Acta paediatrica
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Case Reports
Early sepsis, obstructive jaundice and right-sided diaphragmatic hernia in the newborn.
A male newborn was admitted to our Unit because of early sepsis and shock. He required antimicrobial therapy and mechanical ventilation and initially did well, although he exhibited jaundice and cholestasis. ⋯ A right-sided diaphragmatic hernia was confirmed by a CT-scan, and surgery was performed with good outcome. The association of delayed-onset right-sided CDH following early sepsis and obstructive jaundice has not been published before, and illustrates a scarcely known form of presentation of this condition.
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Diagnostic and therapeutic intervention is common in newborns with neonatal jaundice, motivated by the fear of bilirubin-associated brain damage, kernicterus. In recent years, a resurgence of kernicterus has been noted in countries in which this complication had essentially disappeared. Both early postnatal discharge and relaxation of attitudes to neonatal jaundice have been implicated. Guidelines for the management of neonatal jaundice show significant disparity, attesting to our inadequate understanding of the underlying biology. Aggressive guidelines expose infants to unnecessary risks, risks that are significant when it comes to exchange transfusion, and may also involve improper use of limited resources. Relaxed guidelines, on the other hand, may expose infants to increased risk of brain toxicity. ⋯ At present we have no tools for ensuring certain identification of individuals with increased vulnerability to bilirubin toxicity. Relaxation of guidelines which have been proven safe through prolonged use should therefore be undertaken only in an atmosphere of increased vigilance. Guidelines that allow for a range of therapeutic and diagnostic options underline the need for careful assessment of each case on its individual merits.
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We recorded the incidence and degree of posterior subcapsular cataract (PSC) in 29 children who had undergone autologous (n = 28) or syngeneic (n = 1) bone marrow transplantation (BMT) due to haematologic or lymphoid malignancy. Conditioning prior to transplantation consisted either of a combination of chemotherapy and total body irradiation (TBI) (n = 21) or of chemotherapy only (n = 8). TBI was given in one fraction of 7.5 Gy. ⋯ Twelve patients in the +TBI group had well-preserved visual acuity throughout the study, reflecting a slow progression of PSC. This compares favourably with previous reports of allogeneic BMT, possibly owing to less need for corticosteroids after autologous BMT. We conclude that the incidence of PSC was high after autologous BMT where the conditioning regimen included total body irradiation.
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The aim of the study is to examine the suitability of the Lang II Random Dot Stereotest for use by district nurses in primary healthcare centres. The Lang Stereotest is an inexpensive method. It is easy to apply, but the child's co-operation is required. ⋯ Only one of these cases was referred to an orthoptist as a direct consequence of the screening. The Lang Stereotest showed low reliability and low validity in this community trial. It is concluded that the Lang II Random Dot Stereotest is not suitable for the screening of manifest strabismus in unselected populations of 3-y-old children in Sweden, where a large proportion of cases of strabismus is detected during the first 3 y of life.
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To determine whether parents' observations can be used to predict the severity of the obstructive sleep apnoea syndrome (OSAS) in children. ⋯ Although some parents' observations are more frequently reported in children with severe OSAS, neither any single nor combinations of observations accurately predict the severity of OSAS. Polysomnography is still needed to determine the severity of obstruction.