Aust Paediatr J
· 1989 Oct · PMID 2590128
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During the 1970s, there was an epidemic of neonatal convulsions occurring in apparently normal babies during the fourth and fifth days of life. This syndrome was noted in France as well as in Australia. A study was under...During the 1970s, there was an epidemic of neonatal convulsions occurring in apparently normal babies during the fourth and fifth days of life. This syndrome was noted in France as well as in Australia. A study was undertaken to review the King George V Hospital (KGV) experience with these 'fifth day fitters'. All cases of neonatal convulsions at KGV during the years 1972-85 were reviewed. A total of 94 cases of fifth day fits occurred during this period, accounting for 57% of all neonatal convulsions occurring during 1972-79. The fits occurred in healthy term infants after an uncomplicated pregnancy. They appeared on the fourth and fifth days of life. The seizures lasted an average of 24 h, were refractory to drug therapy and, despite extensive investigation, no cause was found. The infants were assessed as normal at the time of discharge from hospital. Follow-up of these infants was incomplete. However, from the data available, it cannot be assumed to be a benign entity. The 'fifth day fit' syndrome reached epidemic proportions at a number of maternity units during the 1970s. At KGV, no case has been observed since 1982.
Aust Paediatr J
· 1989 Oct · PMID 2590127
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The value of the use of safety restraints for all vehicle occupants has been recognized, and corresponding legislation has been implemented in Australia. However, legislation alone has not been sufficient to increase sig...The value of the use of safety restraints for all vehicle occupants has been recognized, and corresponding legislation has been implemented in Australia. However, legislation alone has not been sufficient to increase significantly the use of safety restraints for infants. In an attempt to address this issue, a statewide infant safety restraint loan scheme has been in operation in Victoria since May 1985. At the time of this study, 203 of 210 municipalities in Victoria were participating in the scheme. An operational evaluation of the Bassinet Loan Scheme (BLS) was undertaken after 18 months of operation. Questionnaires were completed by 426 parents attending selected maternal and child health centres. The questionnaire was designed to provide information about the use of safety restraint for infants aged 0-6 months, parental attitudes towards the restraint, and sociodemographic characteristics. The study demonstrated that 81% of the population surveyed used the infant safety restraint, but only 52% were in the BLS. The pattern of usage of safety restraints for infants was related to maternal age and educational level.
Aust Paediatr J
· 1989 Oct · PMID 2511832
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Twelve per cent of Aboriginal infants born in the Kimberley region of Western Australia in 1980 were of low birthweight; this is more than twice the incidence in the non-Aboriginal population of Western Australia. There...Twelve per cent of Aboriginal infants born in the Kimberley region of Western Australia in 1980 were of low birthweight; this is more than twice the incidence in the non-Aboriginal population of Western Australia. There was widespread faltering of growth (weight and height) after 6 months of age in Aboriginal children whether they were of normal or low birthweight. Growth retardation was more marked in low birthweight babies who showed little evidence of 'catch-up' growth in the first 5 years of life.
Aust Paediatr J
· 1989 Oct · PMID 2511831
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Fourteen patients with precocious puberty were treated for 1-3 years with 900-1800 micrograms/day of intranasal (i.n.) Buserelin. The peak luteinizing hormone and follicle-stimulating hormone responses to intravenous lut...Fourteen patients with precocious puberty were treated for 1-3 years with 900-1800 micrograms/day of intranasal (i.n.) Buserelin. The peak luteinizing hormone and follicle-stimulating hormone responses to intravenous luteinizing hormone-releasing hormone were reduced significantly 4 weeks after starting treatment and remained suppressed while the patients were on treatment. Two patients were withdrawn because of drug non-compliance. Three patients showed regression of pubertal changes, four patients showed no progression and five patients showed progression of breast size or pubic hair staging after 1.5-2 years of treatment. Treatment was changed to the subcutaneous route in two patients because of hormonal escape and accelerated skeletal maturation. The mean growth velocity decreased from 10.78 cm/year (s.e.m. = 0.64) to 7.06 cm/year (s.e.m. = 0.85) after 1 year of treatment (P less than 0.005). After an increase in dosage (from 900 micrograms/day to 1800 micrograms/day) in most patients, further significant falls in growth velocity to 5.29 cm/year (s.e.m. = 0.45), 4.63 cm/year (s.e.m. = 0.8) and 5.06 cm/year (s.e.m. = 0.5) were observed at 18, 24 and 30 months, respectively, compared with the pretreatment value (P less than 0.001). With treatment, the increased rate of skeletal maturation normalized. In 10 patients who had completed 2 years of treatment, the height standard deviation score for bone age improved from a pretreatment value of -2.42 +/- 0.42 to -1.6 +/- 0.42 after 2 years of treatment (P less than 0.01), indicating an improvement in height prognosis. It is concluded that i.n. Buserelin at a dose of 1800 micrograms/day is effective in the treatment of most but not all patients with precocious puberty.
Aust Paediatr J
· 1989 Aug · PMID 2590122
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A case is reported of Rendu-Osler-Weber syndrome presenting in a 9 year old girl as recurrent haemoptysis. Despite a normal chest X-ray, the patient was found to have multiple areas of angiodysplasia in the major airways...A case is reported of Rendu-Osler-Weber syndrome presenting in a 9 year old girl as recurrent haemoptysis. Despite a normal chest X-ray, the patient was found to have multiple areas of angiodysplasia in the major airways of her right lung.
Aust Paediatr J
· 1989 Aug · PMID 2590121
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Renal manifestations in Kawasaki disease are rare, and nephrotic syndrome in this disorder has not been described previously. We report a 3 month old infant with Kawasaki disease, presenting with nephrotic syndrome which...Renal manifestations in Kawasaki disease are rare, and nephrotic syndrome in this disorder has not been described previously. We report a 3 month old infant with Kawasaki disease, presenting with nephrotic syndrome which responded to steroid therapy. The patient, however, developed coronary aneurysms and died of acute myocardial infarction.
Crawford BA, Cowell CT, Greenacre P
… +3 more, Howard NJ, Stevens MM, Silink M
Aust Paediatr J
· 1989 Aug · PMID 2590120
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The effect on carbohydrate metabolism of a high dose growth hormone (GH) regimen (1.2 U/kg per week) was assessed on 24 children who had previously been treated for leukaemia. Sixteen patients received high dose GH and e...The effect on carbohydrate metabolism of a high dose growth hormone (GH) regimen (1.2 U/kg per week) was assessed on 24 children who had previously been treated for leukaemia. Sixteen patients received high dose GH and eight patients received a conventional dose of GH (0.6 U/kg per week). Oral glucose tolerance tests (OGTT) were performed at baseline and after 3 months of treatment with GH. For the entire group between 0 and 3 months, there was a significant increase in mean (and standard deviation) fasting plasma glucose (0.3 +/- 0.6 mmol/L), fasting insulin level (11 +/- 26 mU/L), and 2 h insulin level (20 +/- 40 mU/L). One patient, who received a conventional dose of GH, developed substantial carbohydrate intolerance. For the entire group, there was no change in response to a carbohydrate load at 3 months as measured by the area under the plasma glucose or insulin curve. There was no significant difference between conventional and high dose groups at 3 months as assessed by these parameters. This study demonstrates that a higher dose of GH may be used in these children in an attempt to improve their final height, without increased risk of carbohydrate intolerance in the short term.
Aust Paediatr J
· 1989 Aug · PMID 2590119
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Rates of hospital admissions and bed usage for infections by Aborigines up to 15 years of age were much higher in Western Australia during 1981-86 than they were for the rest of the population. These rates for Aboriginal...Rates of hospital admissions and bed usage for infections by Aborigines up to 15 years of age were much higher in Western Australia during 1981-86 than they were for the rest of the population. These rates for Aboriginal infants for gastroenteritis, for example, were 20-25 times and 40-50 times those for other infants. The rates mostly declined over the 6 years except for gastrointestinal and respiratory infections in Aboriginal infants and young children in rural and remote areas. Hospitalization rates reflect many factors which include disease incidence and severity but also distance, climate and access to medical and nursing care and their utilization. Preventative health programmes must be maintained to help improve the health of young Aborigines.
Sawyer MG, Sarris A, Baghurst PA
… +2 more, Worsley A, Kalucy RS
Aust Paediatr J
· 1989 Aug · PMID 2590118
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This study examined beliefs about the normal development of preschool children held by adolescents, medical students and mothers. A consistent pattern was identified, with adolescents estimating that young children can d...This study examined beliefs about the normal development of preschool children held by adolescents, medical students and mothers. A consistent pattern was identified, with adolescents estimating that young children can do the least, medical students' estimations lying between those of adolescents and mothers, and mothers estimating that the children can do the most. In addition, medical students were found to change their beliefs during the time that they participated in their paediatric teaching programme. It is suggested that paediatricians and other child health professionals take into account the varying beliefs held by different groups in the community when providing advice or teaching about early child development.
Aust Paediatr J
· 1989 Aug · PMID 2590117
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This study of high risk infants aimed to identify which signs at the corrected ages of 1, 4 and 8 months were important for distinguishing those infants who later developed hypertonic cerebral palsy (CP). From a total co...This study of high risk infants aimed to identify which signs at the corrected ages of 1, 4 and 8 months were important for distinguishing those infants who later developed hypertonic cerebral palsy (CP). From a total cohort of 450 infants (350 of birthweight less than 1500 g and 100 of birthweight greater than 1500 g), 26 infants were later diagnosed as having CP and formed the study group. A control group of 26 infants from the same initial cohort who did not develop CP was matched to the study group. Both groups were followed for a minimum of 2 years. At each assessment (1, 4, 8, 24 months corrected age), all children were assessed using a standard medical examination and a detailed neurosensorimotor developmental scale that evaluated neurological signs, motor attainments, primitive reflexes and postural reactions. Each test response was graded as normal, suspect or abnormal and the results for the two groups were compared. Assessment at 1 month failed to identify a number of the CP infants whereas at 4 months there was some overidentification. At 8 months, assessment was highly predictive of cerebral palsy. Individual signs of abnormality were found to be of limited value but the presence of three or more abnormal signs at 8 months was highly predictive of CP.
Aust Paediatr J
· 1989 Aug · PMID 2590116
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Pneumograms were performed on 401 asymptomatic infants: 322 siblings, 15 cousins and 24 twins of sudden infant death syndrome (SIDS) victims; 14 siblings of near-miss SIDS victims, and 26 infants of anxious parents. The...Pneumograms were performed on 401 asymptomatic infants: 322 siblings, 15 cousins and 24 twins of sudden infant death syndrome (SIDS) victims; 14 siblings of near-miss SIDS victims, and 26 infants of anxious parents. The infants of anxious parents had significantly fewer abnormalities than siblings of SIDS victims. In 222 infants subsequently monitored at home, the pneumogram as a predictor of future apnoea had a sensitivity rate of 97.5% and a specificity rate of 72% (P less than 0.001). Infants who were to experience future apnoeas had a significantly higher percentage of time in periodic breathing and a higher density of apnoeas in their original pneumograms. However, the abnormal pneumogram did not predict SIDS, because the eight infants who died all had normal pneumograms.
Aust Paediatr J
· 1989 Aug · PMID 2590115
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Drug utilization has been audited prospectively for all infants cared for in a regional neonatal intensive care unit for a 3-month period. Twenty-five infants had a birthweight less than 1500 g and 54 had a birthweight g...Drug utilization has been audited prospectively for all infants cared for in a regional neonatal intensive care unit for a 3-month period. Twenty-five infants had a birthweight less than 1500 g and 54 had a birthweight greater than 1500 g. The total number of different drugs used was 76 and the mean number received was 8.6 with a range of 0-30. Infants with birthweights less than 1500 g received a mean of 14.5 drugs and infants with birthweights greater than 1500 g received a mean of 4.8 drugs. Almost two-thirds (63%) of doses were given orally, 20% intravenously and 10% via an umbilical artery catheter. Three drugs, one of which was received by 13% of infants, carried manufacturers' inserts advising against use in premature infants or the newborn.
Aust Paediatr J
· 1989 Aug · PMID 2590114
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Southern New Zealand has one of the highest reported rates of the sudden infant death syndrome (SIDS) in the world. Data were collected on 49 infants who died from SIDS in the Dunedin and Invercargill Health Districts of...Southern New Zealand has one of the highest reported rates of the sudden infant death syndrome (SIDS) in the world. Data were collected on 49 infants who died from SIDS in the Dunedin and Invercargill Health Districts of southern New Zealand. Forty-two of the families were interviewed at home following the loss of their infant. In the week prior to death, 17 infants (40%) had an upper respiratory tract infection, although in 11 of these infants their infection had apparently resolved at least 24 h prior to death. Thirty infants (71%) had their faces down into the bedding or their heads covered with bedding. Thirty-four infants (81%) were found dead in the prone position, whereas 49% of New Zealand infants aged 3 months would be expected to sleep prone. Sleep position and the terminal position of the head in relation to SIDS requires further study.
Newman NM, Trinder JA, Phillips KA
… +2 more, Jordan K, Cruickshank J
Aust Paediatr J
· 1989 Aug · PMID 2590113
Polygraphic tracings of 13 normal infants were recorded in a morning sleep at 1 and 2 weeks of age and 1, 2, 3, 4, and 6 months of age. A vibrotactile stimulus graded at 25, 50 and 100 Hz (frequency) and amplitudes of 1,...Polygraphic tracings of 13 normal infants were recorded in a morning sleep at 1 and 2 weeks of age and 1, 2, 3, 4, and 6 months of age. A vibrotactile stimulus graded at 25, 50 and 100 Hz (frequency) and amplitudes of 1, 2 and 3 mm (intensity) was used, each combination being applied twice at 30 s intervals to the hand of the sleeping infant during active sleep (AS) and quiet sleep (QS). The results were analysed as percentages of failure to arouse (FTA) in relation to the number of stimulus trials, the criteria for FTA being the absence of a response in heart or respiratory rate, electroencephalogram, or chin electromyogram. The percentages of FTA from QS did not change significantly from 1 week to 6 months of age, irrespective of frequency or intensity. The percentages of FTA from AS fell sharply and significantly from 1 week to 2 months of age (P less than 0.001). At 3 months of age there was a significant increase followed by a significant decrease at 4 months of age, both changes showing a significant difference at P less than 0.05. Apart from the first week of age, the numbers of FTA from QS were greater than from AS for all stimulus trials. It is concluded that there is an arousal deficit in QS from 1 week to 6 months of age and the temporary deficit in AS at 3 months of age could explain the peak incidence of SIDS at this time.
Aust Paediatr J
· 1989 Aug · PMID 2590112
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The records of medical peer review meetings at the Royal Children's Hospital, Melbourne, were audited for the period 1983-87. This investigation focused on the peer review process, but also evaluated the extent to which...The records of medical peer review meetings at the Royal Children's Hospital, Melbourne, were audited for the period 1983-87. This investigation focused on the peer review process, but also evaluated the extent to which recommended changes in medical practice were carried out. The results showed that few recommendations arose from the meetings despite the clear recognition of a number of problem areas. In the instances where firm recommendations were made, few appeared to have been implemented. The main reasons for this failure were: (i) the review was not an integrated part of the medical management structure of the hospital; (ii) recommendations were frequently not made despite clear expressions of the need for action; (iii) the absence of a designated individual to ensure that recommended actions were implemented, together with the lack of a feedback or internal review process to monitor effectiveness; and (iv) a relatively low profile of the peer review. Despite these shortcomings, the peer review is widely perceived to be a valuable exercise, especially as a general educational tool. However, its potential is far greater, and a model is proposed for a more effective medical peer review programme.