Moses Grossman

Edema and hemolytic anemia in premature infants. A vitamin E deficiency syndrome.

Abstract Widespread edema, anemia, reticulocytosis, thrombocytosis and vitamin E deficiency were noted in seven premature infants during the second month of life. Appropriate studies excluded the usual causes of these findings. The erythrocyte survival times, measured by means of DF32P and 51Cr, were strikingly short, confirming the hemolytic nature of the anemia. All infants had been fed commercial formulas with iron and a high content of polyunsaturated fatty acid, resulting in a low ratio of vitamin E to fatty acids. When vitamin E (alpha-tocopherol acetate), 75 to 100 IU daily, was given separately by mouth to five infants available for treatment and study, serum tocopherol level rose, reticulocyte count fell to normal and erythrocyte survival time lengthened; this was followed by correction of the anemia, clearing of the edema and subsidence of the thrombocytosis. Formulas having low ratios of vitamin E to polyunsaturated fatty acids and added iron supply, an inadequate amount of vitamin E to low-bir...

Prospective study of chlamydial infection in neonates.

Chlamydia trachomatis was recovered from the cervices of 4% (36/900) of pregnant women tested. 20 infants born through chlamydia-infected cervices were followed up for a year, as were 18 infants born to chlamydia-negative mothers. A statistically significant excess of conjunctivitis and pneumonia was found in infants exposed to chlamydia. The attack-rate for inclusion conjunctivitis was 35% (7/20) and for chlamydial pneumonia it was 20% (4/20). Chlamydiae were recovered from 10 of the 20 (50%) exposed infants, and seroconversion was demonstrated in 14 (70%). None of the 18 unexposed infants showed evidence of chlamydial infection. Thus in our clinic 2.8% of all newborns acquired chlamydial infection, with incidence-rates of 14 cases of conjunctivitis and 8 cases of pneumonia per 1000 live births. Neonatal chlamydial infection is thus a major public-health problem warranting a preventive programme based on the fuller provision of diagnostic services and the treatment of infected pregnant women.

Cytomegaloviruria in older infants in intensive care nurseries.

Over a four-month period, urine specimens for viral isolation were obtained weekly from all infants older than three weeks in two intensive care nurseries. These babies comprised 43% of the patients in the nurseries surveyed. Cytomegalovirus was cultured from 13 of 93 (14%) of these infants. Eleven of 13 infants who developed cytomegaloviruria were born prematurely, and nine of these 11 were found to be excreting CMV before they reached 40 weeks postconception. Infants excreting CMV received blood transfusions from a mean of 10.45 (+/- 1.80 SE) different donors versus 5.10 (+/- 0.55 SE) for infants without viruria (P less than 0.002) and five of 14 infants undergoing one or more exchange transfusions developed cytomegaloviruria (P less than 0.05). The possible role of other CMV reservoirs and the importance of these findings are discussed.

Comparison of three topical antimicrobials for acute bacterial conjunctivitis

One hundred fifty-eight patients, 21 years of age or less, presenting with culture-positive (Haemophilus influenzae or Streptococcus pneumoniae) conjunctivitis were treated with trimethoprim-polymyxin B (TP), gentamicin sulfate (GS) or sodium sulfacetamide (SS) ophthalmic solution for 10 days. Clinical response at 3 to 6 days after start of therapy was similar for all test agents: 26 of 55 (47%) patients cured, 25 of 55 (45%) improved for TP; 28 of 57 (49%) cured, 26 of 57 (46%) improved for GS; and 19 of 46 (41%) cured, 22 of 46 (48%) improved for SS. Clinical response at 2 to 7 days after completion of therapy was also similar: 46 of 55 (84%) patients cured, 5 of 55 (9%) improved for TP; 50 of 57 (88%) cured, 5 of 57 (9%) improved for GS; and 41 of 46 (89%) cured, 2 of 46 (4%) improved for SS. Bacteriologic response at 2 to 7 days after completion of therapy was similar for all antimicrobials: 44 of 55 (83%) patients for TP; 39 of 57 (68%) for GS; and 33 of 46 (72%) for SS.

The Hospital Nursery as a Source of Staphylococcal Disease among Families of Newborn Infants

NUMEROUS studies have demonstrated that the newborn infant who acquires a pathogenic staphylococcus in the hospital nursery may retain it asymptomatically for many months, may experience recurrent ...

Complications of smallpox vaccination. Effects of vaccinia immune globulin therapy

This is a report on the complications of smallpox vaccination and effects of vaccinia immune globulin (VIG) in 263 patients from the west coast. Many complications were clearly preventable. The data suggest that untoward reactions could have been prevented by withholding vaccinations from patients with leukemia, agammaglobulinemia, hypogammaglobulinemia, atopic eczema, and from those who had intimate contact with eczematoid individuals. The effectiveness of VIG was not studied in double-blind control; however, it seemed useful in atopic dermatitis, eye involvement, generalized vaccinia, and in some cases of vaccinia necrosum.

Management of the febrile patient.

Fever is one of the most common complaints presented to the childs pediatrician or health provider. Some 20% of children seen in the office or clinic are there because of fever. The first decision the physician faces is over the phone: who should be seen immediately and who can be managed over the phone. The purpose of the consultation and the visit is to separate those with inconsequential febrile illness from those who have serious illnesses, bacterial illnesses in particular, since these could be life-threatening and are amenable to antimicrobial therapy. Many studies performed over the past 10 years are essentially in agreement that high fever in children younger than 2 years includes a subset of about 6 to 10% with bacteremia caused principally by S. pneumoniae and H. influenzae. The higher the fever (particularly over 40%) the higher the risk of bacteremia. Examination of the young child elicits two sets of findings. These are traditional physical clues to a specific diagnosis, such as tachypnea, crepitant rales, stiff neck, swollen joints and others. Additionally there are general observational clues dealing with how sick the child really is. The physician then needs to decide which of several possible laboratory tests need to be done in order to further refine a subset of children at high risk. The white count (less than 5000 or greater than 15,000), the band count (greater than 1500) and the sedimentation rate (greater than 30 mm/hour) have proved useful in various studies, as has examination of the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of Candida Peritonitis with Intravenous Amphotericin Peritoneal Fluid Antibiotic Levels

The child presented in this report received intravenous amphotericin B 0.5 mg/ kg every 36 hours, for dialysis-associated Candida peritonitis. Just prior to her third dose of amphotericin B, the peritoneal fluid concentration of this drug was 0.1 mcg/ml, and the simultaneous serum level was 0.2 mcg/ml. An hour following the third amphotericin B dose, the peritoneal fluid and serum concentrations were 0.2 and 0.4 mcg/ml respectively. The minimal inhibitory concentration (MIC) of amphotericin B for the C. albicans isolated from this patient was 0.05 mcg/ml, and the minimal lethal concentration (MLC) was 0.1 mcg/ml. Treatment included concurrent 5-fluorocytosine, and catheter removal. This is the first time that mea surements of concentrations of amphotericin B in the peritoneal fluid have been reported in a child with peritonitis.

FIVE-YEAR FOLLOW-UP SURVEY OF AN OUTBREAK OF STAPHYLOCOCCAL INFECTION IN A HOSPITAL NURSERY.

IN the spring of 1957 an outbreak of staphylococcal impetigo occurred in our nursery. Type 80/81 was recovered from the lesions, and about one third of the infants were found to carry this strain a...

Serious post-traumatic infections, with special reference to gas gangrene, tetanus and necrotizing fasciitis.

Gas gangrene, tetanus and necrotizing fasciitis do not respond to antibiotic therapy alone. Only a better understanding of the present concepts of prophylaxis, diagnosis and treatment will result in improvement in the serious consequences of these infections. The most important aspect of the prophylaxis of these infections is adequate debridement. The availability of good agents for active and passive immunization against tetanus does not reduce the importance of the proper management of traumatic wounds.