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Biomedical subjects

M B Edmonson

Publications and source records attributed to M B Edmonson.

15 recordsLinked to original sources
PubMed1997

Pediatric residency training in the normal newborn nursery. A national survey.

OBJECTIVE: To determine how and what pediatric residency programs are teaching residents about normal newborn care in the nursery. DESIGN: A mailed survey distributed in 1994. PARTICIPANTS: All 237 known pediatric residency programs in the United States, Canada, and Puerto Rico. RESULTS: Survey response rate was 77% (184 of 237 questionnaires were returned and completed). In 40% of the programs, neonatologists were primarily responsible or co-responsible for teaching residents about management of normal newborns. A normal newborn nursery curriculum had been developed and implemented in 56% of the programs, 30% of programs were developing one, and 13% reported no curriculum. Specific instruction about breast-feeding was not offered in 16% of programs. Circumcisions were most commonly performed by obstetricians; anesthetic use was low (overall median use, 10%) but was more common (P < .002) when circumcisions were performed by pediatricians. The hospital environment and lack of faculty time were cited as the main barriers to teaching residents about normal newborn care. CONCLUSIONS: Although general pediatricians spend a substantial amount of practice time on newborn care, neonatologists were responsible for this teaching in almost half of the pediatric residency programs. Many programs have not developed a curriculum. Instruction about breast-feeding was not universal. Most pediatric residents do not learn to perform circumcisions. General pediatricians should be more involved in the development, implementation, and evaluation of comprehensive newborn nursery curricula to improve training in this important aspect of general pediatric practice.

Canada↗
PubMed1996

Measles vaccination during the respiratory virus season and risk of vaccine failure.

OBJECTIVE: To determine whether measles vaccine failure is more common in persons who were vaccinated during the respiratory virus season, when they were more likely to have had concurrent minor illnesses. DESIGN: Population-based case series and case-control study. SETTING: Wisconsin and Ohio. SUBJECTS: The case series included all 545 of the states' residents who had confirmed measles reported during 1985 through 1990 and a history of receiving a single dose of measles vaccine during 1975 through 1988 at 15 to 59 months of age. In a case-control study restricted to 1984 through 1988 vaccinees, season of vaccination was compared in 170 case children and 6070 control students. MAIN OUTCOME MEASURE: Risk of clinical vaccine failure after measles vaccination during the respiratory virus season (September through May) or the peak season (November through March) compared with summertime (June through August), after adjustment for age at vaccination and place of residence. RESULTS: In the case series of persons with vaccine failure, the proportion who had been vaccinated during the respiratory virus season (74.7%) was no greater than expected (September through May = 74.8% of the year). In the case-control study, vaccination during the respiratory virus season (odds ratio, 0.92; 95% confidence interval, 0.66 to 1.30) or the peak season (odds ratio, 0.93) did not increase the risk of vaccine failure. CONCLUSION: Despite the high and strongly seasonal prevalence of viral respiratory illness in young children, routine childhood measles vaccination during the respiratory virus season does not increase their risk of vaccine failure. Findings provide epidemiologic support for recently strengthened recommendations that measles vaccination not be deferred in children with minor respiratory illnesses.

Antibody Formation↗
PubMed1993

Maternal age at first childbirth and risk of low birth weight and preterm delivery in Washington State.

OBJECTIVE: To study the consequences of delayed first childbearing in a large, population-based US sample, with separate analysis of women aged 40 years or more and adjustment for socioeconomic factors, smoking, medical and reproductive conditions, and route of delivery. DESIGN AND SETTING: Retrospective survey of Washington State birth certificates from 1984 through 1988. SUBJECTS: First liveborn singleton infants of women aged at least 20 years. Of eligible white infants, all those born to women aged 35 to 39 years (n = 4019) and 40 years or more (n = 410) and a maternal age-stratified random sample of white infants of younger women were studied. All eligible black infants were studied. OUTCOME MEASURES: Low (< 2500 g) and very low (< 1500 g) birth weight and preterm delivery (< 37 weeks of gestation). RESULTS: Adjusted odds ratios for delivering a low-birth-weight white infant increased progressively with each 5-year maternal age group, reaching 2.3 (95% confidence interval, 1.6 to 3.4) for women aged 40 years or more compared with those aged 20 to 24 years. The maternal age effects for very low birth weight and preterm delivery were similar; for each, the odds ratio was 1.8 for the oldest group. No significant maternal age effect was found among births of black infants, but only 127 births to women aged 35 years or more were studied. CONCLUSION: Increasing maternal age at first childbirth is an independent risk factor for low birth weight and preterm delivery of white infants in the United States.

Adult↗
PubMed1990

Mild measles and secondary vaccine failure during a sustained outbreak in a highly vaccinated population.

A prolonged school-based outbreak of measles provided an opportunity to study "vaccine-modified" mild measles and secondary vaccine failure. Thirty-six (97%) of 37 unvaccinated patients had rash illnesses that met the Centers for Disease Control clinical case definition of measles, but 29 (15%) of 198 vaccinated patients did not, primarily because of low-grade or absent fever. Of 122 patients with seroconfirmed measles, 10 patients (all previously vaccinated) had no detectable measles-specific IgM and significantly milder illness than either vaccinated or unvaccinated patients with IgM-positive serum. Of 108 vaccinated patients with seroconfirmed measles, 17 patients (16%) had IgM-negative serology or rash illnesses that failed to meet the clinical case definition; their mean age (13 years), age at the time of vaccination, and time since vaccination did not differ from those of other vaccinated patients. The occurrence of secondary vaccine failure and vaccine-modified measles does not appear to be a major impediment to measles control in the United States but may lead to underreporting of measles cases and result in overestimation of vaccine efficacy in highly vaccinated populations.

Adolescent↗
PubMed1987

Caustic alkali ingestions by farm children.

Liquid lye drain cleaners responsible for a childhood epidemic of household ingestions in the early 1970s are now marketed in drastically reduced alkali concentrations and packaged in child-resistant containers. However, farm and industrial caustic agents continue to be sold without poison prevention safeguards, as exemplified by dairy pipeline cleaners (liquid NaOH/KOH concentrations 8% to 25%) used routinely on dairy farms. In this study, the ingestion epidemiology of farm/industrial v household caustic alkali products was compared in a population that included farm children. Forty-three children were admitted from 1973 to 1983 to four rural hospitals for nonintentional caustic alkali ingestion. Farm products constituted 23% of all products and 43% of all drain/pipe cleaners ingested. Dairy pipeline cleaners were the single most common causative substance, injuring ten toddlers (mean age 1.6 years), perforating the esophagus in two. Liquid dairy pipeline cleaners were usually ingested in tiny amounts from nonchild-resistant containers or drinking glasses at evening milking time. In contrast, household drain cleaners were associated with fewer ingestions, with all serious complications related to highly concentrated products not available on the consumer market after 1975. Poison prevention strategies successfully applied in the 1970s to household drain cleaners should be redirected and modified for farm-related caustic alkali agents. Preventive measures are suggested by the highly specific pattern of injury and the small, defined population at risk.

Burns, Chemical↗
PubMed1982

Outer membrane protein subtypes and investigation of recurrent Haemophilus influenzae type b disease.

Ten previously healthy patients, ages 3 to 26 months, developed recurrent episodes of deep-tissue Haemophilus influenzae type b infections from 4 to 191 days (median = 28 days) after the last day of antibiotic therapy given for the first episode. None of the patients had a persistent focus of infection and eight were considered to have had adequate therapy for the initial episode. Bacteremia, without evidence of relapse at the site of the original infection, was documented in eight of the ten recurrent episodes. The ampicillin susceptibilities of the HITB isolates changed between episodes in two of the patients. Blood or CSF isolates from both episodes in seven patients were examined for biotypes and outer membrane protein subtypes. Concordance of both biotype and OMP subtype was present for all seven paired isolates, including the two pairs in which the HITB ampicillin sensitivities had changed. These data imply that some patients become reinfected with their original HITB isolates and that OMP and capsular antigens do not always elicit protective immunity, even after natural infection.

Ampicillin↗
PubMed1979

Spontaneous spinal epidural hematoma in the young.

There have been few descriptions of spontaneous epidural hematoma of the spinal cord in children. Duration of symptoms in previous cases has varied from hours to days. We recently evaluated a 6-year-old girl with cord compression from an extradural clot, who complained of thoracic back pain for 3 months before becoming paraplegic. Our experience suggests that spontaneous epidural bleeding may be responsible for episodic back pain and cord compression in children.

Arteriovenous Malformations↗
PubMed1978

Hemolytic-uremic syndrome confused with acute appendicitis.

Hemolytic-uremic syndrome (HUS) may have signs that are clinically indistinguishable from acute surgical diseases of the abdomen. A 2-year-old girl had HUS and physical findings leading to appendectomy. Various pediatric surgical and medical conditions are mimicked by HUS. Attention to specific diagnostic clues (anemia, evidence of hemolysis, thrombocytopenia, azotemia) may lead to the correct diagnosis of HUS and avoidance of an unnecessary operation.

Acute Disease↗
PubMedDate not supplied

Hospital readmission with feeding-related problems after early postpartum discharge of normal newborns.

CONTEXT: Increasingly short postpartum hospital stays in the United States precipitated a policy debate that culminated in passage of the Newborns' and Mothers' Health Protection Act of 1996. The debate occurred without population-based evidence for adverse health effects in newborns who are discharged early. OBJECTIVE: To determine whether early postpartum hospital discharge of normal newborns increases their risk for hospital readmission with feeding-related problems. DESIGN AND SETTING: Nested case-control analysis of 1991 to 1994 Wisconsin birth certificate and hospital discharge data. SUBJECTS: A total of 210 readmitted case patients and 630 control subjects selected from a cohort of 120 290 normal newborns who weighed at least 2500 g, were delivered vaginally of mothers with uncomplicated medical and obstetrical histories, and were discharged from the hospital either early (day of life 1 or 2) or conventionally (day 3). OUTCOME MEASURE: Readmission at age 4 to 28 days with discharge diagnoses indicating a primary feeding problem, secondary dehydration, or inadequate weight gain. RESULTS: Early discharges increased 3-fold (reaching 521/1000 discharges) during the study period, but feeding-related readmissions (1.7/1000) remained stable. Most readmitted newborns (53.8%) were 4 to 7 days old, many (34.3%) had concurrent dehydration and jaundice, and 29% were admitted through emergency departments. Readmitted newborns were significantly (P<.05) more likely to have been breast-fed, firstborn, or preterm or to have mothers who were poorly educated (<12th grade), unmarried, or receiving Medicaid. Readmission was not associated with early discharge (adjusted odds ratio, 1.05; 95% confidence interval, 0.71-1.53). CONCLUSION: Although several neonatal and maternal factors increase the risk that a normal newborn will be rehospitalized with a feeding-related problem, early discharge following an uncomplicated postpartum hospital stay appears to have little or no independent effect on this risk.

Case-Control Studies↗