The Journal of the Singapore Paediatric Society最新文献

Four hundred and eighty four obese Chinese children who were defined obese by a relative weight of more than 120% of standard weight-for-height had their social status evaluated. The social class of each child was arbitrarily determined according to the father's occupation. The distribution of obese children in various social levels was compared with that of the working population in Singapore. Significantly greater proportions of children were in the upper and middle social classes compared with the general working population. Such trends may be related to the increased affluence of the society and the accompanying changes in life-styles and eating habits, and will influence measures in health education and control of childhood obesity in the future.

71 febrile neonates admitted to the Paediatric and Neonatal Department in 1988 and 1989 were studied. Septic work ups were done for 84% of patients & 80% had lumbar puncture. These infants were subdivided into 5 groups in order to identify the significance of the various stages of septic work up. It was found that 48% of patients with significant infections were only diagnosed after some stage of septic work up. 14% had meningitis and diagnosed only after CSF examination. Only in 13% of patients the diagnosis could be made confidently without a septic work up confirming that the diagnosis of infection in the neonate is difficult and often missed without a septic work up. Clinical impression by paediatricians reduced the number of patients requiring unnecessary investigations and receiving empiric therapy. We recommend maintaining our present cautious policy of admitting neonates with pyrexia.

Diagnosis of gut duplications are often only made intraoperatively as they are uncommon and do not feature strongly in the differential diagnoses. A case of caecal cystic duplication mimicking intussusception is discussed with the aim of improving diagnostic accuracy in future cases. A 7 month old boy presented with the classical triad of abdominal pain, bleeding per rectum and a palpable mass. Barium enema revealed a mass in the caecum suggestive of an intussusceptum. Repeated attempts at hydrostatic reduction were unsuccessful as the mass was immobile. Laparotomy revealed cystic duplication of the caecum without intussusception. The bleeding per rectum was due to an ulcer in the colonic epithelium overlying the cyst.

Chronic diarrhoea in its previously described severe malnourished presentation is not common in Singapore. A retrospective study was made of children with chronic diarrhoea between January to September 1990, at the Department of Paediatrics, National University Hospital. Chronic diarrhoea in our context included all those who presented with diarrhoea of 7 or more days duration. The age range was one month to 11 years, with 23 males and 13 female patients. Approximately half of the patients had associated symptoms like fever. Anthropometric data of these patients revealed none less than the third percentile in height and weight. Clinically the patients were mainly well nourished, mildly dehydrated with no significant pallor or oedema. Perianal erythema though not excoriation was common being present in approximately 50%. Haematological parameters and electrolytes were generally normal. Mild elevation of urea and creatinine levels especially the former was present reflecting the relatively mild dehydration status. Infection was the main cause of the diarrhoea, 55% of stool cultures being positive mainly for Salmonella or rotavirus. Treatment was mainly directed at correcting dehydration. 40% needed antibiotics. Hence, chronic diarrhoea as seen in the National University Hospital is generally not debilitating. An infective cause must first be excluded with usage of antibiotics often necessary in young children.

The premature aging syndromes are a rare eccentric group of syndromes in which predominantly senile features develop prematurely. Cockayne Syndrome is one of several premature aging syndromes; it has been recognised, but hitherto unreported in the local literature. This is a case report of a child with the classical features of Cockayne Syndrome.

Acute viral bronchiolitis is one of the most common causes of paediatric respiratory disease, especially in the first year of life. Young infants and those with pre-existent cardiorespiratory problems are at an increased risk of acute respiratory failure necessitating mechanical ventilation. A prospective study was carried out from November 1988 to October 1989, to analyse the clinical features, aetiology and outcome of patients with severe bronchiolitis. 52 (29.9%) out of 174 cases of acute bronchiolitis admitted were found to be severe. A virus aetiology was identified in 75% of the cases, respiratory syncytial virus (RSV) being the commonest agent. 88.5% of the patients were less than 1 year of age, with a male preponderance of 1.4:1. There was a higher incidence in the Malay ethic group. Despite the viral aetiology, 88.2% were treated with a course of antibiotics. There was one death, and 2 patients had apnea requiring mechanical ventilation.