Haemophilus influenzae type b vaccine: use in the pediatric population.

To assess the use of the Haemophilus influenzae type b vaccine and the attitudes of health professionals regarding its use in the pediatric population, we conducted a study of community clinics, health department clinics, university-based teaching clinics, and private practice groups in the state of Texas. Whereas 59.6% of the private practice groups and 57.1% of the university-based teaching clinics administered the vaccine to more than 75% of their eligible children, 72.7% of community clinics and 81.7% of health department clinics never administered the vaccine to their eligible children. Likewise, whereas 100% of the university-based teaching clinics and 95.7% of the private practice groups had the vaccine available to their patients, only 22.7% of the community clinics and 15.5% of the health department clinics did so. The two most common reasons given by health professionals concerning the nonuse of the vaccine were nonavailability and high cost of the vaccine. Our findings suggest that a large segment of eligible children do not have access to this important vaccine and that children who depend on community and health department clinics for their routine health care are particularly affected in this regard. Strategies identified to increase the use of the vaccine include providing vaccine free of charge, increasing patient awareness of the vaccine benefits, and passing mandatory state laws requiring vaccine administration before day-care enrollment.

The prevention of coronary artery aneurysm in Kawasaki disease: a meta-analysis on the efficacy of aspirin and immunoglobulin treatment.

OBJECTIVE: Varying observations have been made concerning the use of aspirin (ASA) and/or intravenous immunoglobulin (IVIG) in the prevention of coronary artery aneurysm (CAA) in children with Kawasaki disease. A meta-analysis of published articles on the subject was conducted to evaluate the reported efficacy of these therapies. METHODS: All published studies in all languages from 1967 through 1993 obtained from MEDLINE and EMBASE were considered, and a defined set of inclusion and exclusion criteria selected the studies for analysis. These studies were grouped based on whether the children in the studies received: (1) ASA alone, (2) low IVIG (< or = 1 g/kg) and ASA, (3) high IVIG (> 1 g/kg) and ASA, (4) single IVIG (> 1 g/kg) and ASA, (5) high IVIG and low ASA (< or = 80 mg/kg), or (6) high IVIG and high ASA (> 80 mg/kg). Studies that satisfied the test for homogeneity were subjected to further analysis. The best estimate of the true proportion of CAA as well as the 95% confidence interval for each group were calculated at 30 and 60 days. Hypothesis testing was conducted to determine the statistical significance of the calculated difference in each compared treatment group. RESULTS: The best estimate of true proportion of CAA and the 95% confidence interval in each group at 30 and 60 days were: (1) ASA group, 30 days, 22.8% (20.6%, 25%); 60 days, 17.1% (13.6%, 20.7%); (2) low-IVIG group, 30 days, 17.3% (14.3%, 20.2%); 60 days, 11.1% (8.7%, 13.6%); (3) high-IVIG group, 30 days, 10.3% (8.3%, 12.3%); 60 days, 4.4% (2.8%, 6%); (4) single-IVIG group, 30 days, 2.3% (0.5%, 4.2%); 60 days, 2.4% (0.5%, 4.2%); (5) high-IVIG-low-ASA group, 30 days, 13% (9%, 17%); 60 days, 4.8% (2.3%, 7.4%); and (6) high-IVIG-high-ASA group, 30 days, 9.1% (6.9%, 11.4%); 60 days, 4% (2%, 6.1%). CONCLUSION: The incidence of CAA both at 30 and 60 days was significantly lower in low-IVIG than in ASA and in high-IVIG than in low-IVIG groups. Also, the incidence was lower in the single-IVIG than in the high-IVIG group, but this was noted at 30 days and not at 60 days. There was no statistically significant difference in the incidence of CAA both at 30 and 60 days between the high-IVIG-low-ASA and high-IVIG-high-ASA groups.

A chart audit peer review system in an ambulatory service.

A system of providing rapid review of ambulatory patient records using a set of criteria was developed and tested. Of 337 records selected for review, 25% were not reviewable. Of the remaining 75%, virtually one half proved to be lacking in one or more of the established criteria. Deficiencies tended to occur most often in criteria related to the physical examination of the child. Physician compliance with the criteria could not be conclusively shown to improve during the five-month study period, although physician acceptability was judged as good. A large percentage (47.3%) of deficient records could be corrected by the responsible health professional. The chief advantages of the system are that it is rapid and easy to perform. It focuses on the major service provided by the facility, i.e., acute medical care, and on the performance of the individual providing that service.

The effectiveness of diphenhydramine HCI in pediatric sleep disorders.

Fifty children with a variety of sleep disorders were studied in a placebo-controlled, double-blind clinical trial of diphenydramine elixir given in a dosage of 1.0 mg/kg at bedtime. Sleep records measuring latency time, number of awakenings, and duration of sleep were compiled by the patient's parent. A global assessment as to the severity of sleep disturbance and the therapeutic effect of the medication and placebo was made on a weekly basis. Diphenhydramine was significantly better than placebo in reducing sleep latency time and the number of awakenings per night, while sleep duration was marginally increased. There were no essential differences between diphenhydramine and placebo in the other study parameters, i.e., restlessness, nightmares, and difficulty awakening. Diphenhydramine was judged to be more effective than placebo on the weekly global assessment. The results indicate that diphenhydramine is a safe, effective bedtime sleep aid for pediatric patients.

Congenital lentiginosis.

Because lentiginosis may be associated with multiple somatic anomalies (as in the "LEOPARD syndrome"), its recognition is important clinically. A case of lentiginosis detected in the neonatal period, without accompanying defects, is reported. The significance of histologic confirmation and the importance of searching for other abnormalities are discussed.

The comparative efficacy of minocycline and penicillin-V in Staphylococcus aureus skin and soft tissue infections.

The antistaphylococcal properties of orally administered minocycline and penicillin-V were compared for one hundred and fifteen patients receiving minocycline and one hundred and twenty-eight receiving penicillin-V for various types of cutaneous infections. The majority of bacterial isolates were staphylococcal organisms. Of these 82 percent showed initial in vitro sensitivity to minocycline while only 20 percent did to penicillin-V. The percentage of clinical cures was higher with minocycline (74 percent) than with penicillin-V (54 percent), however, most patients, in both groups, showed clinical improvement. The rate of clinical improvement appeared to be significantly faster with minocycline. There was a higher percentage of adverse, chiefly vestibular, effects in the minocycline group (16 percent vs 7 percent). The study clearly demonstrates the superior antistaphylococcal properties of minocycline as compared with penicillin-V.

Febrile seizures: current concepts.

Approximately 2 to 5 per cent of all children experience seizures in association with their febrile illness. In a vast majority of instances, these seizures are of benign nature without any long-term adverse implications. A small percentage of these children develop recurrent febrile seizures and a still smaller percentage develop epilepsy. Several studies have attempted to identify those children who are at risk to develop either recurrences or subsequent epilepsy, while others have examined different modalities of management of children with febrile seizures. This review presents an overview of the problem based on the findings of these studies.

The comparative efficacy of cephalexin and sulfisoxazole in acute urinary tract infection in children.

A double blind, comparative study of the efficacy of cephalexin versus sulfisoxazole was conducted on 100 children with initial episodes of urinary tract infections. The overall bacteriologic and clinical cure rates were comparable for both antimicrobials. Children treated with cephalexin had a clinical cure rate of 86 per cent and a bacterial cure rate of 84 per cent, while those given sulfisoxazole were found to have rates of 82 and 92 per cent respectively. However, cephalexin was noted to have a rather high rate of failure in the therapy of Proteus micrabilis infections (4/8), casting some doubt on its use in urinary infections caused by the organism. Untoward effects associated with either medication were minimal.

The appropriateness of early discharge of hospitalized children with suspected sepsis.

BACKGROUND: Febrile children with suspected sepsis are often hospitalized and empirically treated with parenteral antibiotics pending results of bacterial cultures. The question of just how long such children should be observed and treated following initial negative culture reports has not been adequately addressed. This study was designed to determine the appropriateness of discharging hospitalized culture-negative children with suspected sepsis at the end of 48 hours. METHODS: All children admitted with a diagnosis of "suspected sepsis" over an 8-month period were prospectively evaluated. Based on initial culture data, children were divided into two groups: group A with positive bacterial cultures and group B with negative bacterial cultures. Clinical assessment and review of cerebrospinal fluid, blood, and urine culture data were made at 24 hours, 48 hours, and until discharge, and at 2 weeks following discharge of all group B patients. RESULTS: Of the 83 children enrolled in the study, 8 (9.5%) patients had a culture positive for bacterial infection (group A): meningitis in two, bacteremia in six, and urinary tract infection in two. All cultures were positive within 48 hours. Cultures were negative at 48 hours in the remaining 75 (90.4%) children (group B), and remained negative until discharge and at 2-week follow-up. Eight (10.6%) patients had received antibiotics prior to admission. After the workup, 37 of 73 (50.6%) children received antibiotics for less than 48 hours, while 36 (49.4%) children did so for more than 48 hours. Clinical assessment was normal at 48 hours in 71 of the 75 children. Sixty-three (84%) children available for follow-up continued to do well after discharge. No statistical distinction could be made between those children who remained hospitalized after 48 hours and those children who were dismissed at 48 hours. CONCLUSIONS: Although our study data suggest that culture-negative children hospitalized for suspected sepsis who meet the criteria for normal clinical assessment can be safely discharged at 48 hours, a stronger statistical validation of this approach can be made if a larger sample size is studied.