ABSTRACT
OBJECTIVE: To demonstrate the severity of ocular findings in young children who died of injuries due to motor vehicle crashes. METHODS: Case series of 10 children younger than 3 years who were fatally injured in motor vehicle crashes between January 1, 1994, and December 31, 2002. All children underwent autopsy that included eye examination. All available medical and autopsy records, pathology slides and photographs, and police and traffic department reports were reviewed for each case. RESULTS: Eight patients had retinal hemorrhages, which extended into the periphery in 13 eyes and were bilateral in 7 patients. Three patients had elevated circular retinal folds. Six patients had hemorrhages below the internal limiting membrane, but no patients had deeper splitting of the retina. Nine patients had optic nerve sheath hemorrhages. CONCLUSION: The association of extensive, sometimes severe, ocular hemorrhages with fatal accidental trauma, compared with previous reports of accidental trauma with no or few hemorrhages, indicates the severity of injury required to cause hemorrhages of this magnitude.
Subject(s)
Accidents, Traffic , Retinal Hemorrhage/etiology , Retinal Hemorrhage/pathology , Accidents, Traffic/mortality , Craniocerebral Trauma/etiology , Craniocerebral Trauma/pathology , Eye Hemorrhage/etiology , Eye Hemorrhage/pathology , Humans , Infant , Optic Nerve/blood supply , Retina/pathology , Severity of Illness IndexABSTRACT
BACKGROUND: Children admitted to the hospital with urinary tract infections (UTIs) receive empirical antibiotic therapy. There is limited information on bacterial resistance to commonly prescribed intravenous antibiotics or on the risk factors for increased resistance in these patients. OBJECTIVES: To determine the antibiotic resistance pattern in children admitted to the hospital with UTIs, and to determine if history of UTI, antibiotic prophylaxis, or vesicoureteral reflux increases the risk of resistant organisms. DESIGN/METHODS: We reviewed all of the cases of UTI in children up to 18 years of age who were admitted during a 5-year period to Children's Hospital of Wisconsin, Milwaukee. We recorded age, sex, culture and sensitivity results, imaging that was performed, and past medical history. RESULTS: We identified 361 patients with UTIs. Escherichia coli caused 87% of the infections, although E coli was significantly less common in children receiving prophylactic antibiotics (58%; P<.001) or in children with a history of UTI (74%; P<.001). Resistance to cefotaxime sodium was 3% in the patients not receiving antibiotic prophylaxis, but was 27% in the children receiving prophylactic antibiotics (relative risk, 9.9; 95% confidence interval, 4.0-24.5; P<.001). Resistance to aminoglycoside antibiotics was 1% in the children not receiving prophylaxis and 5% in the children receiving prophylactic antibiotics. CONCLUSIONS: Children who are receiving prophylactic antibiotics and are admitted to the hospital for a UTI are often infected with an organism that is resistant to third-generation cephalosporins. These children are more appropriately treated with an aminoglycoside antibiotic.
Subject(s)
Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiology , Adolescent , Cephalosporins/therapeutic use , Child , Child, Preschool , Drug Resistance, Microbial , Escherichia coli Infections/drug therapy , Humans , Infant , Retrospective StudiesABSTRACT
Increasing evidence of postpartum depression is encouraging pediatricians to include screening and intervention for postpartum depression in standard newborn and infant care. Pediatricians have the most frequent exposure to mothers and infants in the most high-risk time period and they have a vested interest in the well-being of the child and mother. Because the time required to achieve basic screening and referral services is minimal, there is enough evidence that postpartum screening and intervention are crucial components of comprehensive newborn and infant care. It is incumbent upon pediatricians to screen for and intervene in cases of postpartum depression to provide thorough care for infants and their families.
Subject(s)
Depression, Postpartum/diagnosis , Depression, Postpartum/therapy , Pediatrics , Physician's Role , Child Development , Depression, Postpartum/etiology , Female , Humans , Infant , Infant, Newborn , Referral and Consultation , Risk FactorsABSTRACT
BACKGROUND: The American Academy of Pediatrics practice parameter for urinary tract infection suggests a repeat urine culture if the expected clinical response is not achieved within the first 48 hours of therapy. The utility of repeat urine cultures and clinical significance of fever at 48 hours is unclear. OBJECTIVES: To determine the frequency of positive repeat urine cultures in children admitted to the hospital with urinary tract infection, and to describe the fever curves of children admitted to the hospital with urinary tract infection. DESIGN AND METHODS: We reviewed all cases of urinary tract infection in children 18 years and younger who were admitted during a 5-year period to Children's Hospital of Wisconsin (Milwaukee). We recorded temperatures from hospital admission to discharge, age, sex, initial and follow-up culture results, antibiotics received, imaging performed, and medical history. RESULTS: Urinary tract infection was identified in 364 patients, and 291 (79.9%) had follow-up urine cultures. None were positive. Follow-up cultures produced 21,388.50 US dollars in patient charges. Fever lasted beyond 48 hours in 32% of patients. Older children were more likely to have fever beyond 48 hours. CONCLUSIONS: Follow-up urine cultures were of no utility in children hospitalized for urinary tract infection, including those with fever lasting beyond 48 hours or those with an underlying urologic disease. Fever beyond 48 hours is common and should not be used as a criterion for obtaining a repeat urine culture. These conclusions are valid for children with vesicoureteral reflux. Such an approach would result in significant cost savings.
