摘要:

Adrenaline has been used in cardiac resuscitation for many years, yet until recently its mechanism of action and optimal dosage remained poorly investigated or understood. Recent guidelines suggest the use of higher doses of adrenaline at an early stage in paediatric resuscitation. This paper examines the use of adrenaline in paediatric resuscitation and studies the arguments in favour of using higher doses than previously accepted.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01529.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Recent information implicates the stimulation of T cells byStaphylococcus aureusantigens and exotoxins as a likely factor in provoking the inflammatory response in atopic dermatitis.S. aureussecrets exotoxins called superantigens, which stimulate a large proportion of T cells. In addition, protein A, a component of the cell wall ofS. aureus, is a potent B cell mitogen. This understanding provides a rationale for attempting to reduce the staphylococcal skin colonization of patients with severe atopic dermatitis and correlates with the clinical observation in a number of situations of marked improvement in atopic dermatitis following antibiotic treatment.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01530.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The ability to detect subclinical signs of the microvascular complications of diabetes during adolescence and our increased understanding of risk factors for their development provide an opportunity to prevent irreversible organ damage. Glycaemic control makes a major contribution to the risk and progression of microvascular complications. However, the unique psychological and physiological changes of childhood and adolescence present a considerable challenge for those attempting to reduce the burden of adult microvascular disease.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01531.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Although DNA replication is a very accurate process, a small number of new mutations are generated at every cell division. The generation of a new mutation during the formation of an ovum or sperm cell can cause an early miscarriage or birth defect The generation of new mutations during embryogenesis can cause a variety of localized birth defects. The molecular delineation of these errors in somatic and gonadal cells has clarified the basis of some birth defects, and has both refined and complicated genetic counselling for a number of paediatric conditions. The processes responsible for these new mutations are present in all cells. For this reason new mutations accumulate in all cells throughout life and contribute to the ageing process. Thus the molecular events that cause many miscarriages and birth defects are the same as those that ultimately lead to death.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01532.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Two recent studies published in this Journal draw attention to deficiencies in treatment of children with acute infectious diarrhoea in Australia.1,2There is now no doubt that use of correctly constituted oral rehydration solutions provides optimal therapy for affected children unless circulation is compromised, vomiting is more than average, or complicating disorders are present. In the vast majority of cases, these complications do not occur. A high proportion of the childhood population experiences gastroenteritis at some time. It is known that 50% of Melbourne children require medical attention for rotavirus infection alone during their first 3 years of life, although less than 5% require admission.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01533.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: Acute gastroenteritis contributes to significant morbidity and need for hospital admission. The current literature suggests outpatient management is often inappropriate. This study examines the pre‐admission management of children admitted with acute gastroenteritis to a major children's hospital.Methodology: Information was obtained from parental questionnaires and the medical notes for 164 children.Results: Parents were poorly informed regarding appropriate home management Over 70% sought professional advice prior to admission, usually from their general practitioner. Although 58% received advice on fluid therapy, an oral rehydration solution was recommended for only 32%. and only 9% actually used one before admission. Advice regarding fluid requirements was usually inadequate. Inappropriate medications were prescribed for 22% of children, including antibiotics (15.4%). antidiarrhoeals (1.2%) and anti‐emetics (5.5%). Hospitalized children were generally well nourished with minimal dehydration and electrolyte disturbance.Conclusions: Oral rehydration therapy is utilized rarely and medications are over‐utilized in home management of gastroenteritis. Education of parents, general practitioners and hospital doctors is essential to optimize outpatient management The impact of optimal outpatient management on hospital admission rates and morbidity requires formal asses

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01534.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: A retrospective review was conducted to establish the prevalence and clinical features of omental torsion or infarction as a cause of acute abdominal pain in childhood.Methodology: The case records were analysed for all patients admitted with primary omental pathology to the Department of General Surgery, Royal Children's Hospital, Melbourne, between January 1975 and July 1994.Results: From 1975 to 1994 (20 years) 13 children were admitted to our General Surgical Department with primary omental disease. There were nine males and four females under 16 years of age. The presenting complaint was abdominal pain with vomiting or diarrhoea. Four children had major medical conditions. Pre‐operative diagnosis in all cases was acute appendicitis. Appendicectomy and omentectomy were performed without complication in all cases. Histology of the omentum demonstrated torsion, infarction or haemorrhage.Conclusions: All children presented with features of acute appendicitis, a majority were male, and two out of the 13 patients were obese. The absence of any children under 4 years was consistent with the relative paucity of omental fat in younger children. We found no clear mechanism for primary omental torsion, although rotation around the right epiploic artery was observe

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01535.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To assess the relationship between the Griffiths Mental Development Scales at 1 and 3 years and the Stanford‐Binet Intelligence Scale (S‐B) and Beery Test of Visual‐Motor Integration (VMI) at 5 years in extremely low birthweight (ELBW) children.Methodology: Prospective study of 45 ELBW infants, without severe neurosensory impairment, cared for in a single Level III neonatal intensive care unit.Results: At 5 years, 36 (80%) children were of average intelligence, 8 (18%) had borderline intelligence and one was mentally retarded. The Griffiths general quotient (GQ) at 1 year had a weak correlation with the S year IQ (corr. coeff. = 0.47), with only 17% of children with a GQ<— 1 s.d. at 1 year receiving an IQ<— 1s.d. at 5 years. In contrast, the Griffiths GQ at 3 years correlated strongly with 5 year IQ (corr. coeff. = 0.78). Among those children with a 3 year GQ<— 1s.d., 67% had a 5 year IQ<— 1 s.d. and all had a 5 year IQ<89. The 3 year hearing and speech subscale correlated strongly with the 5 year S‐B verbal comprehension factor (corr. coeff = 0.753) and the 3 year combined eye/hand co‐ordination/performance quotient had a moderate correlation with the S‐B non‐verbal reasoning factor (corr coeff = 0.597) and with the Beery VMI (corr coeff = 0.49).Conclusions: The 3 year Griffiths GQ is a good predictor of 5 year S‐B IQ in ELBW children and can be used to identify children who may benefit from interventio

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01536.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To assess the relationship between the subtypes of hypertension in pregnancy and subsequent neonatal haematology.Methodology: Retrospective review of the haematology of newborns of hypertensive mothers at a tertiary neonatal unitResults: Over a 2 year period. 249 infants had full blood examinations. Nineteen (7.6%) were neutropenic and 35 (14.1%) thrombocytopenic, including 11 (4.4%) who were both neutropenic and thrombocytopenic. Neutropenia occurred only in infants whose mothers had severe pre‐eclampsia and eclampsia or pre‐eclampsia with pre‐existing hypertension, whereas thrombocytopenia complicated all maternal hypertension subtypes. Two (10%) of the neutropenic infants developed nosocomial infection while seven (20%) of the thrombocytopenic infants bled. Thirteen (68%) of the neutropenic infants compared with 15 (43%) of the thrombocytopenic infants developed their haematological abnormality within 24 h of birth. All but two infants developed the haematological abnormality by the 5th day of life.Conclusions: Although haematological abnormalities in infants born to hypertensive mothers are uncommon, serious neonatal complications can occur and therefore early haematological screening of these infants is recomm

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01537.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: To study injuries In young people associated with the use of rollerblades, draw comparisons with skateboarding and rollerskating injuries, and suggest strategies for injury prevention.Methodology: Injuries associated with the use of rollerblades, skateboards and rollerskates in young people aged 14 years recorded on the Victorian Injury Surveillance System database since its inception in 1989 were examined to identify secular trends. All injuries associated with these pastimes recorded on the database by three sentinel hospitals during a 1 year period were examined in detail. Medical notes were perused to verify features of the event and obtain further information. A semi‐structured telephone interview of a sample of 10‐14 year old rollerbladers, the most commonly injured age‐group, was carried out to obtain more specific information.Results: There has been a marked increase in the absolute numbers of injuries associated with the use of rollerblades since 1989. In 1992, they were most common in the 10‐14 year age group, which sustained 59% of all injuries; 47% of injuries were fractures of the forearm and wrist. Of a sample of 33 of those injured in the 10‐14 year age group, 10 (30%) had been using rollerblades for the first time. There is some evidence to suggest a concomitant fall in skateboarding injuries.Conclusions: Injury surveillance data collected in Melbourne suggest an increasingly important contribution by rollerblading to the pattern of injury seen in young people. Preventive strategies require further evaluation but could include learning basic techniques in a controlled setting, separation from road traffic and the wearing of helmets and wrist, elbow and kn

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1996.tb01538.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY