ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03008.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03009.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract The aims of this study of short very low birthweight (VLBW) children at or after 8 years of age were to determine: (i) if there were any unsuspected organic causes for their growth failure; and (ii) whether any children might be suitable for treatment with synthetic growth hormone. Thirty‐seven of 195(19%) VLBW children seen at 8 years had heights<10th centile, and of these only 40% (10/25) of families offered an assessment were concerned enough to have the child fully evaluated. No child had an unsuspected organic cause of short stature. The children's parents were significantly shorter than expected for Caucasians (mean parental height s.d. score =– 1.06 (s.d. 0.72),t=– 5.9, P<0.001). On average, the bone age of the short children was delayed by 14.9 months (s.d. 18.8 months) compared with chronological age ((=–3.4, P<0.01). When compared with their parents, the children's mean height s.d. score for their bone age was not significantly different (mean height s.d. score for bone age = ‐ 0.83 (s.d. 1.3),t= 0.6, NS). Only three children qualified for treatment with synthetic growth hormone; all three had been small for gestational age at birth and had birthweights<1000 g. In conclusion, in short VLBW children, only a minority of families and children are likely to be concerned enough about short stature to be fully assessed; an unsuspected organic cause for growth failure is unlikely, and only a few will qualify for synthetic growth horm

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03010.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract As very low birthweight (VLBW) infants are at a high risk of developmental handicap, it is important to establish predictors of long‐term adverse outcome at an early age so that early intervention can be instituted. Longitudinal neurodevelopmental assessments were performed in 107 VLBW infants at 1,4, 8 and 12 months corrected age. Eighteen were diagnosed as ‘dystonic’ at 4 months of age.This study compared the outcomes at 4 and 6 years for 15 of the 18 dystonic with 75 of the 89 non‐dystonic VLBW infants, respectively. At 9 years of age, nine dystonic and 54 non‐dystonic infants were assessed on the Rutter Behaviour Questionnaire. Dystonic children had a lower mean General Cognitive Index (GCI;P=0.001) and a higher incidence of disability as measured by the Burns Neuro‐Sensori‐Motor Developmental Assessment Scale (P = 0.0005) and Kitchen disability grading (P = 0.001). Even if the minor neurological aberrations of the premature dystonia syndrome in VLBW infants abate by one year of life, these infants still constitute a high‐risk group for subsequent neurodevelopmental disability and therefore require close observation and probably e

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03011.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Very little data exist describing the neonatal outcome of infants of birthweight 2500 g or more who require mechanical ventilation. Our aim was to collect population‐based data on such infants in New South Wales (NSW), and to monitor their neonatal morbidity, mortality to 1 year of age and the associated risk factors. The study group (NICUS infants) comprised all 341 infants weighing>2499 g who were admitted to the seven neonatal intensive care units in New South Wales and mechanically ventilated for 4 h or more between 1 January and 31 December, 1987.Two groups of infants emerged: those who were preterm and mostly had hyaline membrane disease, and term and post‐term infants for whom the most common problem was ‘perinatal asphyxia’.The most important factors associated with dying were a birthweight of over 3499 g (OR = 2.6; CI 1.03–6.6) and a 1 min Apgar score<4 (OR = 4.8; C11.4–16.9). Study group mothers were significantly more likely than all NSW mothers to have had a spontaneous abortion in the previous pregnancy (P<0.01), a pre‐existing medical condition or an obstetric complication in this pregnancy, or a Caesarean section for this delivery (P<0.001). This is the first population‐based study of high‐risk neonates without congenital anomalies to clearly document the worsening prognosis associated with a birthweight over 3499 g. Further research should be directed towards identifying prenatal and perinatal factors which might minimize the morbidity and mortality in thi

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03012.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract This paper estimates whether an increase has occurred in the prevalence of asthma symptoms and diagnosed asthma in Australian children over the past two decades. Seventeen population‐based studies undertaken in Australia since 1969 were reviewed. Inclusion criteria were studies using population samples of children aged 5–12 years, with standardized questionnaire measurements. Data from serial National Health Surveys were also examined for trends in recent and chronic asthma.The prevalence of recent (12 month) and cumulative wheeze increased, showing a significant correlation with year of study(r =0.78 andr =0.79, respectively). Diagnosed asthma showed a smaller but still significant increase(r =0.65). The trends observed indicated that diagnosed asthma and reported wheeze have increased by almost 1% per year over the past two decades. Data since 1980 have provided estimates of bronchial hyperreactivity (BHR), but no trend was observed. Substantial increases were noted in the National Health Surveys, with recent asthma prevalence in children aged 5–14 increasing from 3.3% in 1983 to 8.3% in 1989, and chronic asthma prevalence increasing from 4.5% in 1977 to 15.2% in 1989. The findings of this review suggest an increase in the prevalence of asthma symptoms in children, but these observations could also be explained by changes in diagnostic fashion and an increased awareness of asthma s

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03013.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract We examined rates of the most common ear, nose and throat (ENT) surgical procedures among NSW residents under 15 years ot age, against a background of concern for the relevance of differences in clinical practice to cost and quality of health care. We found significant (P<0.01) increases in the rate of procedures involving myringotomy (from 5.8/1000 to 7.6/1000) or adenoidectomy (from 5.6/1000 to 6.3/1000) between 1986 and 1989/90. Over this period the proportion of ENT procedures which involved myringotomy also increased significantly (P<0.01) from 53 to 60%. We found significant (P<0.01) differences in procedural rates between health areas when aggregated into inner and outer metropolitan and rural groups with the mean rate of procedures involving myringotomy highest in the outer metropolitan group in both years. The difference was not due to variation in patient insurance status, per capita hospital bed or staff numbers. We found no evidence that the National Health and Medical Research Council Tonsillectomy and Adenoidectomy Guidelines (first published in 1982) have been effective in influencing clinical practice. The rate of tonsillectomy had been declining in NSW since the late 1970s but has remained stable in recent years. Surgical intervention for middle ear disease is increasin

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03014.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract The effect of synthetic surfactant (Exosurf) replacement on complications from hyaline membrane disease (HMD) in infants<32 weeks gestation and their resource utilization within a neonatal intensive care unit was studied in 1991‐92. A control group was selected from infants admitted to the same unit during the preceding 3 years when Exosurf was not available. The infants were controlled for gestation, weight and severity of HMD.Infants given Exosurf had a significant reduction in the incidence of pulmonary interstitial emphysema (PIE), and a marginal decrease in the incidence of pneumothorax. They required fewer days on the ventilator and consumed less of the scarce financial resources. There was no difference in the mortality rate among the two groups. The changes seen were more evident among those infants between 30 and 31 weeks gestation, compared to those<28 we

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03015.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract After the first year of life, injury is the leading cause of mortality in children and adolescents in Australia and a major cause of morbidity and hospitalization. Studies from Europe and North America and more recently New Zealand have demonstrated that injury rates differ between different socio‐economic groups, with a relatively consistent pattern of higher rates being found in lower socio‐economic groups. To date, the pattern of child injury morbidity by socio‐economic group has not been studied in Australia. Eighteen months of data from Brisbane and Melbourne collections of the National Injury Surveillance Unit data base were analysed and linked to census data from each postcode in the collecting area to calculate injury rates. Injury rates for each postcode were correlated with measures of disadvantage derived from the same census data. There was a consistent pattern of moderately strong statistically significant associations (Pearson correlation coefficients generally 0.30‐0.60) found between measures of disadvantage and injury rate at the postcode level of aggregation. This association was present across cities, age groups, type of injury and for those hospitalized as well as those treated as outpatients. It is apparent that residence in a low income area is a significant predictor of child injury in

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03016.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract Records of 1049 cases of Sudden Infant Death Syndrome (SIDS) (100%) in the Sydney metropolitan area (SMA) from 1980 to 1989 were analysed in relation to ambient temperature, geographical distribution and socio‐economic scale. The SIDS rate varied between eastern and western Sydney and between statistical subdivisions; it peaked sharply in July, coinciding with the monthly mean minimum daily temperature (MMMDT; 6.5 and 5.4°C, respectively). The inverse linear relationship between the SIDS rate and the MMMDT for the regions and the subdivisions was highly significant (P<0.001). The SIDS rate showed a significant inverse linear relationship to two socio‐economic scales (allotment and house value) for 82 of the 87 suburbs (94%) of the SMA. Temperature, indicative of cold weather, was the major factor determining SIDS rates, and this, together with socio‐economic factors, largely explains the observed geographical distribution of SIDS rates in

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1993.tb03017.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY