摘要:

Objective: This study was carried out to evaluate the significance of amniotic fluid protein ingestion and absorption on fetal growth.Methodology: Neonates with small bowel atresia during a 30 year period were studied retrospectively.Results: There were 56 patients enlisted, 17 with duodenal atresia, 18 with jejunal atresia and 21 with ileal atresia. The percentage of mothers with polyhydramnios and the percentage of premature babies decreases as the intestinal atresia becomes more distal. The mean gestational age and the mean birthweight increase as the intestinal atresia becomes more distal. On the other hand, the percentage of the neonates with birthweight below the 50th and the 10th percentiles do not differ significantly as the intestinal atresia becomes more distal.Conclusions: It appears that the variation of birthweights in babies with different levels of small bowel atresia may be due to the difference in gestation caused by polyhydramnios. The effect of amniotic fluid protein absorption on fetal bodyweight could not be demonstrated clinically in this study.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01539.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To describe survival patterns, use of health services and related costs for Australian children with perinatally acquired human immunodeficiency virus (HIV) infection.Methodology: A retrospective cross‐sectional survey was made of 20 children with HIV infection (91% of those diagnosed) and 13 children with maternal antibodies who subsequently seroreverted, treated at 10 medical centres. Details of disease progression and use of health services were obtained from hospital medical records. Monthly costs for three phases of infection were estimated by linking service usage rates with estimates of the unit cost of each service. The average lifetime cost was estimated by combining monthly costs and phase duration estimates from the literature.Results: Patterns of disease progression were similar to those reported internationally, with a median survival of 8 years. Use, of health services increased with severity of illness. Mean monthly costs were $120 per month (1992 Australian dollars) for children with maternal antibodies who subsequently seroreverted, $320 per month for children with HIV infection but no acquired immunodeficiency syndrome (AIDS)‐defining illness, and $1830 per month for children with AIDS. The present value of total lifetime cost for a child with HIV infection was $48174,46% of which was for treatment of AIDS.Discussion: The mean lifetime cost for a perinatally infected child was just over half that for a man with HIV in Australia. Health service usage and costs were lower for Australian than American children with

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01540.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To determine whether inhalation of hypertonic saline (HS) increases sputum expectoration in patients with cystic fibrosis (CF).Methodology: Ten adolescents with CF, who were receiving inpatient treatment for a pulmonary exacerbation, were enrolled in a controlled cross‐over clinical trial. After inhalation of a beta adrenergic drug to prevent possible broncho‐constriction, each patient inhaled for 10min either 0.9% isotonic saline (IS) or 6% HS prior to routine physiotherapy. The following day the patient received the alternative solution. Seven patients undertook a second block after 1‐5 days. Outcome measures included weight of sputum, a visual analogue score to assess the subjective feeling of a cleared chest after physiotherapy, and spirometry.Results: Sputum expectoration (median; Q1,Q3) from the beginning of the inhalation of HS or IS to the final spirometry measure 60min post‐physiotherapy was significantly greater after HS than IS [17.2g (11.7, 34.8)vs11.3g (6.5. 16,1);P— 0.006]. A clinical score of the patient's own judgement of a cleared chest was significantly better after HS than IS. Spirometry results did not change following either of the two inhalations.Conclusions: These data show that the inhalation of 6% HS prior to physiotherapy can increase sputum expectoration in patients with CF and suggest that HS might be an effective, safe and cheap adjunct to regular physiotherapy in patient

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01541.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: The primary aim was to determine whether child anxiety could be reduced by the presence of a parent during anaesthetic induction. Secondary aims involved clarification of the effect of the timing of parental separation, the use of premedication, the seriousness of the surgical procedure, and the flow‐on effect of parental anxiety on the level of child anxiety.Methodology: Subjects were obtained by approaching all parents of children aged from 1 to 8 years admitted for day surgery to a private hospital in Adelaide, South Australia during a 3 month period. Data pertaining to 74 children, representing a response rate of 80.4%, were obtained. Parents were instructed to rate the anxiety of their child for the period immediately prior to separation, and to then rate their own anxiety for the same period of time.Results: Children accompanied during induction were less anxious than those who were not accompanied. Contrary to the belief that child anxiety might be reduced by allowing separation in the theatre holding bay area, it was demonstrated that child anxiety was higher in this group than when separation occurred in the ward. No relationship between premedication or operation severity and either child or parental anxiety was observed. However, parental anxiety was noted to be a significant predictor of child anxiety. Suggestions for a more detailed examination of the relationship between child and parental anxiety in future research were outlined.Conclusions: It was concluded that there are benefits in allowing parents to be present during anaesthetic induction. However, the potential negative effect of parental anxiety must be acknowledged before parents are allowed to accompany their child as a matter of cours

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01542.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To compare working conditions, sources of stress and professional relationships between a group of nurses working in neonatal intensive care units (ICU) and those working in general paediatric teaching hospital wards.Methodology: Surveys were sent to 96 nurses working in general paediatric wards in three Sydney paediatric teaching hospital centres and to 291 nurses working in six major neonatal ICU in Sydney. The survey asked about work environment, patient care, decision‐making, sources of stress and professional relationships. Thirty‐one questions were identical in each survey. The survey also included the General Health Questionnaire (GHQ) as a measure of emotional health.Results: The response rate was ward nurses 86% and neonatal intensive care nurses 66%. Of the 31 identical statements, nine were significantly different between the two groups. Neonatal nurses were more likely to feel that their ward work areas were overcrowded and poorly laid out with little patient‐free space. They had more concerns about inadequate staffing and conflict between nurses and doctors. The general ward nurses were more likely to feel that adequate priority was given to patient pain relief and that they had more influence in such decisions but experienced more stress in keeping up to date and were more likely to feel that communication problems between doctors and nurses were a major source of conflict. Forty per cent of general ward nurses and 32% of neonatal nurses had GHQ scores indicating possible psychological impairment, a significantly higher proportion than would be expected in the population.Conclusions: Paediatric nurses perceive a variety of stresses in their work, with problems in communication between doctors and nurses being a prominent perception. The high GHQ scores may be a reflection of some of those problems. Attention to problems of under‐staffing, better work environment and improved communication may help resolve some of these issues and may have implications for improving patie

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01543.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To perform a feasibility and immunogenicity study of an accelerated schedule of hepatitis B immunization for high‐risk youth.Methodology: High‐risk adolescents attending a youth health centre and nearby youth refuges were immunized with Engerix‐B recombinant vaccine, 20 μg intramuscularly, at 0,2 and 6 weeks. Serology was performed prior to immunization and 3 months after the third dose.Results: Forty‐two subjects (27 female) aged 13‐20 years entered the study. Two (4.8%), already hepatitis B virus (HBV) seropositive, were excluded. Thirty‐six of 40 subjects had one or more risk factors for HBV. Participants were often elusive, needing multiple attempts to establish contact. Twenty (50%) of the 40 completed three immunizations and all 14 studied developed anti‐hepatitis B surface titres of>100mlU/mL (geometric mean titre 630 mIU/mL, 95% confidence intervals 309‐1290).Conclusion: High‐risk youth can be immunized against hepatitis B successfully using an accelerated schedule, but compl

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01544.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To trial and evaluate a system of ‘on the spot’vaccination for children up to the age of 15 years in the Early Childhood Centres of the Central Sydney Area Health Service, at the Royal Alexandra Hospital for Children and in a number of general practices in the area.Methodology: A brief questionnaire was used to collect data from parents and health care professionals about the child's vaccination status and vaccines given ‘on the spot’.Results: Over an 8 week period in August‐September 1993, 5162 questionnaires were completed; 71% of children were up to date with their vaccination. IfHaemophilus influenzaetype b vaccine, which had been introduced only 2 months before commencement of the study, was excluded, 84% of the children were up to date. A total of 441 children were given 663 vaccinations ‘on the spot’. Very few children were too ill to be vaccinated (6%). However, only 30% of those who needed vaccination ‘on the spot’actually received it (441 of 1480), and only 41% (24 of 58) of a subset of those who were not vaccinated were known to have complied 1 month later. Children attending Early Childhood Centres were younger than children attending general practices or the hospital.Conclusions: A high proportion of children who attended for routine or acute health care had vaccinations overdue (30%). If this scheme could be continued and expanded it would have an important impact on vaccination coverage, and hence on the incidence of vaccine‐p

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01545.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Bacterial endocarditis is an uncommon diagnosis in childhood with significant morbidity and mortality. Aortic aneurysm as a complication is well described in adults but there are few reports in the paediatric literature. Two children with bacterial endocarditis are described, whose illnesses were complicated by aortic aneurysm formation requiring surgical intervention.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01546.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To describe the presentation and investigation of an unusual form of congenital dorsal midline thoracic mass.Results: An infant born by emergency Caesarean section at 34 weeks gestation was found to have a large dorsal midline thoracic mass. The infant had normal neurological function in all limbs. Radiological investigation showed no abnormality in the vertebrae. Ultrasonographic investigation suggested the mass to consist of subcutaneous oedema. The mass resolved completely within the first 2 weeks.Conclusions: The lesion observed in this infant represents a very unusual location for a benign condition caused by cervical pressure on the presenting fetal part. The use of ultrasonography enabled rapid exclusion of the more common, potentially serious, causes of a congenital midline dorsal thoracic mass.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01547.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

A case of myxoedema due to Hashimoto's thyroiditis associated with a significant increase in serum creatinine is reported. Thyroid hormone replacement therapy resulted in normalization of the serum biochemistry within 1 month.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01548.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY