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Year of Publication
1.  [No title available] 
doi:10.1136/adc.2006.099531corr1
PMCID: PMC2082987
2.  [No title available] 
PMCID: PMC2066026
3.  [No title available] 
doi:10.1136/adc.2003.045401corr1
PMCID: PMC2082925
4.  [No title available] 
doi:10.1136/adc.2005.77065corr1
PMCID: PMC2082919
5.  [No title available] 
doi:10.1136/adc.2005.088385corr1
PMCID: PMC2082826
6.  [No title available] 
doi:10.1136/adc.2005.084590corr1
PMCID: PMC2082776
7.  [No title available] 
doi:10.1136/adc.2004.068866corr1
PMCID: PMC2082755
8.  [No title available] 
doi:10.1136/adc.2002.023416corr1
PMCID: PMC2082739
9.  Blood pressure centiles for Great Britain 
Archives of Disease in Childhood  2006;92(4):298-303.
Objective
To produce representative cross‐sectional blood pressure reference centiles for children and young people living in Great Britain.
Design
Analysis of blood pressure data from seven nationally representative surveys: Health Surveys for England 1995–8, Scottish Health Surveys 1995 and 1998, and National Diet & Nutrition Survey 1997.
Methods
Blood pressure was measured using the Dinamap 8100 with the same protocol throughout. Weight and height were also measured. Data for 11 364 males and 11 537 females aged 4–23 years were included in the analysis, after excluding 0.3% missing or outlying data. Centiles were derived for systolic, diastolic, mean arterial and pulse pressure using the latent moderated structural (LMS) equations method.
Results
Blood pressure in the two sexes was similar in childhood, rising progressively with age and more rapidly during puberty. Systolic pressure rose faster and was appreciably higher in adult men than in adult women. After adjustment for age, blood pressure was related more to weight than height, the effect being stronger for systolic blood pressure. Pulse pressure peaked at 18 years in males and 16 years in females.
Conclusions
These centiles increase our knowledge of blood pressure norms in contemporary British children and young people. High blood pressure for age should be defined as blood pressure above the 98th centile, and high‐normal blood pressure for age as blood pressure between the 91st and 98th centiles. The centiles identify children and young people with increased blood pressure, and will be of benefit to both clinical practice and research.
doi:10.1136/adc.2005.081216
PMCID: PMC2083671  PMID: 16905566
10.  A low cost, colour coded, hand held spring scale accurately categorises birth weight in low resource settings 
Archives of Disease in Childhood  2006;91(5):410-413.
Aims
To determine the accuracy of a low cost, spring calibrated, hand held scale in classifying newborns into three weight categories (⩾2500 g, 2000–2499 g, <2000 g).
Methods
The test device was compared to a gold standard digital baby scale with precision to 2 g. In Sarlahi district, Nepal, 1890 newborns were eligible for the study. Measurements were collected for both the test device and the digital scale from 1820 (96.3%) newborns.
Results
The overall low birth weight (LBW) prevalence rate for the gold standard digital scale was 28.1% (511/1820). Sensitivity (93.7%) and specificity (97.6%) of the test device was high compared to LBW classifications based on digital weight measurements. Classification of infants into the <2000 g category was 5.0% and 4.7% for the gold standard and test device, respectively. Sensitivity and specificity of the test device in identifying infants <2000 g was 87.8% and 99.6%, respectively. Positive predictive values were high (>91%) for both weight categories
Conclusions
This low cost, simple‐to‐use device classified infants into weight categories with a high degree of consistency and accuracy that exceeds that of surrogate measures. This new device is useful for identifying and targeting life saving interventions for LBW, high risk infants in settings where infants are born in the home and conventional weighing scales are unavailable.
doi:10.1136/adc.2005.088781
PMCID: PMC2082743  PMID: 16464960
low birth weight; neonatal; scale; sensitivity; specificity; validity
11.  A low cost, colour coded, hand held spring scale accurately categorises birth weight in low resource settings 
Archives of disease in childhood  2006;91(5):410-413.
Aims
To determine the accuracy of a low cost, spring calibrated, hand held scale in classifying newborns into three weight categories (>2500 g, 2000−2499 g, ,2000 g).
Methods
The test device was compared to a gold standard digital baby scale with precision to 2 g. In Sarlahi district, Nepal, 1890 newborns were eligible for the study. Measurements were collected for both the test device and the digital scale from 1820 (96.3%) newborns.
Results
The overall low birth weight (LBW) prevalence rate for the gold standard digital scale was 28.1% (511/1820). Sensitivity (93.7%) and specificity (97.6%) of the test device was high compared to LBW classifications based on digital weight measurements. Classification of infants into the ,2000 g category was 5.0% and 4.7% for the gold standard and test device, respectively. Sensitivity and specificity of the test device in identifying infants ,2000 g was 87.8% and 99.6%, respectively. Positive predictive values were high (.91%) for both weight categories
Conclusions
This low cost, simple-to-use device classified infants into weight categories with a high degree of consistency and accuracy that exceeds that of surrogate measures. This new device is useful for identifying and targeting life saving interventions for LBW, high risk infants in settings where infants are born in the home and conventional weighing scales are unavailable.
doi:10.1136/adc.2005.088781
PMCID: PMC2082743  PMID: 16464960
12.  Blood pressure centiles for Great Britain 
Archives of Disease in Childhood  2006;92(4):298-303.
Objective:
To produce representative cross-sectional blood pressure reference centiles for children and young people living in Great Britain.
Design:
Analysis of blood pressure data from seven nationally representative surveys: Health Surveys for England 1995–8, Scottish Health Surveys 1995 and 1998, and National Diet & Nutrition Survey 1997.
Methods:
Blood pressure was measured using the Dinamap 8100 with the same protocol throughout. Weight and height were also measured. Data for 11 364 males and 11 537 females aged 4–23 years were included in the analysis, after excluding 0.3% missing or outlying data. Centiles were derived for systolic, diastolic, mean arterial and pulse pressure using the lambda-mu-sigma (LMS) equations method.
Results:
Blood pressure in the two sexes was similar in childhood, rising progressively with age and more rapidly during puberty. Systolic pressure rose faster and was appreciably higher in adult men than in adult women. After adjustment for age, blood pressure was related more to weight than height, the effect being stronger for systolic blood pressure. Pulse pressure peaked at 18 years in males and 16 years in females.
Conclusions:
These centiles increase our knowledge of blood pressure norms in contemporary British children and young people. High blood pressure for age should be defined as blood pressure above the 98th centile, and high-normal blood pressure for age as blood pressure between the 91st and 98th centiles. The centiles identify children and young people with increased blood pressure, and will be of benefit to both clinical practice and research.
doi:10.1136/adc.2005.081216
PMCID: PMC2083671  PMID: 16905566
13.  Improving infant sleep and maternal mental health: a cluster randomised trial 
Archives of Disease in Childhood  2006;92(11):952-958.
Objectives
To determine whether a community‐delivered intervention targeting infant sleep problems improves infant sleep and maternal well‐being and to report the costs of this approach to the healthcare system.
Design
Cluster randomised trial.
Setting
49 Maternal and Child Health (MCH) centres (clusters) in Melbourne, Australia.
Participants
328 mothers reporting an infant sleep problem at 7 months recruited during October–November 2003.
Intervention
Behavioural strategies delivered over individual structured MCH consultations versus usual care.
Main outcome measures
Maternal report of infant sleep problem, depression symptoms (Edinburgh Postnatal Depression Scale (EPDS)), and SF‐12 mental and physical health scores when infants were 10 and 12 months old. Costs included MCH sleep consultations, other healthcare services and intervention costs.
Results
Prevalence of infant sleep problems was lower in the intervention than control group at 10 months (56% vs 68%; adjusted OR 0.58 (95% CI: 0.36 to 0.94)) and 12 months (39% vs 55%; adjusted OR 0.50 (0.31 to 0.80)). EPDS scores indicated less depression at 10 months (adjusted mean difference −1.4 (−2.3 to −0.4) and 12 months (−1.7 (−2.6 to −0.7)). SF‐12 mental health scores indicated better health at 10 months (adjusted mean difference 3.7 (1.5 to 5.8)) and 12 months (3.9 (1.8 to 6.1)). Total mean costs including intervention design, delivery and use of non‐MCH nurse services were £96.93 and £116.79 per intervention and control family, respectively.
Conclusions
Implementing this sleep intervention may lead to health gains for infants and mothers and resource savings for the healthcare system.
Trial registration
Current Controlled Trial Registry, number ISRCTN48752250 (registered November 2004).
doi:10.1136/adc.2006.099812
PMCID: PMC2083609  PMID: 17158146
14.  Bronchoscopy following diagnosis with cystic fibrosis 
Archives of Disease in Childhood  2006;92(10):898-899.
We recently changed our practice to perform bronchoscopy following diagnosis with cystic fibrosis. On a retrospective review of 25 children, Pseudomonas aeruginosa was detected in bronchoalveolar lavage for the first time in five children (20%) and Staphylococcus aureus in four (16%). Lavage culture was positive in eight of 18 children without respiratory symptoms. This highlights the potential of bronchoscopy following diagnosis, even in asymptomatic children.
doi:10.1136/adc.2006.105825
PMCID: PMC2083238  PMID: 17088336
15.  Investigation of unexplained infant deaths in Jerusalem, Israel 1996–2003 
Archives of Disease in Childhood  2006;92(8):697-699.
Background
Sudden infant death syndrome (SIDS) is a diagnosis of exclusion that may be assigned only after investigations including a forensic autopsy are performed to exclude possible organic and environmental causes of death. Israeli society is influenced by the Jewish and Islamic faiths, which permit autopsy only under selected circumstances. Against this background, we carried out a study to determine what examinations are performed to investigate unexplained infant deaths in Jerusalem, Israel.
Methods
We examined hospital, Ministry of Health and Ministry of Interior records of unexplained infant deaths in the Jerusalem district from the years 1996–2003.
Results
Ninety six cases were identified from all sources. Forty nine (51%) infants were brought to a hospital at or near the time of death. Studies to determine the cause of death were performed in 54% of cases for which medical records were available for review. These studies included bacterial cultures (44%), skeletal surveys (12%), computerised tomography (3%) and metabolic studies (3%). Only one forensic autopsy was performed, and in no instance was the death site examined by medical personnel. There was a high rate of retrospective review by district health physicians. The most frequently assigned cause of death was SIDS.
Conclusions
: The capacity of public health officials and forensic pathologists to investigate unexplained infant deaths is strongly affected by the legal, religious and political milieu in which they work. Efforts should be made to develop socially acceptable methods of improving the quality of infant death investigations in Jerusalem.
doi:10.1136/adc.2006.107425
PMCID: PMC2083878  PMID: 17074788
sudden infant death syndrome; autopsy; forensic investigation; religion
16.  Pyridoxine‐dependent seizures in Dutch patients: diagnosis by elevated urinary alpha‐aminoadipic semialdehyde levels 
Archives of Disease in Childhood  2006;92(8):687-689.
Background
Pyridoxine‐dependent seizures (PDS) is a rare, autosomal recessively inherited disorder. Recently α‐aminoadipic semialdehyde (α‐AASA) dehydrogenase deficiency was identified as a major cause of PDS, which causes accumulation of both α‐AASA and pipecolic acid (PA) in body fluids.
Methods
We studied urinary and plasma α‐AASA and PA levels in 12 Dutch clinically diagnosed patients with PDS.
Results
α‐AASA was elevated in both urine and plasma in 10 patients. In these patients plasma PA levels were also elevated but urinary PA levels were normal.
Discussion
In all patients with clinically definite PDS, and in most patients with probable or possible PDS, the clinical diagnosis of PDS could be confirmed at the metabolite level. Non‐invasive urinary screening for α‐AASA accumulation provides a reliable tool to diagnose PDS and can save these patients from the classical and potentially dangerous pyridoxine withdrawal test to prove PDS.
doi:10.1136/adc.2006.103192
PMCID: PMC2083882  PMID: 17088338
17.  Nasopharyngeal aspiration for diagnosis of pulmonary tuberculosis 
Archives of Disease in Childhood  2006;92(8):693-696.
Background
Confirmation of pulmonary tuberculosis (PTB) in young children is difficult as they seldom expectorate sputum.
Aim
To compare sputa obtained by nasopharyngeal aspiration and by sputum induction for staining and culture of Mycobacterium tuberculosis.
Patients and methods
Patients from Mulago Hospital, Kampala with symptoms suggestive of PTB were considered for inclusion in the study. Those with a positive tuberculin test and/or a chest radiograph compatible with tuberculosis were recruited. Infection with human immunodeficiency virus (HIV) was confirmed by duplicate enzyme‐labelled immunosorbent assay or in children <15 months by polymerase chain reaction (PCR). Direct PCR was undertaken on 82 nasopharyngeal aspirates.
Results
Of 438 patients referred, 94 were recruited over a period of 5 months. Median (range) age was 48 (4–144) months. Of 63 patients tested, 69.8% were infected with HIV. Paired and uncontaminated culture results were available for 88 patients and smear results for 94 patients. Nasopharyngeal aspirates were smear‐positive in 8.5% and culture‐positive in 23.9%. Induced sputa were smear‐positive in 9.6% and culture positive in 21.6%. Overall, 10.6% were smear‐positive, 25.5% were culture‐positive and 26.6% had smear and/or culture confirmed tuberculosis. Direct PCR on nasopharyngeal aspirates had a sensitivity of 62% and specificity of 98% for confirmation of culture‐positive tuberculosis.
Conclusions
Nasopharyngeal aspiration is a useful, safe and low‐technology method for confirmation of PTB and, like sputum induction, can be undertaken in outpatient clinics.
doi:10.1136/adc.2006.108308
PMCID: PMC2083896  PMID: 17185437
nasopharyngeal aspirates; diagnosis; tuberculosis
18.  Assessing the population impact of low rates of breast feeding on asthma, coeliac disease and obesity: the use of a new statistical method 
Archives of Disease in Childhood  2006;92(6):483-485.
Background
Lack of breast feeding has been reported to be associated with a number of chronic childhood disorders.
Aim
To use a recently described measure, the population impact number of eliminating a risk factor over a time period (PIN‐ER‐t), to quantify the burden of low rates of breast feeding in a UK population of babies born in 2002 with regard to asthma, coeliac disease and obesity.
Methods
We performed literature searches for systematic reviews with meta‐analyses that had investigated the association between breast feeding and asthma, coeliac disease and obesity. Based on these data, and published data on the prevalence of breast feeding and the prevalence of the disorders, we calculated PIN‐ER‐t and estimated the number of cases of each disorder which could be prevented by eliminating “no breast feeding” as a risk factor.
Results
In the population of the 596 122 babies born in England and Wales in 2002, the number of cases of asthma, coeliac disease and obesity that could be prevented over 7–9 years if “no breast feeding” as a risk factor was eliminated were 33 100 (95% CI 17 710 to 47 543), 2655 (95% CI 1937 to 3343) and 13639 (95% CI 7838 to 19308), respectively.
Conclusions
The population burden of low breast feeding rates is high with regard to these chronic disorders. The use of PIN‐ER‐t allows the population burden of low breast feeding rates to be quantified and communicated in a way that will make it easier for both the general public and decision makers to understand.
doi:10.1136/adc.2006.097667
PMCID: PMC2066141  PMID: 16840504
breast feeding; chronic disorders; population burden; PIN‐ER‐t
19.  Live viral vaccines in a DiGeorge syndrome patient 
Archives of Disease in Childhood  2006;92(6):519-520.
We report a case of pneumonia in a 13 month old male child with partial DiGeorge syndrome who died after inadvertently receiving live viral vaccines. Although live viral vaccines have been used safely in some children with DiGeorge syndrome, there are insufficient data to recommend their routine use in those with severe immunodeficiency.
doi:10.1136/adc.2006.097493
PMCID: PMC2066142  PMID: 16798784
DiGeorge syndrome; vaccine; viral
20.  Prevalence rates for constipation and faecal and urinary incontinence 
Archives of Disease in Childhood  2006;92(6):486-489.
Objective
To evaluate the prevalence rates for constipation and faecal and urinary incontinence in children attending primary care clinics in the United States.
Methods
Retrospective review of case records of all children, 4–17 years of age, seen for at least one health maintenance visit during a 6 month period and followed from birth or within the first 6 months of age in our clinics. We reviewed all charts for constipation, faecal incontinence and urinary incontinence.
Results
We included 482 children in the study, after excluding 39 children with chronic diseases. The prevalence rate for constipation was 22.6% and was similar in boys and girls. The constipation was functional in 18% and acute in 4.6%. The prevalence rate for faecal incontinence (⩾1/week) was 4.4%. The faecal incontinence was associated with constipation in 95% of our children. The prevalence rate for urinary incontinence was 10.5%; 3.3% for daytime only, 1.8% for daytime with night‐time and 5.4% for night‐time urinary incontinence. Faecal and urinary incontinence were significantly more commonly observed in children with constipation than in children without constipation.
Conclusion
The prevalence rates were 22.6% for constipation, 4.4% for faecal incontinence and 10.5% for urinary incontinence in a US primary care clinic. Children with constipation had higher prevalence rates for faecal and urinary incontinence than children without constipation. Boys with constipation had higher rates of faecal incontinence than girls with constipation.
doi:10.1136/adc.2006.098335
PMCID: PMC2066162  PMID: 16857698
functional constipation; acute constipation; faecal incontinence; daytime urinary incontinence; night‐time urinary incontinence
21.  Fluid therapy for children: facts, fashions and questions 
Archives of Disease in Childhood  2006;92(6):546-550.
Fluid therapy restores circulation by expanding extracellular fluid. However, a dispute has arisen regarding the nature of intravenous therapy for acutely ill children following the development of acute hyponatraemia from overuse of hypotonic saline.
The foundation on which correct maintenance fluid therapy is built is examined and the difference between maintenance fluid therapy and restoration or replenishment fluid therapy for reduction in extracellular fluid volume is delineated. Changing practices and the basic physiology of extracellular fluid are discussed. Some propose changing the definition of “maintenance therapy” and recommend isotonic saline be used as maintenance and restoration therapy in undefined amounts leading to excess intravenous sodium chloride intake.
Intravenous fluid therapy for children with volume depletion should first restore extracellular volume with measured infusions of isotonic saline followed by defined, appropriate maintenance therapy to replace physiological losses according to principles established 50 years ago.
doi:10.1136/adc.2006.106377
PMCID: PMC2066164  PMID: 17175577
22.  Should paediatric central lines be aspirated before use? 
Archives of Disease in Childhood  2006;92(6):517-518.
As blood clots commonly occur in the lumens of paediatric haemodialysis central‐venous lines, they must be routinely aspirated before use to prevent pulmonary emboli. The smaller diameter lines used for parenteral nutrition and cancer chemotherapy are seldom managed this way. We looked for clots formed when children undergoing cancer chemotherapy had their heparin‐locked central lines accessed, and compared with the lines of children undergoing haemodialysis. Patients undergoing haemodialysis had clots aspirated on 83% of occasions, and each child had clots at least once. Clots also occurred in the smaller lines, but they were less frequent (64%, p = 0.01), and had a lower median weight than those in dialysis lines (14.1 v 25.2 mg, p = 0.01). When small diameter central lines are used without initial aspiration, small pulmonary emboli are likely to occur, but are unlikely to be individually clinically important. Daily use, as with long‐term parenteral nutrition, might result in >3 g of clot being embolised annually. Consideration should be given to aspirating all paediatric central lines before use.
doi:10.1136/adc.2006.100073
PMCID: PMC2066167  PMID: 17068071
23.  Beyond counting cases: public health impacts of national Paediatric Surveillance Units 
Archives of Disease in Childhood  2006;92(6):527-533.
Paediatric Surveillance Units (PSUs) have been established in 14 countries and facilitate national, prospective, active surveillance for a range of conditions, with monthly reporting by child health specialists. The International Network of Paediatric Surveillance Units (INoPSU) was established in 1998 and facilitates international collaboration among member PSUs and allows for sharing of resources, simultaneous data collection and hence comparison of data from different geographical regions. The impact of data collected by PSUs, both individually and collectively as members of INoPSU, on public health outcomes, clinical care and research is described.
doi:10.1136/adc.2006.097451
PMCID: PMC2066170  PMID: 17158859
child health; paediatrics; population surveillance; public health; rare diseases
24.  Reference chart for relative weight change to detect hypernatraemic dehydration 
Archives of Disease in Childhood  2006;92(6):490-494.
Objective
The validity of the rule of thumb that infants may have a weight loss of 10% in the first days after birth is unknown. We assessed the validity of this and other rules to detect breast‐fed infants with hypernatraemic dehydration.
Design
A reference chart for relative weight change was constructed by the LMS method. The reference group was obtained by a retrospective cohort study.
Participants
1544 healthy, exclusively breast‐fed infants with 3075 weight measurements born in the Netherlands and 83 cases of breast‐fed infants with hypernatraemic dehydration obtained from literature.
Results
The rule of thumb had a sensitivity of 90.4%, a specificity of 98.3% and a positive predictive value of 3.7%. Referring infants if their weight change is below −2.5 SDS (0.6th centile) in the reference chart in the first week of life and using the rule of thumb in the second week had a sensitivity of 85.5%, a specificity of 99.4% and a positive predictive value of 9.2%.
Conclusions
The rule of thumb is likely to produce too many false positive results, assuming that for screening purposes the specificity needs to be high. A chart for relative weight change can be helpful to detect infants with hypernatraemic dehydration.
doi:10.1136/adc.2006.104331
PMCID: PMC2066175  PMID: 16880225
breast feeding; weight loss; growth monitoring; infancy; hypernatraemic dehydration
25.  Quality of life and congenital heart defects: comparing parent and professional values 
Archives of Disease in Childhood  2006;92(5):388-393.
Objective
To compare preferences obtained from health professionals with those from parents for the longer‐term health outcomes of children with congenital heart defects.
Setting
Cardiology conference; hospital.
Participants
109 paediatric cardiology professionals (72% female, median age 38 years) and 106 parents of children with congenital heart defects (82% female, median age 37 years).
Interventions
Eight health state descriptions, for cardiac and neurological disability resulting from congenital heart defects, were developed and presented with a self‐administered anonymous questionnaire. Respondents were asked to rank health state descriptions from best to worst, score each health state using a visual analog scale and mark death on this scale.
Results
Health professionals and parents agreed in the order of ranking health states from best to worst. Both groups assigned the lowest scores to health states with severe neurological disability. Scores did not differ significantly by age, sex or whether the respondent was in the health professional or parent group. Of all respondents, 8% (17) scored at least one health state description worse than death.
Conclusions
Parents and health professionals place similar values on the quality of life outcomes of children with congenital heart defects. Both are more averse to health states describing worse neurological than cardiac disability. Improving our understanding of the relative importance of different outcomes to children and families is an important basis for sharing decisions about clinical care. The views of young people with congenital heart defects should be an important focus for future enquiry into health outcomes.
doi:10.1136/adc.2005.075606
PMCID: PMC2083724  PMID: 16737999

Results 1-25 (556)