摘要:

AbstractFibronectin has in the past been considered to function simply as a non‐specific plasma opsonin. However, recent studies have demonstrated that this molecule plays an important role in fundamental components of the immune response, for example, neutrophil adhesion, T cell activation and endothelial function. Additionally, fibronectin is important in lung homeostasis where it contributes to alveolar epithelial integrity. In this study plasma fibronectin levels were measured longitudinally in a group of extremely preterm infants, mean gestational age 27 weeks.Plasma fibronectin levels at birth were significantly lower in the preterm study group than in term controls (mean 91±33 μg/mL compared with 214±62 μg/mL in the term controls,P<0.0001). The preterm cohort demonstrated a more than two‐fold rise in plasma fibronectin on days one and two; levels fell almost to baseline values by day three with a subsequent slow rise to a plateau by day 28. No further increase was seen by day 56. This sequence of early changes in fibronectin levels mirrored closely the time course of respiratory distress syndrome. Infants of mothers with pre‐eclampsia had significantly lower peak fibronectin levels than in those without (P= 0.016), and those infants with bronchopulmonary dysplasia showed a trend towards lower basal fibronectin levels (P= 0.07) and a greater difference between peak and basal levels (P= 0.05).Neonates, particularly those born preterm, have blunted immunological responses to infection. Fibronectin plays a key role in immunological responsiveness. The significant changes in fibronectin levels after birth in the preterm neonate are likely to have important pathophysiological consequences. The relationship between alterations in fibronectin after birth, endothelial and epithelial cell function, and respiratory distress syndrome (RDS) remain to be

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00563.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThree hundred and nine septic screens were performed on 123 consecutively admitted infants of<30 weeks gestation. As part of the septic screen, serial quantitative measurements of C‐reactive protein (CRP) were performed daily until discontinuation of antibiotic therapy. Complete blood counts were performed daily for the first 2 days of each septic episode.The babies had a mean birth weight of 1035.8 g s.d. 273.2 and a mean gestational age of 27 weeks s.d. 1.8. A CRP level of 10 mg/L or above was considered abnormal. Subsequently the receiver operator characteristic curve for CRP was constructed to demonstrate the ideal cut off value.Of the 309 septic screens, there were 51 instances of proven sepsis and 39 instances of deep culture negative sepsis. In the remaining 219, a diagnosis of proven or deep culture negative sepsis could not be made.On the first day of the septic episode CRP showed a sensitivity of 62.7%, specificity of 87.2% and negative predictive value of 92.2% for proven sepsis. There was a significant increase in the sensitivity (90.2%) and negative predictive value (97.7%) of CRP with a specificity of 80.6 when both day 1 and 2 estimations were combined.We conclude that when the CRP is elevated on day 1 and/or day 2, the diagnosis of sepsis is extremely likely and when the CRP is within normal limits on days 1 and 2 of the septic episode, neonatal sepsis can be confidently excluded and antibiotic therapy cease

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00564.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractIn 22 infants continuous measurements were made of the concentration of carbon dioxide (CO2) in inspired air during sleep. Evidence was found of CO2enrichment of inspired air in certain environmental conditions. The levels achieved were not sufficiently high to acutely endanger an infant. Carbon dioxide concentrations as high as 2‐3% were observed in the prone position when the infant's head was under a blanket and when the lower face was obscured by bedding. Sleeping prone on a sheepskin also resulted in an increased concentration of CO2but to a lesser extent than being under a blanket. In awake infants the presence of a pacifier also promoted an excess of CO2in the inspired air, both in the prone and supine positions. The physiological and clinical implications of these findings, in relation to the Sudden Infant Death Syndrome (SIDS), are unknown and warrant investigatio

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00565.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBetween April 1989 and October 1991,13 severely ill infants, median age 13 days (range 1‐180 days), median weight 3.5 kg (range 2.5‐4.8 kg), received continuous venovenous haemofiltration (CVVH) for a median duration of 39 h (range 5‐234 h). Filtration was performed through a double lumen catheter inserted into a central vein. The indications for filtration included acute renal failure (8), fluid overload (5), inborn errors of metabolism (3) and sepsis (1). Some infants had more than one indication. The median Paediatric Risk of Mortality (PRISM) score on the day of admission to the intensive care unit was 27 (range 8‐42). No change in the level of respiratory support was required following the commencement of CVVH. Serum electrolyte concentrations and plasma osmolality remained normal throughout. Serum creatinine fell from a mean of 0.11 mmol/L (95% Cl 0.058‐0.168) to 0.07 mmol/L (Cl 0.034‐0.112). Urea fell from a mean of 9.5 mmol/L (Cl 4.4‐14.6) to 6.5 mmol/L (Cl 2.7‐10.3). Platelet counts fell by 40‐50% from a mean of 126x106/mm3(Cl 72‐180) to 69x 106/mm3(Cl 36‐103) 18 h following commencement of filtration but no bleeding was encountered. The main complication was a thrombosis of the superior and inferior vena cava in one infant. Four infants survived to be discharged from intensive care. Continuous venovenous haemofiltration, with its inherent advantages over arteriovenous haemofiltration, is feasible in small infants using standard

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00566.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractWe have used data from existing health records to study the birthweights and percentage weights for age (%W/A) of children in five Aboriginal communities in Queensland. The data are from cohorts of children born in the 1950s‐80s at Cherbourg, the 1960s‐80s at Yarrabah and the 1970s‐80s in Woorabinda, Palm Island and Doomadgee. Birthweights have not changed significantly in any of the communities and generally remain below the international level. The weights for 1 and 5 year old children have improved significantly at Cherbourg and Palm Island, but have dropped significantly at Doomadgee. The overall pattern is for children on remote communities to have a lower %W/A and less improvement in %W/A than those closer to population centres. Other workers have found the same pattern elsewhere. These patterns of growth are probably not directly related to the level of general health services, but rather to other facilities available and attitudes of mothers to child care. The results also show that Aboriginal children can reach international levels of %W/A, so the poor growth in many communities is potentially preven

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00567.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractEvaluating hand wash products in terms of user acceptability and effectiveness against methicillin‐resistantStaphylococcus aureus(MRSA) has been part of a long‐term strategy to eliminate endemic MRSA from the neonatal intensive care unit at the Royal Women's Hospital (Brisbane). Following the introduction of a new hand wash disinfectant (triclosan 1% wt/vol), new cases of MRSA colonization were monitored for 12 months. In addition, the use of antibiotics, the incidence of multi‐resistant Gram‐negative cultures and neonatal infections were noted. No changes were made to any procedures or protocols during the trial. All babies colonized with MRSA had been discharged from the nursery within 7 months of the introduction of triclosan and in the subsequent 9 months no new MRSA isolates had been reported. Reduction in the use of vancomycin has resulted in a cost saving of approximately $A17000. The total number of Gram‐negative isolates has not increased, althoughPseudomonas aeruginosais now reported more often. Compared with the previous 12 months. fewer antibiotics were prescribed and fewer nosocomial infections recorded

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00568.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe deposition of technetium radiolabelled aerosol within the lungs of 12 stable cystic fibrosis patients (mean age 12.7 years) was compared using the Acorn nebulizer and mouthpiece alone, and the Acorn nebulizer attached to the Mizer Aerosol Conservation Device (MACD). The total activity delivered to the patient using the MACD was 11.1% (\pm7.8% s.d.) of the initial dose, compared to 5.8% (\pm4.2% s.d.) with the nebulizer and mouthpiece alone (P<0.05). With the MACD, 84% of the intrapulmonary dose was delivered to the peripheral regions, compared to 76.5% with the nebulizer and mouthpiece (P<0.05). No significant correlation was found between aerosol deposition and pulmonary function. The Mizer Aerosol Conservation Device significantly increases both total intrapulmonary aerosol deposition and peripheral aerosol distribution.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00569.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractTwo cases of central nervous system germinoma are described which highlight the various presentations of this tumour in different anatomical locations. The first case is that of a 15 year old boy with a suprasellar germinoma who presented with the classical triad of diabetes insipidus, visual disturbance and hypopituitarism. The need for full hormonal evaluation and replacement therapy is stressed. In the second case a 14 year old boy with pineal germinoma presented with features of raised intracranial pressure, Parinaud's syndrome and normal anterior pituitary function. Both cases were treated with corticospinal irradiation which resulted in regression of the tumours. Follow up has now been for over 4 years with no sign of recurrence.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00570.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractA case of neonatal adrenal haemorrhage presenting as a unilateral acute scrotum is reported, and the role of ultrasound (US) examination in diagnosis is discussed.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00571.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractWe report a Chinese girl with Epstein‐Barr virus (EBV) associated aplastic anaemia and hepatitis. Epstein‐Barr virus genome was demonstrated in her bone marrow cells and EBV‐specific serology suggested reactivation of EBV infection. She was initially treated with anti‐thymocyte globulin (ATG) and methylprednisolone but with no haematologic response, and liver function continued to deteriorate. She was then treated with acyclovir. Her aplastic anaemia improved and hepatitis resolved, and there was eradication of EBV genome from her bone marro

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1994.tb00572.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY