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R G Faix

Publications and source records attributed to R G Faix.

54 records · Page 3Linked to original sources
PubMed1985

Cytomegalovirus antigenic heterogeneity can cause false-negative results in indirect hemagglutination and complement fixation antibody assays.

Cord sera and antepartum maternal sera from three congenitally cytomegalovirus (CMV)-infected infants and their mothers were CMV seronegative (titer, less than 8) in a complement fixation (CF) assay with a glycine-extracted CMV AD169 antigen; sera from two of the infants and mothers were also seronegative in a commercial indirect hemagglutination (IHA) assay with AD169 antigen. In tests with their own CMV isolates propagated and made into glycine-extracted CF antigen, all were seropositive. When 108 random cord sera were assayed for CF antibody with AD169, Davis, and A antigens (A is a locally derived antigen from one of the above infants), 44 were seropositive and 54 were seronegative for all three antigens. Of the remaining 10 sera, 4 were positive for A only, 3 were positive for A and Davis only, 2 were positive for Davis and AD169 only, and 1 was positive for AD169 only. All 10 were positive when a mixture of all three antigens was used. The IHA assay with AD169 antigen was positive with only 4 of these 10 sera. These results suggest that up to 6% of sera may be misclassified as seronegative in the CF and IHA assays if only a single antigen is used.

Antibodies, Viral↗
PubMed1985

Association of septic shock caused by early-onset group B streptococcal sepsis and periventricular leukomalacia in the preterm infant.

Early-onset group B streptococcal sepsis frequently produces shock in preterm infants, a condition also felt to be contributory to the development of periventricular leukomalacia. During a 2-year study period, 628 preterm infants who were admitted to the neonatal intensive care unit underwent serial sonographic brain scanning; periventricular leukomalacia was diagnosed in eight infants (1.2%). The four infants (100%) who survived group B streptococcal sepsis with septic shock developed periventricular leukomalacia, whereas none of the four survivors (0%) of septic shock caused by other organisms and three of 27 survivors (11%) of shock not caused by infection developed periventricular leukomalacia. Because of the frequency of this lesion, it is suggested that all preterm survivors of group B streptococcal sepsis with septic shock should have serial sonography screening for detection of periventricular leukomalacia. Early detection will not assure cure but may facilitate prognostication, follow-up, and earlier institution of rehabilitative therapy to produce a better outcome.

Encephalomalacia↗
PubMed1985

Transillumination in neonatal diagnosis.

Transillumination is a safe, nonionizing, and noninvasive diagnostic technique that is particularly well-suited for use in the newborn. In addition, its portability, minimal expense, and facility make it a useful and necessary tool for the neonatal intensive care unit. This article reviews the principles of transillumination, describes equipment currently in use, and summarizes the clinical applications of transillumination.

Abdomen↗
PubMed1984

Systemic Candida infections in infants in intensive care nurseries: high incidence of central nervous system involvement.

The clinical courses in 27 infants with culture or autopsy evidence of systemic candidiasis were reviewed. Twenty-two infants (group 1) had persistent signs of sepsis and clinical deterioration or died before institution of antifungal therapy. Five infants (group 2) improved markedly before culture results were reported, and recovered without systemic antifungal therapy. Fourteen infants in group 1 (64%) had central nervous system infection. Of four patients in whom CNS involvement was diagnosed only postmortem, antemortem cerebrospinal fluid from three was abnormal despite sterile cultures; no antemortem CSF was obtained in the other. In meningitis caused by susceptible organisms addition of flucytosine sterilized CSF within 5 days, although prior amphotericin monotherapy had been unsuccessful. Of 14 patients in group 1 who received systemic antifungal therapy, only one died with Candida infection. Toxicity from antifungal agents occurred in 11 of 13 successfully treated infants, but was reversible in every case except one by modifying the dosage. Our data indicate that (1) CNS infection is very common in infants with systemic candidiasis, (2) combined flucytosine-amphotericin therapy may facilitate treatment of CNS infection and should be the initial therapy for systemic candidiasis in infants, (3) Gram stains of CSF and urine enhance early diagnosis, (4) isolation of Candida from normally sterile body fluids in high-risk infants should be considered pathogenic and therapy initiated unless the clinical course strongly suggests otherwise, and (5) toxicity from antifungal agents is common but usually reversible.

Amphotericin B↗
PubMed1983

Cytomegalovirus-specific cell-mediated immunity during pregnancy in lower socioeconomic class adolescents.

The role of maternal cytomegalovirus (CMV)-specific cellular immunity in gestational CMV excretion and transmission of congenital infection was assessed by studying CMV-specific mononuclear proliferation (CMV-MP) longitudinally during pregnancy in 59 lower socioeconomic class adolescents. CMV-MP was absent in mothers seropositive for CMV on more than 40% of occasions tested, but no significant difference was noted at any time in frequency or degree of CMP-MP between the 16 mothers who shed virus and the 29 who were seropositive for CMV but did not shed virus. The presence of CMV-MP did not preclude gestational CMV excretion. The lone mother who bore a congenitally infected infant lacked CMV-MP on all three occasions when she shed virus. CMV-MP was noted in cord blood from 14 uninfected infants of seropositive mothers. Maternal CMV-specific cellular immunity is not the major determinant of gestational CMV excretion, but the extent of its role in modulating transmission of congenital infection is yet unclear.

Adolescent↗
PubMed1983

Cytomegalovirus-specific cell-mediated immunity in lower-socioeconomic-class adolescent women with local cytomegalovirus infections.

The factors that regulate cytomegalovirus (CMV) excretion from the genitourinary tract are poorly understood. To assess the role of cell-mediated immunity in such excretion, a CMV-specific mononuclear blastogenesis assay was used to study a predominantly lower-socioeconomic-status population of 92 healthy nonpregnant adolescent women who also had CMV complement-fixing antibody titers and viral cultures of cervix, urine, saliva, and blood performed. Eighteen were studied more than once. No blood cultures were positive and no seroconversions were noted. There was no significant difference for frequency or degree of systemic CMV-specific blastogenesis between the 20 who were culture positive and the 41 who were seropositive but culture negative, although 40% of the culture-positive group and 27% of the seropositive, culture-negative group lacked CMV-specific blastogenesis. One of 31 seronegative subjects displayed CMV-specific blastogenesis. No systematic deficits were noted in any groups or individuals for E rosette number or mitogen response, though some isolated significant differences among groups for mitogen responses existed. Local CMV excretion in the study population was not related to systemic CMV-specific mononuclear blastogenesis.

Adolescent↗
PubMed1981

Elevated IgA concentration in milk produced by mothers delivered of preterm infants.

Concentrations of immunoglobulins G, M, and A were measured by double-antibody radioimmunoassay in morning milk samples collected during the first month postpartum from 35 mothers delivered of preterm infants and 14 mothers delivered of term infants. Mean concentrations of IgG (1.8, to 2.8 mg/gm protein) and IgM (2.8 to 11.7 mg/gm protein) were similar in milk from both groups of mothers. In contrast, IgA was present in significantly higher concentrations throughout the first month postpartum in milk from mothers delivered of preterm infants than in milk from those giving birth at term (P less than 0.01). To determine the effect of milk flow on IgA concentration, IgA was also measured in complete 24-hour milk collections; milk from mothers with preterm deliveries again contained significantly higher concentrations of IgA than milk from mothers with term deliveries (P less than 0.01). This higher IgA concentration was not secondary to method of milk expression. The concentration of IgA was found, however, to vary inversely with milk volume (P less than 0.01). Although mean values of milk volumes for the groups were not statistically different, the overall lower volumes of milk produced by mothers giving birth preterm resulted in comparable total IgA production per 24 hours. There were no differences in serum IgA concentrations of preterm infants fed their own mother's milk and comparable infants fed a cow milk formula, suggesting that IgA in milk is not absorbed from the intestine in significant amounts.

Animals↗
PubMedDate not supplied

Streptococcus mitis infection in newborns.

Although neonatal infections caused by Streptococcus viridans have been suggested to be less severe than those caused by classic neonatal pathogens, little is known about neonatal infections caused by specific species within this group of bacteria. We report six infants who had S. mitis isolated from blood culture. All were infected at < or = 3 days of age; five of the mothers had perinatal risk factors for neonatal sepsis. Five infants were preterm and three had birth weights < or = 2500 gm. Hematologic abnormalities were common. Two died as a result of the infection. Antibiotic susceptibility testing of four isolates revealed resistance to penicillin and ampicillin in three and resistance to gentamicin in two. In vivo resistance was not observed. S. mitis is not part of normal skin flora, should not be assumed to be a contaminant, and can cause severe neonatal disease. If S. mitis or S. viridans are recovered from a normally sterile body site and the patient fails to improve with penicillin therapy, it seems prudent to switch to vancomycin until susceptibility results are available.

Anti-Bacterial Agents↗
PubMedDate not supplied

Group C streptococcal infection in a term newborn infant.

Group C streptococci were recovered from the cerebrospinal fluid of a term infant with symptoms whose mother had received intrapartum antibiotic therapy for chorioamnionitis. This case highlights that beta-hemolytic streptococci of Lancefield groups other than A or B can be isolated from a normally sterile site and should be considered as pathogens. It also underscores the potential importance of sampling cerebrospinal fluid in an infant with symptomatic suspected sepsis, especially in the setting of exposure to maternal antimicrobial agents.

Anti-Bacterial Agents↗
PubMedDate not supplied

Improving the timing of antibiotic administration to high-risk newborns.

OBJECTIVES: To describe the timing of initiation of administration of parenteral antibiotics to infants with suspected sepsis at birth, identify barriers to prompt administration, and assess the effectiveness of subsequent interventions designed to minimize these barriers. The goals were to administer antibiotics within 1 hour of the physician order and within 2 hours of birth with more than 80% compliance for both goals. STUDY DESIGN: Retrospective chart review and prospective interventions involved 488 infants born at the University of Michigan Medical Center with indications for antibiotic therapy at birth. After an initial audit of the charts of 56 infants and the identification of poor compliance with the goals, unit policies and educational programs were developed to facilitate timely antibiotic administration. After a second audit demonstrated improvement but failure to attain the target compliance rates, review of individual cases with the responsible physician and nurse was initiated. Time intervals between birth, writing the order for antibiotics, noting the order by the nurse, and administration of antibiotics were tracked for an additional 20 months after these interventions. RESULTS: Before the interventions, antibiotics were administered to 28% of infants within 1 hour of the physician order (mean +/- SEM 1.58 +/- 0.11 hours) and to 19% within 2 hours of birth (3.12 +/- 0.16 hr). By the conclusion of the study, antibiotics were administered to 87% (p < 0.0001) of infants within 1 hour of the physician order (0.79 +/- 0.04 hour; p < 0.001) and to 92% (p < 0.0001) within 2 hours of birth (1.26 +/- 0.06 hours; p < 0.001). CONCLUSIONS: Administration of the first dose of parenteral antibiotics to newborns with suspected sepsis at birth frequently takes more than 1 hour after the order is written and more than 2 hours after birth. Efforts to identify and minimize common barriers significantly improved the timing of antibiotic administration. Additional improvement was attained by means of continued surveillance and individual feedback to caregivers of infants when timing objectives were not fulfilled.

Anti-Bacterial Agents↗