bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes of neonatal clinicians towards resuscitation of the extremely premature infant: An exploratory survey
Authors: Oei J , Askie Lm , Tobiansky R , Lui K 
Published: March 2003

Objective: This study aims to explore the current attitudes of Australian neonatologists and nurses towards the resuscitation of extremely preterm infants. Methodology: An anonymous questionnaire regarding resuscitation of infants of less than 28 weeks gestation was sent to all neonatologists and three registered nurses in each perinatal centre in Australia. Results: One hundred and thirty‐three questionnaires were sent. A return rate of 93% and 73% was obtained from neonatologists and nurses, respectively. Twenty‐two per cent of neonatologists would ‘occasionally’ resuscitate at 22 weeks while none of the nurses would. A considerable proportion of neonatologists (23%) but only a few nurses (6%) would ‘quite often’ resuscitate 23‐week infants. The majority of neonatologists (85%) and nurses (88%) would ‘almost always’ resuscitate 24 week infants. More than half of the respondents would ‘occasionally’ resuscitate a 400–499 g infant and most would resuscitate infants weighing more than 500 g. Clinicians were not as optimistic of long‐term outcome as they were for survival. Typically, only 52% of neonatologists and 38% of nurses thought babies of 25 weeks gestation had a greater than 50% chance of survival without major handicap. Parental wishes and the presence of congenital abnormalities were major influences on decision to resuscitate. Hypothetically, most respondents, more doctors than nurses, would consider initiating resuscitation without parental consent at a median gestation of 25 weeks. Conclusions: The majority of Australian clinicians would resuscitate at a gestation of 24 weeks or greater or at a birth weight of over 500 g despite conservative estimates of intact survival. This survey has brought to light the importance of communication with parents prior to extreme premature birth.
Treatment of pleural empyema
Authors: Chan Pwk , Crawford O , Wallis C , Dinwiddie R 
Published: March 2003

Objective: To determine the clinical presentation and treatment strategies for children admitted with pleural empyema. Methodology: Retrospective review of medical and radiological records of 54 patients admitted with pleural empyema between January 1989 and April 1997. Results: Fever (98%), cough (83%), chest pain (38%), clinical cyanosis (17%) and abdominal pain (16%) were common clinical features. The causative organism was identified in 17 patients (31%). Intravenous antibiotics were given for a mean of 18.2 ± 7.5 days. Forty‐seven (87%) patients had closed chest tube drainage and 21(39%) patients underwent decortication for unsatisfactory response to medical treatment. The chest tube insertion was more likely to be delayed in patients who required decortication, although the difference was not significant (8.1 ± 5.4 vs 6.3 ± 5.2 days of illness, P = 0.67). All patients were discharged well, with almost complete resolution of the chest radiograph at 6 months. Conclusions: Intensive medical management with adequate chest tube drainage and appropriate antibiotics will result in full resolution for most patients. Surgical intervention is important in patients who fail to receive adequate treatment early in the disease.
Impact of infant feeding practices on the risk of mother to child transmission of HIV‐1 in Zimbabwe
Authors: Olayinka Ba , Oni Ao , Mbajiorgu Fe 
Published: March 2003

Objective: To determine the magnitude of the contribution of infant feeding practices on the risk of mother to child transmission (MTCT) of the HIV‐1 infection. Methodology: Prospective data from birth until 24 months of age on 236 infants born to HIV‐positive mothers in Harare, Zimbabwe was analysed for this study. However, because only a small proportion of infants (2.1%) were HIV‐1 polymerase chain reaction (PCR) tested shortly after birth, the PCR results for infants at birth were not incorporated into our analyses. The contribution of infant feeding practices on the risk of MTCT of HIV‐1 was assessed using Cox Proportional Hazards Regression Models. Results: The incidence of HIV‐1 through MTCT was greatest among breastfed (8.33 per 100 child‐months) and mixed fed (8.64 per 100 child‐months) infants by 3 months. After adjustment for maternal age, marital status, education and infant antibody HIV‐1 status, the cumulative relative risk of MTCT of HIV‐1 was 4.19 (95% confidence interval (CI) 3.44, 5.09) among breastfed and 1.10 (95% CI 0.97, 1.25) among mixed fed infants. The overall MTCT rate of HIV‐1 in this study was 40.3%. Conclusions: Breastfed infants had the greatest cumulative relative risk of MTCT of HIV‐1, followed by mixed fed infants, with the highest incidences occurring within the first 3 months.
Cardiac responses to mild hypoxic hypercapnia in newborn babies: No effect of sleep position
Authors: Naidoo M , Colditz Pb , Browne Ca , Dunster Kr 
Published: March 2003

Objective: To evaluate whether cardiac responses to a level of hypoxic hypercapnia that may be observed in rebreathing studies are altered with infant sleep position. Methodology: Eighteen healthy term infants (< 5‐days‐old) were studied. Heart rate (HR) and HR variability were monitored during air breathing and during 3 min exposure to a mixture of 15% O2/3% CO2 in both the prone and supine positions. Power spectral analysis of HR was performed. Results: Heart rate was the only measured variable to be significantly changed in response to 15% O2/3% CO2. Hypoxic hypercapnia elicited no significant responses in power spectral HR variables. There was no effect of sleeping position on any of the measured variables. Conclusions: There are no significant differences in cardiac responses to mild hypoxic hypercapnia between sleep positions and power spectral indices of the autonomic control of HR are not altered by sleep position in newborn babies.
Parental attitudes to health of children in child‐care centres and options when children are ill
Authors: Slack‐Smith L M , Read A W , Stanley F J 
Published: March 2003

Objective: To determine parental attitudes regarding the health of children attending child‐care centres, to explore concerns when children who normally attend child care are ill, and to investigate options in these circumstances. Methodology: Focus groups conducted with parents whose children attended child‐care centres. Ten focus groups were conducted. Results: Many parents encountered difficulty when children who normally attend child care were ill and there was a lack of options for care. Parents were concerned about the spread of infections among children but considered that there were also many health and other advantages for their children in attending child care. Child‐care centres were perceived as providing a valuable support role for families. Conclusions: Many parents lack adequate options for care when their children are ill. Parents’ concerns regarding health in child care are important in policy decisions regarding the health of children in child care, and the development of alternative care services for children.
Single‐daily ceftriaxone plus amikacin versus thrice‐daily ceftazidime plus amikacin as empirical treatment of febrile neutropenia in children with cancer
Authors: Ariffin H , Arasu A , Mahfuzah M , Ariffin WA , Chan LL , Lin HP 
Published: March 2003

Objective: Empirical antibiotic treatment for febrile neutropenic patients has been the mainstay of treatment for many years. Beta‐lactam antibiotics and aminoglycosides have been the most frequently used drug combination. The purpose of this study was to evaluate the efficacy, safety, tolerance and costs of single‐daily ceftriaxone plus amikacin versus thrice‐daily dose of ceftazidime plus amikacin. Methodology: One hundred and ninety‐one episodes of fever and neutropenia in 128 patients from October 1997 to December 1998 were included in a prospective, open‐label, single‐centre study. Patients were randomly assigned to either treatment group and evaluated as successes or failures according to defined criteria. Daily assessments were made on all patients and all adverse events recorded. Univariate and multivariate analysis of outcomes and a cost analysis were carried out. Results: There were 176 evaluable patient‐episodes with 51.1% in the single‐daily ceftriaxone–amikacin group and 48.9% in the ceftazidime–amikacin group. There were 50 positive blood cultures: 12 Gram‐positive bacteria, 33 Gram‐negative bacteria and five fungi. Pseudomonas aeruginosa (P. aeruginosa) accounted for 14% of total isolates. The overall success rate was 55.5% in the ceftriaxone group compared to 51.2% in the ceftazidime group (P = 0.56). Mean time to defervescence was 4.2 days in the single‐daily group and 4.3 days in the thrice‐daily group. There were nine infection‐related deaths; five in the single‐daily ceftriaxone group. The daily cost of the once‐daily regime was 42 Malaysian Ringgit less than the thrice‐daily regime. There was a low incidence of adverse effects in both groups, although ototoxicity was not evaluable. Conclusions: The once‐daily regime of ceftriaxone plus amikacin was as effective as the ‘standard’ combination of thrice‐daily ceftazidime and amikacin with no significant adverse effects in either group. The convenience and substantial cost benefit of the once‐daily regime will be particularly useful in developing countries with limited health resources and in centres with a low prevalence of P. aeruginosa.
Frequency and perception of cough severity
Authors: Chang AB , Phelan PD , Robertson CF , Newman RG , Sawyer SM 
Published: March 2003

Objective: The frequency of the common symptom of cough in children is unknown. The aim of this study was to compare cough frequency and perception of cough severity in children with and without recurrent cough. Methodology: Eighty‐four children with (C) and without (NC) recurrent cough were recruited in the same season. Cough frequency (measured with cough‐meter) and subjective cough severity (measured on parent‐completed and child‐completed diary cards on two subjective systems), were compared between the two groups. Results: Cough frequency in C (median 65/day) was significantly higher than in NC (10/day). The correlation between daytime and night‐time cough was higher in NC (rs = 0.51, P < 0.00001) than in C (rs = 0.3, P = 0.05). The C group had significantly higher coughs per score than NC, for both subjective methods. Conclusion: Children with recurrent cough have a higher frequency and different pattern of cough than controls enrolled in the same season. Subjective perception of cough severity is dependent on the population studied.
Duration of antibiotics in children with osteomyelitis and septic arthritis
Authors: Vinod MB , Matussek J , Curtis N , Graham HK , Carapetis JR 
Published: March 2003

Objective:  To evaluate the outcomes of children with acute osteomyelitis and septic arthritis at a hospital where short‐duration antibiotic treatment (≤3.5 weeks) was considered routine.Methodology:  We carried out a retrospective chart review, with telephone interviews to follow up and determine long‐term outcomes. Patients were selected to be at low risk for complications (illness ≤14 days, no underlying disease, uncomplicated presentation).Results:  Thirty‐two children with osteomyelitis (OM), 34 with septic arthritis (SA) and five with OM and SA (OMSA) were included. Blood cultures were positive (mainly Staphylococcus aureus) in 15% of patients who had not had prior antibiotic treatment, and microbiological confirmation (positive blood culture, Gram stain or culture of surgical specimen) was obtained in 36%. The median duration of antibiotic treatment was 5.4, 4.4 and 5.0 weeks for OM, SA and OMSA, respectively. Only 22% of patients received antibiotics for 3.5 weeks or less. Overall, the recurrence rate was 1.4%. At follow‐up, only two patients had mild occasional pain at the site of the original infection; all patients had normal function.Conclusions:  Contrary to expectations and local protocols, most patients were treated with conventional long‐duration therapy. Patients treated for short courses had good outcomes. The low rate of complications may make randomized controlled equivalence trials unfeasible. Increasing evidence of the efficacy and safety of short‐duration treatment (3−3.5 weeks) for acute, uncomplicated OM or SA in children suggests that this could be accepted as the standard treatment. However, this should be evaluated prospectively using a register, with at least 12 months’ of follow‐up.
Educational outcome at 8 years for children who were born extremely prematurely: A controlled study
Authors: Bowen JR , Gibson FL , Hand PJ 
Published: March 2003

Objective:  To assess the educational outcome and utilization of special education resources at age 8 years in children who were born extremely prematurely, and to compare this outcome with a matched cohort of children born full‐term.Methods:  All children with gestational age less than 28 weeks or birthweight of less than 1000 g, born at Royal North Shore Hospital from July 1985 through June 1990 were enrolled in a study of long‐term outcome. A cohort of full‐term children matched for age, sex and school with non‐disabled extremely premature children was enrolled at age 8 years. Children were assessed using standardized measures of cognitive and academic achievement. Information was obtained from teachers regarding educational support and academic progress.Results:  Of 82 extremely premature children assessed at age 8 years, 8 (10%) had a severe disability, 13 (16%) had a mild or moderate disability and 61 (74%) were non‐disabled (IQ ≥ 85, no neurosensory disability). Thirty‐five (43%) required special education support, 22 (27%) were below grade level in reading or mathematics and 25 (30%) were performing at grade level without support. Compared with controls, non‐disabled extremely premature children had lower scores on standardized measures of academic achievement and were more likely to be reported by teachers as falling below grade level in reading (48% vs 13%; P < 0.001), mathematics (48% vs 10%; P < 0.001) and spelling (48% vs 17%; P < 0.002), and to require special education support (25% vs 4%; P = 0.004).Conclusion:  Parents and professionals caring for extremely premature children need to be alert to the additional support that these children may require at school.
Developmental outcome of preterm infants after surfactant therapy: Systematic review of randomized controlled trials
Authors: Sinn JKH , Ward MC , Henderson‐Smart DJ 
Published: March 2003

Objectives:  To review neuro‐developmental outcome at 1 and 2 years of age following randomized controlled trials (RCT) of neonatal surfactant therapy.Methods:  A systematic review of the MEDLINE, Embase and Cochrane Controlled Trial Register databases, searching for RCT of surfactant replacement therapy with follow‐up outcomes, was carried out. The main outcome measures were severe and mild disability at 1 and 2 years plus composite adverse outcome of death and/or severe disability.Results:  A meta‐analysis using odds ratios was carried out on 13 RCT. There were a total of 2218 treated and 2090 control infants who underwent follow up at 1 year of age. There were 303 treated and 292 control infants with follow up at between 18 months and 2 years of age. Surfactant therapy was associated with a lower rate of mild disability at 1 year (OR 0.79; 95% CI 0.66−0.95). There was a reduction in the combined adverse outcome (death or severe disability rate) at 1 year (OR 0.8; 95% CI 0.72−0.89). Neither the 1 year nor the 2 year follow‐up examination showed a statistical difference in the severe disability rate between the control and treated group.Conclusion:  Surfactant therapy increases survival without an increase in subsequent morbidity at 1 and 2 years of age.
Telephone reminders improve adolescent clinic attendance: A randomized controlled trial
Authors: Sawyer SM , Zalan A , Bond LM 
Published: March 2003

Objectives: To measure the effect of telephone reminders on adolescent clinic attendance. Methods: Clinic bookings of adolescents were randomly assigned to either a telephone reminder one day prior to their appointment, or a routine booking (no reminder). The setting was four general adolescent health clinics within a tertiary public adolescent health care service at the Centre for Adolescent Health. The main outcome measures were clinic non‐attendance, reason for non‐attendance, and satisfaction with the booking system. Results: One hundred and seventy one adolescent appointments were studied. Of these, 51.5% were female, and 25% of bookings were for new, rather than review appointments. One hundred and one adolescents were randomly allocated to the reminder group, of whom 87% were contacted. The use of reminders (intention to treat analysis) significantly reduced the non‐attendance rate from 20% to 8% (odds ratio 0.35; P = 0.03). Non‐attendance was three times more likely for a new appointment than for review appointments. ‘Forgetting’ was the most common explanation given by patients (35%) who did not attend. Seventy‐nine per cent of parents reported telephone reminders were helpful at prompting attendance. Conclusion: Telephone reminders greatly improved attendance at these adolescent clinics. The background non‐attendance rate and the proportion of high‐risk patients for non‐attendance (new appointments in this setting) will determine whether reminders are more efficiently targeted at specific bookings than used routinely.
Systematic review of rheumatic heart disease prevalence in children in developing countries: The role of environmental factors
Authors: Steer AC , Carapetis JR , Nolan TM , Shann F 
Published: March 2003

Objectives:  To consider the worldwide prevalence of rheumatic heart disease in children in developing countries using surveys with uniform methodologies, and to consider the effect of environmental factors including socio‐economic status, overcrowding, urbanization, nutrition and access to medical services on the distribution of rheumatic heart disease in developing countries.Methods:  Sixty‐one surveys of the prevalence of rheumatic heart disease in developing countries were found using a systematic review of MEDLINE from January 1976 to July 1999. Twenty‐four studies were selected for comparison based on their uniform methodological and diagnostic techniques.Results:  There is a high prevalence of rheumatic heart disease in the Pacific region with a lower prevalence in the Indian subcontinent, Asian, sub‐Saharan African, Mediterranean, Latin American and Caribbean regions. However, aside from the Indian subcontinent, these regions have not been well studied, and it may be that the true prevalence is actually higher.Conclusions:  There is a lack of good quality prevalence surveys of rheumatic heart disease in developing countries. It appears that a threshold level where higher socio‐economic status is associated with reduced prevalence of rheumatic heart disease is not reached in developing countries. Therefore, differences in prevalence between socio‐economic groups in the one area cannot be detected. A similar case can be made for overcrowding. Many regions need well‐designed studies of rheumatic heart disease that incorporate assessment of environmental factors as well as the study of the microbiological epidemiology of rheumatic heart disease and group A streptococci.
Salinisation: A major threat to water resources in the arid and semi‐arid regions of the world
Authors: Williams W. D. 
Published: March 2003

AbstractSemi‐arid and arid regions (i.e. drylands with annual mean rainfall between 25 and 500 mm) cover approximately one‐third of the world’s land area and are inhabited by almost 400 million people. Because they are a resource in short supply, waters in drylands are under increasing human pressures, and many are threatened by rising salinities (salinisation) in particular. Rising salinities result from several causes. The salinities of many large natural salt lakes in drylands are rising as water is diverted from their inflows for irrigation and other uses. The excessive clearance of natural, deep‐rooted vegetation from catchments and the discharge of saline agricultural wastewater causes the salinity of many freshwater lakes, wetlands and rivers to rise. The salinisation of some fresh waters is caused by rising saline groundwaters. And in some regions, increasing climatic aridity may be a cause of salinisation. Whatever the cause, salinisation has significant economic, social and environmental impacts. They are usually deleterious and often irreparable. Decreased biodiversity, changes in the natural character of aquatic ecosystems, and lower productivity are frequent ecological effects. In some dryland countries, salinisation is viewed as the single most important threat to water resources. However, the extent and importance of salinisation as a global threat has been greatly underestimated. Recognition of this is the first step in any attempt to manage it effectively. The aims of the present paper, therefore, are three‐fold. First, it aims to define the problem and indicate its extent; second, it aims to outline the causes and effects of salinisation; third, it aims to highlight the social, economic and environmental costs and comment on management responses. An overarching aim is to draw attention to the importance of salinisation as a phenomenon of global significance to waters in drylands.
Numerical simulation of domestic wastewater sewer performance
Authors: Dabrowski Wojciech , Piaseczny Grzegorz 
Published: March 2003

AbstractThe hydraulics of municipal sewers were considered with respect to flow rate fluctuations that sometimes cause accumulation and sometimes cause scouring of the sediments. The minimal slopes that would ensure self‐cleaning conditions once a day and the required capacity for the yearly maximum peak flows were calculated. The range of fluctuations in shear stresses along the sewer walls and in the wastewater table were observed and compared for sewers of different diameters. From these computations a simple design rule for predicting minimal slopes was developed.
Forms of particulate phosphorus in suspension and in bottom sediment in the Danube Delta
Authors: Bostan V. , Dominik J. , Bostina M. , Pardos M. 
Published: March 2003

AbstractIn the summer of 1995, samples of suspended solids and bottom sediments were collected from the lower course of the Danube, downstream from potential pollution sources such as tributaries draining industrialised and densely populated watersheds (the Jiu, Olt, Arges and Ialomita rivers) or big cities on the border of the river (Tulcea, Galati, Braila), and from the Danube Delta. Chemical and toxicological analyses were carried out on these samples. In the present paper, the results of the measurements of the forms of particulate phosphorus are discussed. Phosphorus occurring in the bottom sediments and the suspended solids has various origins and chemical forms. These forms may be operationally defined as: organic phosphorus (OP), apatite inorganic phosphorus (AP) and non‐apatite inorganic phosphorus (NAIP). The AP shows low variability, ranging from 350 to 400 p.p.m. for suspended solids and from 425 to 500 p.p.m. for bottom sediments. This is essentially due to the detrital origin of this form. These values are typical for freshwater sediments in European rivers. The NAIP, which originates both from natural sources and from human pollution, shows a high variability. This indicates that the nutrient pollution is derived from both point and non‐point sources in the watershed. The NAIP concentrations of 800 p.p.m. (Vadul Oii) and 850 p.p.m. (Oltenita) are very high (fourfold the average for European rivers), indicating that strong anthropogenic sources of phosphorus are present in the lower Danube watershed. As the NAIP is potentially bioavailable, its high concentration may contribute to eutrophication in the lower Danube and the Danube Delta.