RESUMEN
OBJECTIVE: To evaluate the effect of recombinant human deoxyribonuclease I (rhDNase) in shortening the length of the hospitalization and improving the chest radiographs (CXRs) in hospitalized infants with respiratory syncytial virus (RSV) infection as a result of its mucolytic properties. METHODS: Randomized, double-blind, placebo-controlled investigation of 75 patients with RSV bronchiolitis. The study was conducted at the University of Michigan Medical Center and St. Joseph Mercy Hospital, both in Ann Arbor, MI. RESULTS: The respiratory rate, wheezing, and retraction difference scores, obtained by subtracting the hospital discharge score from the corresponding hospital admission score, show no difference between the two groups, but the CXR difference scores show that the rhDNase group improved by 0.46 while the placebo group worsened by 0.60 (p < 0.001). Analysis of covariance for the hospital discharge CXR score after adjusting for the hospital admission score for both groups was done. There was a difference in scores between the two groups, with adjusted mean for the study group of 2.03, and 2.76 for the placebo group (p < 0.001). Paired t test statistics in each of the two groups were computed. For the placebo group, the mean increase of 0.60 was significant (p = 0.02), and the mean decrease of 0.46 for the rhDNase group was also significant (p = 0.02). A one-way analysis of covariance with the hospital discharge CXR scores as the dependent variable and the hospital admission score as the covariate showed that there was a significant difference between the groups (p = 0.01). CONCLUSION: In patients with RSV bronchiolitis, there was significant improvement in the CXRs with the use of rhDNase compared to significant worsening in the placebo group. To our knowledge, this is the first report of the use of rhDNase to treat RSV bronchiolitis.
Asunto(s)
Bronquiolitis Viral/tratamiento farmacológico , Desoxirribonucleasa I/uso terapéutico , Proteínas Recombinantes/uso terapéutico , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Bronquiolitis Viral/diagnóstico por imagen , Método Doble Ciego , Femenino , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Pulmón/diagnóstico por imagen , Masculino , Infecciones por Virus Sincitial Respiratorio/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
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.
Asunto(s)
Corioamnionitis/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Resultado del Embarazo , Infecciones Estreptocócicas/diagnóstico , Streptococcus equi/aislamiento & purificación , Antibacterianos/uso terapéutico , Corioamnionitis/tratamiento farmacológico , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Infecciones Estreptocócicas/líquido cefalorraquídeo , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/etiologíaRESUMEN
OBJECTIVE: To assess the relationship between early discharge, breast feeding, and other factors on hospital readmission of newborns. DESIGN: Retrospective record review. SETTING: An urban, private community hospital. PATIENTS: All newborns born over a 1-year period who were readmitted to the hospital within the first 3 weeks of life (n=117). The control group consisted of a systematic sampling of newborns born over the same period who were not readmitted (n=147). RESULTS: Early discharge, defined as discharge when younger than 24, 36, or 48 hours of age, does not seem to contribute to readmission. However, newborns whose initial stay was longer than 72 hours were at significantly lower risk for readmission (P=.02, chi(2)). Factors in the initial hospitalization associated with readmission included vaginal delivery and length of stay less than 72 hours (difference, 12 percentage points; 95% confidence interval [CI], 4% to 20%; P=.005), need for performance of a complete blood count (CBC) (difference, 16 percentage points; CI 6% to 26%; P=.002), presence of jaundice (difference, 17 percentage points; CI, 5% to 29% P=.005), and gestational age 37 weeks or less (difference, 10 percentage points; CI, 2% to 18%; P=.02), discharge weight less than 3 kg (difference, 11 percentage points; CI, 0 to 22%; P=.05). However, almost all newborns delivered vaginally were discharged within less than 72 hours, so our ability to comment on the independent effect of delivery mode on readmission is limited. A trend toward significance was noted between breast-feeding and readmission (difference, 9 percentage points; CI, 0% to 18%; P=.07). However, when only vaginal deliveries were considered, this association was statistically significant (difference, 13 percentage points; CI, 4% to 22%; P=.02). A significant association was noted between breast-feeding and jaundice or dehydration. Of babies admitted with jaundice or dehydration, 94% were breast-fed, compared with 67% of babies admitted with neither jaundice nor dehydration (difference, 27 percentage points; CI, 13% to 41%; P<.001). CONCLUSIONS: These findings strongly suggest that early discharge (at younger than 24, 36, or 48 hours of age) from the hospital is not associated with hospital readmission within the first 3 weeks of life. Factors associated with readmission included breast-feeding, vaginal delivery and length of stay less than 72 hours, jaundice or need for a CBC, gestational age of 37 weeks or less, and discharge weight less than 3 kg.
Asunto(s)
Recién Nacido , Alta del Paciente , Readmisión del Paciente , Femenino , Hospitales con más de 500 Camas , Hospitales Comunitarios , Humanos , Masculino , Registros Médicos , Michigan , Estudios Retrospectivos , Factores de TiempoRESUMEN
Four patients with bacterial meningitis are reported. On initial examination 1 patient had a slightly abnormal cerebrospinal fluid (CSF), and in the other 3 patients the CSF was completely normal. An obviously purulent CSF was obtained when lumbar puncture was repeated 14-48 hours later. All 4 patients presented initially with pyrexia, and either neck stiffness or convulsions. In 3 of the 4 patients a cause for pyrexia was found on initial examination but lumbar punctures were done for neck stiffness or convulsions to exclude meningitis. The problems and the need to repeat a lumbar puncture, as well as the importance of blood cultures in a patient with suspected meningitis, are discussed. The fact that a normal specimen of CSF does not exclude meningitis is stressed.