Biomedical subjects
Publications and source records attributed to E L Gresham.
The clinical course of 11 patients with neonatal group D streptococcal septicemia is reviewed. Two of the infants died and hydrocephalus developed in one. Group D Streptococcus, both enterococci and nonenterococci, should be considered pathogenic in the neonate until proved otherwise. The antibiotics of choice for treating such infections in the newborn are ampicillin sodium and either kanamycin sulfate or gentamicin sulfate.
The effectiveness of a telephone call to the parents after the death of an infant has been assessed. Eleven parents who had received no formal contact after the death of their infant were interviewed at the hospital eight to 25 weeks (mean, 18 weeks) after than crisis. Eighteen other parents whose infants died were called three to 19 days (mean, nine days) after the death. The call lasted 26 minutes (range, 15 to 40 minutes). These parents were also interviewed at the hospital at nine to 27 weeks (mean, 15 weeks) after the death. Nine different problems were evaluated. Three of the 18 families who received a call had ten moderate or major problems compared with the 36 moderately severe or major problems in all 11 control families. This study documents the beneficial outcome of a telephone call in ameliorating emotional problems in the parents.
Fifteen low birth weight infants had their conditions complicated by the formation of a lactobezoar. The mean gestational age was 30.3 weeks; mean birth weight was 1,184 g, and the mean age at the time of diagnosis was 11.8 days. Twelve of the infants were receiving an 80 kcal/dL-formula and one infant, a 40 kcal/dL-formula designed for the premature infant. Symptoms included abdominal distension, emesis or increased gastric residual, diarrhea, hematest-positive stools, abdominal mass, and gastric perforation.
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Nephelometric measurement of light-scattering index and visual estimates of turbidity have been advocated to monitor serum Intralipid levels. This study describes a simple modified fluorometric method for accurately measuring lipid particles in serum and examines the reliability of such estimates compared with other chemical measurements. Ten percent IL was diluted with either saline or serum to various concentrations (0 to 250 mg/dl). The LSI showed an excellent correlation with known IL standard solutions in saline or serum (R = 0.99) and with triglyceride concentrations (R= 0.98). One hundred nine blood samples were obtained from 35 patients (28 neonates) receiving IL. An elevated TG, free fatty acid, or cholesterol level could not be reliably predicted from the LSI. The ability of clinical personnel to visually grade the degree of turbidity was evaluated by having them assign a turbidity score of 0 to 4+ to 39 hematocrit tubes which contained clear, hemolyzed, or icteric serum, each of which had IL concentrations varying from 0 to 292 mg/dl. The 15 tubes of identical IL concentration of 99 mg/dl were graded from 0 to 4+ by two of the observers, from 1 to 4+ by three of the observers, and 0 to 3+, 1 to 3+, and 2 or 3+ by one each of the observers. This study shows that (1) in vitro fluorometric LSI correlates well with IL concentrations; (2) in vivo correlations of LSI with FFA, cholesterol, and TG are poor; and (3) personnel are unable to reliably grade turbidity by visual examination of hematocrit tubes. Infants on IL should be monitored by TG and FFA levels.
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This study was designed to assess the diagnostic efficacy of the routine lateral chest film in symptomatic newborn infants. The initial anteroposterior chest film was supplemented by alateral view in 53 consecutive patients on admission to the newborn intensive care unit. Subsequently three radiologists and two neonatologists performed independent analysis of the anterposterior films with and without the lateral view. A total of 530 observations were tabulated. Assessment of degree of lung inflation and discovery of abnormalities of the heart, mediastinum, and trachea were unaffected by the use of the lateral radiograph. A correct primary diagnosis was made in 74% of all cases by the anteroposterior chest film alone and in 71% by the anteroposterior/lateral series. Degree of confidence in the primary diagnosis did not change when the lateral chest radiograph was added. There was no appreciable difference in detection of complicatins of the primary disease in either series. We conclude that the risks (e.g., radiation and environmental disturbance) of the routine admission lateral chest radiograph are substantially greater than any benefits to be gained.
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Current official recommendations are that parents and personnel with oral herpes lesions be isolated from newborn infants. A survey of 110 neonatal centers, 50% of them replying, showed that most centers do not isolate mothers with oral herpes from their newborn infants. A review of the literature suggest that exposure of infants to personnel or family with oral herpes lesions might occasionally result in disseminated neonatal herpes simplex virus disease. Since the separation of a mother from her newborn infant up to 1 week of ages is a decision that should not be taken lightly, more information is urgently needed to decide whether or not to isolate mothers and hospital personnel with oral herpes lesions from newborn infants. Recommendations to obtain more information concerning these infants are provided.
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Ventricular arrhythmia in the perinatal period is observed with greater frequency than reported in the literature. Four cases from the authors' experience and an analysis of the literature are presented. Of the total of 45 cases, nine were detected in utero, three persisted beyond the neonatal period, and two resulted in death with associated disorders. Twenty-four percent of the entire group had serious medical disorders associated with arrhythmia; however, 43% of the group with ventricular tachycardia had major associated disease.
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A retrospective study of 400 infants requiring umbilical artery catheterization performed from 1969 to 1971 at Indiana University Medical Center and Marion County General Hospital disclosed six cases of associated osteomyelitis. A similar review of approximately 550 cases of umbilical artery catheterization at Harbor General Hospital from 1972 to 1974 revealed an additional case. The causative organism was Staphylococcus aureus in each instance. Mean onset of symptoms following catheter removal was ten days. In all instances osteomyelitis occurred on the side ipsilateral to insertion and distal to the catheter tip. Postulated mechanisms include bacterial contamination of the catheter, thrombus formation, and local hypoxia from partial occlusion of the vessels by a large catheter.
We have presented some of the nutritional complications encountered in two major pediatric congenital disorders. Although these conditions represent two more common major defects, it is unlikely that many health care providers will manage large numbers of these patients. Nevertheless, the nutrition principles apply to other nutritional dilemmas of chronically ill children. When an infant consumes a low volume intake, regardless of etiology, concerns such as provision of adequate nutrition, within the confines of the infant's water balance, become paramount. Methods have been discussed for increasing caloric density and for monitoring dietary safety and adequacy. When an infant has a propensity for becoming obese one needs to consider preventive measures such as providing sound nutrition information, support, and follow-up for both patient and family. Nutritional problems can become magnified unless adequate support is provided for total health and social needs of the family. The role of the dietitian must be one active participation within the the framework of an interdisciplianry team so that appropriate innovative nutrition programs can be developed and implemented.