ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A total of 254 previously healthy outpatient neonates 31 days of age or younger with a rectal temperature ≥38°C were enrolled in a prospective study during an 18-month period to evaluate the validity of applying low risk criteria for bacterial infections in this population. All of the neonates received standard physical examinations and laboratory evaluations including blood and urine cultures at the time of admission. Those who had no evidence of ear, eye, soft tissue, umbilical or skeletal infection had between 5000 and 15 000 white blood cells/mm3, had a C-reactive protein of less than 20 mg/liter or an erythrocyte sedimentation rate less than 30 mm/ hour and a normal urinalysis were considered at low risk for bacterial infections. Bacterial infections were confirmed by cultures of the various body fluids. Bacterial infections were present in 17.7% (45 neonates) and bacteremia or meningitis in 5.1% (13 neonates). Eight (6.0%) of the 134 neonates who met the criteria had bacterial infections, while only 1 (0.7%) had bacteremia and meningitis, compared with 37 (30.8%) and 12 (10.0%), respectively, of the 120 who did not meet the criteria (bothP< 0.05). The negative predictive value of meeting the low risk criteria were 94.0% for excluding all bacterial infections and 99.3% for bacteremia and meningitis, respectively. Our data suggest that the criteria proposed here are useful in predicting febrile outpatient neonates at low risk for bacteremia or meningitis, but not for all bacterial infections. Our data support a recommendation for a complete work-up for sepsis, hospitalization and careful observation for febrile outpatient neo- nates who meet the suggested low risk criteria for bacterial infections, reserving the addition of parenteral antibiotic therapy for those who do not.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Lumbar puncture (LP) is performed frequently in pediatric emergency departments to diagnose meningitis in infants and young children with fever. Children selected to have LP who do not have meningitis may, however, have other serious bacterial infections. We surveyed lumbar punctures performed in the Boston City Hospital Pediatric Emergency Department and monitored the incidence of meningitis and other serious bacterial infections. Meningitis was diagnosed in 8% of children who underwent LP. An additional 10.5% of children who underwent LP and had normal cerebrospinal fluid had positive cultures of blood (3.1%), urine (4.1%) or stool (3.3%). The decision to perform lumbar puncture identifies children at risk of having not only meningitis but other serious bacterial illnesses. Those children 2 years of age and younger with normal cerebrospinal fluid should be considered for cultures of blood, urine and possibly stool.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

An enzyme-linked immunosorbent assay was developed for the detection of specific salivary IgA antibodies toGiardia lamblia.Among 73 infants and children in a day care center 9 asymptomatic subjects had stools positive forG. lamblia.Salivary antigiardia IgA concentrations, expressed as OD units, were higher in the 2− to 4-year-old group: 0.899 ± 0.03vs.0.660 ± 0.03 in the <2-year old group (P< 0.001). In both groups values were higher in the infected children (1.099 ± 0.04vs.0.629 ± 0.09 in the < 2-year-old group and 1.053 ± 0.07vs.0.859 ± 0.03 in the 2-to 4-year-old group). In children infected throughout the study period, salivary antigiardia antibodies remained consistently high and in 2 children whose stools were initially negative a significant rise in OD value was observed after stools tested positive. Total salivary IgA did not differ between the two age groups and did not correlate with specific salivary antigiardia antibodies in individual subjects. The enzyme-linked immunosorbent assay for detection of specific salivary antibodies to G.lambliacan be used in the study of the mucosal immune response to the parasite, and may serve as an screening tool in monitoring the exposure of various populations to G.lamblia.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

During the summer of 1988, an outbreak of poliomyelitis caused by poliovirus 1 occurred in Israel, during which a national mass immunization campaign with oral poliovirus was undertaken. This prospective study was undertaken to assess the effect of maternal oral poliovirus immunization during the third trimester of pregnancy on neonatal immunity against poliovirus. Cord blood specimens of 88 neonates, born 2 to 7 weeks after maternal immunization, were examined for antipoliovirus antibodies and compared with 100 samples obtained from neonates 7 months before the outbreak. Blood samples were also obtained from the 62 mothers of neonates who had been immunized 2 to 5 weeks before delivery. Sera were tested for neutralizing antibodies to the 3 poliovirus types using a microneu-tralization technique. The geometric mean titer to poliovirus type 1 was significantly higher in neonates whose mothers were immunized during pregnancy (87.1) than in the offspring of the nonvaccinated group (53.0),P< 0.05. Two to 3 weeks after immunization, geometric mean titers against all 3 poliovirus types were higher in maternal blood than in cord blood whereas 4 to 5 weeks after vaccination a significant difference was found for type 3 only. Although oral poliovirus immunization during pregnancy resulted in higher neonatal antibody titers to poliovirus type 1, the proportion of newborns with titers of <1:8 to the 3 poliovirus types did not change significantly.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study was designed to provide a preliminary assessment of the occurrence of tuberculosis exposure, infection and disease within a national sample of infants and children with human immunodeficiency virus (HIV) exposure or infection, and to determine the prevalence ofMycobacterium tuberculosisisolates resistant both to isoniazid and rifampin in these patients or their adult source contacts. A retrospective questionnaire survey was conducted of infants and children with HIV exposure or infection evaluated by pediatric HIV referral centers in the United States comprising the pediatric units or subunits of the Pediatric Acquired Immunodeficiency Syndrome Clinical Trials Group (PACTG). Seventy of 72 sites during a mean period of 5 (range, 1 to 12) years participated in this study and had provided care for 14 038 patients. There were 75 cumulative total cases of tuberculosis disease seen since each site was established. Therapy for asymptomatic infection was given to another 40 children and for tuberculosis expo.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Pharmacokinetics of vancomycin and dosage requirements were evaluated prospectively in 28 pediatric cancer patients 9 months to 13 years of age. The predictive performance of a two-compartment Bayesian forecasting program was also evaluated. A mean (±SD) daily dosage of 75 ± 22 mg/kg/day was necessary to attain a mean peak serum vancomycin concentration (SVC) of 23.1 ± 5.8 mg/liter and a mean trough SVC of 6.2 ± 2.3 mg/liter. Mean vancomycin clearance, volume of distribution and serum half-life were 0.153 ± 0.033 liter/hour/kg, 0.63 ± 0.08 liter/kg and 2.95 ± 0.48 hours. Final peak SVCs, which reflected the last dosage regimens received, were predicted with minimal bias (mean prediction error, −1.2 mg/liter) and accurate precision (root mean-squared prediction error, 2.0 mg/liter) whereas trough SVCs were predicted with even smaller bias (mean prediction error, −0.1 mg/liter) and greater precision (root mean-squared prediction error, 0.8 mg/liter). This study showed that pediatric cancer patients with normal renal function required vancomycin dosage regimens substantially greater than the standard 40 mg/kg/day to attain the desired SVCs.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

During a 2-year period 159 malnourished children ages 3 months to 5 years with radiologic evidence of pneumonia were investigated to determine the cause of their pneumonia. In addition 119 malnourished children without pneumonia, 119 well-nourished children with pneumonia and 52 well-nourished children without pneumonia were studied as controls. Percutaneous lung aspiration was performed on 35 malnourished and 59 well-nourished children with pneumonia. Bacteria were isolated from the blood, lung or pleural fluid of 28 (18%) malnourished children with pneumonia, 42 (35%) well-nourished children with pneumonia and from the blood of 5 (4%) malnourished children without pneumonia.Streptococcus pneumoniaeandHaemophilus influenzae,which were the two organisms isolated most frequently in both groups of children with pneumonia, were found in 17 (11%) malnourished and 39 (33%) well-nourished children with pneumonia.Mycobacterium tuberculosiswas detected in 5 malnourished children with pneumonia. A potentially pathogenic virus was identified in 35% of malnourished children with pneumonia and 40% of well-nourished children with pneumonia, and from 25% of children without pneumonia. The viruses identified most frequently were adenovirus and respiratory syncytial virus. There were 26 viral isolates from lung aspirate specimens. Respiratory syncytial virus was more frequently isolated from well-nourished children, while herpes simplex was more often found in malnourished children. Both bacterial and viral agents were identified in 25 children. In situations where measles and kwashiorkor are uncommon, the likely bacterial causes of community-acquired pneumonia in both well-nourished and malnourished children are S.pneumoniaeandH. influenzaebut, in malnourished children, particularly those with edema, the possibility of other causes, particularlyM. tuberculosis,must always be kept in mind.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Otitis media (OM) develops in the first months of life and persists throughout childhood in many rural Aboriginal children. We have followed Aboriginal and non-Aboriginal infants from birth to determine the relationship of the early onset of OM to nasopharyngeal colonization with respiratory pathogens. Aboriginal infants were colonized with multiple species of respiratory bacteria (Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae) at a rate of 5% per day and the timing of colonization predicted the onset of persistent OM in individual Aboriginal infants. Non-Aboriginal infants became colonized byM. catarrhalisalone at the slower rate of 1% per day and experienced transient episodes of OM in the absence of colonization. We attribute early bacterial colonization in most Aboriginal infants to high rates of cross-infection due to overcrowding, poor hygiene and high rates of bacterial carriage. Early age of infection and the multiplicity of bacterial types may contribute to prolonged carriage and to eustachian tube damage leading to persistent OM. Thus Aboriginal infants are “otitis-prone” and might qualify for prophylactic antibiotics.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We randomly allocated 80 children with suspected multidrug-resistant tyhpoid fever to therapy with either cefixime or ceftriaxone. Of these, an alternative diagnosis was subsequently made in 10 children and another 10 were excluded because cultures were negative. In 9 cases the typhoidal organisms isolated were susceptible to first-line drugs. In all, 50 children were randomly allocated to receive therapy with either intravenous ceftriaxone (65 mg/kg/day once daily, Group A, n = 25) or oral cefixime (10 mg/kg/day divided every 12 hours, Group B, n = 25) for 14 days. The two groups were comparable in their clinical characteristics, duration and severity of illness at the time of admission. The time to defervescence was comparable in both groups (8.3 Φ 3.7vs.8.0 Φ 4.1 days,P= not significant). An equal number (3 in each group) failed to respond and underwent a change in therapy. Three children in Group A and one in Group B relapsed. No adverse effects were seen in either group during the course of therapy. Our data suggest that oral cefixime can be used as effectively as parenter-ally administered ceftriaxone for management of typhoid fever in children.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID