Development of a successful rotavirus vaccine is a major aim of the WHO Diarrhoea1 Diseases Control Programme 1 . Results of epidemiological studies and estimates of the cost‐effectiveness of a successful vaccine in both developed and developing countries have shown that it is appropriate to devote resources to this objective.
Abstract Injuries account for 50% of deaths in Australian children aged 1‐14 years, and are a major cause of hospital admission and disability. Injury surveillance systems involving the establishment of ongoing, systematic collection and analysis of data relevant to injury prevention and trauma management have a critical role in the effective control of the injury pandemic. Contemporary Australian initiatives including the establishment of the National Injury Surveillance and Prevention Project, new national public health programmes and research initiatives have the potential to establish a new wave of injury control programmes on a firm scientific base.
Abstract Fetal echocardiography provides an opportunity to diagnose congenital heart disease as early as the midtrimester of pregnancy, allowing for proper planning of perinatal care and counselling of the parents. This paper reviews the accuracy and outcomes of fetal cardiac ultrasound studies at The Prince Charles Hospital over the past 4 years.
Journal of Paediatrics and Child HealthVolume 25, Issue 4 p. 187-188 Cigarette advertising: A matter for paediatric concern D. BENNETT, Corresponding Author D. BENNETT Adolescent Medical Unit, Children's Hospital, Camperdown, New South Wales, AustraliaD. Bennett, Head, Adolescent Medical Unit, Children's Hospital, Camperdown, NSW 2050, Australia.Search for more papers by this author D. BENNETT, Corresponding Author D. BENNETT Adolescent Medical Unit, Children's Hospital, Camperdown, New South Wales, AustraliaD. Bennett, Head, Adolescent Medical Unit, Children's Hospital, Camperdown, NSW 2050, Australia.Search for more papers by this author First published: August 1989 https://doi.org/10.1111/j.1440-1754.1989.tb01451.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Armstrong B.K., Daube M.M., Shean R.E. A smoke-free Australia—our bicentenary resolution? (Editorial) Med. J. Aust. 1988; 149: 1–2. 10.5694/j.1326-5377.1988.tb120471.x CASPubMedWeb of Science®Google Scholar 2 Hill D.J. Australian patterns of tobacco smoking in 1986. Med. J. Aust. 1988; 149: 6–10. 10.5694/j.1326-5377.1988.tb120474.x CASPubMedWeb of Science®Google Scholar 3 Hammond E.C. Smoking in relation to death rates in one million men and women In W. Haenszel, ed., Epidemiological Approaches to the Student of Cancer and Other Chronic Diseases. National Cancer Institute Monograph 19. NCIM Bethesca 1966. Google Scholar 4 Young People's Health—A Challenge for Society. Report of a WHO Study Ge on Young People and ‘Health for All by the Year 2000’. Technical Report Sees 731, World Health Organization, Geneva. 1986; 45. Google Scholar 5 Chapman S., Fitzgerald B. Brand preference and advertising recall in adolescent smokers: some implications for health promotion. Amer. J. Public Health 1984; 72: 491–4. 10.2105/AJPH.72.5.491 CASWeb of Science®Google Scholar 6 New South Wales Drug and Alcohol Authority. Survey of drug use by seconcary school students. 1987; 18. Google Scholar 7 Trade Practices Tribunal. Review of the Trade Practices Commission's determination in respect of the authorization of certain codes of the Media Council of Australia. 1987; 117. Google Scholar 8 US Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. Report of the Surgeon General. Centers for Disease Control. Public Health Service Office on Smoking and Health. DHHS Publication no. (CDC) 89–8411. 1989. Google Scholar 9 Doyle A.E., Rand M. et al. The Australian Tobacco Research Foundation. Letter to the editor, from members of Scientific Advisory Committee. Med. J. Aust. 1988; 148: 152. 10.5694/j.1326-5377.1988.tb112788.x CASPubMedWeb of Science®Google Scholar 10 Cullingford R., Da Cruz L., Webb S., Shean R., Jamrozik K. Legibility of health warnings on billboards that advertise cigarettes. Med. J. Aust. 1988; 148: 336–8. 10.5694/j.1326-5377.1988.tb133733.x CASPubMedWeb of Science®Google Scholar 11 Non-Smokers' Rights Association. A catalogue of deception: the use and abuse of the voluntary regulation of tobacco advertising in Canada. Non-Smors' Rights Association, Toronto . 1986; Appendix A:2. Google Scholar 12 SA Government rejects cigarette advertising offer. AD News 11 March 1968. Google Scholar 13 Minority report to the Media Council of Australia, from public sector members of the Cigarette Advertising Code Council on Revisions to the voluntary code of cigarette advertising. 20 July 1988. Google Scholar 14 Trade Practices Tribunal. Review of the Trade Practices Commission authorisation of certain codes of the Media Council of Australia. Reasons for decision. 2 December 1988; p. 35. Google Scholar 15 Bjartveit K., Lund K.E. Smoking control in Norway. National Council on Smoking and Health, Oslo . November 1987. Web of Science®Google Scholar 16 Health or Tobacco. An end to tobacco advertising and promotion. Toxic Substances Board, Wellington , NZ , May 1989. Google Scholar 17 Musk A.W., Shean R., Woodward S. Legislation for smoking control in Westem Australia. Brit. Med. J. 1985; 290: 1562–5. 10.1136/bmj.290.6481.1562 CASPubMedWeb of Science®Google Scholar 18 Marsh A., Matheson J. Smoking attitudes and behaviour: an enquiry carried out on behalf of the Department of Health and Social Security. Her Masty's Stationery Office, London . 1983. Google Scholar Volume25, Issue4August 1989Pages 187-188 ReferencesRelatedInformation
The records of medical peer review meetings at the Royal Children's Hospital, Melbourne, were audited for the period 1983-87. This investigation focused on the peer review process, but also evaluated the extent to which recommended changes in medical practice were carried out. The results showed that few recommendations arose from the meetings despite the clear recognition of a number of problem areas. In the instances where firm recommendations were made, few appeared to have been implemented. The main reasons for this failure were: (i) the review was not an integrated part of the medical management structure of the hospital; (ii) recommendations were frequently not made despite clear expressions of the need for action; (iii) the absence of a designated individual to ensure that recommended actions were implemented, together with the lack of a feedback or internal review process to monitor effectiveness; and (iv) a relatively low profile of the peer review. Despite these shortcomings, the peer review is widely perceived to be a valuable exercise, especially as a general educational tool. However, its potential is far greater, and a model is proposed for a more effective medical peer review programme.
A case of arrhythmogenic right ventricular dysplasia in a 10 year old girl is described which provides some evidence for an inherited aetiology of this unusual form of heart disease. The parents of this child were first cousins, thus increasing the possibility of inherited disorders in their offspring. She had been known from infancy to have the rare disorder of congenital deficiency of intestinal enteropeptidase, and low serum immunoglobulins G and A. An untyped adenovirus was grown from a myocardial biopsy taken early in the course of her cardiac disease. However, it is unlikely that this virus was a major factor in the aetiology of her cardiac disease. Both the cardiac and intestinal diseases are now commonly believed to result from hereditary factors, and this report provides further support for this view.
Accurate delivery of low flow oxygen is essential for the management of infants with chronic respiratory failure. Twenty-seven examples of one low flow oxygen meter were tested. Measured flows were found to differ greatly from indicated settings, particularly at 250 mL/min settings. Knowledge of such errors as well as improved quality control are essential for appropriate management of oxygen therapy.
Journal of Paediatrics and Child HealthVolume 25, Issue 4 p. 189-191 What is the role of paediatric ECMO in Australia? W. BUTT MB, BS, FRACP, Corresponding Author W. BUTT MB, BS, FRACP Staff Specialist in Intensive Care Royal Children's Hospital, Melbourne, Victoria, AustraliaDr W. Butt, Intensive Care Unit, Royal Children's Hospital, Parkville, Vic. 3052, Australia.Search for more papers by this authorP. McDOUGALL MB, BS, FRACP, P. McDOUGALL MB, BS, FRACP Deputy Director of Neonatology Royal Children's Hospital, Melbourne, Victoria, AustraliaSearch for more papers by this author W. BUTT MB, BS, FRACP, Corresponding Author W. BUTT MB, BS, FRACP Staff Specialist in Intensive Care Royal Children's Hospital, Melbourne, Victoria, AustraliaDr W. Butt, Intensive Care Unit, Royal Children's Hospital, Parkville, Vic. 3052, Australia.Search for more papers by this authorP. McDOUGALL MB, BS, FRACP, P. McDOUGALL MB, BS, FRACP Deputy Director of Neonatology Royal Children's Hospital, Melbourne, Victoria, AustraliaSearch for more papers by this author First published: August 1989 https://doi.org/10.1111/j.1440-1754.1989.tb01452.xCitations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Short B.L., Miller M.K., Anderson K.D. ECMO in management of respiratory failure in neonates. Clin. Perinatol. 1987; 14: 737. 10.1016/S0095-5108(18)30760-7 CASPubMedWeb of Science®Google Scholar 2 Hirschl R.B., Bartlett R.H. ECMO support in cardiorespiratory failure. Adv. Surg. 1987; 21: 189–212. Google Scholar 3 Ortiz R.M., Cilley R.E., Bartlett R.H. ECMO in pediatric respiratory failure. Pediatr. Clin. North Amer. 1987; 34: 39–46. 10.1016/S0031-3955(16)36179-X CASPubMedWeb of Science®Google Scholar 4 Bartlett R.H., Roloff D.W., Carnell R.G., Andrews A.F., Dillon P.W., Wischenberger J.B. Extracorporeal circulation in neonatal respiratory failure: a prospective randomised study. Pediatrics 1985; 764: 77–85. Google Scholar 5 Harris W.E., Darling E.M., Healon J.F.G., Arensman R.M. Complications of long term extrecorporeal membrane oxygenation other than haemorrhage. In Procoedings of the Fifth Annual ECMO Symposium of the Children's Hospital National Medical Center . Children's Hospital National Medical Center, Washington D.C. 1989; 26. Google Scholar 6 Rosenberg E.N., Willerson S.A., Cook L.N. Three years of follow-up of extracorporeal membrane oxygenation patients. In Proceedings of the Fifth Annual ECMO Symposium of the Children's Hospital National Medical Center . Children's Hospital National Medical Center, Washington D.C. 1989; 11. Google Scholar 7 Adolph V., Ehelund K., Smith C. et al. Developmental outcome in infants treated with extracorporeal membrane oxygenation. In Proceedings of the Fifth Annual ECMO Symposium of the Children's Hospital National Medical Center . Children's Hospital National Medical Center, Washington D.C. 1989; 13. Google Scholar 8 Schumacher R., Palmer T., Bartlett R. Outcome of infants treated with ECMO. In Proceedings of the Fifth Annual ECMO Symposium of the Children's Hospital National Medical Center . Children's Hospital National Medical Center, Washington D.C. 1989; 15. Google Scholar 9 Nield T., Ramos A., Turbau R. et al. One year outcome of neonatal ECMO. In Proceedings of the Fifth Annual ECMO Symposium of the Children's Hospital National Medical Center . Children's Hospital National Medical Center, Washington D.C. 1989; 16. Google Scholar 10 Pearson G.D., Short B.L. Economic analysis of ECMO. J. Intens. Care Med. 1987; 2: 116–20. 10.1177/088506668700200207 Google Scholar Citing Literature Volume25, Issue4August 1989Pages 189-191 ReferencesRelatedInformation
The clinical features of 60 female adolescents (mean age 15 +/- 0.3 years) presenting consecutively to a rheumatologist are reviewed. Thirty-five per cent met criteria for well-defined chronic pain syndromes, 19 having fibrositis syndrome and two having a reflex sympathetic dystrophy syndrome. Other diagnoses were inflammatory arthritis (30%), anterior knee pain syndromes (13.3%), tendinitis (8.3%) and miscellaneous conditions (13.3%). The high prevalence of chronic pain syndromes in this patient group is highlighted and an approach to management is suggested.
Neonatal cystic fibrosis (CF) screening has been performed in New Zealand for a total of 7 years. This study reports the experience with this procedure in New Zealand over a 4 year period and compares it with 2 years when diagnoses of CF were suggested by clinical features only. A total of 72 infants were confirmed as having CF during 4 years of screening. Twenty-eight infants were found to have CF during 2 years in which screening was not performed. There were 29 false positive diagnoses during the screening years and six false negative diagnoses. Three of the false negative diagnoses occurred because of laboratory error, but three occurred because either the first or second measurement of immunoreactive trypsinogen (IRT) was normal. Faecal chymotrypsin was measured in samples from 434 infants at the time of the second IRT and assisted with the diagnosis for one infant which might otherwise have been missed. Only 42.5% of infants were asymptomatic at the time of the confirmatory sweat test. Significant morbidity and mortality was associated with meconium ileus which occurred in 24% of infants with CF. Improved ascertainment of cases of CF has occurred since screening began. Further follow-up is required to determine other benefits of newborn screening.
A case report of envenomation by a common brown snake, Pseudonaja textilis, in a 3.3 year old boy is presented. He suffered a brief grand mal convulsion 10 min after the bite which was shortly after removal of a compression bandage. A severe coagulopathy of the defibrination type required administration of five ampoules of brown snake monovalent antivenom (CSL). The association of envenomation by snakes and convulsions is discussed, as is the management of severe defibrination due to envenomation.
A full-term male neonate, weighing 2540 g at birth, was admitted to hospital on day 2 because of vomiting and severe dehydration. Duodeno-duodenostomy was performed on day 5 for congenital duodenal atresia. The child was well postoperatively until day 9, when he developed fever. Intermittent fever continued despite treatment with several antibiotics. He became seriously ill on day 15 and developed disseminated intravascular coagulation. Treatment with antifungal drugs (amphotericin B and 5-flucytosine) was effective for systemic candidiasis, but candida endophthalmitis developed. There was a persistent vitreous lesion in the left eye, which after cessation of therapy has been improving gradually. Systemic candidiasis and candida endophthalmitis should be considered in neonates who develop signs of sepsis postoperatively.
Abstract One hundred and seven children with faecal incontinence were evaluated and managed over a 3 year period by a multidisciplinary team. After initial clinical assessment, evaluation of defaecatory mechanisms (using a balloon model) and assessment of personal‐social development and self‐concept were undertaken. Management was based on initial bowel evacuation, short‐term laxatives, and habit training involving systematic use of positive reinforcement; 69 children received biofeedback conditioning. Idiopathic megacolon with constipation and soiling was the most common finding (98 cases). Other diagnoses included previously undiagnosed neurogenic bowel (three cases), post‐surgical anal anomalies (four cases), and psychogenic encopresis (two cases). Idiopathic megacolon was characterized by decreased rectal sensation, increased threshold for external sphincter relaxation and an inability to evacuate. Faecal incontinence was associated with an undesirably low social self‐concept (70% of the 40 evaluated), but was not related to a delay in development (mean general developmental quotient = 105 ± 8, for the 35 tested). Family psychopathology warranting referral for family therapy was found in 14 children (13%). The management programme yielded a short‐term (3 months) cure rate of 68% and a long‐term (12 months) cure rate of 90%, with 10% having continued soiling which varied from occasional to several incidents/week. No significant improvement in self‐concept was observed overall, although marked improvements were observed in some children. We conclude that disordered defaecatory dynamics are a major determinant of faecal incontinence in children. Undesirably low social self‐concepts but normal developmental ability accompany this condition. Management is facilitated by a multidisciplinary approach, acknowledging the role of both behavioural and physiological components of the problem. This approach is effective in eradicating soiling in the majority of cases, comparing favourably with other published data.
Abstract Rates of hospital admissions and bed usage for infections by Aborigines up to 15 years of age were much higher in Western Australia during 1981‐86 than they were for the rest of the population. These rates for Aboriginal infants for gastroenteritis, for example, were 20‐25 times and 40‐50 times those for other infants. The rates mostly declined over the 6 years except for gastrointestinal and respiratory infections in Aboriginal infants and young children in rural and remote areas. Hospitalization rates reflect many factors which include disease incidence and severity but also distance, climate and access to medical and nursing care and their utilization. Preventative health programmes must be maintained to help improve the health of young Aborigines.
Abstract A patient with Sturge‐Weber syndrome developed seizures at the age of 4 years. At 13 years of age, she had intractable complex partial seizures with marked visual symptomatology. Interictal encephalograms showed bilateral slow activity, more marked over the right hemisphere with epileptogenic activity maximal in the right temporal region. Serial computerized axial tomography scans demonstrated evoluton of bilateral occipital lesions with calcification and adjacent low density areas that were more marked on the right. Magnetic resonance imaging, angiography and neuropsychological evaluations were performed. An extensive resection of the right occipital lobe was achieved. One year after surgery, the patient has had seven brief seizures. Delineation of an epileptogenic focus and surgical removal of the lesion in patients with intractable seizures can now be considered in selected patients with bilateral central nervous system pathology.
Doppler flow velocity (DFV) in the anterior cerebral artery was recorded every 12 h and cerebral perfusion pressure (CPP) continuously in 21 sick, ventilated preterm neonates for 48 h from shortly after birth. Ten received a neuromuscular blocker, seven were sedated with morphine infusions and five received neither of these treatments. Variability of DFV and CPP was assessed by the coefficient of variation (CV) and the autocorrelation function (ACF). Variability of both signals was lowest in the group treated by neuromuscular blockade (DFV CV 3, s.d. = 0.8; CPP CV 9, s.d. = 2.2; CPP ACF 37, s.d. = 19.2), intermediate in the group receiving sedation by morphine infusion (DFV CV 3.4, s.d = 0.7; CPP CV 11, s.d. = 2.2; CPP ACF 31, s.d. = 21.6) and highest in the group receiving neither treatment (DFV CV 5, s.d. = 1.8; CPP CV 14, s.d. = 2.3; CPP ACF 27, s.d. = 16.7). Variability also increased with decreasing gestational age, suggesting that immature cerebrovascular regulatory mechanisms were present in the least mature neonates.
Abstract Twenty‐two individuals with Prader‐Willi Syndrome in New South Wales were surveyed. The results show that males were diagnosed at a significantly earlier age than females and suggest a recent trend towards earlier diagnosis. The advantages of early diagnosis are discussed. In those in whom cytogenetic studies had been performed, 47% were found to have a deletion involving chromosome 15q11–13. Profound neonatal hypotonia had been present in all cases. Obesity became apparent between 1.5 and 10 years (mean = 3.8 years). Facial dysmorphism was reported in 83% and acromicria in 100%. Sixty‐two per cent of subjects were regarded as less pigmented than first degree relatives. Cognitive assessments were performed on nine subjects. Two (22%) were functioning in the normal range of intelligence. Behaviour problems, both food‐related and non‐food‐related, were present in the majority and placed considerable stress on the family caring for the individual with Prader‐Willi Syndrome.
Recent evidence suggests that malnutrition has a negative impact on pulmonary function in children with cystic fibrosis. In the past, dietary management has aimed at high energy low fat intake, but this has recently been shown to fall far short of the 120‐150% of the recommended daily allowance for energy cystic fibrosis patients require. This paper outlines the current principles of nutritional management for children with cystic fibrosis. These include a high energy, high fat containing diet (within limits of individual tolerance); high carbohydrate intake; high salt intake; replacement of fat‐soluble vitamins; appropriate use of pancreatic enzyme preparations; and supplemental feeding when indicated. It is vital that a nutrition education programme be established for each child and his or her family so that the emphasis shifts from treatment of malnutrition to prevention. The long‐term aim must be to promote an independent, healthy lifestyle which incorporates good nutrition and other healthy pursuits such as exercise.
