Phototherapy and exchange transfusion for neonatal hyperbilirubinaemia: neonatal academic hospitals' consensus guidelines for South African hospitals and primary care facilities.

The purpose of this document is to address the current lack of consensus regarding the management of hyperbilirubinaemia in neonates in South Africa. If left untreated, severe neonatal hyperbilirubinaemia may cause kernicterus and ultimately death and the severity of neonatal jaundice is often underestimated clinically. However, if phototherapy is instituted timely and at the correct intensity an exchange transfusion can usually be avoided. The literature describing intervention thresholds for phototherapy and exchange transfusion in both term and preterm infants is therefore reviewed and specific intervention thresholds that can be used throughout South Africa are proposed and presented graphically. A simplified version for use in a primary care setting is also presented. All academic heads of neonatology departments throughout South Africa were consulted in the process of drawing up this document and consensus was achieved.

A prospective study of long-term use of amikacin in a paediatrics department. Indications, administration, side-effects, bacterial isolates and resistance.

Amikacin (Amikin; B-M) was used as the only aminoglycoside for 18 months in a paediatric department within a general hospital because of high levels of resistance of Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter cloacae isolates to tobramycin, gentamicin and netilmicin. Between 1 February 1987 and 31 July 1988, 816 children were treated with a slow intravenous injection at a standardised dose adjusted for weight and age. Respiratory disease was present in 35.8% of 537 neonates, 56.4% of 190 infants and 70.9% of 89 older children. Escherichia coli (65 isolates), Klebsiella species (59 isolates), Enterobacter species (26 isolates) and P. aeruginosa (22 isolates) constituted the most common Gram-negative pathogens. The positive blood culture yield was 7.8%. Satisfactory median peak and trough serum amikacin levels were achieved. No significant renal side-effects were noted. Severe bilateral hearing loss in 1 low-birthweight infant resulted from inadvertent overdosage. At the end of this 18-month surveillance period 97.7% of E. coli, 98.6% of K. pneumoniae, 96.3% of E. cloacae, and 98.0% of P. aeruginosa isolates remained sensitive to amikacin, while resistance of K. pneumoniae to tobramycin, netilmicin and gentamicin decreased significantly (P less than 0.003, P less than 0.001 and P less than 0.007 respectively; chi-square test).

Plasma vitamin E values in the newborn.

Plasma vitamin E values of newborn infants in a Coloured population of Cape Town have been determined. The mean plasma alpha-tocopherol value was 3,2 +/- 0,8 mg/l. A significant correlation between the plasma alpha-tocopherol level and plasma total lipid content (r = 0,45; P less than 0,001) and plasma cholesterol level (r = 0,65; P less than 0,001) has been found. However, maternal and neonatal plasma vitamin E levels were unrelated.

Examination of methods for enumerating hemicellulose-utilizing bacteria in the rumen.

Counts of colonies that developed after 4 days on agar medium containing 0.3% xylan and preincubated rumen fluid were similar to counts of xylanolytic bacteria obtained when total culturable counts were multiplied by the percentage of isolates capable of producing acid from xylan. Shortening the incubation period reduced the chance of including satellite colonies of non-xylanolytic organisms in the count. Nearly all of the xylanolytic isolates irrespective of the medium from which they were isolated degraded and utilized xylan extensively. The use of a culture medium containing a high concentration (3%) of xylan is also described. The number of colonies capable of producing clearings in this medium was less than 10% of the total culturable counts. Isolates from such colonies were shown to produce diffusible (extracellular) xylanases.

Inclusion of xylan in a medium for the enumeration of total culturable rumen bacteria.

The influence of the inclusion of xylan in a medium for enumeration of total culturable rumen bacteria was investigated. Maximum colony numbers were obtained on a medium, GCSX-2, which contained 0.033% each glucose and cellobiose and 0.067% each soluble starch and xylan. This medium gave higher colony counts than either medium 98-5 of Bryant and Robinson (J. Dairy Sci. 44:1446-1456, 1961), medium 98-5 of Chung and Hungate (Appl. Environ. Microbiol. 32:649-652, 1976), containing an added lucerne (hemicellulose + cellulose) fiber substrate, or medium GCSX-2 with the added lucerne (hemicellulose + cellulose) fraction. The time of collection of rumen fluid influenced the colony counts on the media containing the lucerne fiber substrate but was without effect on medium GCSX-2.

Effects of selected herbicides and plant hormones on Prototheca wickerhamii.

Prototheca wickerhamii was treated in vitro with 11 different herbicides and plant hormones. Growth was inhibited by indolyl-3-acetic acid, indolyl-3-butyric acid and indolyl-3-propionic acid at 400 mug per ml. Coconut milk was stimulatory.