ABSTRACT
We investigated the epidemiology and clinical features of invasive S. pyogenes infection in a pediatric population over a 7-year period (1984-90) by retrospective review. An increasing frequency in invasive infections had occurred (0-11.81/10,000 admissions). A large proportion (48%) of these were orthopedic infections. An epidemic strain was typed as M1T1. This increase appears to have occurred in the context of an overall increase in S. pyogenes infections ("scarlet fever" 1.47-11.22/10,000 outpatients; "strep throat" 4.41-46.54/10,000 outpatients).
Subject(s)
Streptococcal Infections/epidemiology , Streptococcus pyogenes/isolation & purification , Adolescent , Bacteremia/microbiology , British Columbia/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Pharyngitis/microbiology , Retrospective Studies , Streptococcal Infections/microbiology , Time FactorsABSTRACT
A newborn boy with congenital contractural arachnodactyly (CCA) was found to have an atrial septal defect, ventricular septal defect, patent ductus arteriosus, and aortic arch anomalies. These resulted in congestive failure but subsequent progressive dilatation of both great arteries and development of aortic regurgitation were associated with eventual cardiorespiratory failure and death at 11.5 months. Others have noted that cardiac anomalies in CCA may be comparable with those of infantile Marfan's syndrome. Our case further extends the spectrum of cardiac abnormalities in CCA and substantiates that there is overlap with infantile Marfan's syndrome. This fact and our literature review suggest that early and complete cardiac assessment is necessary for appropriate management and evaluation of prognosis in any newborn infant with findings suggestive of either condition.
Subject(s)
Abnormalities, Multiple , Connective Tissue Diseases/congenital , Contracture/congenital , Hand Deformities, Congenital/complications , Heart Defects, Congenital/complications , Connective Tissue Diseases/complications , Contracture/complications , Ear, External/abnormalities , Echocardiography , Heart Defects, Congenital/diagnostic imaging , Humans , Infant, Newborn , MaleABSTRACT
Three cases of supraventricular tachycardia (SVT) associated with the use of furosemide infusion (FI) in children following cardiac surgery are reported. The SVT occurred three to seven hours after starting an infusion at 1.0 mg.kg-1.hr-1. All three patients had a diuresis of 8-10 ml.kg-1.hr-1 compared with a mean average of 2.5 ml.kg-1.hr-1 in 22 other patients who had received a similar infusion. A rapid fluid shift was the most likely mechanism of the tachycardia. Sotalol was effective in controlling the tachycardia in the two patients in whom it was tried. We now recommend a starting dose of 0.3 mg.kg-1.hr-1 in using furosemide as a continuous infusion, with hourly increments of 0.1 mg.kg-1.hr-1 until the desired diuresis is obtained.
Subject(s)
Furosemide/adverse effects , Tachycardia, Supraventricular/chemically induced , Cardiopulmonary Bypass , Female , Furosemide/administration & dosage , Heart Defects, Congenital/surgery , Humans , Infant , Infant, Newborn , Infusions, Intravenous , MaleSubject(s)
Intermittent Positive-Pressure Ventilation , Respiratory Syncytial Viruses , Respirovirus Infections/drug therapy , Ribavirin/administration & dosage , Adolescent , Aerosols , Bronchiolitis, Viral/drug therapy , Child, Preschool , Humans , Humidity , Infant , Infant, Newborn , Intubation, Intratracheal , Pneumonia, Viral/drug therapy , Ribavirin/therapeutic useABSTRACT
Two cases of Branhamella catarrhalis bacteremia in childhood are presented. The literature is reviewed for this unusual cause of bacteremia.
Subject(s)
Moraxella catarrhalis , Sepsis/microbiology , Child , Child, Preschool , Female , Humans , Male , Moraxella catarrhalis/isolation & purification , Sepsis/drug therapyABSTRACT
The reliability of "leak" as a criterion for elective extubation of children with croup treated with nasotracheal intubation was studied during the three month "croup epidemic" in Ontario of September 1, 1983 to November 30, 1983. Twenty-eight patients experienced 36 extubations; 31 planned and five accidental. Three of 23 (13 per cent) planned extubations with "leak" required reintubation whereas three of eight (38 per cent) children electively extubated after seven days of intubation without "leak" required reintubation. "Leak" is a helpful but not absolute prognostic indicator of a successful extubation.
Subject(s)
Croup/therapy , Intubation, Intratracheal , Laryngitis/therapy , Age Factors , Child , Child, Preschool , Humans , Infant , Intubation, Intratracheal/instrumentation , Time FactorsABSTRACT
A 15-year-old girl with a 9-year history of idiopathic thrombocytopenic purpura resistant to high-dose steroid therapy and to splenectomy was admitted to hospital at 35 weeks' gestation with a platelet count of 10 X 10(9)/L. The bleeding time was normal, and measures of platelet aggregation were nearly so. Treatment with high intravenous doses of polyvalent immune globulin led to a rise in the platelet count to more than 110 X 10(9)/L within 5 days. An elective cesarean section was performed through the lower uterine segment with good hemostasis. After delivery the platelet count fell to its former level, but no postpartum bleeding occurred. There was a brief episode of thrombocytopenia in the infant, with some petechiae but no other hemorrhagic manifestations. No untoward effects of the immune globulin infusion were observed in either mother or daughter.
