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Results of surgical treatment for extrahepatic biliary atresia in United Kingdom 1980-2. Survey conducted on behalf of the British Paediatric Association Gastroenterology Group and the British Association of Paediatric Surgeons.

A postal survey identified 114 infants with biliary atresia (roughly one in 21 000 live births). Biliary operations were performed on 107. Of the 105 infants who were followed up, 35 were free of jaundice at 10 months to 3 1/2 years. Good results occurred most often in those operated on by 12 weeks and were also related to the number of cases operated on in each centre. Only two of 18 infants treated in centres dealing with one case a year were free of jaundice compared with 11 of 38 at centres treating two to five cases a year and 22 of 49 in a centre treating more than five cases a year. Jaundice in an infant of more than 2 weeks associated with yellow urine or pale stools is never physiological and requires urgent investigation to identify causes for which effective treatment may be possible. Identification of suspected cases by 4 weeks of age and a greater concentration of investigative and surgical skills should improve the short term results of surgery and the long term prognosis of biliary atresia.

Age Factors↗

The organization of services for children with diabetes in the United Kingdom: report of the British Paediatric Association Working Party.

A British Paediatric Association Working Party was set up in 1987 to examine the organization of services for children with diabetes in the United Kingdom. A questionnaire survey identified 360 consultant paediatricians providing care for children with diabetes in 205 Districts or Health Boards. Sixty-three per cent (227) of paediatricians saw children in a designated paediatric diabetic clinic, 61% (220) reported that a diabetes nurse specialist regularly attended the clinic, and 70% (251) that a dietitian did so. Haemoglobin A1 or other glycosylated proteins were regularly measured by 91% (326) of paediatricians, 76% (274) regularly tested for urinary protein, and 79% (285) and 86% (310) checked blood pressure and eyes, respectively. However, 27% (55) of the Districts or Health Boards in the survey had no designated paediatric diabetic clinic. When the data were analysed by assigning paediatricians to categories according to their degree of specialization in diabetes only 33% (118) paediatricians could be described as having a specialist interest in diabetes. There were significant differences in the services provided by the specialist paediatricians when compared with the non-specialists, particularly with respect to the professional staff regularly seeing children in clinics and services to the adolescents. The Working Party recommends that services for children with diabetes may be improved by encouraging at least one paediatrician in each District to develop a special expertise in diabetes. Designated children's diabetic clinics with appropriate supporting staff and services should be available in all Districts.

Adolescent↗

The bacteriological screening of donated human milk: laboratory experience of British Paediatric Association's published guidelines.

This study was undertaken to assess the application of the British Paediatric Association's (BPA) published guidelines to the bacteriological screening of breast milk donated to a District General Hospital milk bank. Samples of donated milk were subjected to bacterial counts and provisional identification after both 24 and 48 h incubation on cysteine lactose electrolyte-deficient (CLED) and Columbia blood agar. 21.8% (76 out of 348) donations of milk failed to reach the BPA acceptable criteria. The organisms responsible for the rejection of these samples were all evident within 24 h incubation, and were not significantly confined to one medium. A large percentage of rejected samples originated from a small number of donor mothers; 63.2% came from one donor. In applying BPA guidelines, both CLED and Columbia blood agar were found to be equally effective in screening for unacceptable organisms in prepasteurization donated breast milk. The 24 h period allowed for bacteriological screening, prior to pasteurization of milk samples, was sufficient to allow the growth of all potentially pathogenic bacteria in this study. To prevent the donation of consistently contaminated milk, more active communication between the milk bank staff and the donor is recommended.

Acinetobacter↗