Donald V. Eitzman

Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections

Gram-negative organisms, responsible for a high rate of colonization and infection in an intensive care nursery, were recovered frequently from hands of personnel, despite regular hand antisepsis. In sequential hand cultures contamination of hands by gram-negative organisms was transient in some nurses, but active multiplication of the organisms occurred on the hands of others and in a few nurses a temporary carrier state appeared to exist. The results of this study suggest that the hands of hospital personnel may serve not only as a passive vehicle in the nosocomial transmission of gran-negative bacteria, but also may constitute a reservoir of nosocomial organisms.

Transient congenital leukemia in 7 infants with mongolism

3. Stein, W. H.: A chromatographic investigation of the amino acid constitutes of normal urine, J. Biol. Chem. 201: 45, 1953. 4. Folin, O.: Laws governing the chemical composition of urine, Am. J. Physiol. 13: 66, 1905. 5. Stambaugh, R., Davidson, D. T., Jr., and Elkinton, J. R.: Variation in excretion of certain amino acids with age, Clin. Chem. 9: 210, 1963. Brie[ clinical and laboratory observations 3 0 3

Platelet dysfunction and coagulopathy in intraventricular hemorrhage in the premature infant

We investigated platelet count, bleeding time, platelet aggregation, prothrombin time, activated partial thromboplastin time, and fibrinogen level in 58 very low-birth-weight infants during the first postnatal day to determine the relationship between hemostatic disorders and intraventricular hemorrhage. Thirty-two of the 58 infants (55%) were found to have periventricular-intraventricular hemorrhage by computerized tomography or autopsy. Nine patients (16%) had subarachnoid hemorrhage only and 17 (29%) had no evidence of intracranial hemorrhage. Infants with IVH had a significantly lower mean platelet count than did infants with no SAH/IVH. However, only five patients with IVH had initial thrombocytopenia. The IVH group had a mean bleeding time which was significantly prolonged compared to that of the group without SAH/IVH. Similarly, patients with IVH had a mean platelet aggregation response which was significantly diminished in comparison to that of patients with no SAH/IVH. Infants with IVH had a significantly longer mean PT than did infants with no SAH/IVH. In addition, babies with IVH had a significantly longer mean APTT compared to that of babies without SAH/IVH. The groups did not differ significantly with respect to fibrinogen levels. Three infants with IVH had disseminated intravascular coagulation in the early neonatal period. These data suggest that disorders of platelet-capillary interaction and defects in the intrinsic and extrinsic coagulation pathways may play important roles in intraventricular hemorrhage in the premature infant.

Educational Disabilities of Neonatal Intensive Care Graduates

Objective. To determine the relationship between perinatal and sociodemographic factors in low birth weight and sick infants hospitalized at regional neonatal intensive care units (NICUs) and subsequent educational disabilities. Method. NICU graduates born between 1980 and 1987 at nine statewide regionalized level III centers were located in Florida elementary schools (kindergarten through third grade) during academic year 1992–1993 (n = 9943). Educational disability was operationalized as placement into eight mutually exclusive types of special education (SE) classifications determined by statewide standardized eligibility criteria: physically impaired, sensory impaired (SI), profoundly mentally handicapped, trainable mentally handicapped, educable mentally handicapped, specific learning disabilities, emotionally handicapped, and speech and language impaired (SLI). Logistic regression was used to estimate the odds of placement in SE for selected perinatal and sociodemographic variables. Results. Placement into SE ranged from .8% for SI to 9.9% for SLI. Placement was related to four perinatal factors (birth weight, transport, medical conditions [congenital anomalies, seizures or intraventricular hemorrhage] and ventilation), and five sociodemographic factors (childs sex, mothers marital status, mothers race, mothers educational level, and family income). Perinatal factors primarily were associated with placement in physically impaired, SI, profoundly mentally handicapped, and trainable mentally handicapped. Perinatal and sociodemographic factors both were associated with placement in educable mentally handicapped and specific learning disabilities whereas sociodemographic factors primarily were associated with placement in emotionally handicapped and SLI. Conclusions. Educational disabilities of NICU graduates are influenced differently by perinatal and sociodemographic variables. Researchers must take into account both sets of these variables to ascertain the long-term risk of educational disability for NICU graduates. Birth weight alone should not be used to assess NICU morbidity outcomes.

The correlation of maternal cytomegalovirus infection during varying stages in gestation with neonatal involvement

An obstetric population was prospectively followed for evidence of primary maternal cytomegalovirus infection during gestation. The cord serum of infants whose mothers had serologic evidence of infection was analyzed for the level of IgM and for the presence of specific anticytomegalovirus IgM antibodies. The progeny were cultured for cytomegalovirus. In the four cases of maternal infection identified, the cord sera were found to be positive by immunofluorescence for anticytomegalovirus IgM immunoglobulins and correlated with recovery of virus in the immediate neonatal period or beyond. There was a direct correlation between severity of neonatal infection and presumed duration of disease in utero. These observations suggest that cytomegalovirus is capable of infecting the products of conception irrespective of gestational age, and that the clinical manifestations of congenital cytomegalovirus infection appear to be primarily a reflection of the duration of infection in utero.

A prospective controlled trial of oral kanamycin in the prevention of neonatal necrotizing enterocolitis

Alimentary kanamycin, 15 mg/kg/day, was given as prophylaxis for neonatal necrotizing enterocolitis in a prospective study. Newborn infants of less than 1,500 gm birth weight who survived until initiation of alimentary nutrition at the University of Florida Neonatal Intensive Care Unit were admitted to a control or study group based on the last digit of the hospital number. Alimentary kanamycin was not absorbed; all blood levels determined were less than 0.5 μg/ml. The two groups had similar gestational ages, birth weights, severity of neonatal illness, and frequency of therapeutic procedures. In the study group of 35 infants, none developed neonatal necrotizing enterocolitis, whereas five cases occurred in the 40 control infants (p=0.038).

Intracranial hemorrhage and vitamin K deficiency in early infancy

We report late-onset (1/2 to 6 months of age) intracranial hemorrhage related to vitamin K deficiency in 32 breast-fed infants, 31 of whom received no prophylactic vitamin K at birth. Computerized tomography showed mild to severe intracranial hemorrhage. Most (90.6%) had subarachnoid hemorrhage, either alone or in combination with subdural hemorrhage (37.5%), parenchymal hemorrhage (31.3%), or intraventricular hemorrhage (12.5%). In three (9.4%) the infratentorial region was involved.

Serum creatine phosphokinase MB fraction in newborns with transient tricuspid insufficiency.

RECENTLY, we reported 14 term newborn infants affected by severe perinatal stress who subsequently manifested cyanosis, congestive heart failure and transient murmurs of tricuspid insufficiency.1 T...

Septicemia and Meningitis in a Newborn Due to Pasteurella Multocida

Assistant Professor, Department of Microbiology, School of Medicine, University of Florida. Director of Clinical Microbiology Laboratory, University Hospital and Clinics, University of Florida, Gainesville, Fla. Present address: Dept. of Pathology, The Swedish Hospital, Minneapolis, Minnesota. † Chief Microbiologist, Clinical Microbiology Laboratory, University Hospital and Clinics, University of Florida.

Cerebral Blood Flow during Acute Acidosis in Perinatal Goats

Summary: Changes in cerebral blood flow in response to three states of acute acidosis, posthypoxic, lactic acid, and respiratory, were estimated by the microsphere technique. In all three states, the fraction of the systemic blood flow reaching the brain and the rate (ml/min) of blood flow to it increased. The increase in flow was linearly related both to the PaCO2 and to H+. Others have shown the flow rate to increase with hypercapnia, but the increase associated with an increase in hydrogen ion concentration while the PaCO2 was maintained at control levels does not appear to have been observed in mature animals.Speculation: The significant increase in cerebral blood flow seen in perinatal goats during acute acidosis seems to be a result of a decrease in cerebral vascular resistance in an attempt by the cerebral vascular bed to preserve flow to the brain during stress.