摘要:

AbstractCyclical vomiting syndrome is an uncommon, disabling symptom complex of unknown cause, with features in common with migraine. It affects principally children and adolescents. Differential diagnosis and theories of pathogenesis are discussed. Therapy should be aimed at prophylaxis of vomiting bouts, 'switching off’ episodes once they commence and preventing complications of established vomiting episodes. Families need rapid access to care to minimize morbidity and disruption to functionin

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00748.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractThe prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. Chorioretinitis occurs in 10–15% of symptomatic babies and almost always indicates significant mental impairment. Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. The mortality of symptomatic congenital CMV infection is about 30

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00749.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objectives:Factors that appear to influence treatment adherence among adults have been the focus of considerable research in recent years. However, less research has focused on children's treatment adherence. This paper reviews current knowledge about factors that appear to influence adherence among children and adolescents.Methodology:Factors associated with adherence to medical regimens reviewed here include: (i) the psychosocial characteristics of children and their parents; (ii) the nature of the treatment regimen; and (iii) the relationship between health practitioners, parents and paediatric patients.Conclusions:Issues for future research include: (i) the adherence of both children and their parents to children's treatment, and the allocation of responsibility for treatment adherence; (ii) the wide range of behaviours involved in regimen adherence should be acknowledged; patients' adherence to one aspect of their regimen should not be considered indicative of their overall adherence; and (iii) longitudinal studies are required to examine the causal relations between patient adherence and its antecedents.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00750.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00751.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Methodology:A cross‐sectional study of growth, puberty and endocrine function was performed on 35 girls and 33 boys with thalassaemia major.ResultsDespite regular transfusion and chelation therapy, 75% of the girls and 62% of the boys over the age of 12 years were below the third percentile for height. Hypogonadotropic hypogonadism was found in a similar percentage of patients. Moderate to marked zinc deficiency secondary to chelation therapy was considered unlikely because normal serum zinc levels were found in all but three of our patients, but we could not exclude the possibility of a marginal status of zinc nutrition causing growth failure. Growth hormone deficiency and diabetes mellitus were sometimes encountered but hypothyroidism, hypoparathyroidism and adrenal insufficiency were rare among our patients. Most of the patients with growth failure had normal growth hormone (GH) response to insulin induced hypoglycaemia. The serum insulin‐like growth factor‐1 (IGF‐1) levels were low in our patients and no significant difference in the serum IGF‐1 levels was found between prepubertal children with or without growth failure (0.4±0.1 mU/mLvs0.37±0.11 mU/mL, P = 0.39). Similarly, no difference in the serum IGF‐1 levels was found between pubertal children with or without growth failure (0.48 ± 0.2 U/mLvs0.56 ±0.14 U/mL, P= 0.26).ConclusionsDelayed sexual maturation and a possible defect in growth unrelated to the GH‐IGF‐1 axis may be responsible for the growth failure in adolescent children with

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00752.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objectives:We examined the effectiveness of nasal continuous positive airway pressure (CPAP) for treatment of sleep apnoea in infants.Methodology:We studied five infants who all had significant central and mixed apnoea and severe sleep fragmentation. Polysomnographic recordings were performed on 2 consecutive nights in these infants. One night was used as a control study and during the second night nasal CPAP was applied throughout the nightResults:Nasal CPAP significantly reduced apnoea in each infant, with the apnoea index (apnoeas/h) decreasing from 65.6± 14.6 during the control study to 10.5± 14.6 during CPAP in non‐rapid eye movement (non‐REM) sleep, and from 106± 13.9 during the control study to 26.6± 13.9 during CPAP in REM sleep. Nasal CPAP also improved the sleep fragmentation markedly; REM sleep increased from 14.2± 1.2% of sleep during the control study to 27.1 ± 1.2% of sleep during CPAP.Conclusions:We conclude that nasal CPAP is an effective treatment for infantile apnoea. Sleep apnoea in these infants is associated with profound sleep fragmentation, which is reversed by n

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00753.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objectives:To assess whether poor parental knowledge about asthma was a risk factor for readmission of their children to hospital.Methodology:Parents of children who were admitted to the paediatric facility at Newcastle Mater and John Hunter Hospitals were administered a previously validated asthma knowledge questionnaire with a maximum possible score of 31.Results:The mean parental knowledge scores for three groups of children were determined: those with a previous diagnosis of asthma being readmitted to hospital (170 children, mean score 18.3); those with a previous diagnosis of asthma being admitted for the first time (114 children, mean score 17.2); and children being admitted with their first attack of asthma (65 children, mean score 15.6). There was a significant difference in parental asthma knowledge between the first and third group (P<0.001) but not between the first and second group. A linear regression model with knowledge score as an outcome found that increased knowledge was associated with previously diagnosed asthma, higher parental occupation and no smoker in the home.Conclusions:Knowledge was poor in all groups. Readmission rate was related to the severity of the child's asthma.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00754.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objectives:To document clinical manifestations, laboratory findings and outcome of childhoodHaemophilus influenzaetype b (Hib) infections.Methodology:Medical records of 235 children with Hib disease admitted to hospital during a 2 year period were reviewed; additional information was obtained by questionnaire and follow up 6 weeks after discharge.Results:Three‐quarters of patients presented with either meningitis or epiglottitis. Children with epiglottitis were older, had shorter illnesses and were less likely to have had antibiotics before admission than those with meningitis; 38% of the latter had been given some antibiotic therapy, with no apparent effect on the outcome. Fever persisted for 7 days or more in 23% of patients with meningitis. Death from meningitis occurred in 3.8% of patients and was due to fulminating disease.Conclusions:These data will assist in recognition and appropriate management of Hib disease as the clinical manifestations become less familiar following the introduction of immunization. Specific laboratory diagnosis is required for accurate surveillance, which should be maintained in order to ensure high immunization rate

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00755.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objectives:To determine the risk of hospitalization and the growth during the first year of life in infants with bronchopulmonary dysplasia (BPD) and birthweight matched controls.Methodology:The study population consists of 78 infants of 26 to 33 weeks gestation with BPD of whom 20 were discharged on home oxygen therapy. The 78 control infants were matched with the study infants for broad based birthweight categories. Infants were reviewed at 4,8 and 12 months corrected for prematurity at which time the history of rehospitalization was recorded and growth parameters were measured.Results:Infants with BPD were found to have a higher overall rate of rehospitalization (58vs35%, relative risk (RR) 1.7,95% confidence interval (Cl) 1.2‐2.4) and were more likely to be readmitted for respiratory illnesses (39vs20%, RR 1.9, 95% Cl 1.1‐3.2) and for poor growth (14vs1%, RR 14, 95% Cl 1.7‐82) than the control group. Many infants, both study and control, remained below the 10th percentile at 1 year of age. More BPD infants were below the 10th percentile in weight at the 4 month visit than the control infants (30vs15%,P= 0.034). This difference was neither present at subsequent visits nor in the other major growth parameters. The 20 BPD infants who were on home oxygen therapy were more frequently hospitalized for concerns with failure to thrive (30vs9%, RR 3.3,95% Cl 1.2‐8.9) than the remaining 58 BPD infants. No significant differences were detected in the overall rate of rehospitalization. Poor growth at the corrected age of 1 year was similar in the two subgroups of infants.Conclusions:BPD infants are at increased for risk rehospitalization during the first year of life. While many infants with BPD have growth failure, it is suggested that the provision of appropriate supplemental oxygen at home may result in those infants having similar growth patterns when compared to birthweight matched preterm infants with

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00756.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objectives:This study was designed to ascertain the prevalence of respiratory symptoms in South Australian preschool children and to investigate the relationship between prevalence rates and geographic location.Methodology:Data were collected from 14124 families with a child aged 4 years 3 months to 5 years of age. This sample represents 73% of the State preschool population of that age. At the time of a routine preschool health check, parents completed a questionnaire regarding their child's respiratory health and place of residence (postcode).Results:Results showed that the prevalence rates were as follows: (i) ever having chest wheezing 38.6%; (ii) chest wheezing within the preceding 12 months 25.2%; (iii) ever having asthma 22.5%; (iv) ever having a dry cough at night 33.7%; (v) ever having bronchitis or cough with sputum 55.3%; (vi) ever having hay fever 29.7%; (vii) prone to excessive head colds 32.6%; and (viii) ever having eczema 18.8%. Over 38% of parents claimed that winter was the season for the most frequent or severe attacks of wheezing and 31.7% claimed no seasonal difference. Winter was the season most associated with episodes of bronchitis (50.9%), with no seasonal difference in episodes for 29.8% of children. Prevalence rates differed by geographic location within South Australia and within the Adelaide metropolitan region.Conclusion:This population‐based survey shows that over 22% of South Australian 4 to 5 year old preschool children have had (or continue to have) asthma. The study also documented the geographic distribution of respiratory symptom prevalence within South Australi

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00757.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY