Adelaide Children Research Articles

The effects of air pollution on asthma hospital admissions in Adelaide, South Australia, 2003-2013: time-series and case-crossover analyses.

Air pollution can have adverse health effects on asthma sufferers, but the effects vary with geographic, environmental and population characteristics. There has been no long time-series study in Australia to quantify the effects of environmental factors including pollen on asthma hospitalizations. This study aimed to assess the seasonal impact of air pollutants and aeroallergens on the risk of asthma hospital admissions for adults and children in Adelaide, South Australia. Data on hospital admissions, meteorological conditions, air quality and pollen counts for the period 2003-2013 were sourced. Time-series analysis and case-crossover analysis were used to assess the short-term effects of air pollution on asthma hospitalizations. For the time-series analysis, generalized log-linear quasi-Poisson and negative binomial regressions were used to assess the relationships, controlling for seasonality and long-term trends using flexible spline functions. For the case-crossover analysis, conditional logistic regression was used to compute the effect estimates with time-stratified referent selection strategies. A total of 36,024 asthma admissions were considered. Findings indicated that the largest effects on asthma admissions related to PM2.5 , NO2 , PM10 and pollen were found in the cool season for children (0-17 years), with the 5-day cumulative effects of 30.2% (95% CI: 13.4-49.6%), 12.5% (95% CI: 6.6-18.7%), 8.3% (95% CI: 2.5-14.4%) and 4.2% (95% CI: 2.2-6.1%) increases in risk of asthma hospital admissions per 10 unit increments, respectively. The largest effect for ozone was found in the warm season for children with the 5-day cumulative effect of an 11.7% (95% CI: 5.8-17.9%) increase in risk of asthma hospital admissions per 10 ppb increment in ozone level. Findings suggest that children are more vulnerable and the associations between exposure to air pollutants and asthma hospitalizations tended to be stronger in the cool season compared to the warm season, with the exception of ozone. This study has important public health implications and provides valuable evidence for the development of policies for asthma management.

Vitamin D status and its predictors among pre-school children in Adelaide.

To assess vitamin D status and its predictors in a representative population sample of pre-school children in Adelaide (latitude of 35°S). Cross-sectional survey of children aged between 1 and 5 years from areas of low, medium and high socio-economic status as identified from the 2001 Census data, Australian Bureau of Statistics. Children were recruited between September 2005 and July 2007 using a door knocking protocol based on a stratified sampling method to obtain a representative sample of this age group. Serum 25-hydroxyvitamin D (25(OH)D) was determined using a radio-immunoassay kit. Vitamin D deficiency was defined as serum 25(OH)D) <30 nmol/L and insufficiency defined as serum 25(OH)D ≥30 and <50 nmol/L according to the Institute of Medicine. Fifty-two per cent of eligible children took part in the study. Mean (standard deviation) serum 25(OH)D was 73 (26) nmol/L (n = 221). The prevalence of vitamin D deficiency and insufficiency was 4% and 16%, respectively, with the prevalence being higher in winter (8% and 22%, respectively). Season of the year of blood collection and mother being born in Australia were significant predictors of serum 25(OH)D concentration, but age, sex, socio-economic status, BMI category or dietary supplement use were not related to vitamin D status. Vitamin D status of this representative sample of pre-school children in Australia is adequate, and the prevalence of vitamin D deficiency is low based on the Institute of Medicine criteria.

Nutrient intakes and status of preschool children in Adelaide, South Australia

To determine the nutrient intakes and status of preschool children from a representative population sample in Adelaide. Cross-sectional survey of children aged 1-5 years, using a stratified random sampling method and a doorknocking strategy, between September 2005 and July 2007. Dietary intake, assessed using a 3-day weighed-food diary; anthropometrics, biomarkers of iron, zinc and vitamin B(12), and fatty acid profiles assessed using standard methods. Median energy intakes were within dietary recommendations for the age group. Overall energy contributions from carbohydrate, protein, fat and saturated fat intakes were 50%, 17%, 33% and 16%, respectively. The rates of inadequate intake of iron, zinc, calcium and vitamin C were low, as was the prevalence of iron deficiency (5%). Only a minority of children achieved the adequate intake for n-3 long-chain polyunsaturated fatty acids (32%) and dietary fibre (18%). There was no association between socioeconomic status and intakes of macronutrients and key micronutrients. Fourteen per cent of children were obese (BMI, > 95th percentile); no association between BMI and energy intake was shown. The dietary intake of children in the study was adequate for macronutrients and the majority of micronutrients. However, low intakes of fibre and n-3 long-chain polyunsaturated fatty acids and high saturated fat intakes have raised concerns that this dietary pattern may be associated with adverse long-term health effects.

The History and Development of the Human Genetics Society of Australasia

The Human Genetics Society of Australasia is a vibrant professional society with more than 900 members that promotes and regulates the practice of human and medical genetics in Australia and New Zealand. The growth of human genetics was stimulated by the development of diagnostic clinical cytogenetics laboratories in the early to mid 1960s. This coincided with the recognition by medical specialists, mainly pediatricians, that genetic disorders, especially inborn errors of metabolism and birth defects, were of clinical interest and potentially challenging areas for their skills. The organization of professionals in human genetics was slow to evolve. There was an early Western Australian Human Genetics Society, and the cytogenetics community had begun to meet annually from about 1966 but was coordinated by a mailing list rather than as a formal organization. In 1976, as part of the celebrations of the Centenary Year of the Adelaide Children's Hospital, a clinical genetics meeting involving several high profile international speakers and most of the senior medical geneticists in Australia and New Zealand along with the annual meeting of the loose-knit cytogeneticists group agreed that a small working group be charged with setting up a Human Genetics Society. The society was formally incorporated in South Australia in 1977.

Letters to the Editor

4 October 2006 Dear Editor, NOSOCOMIAL ROTAVIRUS INFECTION IN AN AUSTRALIAN CHILDREN’S HOSPITAL There have been some exciting developments in the field of rotavirus vaccination with the successful completion of large phase III trials demonstrating the safety and efficacy of both an attenuated human rotavirus vaccine (Rotarix, GlaxoSmithKline, Boronia, Australia)1 and a pentavalent human-bovine reassortant vaccine (RotaTeq, CSL Limited/Merck & Co Inc, Melbourne, Australia).2 These vaccines were licensed in Australia by the Therapeutic Goods Administration in the first half of 2006 and applications made to the Pharmaceutical Benefits Advisory Committee have resulted in a recommendation for funding under the National Immunisation Program. Rotavirus vaccination is likely to have an impact on community and hospital-treated episodes of rotavirus gastroenteritis in Australia and elsewhere. Vaccination of infants is estimated to prevent around 85–100% of hospitalisations due to rotavirus gastroenteritis in the first year following vaccination.1, 2 Studies from other countries have shown that a significant burden of hospital-treated rotavirus infection is acquired in hospital nosocomially. Nosocomial infection rates have not been studied in Australia since a 1989 report that 14% of children <3 years old admitted to general paediatric wards at the Adelaide Children’s Hospital developed nosocomial rotavirus infection.3 We have collected data on nosocomial rotavirus infections at the Children’s Hospital at Westmead since 1996. Since 1999, all faecal specimens from inpatients with diarrhoea sent for microbiological analysis have been tested for rotavirus using the Rotazyme enzyme-linked immunosorbent assay (ELISA), whether requested or not. Between 1999 and 2004, the incidence density of proven nosocomial rotavirus infection (defined as rotavirus diarrhoea with onset at least 72 h after admission and up to 24 h after discharge) in children <2 years old admitted during the winter rotavirus season, varied between 6.7 and 14.8 cases per 10 000 rotavirus-free days in hospital. When cases of possible nosocomial infection (defined as rotavirus diarrhoea with onset between 24 and 72 h after admission or between 24 and 72 h after discharge) were added to the proven cases, the incidence density for the study period varied between 9.2 and 19.3 cases per 10 000 rotavirus-free days in hospital. Over the study period, 14.5% of all ELISA confirmed rotavirus infections were proven to be hospital-acquired, and 19.4% were either proven or probably hospital-acquired. These ratios of nosocomially acquired compared with all confirmed rotavirus infections are at the lower end of the range reported in a systematic review of 14–51%,4 although these values are likely to be dependent upon the age ranges studied and the institutional referral patterns for hospital and community stool specimens. Because we did not attempt to systematically test stools from all hospitalised children or to follow-up children after discharge, it is likely that the true rates of nosocomial infection may be significantly higher than the rates reported here. In one report, 39.3% of nosocomial infections were asymptomatic and 67.6% occurred after discharge.5 Asymptomatic infection is important in that it probably contributes to the subsequent transmission of the virus. In other institutions, nosocomial rotavirus infection has been found to contribute significantly to patient length of stay and to the costs of care,6 although we have not attempted to directly calculate these parameters. Despite careful attention to infection control practices, nosocomial rotavirus infections remain a significant problem in paediatric hospitals. Universal rotavirus vaccination in infancy is likely to reduce the number of hospitalised children with community-acquired rotavirus and may have a significant impact on reducing nosocomial infection rates in Australian paediatric hospitals.

Social support satisfaction of Australian children

This is the first in-depth study of the social support satisfaction of Australian children, measured using the “My Family and Friends” interview (Reid, Landesman, Treder, &amp; Jaccard, 1989). This, together with the Self-Perception Profile for Children (Harter, 1985), was administered to 70 Adelaide children aged 9–11. A main effect of support provider and an interaction between support type and provider were found. Self-esteem was predicted by both overall social support satisfaction and network size. The Australian children reported lower levels and different patterns of support in comparison with previously published data from the USA. Australian parents were perceived as less “generalist” in their support, giving particularly low levels of companionship support. Friends gave high levels of companionship support but low levels of all other types; this, as in the case of parents, makes Australian friends more “specialist” supporters than their US counterparts.

Using GIS to Identify Risk of Elevated Blood Lead Levels in Children in Adelaide

Environmental lead poses significant health risks to small children in most western countries. However, many surveys examining the prevalence of elevated paediatric blood lead levels give insufficient attention to the geography of the major known risk factors. GIS can address the spatial variation inherent in the distribution of these risk factors, and can identify areas, streets and even individual dwellings with a high probability of environmental lead. Predictions of risk can then be validated with analysis of blood or dust samples. This analysis forms the basis for a model predicting the presence and risk of environmental lead for any city and offers a means of targeting further investigation of lead exposure, more accurately estimating the number of children at risk using small area census data and selecting areas for future sample surveys. The need to develop a cost‐efficient and accurate method of modelling lead exposure risk in childhood is a task to which GIS is clearly well suited.

Iron status and dietary iron intake of 6-24-month-old children in Adelaide.

Chronic iron deficiency in children is associated with anaemia and impaired mental and psychomotor development. The aim of this study was to assess the iron status and dietary intake of 6-24-month-old Caucasian and Asian children living in metropolitan Adelaide. A total of 234 healthy children (82% Caucasian and 18% Asian) aged 6-24 months were studied. Dietary iron intake of children was estimated from semiquantitative diet recall questionnaire administered to their parents. Blood samples for full blood count, serum ferritin (SF), serum iron (SI) and transferrin (TF) level estimations were obtained by venesection. Based on the laboratory test results, infants were classified as iron sufficient (IS) if the haemoglobin (Hb) concentration was > 110 g L(-1), SF > or = 15 microg L(-1), TF2 3.0 g L(-1), SI > or = 8 micromol L(-1) and iron saturation (ISAT) > or = 12%; or nonanaemic iron deficiency (NAID) if the Hb concentration was > 110 g L(-1) and SF < 15 microg L(-1) or SI < 8 micromol L(-1), TF > 3.0 g L(-1), and ISAT < 12%; or as iron deficiency anaemia (IDA) if the Hb concentration was < 110 g L(-1) in association with SF < 15 microg L(-1) or with SI < 8 micromol L(-1), TF > 3.0 g L(-1) and ISAT < 12%. Sixty-nine per cent of Caucasian children were classified IS, 25% as NAID and 6% were IDA; while 72% of Asian children were classified IS, 14% as NAID and 14% were IDA. Multivariate analysis demonstrated that factors associated with iron deficiency (SF </5 microg L(-1)) included age, duration of breast-feeding and cows' milk intake. Iron deficiency is common in our young population. Additional strategies to prevent IDA need be developed and evaluated in Australian infants.

Brain tumours in infancy: a clinicopathological study

To investigate the clinicopathological features of brain tumours occurring in the first year of life, the records of the Department of Histopathology at the Adelaide Children's Hospital were examined for cases where the initial diagnosis of intracranial neoplasm had been made in infancy. Surgical material was available for review from 1972 to 1993 and autopsy cases were reviewed for an additional 12 years from 1962 to 1993. Twenty-four infants with intracranial neoplasms were diagnosed ranging in age from 5 days to 1 year (average = 7 months). There were 23 surgical cases and 1 autopsy case. The male to female ratio was 17:7. Fifty-eight percent of the tumours were located in the supratentorial region. Although the incidence is relatively low, this study demonstrates that a wide range of brain tumours, which differ significantly in both clinical presentation and location from those found in the older child, do occur during the first year of life. The location of the primary tumour may be affected by associated congenital malformations, and metastatic malignancy, although rare, may occur. Antenatal ultrasound examination may be useful in identifying congenital intracranial tumours.

Infant and child feeding practices: a preliminary investigation.

The objective of this preliminary investigation was to examine the feeding practices of infants and pre-school children in Adelaide, and thereby contribute to the development of appropriate preventive dental strategies. A stratified random sample of 160 two year old and three year old pre-school children in the Adelaide Statistical District was obtained. Information about feeding practices and use of comforters or 'dummies' was obtained through a self-administered questionnaire completed by parents of the selected children. Information was collected for the age periods of 0-3 months, 4-6 months, 7-12 months, 13-24 months and 25-36 months. Most of the children (81.8 per cent) were breast-fed at some stage. However the percentage of children being breast-fed decreased markedly across age periods, particularly to 13-24 months, when only 15.9 per cent of children were being breast-fed. Over half of the children, had been bottle-fed with infant formula at some stage. The highest percentage of children being bottle-fed with infant formula occurred in the 4-6 months (42.6 per cent) closely followed by the 7-12 months age period (37.4 per cent). Nearly two-thirds of children were bottle-fed with cow's milk at some stage. The highest percentage of children being bottle-fed with cow's milk occurred in the 13-24 months age period (49.6 per cent). A quarter (24.5 per cent) of the children were put to bed at some stage with a bottle containing cariogenic fluids. The majority of children used a 'dummy' at some stage during both day-time and night-time. Parents are in need of advice on appropriate feeding patterns for infants and young children.

A decade of gastroschisis in the era of antenatal ultrasound.

Gastroschisis is an uncommon condition in which viscera protrude at the base of the umbilical cord. To investigate the possible relationships between antenatal ultrasound findings, patient demographics, smoking, alcohol consumption and this condition, 21 causes are reviewed. The medical records and antenatal ultrasounds of 21 children diagnosed with gastroschisis at the Adelaide Children's Hospital between 1 January 1985 and 31 December 1992 were reviewed. Antenatal ultrasound was employed in 15 cases, and the diagnosis was accurately made in 13 (86.7%) of these. There were 17 live births, two elective terminations and two pre-term abortions. Seven of the 21 cases had associated anomalies. The anomalies included five atresias, a ventricular septal defect (VSD), and a dislocated gall-bladder. Postoperative complications (which included one death) occurred in seven of the 17 patients. Bowel dilatation or thickening was first detected on five ultrasound examinations performed before 21 weeks' gestation, and four ultrasounds after 21 weeks. The nine cases with bowel changes on ultrasound were associated with a high atresia rate and a longer hospital stay, but not with an increased complication rate. Maternal race, parity, and alcohol consumption were not associated with increased risk of fetal gastroschisis. All mothers were under 27 years of age. There were nine mothers who smoked during pregnancy and a disproportionate number of mothers who lived outside the metropolitan area with gastroschisis-affected offspring. Bowel changes seen on antenatal ultrasound increase the chances of intestinal atresia and longer hospitalization. Smoking during pregnancy may be associated with an increased risk of gastroschisis.

Dehydration Deaths in Infants and Young Children

Dehydration in developed countries is an uncommon but important mechanism resulting in the death of infants and children. The clinicopathological features of a series of 37 fatal dehydration cases autopsied at the Adelaide Children's Hospital over a 33-year period (1961-1993) are presented. Causative factors for dehydration included gastroenteritis (21 cases), gastroenteritis with high environmental temperature (one case), high environmental temperatures (six cases), neglect/failure to thrive (four cases), mental retardation/chromosomal abnormality (three cases), congenital adrenal hyperplasia (one case), and unsuspected cystic fibrosis (one case). The mean age at death was 11.4 months (range 2 weeks to 6.25 years; median 6 months; 95% confidence interval 6 months to 1 year and 4 months; male-to-female ratio, 19:18). Sixteen of the 22 cases of fatal gastroenteritis (73%) occurred during the fall/winter months (March to August). There were a total of seven aboriginal or part aboriginal children in the group (19%). Children with mental retardation were at higher risk of dehydration, and previously unsuspected cases of child abuse/neglect also presented with lethal dehydration. Vitreous humor electrolyte levels and immunoassay for rotavirus were useful diagnostic adjuncts.

A Factor Study on the Attitudes of Children to Bullying

Summary The study described represents an attempt to investigate the attitudes of English boys and girls in the last year of their primary school to victims of bullying. The process employed is similar to that first described by Rigby and Slee (1991) who collected data from children in Adelaide. Their findings concerning the frequency of bully/victim problems was roughly in line with findings from Norway, Great Britain and Ireland and so their results on attitudes towards victims probably reflect accurately general trends. It is clear, however, that within‐school attempts to prevent bullying must take into account the trend of attitudes towards victims. It is also clear that sub‐cultural and familial influences will largely determine the nature of these trends. It is appropriate, therefore, to determine variations in trends when the children sampled come from areas with a high frequency of bullying. As part of a large anti‐bullying initiative, Rigby and Slee's questionnaire assessing attitudes towards vic...

A profile of heart disease risk factors and their relation to parents' education, fathers' occupation and family history of heart disease in 843 South Australian families: the Adelaide Children's WHO Collaborative Study.

A study was conducted to determine whether the prevalence of risk factors among pre-adolescent children is associated with their parents' risk factor status and what influence family history of ischaemic heart disease (IHD) and socio-economic status (SES) had. This was a cross-sectional study of 856 children, mean age 8.6 years, and their parents who underwent the World Health Organization and National Heart Foundation protocols for the study of arteriosclerosis precursors. Historical, demographic, anthropometric, clinical and biochemical outcome measures were used. There was the expected burden of illness reported for the grandparents and parents, with the latter conforming to their expected age group's heart disease risk factor status. The mean serum total cholesterol (TC) level for boys was 4.43 (+/- 0.79) mmol/L and girls 4.62 (+/- 0.84) mmol/L, with the 95th percentile for boys and girls combined being 5.88 mmol/L. The level corresponding to two standard deviations above the mean was 6.0 mmol/L. Childrens' IHD risk factor status reflected their parents' with TC, skin fold thickness and body mass index most closely correlated, followed by blood pressure. The greatest correlation was between the childrens' TC and their mothers'. Socio-economic status as assessed by the parents' education level and fathers' occupational status produced differences in their childrens' risk factors, with mother's level of education having the major influence. There was no impact of family history of IHD. From these results it would appear that screening of the pre-adolescent may be appropriate but longitudinal study will be important to establish this by documenting persistence of risk factor status. Also, it would appear that a child's future risk from IHD morbidity may be due to environmental influences mediated through differences in SES. As the level of IHD risk factors is reduced within the community, the extent of parent-child transmission of measurable IHD risk factors in families of high IHD risk may be reduced.

Brain tumours in infancy - A clinicopathological study

To investigate the clinlcopathologlcal features of brain tumours within the first year of life in Infants presenting to the Adelaide Children’s Hospital Department of Histopathology, surgical material from 1972 to 1993 and autopsies from 1962 to 1993 were reviewed. Twenty-four Infants were found, including 23 surgical cases and one autopsy case (age = 5 days to 1 year; ave = 7 months; M:F = 17:7). The most common presenting clinical symptoms were vomiting and macrocranla; other non-specific manifestations included irritability, poor feeding, loss of weight, malaise and rhinorrhoea. One case had been Identified on antenatal ultrasound performed for possible macrosomia at 34 wks. The tumours consisted of seven low- grade astrocytomas, one glioblastoma multiforme, six medulloblastomas, three teratomas, two gangliogliomas and one ependymoma. Rare neoplasms included a metastatic hepatoblastoma to the choroid plexus, a mixed primitive neuroectodermal tumor/malignant astrocytoma, a subependymoma/astrocytoma, and a choroid plexus papilloma attached to the meningeal surface associated with a developmental malformation of the ventricles. Fifty-eight percent of the tumours were located in the supratentorial region. This study demonstrates that a wide range of brain tumours occur during the first year of life with a male predominance, which differ significantly, in both clinical presentation and location from those found in the older child. Metastatic malignancy, although rare, may still occur and the location of the tumour may be affected by associated congenital malformations. Antenatal ultrasound examination may be useful in identifying congenital Intracranial tumours.

Effect of pelvic irradiation on gastrointestinal functions: a prospective longitudinal study E YEOH, M HOROWITZ, A RUSSO ET AL Royal Adelaide Hospital and Adelaide Children's Hospital, Adelaide, Australia

Effect of pelvic irradiation on gastrointestinal functions: a prospective longitudinal study E YEOH, M HOROWITZ, A RUSSO ET AL Royal Adelaide Hospital and Adelaide Children's Hospital, Adelaide, Australia

Studies on the procoagulant from the venom of Australian brown snakes (Pseudonaja spp.): V. Williams, 1J. White2 and P. Mirtschin3 ( 1Haematology Department, and 2State Toxinology Services, Adelaide Children's Hospital, North Adelaide SA 5006, Australia; and 3Venom Supplies, Tanunda SA, Australia)

Studies on the procoagulant from the venom of Australian brown snakes (Pseudonaja spp.): V. Williams, 1J. White2 and P. Mirtschin3 ( 1Haematology Department, and 2State Toxinology Services, Adelaide Children's Hospital, North Adelaide SA 5006, Australia; and 3Venom Supplies, Tanunda SA, Australia)

Snakebite and spider bite in Australia: J. White (State Toxinology Services, Adelaide Children's Hospital, North Adelaide SA 5006, Australia)

Snakebite and spider bite in Australia: J. White (State Toxinology Services, Adelaide Children's Hospital, North Adelaide SA 5006, Australia)

An object-oriented approach to data display and storage: 3 years experience, 25,000 cases.

Object-oriented programming techniques were used to develop computer based data display and storage systems. These have been operating in the 8 anaesthetising areas of the Adelaide Children's Hospital for 3 years. The analogue and serial outputs from an array of patient monitors are connected to IBM compatible PC-XT computers. The information is displayed on a colour screen as wave-form and trend graphs and digital format in 'real time'. The trend data is printed simultaneously on a dot matrix printer. This data is also stored for 24 hours on 'hard' disk. The major benefit has been the provision of a single visual focus for all monitored variables. The automatic logging of data has been invaluable in the analysis of critical incidents. The systems were made possible by recent, rapid improvements in computer hardware and software. This paper traces the development of the program and demonstrates the advantages of object-oriented programming techniques.

A role for ultrasound in assessment of the child with a painful hip.

Journal of Paediatrics and Child HealthVolume 29, Issue 4 p. 247-249 A role for ultrasound in assessment of the child with a painful hip G.W. LE QUESNE, Corresponding Author G.W. LE QUESNE Department of Diagnostic Ultrasound, Adelaide Children's Hospital, Adelaide, South Australia, AustraliaDr G. W. Le Quesne, Department of Diagnostic Ultrasound. Adelaide Children's Hospital, North Adelaide, South Australia 5006, Australia.Search for more papers by this author G.W. LE QUESNE, Corresponding Author G.W. LE QUESNE Department of Diagnostic Ultrasound, Adelaide Children's Hospital, Adelaide, South Australia, AustraliaDr G. W. Le Quesne, Department of Diagnostic Ultrasound. Adelaide Children's Hospital, North Adelaide, South Australia 5006, Australia.Search for more papers by this author First published: August 1993 https://doi.org/10.1111/j.1440-1754.1993.tb00503.xCitations: 1AboutPDF 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 onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume29, Issue4August 1993Pages 247-249 RelatedInformation