Reflections on errors in neonatology: I. The "Hands-Off" years, 1920 to 1950.
This series discusses errors in neonatology since the 1920s. Three historical periods are defined: the "Hands-Off" years, 1920 to 1950; the "Heroic" years, 1950 to 1970; and the "Experienced" years, 1970 to 2000. In this article, the "Hands-Off" years, we discuss lowered thermal environment, supplemental oxygen, initial thirsting and starving, synthetic vitamin K, SMA formula, and diaper markings. (+info
Children at risk of giardiasis in Auckland: a case-control analysis.
The incidence rate of giardiasis in New Zealand is one of the highest among developed countries, peaking in the 1-4 year age group. A case-control study was undertaken to identify risk factors for giardiasis among Auckland children under 5 years of age. The exposure history of 69 cases and 98 controls were analysed. Ninety-five per cent cases and 86% controls used water from the Auckland Metropolitan mains (AMM) supply for domestic purpose, 44 cases and 42 controls swam and 59 cases and 54 controls wore nappies. Children wearing nappies were at significantly increased risk of the disease (OR = 30, 95% CI = 1.01-8.9), as were those from households which had more than one child wearing a nappy (6.5, 1.8-23.4). The Auckland metropolitan mains water supply was associated with a reduced risk compared to other drinking water sources. Significantly increased risks were also associated with drinking water consumed away from home (4.7, 2.2-10.1), swimming at least once a week (2.4, 1.1-5.3) and travelling domestically (2.5, 1.03-6.0). The study identified vulnerable groups and modifiable risk factors for diarrhoeal diseases, particularly Giardia infection. Nappy wearing was an independent risk factor for infection. Further study is advocated to ensure better protection of public health, especially for children. (+info
Measurement of urine output by weighing nappies.
The effect of humidity on measurement of neonatal urine output was assessed by weighing nappies in a clinically relevant context. Saline was used as dummy urine, on modern nappies in incubators at various humidity settings. In at least some additional humidity, no clinically relevant evaporative loss occurred. (+info
Urine culture collected from gel-based diapers: developing a novel experimental laboratory method.
BACKGROUND: Urinary tract infection diagnosis is based on urine culture, taken from a midstream collection. Obtaining samples in this manner is difficult in elderly patients suffering from incontinence and in infants. OBJECTIVES: (1) Develop a method for urine collection using gel-based diapers and (2) compare culture results from gel-based diapers with those of the same urine, examined by accepted methods. METHODS: Urine was collected and cultured by standard bacteriologic techniques at the microbiology laboratory of Soroka Medical Center, Beer-Sheva, Israel. Gel-based diapers were manually dampened with the same urine samples, and samples from diapers were cultured 0 to 3 hours after dampening. RESULTS: Comparison showed good correlation between direct urine cultures and cultures obtained from gel based diapers (R = 1.000). Total sensitivity was 100% and specificity 97%. CONCLUSIONS: (1) Urine can be cultured from gel-based diapers and (2) a larger sample of in vivo trials will be needed to make this technique clinically applicable in an outpatient setting. (+info
An improved urine collection pad method: a randomised clinical trial.
AIM: To evaluate a modified urine collection pad (UCP) method for its ability to reduce heavy mixed growth bacterial contamination of UCP samples in young children with suspected urinary tract infection (UTI). METHOD: Febrile children under 2 years of age were randomised to two UCP METHODS: the same UCP kept in the nappy until urine was passed (single UCP group), or the UCP replaced with a fresh one every 30 minutes until urine was passed (replaced UCP group). In both groups a moisture sensitive audio alarm was used to signal passage of urine. RESULTS: Eighty children were enrolled and a satisfactory sample was obtained in 68 (37 in the single UCP group and 31 in the replaced UCP group). In 12 children (15%), collection failed, mainly because of faecal soiling of the pad. UTI occurred in three children (4%). In the remaining 65 samples, heavy mixed growth (> 10(5) organisms/ml) occurred in 1/31 (3%) in the replaced UCP group compared with 10/35 (29%) in the single UCP group (p = 0.008). There were no adverse effects from the use of the moisture sensitive audio alarm. CONCLUSION: Changing the UCP every 30 minutes almost eliminates heavy mixed growth contamination of UCP samples and substantially increases the proportion of UCP results that confidently exclude UTI. This represents a simple and clinically important improvement to the UCP method which is reliable for diagnosing and excluding UTI in young children still in nappies. It has potential for use in outpatient clinics, in the primary healthcare setting, or at home. (+info
Disposable diaper to collect urine samples from young children for pyrethroid pesticide studies.
Disposable diapers are widely used in the US and many other areas in the world; therefore, they are ideal media for urine collection for measurement of young children's exposure to pesticides. However, disposable diapers normally contain polyacrylate polymers that make the extraction and analysis of urine very difficult. The objectives of this paper were to evaluate whether disposable diapers that contain polyacrylate granules can be extracted using salt solutions, and whether they can be used for the collection and quantitative measurements of selected urinary pyrethroid pesticide metabolites and creatinine. The storage stability of the metabolites and creatinine in a wet diaper at body temperature and at refrigeration temperature was also evaluated. Salt solutions including calcium chloride dihydrate, magnesium sulfate, ammonium acetate, and sodium chloride solutions were tested for efficiency of polymer shrinkage. Pyrethroid metabolites 3-(2,2-dichlorovinyl)-2,2-dimethyl-(1-cyclopropane) carboxylic acid (DCCA), 3-(2,2-dibromovinyl)-2,2,dimethyl-(1-cyclopropane) carboxylic acid (DBCA) and 3-phenoxybenzoic acid (3-PBA) were analyzed using LC/MS/MS and evaluated for recoveries in the urine released from the diapers. The study found calcium chloride dihydate to be satisfactory in releasing urine and metabolites from the polymers. The percent recoveries for the three tested pyrethroid metabolites were mostly in the range of 65-130. The percent recoveries for creatinine were in the range of 71-133. The detection limit for each of the three metabolites was 0.1 microg/l. The pyrethroid metabolites and creatinine were stable on the diaper for at least 72 h. We concluded from this study that calcium chloride dihydrate can successfully release urine and metabolites from polyacrylate-containing diapers, and the method is promising for studies of pyrethroid metabolites. (+info
An outbreak of Cryptosporidium hominis infection at an Illinois recreational waterpark.
Cryptosporidium has become increasingly recognized as a pathogen responsible for outbreaks of diarrhoeal illness in both immunocompetent and immunocompromised persons. In August 2001, an Illinois hospital reported a cryptosporidiosis cluster potentially linked to a local waterpark. There were 358 case-patients identified. We conducted community-based and waterpark-based case-control studies to examine potential sources of the outbreak. We collected stool specimens from ill persons and pool water samples for microscopy and molecular analysis. Laboratory-confirmed case-patients (n=77) were more likely to have attended the waterpark [odds ratio (OR) 16.0, 95% confidence interval (CI) 3.8-66.8], had pool water in the mouth (OR 6.0, 95% CI 1.3-26.8), and swallowed pool water (OR 4.5, 95% CI 1.5-13.3) than age-matched controls. Cryptosporidium was found in stool specimens and pool water samples. The chlorine resistance of oocysts, frequent swimming exposures, high bather densities, heavy usage by diaper-aged children, and increased recognition and reporting of outbreaks are likely to have contributed to the increasing trend in number of swimming pool-associated outbreaks of cryptosporidiosis. Recommendations for disease prevention include alteration of pool design to separate toddler pool filtration systems from other pools. Implementation of education programmes could reduce the risk of faecal contamination and disease transmission. (+info
The effects of undergarment type on the urinary continence of toddlers.
There is a growing trend toward later toilet training of typically developing children. This trend is a problem for caregivers and professionals who work with young children, because it is associated with a number of costs and health risks in child-care settings. Results of a recent study (Tarbox, Williams, & Friman, 2004) suggest that wearing underwear may facilitate the development of toileting skills. Based on these findings, we examined the effects of wearing disposable diapers, disposable pull-on training pants, and underwear on urinary continence of 5 typically developing toddlers in a child-care setting. Underwear decreased incontinence and increased continent urinations for 2 of the 5 participants, produced no improvement in 2 participants, and when combined with increased fluid intake and longer sitting periods, produced some favorable trends for the 5th participant. (+info