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Biomedical subjects

E D Shapiro

Publications and source records attributed to E D Shapiro.

At least 91 records · Page 5Linked to original sources
PubMed1986

Studies of breast-feeding and infections. How good is the evidence?

We assessed the extent to which studies of the association between breast-feeding and infection met four important methodological standards that relate to both the scientific validity and the generalizability of the studies. Of the 20 studies (14 cohort, six case-control), only six met three or four of the methodological standards. Four of these six studies found that breast-feeding was not protective against infections and two found that breast-feeding was protective against infections. In the three studies in which statistical adjustments were made for three additional potentially important confounding variables--size of the family, smoking of cigarettes by the mother, and the mother's level of education-the apparent protective effect of breast-feeding against respiratory tract infections disappeared after the adjustments were made. We found that most of the studies have major methodological flaws that may have compromised their conclusions. The studies that met important methodological standards and controlled for confounding variables suggest that breast-feeding has at most a minimal protective effect in industrialized countries.

Breast Feeding↗
PubMed1986

Risk factors for development of bacterial meningitis among children with occult bacteremia.

To identify risk factors for the development of bacterial meningitis, we compared clinical characteristics in children with occult bacteremia who did and those who did not subsequently develop bacterial meningitis. The estimates of risk were adjusted for the possible confounding effects of other characteristics by using logistic regression. Of 310 children (median age 15 months) who had occult bacteremia with Streptococcus pneumoniae, Haemophilus influenzae type b, or Neisseria meningitidis at either Yale-New Haven Hospital or Children's Hospital of Pittsburgh, bacterial meningitis subsequently developed in 22 (7%). Compared with the risk associated with occult bacteremia with S. pneumoniae, the adjusted relative risk for bacterial meningitis was 85.6 (P less than 0.0001) and 12.0 (P = 0.0001) for N. meningitidis and H. influenzae type b, respectively. By contrast, the adjusted relative risk associated with a lumbar puncture at the initial visit was only 1.2 (P = 0.78). The development of bacterial meningitis in children with occult bacteremia is strongly associated with the species of bacteria that causes the infection, but not with a lumbar puncture or with other clinical characteristics identifiable at the initial visit.

Anti-Bacterial Agents↗
PubMed1986

Clinical features as predictors of functional status in children with cystic fibrosis.

Previous clinical studies in patients with cystic fibrosis have demonstrated substantial variability in the symptoms present at diagnosis and in subsequent survival rates. In this study we assessed the association between features present at diagnosis and the clinical course of cystic fibrosis in 89 patients. The 5- and 10-year outcomes for children with cystic fibrosis were better than has been generally appreciated. Overall, two thirds of the patients had either improved or remained at the same level of morbidity 5 years after diagnosis. Children who presented with isolated gastrointestinal symptoms had a good clinical course; some actually improved clinically during the first 5 to 10 years after diagnosis. In contrast, children who presented with respiratory disease frequently had clinical deterioration during the follow-up period. Neither age at presentation nor the initial level of morbidity was significantly related to subsequent outcome. We conclude that clinical features apparent at diagnosis are valuable prognostic indicators in children with cystic fibrosis.

Child↗
PubMed1986

Does breast-feeding protect against infections in infants less than 3 months of age?

To determine whether breast-feeding protects infants from infections, a case-control study was conducted. The cases were previously healthy children who were admitted to Yale-New Haven Hospital for an infectious illness at or before 90 days of age. The controls were chosen from the log of births and matched to the cases for five important demographic variables. In addition, logistic regression models were used to adjust the results for other potential confounders. To minimize the potential surveillance bias that might occur if formula-fed and breast-fed infants with the same degree of illness have a different probability of being hospitalized, the case-control pairs were stratified by the severity of the medical condition of the case at the time of hospitalization. For the 281 case-control pairs, the matched odds ratio was .50 (95% confidence interval .32, .77; P less than .005), which indicates that breast-feeding is protective against infections. However, this apparent protective effect was diminished substantially when the data were stratified according to the severity of illness: the matched odds ratio for the 164 infants with serious illnesses was .79 (.47, 1.32; P less than .50), and for the 117 infants with mild illnesses it was .17 (.03, .44; P less than .001). These stratified results suggest that breast-feeding protects infants from hospitalization rather than from infections. Failure to consider the problem of surveillance bias may lead to erroneous conclusions about the protective effect of breast-feeding.

Bacterial Infections↗
PubMed1985

Prophylaxis for bacterial meningitis.

Close contact of patients with bacterial meningitis that is caused by either Haemophilus influenzae type b or Neisseria meningitidis are at an increased risk of developing invasive infections with these bacteria. Chemoprophylaxis with rifampin and immunoprophylaxis with vaccines may prevent some secondary infections.

Antibody Formation↗
PubMed1985

Oral trimethoprim/sulfamethoxazole for prevention of bacterial infection during the induction phase of cancer chemotherapy in children.

We conducted a randomized, double-blind, placebo-controlled study to evaluate the efficacy of oral trimethoprim/sulfamethoxazole (TMP/SMX) in the prevention of bacterial infections in children with cancer. Sixty-three patients with acute leukemia were studied during the induction phase of chemotherapy; 28 patients with solid tumors who were starting intensive chemotherapy were also enrolled and treated for 2 months. There was no significant difference in the frequency of febrile episodes between the 43 children receiving trimethoprim/sulfamethoxazole and the 48 receiving placebo. However, when the group of 74 children who experienced granulocytopenia (absolute granulocyte count less than 500/microL) was analyzed separately, significant reductions in the frequencies of confirmed bacteremia (2.6% v 20.0%, P = .02) and febrile episodes (35.9% v 65.7%, P = .01) were observed in the trimethoprim/sulfamethoxazole group. Furthermore, life table analysis showed that children with leukemia receiving trimethoprim/sulfamethoxazole had significantly more days without fever and without bacteremia. No benefits from prophylaxis were recognized in the subgroup with solid tumors. Although the frequency of oral thrush was greater (P = .02) in the trimethoprim/sulfamethoxazole group (25.6%) than in the placebo group (6.3%), invasive fungal infection did not occur. Although the mean duration of granulocytopenia was greater among those receiving trimethoprim/sulfamethoxazole (13.7 v 9.0 days, P = .05), this did not appear to increase the overall risk for bacterial infection. These data suggest that trimethoprim/sulfamethoxazole reduces the frequency of bacteremia and febrile episodes in granulocytopenic children undergoing induction chemotherapy for acute leukemia.

Adolescent↗
PubMed1984

Exclusion of ill children from day-care centers. Policy and practice in New Haven, Connecticut.

Despite evidence that children who attend group day-care centers have an increased frequency of infectious illnesses, appropriate criteria for exclusion of ill children from day-care centers have not been defined. Of the 89 licensed day-care centers in the New Haven area, 53 (60%) returned an anonymous questionnaire about their practices in managing ill children. Most of the centers (median size--38) included only children aged 3 to 5 years. The percentage of centers that excluded children with specific signs or symptoms varied from 100% for fever to 30% for either cough or runny nose. Although all of the day-care centers excluded children with fever, the minimum temperature defined as fever varied substantially (median--99.1 degrees F). Most centers (62%) relied on the parents' discretion for allowing an ill child to return to the center.

Child Day Care Centers↗
PubMed1984

A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections.

The protective efficacy of pneumococcal vaccine against systemic pneumococcal infections in adults with the current indications for the vaccine was evaluated in a case-control study. Six (7%) of the 90 cases and 16 (18%) of the matched controls had received pneumococcal vaccine for an odds ratio of 0.33 (p less than 0.05). The vaccine's protective efficacy was 67%, which remained virtually unchanged after adjusting for potential confounding variables. The vaccine's efficacy was 77% for patients at moderately increased risk of pneumococcal infections, but 0% for patients who were severely immunocompromised. The vaccine's protective efficacy was 70% (p less than 0.05) for all patients 55 years or older after controlling for indications for the vaccine in addition to age. Pneumococcal vaccine confers substantial protection against systemic pneumococcal infections on the elderly and patients with illnesses associated with a moderately increased risk of pneumococcal infections.

Adolescent↗
PubMed1982

Prevention of iatrogenic neonatal respiratory distress syndrome: elective repeat cesarean section and spontaneous labor.

Neonatal respiratory distress syndrome (RDS) is an important complication of elective repeat cesarean section. In a review of 68,880 consecutive deliveries, 1,897 women underwent elective cesarean section at a gestation estimated to be greater than or equal to 38 weeks. Seventy-one (4.3%) of the infants of the 1,649 women who were not in labor at the time of delivery developed neonatal RDS. None of the infants of the 248 women who were in spontaneous labor at the time of delivery developed RDS (P less than 0.005). There were no cases of uterine rupture in either group. Of the 71 infants who developed RDS, 29 (41%) were judged to be at term on the basis of both examination and birth weight. Misapplication of fetal ultrasound data contributed to the premature delivery of more than one third of the infants with RDS. Awaiting the onset of spontaneous labor to determine the timing of repeat cesarean section in women at term is an effective way to preventing iatrogenic neonatal RDS.

Cesarean Section↗
PubMed1982

Broviac catheter-related bacteremia in oncology patients.

In 27 pediatric oncology patients (median age, 2 years) undergoing chemotherapy for malignant tumours, Silastic Broviac catheters were placed to provide vascular access. The catheters were in place for a total of 174 patient-months. There were 14 episodes of Broviac catheter-related bacteremia or fungemia that occurred in six patients: one patient had six bacteremic episodes, one patient had four episodes, and four patients each had one bacteremic episode. Cultures of blood drawn from Broviac catheter were positive in all instances, and in 12 of 14 samples drawn from the peripheral vein. The most common initial symptoms were fever and chills. The species causing the infections were Enterobacter cloacae (three cases), Staphylococcus epidermidis (three cases), Staphylococcus aureus (three cases), Klebsiella pneumoniae (two cases), Escherichia coli (two cases), Pseudomonas dentrificans, Pseudomonas aeruginosa, and Candida tropicalis. Antimicrobials administered through the catheter cured the infection in ten of the 11 cases in which they were used.

Adolescent↗
PubMed1982

Bacteriology of the maxillary sinuses in patients with cystic fibrosis.

The maxillary sinuses of 20 patients (median age, 15 years) with cystic fibrosis were examined with ultrasound, radiography, and transantral sinus aspiration (14 bilateral and six unilateral for a total of 34 aspirates). The sinus aspirations were performed with careful sterile techniques, and the material that was recovered was cultured quantitatively for both aerobic and anaerobic bacteria. Nineteen (95%) of the 20 patients had at least one positive (greater than or equal to 10(4) colony-forming units/ml) culture of sinus aspirate. The organisms most commonly recovered from the sinus aspirates were Pseudomonas aeruginosa (13), Haemophilus influenzae (10), streptococci (five), and anaerobes (five). There was no association between the bacterial species recovered from the sinus and the predominant bacterial species in the nasopharyngeal, throat, or sputum culture. Although most patients had been chronically receiving therapeutic oral doses of antimicrobial agents, bacteria sensitive to the antimicrobial agents that the patient had been taking (excluding P. aeruginosa) were recovered from the sinuses of nine of these 10 patients.

Adolescent↗