摘要:

ABSTRACTThe pathogenesis of chronic neonatal lung disease involves the combined iatrogenic insults of oxygen toxicity and barotrauma in addition to lung inflammation. Newer ventilator strategies using smaller tidal volumes (3–7 mL/kg) in order to avoid overdistension, higher positive end‐respiratory pressure and lower peak inspiratory pressures decrease barotrauma. Earlier reduction ofFiO2through the use of surfactant, high frequency ventilation and nitric oxide reduce oxygen toxicity. Other measures include careful fluid balance, avoidance of prolonged paralysis and early steroids to decrease inflammat

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00957.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTPaediatricians are often asked to see children and adolescents with behavioural disorders which include an element of violence directed at peers, family members or teachers. Inevitably this group of children poses a considerable management challenge, irrespective of the multiple aetiological contributions to the behaviours. This paper renews some of the evidence for a neurophysiological contribution to violent behaviour, provides a rationale for pharmalogical treatment and outlines a suggested management plan based on extensive clinical experience. The results of this regimen have been highly successful. This regimen is inexpensive, successful and empowers both patient and family through the development of positive interpersonal interactions.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00958.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To establish the prevalence of specific chronic conditions of childhood in the Auckland area and to quantify resource use by these children.Methodology: Estimates were made from available registry data and published data sources of the population of children with selected chronic conditions resident in the Auckland Area Health Board area. Resource use data were extracted for admissions to Auckland public hospitals and from providers of community based technology services.Results: The largest community prevalence groups are those with asthma, intellectual handicap, congenital heart disease and epilepsy. Children aged 0‐14 with chronic conditions accounted for at least 14340 hospital days stay in Auckland in 1992 at an estimated minimum cost of $7.9 million. Over 200 children are dependent on technological aids at home.Conclusions: There are sparse data on the numbers and needs of children with chronic conditions in the population. A non‐categorical approach which crosses disease entities may be the best method of meeting common ne

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00959.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To determine whether the neonatal chest radiograph (CXR) at 28 days in very low birthweight (VLBW) infants who develop chronic neonatal lung disease (CNLD) predicts oxygen therapy duration or CXR abnormalities in early childhood. Also, to assess the inter‐observer reliability of the radiologists scoring the CXR.Methodology: Clinically well survivors of CNLD (n= 46) had neonatal CXR scored (mean age 28.5 days) and compared with current CXR (mean age 40 months). The CXR were scored independently and ‘blindly’ by two paediatric radiologists using a standardized scoring system (range 0‐10).Results: There was no correlation between neonatal CXR scores and current CXR scores for either radiologist. There was no association between CXR severity scores and duration of oxygen therapy for either neonatal or current CXR. Radiologist A scored the current CXR significantly more abnormal than radiologist B [medians (range): 3 (1‐6)vs1 (0‐5),P<0.001] with reasonable correlation (r= 0.593,P<0.005) but worse than chance agreement (kappa = ‐ 0.034). The median scores for the neonatal CXR were similar [1.5 (0‐8)vs2 (0‐8),P= 0.789] and again there was good correlation (r= 0.760,P<0.0005) although poor individual agreement (kappa = 0.243) between radiologists.Conclusions: Follow‐up CXR abnormalities in VLBW infants with CNLD are usually minor and are not predictive of the duration of oxygen therapy that will be required nor of the CXR appearance in early childhood. Considerable inter‐observer variation exists in the interpretati

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00960.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To determine whether use of nebulized salbutamol therapy for treatment of an acute attack of asthma in children is associated with hypokalaemia and if so what is its frequency, severity and effect on recovery.Methodology: Forty‐six children, aged 10 months to 12 years (mean 7.9±1.5 years) with acute attack of bronchial asthma, treated initially with three doses of nebulized salbutamol 0.15‐0.3mg/kg, every 30 min participated in the study. Blood for serum potassium was obtained at the beginning and after three doses of nebulized salbutamol therapy, before administering other drugs.Results: The mean±SD serum potassium level decreased marginally from 3.9±0.5mEq/L to 3.7±0.5mEq/L (P<0.05). A decrease in serum potassium concentration was noted in 26 (56.5%) and hypokalaemia (serum potassium<3.5 mg/L) in 17 (39%) patients. It was more frequent in patients who had received oral salbutamol for the preceding 7 days. The average time taken for recovery was longer in patients who had hypokalaemia than those who had normal serum potassium concentration (8.6±2.7 hvs6.5±2.7 h;P<0.005).Conclusions: Hypokalaemia may occur in about one‐third of patients treated with three doses of nebulized salbutamol therapy, especially those on prior oral salbutamol therapy. The monitoring of serum potassium concentration may be warranted in su

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00961.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To compare birthweight for gestational age of Aboriginal with Caucasian infants and investigate the origins of their differences.Methodology: Data pertaining to birthweight, gestational age at delivery and pathological factors were abstracted from birth records of 1301 Western Australian singleton Aboriginal pregnancies dated before 24 weeks by ultrasound fetometry and compared with routinely collected data pertaining to Caucasian births of the same period.Results: Median birthweight for gestation was lower in Aboriginal than in Caucasian infants for deliveries after 35 weeks of gestation, and that of pure‐descent lower than that of mixed‐descent Aboriginal infants at all gestations. Pathological factors (e.g. diabetes, urogenital infections, alcoholism and leprosy) occurring more commonly in Aboriginal than in Caucasian pregnancies accounted for most of the differences in birthweight for gestation between mixed‐descent Aboriginal and Caucasian infants but a discrepancy of almost 180 g remained between pure‐descent Aboriginal and Caucasian infants.Conclusions: Identified pathological factors contribute but do not entirely explain the lower birthweights for gestation observed in Aboriginal

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00962.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To define the bowel habits of healthy Australian children aged up to 2 years.Methodology: One hundred and forty children were recruited in six age categories with a minimum of 20 children per category. Data on bowel habit was recorded by parents daily for 1 week.Results: Stool frequency decreased with age. Ninety‐five percent of infants 0‐14 days passed more than two stools per day compared with 21% at age 13‐24 months. Breastfed infants passed more frequent and looser stools than children fed infant formula and solids and also showed a wider variation in frequency.Conclusions: Mean stool frequency decreased with age as did the variation. This is a combined effect of age and feed type. These data can be used as a guide to the bowel habit of healthy Australian chi

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00963.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To study the effect of phototherapy for neonatal hyperbilirubinaemia on thyroid function as neonatal thyroid screening is sometimes performed during exposure to phototherapy.Methodology: Infants with non‐haemolytic hyperbilirubinaemia were sequentially allocated to fibre‐optic phototherapy, conventional daylight phototherapy, or a combination of both. Bilirubin concentration was monitored 12 hourly by capillary blood sampling; venous blood was sampled for thyroid stimulating hormone (TSH) and free thyroxine (fT4) determinations, at start of exposure, at 24 h, end of exposure and 1 day later. Comparable unexposed infants served as controls.Results: All 123 study infants and 25 controls remained well during the study. Bilirubin levels declined during phototherapy, being most rapid in the combination group. The TSH and fT4values at start of exposure were 3.86 ± 0.41 mU/L (mean ± SEM) and 33.20 ± 1.16 pmol/L, respectively, in the fibre‐optic group, 3.62 ± 0.38 mU/L and 37.22 ± 1.76 pmol/L in the daylight group, and 4.40 ± 0.48 mU/L and 29.91 ± 1.13 pmol/L in the combined group, compared with 5.77 ± 0.40 mU/L and 34.46 ± 1.68 pmol/L in the control group. The TSH and fT4values declined with increasing age in the phototherapy and control groups with end of exposure values of 2.90 ± 0.28mU/L and 27.71 ± 0.71 pmol/L, 2.77 ± 0.31 mU/L and 33.52 ± 1.22pmol/L, and 3.44 ± 0.30 mU/L and 27.54 ± 0.88 pmol/L, respectively, compared with 4.21 ± 0.61 mU/L and 27.19 ± 2.33 pmol/L (at 72 h) in the control group. The pattern of TSH and fT4decline in the exposed and control groups was similar, being related to increasing age.Conclusions: The validity of neonatal thyroid screening is not affected by fibre‐optic or conventional photothe

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00964.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To derive newborn percentile charts using NSW population and hospital‐based data.Methodology: Birthweight data for liveborn singleton infants were obtained from the New South Wales Midwives Data Collection (MDC) from 1990 to 1994 inclusive (n= 422139). Data were also collected from King George V Hospital (KGV) for liveborn singleton infants less than 35 weeks of gestation for 1982‐89 inclusive, and for all gestations for 1990‐95 inclusive (n= 30 610). Birthweight percentiles were derived using the MDC data separately for mates and females. Head circumference (n= 29 090) and birth length percentiles (n= 26 973) were derived from the KGV data.Results: The charts derived from MDC data had generally higher percentiles than previously published charts. These represent the largest Australian population‐based study published to date.Conclusions: Periodic review of newborn growth charts is recommended because of changing ethnic and socio‐economi

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00965.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To develop a generic measure of health outcome (the RAHC Measure of Function) for paediatric health services.Methodology: The RAHC Measure of Function (MOF) was modified from the Child Global Assessment Scale. The utility and reliability of the MOF was then tested by inter‐clinician agreement on case scenarios, by inter‐clinician agreement in outpatients, by parent‐clinician agreement in outpatients and by responsiveness to change in acute admissions.Results: The inter‐clinician agreement on MOF ratings for case scenarios was moderately good, with an overall kappa of 0.42;P<0.0001. Clinicians at respiratory and child psychiatry clinics nominated the same or adjacent MOF category to describe 100% (95% Cl: 71.5‐100) and 90% (95% Cl: 68.3‐98.8%) of 11 and 20 cases assessed, respectively. Parents nominated the same or adjacent MOF category as the attending clinician for 89.7% (95% Cl: 72.7‐97.8) and 82.9% (95% Cl: 67.9‐92.9) of 29 and 41 children in the same two clinics. Twenty‐eight inpatient children had an MOF assessed on admission and discharge, and the median MOF score improved from 50.5 to 79 points (z= 4.53;P<0.0001).Conclusions: The MOF is easy to use and provides a valuable description of health outcome that parents are able to understand. The MOF is moderately reliable, is likely to be sufficiently reliable to compare groups of paediatric patients and is res

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb00966.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY