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Biomedical subjects

F Newall

Publications and source records attributed to F Newall.

7 recordsLinked to original sources
PubMed2004

Arterial ischaemic stroke in children.

OBJECTIVE: Arterial ischaemic stroke (AIS) in childhood is a serious disorder about which little is published. The aim of this study is to determine the epidemiology and outcome of AIS in Australian children. METHODS: Cases of childhood AIS occurring at the Royal Children's Hospital, Melbourne 1993-2001, were identified by medical record search using International Classification of Disease Codes. Information was collected on demographics, risk factors, arterial distribution, results of thrombophilic testing, management and outcome. RESULTS: During the 8 years of review 95 patients presented with 98 cases of AIS calculating an incidence of 1.8 per 100000 children per year. Children less than 12 months of age represented greater than one third of all cases. Identifiable risk factors were present in 64% of cases with congenital heart disease the major risk factor. Thrombophilic testing was incomplete with initial abnormalities present in 18% of cases tested. The estimated stroke-related mortality was 8.4%. Of the patients who survived and who had follow-up details available, 78% had a neurological deficit. Twenty-six patients (26%) received anticoagulation. There was no statistically significant association between treatment with anticoagulation and normal neurological outcome. CONCLUSION: AIS is over-represented in children under 12 months of age and results in death or residual neurological impairment in the majority of cases. Further prospective studies are needed to identify risk factors for poor outcome. The recently established Australian and New Zealand Stroke and Thrombophilia Registry should provide important information on clinical and laboratory based risk factors and create a basis for international clinical trials to improve the outcome of childhood AIS.

Adolescent↗
PubMed2002

Post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is a potentially disabling complication occurring in up to 67% of adult patients following deep venous thrombosis (DVT). PTS has recently been recognised in children. We present three cases of symptomatic PTS in children, which occurred following the use of central venous lines (CVLs). In two cases, no symptoms of acute thrombosis were noted. The cases highlight the clinical presentation of this syndrome. A review of the literature revealed two reports describing PTS occurring in children following DVT with an estimated incidence of 7-12%. It is concluded that PTS is an important complication of DVT in children. The clinical findings of pain, swelling, and brawny induration are similar to adult patients. The effect on growing limbs is not known. Paediatricians should be aware of the potential of PTS in all children who are at risk of DVT, including patients with malignancy, congenital heart disease, and children who have had previous CVLs, even in the absence of documented acute DVT.

Adolescent↗
PubMedDate not supplied

A survey of pediatric cardiology nurses' understanding of warfarin therapy.

Children with underlying cardiac defects represent the largest cohort of pediatric patients requiring oral anticoagulant therapy. This study aimed to determine how much pediatric cardiology nurses understood about warfarin therapy, given their role as patient educators. Surveys were sent to four Australian pediatric hospitals that provided inpatient cardiac services. Data are presented descriptively, with relationship between variables analyzed using linear regression analysis. Forty-one completed questionnaires were received from 94 registered nurses. The majority of nurses held an undergraduate degree in nursing and were classified as senior registered nurses. Nurses did not demonstrate a good understanding of warfarin therapy. Knowledge deficits were identified across a broad spectrum of areas, with only 30% of nurses reporting that they felt equipped to provide families with education regarding oral anticoagulant therapy. Nurses regularly provide patients with education regarding medication regimes; however, the effectiveness of that education is rarely evaluated. This study suggests that pediatric nurses working with patients who are often prescribed oral anticoagulant therapy have significant knowledge deficits about anticoagulant therapy. The impact of this lack of knowledge on the effectiveness of patient education has not been evaluated, but it is unlikely to be helpful.

Anticoagulants↗
PubMedDate not supplied

Heparin-induced thrombocytopenia in children.

OBJECTIVE: To audit the frequency of heparinoid (standard heparin and low molecular weight heparin) use in a tertiary paediatric hospital, and to determine the occurrence of heparin-induced thrombocytopenia (HIT). METHODS: A 1-week cross-sectional audit of all heparinoids given to inpatients at a tertiary paediatric hospital was undertaken and a retrospective medical record review of all suspected HIT cases at the tertiary paediatric centre over a 2-year period was carried out. RESULTS: One hundred and sixteen patients received heparinoid medications over a 7-day period. An average of 29 children received heparin daily. The retrospective medical record review identified four patients with suspected HIT over a 2-year period. Two patients developed thrombotic complications, which were fatal in one patient. CONCLUSION: Heparin is used frequently in paediatric tertiary hospitals, yet the occurrence of HIT in children is much lower than that reported in adults. Improved laboratory techniques could facilitate improved screening and diagnosis of this serious adverse drug reaction.

Adolescent↗
PubMedDate not supplied

Cerebral sinus venous thrombosis in children.

OBJECTIVE: Cerebral sinus venous thrombosis (cerebral SVT) is rare in children. Information on clinical characteristics, radiological findings and outcome is emerging. METHODS: Cases of cerebral SVT diagnosed between 1995 and 2001 were identified by a computer-assisted search using International Classification of Disease codes. Medical records were reviewed to collect information on clinical presentation, investigations, treatment and outcome. RESULTS: Sixteen cases of cerebral SVT were identified. All cases presented in association with head and neck pathology. The majority of cases presented with symptoms of raised intracranial pressure and focal neurological signs. Magnetic resonance imaging identified all cases of cerebral SVT whilst CT scanning failed to demonstrate the diagnosis in two cases. Management with anticoagulation was associated with radiological resolution of the thrombosis and normal neurological outcome. Long-term follow up demonstrated neurological deficits in greater than 40% of patients. CONCLUSION: Cerebral SVT in children is associated with significant residual neurological morbidity. Prospective studies to identify predictors of outcome and effective management interventions are required.

Adolescent↗
PubMedDate not supplied

Use of in-line filters in pediatric intravenous therapy.

This study arose from a need to justify the extensive use of in-line intravenous filters in an Australian pediatric teaching hospital. The incidence of septicemia was observed for two 12-month periods before and after the withdrawal of in-line i.v. filters from patients with central venous access devices. A total of 19,221 i.v. days were monitored in 88 children in two 1-year periods. No significant differences were found in the incidence of septicemia between the children who had filters fitted and those who did not. As a result, the routine fitting of filters to i.v. lines infusing fluids filtered during manufacture under a laminar flow has been discontinued with significant cost savings.

Adolescent↗