Daniels L, Davidson GP, Martin AJ
… +1 more, Pouras T
Aust Paediatr J
· 1989 Jun · PMID 2504140
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The use of overnight, nasogastric, nutritional supplementation during hospitalization of children with cystic fibrosis (CF) receiving antibiotic therapy for acute exacerbations of respiratory disease was evaluated in 11...The use of overnight, nasogastric, nutritional supplementation during hospitalization of children with cystic fibrosis (CF) receiving antibiotic therapy for acute exacerbations of respiratory disease was evaluated in 11 children (mean age = 7.75 years). Supplementary feeding significantly increased inpatient energy intake from 116 +/- 30% to 165 +/- 30% (P less than 0.001) of recommended dietary allowance with minimal effect on oral intake. It also resulted in significantly improved weight gains but neither increased energy intakes nor weights were sustained at short-term (mean = 5.7 weeks) or long-term (mean = 21.6 weeks) follow-up. The notion that short bursts of nasogastric feeding for inpatients with CF improve growth status is not supported. However, the study did show that treatment of chest infections alone does not positively affect spontaneous oral energy intake.
The prevalence and incidence of illness was examined in a birth cohort of Christchurch children studied during the age range of 5-10 years. At this age, children had an average of 12 consultations with family doctors; 26...The prevalence and incidence of illness was examined in a birth cohort of Christchurch children studied during the age range of 5-10 years. At this age, children had an average of 12 consultations with family doctors; 26% were admitted to hospital and 53% made one or more attendances at hospital outpatient departments. The majority of general practitioner contacts involved five groups of conditions: respiratory illness; integumental lesion; accidents; gastrointestinal conditions; and hearing problems. Hospital admissions were dominated by five types of admission: respiratory illness; accidents; gastrointestinal conditions; genito-urinary problems; musculoskeletal problems. More than two-thirds of outpatient attendances were accounted for by accidents, respiratory illness, musculoskeletal problems, vision problems, and hearing problems. Trends in rates of medical consultation for accidents and respiratory illness during the period from birth to 10 years are described and the implications of the findings are discussed.
There were 102 cases of intestinal perforation seen in children at the Department of Paediatric Surgery at S.S. Hospital, Varanasi during a 3 year period. Enteric (typhoid) perforation (29%), intussusception (15%) Ascari...There were 102 cases of intestinal perforation seen in children at the Department of Paediatric Surgery at S.S. Hospital, Varanasi during a 3 year period. Enteric (typhoid) perforation (29%), intussusception (15%) Ascaris lumbricoides infestation (9%) and appendicitis (9%), which are rarities in the reported literature, were the major causes of intestinal perforation. Radiological evidence of pneumoperitoneum was seen in 88% of patients. The majority of cases in this study were older than 5 years of age (48%). Peritoneal fluid culture revealed Escherichia coli and Klebsiella to be the most common aerobic micro-organisms, while Bacteroides fragilis, Clostridia and Peptostreptococcus were the most frequent anaerobes. The overall mortality rate was high (19%).
Ten cases of neonatal gastrointestinal anomalies and bowel obstruction are described, in which contrast studies were carried out prior to transfer. Nine of the 10 infants had bile-stained vomiting, indicating the need fo...Ten cases of neonatal gastrointestinal anomalies and bowel obstruction are described, in which contrast studies were carried out prior to transfer. Nine of the 10 infants had bile-stained vomiting, indicating the need for immediate surgical referral. The contrast studies resulted in delayed referral, deferment of appropriate resuscitation, and complications associated with the study. In several cases the wrong type of study, or the wrong contrast medium was used. These 10 infants required urgent surgical referral, not a sophisticated radiological procedure in geographic and surgical isolation.
Records of all children presenting with urinary calculi in the period 1972-86 were reviewed in order to detail clinical features, laboratory and radiographic findings and treatment. Of a total of 85 children, 59 were Abo...Records of all children presenting with urinary calculi in the period 1972-86 were reviewed in order to detail clinical features, laboratory and radiographic findings and treatment. Of a total of 85 children, 59 were Aboriginal and 26 were Caucasian. The features of urolithiasis differed between these groups. In the Aboriginal patients, calculi consisted mainly of uric acid and urates. Important clinical characteristics of this group included a young age at presentation (median = 2.1 years) and frequent presentation with failure to thrive. Calculi were commonly located in the upper urinary tract and most required surgical removal. Documented sequelae included renal scarring and hypertension. Caucasian children presented at a later age (median = 10.5 years), frequently with abdominal pain, and most calculi were associated with an underlying urological or metabolic abnormality.
The breath hydrogen test for carbohydrate malabsorption has been proved to be sensitive, specific and noninvasive. This study was performed to determine its applicability in the newborn period. Postprandial hydrogen excr...The breath hydrogen test for carbohydrate malabsorption has been proved to be sensitive, specific and noninvasive. This study was performed to determine its applicability in the newborn period. Postprandial hydrogen excretion in the first 5 days of life was measured in 105 full-term normal newborns, who were either artificially or breast fed. Samples of expired air were collected via a nasopharyngeal catheter at 30 min intervals between feeds. Some babies showed no hydrogen production after 5 days, while others produced high (200 parts/10(6] levels. The incidence of hydrogen production increased postnatally--more than 80% of babies produced hydrogen by 5 days of age. None of the babies was unwell or developed frequent or loose stools suggestive of clinical carbohydrate malabsorption. It is therefore postulated that these high hydrogen levels reflect biochemical evidence of clinically insignificant carbohydrate malabsorption in this age group. This study shows clearly that an interfeed interval of 4 h in these babies is insufficient to cause breath hydrogen levels to fall in a predictable way. The ethical and practical difficulties in fasting these infants for longer periods suggest that conventional carbohydrate challenges with breath hydrogen estimations will be difficult in the neonate.
In the present economic climate and with increasing expenditure on neonatal intensive care, there has been a demand for economic evaluation and justification of neonatal intensive care programmes. This study assesses the...In the present economic climate and with increasing expenditure on neonatal intensive care, there has been a demand for economic evaluation and justification of neonatal intensive care programmes. This study assesses the inhospital costs of neonatal intensive care. Fixed and variable costs were calculated for services and uses of an Intensive/Special Care Nursery for the year 1985 and corrected to 1987 Australian dollar equivalents. Establishing a new neonatal intensive care unit of 43 costs in an existing hospital with available floor space including operating costs for a year were estimated in Australian dollars for 1987 at $6,408,000. Daily costs per baby for each were $1282 ventilator, $481 intensive, $293 transitional and $287 recovery, respectively. The cost per survivor managed in the Intensive/Special Care Nursery in 1985 showed the expected inverse relationship to birthweight being $2400 for greater than 2500 g, $4050 for 2000-2500 g, $9200 for 1500-1999 g, $23,900 for 1000-1499 g and $63,450 for less than 1000 g. Further analysis for extremely low birthweight infants managed in 1986 and 1987 demonstrated costs per survivor of $128,400 for infants less than 800 g birthweight and $43,950 for those 800-999 g. This methodology might serve as a basis for further accounting and cost-evaluation exercises.
A case of arrhythmogenic right ventricular dysplasia in a 10 year old girl is described which provides some evidence for an inherited aetiology of this unusual form of heart disease. The parents of this child were first...A case of arrhythmogenic right ventricular dysplasia in a 10 year old girl is described which provides some evidence for an inherited aetiology of this unusual form of heart disease. The parents of this child were first cousins, thus increasing the possibility of inherited disorders in their offspring. She had been known from infancy to have the rare disorder of congenital deficiency of intestinal enteropeptidase, and low serum immunoglobulins G and A. An untyped adenovirus was grown from a myocardial biopsy taken early in the course of her cardiac disease. However, it is unlikely that this virus was a major factor in the aetiology of her cardiac disease. Both the cardiac and intestinal diseases are now commonly believed to result from hereditary factors, and this report provides further support for this view.
A patient with Sturge-Weber syndrome developed seizures at the age of 4 years. At 13 years of age, she had intractable complex partial seizures with marked visual symptomatology. Interictal encephalograms showed bilatera...A patient with Sturge-Weber syndrome developed seizures at the age of 4 years. At 13 years of age, she had intractable complex partial seizures with marked visual symptomatology. Interictal encephalograms showed bilateral slow activity, more marked over the right hemisphere with epileptogenic activity maximal in the right temporal region. Serial computerized axial tomography scans demonstrated evolution of bilateral occipital lesions with calcification and adjacent low density areas that were more marked on the right. Magnetic resonance imaging, angiography and neuropsychological evaluations were performed. An extensive resection of the right occipital lobe was achieved. One year after surgery, the patient has had seven brief seizures. Delineation of an epileptogenic focus and surgical removal of the lesion in patients with intractable seizures can now be considered in selected patients with bilateral central nervous system pathology.
A Chinese infant with Pompe's disease (type II glycogenosis) had an unusual presentation of supraventricular tachycardia. The patient subsequently died of ventricular fibrillation. The clinical presentation and the mecha...A Chinese infant with Pompe's disease (type II glycogenosis) had an unusual presentation of supraventricular tachycardia. The patient subsequently died of ventricular fibrillation. The clinical presentation and the mechanism of the arrhythmia are discussed.
Sixty children aged 5-13 years with moderately severe asthma took part in a double-blind, placebo-controlled trial of ketotifen. The design incorporated a 22 week study period, the addition of ketotifen or placebo to the...Sixty children aged 5-13 years with moderately severe asthma took part in a double-blind, placebo-controlled trial of ketotifen. The design incorporated a 22 week study period, the addition of ketotifen or placebo to the current medication, and a controlled withdrawal of the regular therapy. Children receiving ketotifen showed significantly lower mean numbers of asthma attacks and less absence from school. The addition of ketotifen to existing treatment was associated with marginally significant changes in rates of day and night wheezing. In the second phase of study, additional therapy was withdrawn from both the ketotifen and placebo groups which resulted in a high (percentage) withdrawal. Children receiving ketotifen did not have a significantly lower failure rate than those given placebo.
A double-blind crossover study was performed on 33 children with asthma to compare the effectiveness of nebulized solutions of preservative-containing and preservative-free ipratropium bromide. Both solutions produced br...A double-blind crossover study was performed on 33 children with asthma to compare the effectiveness of nebulized solutions of preservative-containing and preservative-free ipratropium bromide. Both solutions produced bronchodilation. No significant differences were found between the two solutions at any time after nebulization in minimum and maximum changes from baseline value or in the areas under the lung function time curves. The presently formulated preservative-containing ipratropium bromide solution was not shown to be inferior to a preservative-free compound.
A case report of envenomation by a common brown snake, Pseudonaja textilis, in a 3.3 year old boy is presented. He suffered a brief grand mal convulsion 10 min after the bite which was shortly after removal of a compress...A case report of envenomation by a common brown snake, Pseudonaja textilis, in a 3.3 year old boy is presented. He suffered a brief grand mal convulsion 10 min after the bite which was shortly after removal of a compression bandage. A severe coagulopathy of the defibrination type required administration of five ampoules of brown snake monovalent antivenom (CSL). The association of envenomation by snakes and convulsions is discussed, as is the management of severe defibrination due to envenomation.
During an 8 month period, 298 evaluations of direct and buffy coat films of peripheral blood for the detection of bacteraemia were undertaken in 287 infants (243 less than 24 h of age and 55 aged between 2 days and 30 da...During an 8 month period, 298 evaluations of direct and buffy coat films of peripheral blood for the detection of bacteraemia were undertaken in 287 infants (243 less than 24 h of age and 55 aged between 2 days and 30 days). Bacteraemia was diagnosed by simultaneously drawn aerobic and anaerobic blood cultures. Intracellular organisms were observed in both the direct and buffy coat films of only four of 24 infants with bacteraemia, giving a sensitivity of 17%, specificity of 100% and positive and negative predictive values of 100% and 93%, respectively. Of 12 infants with bacteraemia on the first day of life, eight were asymptomatic when studied, and none of the 12 had positive smears. As two of four infants with positive smears died, it is concluded that in fulminating sepsis the tests seem to correlate with the degree of illness and may give useful information as to the causative organism and the choice of antibiotic. However, as a screening test, the present methodology lacks sensitivity and cost-effectiveness.
Real time ultrasound scans using an ATL 300C sector scanner with 5-7.5 MHz transducer were performed on days 1, 4, 7 and thereafter as clinically necessary on 153 consecutively discharged very low birthweight (VLBW) infa...Real time ultrasound scans using an ATL 300C sector scanner with 5-7.5 MHz transducer were performed on days 1, 4, 7 and thereafter as clinically necessary on 153 consecutively discharged very low birthweight (VLBW) infants. One hundred and forty-six long-term survivors were assessed fully at 2 years. The prevalence of cerebroventricular haemorrhage (CVH) in these survivors was 34.2% (grade 1-21.2%; grade 2-4.8%; grade 3-3.4%; grade 4-4.8%), ventricular dilatation 19.9% (including 4.1% with ventriculoperitoneal shunt), and ischaemia 9%. Impairments at 2 years were classified as nil, mild, moderate, severe or multiply severe, based on the criteria of Kitchen et al. Overall, 120 infants (82.2%) were unimpaired and 6.2% had mild, 3.4% had moderate, 4.1% had severe and 4.1% had multiply severe impairment. The major factors associated with impairment were gestational age less than 28 weeks, birthweight less than 1000 g, vaginal delivery, respiratory distress syndrome, mechanical ventilation, pulmonary air leaks and CVH. When these factors were reanalysed in a logistic regression model for odds ratios, only CVH (P less than 0.005) and birth by spontaneous vaginal delivery (P less than 0.05) were significant. The prevalence of impairment was 11.4% with no CVH, 6.5% grade 1, 71% grade 2, 20.0% grade 3 and 100.0% grade 4 CVH. The sensitivity of CVH of grade 2 or greater as a screening test was 64.7% for impairment, 78.6% for cerebral palsy and 70% for severe intellectual handicap. The mean general quotient (GQ) (Griffiths) at 2 years for infants with CVH was 89.1, and 97.5 for those without CVH (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)