C. Henry Kempe

Prediction and prevention of child abuse and neglect

Abstract Utilizing an interview, a questionnaire, and observations during labor, delivery, and the postpartum period, a sample of one hundred mothers was identified as at high risk for abnormal parenting practices. These mothers were randomly divided into a “High-Risk Intervene” group (N=50) and a “High-Risk Nonintervene” group (N=50). The “Intervene” group received comprehensive pediatric follow-up by a single physician, a lay health visitor, and/or a public health nurse in the home. The “Non-intervene” group received routine care, although the results of these screening procedures were shared with the physicians and nurses responsible for their ongoing care. Another group of 50 mothers, who delivered during the same time period and who were assessed as low risk in terms of abnormal parenting practices, served as controls. When the children were approximately two years old (mean age 26.8 months), 25 families in each of the three groups were chosen at random for detailed evaluation.

The 1978 Presidential Address of the American Pediatric Society: The Future of Pediatric Education

The 1978 Presidential Address of the American Pediatric Society: The Future of Pediatric Education

The Characteristics and Management of Child Abuse in the U.S. Army-Europe

A 12-month epidemiologic study of child abuse and neglect within a population of 100,000 military personnel and family members in a geographic area of 5,400 square miles in Ger many showed a significantly high rate of child abuse, including a high rate for deaths (9%).

1085 DIAGNOSIS AND TREATMENT OF PURULENT NASOPHARYNGITIS – A DOUBLE-BLIND, TWO-DRUG EVALUATION

132 children with purulent nasopharyngitis and no other indication for specific treatment had gram stain and bacterial culture of nasopharyngeal discharge and were randomized to 4 treatment groups with antibiotic (A=cephalexin) or decongestant/anti-histamine (D=pseudoephedrine/triprolidine) or their corresponding placebo equivalents (A+D+, A+D−, A−D+, A−D−). Follow-up parent, physician, and bacteriologic evaluations were performed after 5 days of therapy without knowledge of active drug status. Groups were comparable for age, sex, race, number of patients withdrawn from study, days ill, fever >38.0 C, appearance of discharge, nasal crusting, and number of days until follow-up. 21% of patients grew H. influenzae type b and only 8% S. pyogenes on initial culture. Nasal crusting was significantly (p<0.01) associated with the growth of S. pneumoniae or H. influenzae type b, suggesting a possible pathologic relationship. There were, however, no significant differences between active drug and placebo treatment groups for change in nasal discharge, complications, apparent drug benefit, or change in nasal flora with active antibiotic treatment. Significantly (p<0.05) more side effects were attributed to the D+ treatment groups. Routine culture and/or treatment of purulent nasopharyngitis cannot be recommended unless properly controlled studies demonstrate a significant drug benefit.

A Vindication of the Rights of Children

The title of this lecture is modified after the classic essay, “A Vindication of the Rights of Women” written in 1792 by Mary Wollstonecraft which set forth the plight of women in those days.

1054 INFLUENCE OF INOCULUM SIZE ON INTERPRETATION OF SUSCEPTIBILITY TESTING OF HAEMOPHILUS INFLUENZAE: MOXALACTAM VS. AMPICILLIN

A direct relationship between inoculum size and in vitro antibiotic susceptibility is readily apparent in the response of Haemophilus influenzae to beta-lactamase antibiotics. We studied three strains of H. influenzae, (AmpS ChloroS, AmpR ChloroS, and AmpR ChloroR) in parallel under varying inocula conditions against Moxalactam and Ampicillin. The AmpS strain showed little or no inoculum effect with Moxalactam or Ampicillin while the AmpR strains showed dramatic differences in response to Ampicillin but not Moxalactam as demonstrated by broth dilution, agar dilution, and disk diffusion techniques. The inoculum effect was found to be independently related to the total number of colony-forming units (CFU) inoculated as well as the density of organisms (CFU/ml). Kinetic studies demonstrated significant differences between conventional broth growth curves and a continuous antibiotic flow system. Beta-lactamase producing H. influenzae reduced Ampicillin concentrations in “stagnant” in vitro systems but not in dynamic systems more analogous to the steady state of patients. Extrapolation from in vitro susceptibility studies to therapeutic decision-making requires knowledge beyond the MIC of an organism at a standard inoculum size, including: the total number of organisms in a patient, the maximum concentration of organisms in a patient, antibiotic tissue penetration, antibiotic turnover, and the effect of host defenses.