Archives of disease in childhood
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Randomized Controlled Trial Comparative Study Clinical Trial
Equipping the community to measure children's height: the reliability of portable instruments.
To compare (1) the reliability of two expensive and two inexpensive measuring instruments, suitable for use in the community and (2) the reliability of experienced compared with inexperienced observers. ⋯ Inexpensive height measuring equipment, once accurately installed, is no less reliable than the most expensive. Inexperienced observers can, with care, measure as reliably as those with long experience. Every effort should be made, however, to ensure that the progress of individual children is monitored not only by the same observer, but on a long term basis.
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Paediatric inpatient utilisation in a district general hospital was studied for 20 general practices covering a population of 26,433 children. The factors influencing the rate and route of admission (general practitioner (GP) or accident and emergency department) were analysed for 894 emergency non-traumatic admissions over a 12 month period. The overall rate of acute, nontraumatic admission was 33.8/1000; 35% of these admissions were via the accident and emergency department. ⋯ Using multiple logistic regression analysis, the risk of being admitted via the accident and emergency department relative to GP admission was shown to be higher for older children (odds ratio for each year of age 1.05) and less for children registered with large practices with more GPs (odds ratio for each extra GP 0.36) or practices with more children under 15 (odds ratio per extra child 0.9991). Access to hospital as measured by isochrone bars and social characteristics of the ward of residence of each child admitted were not associated with the route of admission. The admission rate for each practice was positively, but not statistically significantly, associated with the unemployment rate attributed to the list, the unemployment rate of the ward where the practice was located, and the percentage of admissions via accident and emergency, and negatively associated with the percentage of the list under 15 years.
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To determine clinical signs that can predict pneumonia (confirmed by radiography) in infants under 2 months of age, 101 infants with pneumonia and 150 with an upper respiratory infection (but not pneumonia) were studied. Ten infants with pneumonia and 15 with an upper respiratory infection did not have the cough and/or difficult (or rapid) breathing that are recommended as 'entry criteria' by the World Health Organisation (WHO). The remaining infants met WHO entry criteria; in them sensitivity and specificity of respiratory rate > or = 60/min and/or severe chest indrawing to diagnose pneumonia was 85% and 97% respectively. ⋯ However, the non-specific signs were the only clue to diagnosis in five infants weighing < or = 2500 g. At age < 7 days, a weight < or = 2500 g and cyanosis were associated with significantly higher risk of mortality. These findings support the use of a respiratory rate > or = 60/min and/or chest indrawing for identification of pneumonia, and suggest addition of nasal flaring to the criteria for case identification in infants under 2 months with cough and/or difficult or rapid breathing.
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Nine patients with central hypoventilation syndrome (CHS) were treated with negative extrathoracic pressure ventilation (VNEP). Treatment with VNEP was started between 20 days and 57 months of age, which was two days to 47 months after diagnosis. The equipment to provide VNEP utilised a new system with a latex neck seal and Perspex chamber allowing easy access to the child. ⋯ VNEP is an effective, non-invasive, treatment in infants with CHS if initiated before tracheostomy. It may improve the children's quality of life during the daytime. If upper airway obstruction is a problem in the first year of life, it may be combined with nasal mask CPAP.
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Comparative Study
Cerebrospinal fluid concentrations of interleukin-1 beta, tumour necrosis factor-alpha, and interferon gamma in bacterial meningitis.
To investigate the role of the inflammatory cytokines, the cerebrospinal fluid concentrations of interleukin (IL)-1 beta, tumour necrosis factor-alpha (TNF-alpha), and interferon gamma (IFN-gamma) were measured in 11 children with bacterial meningitis and two with mycoplasmic meningoencephalitis and compared with those in 50 children with aseptic meningitis and 15 with non-pleocytotic cerebrospinal fluid. Concentrations of IL-1 beta and TNF-alpha were each significantly higher in the cerebrospinal fluid of patients with bacterial meningitis than in those with aseptic meningitis or those with non-pleocytotic cerebrospinal fluid. ⋯ On the other hand, the IFN-gamma concentration was the highest in the cerebrospinal fluid of patients with aseptic meningitis. These results suggest that the inflammatory cytokines are differently released in the intrathecal space infected with viruses or bacteria.