Aust Paediatr J
· 1988 Dec · PMID 3149465
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Fifteen preterm babies (mean gestation: 26.7 weeks; mean birthweight 860 g) with significant glucose intolerance were treated with insulin infusions. During the insulin infusions there was a significant increase in both...Fifteen preterm babies (mean gestation: 26.7 weeks; mean birthweight 860 g) with significant glucose intolerance were treated with insulin infusions. During the insulin infusions there was a significant increase in both the mean energy intake (60.8 +/- 25.1 cal/kg per day to 79.9 +/- 24.5 cal/kg per day; P less than 0.001) and the mean amount of intravenous dextrose tolerated (7.0 +/- 2.7 mg/kg per min to 9.2 +/- 2.6 mg/kg per min; P less than 0.01). The infusions were initiated at a mean postnatal age of 5.3 days (range: 2-12 days) and were continued for 1.5-17.5 days. Of the 998 blood glucose estimations performed during the insulin infusions, 28 (2.8%) were less than 2 mmol/l and 216 (21.6%) greater than 8 mmol/l. We conclude that continuous insulin infusion is a safe and effective way of managing glucose intolerance in very low birthweight infants, provided adequate means for continuous monitoring of blood glucose are available.
Aust Paediatr J
· 1988 Dec · PMID 3149464
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Twenty-seven infants with severe persistent pulmonary hypertension of the newborn were seen in 33 months. Asphyxia with or without meconium aspiration was the cause in the majority of cases. Other causes were group B str...Twenty-seven infants with severe persistent pulmonary hypertension of the newborn were seen in 33 months. Asphyxia with or without meconium aspiration was the cause in the majority of cases. Other causes were group B streptococcal sepsis and acute fetal blood loss. The mortality rate was 11%. Twenty-three of the 24 survivors were followed. Their age at follow-up ranged 12-37 months. The mean score for mental development was within the normal range while that for psychomotor development was 1 standard deviation below normal. Seven infants were judged to be at risk of attention deficit disorder. Predictor variables related to these outcomes were cardiotocography, meconium aspiration, first pH, highest PaCO2 after resuscitation and mother's education. All infants except one were perceived as normal by their parents.
Aust Paediatr J
· 1988 Dec · PMID 3149463
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An Ohmeda Biox 3700 oximeter was evaluated during treatment of 12 patients with respiratory distress. The infants were of 27-33 weeks' gestation and between 2 days and 5 months postnatal age. Blood gases were taken from...An Ohmeda Biox 3700 oximeter was evaluated during treatment of 12 patients with respiratory distress. The infants were of 27-33 weeks' gestation and between 2 days and 5 months postnatal age. Blood gases were taken from indwelling arterial catheters and were measured on an ABL 30 blood gas analyser. The study tested the accuracy of the oximeter in detecting hypoxia (PaO2 less than 55 mmHg) and hyperoxia (PaO2 greater than 80 mmHg). Results are based on 175 paired observations. Guidelines are suggested for the use of the pulse oximeter under three conditions. In a newborn infant with acute respiratory distress without direct arterial access, the limits should be set at 85% (lower) and 90% (upper). In an older infant with chronic respiratory distress, the upper limit of use should be 95%. In order to avoid oxygen tensions less than 55 mmHg which would increase the risk of pulmonary vasoconstriction, however, the lower limit should be 87%. Infants with indwelling arterial lines during their first few weeks of treatment should have oxygen tension measurements and simultaneous oxygen saturation readings plotted on a graph at the bedside. The graph should be updated every 48 h to take into account changed levels of 2,3-diphosphoglycerate, haemoglobin F, and carboxyhaemoglobin and the recommended limits should be changed accordingly.
Sullivan MJ, Taylor BJ, Broadbent RS
… +3 more, Yun K, Lovell-Smith M, Donald RA
Aust Paediatr J
· 1988 Dec · PMID 3071997
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A neonate with persistent hyperinsulinaemic hypoglycaemia is presented in whom the use of intravenous somatostatin SMS 201-995 allowed good glycaemic control over 10 days. A 95% pancreatectomy was then performed.A neonate with persistent hyperinsulinaemic hypoglycaemia is presented in whom the use of intravenous somatostatin SMS 201-995 allowed good glycaemic control over 10 days. A 95% pancreatectomy was then performed.
Chen JD, Denton MJ, Serravalle S
… +1 more, Morgan G
Aust Paediatr J
· 1988 Dec · PMID 2907402
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Restriction fragment length polymorphism studies and gene dosage analysis using the intragenic probes pERT87 were used to detect deletions in potential carriers in a family with Duchenne muscular dystrophy in which the o...Restriction fragment length polymorphism studies and gene dosage analysis using the intragenic probes pERT87 were used to detect deletions in potential carriers in a family with Duchenne muscular dystrophy in which the only affected male was deceased. Two females were found to have inherited the paternal pERT87 alleles but not the maternal alleles, suggesting that they have inherited the pERT87 deletion from their mothers. The hybridization signals of pERT87 from these two females upon gene dosage analysis also suggested that they had a single copy of pERT87. The chorionic villi of a male fetus from one of these two females was found to be deleted for pERT87, suggesting that it was affected. This result confirmed the carrier status of the mother.
Aust Paediatr J
· 1988 Oct · PMID 3265870
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In a study using gas chromatography-mass spectrometry (GC-MS) on urine specimens from 16 normal infants and 16 infants with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (aged 1 day to 4 weeks), t...In a study using gas chromatography-mass spectrometry (GC-MS) on urine specimens from 16 normal infants and 16 infants with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (aged 1 day to 4 weeks), the major steroids recognized in all infants were: 16 alpha-hydroxy-dehydroepiandrosterone, 16 beta-hydroxy-dehydroepiandrosterone, 16-oxo-androstenediol, androstenetriol, 15 beta,17 alpha-dihydroxy-pregnenolone and 16 alpha-hydroxy-pregnenolone. Pregnanetriol was detectable in three normal infants (aged 3, 6 and 15 days) but the levels seen in 15 CAH patients were in a higher range. Pregnanetriolone, 5 beta-17-hydroxy-pregnanolone and 15 beta,17 alpha-dihydroxy-pregnanolone were present in the urine of 15 CAH patients, but were not detectable in any of the normal infants. The older the patient, the higher the level was of each of these four steroids. The results indicate that, even on day 1, patients with CAH due to 21-hydroxylase deficiency may be positively identified using GC-MS of urine specimens. This does not preclude the possibility that a minority of patients with CAH, most likely those with mild 21-hydroxylase deficiency, may not exhibit the characteristic GC-MS findings on day 1, as seen in one of the 16 CAH patients.
Aust Paediatr J
· 1988 Oct · PMID 3265869
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Forty-two cases of severe staphylococcal infection occurring over a 10-year period in the neonatal unit at Queen Mary Hospital are described. There was a 4.5-fold increase in incidence in the latter half of the study per...Forty-two cases of severe staphylococcal infection occurring over a 10-year period in the neonatal unit at Queen Mary Hospital are described. There was a 4.5-fold increase in incidence in the latter half of the study period, when methicillin-resistant Staphylococcus aureus (MRSA) emerged. The isolated MRSA were also resistant to gentamicin, but sensitive to vancomycin, fusidic acid, co-trimoxazole and amikacin. Comparison between MRSA and methicillin-sensitive cases showed that the former was associated with a longer hospital stay after diagnosis. Overall mortality was 9.5%. Two cases with meningitis died. MRSA is at least as virulent as its methicillin-sensitive counterparts. The treatment implications of severe neonatal staphylococcal infection are discussed.
Aust Paediatr J
· 1988 Oct · PMID 3228400
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The unique association of idiopathic diffuse membranous nephropathy and micro-angiopathic haemolytic anaemia and thrombocytopenia is described. A 7 year old Vietnamese boy with a 1-month history of anaemia resistant to o...The unique association of idiopathic diffuse membranous nephropathy and micro-angiopathic haemolytic anaemia and thrombocytopenia is described. A 7 year old Vietnamese boy with a 1-month history of anaemia resistant to oral iron supplements presented with acute onset of nephrotic syndrome. Investigations revealed a micro-angiopathic haemolytic anaemia and thrombocytopenia. There was no associated oliguria or uraemia. Diffuse membranous nephropathy was diagnosed by renal biopsy. Apart from a fourfold rise in enterovirus titres, no underlying cause for the haematological or glomerular abnormalities was found. There was an apparent, partial haematological response to fresh frozen plasma infusions, but not to Vitamin E.
Grimmond TR, Radford AJ, Brownridge T
… +4 more, Farshid A, Harris C, Turton P, Wordsworth K
Aust Paediatr J
· 1988 Oct · PMID 3228399
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A survey of Giardia lamblia prevalence was carried out in Adelaide, South Australia, among Aboriginal and non-Aboriginal children attending day-care centres. A single-stool examination in 178 children aged 6 years and un...A survey of Giardia lamblia prevalence was carried out in Adelaide, South Australia, among Aboriginal and non-Aboriginal children attending day-care centres. A single-stool examination in 178 children aged 6 years and under revealed an overall prevalence rate of 10.7% with all carriers being 1-4 years of age. Within this age group, Giardia prevalence among Aboriginal children (11/32) was significantly higher than that among non-Aboriginal children (eight of 99) (Chi-square analysis, P less than 0.001). Furthermore, among Aboriginal children, a significant association (P less than 0.05) was found between giardia carriage and the family's contact with rural Aboriginal settlements or people from these areas. Aboriginal children with no rural contact had a giardia prevalence similar to non-Aboriginal children.
Aust Paediatr J
· 1988 Oct · PMID 3228398
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Medical records of all 483 infants live-born at 24-32 weeks' gestation in our hospital during the years 1982-86 were reviewed in order to determine postnatal age at time of death for those who died in the first year afte...Medical records of all 483 infants live-born at 24-32 weeks' gestation in our hospital during the years 1982-86 were reviewed in order to determine postnatal age at time of death for those who died in the first year after birth. Twenty-seven died from immaturity without receiving intensive care and 11 died from lethal congenital malformations. Eighty (18%) of the remaining 445 who received intensive care died: 31% on day 1, 45% on days 2-7, 12% on days 8-28 and 11% on days 29-365. The neonatal mortality rate for those receiving intensive care was 160/1000, and the postneonatal mortality rate was 20/1000. Delayed mortality was most common in infants of 26-27 weeks' gestation, with 20% (five) of their deaths occurring after 28 days. In each gestational age range, the majority of hospital admission days were occupied by survivors (24-25 weeks = 62%; 26-27 weeks = 91%; 28-29 weeks = 91%; 30-32 weeks = 99%) rather than non-survivors. Whilst postneonatal mortality is a significant concern, these data suggest that if infants born at less than 33 weeks' gestation are offered intensive care and survive the early neonatal period, the long-term outcome is more likely to be survival rather than delayed death. Furthermore, the majority of hospital admission days invested in such infants involves those who will be discharged home rather than those who will not.
Aust Paediatr J
· 1988 Oct · PMID 3228397
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The hand-grip strength was measured as part of the 5-year neurodevelopmental assessment of 24 very low birthweight (VLBW) and 18 normal birthweight (NBW) children. Hand-grip strength was significantly lower in the VLBW c...The hand-grip strength was measured as part of the 5-year neurodevelopmental assessment of 24 very low birthweight (VLBW) and 18 normal birthweight (NBW) children. Hand-grip strength was significantly lower in the VLBW children for left and right hands tested individually and for both hands used concurrently. Increasing hand-grip strength was significantly related to 5-year weight percentiles and to being in the NBW group. More of the VLBW children weighed less than the 10th percentile. After adjusting for the 5-year weight percentile, the hand-grip strength of VLBW children was still significantly lower than that for NBW children. This is another aspect of development in which VLBW children are disadvantaged.
Aust Paediatr J
· 1988 Oct · PMID 3067698
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The presence of bile in the peritoneal cavity and obstructive jaundice without liver derangement in the neonatal period is pathognomonic of spontaneous perforation of the bile-ducts. These features can be demonstrated pr...The presence of bile in the peritoneal cavity and obstructive jaundice without liver derangement in the neonatal period is pathognomonic of spontaneous perforation of the bile-ducts. These features can be demonstrated preoperatively with ultrasound, nuclide imaging and liver function tests, without recourse to paracentesis, and the risk of contaminating the bile ascites. Furthermore, the presence of isotope in the general peritoneal cavity will exclude the diagnosis of a choledochal cyst so that jejunum should not be anastamosed to the 'false capsule' of a spontaneous perforation.
Aust Paediatr J
· 1988 Oct · PMID 3067697
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A case of adrenal hypoplasia and pituitary agenesis in a normocephalic female infant is described. Twenty-eight other cases from the world literature were reviewed. There were 18 females and 11 males. More than one affec...A case of adrenal hypoplasia and pituitary agenesis in a normocephalic female infant is described. Twenty-eight other cases from the world literature were reviewed. There were 18 females and 11 males. More than one affected infant was described in five families, suggesting autosomal recessive inheritance. The mode of presentation, subsequent course, pathology and possible pathogenesis are discussed.