[Contribution of nursing to breast and human milk feeding in neonatology].
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Biomedical subjects
Publications and source records attributed to L Hohenauer.
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The recommended program of Child Health Care in Austria needs some additions: The first routine visit should be done between the 3rd and 5th week of life because of the insecurity of the young mother. The orthopedic examination must comprise the ultrasonographic examination of the hip. At 7-9 months of age the urinary screening for neuroblastoma must be incorporated into the existing program. The vaccination against haemophilus influenzae Type B must be added to the existing vaccination recommendations. During school age three additional examinations are recommended at 6, 10 and 15 years respectively.
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1% of registered AIDS cases are children, 80% have been perinatally infected. Special diagnostic criteria have to be applied for infants. Intrauterine infection can produce a specific malformation syndrome. Chronic pulmonary illness can be caused by pulmonary lymphoid hyperplasia and-less frequently-by Pneumocystis carinii pneumonia. Pulmonary lymphoid hyperplasia is responsive to corticoids. HIV infected mothers should refrain from breast feeding. Teenagers have to be informed adequately about the risks of and how to avoid HIV infection.
Among 1252 consecutively treated intensive-neonatologic patients during the years 1985 to 1987 79 cases (= 6.5%) of neonatal septicemia were diagnosed by positive blood- and/or cerebrospinal fluid cultures. The relation between early onset type (up to the 4th day of life) and late onset type was 4:1. The most frequent pathogen was Staphylococcus epidermidis (40% of early onset type, 56% of late onset type) followed in the case of early onset type by Listeria monocytogenes (13%), Streptococci (11%), E. coli (11%) and Staphylococcus aureus (10%). Susceptibility to antibiotics is described. Primary therapy of early onset type septicemia must be effective against Listeria monocytogenes and Streptococci. We recommend a combination of a beta-lactam- and an aminoglycosid antibiotic. In case of late onset type we used a cephalosporin in combination with netilmycin. The importance of good hospital hygiene, frequent blood cultures and correct application of aminoglycosid antibiotics is pointed out.
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Among 829 consecutively treated neonatal intensive care patients during the years 1985 and 1986 46 cases of early onset type an 14 cases of late onset type (beyond the 4th day of life) of sepsis neonatorum were diagnosed. Mortality was 20%. In 40% of the cultures penicillin-resistant staphylococcus epidermidis was found. It was resistant to Penicillin however fully sensitive to Cefamandol, Netilmycine and Amicacine. Primary therapy of early onset type of sepsis has to be effective against Streptococci and against Listeria monocytogenes. Blood culture is the only way to proove or to exclude sepsis at a rational way. Good hospital hygiene can prevent a part of late onset type of sepsis. Immuntherapy is regarded as an import part of Sepsistherapy in the newborn.
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During a period of 22 months there were 84 cases of congenital cardiac malformations diagnosed during the first year of life. This figure corresponds to about 80% of all existing cardiac malformations present in the population covered. Noninvasive measures including echocardiography were sufficient for diagnostic and therapeutic decisions in 75% of the cases. 18% of the malformations had to be operated during the first year of life. There were 8 deaths, 5 of them due to irreparable malformations or underlying conditions.