摘要:

Objective:The importance of lumbar puncture (LP) as part of the evaluation of suspected neonatal sepsis is assessed, as it may be the only positive diagnostic test in about 10% of septic babies with meningitis but negative blood cultures. However, LP may compromise respiratory function, and the interpretation of cerebrospinal fluid (CSF) may not be straightforward.Conclusion:The clinical setting and the probability of meningitis are important determinants of the likely value of LP. For asymptomatic neonates with obstetric risk factors for sepsis, and for babies with early‐onset respiratory distress alone, LP may be delayed and only performed later if blood cultures are positive. This is because hundreds of LP will be needed to diagnose a single case. However, infants with suspected late‐onset sepsis should have an immediate LP because finding Gram‐negative bacilli or fungi in the CSF will affect treatment ch

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02899.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:Attention is drawn to possible disadvantages arising from the introduction of universal varicella vaccination in infancy.Methodology:Comparisons are made between universal infant varicella vaccination and the current measles immunization programme, and a review of current literature on age‐specific complications of varicella and cost‐benefit analyses of varicella vaccination.Results:Universal infant vaccination will cause a greater proportion of varicella cases to occur in adults, including pregnant women, who are at greater risk of serious complications compared to children. Although economic costs resulting from lost time from work will fall dramatically, health costs may rise.Conclusions:Universal infant vaccination should only be considered if measles is first controlled, and then only if more information on duration of protection becomes available and combined measles‐mumps‐rubella‐varicella vaccines are

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02900.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02901.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:To evaluate the utility of lumbar puncture done routinely as part of complete workup in neonatal sepsis.Methodology:Two hundred and nine consecutive lumbar punctures performed in 169 neonates were prospectively evaluated for the diagnosis of meningitis over a 6 month period in a tertiary care referral neonatal unit.Results:Among babies with ‘suspected clinical sepsis’, five (3.3%) were diagnosed to have meningitis. None of the clinically normal babies with high risk obstetric factors alone had meningitis. The lumbar puncture was traumatic in 22.9%, and in 26.3% the fluid obtained was inadequate for complete analysis. The results were inconclusive in 37% of the cases.Conclusion:Based on this study, routine lumbar puncture may not be required in clinically normal newborns with adverse obstetric factors. In babies with clinical sepsis, though the yield is not very high; there are no reliable clinical or laboratory markers to predict which babies will have meningitis and hence these babies would warrant a lumbar punct

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02902.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:This study compares the use of standard overhead fluorescent phototherapy units with the BiliBlanket a woven fibreoptic pad which delivers high intensity light with no ultraviolet or infrared irradiation in the treatment of jaundice in preterm infants.Methodology:We chose to study infants between 800 and 2500 g, with strict criteria for commencing and ceasing phototherapy. Serum bilirubin levels were followed at 12–24 h intervals until 24 h after cessation of phototherapy. Infants were allocated at random to receive either conventional phototherapy or the BiliBlanket.Results:There were 24 infants in the conventional group and 20 in the BiliBlanket group. Mean duration of phototherapy was compared and was 44 h for the conventional group versus 42 h for the BiliBlanket group.Conclusions:We have shown that the BiliBlanket is as effective as conventional phototherapy and was well accepted by nursing staff and parent

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02903.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Methodology:Docosahexaenoic acid levels were measured by gas chromatography in samples of frontal lobe and brain‐stem taken from 28 and 26 infants, respectively, who had died of sudden infant death syndrome (SIDS).Results:Significantly higher levels of docosahexaenoic acid were present in the frontal lobe tissues derived from the 13 breast fed infants (age range = 3.3–36.3 weeks; mean 15.9 ± 11.3 weeks) compared to the 15 formula fed infants (age range = 6.9–47.7 weeks; mean 19.3 ± 10.6 weeks); mean (± s.d.) levels were 8.5 ± 1.1% and 7.6 ± 0.8% of total fatty acids (P= 0.019). There was, however, no significant difference in brainstem docosahexaenoic acid levels between breast and formula fed infants.Conclusions:Given these variable findings, further investigation of the relationship between dietary fatty acid intake and cerebral lipid levels may help to clarify whether different modes of feeding have a role in the pathogenes

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02904.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:Information regarding cerebral oedema in diabetic children with ketoacidosis does not point to any causal factor or any predictor of outcome. Cases of diabetic ketoacidosis resulting in cerebral oedema at Royal Children's Hospital, Melbourne, over the last 20 years were reviewed.Methodology:The study was divided into two 10‐year periods during which different fluid protocols were used. During the earlier period dehydration was corrected rapidly (over six h) with a fluid isotonic for sodium. During the latter period rehydration was over 24 h using half‐normal saline.Results:A similar number of patients developed cerebral oedema in the two periods (six of 3134 vs six of 3373). Only half of the patients (six) developed cerebral oedema during their initial presentation of diabetes mellitus. The age range was similar (1 to 15 years) with eight males and four females. Survival from cerebral oedema (four of 12) was not predicted by demographic or biochemical findings, including initial biochemistry, age, duration of ketoacidosis and the management protocols.Conclusions:This study suggests that the rate of salt and water replacement in diabetic ketoacidosis are not key determinants of the appearance of cerebral oedema. No factors predictive of survival from cerebral oedema have been identified, though this is a rare entity and case numbers were small. Nevertheless, current protocols at Royal Children's Hospital and most other centres utilize slow rates of rehydration with isotonic saline fluids. Further review in 5–10 years may determine whether this protocol is effective in reducing rates of cerebral oedema complicating diabetic ketoaci

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02905.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:To assess the provision and use of action plans in children attending hospital because of asthma.Methodology:An interviewer administered a structured questionnaire to the parents of 279 children attending the Casualty Department, Outpatient clinics or admitted to hospital because of asthma, at two Level 3 teaching hospitals.Results:Only 82 (29%) of the children attending hospital had a written action plan. The majority (57%) were devised by paediatricians and covered the salient aspects of care. However, indications for steroid use were included in only 28% of plans and only 37% of the action plans in children over 5 years incorporated the use of peak flow meters.Conclusion:Action plans are still under‐utilized in children with asthma. General practitioners should be encouraged to consider the use of action plans for the group of children not already covere

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02906.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:Current approaches to therapy for cerebral palsy tend to be child‐focussed and claim functional improvements. Such approaches lead to demands for more therapy and more services as the solution for problems associated with cerebral palsy. This report suggests an alternative approach.Methodology:The literature on therapy methods for cerebral palsy is reviewed and compared with the literature on early intervention for children with intellectual disabilities.Results:The claims for functional improvements resulting from therapy methods cannot be substantiated. The literature on early intervention for children with cognitive impairments indicates a shift in emphasis from the child's impairments to the whole child, the family and the wider community.Conclusions:Demands for more and better therapy are, at best, simplistic and tend to detract from the real needs of the child and family. An ongoing ecological approach is more likely to produce positive outcome

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02907.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:To determine the simplest combination of symptoms and signs for use as a triaging procedure in young infants presenting to hospital, and to compare this with the ‘Baby Check’ system.Methodology:Six hundred and eighty‐two babies were assessed when presenting with acute illness to a children's hospital emergency department. Results of analysis were compared to the results of the Baby Check system, which was derived from the data on the same babies.Results:The presence of at least one of the following markers: drowsiness on examination, significant chest wall recession, generalized pallor, a history of feeding less than 50% or decreased activity, had a sensitivity of 91%, a specificity of 72%, a positive predictive value of 29% and a negative predictive value of 98% when predicting the need for intervention in hospital. The ‘Baby Check’ system with a score of 13 or more had a sensitivity of 95%, a specificity of 70%, a positive predictive value of 28% and a negative predictive value of 99%. Less common but predictive markers such as bile‐stained vomiting, respiratory grunt, apnoea and convulsions add further to the sensitivity. Based on this data set, if historical variables alone (the presence of either drowsiness, difficult breathing, being more pale than usual, feeding less than 50% or decreased activity) were used (as in telephone screening) 92% of babies needing treatment in hospital would be identified.Conclusion:A simple five‐marker system is almost as powerful as the 19‐marker Baby Check system and provides a useful basis for a triaging system and educational guidelines when assess

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb02908.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY