Prediction of chronic neonatal lung disease in very low birthweight neonates using clinical and radiological variables.

There are good theoretical reasons for earlier intervention in neonates likely to develop chronic neonatal lung disease (CNLD). Very low birthweight (VLBW) neonates who receive artificial ventilation are at high risk of CNLD. A test was therefore developed to predict CNLD based on clinical and radiological information readily available at 7 days of age in VLBW neonates. Logistic regression analysis was used to identify those factors significantly and independently associated with CNLD. For each neonate it was possible to insert the value of the independent factors into the equation, providing a probability value between 0 and 1. By selecting different cut off values between 0 and 1, and knowing which neonates had developed CNLD, it was possible to assess the use of varying probability values as a predictive test for CNLD. The variation in these two parameters was graphically represented by a receiver operator characteristic (ROC) curve. The area under the ROC curve was used to represent the discriminatory capacity of the test over its full range of values. The maximum area under an ROC curve is unity. The area under the ROC curve was similar in a model with and without radiographic information (0.926 and 0.913 respectively) and was 0.937 in neonates from another hospital.

Delayed detection of congenital hearing loss in high risk infants.

OBJECTIVE: To examine the methods used to investigate children at high risk of congenital hearing impairment, and to see whether the introduction of evoked response audiometry has reduced the mean age at which hearing loss is identified. DESIGN: Clinicians who notified children to the national congenital rubella surveillance programme were asked retrospectively to complete a questionnaire examining the methods used to identify hearing impairment and the age at testing in two consecutive five year cohorts. The presence or absence of hearing loss was confirmed by obtaining the results of audiometric evaluations and, whenever possible, a recent pure tone audiogram. SETTING: The United Kingdom. PATIENTS: Children notified to the national congenital rubella surveillance programme and born in 1978-87 in whom IgM specific for rubella was detected shortly after birth. MAIN OUTCOME MEASURES: The age at which hearing loss was identified and the degree of loss in decibels at 250, 500, 1000, 2000, and 4000 Hz measured by pure tone audiometry. RESULTS: 61 (52%) Of 117 children born in 1978-82 had a hearing impairment of 40 dB or greater in both ears. The mean loss was 93 dB. In the following five years 75 (47%) of 159 children had impaired hearing, their mean loss being 96 dB. The age at which the hearing loss was confirmed decreased from 11.6 to 9.8 months as a result of earlier auditory evoked response testing. Nevertheless, only eight (13%) of the children with hearing impairment born in 1978-82 and 16 (21%) of those born in 1983-7 had these tests performed in the first six months of life. CONCLUSIONS: Unacceptable delays in identifying hearing loss occurred in this high risk group because of failure to arrange auditory evoked response testing in early infancy. Evoked response audiometry is sensitive and specific and should be undertaken within the first few months of life for all infants known to be at risk of sensorineural hearing loss.

Onset and severity of hearing loss due to congenital rubella infection.

Of 111 children born in 1978-82 with congenital rubella infection, confirmed by the detection of rubella specific IgM shortly after birth, 68 were reported to be hearing impaired when notified to the National Congenital Rubella Surveillance Programme (NCRSP). The average age at which the diagnosis of hearing impairment was confirmed was 11.6 months. Recent audiograms showed a hearing loss that was usually uniform across all frequencies, equal in both ears and severe, averaging 93 dB across the range 250-4000 Hz. Despite the early diagnosis of congenital rubella and the known risk of deafness, only eight of 57 infants had been tested for auditory evoked responses in the first 6 months of life; all eight had severe hearing loss. Evidence of progressive hearing loss was found in only one of the 57 children. Definitive hearing tests (as distinct from screening tests) were frequently delayed until after the first birthday. Newborn babies identified as being at high risk of congenital deafness should have a full audiological assessment in early infancy.

Prevalence of child sex rings.

Within a geographically defined population of 710,000, 31 child sex rings were identified by the police during a 2-year period. A total of 47 male perpetrators aged 16 to 82 years and 334 children aged 4 to 15 years were involved. The perpetrators usually operated alone or in pairs. Three rings were expanding and developing into semicommercial enterprises, however and four or more men participated in them. Children acting as ringleaders recruited victims for the perpetrator in 22 rings, usually in exchange for money. The offenses reported included fondling and masturbation (30 rings), oral, anal, or vaginal intercourse (21 rings), and production of child pornography (two rings). In addition, two adolescent prostitution rings involving 12- to 18-year-old boys were investigated by the police. During the 2-year period these sex rings accounted for 4.6% of all cases of child sexual abuse reported to the police and 6.6% of the subsequent prosecutions.

Decreasing gestational age and birthweight in spastic diplegia.

Over a 4-year period a significant fall occurred in the mean birthweight and mean gestational age of prematurely born children who subsequently developed spastic diplegia. This coincided with a considerable improvement in perinatal mortality in the unit in which they were delivered. However, although the number of premature deliveries remained stable, the disorder did not become less common. No specific aetiological factors were identified, but the 24 affected children frequently had a history of adverse prenatal or perinatal factors. We conclude that high standards of obstetric and neonatal care prevent the subsequent development of spastic diplegia in low birthweight infants. However, these factors have also improved the survival of very low birthweight infants who have a much higher risk for the disorder and this has prevented a significant reduction in its frequency.

Familial cerebral palsy associated with normal intelligence.

We describe two families affected by a recessively transmitted familial cerebral palsy with onset in infancy. Two sisters in the first family have a severe spastic diplegia. The older sister also has mild mental retardation and hypothyroidism whilst the younger sister is of normal intelligence. Two brothers in the second family have a spastic quadriparesis, fifth finger camptodactyly and normal intelligence.

Child sex rings.

Details of 11 child sex rings identified in one working class community were obtained by interviewing investigating police officers and examining health and social services records. The rings contained 14 adult male perpetrators and 175 children aged 6-15 years. Most perpetrators used child ringleaders to recruit victims; others became a "family friend" or obtained a position of authority over children. Secrecy was encouraged and bribery, threats, and peer pressure used to induce participation in sexual activities. Offences reported included fondling, masturbation, pornography, and oral, vaginal, and anal intercourse. Eleven perpetrators were successfully prosecuted; all but one received a sentence of three years or less. Behavioural problems were common among those children who had participated for a long time. Child sex rings are difficult to detect and may be common. Many children are seriously abused as a consequence of them.

Sexual abuse of children in Leeds.

Temporal trends in physical and sexual abuse of children within a geographically defined area were examined, and cases of suspected sexual abuse referred to paediatricians during 1984 were studied in detail. After remaining static for four years referrals due to all types of abuse trebled between 1979 and 1984, and referrals due to sexual abuse increased from none to 50 a year. In 1984, 50 children (39 girls) aged 1-16 were referred because of possible sexual abuse. Abuse was confirmed or considered to be likely in 30 (28 girls). The perpetrator was a male relative or family friend in 17 cases and a man participating in a child sex ring in seven cases. Physical examination often did not show anything remarkable, but three girls had venereal infections. These figures suggest that paediatricians and child psychiatrists will increasingly be presented with cases of sexual abuse in children.

The consequences of antenatal rubella testing.

During 1983, 3,199 women attending an antenatal clinic were rubella serotested and 117 (3.7%) found to be non-immune. Only 76 (65%) were vaccinated post-partum. Although non-compliance and contra-indications to vaccination contribute to the reasons why patients were not immunized, the major factor was communication failure between the hospital and general practitioner. Recommendations are made to improve the uptake of vaccine by this group of susceptible women.

Families with more than one handicapped child.

Clinical patterns, aetiological factors and utilization of services were studied in 40 families who had more than one handicapped child. By retrospective review of the case notes and interviewing consenting parents (90%), data relating to diagnosis, investigations, genetic counselling, social circumstances and help received were obtained. Both children had the same disorder in 31 families, however in only nine of these families did the children have a specific diagnosis. Non-specific mental retardation was the commonest disorder (40 children). Of the 673 special investigations performed, only 14 were diagnostic. Genetic counselling had been given to only 19 families. Thirty-two of the families had remained as stable units and of the children, 51 received attendance allowances and 21 had periods of respite care. The implications of these findings are discussed.