ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01062.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01063.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01064.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractSchool medical services in Australia have a long tradition of providing community‐based services to school‐aged children, and in some states to preschool children. Conceived as a public health measure early this century, doctors and nurses worked in schools to address the health issues of the time, which were largely to do with nutrition, hygiene, and infectious diseases.1It was perceived that many children had poor access to medical care, and began school with unaddressed health problems which often had a deleterious effect on their learning. Doctors were often employed by education authorities and only transferred to health departments many years later. In some states the service was expanded subsequently to include preschool children, based on the concept that the earlier problems were detected the earlier they could be treated appropriately and the greater the benefits to the child.While social structures, community needs and paediatric morbidity patterns have changed dramatically over recent years, there is a widespread perception that in some states school medical services have not yet embraced fully the changing needs of the population of school children they are designed to serve. Hamstrung by political expediency (with decision‐making driven by political rather than scientific considerations) and bureaucratic inertia, school nurses and doctors often operate in structures and systems that are urgently in need of review and reorganization. In this paper the rationale for current processes will be reviewed critically, a model of school health services focused on contemporary paediatric needs is proposed, and a set of factors which are considered essential to the development of the school health services of the future is out

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01065.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractThe pattern of neonatal bacterial infection, its management and the types of infection control policy were ascertained in 20 neonatal intensive care units (NICU) in Australia by questionnaire survey. Group BStreptococcusandEscherichia coliwere the predominant organisms responsible for perinatally acquired infection for which the most common antibiotic combination used was Penicillin and Gentamicin.Staphylococcus epidermidisandaureus(majority Methicillin resistant) were the predominant organisms responsible for nosocomial infection for which the most common antibiotic combination used was Vancomycin and Cefotaxime. ASerratiaepidemic was experienced in four NICU. Lumbar and suprapubic punctures were frequently done as part of the diagnostic workup in nosocomial infections but not with perinatally acquired infections. Haematological indices considered useful as a diagnostic aid varied between NICU and acute phase reactants were rarely relied upon for diagnosis or for monitoring treatment response. Granulocyte transfusion and intravenous immunoglobulins were infrequently used in therapy. No consensus was found on infection control policies. Eight NICU required routine gowning on entry, two restricted sibling visiting and four restricted visiting by relatives and friends. Although routine bacteriological surveillance on staff or equipment was uncommon, serial cultures were carried out in infants from the body surface in six NICU and from the endotracheal aspirate in 17 NICU. Antiseptics used with technical procedures included iodine, chlorhexidine and alcohol used singly or in combination. Skin and umbilical cord care also varied between NICU. The literature was reviewed to determine the effectiveness or otherwise of some of the existing policies in the prevention or management of neonatal infection to encourage consensus towards a more rational approach to neonatal infection in Australia.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01066.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractFifteen children (11 males and four females), on oral Zidovudine (AZT) for symptomatic HIV infection were studied retrospectively. Twelve acquired HIV via blood products, two from vertical transmission (maternal intravenous needle sharing) and one through breast feeding. Their mean age at the start of therapy was 8.6 years (s.d. 4.4 years, range 1.8‐15.3 years). The main indications for therapy were failure to thrive (FTT) in 10, recurrent respiratory tract infections (RRTI) in eight, and developmental delay (DD) in one, with overlapping indications beingPneumocystis cariniipneumonia (PCP) in one and pulmonary lymphoid hyperplasia (PLH) in two. The mean commencement dose was 24 mg/kg per day orally in 3‐6 divided doses (range 16‐35 mg/kg per day). The duration of therapy was 2 weeks‐21/2 years. Significant improvement in growth was observed by 2 months; at 6 months, growth was sustained in these otherwise ill children, with only two falling below pretreatment weight. Decrease in the frequency of RRTI based on subjective reports of the attending clinicians was observed in seven of the eight evaluable children still on therapy.Improvement in PCP and PLH occurred in two children and modest improvement was subjectively reported in PLH in one while still early in the course of therapy. Overall, AZT was well tolerated. Dose modifications were for neutropenia in three (of which only two were drug related), rapidly falling neutrophil count in one, anaemia in two (with concurrent history of chronic gastrointestinal tract blood loss in one), severe GIT irritation in one and transient sedation in one. Seven opportunistic infections were reported (three in the same patient) of which two occurred following cessation of therapy, one after only 2 weeks of therapy, and one had not been on primary prophylactic therapy. Three deaths occurred, one associated with opportunistic infections and two while off therapy (one respiratory failure, o

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01067.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractAn extracorporeal membrane oxygenation (ECMO) centre has been established in the sole outborn‐only level 3 nursery in Melbourne. In the absence of other guidelines, an infant may qualify for ECMO if the expected mortality, based on assessment of the severity of hypoxia, exceeds 80%. However, for a non‐ECMO centre, this involves the additional hazard of transport for an already critically‐ill infant. The aim of this study was to determine the predictors of at least 80% mortality in babies who might have qualified for ECMO but who were cared for in a non‐ECMO level 3 nursery. Regardless of the severity or duration of hypoxia, we were unable to identify a group of infants whose mortality exceeded 80%. Since outborn infants were disproportionately over‐represented amongst those who might qualify for ECMO, it would be advisable to admit preferentially those born outside the level 3 perinatal centres who might qualify for ECMO directly to the ECMO centre. For infants born within our level 3 perinatal centre, it is recommended not to transfer those who might qualify based on data from other centres until the exact role of ECMO is determined. Alternatively, a randomized controlled trial of transfer versus non‐transfer to the ECMO centre for severely hypoxic infants cared for in non‐ECMO level 3 nurseries could

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01068.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractWe examined whether serum C‐reactive protein (CRP) measurements used in conjunction with leucocyte counts help in the diagnosis of perinatally acquired and nosocomial infections in very preterm newborn infants. One hundred and twenty‐five infants born at a gestational age between 23 and 31 weeks with respiratory distress were studied at birth. A similar group of 85 infants beyond 3 days of age were also studied on 100 occasions for suspected infection. The diagnosis of proven or probable infection was correlated with abnormal haematology (leucopenia10 mg/L) singly or in combination. The sensitivity of an elevated CRP was relatively higher than abnormal haematology in both early and late infections and the sensitivity was highest when either test was abnormal. Similarly, the specificity, positive and negative predictive values and efficiency of an elevated CRP was relatively higher than abnormal haematology. The performance of the tests in 45 infants born at 23‐28 weeks gestation was similar to that in 80 infants born at 29‐31 weeks gestation. It was concluded that both CRP and leucocyte counts should be determined as they provide valuable information in the diagnosis of neonatal bacterial in

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01069.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractSerial cranial ultrasound scans were performed in 178 preterm Chinese infants (gestation<35 weeks, birthweight<2000 g) to study the incidence, age of onset and associating risk factors of periventricular haemorrhage (PVH), and also the occurrence of post‐haemorrhagic ventricular dilatation and periventricular leucomalacia (PVL). Sixty‐four infants developed haemorrhage, giving an incidence of 36%. Among infants of birthweight<1500 and<1000 g the respective incidence was 52 and 69%. Seventy‐two per cent (46 of 64) of haemorrhages were initially detected within the first 3 days of life, but delayed haemorrhage occurring after 1 week of age occurred in nine infants. In eight of these infants PVH had been shortly preceded by a major clinical disaster. Eleven perinatal factors were found to be significantly associated with PVH but only systemic hypotension showed a significant independent association. Post‐haemorrhagic ventricular dilatation developed in 17 (46%) of the 37 infants who survived for more than 1 month after PVH. This was transient in 41%, persistent but stable in 29% and progressive in 29%. PVL was detected in eight infants who survived the initial period follow

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01070.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractThe outcome of 38 children with endstage renal failure who entered a dialysis and renal transplant programme over a period of 16 years is reported. The initial care was given in an adult programme but in 1985 this was changed to a comprehensive and specifically paediatric programme. Patient survival was 97, 86 and 80% at 1, 5 and 10 years respectively. Thirty‐four of the patients spent a mean period of 19 months (range 1‐160 months) on dialysis with the preferred form of dialytic therapy being continuous ambulatory peritoneal dialysis. Primary cadaveric graft survival was 72 and 42% at 1 and 3 years respectively; although since 1985 1 year graft survival has risen to 90%. The major long term problems have been growth failure and poor social development. Eighty‐seven per cent of children have been able to continue normal schooling, and of the 18 who have left school 14 (78%) are employed or undertaking tertiary education. Thus dialysis and transplantation has allowed not only excellent patient survival but also the achievement of satisfactory educational standards and subsequent employment for the majority of pat

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1990.tb01071.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY