival for ages <1,1‐5 and >5 years were 70, 70 and 69% respectively) but did differ according to nutritional status at OLT (actuarial 2 year survival for children with Z scores for weight <−1 was 57%, >−1 was 95%; P=0.004). Significant catch‐up weight gain was observed by 18 months post‐transplant, while height improved less rapidly. Quality of life (assessed by Vineland Adaptive Behaviour Scales incorporating socialization, daily living skills, communication and motor skills) was good (mean composite score 91±19). All school‐aged children except one were attending normal school. Two children had mild to moderate intellectual handicap related to post‐operative intracerebral complications. Satisfactory long‐term survival can be achieved after OLT in children regardless of age but the importance of pre‐operative nutrition is emphasized. Survivors have an excellent chance of a good quality of life and of satisfactory catch‐up weight gain and growth.
Benign intracranial hypertension in childhood: A review of 23 patients
Authors: DHIRAVIBULYA K. , OUVRIER R. , JOHNSTON I. , PROCOPIS P. , ANTONY J. 
Published: March 2008

Abstract  Twenty‐three patients with benign intracranial hypertension (BIH) were seen at the Royal Alexandra Hospital for Children, Sydney over an 18 year period to 1988. Age at presentation ranged from 6 months to 13 years and 5 months. The female to male ratio was 2.3: 1. The aetiological factors (sometimes multiple) included: chronic middle ear infection, 30%; dural sinus thrombosis, 22%; head injury, 13% Vitamin A overdosage, 4%; tetracycline exposure, 4%; and no apparent cause, 43%. Headache was the most common presenting symptom occurring in 91% of patients, followed by vomiting in 65% and blurred or double vision in 57%. Papilloedema occurred in 96% of patients, abducens palsy was noted in 48% and visual impairment in 45%. All patients improved clinically after treatment, one with lumbar puncture only. Of 17 patients treated with steroids, 10 patients recovered and seven patients went on to lumboperitoneal shunt. Two patients recovered with steroid and diuretic treatment. Of two patients initially treated with diuretics only, one recovered and one subsequently required a shunt. Only one patient was initially treated with a lumboperitoneal shunt. Three of the shunted patients had shunt block requiring revision. None had permanent visual loss or other significant sequelae.The visual prognosis of BIH in childhood is good. In view of the relatively high complication rate of steroids and shunting, a controlled comparison of steroid vs acetazolamide/diuretic therapy should be undertaken.
Insulin deficiency: Effects on fetal growth and development
Authors: FOWDEN A. L. 
Published: March 2008

AbstractInsulin deficiency in either the mother or foetus has significant effects on fetal growth and development. In the human, maternal insulin deficiency, or diabetes mellitus, leads to macrosomia and increased adiposity of the foetus, while specific fetal hypo‐insulinaemia is associated with intra‐uterine growth retardation. When maternal diabetes is induced in experimental animals, no consistent increases in fetal bodyweight are observed although the body fat content of the foetus is increased in the majority of species studied. The magnitude of the fetal weight gain during maternal diabetes appears to be determined by the body fat content of the foetus, the severity and duration of the diabetes and by the temporal pattern of maternal hyperglycaemia observed during pregnancy. The latter factors, in particular, influence the level of insulin in the foetus which, in turn, regulates the rate of intra‐uterine growth. By contrast, fetal insulin deficiency has a more uniform effect on fetal growth and leads to impaired growth in both experimental and naturally occurring hypo‐insulinaemic conditions. Fetal insulin deficiency reduces fetal growth by decreasing nutrient uptake and utilization of the fetal tissues and by altering the circulating concentrations of the insulin‐like growth factors. Consequently, deficiencies in either fetal or maternal insulin secretion during pregnancy can alter fetal growth and have important consequences for perinatal survival and postnatal morbidity.
Priorities and practice in tropical paediatrics
Authors: BIDDULPH J. 
Published: March 2008

AbstractMore than 14 million children under 5 years of age die annually in the Third World, mainly due to diarrhoea, pneumonia, malaria and immunizable diseases. The problems of poverty, malnutrition, poor sanitation, illiteracy and high fertility that traditionally are associated with underdevelopment are now being compounded by social disruption due to rapid changes in lifestyle, new diseases such as AIDS and Third World debt.A vital part of the solution is provision of basic medical and education services to all, with emphasis on female literacy and improving the status of women. Key elements in providing basic medical services are delegation and empowerment. Doctors must delegate the delivery of essential child health services to appropriately trained and adequately supported auxiliaries. Parents, especially mothers, need to be empowered with the knowledge and resources to recognize and manage, or assist in the management of, their children's health problems.