Biomedical subjects
Publications and source records attributed to B F Andrews.
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OBJECTIVE: To determine the long-term outcome of neonatal bacterial meningitis and the relationship between the outcome and specific features in the acute stage of the disease; and to compare the outcome between infants with neonatal meningitis and high-risk infants without meningitis. DESIGN: Prospective clinical evaluations of 21 survivors of meningitis and 21 matched controls who were retrospectively selected from a high-risk patient population. SETTING: Program of follow-up performed at the Children and Youth Project's High Risk Center of the Department of Pediatrics, University of Louisville, Louisville, Ky. Neonates were inborn at a university hospital with a high-risk obstetric unit and level III nursery. PATIENTS: Twenty-six consecutive neonates born between 1970 and 1980 with culture-proven bacterial meningitis, excluding neonates with congenital neurologic defects. Nineteen of 21 survivors and 21 controls matched by age, sex, race, birth weight, and gestational age were followed up from 1 to 14 years (mean, 7.8 years). Both survivors and controls fell below the federal poverty guidelines. RESULTS: Gram-positive meningitis was twice as common as gram-negative meningitis with co-occurrence of meningitis and sepsis in half of the cases. Neonates with gram-positive meningitis and higher birth weight had a higher survival rate, but this finding was not statistically significant. The mortality rate in neonates with gram-negative meningitis was almost three times higher than that of neonates with gram-positive meningitis, but no significant difference was observed between their morbidity rates. Eight (38%) of 21 survivors were normal, while another eight (38%) and five (24%) had mild and moderate to severe sequelae, respectively. Survivors of meningitis had lower IQ scores and more severe sequelae than matched controls. CONCLUSION: Neonatal bacterial meningitis results in poorer long-term outcome than in controls, but improved outcome compared with previous studies of neonatal meningitis.
Plasma phenylalanine (Phe) and tyrosine (Tyr) concentrations were measured by high-performance liquid chromatography in arteriolar blood obtained by finger prick from 78 normal volunteers and 36 heterozygote carriers of phenylketonuria (PKU). Subjects were tested at midday, 3 to 4 hours after their breakfast. Values for the micromolar ratio of Phe/Tyr and Phe2/Tyr for control subjects fell below 1.2 and 80, respectively; values for all carriers of PKU were higher for one or both ratios. This method should be applicable to widespread screening of the general population for carriers of the gene for PKU.
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While not immutable, legal principles are among the more sturdy and commanding guides of our professional behavior toward patients. By protecting privacy and autonomy inherent in the Patients Bill of Rights, legal principles shore up what is vulnerable and fearful in the patient's approach to making sense out of their plight.
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Respiratory distress is the most frequent symptom initiating referral to neonatal intensive care centers. Previous reports have indicated that 40% of infants with sepsis proved by blood culture had respiratory symptoms as their clinical presentation. In this prospective study there were 145 consecutive infants referred because of respiratory distress. Two-site blood cultures were collated with all other clinical and laboratory data to confirm a diagnosis of septicemia. There was a 4.8% incidence of bacteremia, and clinical and laboratory parameters confirmed septicemia in 3.5% of infants studied. Sixty percent of these infants had group B streptococcal sepsis, and 80% had leukopenia. The low incidence of confirmed septicemia in infants referred because of respiratory distress suggests that antibiotic therapy should not be routine.
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Neonatal mortality has declined since the advent of intensive care. The incidence of cerebral palsy has likewise decreased in spite of increased survival of low birth weight infants.
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Retrolental fibroplasia (RLF) has most often been observed in preterm infants exposed to high ambient oxygen concentrations. This case report describes an infant near term who was never exposed to supplemental oxygen but in whom stage 4 RLF developed. The etiologic role of exchange transfusion is discussed.
With the use of ethanol in hyperalimentation regimens and for the inhibition of premature labor, there is increased opportunity for exposure of the fetus to this potentially toxic substance. We reviewed the literature regarding the effects of ethanol on the fetus and neonate, and illustrate its potential toxicity by the report of a case of neonatal depression secondary to acute maternal ethanol ingestion.
Information from 50 infants with neonatal septicemia from the Louisville General Hospital during an eight-year period (1964-1972) is presented. Twenty-five infants had gram-positive and the other 25 had gram-negative organisms. E. coli (13 cases), staphylococcus (10 cases), and hemolytic Streptococcus non-Group A (7 cases) were the mustcommon causative microorganisms. Only one of the 25 infants with gram-positive sepsis died; three with gram-negative sepsis died. Listeria monocytogenes was demonstrated in three infants; all had meningitis with no mortality. Early diagnosis, prompt intensive antibacterial therapy, and a high index of suspicion are most helpful for reducing the morbidity and mortality.
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