Biomedical subjects
J C Gershel
Publications and source records attributed to J C Gershel.
Urinary tract infections in febrile infants younger than 8 weeks of age.
In this prospective study of 442 infants younger than 8 weeks of age who attended a pediatric emergency department with temperature greater than or equal to 100.6 degrees F (38.1 degrees C), urinary tract infections (UTIs) were found in 33 patients (7.5%), 2 of whom were bacteremic. Clinical and laboratory data were not helpful for identifying UTIs. Of the 33 patients with UTIs, 32 had urinalyses recorded; 16 were suggestive of a UTI (more than five white blood cells per high-power field or any bacteria present). Of the 16 infants with apparently normal urinalysis results, three had an emergency department diagnosis suggesting an alternative bacterial focus of infection. If the physician had decided on the basis of apparently normal urinalysis results to forgo obtaining a urine culture, more than half of the UTIs would have been missed. Bag-collected specimens were significantly more likely to yield indeterminate urine culture results than either catheter or suprapubic specimens. In addition, uncircumcised males were significantly more likely to have a UTI than circumcised boys. These results suggest that a suprapubic or catheter-obtained urine specimen for culture is a necessary part of the evaluation of all febrile infants younger than 8 weeks of age, regardless of the urinalysis findings or another focus of presumed bacterial infection.
Which febrile infants younger than two weeks of age are likely to have sepsis? A pilot study.
During a 7-year period we prospectively studied 46 infants younger than 2 weeks of age with rectal temperatures of 100.6 degrees F or higher. Before performing a full laboratory evaluation for sepsis, house officers recorded their impressions of whether the infants were likely to have sepsis. Using the combination of impression of sepsis, white blood cell count and erythrocyte sedimentation rate, infants were assigned to one of two sepsis risk groups (high or low). All patients were hospitalized and treated with parenteral antibiotics. Sepsis or meningitis was diagnosed in 8.7% of the patients. Thirty-five of the 46 infants had sufficient data for risk group assignment. Sepsis or meningitis was diagnosed in 3 of 11 high risk infants vs. 0 of 24 low risk patients (P = 0.025). Of the 21 infants initially admitted without an identified bacterial source, 4 subsequently developed a bacterial complication, i.e. a bacterial focus that, although present at the time of admission, became apparent only after hospitalization. A bacterial complication was identified during the hospital course in 3 of 4 high risk infants vs. 1 of 17 low risk patients (P = 0.012).
Dose-related effects of nebulized metaproterenol in asthmatic children.
The dose-related effects of inhaled 5% metaproterenol solution in asthmatic children between the ages of six and 12 years with acute bronchospasm were evaluated. Tests included FEV1.0, FEF25-75, and PEFR. For entry into the study, subjects were required to have an FEV1.0 or an FEF25-75 less than 80% of the child's predicted normal value based on height and race. Sixty children were randomly assigned in double-blind fashion to receive one of four different doses of 5% metaproterenol inhalant solution: 0.0 ml (placebo), 0.1 ml, 0.2 ml, or 0.3 ml. Drug efficacy was assessed by spirometry using a DeVilbiss Surveyor I spirometer. Spirometry was performed prior to inhalation of the test dose (baseline) and four times after inhalation: immediately after and 15, 30, and 60 minutes after inhalation. Patients in the three treated groups had significantly higher peak post-dose FEV1.0 and FEF25-75 than the placebo group but were not significantly different from one another. There was a significant relationship between dose and incidence of side effects. These results suggest that 0.1 ml (5 mg) of nebulized metaproterenol may provide as much bronchodilatation as higher doses with fewer side effects.