Randomized trial of granulocyte transfusions versus intravenous immune globulin therapy for neonatal neutropenia and sepsis.

We prospectively studied newborn infants with sepsis and neutropenia who were randomly selected to receive standard supportive care and either adjuvant granulocyte transfusions or intravenous immune globulin (IVIG) infusions; 21 infants received granulocyte transfusions and 14 received IVIG infusions. Half of the patients were premature (gestational age less than or equal to 32 weeks); the average postnatal age was 5 days (range 3 to 8 days). All infants had neutropenia by the criteria of Manroe et al., and the mean average bone marrow neutrophil storage pool ranged between 35% and 37%. There were no significant differences with respect to serum IgG, IgA, IgM, and total hemolytic complement values between treatment groups or between survivors and nonsurvivors. Clinical severity as defined by hypoxia, acidosis, and hypotension was similar between treatment groups. Group B streptococcus was the most common organism identified and accounted for almost 33% of all bacterial isolates. There was a significantly different survival rate in the group receiving polymorphonuclear leukocyte transfusions (100%, 21/21) compared with the group receiving IVIG infusions (64%, 9/14; p = less than 0.03). There were no significant complications in either treatment group with respect to fluid overload, secondary infection, blood group sensitization, pulmonary complications, or graft-versus-host disease. This pilot study suggests a possible benefit of granulocyte transfusions compared with 'IVIG therapy in the adjuvant treatment of neonatal neutropenia and overwhelming bacterial sepsis.

Ligation of the patent ductus arteriosus in newborn respiratory failure.

Patent ductus arteriosus (PDA) is commonly associated with respiratory disease in newborn infants and may require ligation. Surgical ligation of the PDA can be done in small infants with low operative risk and minimal complications. The outcome of patients after ligation depends primarily on the severity of the underlying pulmonary disease. One hundred fifty-one patients have undergone ligation in an eight-year period at this center. A simplified technique performed in the neonatal intensive care unit with the use of local anesthesia and conventional ventilator management is described.

Pseudoaneurysm of the thoracic aorta: a late complication of umbilical artery catheterization.

Pseudoaneurysm of the thoracic aorta developed in an infant eight months following neonatal catheterization of the umbilical artery. Infection and placement of a stiff polyvinyl chloride catheter in the thoracic aorta appear to be the etiological factors. Preoperative diagnosis was posterior mediastinal tumor, and pseudoaneurysm was not included in the differential. Dacron graft patch angioplasty repair using partial cardiopulmonary bypass was successful. Postoperatively the patient has done well with no pressure gradient. Pseudoaneurysm should be suspected whenever a mediastinal mass appears in children who have had thoracic placement of umbilical artery catheters.

The effect of parental relationships on the management of cystic fibrosis and guidelines for social work intervention.

Cystic fibrosis is a multiple-system chronic disease of genetic origin usually manifested in infancy or early childhood resulting in an abbreviated life span of its victims. Effective management on a daily basis consists of complex regimens which impose a heavy burden on parents. Failure to adhere to them can result in episodes of recurrent lung infection which can further shorten the life span of the patient. The present rate of family breakdown in the United States is a factor that needs to be recognized in the home management of the "CF" patient. This study of 37 families explores the impact of parental relationships on the home care of CF children. Its findings confirm that children living at home with two natural parents received more optimal care and were in better physical condition than those with only one natural parent. This paper suggests guidelines for social work intervention to promote more effective home management of the child with this disease and to counteract when indicated the effect of the loss of traditional parental relationships.

Fiberoptic bronchoscopic nasotracheal intubation in children.

A new method for nasotracheal intubation of infants and young children is described. This method offers a smooth, reliable, and rapid means of entry into these children's airways in a safe and efficient manner in a wide variety of cardiorespiratory illnesses. This technique should be reserved for well-trained physicians with adequate equipment and experience. It is an optional technique for intubation that should be available in all modern general and children's hospitals throughout the country.

Comparison of three techniques of lung lavage in patients with cystic fibrosis.

One hundred fifty-three lung lavage procedures were performed on 81 cystic fibrosis patients during the years 1963 to 1976. Local analgesia was used in 24 lavages done via a rigid bronchoscope and in a group of 73 lavages directed by a fiberoptic bronchoscope. No abnormalities in cardiac rate or rhythm were observed with the lavages directed by fiberoptic bronchoscope. Fifty-six lavages were performed under general anesthesia with 20 cardiac abnormalities being noted among this group. Subjective improvement was noted in 96% of the 56 patients who had lavage under general anesthesia. Objective improvement was apparent in 45% of the 24 patients who had lavage with the rigid bronchoscope and 64% of the 36 patients who had lavage by fiberoptic bronchoscopy. It is concluded that patients with cystic fibrosis of varying stages of disability can more safety (and with good improvement) have bronchial washouts with the fiber-optic bronchoscope than with either of the other two techniques.

Incidence of serum antibodies to several Aspergillus species and to Candida albicans in cystic fibrosis.

The incidence of serum IgE antibodies to several species of aspergillus and the incidence of serum precipitins to these species and to Candida albicans were determined in 22 children with cystic fibrosis, 17 children with bronchial asthma, and 18 control subjects. IgE antibodies were found in 50 per cent of the patients with cystic fibrosis and in 29 per cent of the patients with bronchial asthma; none was found in the control subjects. Precipitins to aspergillus species were present in 59 per cent of the patients with cystic fibrosis, 35 per cent of the patients with bronchial asthma, and 11 per cent of the control subjects. Greater differences were noted when the total number of precipitin bands in each group was compared. There was a trend for the more severe cases of cystic fibrosis (based on the Shwachman-Kulczycki score) to have a greater incidence of precipitins and a lower frequency of IgE antibodies to aspergillus than the milder cases. Candida precipitins were found more frequently in patients with cystic fibrosis (45 per cent) than in patients with bronchial asthma (18 per cent); none was found in the control group. The potential role of fungal hypersensitivity in cystic fibrosis and the therapeutic implications are discussed in light of these findings.