Gaps in the childhood malaria burden in Africa: cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy.
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Evaluations of the African childhood malaria burden do not fully quantify the contributions of cerebral malaria (CM), CM-associated neurological sequelae, malarial anemia, respiratory distress, hypoglycemia, and pregnancy-related complications. We estimated the impact of these malaria manifestations on members of the African population < 5 years old. Calculations were based on an extensive literature review that used National Library of Medicine search engines, other bibliographic sources, and demographic data. In sub-Saharan Africa, CM annually affects 575,000 children < 5 years of age and 110,000 (approximately 19% case fatality rate [CFR]) die. Childhood survivor, of CM experience developmental and behavioral impairments: each year, 9,000-19,000 children (> 2% of survivors of CM) < 5 years of age in Africa experience neurological complications lasting > 6 months. Severe malarial anemia heavily burdens hospitals with rising admission and CFRs and with treatments that are complicated by limited and sometimes contaminated blood supplies. Severe malarial anemia occurs 1.42-5.66 million times annually and kills 190,000-974,000 (> 13% CFR) children < 5 years of age annually. Respiratory distress, hypoglycemia, and overlapping clinical manifestations cause 1.12-1.99 million cases and > 225,000 (> 18% CFR) additional deaths among African children with malaria. Maternal, placental, or fetal malaria infection during pregnancy adversely affects development and survival of fetuses and newborns through low birth weight (LBW), maternal anemia, and possibly abortion and stillbirth. Between 167,000 and 967,000 cases of malaria-associated LBW occur yearly; malaria-induced LBW kills 62,000-363,000 (> 38% CFR) newborns each year. All the gaps in the burden comprise 0.4-1.7 million deaths annually, > 50% of which are due to severe malarial anemia. These malaria-induced medical problems constitute major clinical, public health, and research challenges in that they may contribute to more than double the mortality than is generally acknowledged. (+info)
Pharmacology of some oral penicillins in the newborn infant.
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Serum and urine concentrations of ampicillin, amoxycillin, and flucloxacillin achieved after oral administration have been measured in 27 newborn infants. Compared with adults and children, newborn infants show a delay in achieving adequate blood concentrations, presumably due to delayed absorption. However most infants achieve therapeutic concentrations in the serum. Infected newborn infants should be given these antibiotics by intramuscular injection for the first dose, but thereafter oral therapy (25 mg/lg every 6 hours begun concomitantly) should be satisfactory. The better absorption of amoxycillin compared with ampicillin reported in adults has not been confirmed in the newborn infant. (+info)
Monitoring of nonlinear respiratory elastance using a multiple linear regression analysis.
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The elastic pressure/volume (P/V) curve obtained by the multiple linear regression (MLR) technique using a new model, was compared with the quasi-static P/V points obtained by the rapid airway occlusion technique. Seven infants were studied during mechanical ventilation using a pressure controlled mode. The resistive pressure was subtracted from airway opening pressure, thus determining the elastance related pressure, which was then plotted against the volume to make an MLR-elastance curve. Quasi-static P/V curves of the rapid occlusion technique were constructed by plotting the different inspiratory and expiratory volumes against the corresponding values of the quasi-static airway pressure. The calculated MLR-elastance curves closely fit the experimental quasi-static P/V points obtained by the occlusion technique. There were, however, some discrepancies due to the viscoelastic behaviour of the respiratory system. Although slightly altered by these discrepancies, the multiple linear regression-elastance curves did fit the observed quasi-static pressure/volume characteristics for use in clinical practice. The multiple linear regression technique may prove to be clinically useful by continuous monitoring of respiratory system mechanics during mechanical ventilation. (+info)
A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants.
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OBJECTIVE: To compare the effectiveness of the Infant Flow Driver (IFD) with single prong nasal continuous positive airway pressure (nCPAP) in preterm neonates affected by respiratory distress syndrome. DESIGN: Randomised controlled study. PATIENTS: Between September 1997 and March 1999, 36 preterm infants who were eligible for CPAP treatment were randomly selected for either nCPAP or IFD and studied prospectively for changes in oxygen requirement and/or respiratory rate. The requirement for mechanical ventilation, complications of treatment, and effects on mid-term outcome were also evaluated. RESULTS: Use of the IFD had a significantly beneficial effect on both oxygen requirement and respiratory rate (p < 0.0001) when compared with nCPAP. Moreover, O(2) requirement and respiratory rate were significantly decreased by four hours (p < 0.001 and p < 0.03 respectively). The probability of remaining supplementary oxygen free over the first 48 hours of treatment was significantly higher in patients treated with the IFD than with nCPAP (p < 0.02). IFD treated patients had a higher success (weaning) rate (94% v 72 %) and shorter duration of treatment (49.3 (31) v 56 (29.7) hours respectively; mean (SD)), although the difference was not significant. CONCLUSIONS: IFD appears to be a feasible device for managing respiratory distress syndrome in preterm infants, and benefits may be had with regard to oxygen requirement and respiratory rate when compared with nCPAP. The trend towards reduced requirement for mechanical ventilation, shorter clinical recovery time, and shorter duration of treatment requires further evaluation in a multicentre randomised clinical trial. (+info)
Non-invasive assessment of shunt and ventilation/perfusion ratio in neonates with pulmonary failure.
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AIMS: To make non-invasive measurements of right to left (R-L) shunt and reduced ventilation/perfusion ratio (V(A)/Q) in neonates with pulmonary failure and to examine sequential changes in these variables after treatment. METHODS: Twelve neonates with pulmonary failure were studied. They ranged in gestational age from 24 to 37 (median 27) weeks and were 1-39 (median 4) days old. Shunt and reduced V(A)/Q were derived from their effects on the relation between inspired oxygen pressure (PIO(2)) and arterial oxygen saturation measured with a pulse oximeter (SpO(2)). Pairs of PIO(2) v. SpO(2) data points were obtained by varying PIO(2) in a stepwise fashion. A computer algorithm based on a model of pulmonary gas exchange fitted a curve to these data. With PIO(2) on the abscissa, an increase in shunt produced a downward movement of the curve, whereas reducing V(A)/Q to < 0.8 shifted the curve to the right. The right shift gives a variable that is inversely related to V(A)/Q, the PIO(2) - PO(2) difference, where PO(2) is mixed capillary oxygen pressure. RESULTS: Ten of the 12 infants on the first study day had large shunts (range 5.9-31.0%, median 19.9%, normal < 8%) and large PIO(2) - PO(2) differences (range 9.7-64.4 kPa, median 19.8 kPa, normal < 7 kPa) equivalent to a median V(A)/Q of 0.2 (normal median V(A)/Q = 0.8). Sequential improvement in shunt and V(A)/Q were shown in most infants after treatment. Sudden large changes in these variables were shown in two infants. CONCLUSION: This simple non-invasive method distinguishes between shunt and reduced V(A)/Q in neonates with pulmonary failure. (+info)
Alveolar capillary dysplasia with misalignment of pulmonary veins and anterior segment dysgenesis of the eye: a report of a new association and review of the literature.
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The association of alveolar capillary dysplasia with misalignment of pulmonary veins (ACD-MPV) and ocular abnormalities has not been previously reported. We present a case of ACD-MPV and anterior segment dysgenesis of the eye in a full-term infant as well as a review of the relevant literature. (+info)
Effect of body position on gastric emptying in the neonate.
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The effect of body position on gastric emptying was investigated in 48 neonates. The rate of gastric emptying is the same for healthy term, preterm, and small-for-dates infants. Infants with respiratory distress syndrome have delayed gastric emptying and a high incidence of abdominal distension and pooling of feeds in the stomach in the supine position. The stomach empties more rapidly in the prone and right lateral positions than in the supine and left lateral positions. These findings indicate that the prone or right lateral positions are to be preferred for nursing neonates, especially those in whom intolerance to the volume of feeds is likely to be a problem. Supine or left lateral positions have little merit in helping gastric emptying and should not be used routinely in hospital nurseries. (+info)
Surfactant protein (SP) B associations and interactions with SP-A in white and black subjects with respiratory distress syndrome.
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BACKGROUND: The etiology of respiratory distress syndrome (RDS) is multifactorial and/or multigenic. Surfactant protein A (SP-A) and/or SP-B genetic variants have been identified as risk or protection factors for RDS. METHODS: We genotyped subjects with and without RDS for the SP-B intron 4 size variants (invariant (inv), deletion (del), insertion (ins) and for four (-18 (A/C), 1013 (A/C), 1580 (C/T), 9306 (A/G)) SP-B single nucleotide polymorphisms (SNP), to study case-control associations in black and white subjects. We also determined whether specific SP-B variants interact with RDS susceptibility or protective SP-A variants to enhance or reduce risk for RDS. RESULTS: Based on odds ratio: (1) the SP-B intron 4 del variant in white subjects is more of an RDS risk factor for males and for subjects of 28 weeks +info)