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[Cryptosporidium hominis diarrhea outbreak and transmission linked to diaper infant use].

BACKGROUND AND OBJECTIVE: On the basis of several cases of cryptosporidiosis detected in a child day-care center, we stablished the extent of the outbreak and investigated causes of parasite transmission. PATIENTS AND METHOD: A retrospective cohort study was designed on all children attending day-care center and care givers to determine their infection status and identify risk factors associated to the outbreak. RESULTS: 24 cases of cryptosporidiosis were detected, with an attack rate of 0.46 (24/52); 12 of them were parasitologycally confirmed. All care givers were negative for Cryptosporidium and none of them reported symptoms of acute gastroenteritis. Transmission pattern was compatible with person to person modes. Among the factors investigated, two were associated with the risk of disease: diaper wear (relative risk = 2.06; p = 0.059); and diarrhea in relatives (relative risk = 2.05; p = 0.01). In all confirmed cases, Cryptosporidium hominis (previously known as C. parvum, genotype 1), was identified. CONCLUSIONS: Cryptosporidiosis should be considered as a possible cause of outbreaks of gastroenteritis at day-care centers. Increasing care on diaper changing practices, specially over children with diarrhea, may be the key factor to prevent transmission of Cryptosporidium.

Child Day Care Centers↗

[Infant diapers].

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Diaper Rash↗

Evaluations of diapers containing absorbent gelling material with conventional disposable diapers in newborn infants.

We evaluated 149 infants diapered in either conventional cellulose core disposable diapers or diapers containing cellulose core with absorbent gelling material. The infants were evaluated from 1 day of age to 14 weeks of age for the prevalence and severity of diaper dermatitis. We identified a low prevalence of diaper dermatitis throughout the study period. At 14 weeks of age, we noted that infants in diapers containing absorbent gelling material had significantly less diaper dermatitis than those in conventional disposable diapers. Despite the overall low prevalence of diaper dermatitis in the newborn period, 7 of 204 infants evaluated had small skin erosions in the diaper area noted within the first 4 days of age. Both diaper types were associated with infants with erosions. This surprisingly high incidence of erosions in newborn infants suggests previously undocumented increased skin fragility of full-term infants.

Diaper Rash↗

Changes in diapered and nondiapered infant skin over the first month of life.

Time- and site-dependent differences in epidermal barrier properties were investigated over the first 28 days of life in healthy term newborn infants. Diapered and nondiapered skin sites were contrasted to the volar forearm of adults (mothers). Thirty-one term infants were evaluated in the hospital on postnatal day 1 and at home on days 4, 7, 14, 21, and 28 for a total of six visits. Measurements included baseline skin hydration, continuous capacitive reactance, peak water sorption, rate of water desorption, skin pH, skin temperature, and environmental conditions. Changes in epidermal barrier properties over the first 4 weeks of life included an increase in surface hydration, a decrease in transepidermal water movement under occlusion, a decrease in surface water desorption rate, and a decrease in surface pH. Diapered and nondiapered regions were indistinguishable at birth but exhibited differential behavior over the first 14 days, with the diapered region showing a higher pH and increased hydration. Maternal measurements remained constant throughout the period. We conclude that healthy newborn skin undergoes progressive changes in epidermal barrier properties over the first 28 days. Adult skin testing does not replicate newborn skin during the first month of life.

Adult↗

Disposable diapers and infant skin.

In an experiment on skin rash caused by diapers, adult skin was used to compare the effects of disposable diapers (A; Pampers), conventional disposable diapers (B), and cotton diapers. Pieces of each type of diaper measuring 2 X 2 cm and containing 0.2 ml saline solution were pasted on forearm skin for 5 h. Water content of the corneum was measured with an impedance meter 1 h after the pieces were removed. Results were excellent for diapers A and B: there were no significant differences observed in water content of the corneum when A and B were compared with conventional cotton diapers. The advantages of disposable diapers were confirmed in infants.

Adult↗

The infant with a reddish diaper.

The infant with a reddish diaper presents a diagnostic challenge to the primary care physician. As described by Dr Baumgardner, the cause may be benign, but more ominous disorders must be ruled out.

Crystallization↗

Exposure assessment to dioxins from the use of tampons and diapers.

Over the past several years there has been concern over exposure to dioxins through the use of tampons and other sanitary products. This article describes attempts to estimate dioxin exposures from tampons and infant diapers; we then compare exposure estimates to dietary dioxin exposures. We analyzed four brands of tampons and four brands of infant diapers obtained from commercial establishments in San Francisco, California, for dioxin concentrations. We estimated exposures to dioxins on the basis of a screening level analysis that assumed all dioxins present were completely absorbed. We also estimated exposures by using a more refined analysis that incorporates partition coefficients to estimate bioavailability. None of the products contained 2,3,7,8-tetrachlorodibenzo-p-dioxin, the most potent dioxin, although other dioxins were present at detectable concentrations in all samples. We observed minimal differences in the concentrations of dioxins between 100% cotton and cotton/pulp products. The refined exposure analysis indicates that exposures to dioxins from tampons are approximately 13,000-240,000 times less than dietary exposures. The refined exposure analysis showed that exposure to dioxins from the diet is more than 30,000-2,200,000 times the exposure through diapers in nursing infants. Although dioxins are found in trace amounts in both cotton and pulp sanitary products, exposure to dioxins through tampons and diapers does not significantly contribute to dioxin exposures in the United States.

Adult↗

Clinical studies with disposable diapers containing absorbent gelling materials: evaluation of effects on infant skin condition.

Disposable infant diapers with absorbent gelling material (cross-linked sodium polyacrylates) incorporated into the core were clinically evaluated for their effect on infant skin condition. Absorbent gelling materials tightly hold water and provide pH control by a buffering capacity as well as by helping to segregate urine apart from feces. Four clinical studies were conducted with each following a rigid protocol that controlled for variables of diet and age in addition to the diaper material that may influence the development of diaper dermatitis and helped to control for any inherent bias in the study. This allowed for the controlled assessment of skin condition with respect to diaper type. Absorbent gelling material-containing disposable, conventional (100% cellulose core) disposable, and home-laundered cloth diapers were test products. In these studies 1614 infants were initially enrolled with 522 of them assigned to absorbent gelling material disposable, 738 to conventional disposable, and 354 to home-laundered cloth diapers. Objective measurements of skin wetness (transepidermal water loss) and skin pH, as well as double-blind grading of diaper dermatitis, were the measures of skin condition. Absorbent gelling material disposable diapers were associated with significantly reduced skin wetness, closer to normal skin pH, and lower degrees of diaper dermatitis when compared to conventional disposable or home-laundered cloth diapers. The results are consistent with the hypothesis that better control in the diaper area of skin wetness, skin pH, and the prevention of the mixing of urine and feces produces a better diaper environment.

Acrylic Resins↗

Diaper performance: maintenance of healthy skin.

Skin wetness is proportional to diaper wetness, and with increased skin wetness, the potential for diaper dermatitis is increased. This study evaluated a wide range of infant diaper products. Eighty healthy volunteers wore 2-inch wetted diaper patches on their volar forearm for two hours. An evaporimeter was used to measure excess skin wetness attributed to the patches. The amount of moisture retained in the patch was also calculated. We found that superabsorbent (SA) disposable diapers kept the skin drier and retained more synthetic urine than cloth reusable and conventional disposable brands, and thus have the greatest potential for helping prevent diaper dermatitis. The SA brands evaluated did an equally adequate job in keeping the skin dry and in retaining moisture. Conventional disposable diapers were less able to keep the skin dry than SA diapers and were not superior to cloth products in most instances. Cloth diapers' performance depended on their composition. Those with several layers of the same fabric were less successful in keeping the skin dry than ones that contained middle layers of different nonwoven components.

Diaper Rash↗

Effects of breathable disposable diapers: reduced prevalence of Candida and common diaper dermatitis.

Infants wearing breathable disposable diapers experienced significantly less diaper dermatitis (DD) compared to infants wearing standard, nonbreathable disposable diapers in a series of double-blind clinical trials. Severe DD, including confirmed infection with Candida albicans, was reduced by 38-50% among infants wearing highly breathable (HB) diapers. The prevalence of DD was inversely related to the breathability of the garments. The inhibitory effect of breathable diapers on the survival of Candida was further confirmed in controlled experiments with adult volunteers. A suspension of C. albicans cells was applied to delineated sites on the volar forearm. Each site was then covered by a full-thickness patch from either an HB or a standard diaper. Survival of Candida colonies was reduced by almost two-thirds in the breathable diaper-covered sites compared to the control sites.

Candidiasis↗

Daily intake and urinary excretion of genistein and daidzein by infants fed soy- or dairy-based infant formulas.

Our aims were to measure isoflavone intake from soy- and dairy-based infant formulas and breast milk and to assess the ability of infants to digest and absorb soy isoflavones by measuring daily urinary excretion rates. We recruited 29 infants: 4 received soy-based formula and 25 received dairy-based formula. We collected pooled urine samples from 3-5 disposable diapers worn during a 24-h period and developed and validated methods for extracting isoflavones from the diapers. Infants were studied every 1 or 2 wk, starting at 2-6 wk of age and continuing until 16 wk. Only soy-based formulas contained isoflavones in concentrations detectable by HPLC (limits: 0.05 mg/L for liquids and 0.1 mg/kg for solids). Soy-based formulas provided a mean (+/-SEM) daily dose of isoflavones (genistein plus daidzein) of 3.2 +/- 0.2 mg/kg body wt, which remained fairly constant (CV: 12%) regardless of age < or = 16 wk. Isoflavones were measurable in all samples from soy-fed infants, but not in urine from dairy-fed infants. Daily isoflavone excretion rates varied little among infants [range of mean individual values (mg x kg(-1) d(-1)): daidzein, 0.37 +/- 0.03 to 0.58 +/- 0.06; genistein, 0.15 +/- 0.03 to 0.32 +/- 0.04] and did not change with age < or = 16 wk. The mean percentage of the daily intake recovered in the urine of soy-fed infants was 38 +/- 4% for daidzein and 13 +/- 3% for genistein, and remained constant with age. These values are similar to those for adults and indicate that young infants are able to digest, absorb, and excrete genistein and daidzein from soy-based formulas as efficiently as do adults consuming soy products.

Adult↗