The Journal of the Singapore Paediatric Society最新文献

Brain neoplasms are a common cause of childhood morbidity and mortality. Neurological presentations usually result in a relatively early diagnosis and management of the neoplasms. Non neurological manifestations may result in later detection and possibly a higher eventual morbidity and mortality. Hence, the importance of a keen index of suspicion in assessment of cases to detect subtle neurological signs and symptoms. Cranial magnetic resonance imaging has been found to be especially useful in the definition of brain neoplasms. In this paper, four cases with non neurological manifestations are presented (one diencephalic syndrome, one failure to thrive, one precocious puberty and one gastrointestinal symptoms).

The hypochromic, microcytic anemias are the most frequently encountered anemias on a world-wide scale, with iron deficiency anemia ranking as the commonest. Severe iron deficiency anemia seldom poses a problem in diagnosis if all the classical features are present. However, subclinical mild iron deficient states often require several laboratory tests to determine the diagnosis with certainty. To begin, the initial suspicion of an underlying subclinical iron deficient state is dependent on the laboratory method used to determine the red blood cell parameters. Next, many common conditions in children can influence the results of classical iron studies. Finally, iron deficiency has to be distinguished from other hypochromic, microcytic anemias, in particular the heterozygous thalassemic states which are so prevalent here in South-East Asia. This paper outlines some of these problems encountered in pediatric clinical practice.

A 4-year experience of neonatal jaundice, from 1982-1985, in Toa Payoh Hospital, Singapore was reported previously. The second 4-year experience (1986-1989) of neonatal jaundice is reported. The Department had a more liberal policy in the management of milder cases of neonatal jaundice since 1986, after acquisition of more phototherapy units. It is the purpose of this paper to examine the change in pattern of neonatal jaundice in the same department over these 2 study periods and a comparison is made. The reported frequency of neonatal jaundice in these 2 study periods rose from 7.9% to 10% of all babies in this hospital. Babies who have some form of treatment such as phototherapy are considered as cases of neonatal jaundice. However, the incidence of hyperbilirubinaemia (defined as serum bilirubin level of 255 umol/L or 15 mg/dl or greater) fell from 3.23% to 2.11% of all livebirths in these 2 study periods. ABO Incompatibility, glucose-6-phosphate dehydrogenase (G6PD) deficiency and low birth weights (LBW) remain as the common aetiological factors of neonatal jaundice. The indications of exchange blood transfusions have changed considerably. There were less exchange blood transfusions for severe neonatal jaundice due to G6PD deficiency. However, more LBW babies underwent exchange blood transfusion. No case of kernicterus was reported for more than 10 years.

Munchausen syndrome by proxy is the falsification of symptoms by parents which results in their children having unnecessary and sometimes harmful hospital procedures. We describe a case of Munchausen syndrome by proxy in a 15 month-old toddler. The diagnosis, management and outcome of this syndrome is also discussed.