ABSTRACT
INTRODUCTION: Gentamicin is widely used in full-term neonates as empirical therapy for early-onset suspected or proven sepsis. Several dosing schedules for gentamicin have been recommended for this neonatal population. OBJECTIVE: To compare gentamicin serum levels, efficacy and toxicity of two dosing schedules in term and preterm newborns. MATERIAL AND METHODS: The study included 200 newborns who were started on gentamicin therapy. Group A (N=100) was prescribed a multiple-daily dosing regimen and Group B (N=100) on a once-daily dosing regimen. Newborns in Group A received gentamicin at 2.5-3.5 mg/kg/dose q12-18 h depending on postnatal age and serum creatinine levels, and newborns in Group B received 4-5 mg/kg/dose q24-48 h depending on postconceptional and postnatal age. All peak and trough serum drug levels, demographic data, and markers of potential nephrotoxicity and ototoxicity were compared. RESULTS: Peak serum gentamicin levels were significantly higher (8.2+/-0.22 microg/ml vs. 5.9+/-0.13 microg/ml; p Subject(s)
Gentamicins/therapeutic use
, Systemic Inflammatory Response Syndrome/drug therapy
, Creatinine/metabolism
, Drug Administration Schedule
, Gentamicins/administration & dosage
, Humans
, Infant, Newborn
, Infant, Premature
, Prospective Studies
ABSTRACT
Introducción: La gentamicina es uno de los antibióticos más utilizado en el tratamiento de las infecciones bacterianas graves del recién nacido y diferentes pautas de dosificación de gentamicina han sido recomendadas en este grupo poblacional. Objetivo: Comparar las concentraciones séricas, la eficacia y la toxicidad de dos pautas de dosificación de gentamicina en recién nacidos a término y pretérmino. Material y métodos: Se evaluó prospectivamente a 200 recién nacidos que recibieron tratamiento con gentamicina. En el grupo A (n = 100) se administró según una pauta de múltiples dosis diarias (2,5-3,5 mg/kg/dosis cada 12-18 h), dependiendo de la edad posnatal y las concentraciones séricas de creatinina. En el grupo B (n = 100) se administró en pauta de única dosis diaria (4-5 mg/kg/dosis cada 24-48 h), según la edad posnatal y posconcepcional. Entre ambos grupos se compararon las concentraciones pico y valle séricas de gentamicina, los datos generales y la prevalencia de nefrotoxicidad y ototoxicidad. Resultados: Las concentraciones pico de gentamicina fueron significativamente superiores (8,2 ± 0,22 μg/ml frente a 5,9 ± 0,13 μg/ml; p £ 0,001) y las concentraciones valle fueron significativamente inferiores (0,9 ± 0,06 μg/ml frente a 1,7 ± 0,08 μg/ml; p £ 0,001) en el grupo B. No hubo diferencias significativas entre ambos grupos respecto a la eficacia clínica, o a la prevalencia de nefrotoxicidad u ototoxicidad. Conclusiones: La pauta de gentamicina en única dosis diaria es efectiva, segura y disminuye el riesgo de concentraciones séricas fuera de rango terapéutico en recién nacidos pretérmino y a término (AU)
Introduction: Gentamicin is widely used in full-term neonates as empirical therapy for early-onset suspected or proven sepsis. Several dosing schedules for gentamicin have been recommended for this neonatal population. Objective: To compare gentamicin serum levels, efficacy and toxicity of two dosing schedules in term and preterm newborns. Material and methods: The study included 200 newborns who were started on gentamicin therapy. Group A (N = 100) was prescribed a multiple-daily dosing regimen and Group B (N = 100) on a once-daily dosing regimen. Newborns in Group A received gentamicin at 2.5-3.5 mg/kg/dose q12-18 h depending on postnatal age and serum creatinine levels, and newborns in Group B received 4-5 mg/kg/dose q24-48 h depending on postconceptional and postnatal age. All peak and trough serum drug levels, demographic data, and markers of potential nephrotoxicity and ototoxicity were compared. Results: Peak serum gentamicin levels were significantly higher (8.2 ± 0.22 μg/ml vs. 5.9 ± 0.13 μg/ml; p £ 0.001) and trough levels were significantly lower (0.9 ± 0.06 μg/ml vs. 1.7 ± 0.08 μg/ml; p £ 0.001) in Group B than in Group A. There was no significant difference between the groups either in the clinical failure rate or in the nephrotoxicity or ototoxicity outcomes. Conclusions: Once-daily dosing regimen of gentamicin in preterm and term newborns is safe and effective, with a reduced risk of serum drug concentrations falling outside the therapeutic range (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Gentamicins/therapeutic use , Dose-Response Relationship, Drug , Efficacy/methods , Treatment Outcome , Apgar Score , Bronchopneumonia/drug therapy , Pneumonia, Aspiration/drug therapy , Meconium Aspiration Syndrome/drug therapy , Homeopathic Dosage/classification , Homeopathic Dosage/standards , Sepsis/complications , Sepsis/drug therapy , Ampicillin/therapeutic use , Metronidazole/therapeutic use , Cloxacillin/therapeutic useABSTRACT
No disponible
No disponible
Subject(s)
Male , Female , Child , Humans , Health Services Misuse/statistics & numerical data , Munchausen Syndrome by Proxy/epidemiology , Health Services Needs and Demand/trends , Child Health Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Anxiety/epidemiologyABSTRACT
No disponible
Subject(s)
Infant, Newborn , Infant , Child , Child, Preschool , Humans , Primary Health Care/statistics & numerical data , Child Health Services/statistics & numerical data , Pediatrics , Prospective StudiesABSTRACT
AIM: To know the influence of mother's anxiety in the number of office visits made by the children al primary care paediatric setting. DESIGN: Case control study. SETTING: Primary care. 17th Health Area. Valencian Community. Spain. PATIENTS: 134 mothers. Overuse was defined as number of visits higher than the average of visits in all children plus one standard deviation in a certain period. 14.89% were over users. 46 mothers (35.12%) from over user children and 85 (64.88%) from non over users. MEASURES: Anxiety scale STAI (Spielberger State-Trait Anxiety Inventory) short form. Mother's job and number of mother's children. RESULTS: Mother's of over user's children score higher in STAI scale. Number of children or mother's job is not associated with STAI scores. In multivariate analysis anxiety is an important factor associated to over user's children. CONCLUSIONS: Mother's anxiety is associated with over user's children in primary care paediatric setting. This is a modifiable factor to influence in the number of inappropriate office visits.
Subject(s)
Anxiety , Child Health Services/statistics & numerical data , Health Services Misuse , Mother-Child Relations , Mothers/psychology , Office Visits/statistics & numerical data , Primary Health Care , Adolescent , Adult , Age Factors , Anxiety/diagnosis , Case-Control Studies , Child , Child, Preschool , Employment , Family Characteristics , Female , Humans , Infant , Infant, Newborn , Male , Manifest Anxiety Scale , Multivariate Analysis , Odds Ratio , Prospective StudiesABSTRACT
Objetivo. Conocer la influencia de la ansiedad materna en la frecuentación de las consultas de pediatría de atención primaria. Diseño. Estudio de casos y controles. Emplazamiento. Consultas de pediatría del Área 17 de la Comunidad Valenciana. Participantes. Se incluyó en el estudio a 131 mujeres, 46 de ellas (35,12%) madres de niños hiperfrecuentadores definidos por haber superado la media de consultas más 1 desviación estándar en un período determinado, y 85 madres de niños normofrecuentadores (64,88%). Mediciones principales. Puntuación en escala de ansiedad STAI (ansiedad estado y ansiedad rasgo), presencia de ansiedad (definida cuando superan el percentil 50), relación entre la puntuación en las escalas y la situación laboral materna, y número de hijos. Resultados. Las puntuaciones de las madres de los hiperfrecuentadores son significativamente más elevadas. No obtenemos diferencias en los resultados según el número de hijos y la situación laboral materna. En el análisis multivariable, la variabilidad explicada aumenta al considerar la ansiedad (el 22,7 frente al 14,9%). Conclusiones. La ansiedad materna influye en la hiperfrecuentación de los niños. Las madres de los hiperfrecuentadores presentan puntuaciones más elevadas en las escalas de ansiedad. Éste puede ser uno de los pocos factores modificables, susceptible de intervención, para intentar reducir la hiperfrecuentación en pediatría
Aim. To know the influence of mother's anxiety in the number of office visits made by the children al primary care paediatric setting. Design. Case control study. Setting. Primary care. 17th Health Area. Valencian Community. Spain. Patients. 134 mothers. Overuse was defined as number of visits higher than the average of visits in all children plus one standard deviation in a certain period. 14.89% were over users. 46 mothers (35.12%) from over user children and 85 (64.88%) from non over users. Measures. Anxiety scale STAI (Spielberger State-Trait Anxiety Inventory) short form. Mother's job and number of mother's children. Results. Mother's of over user's children score higher in STAI scale. Number of children or mother's job is not associated with STAI scores. In multivariate analysis anxiety is an important factor associated to over user's children. Conclusions. Mother's anxiety is associated with over user's children in primary care paediatric setting. This is a modifiable factor to influence in the number of inappropriate office visits
Subject(s)
Infant, Newborn , Infant , Child , Adult , Adolescent , Child, Preschool , Humans , Anxiety/diagnosis , Health Services Misuse , Mother-Child Relations , Mothers/psychology , Primary Health Care , Office Visits , Child Health Services , Age Factors , Case-Control Studies , Employment , Family Characteristics , Manifest Anxiety Scale , Multivariate Analysis , Odds Ratio , Prospective StudiesABSTRACT
La hiperfrecuentación es un problema con importantes repercusiones, no sólo sobre los profesionales, sino sobre todo el sistema sanitario, ya que las personas que se comportan como hiperfrecuentadores generan una sobrecarga asistencial y consumen gran parte de los recursos. El presente trabajo se plantea con el objetivo de analizar los datos disponibles acerca de la hiperfrecuentación en las consultas de pediatría de atención primaria y los factores asociados con ella. Numerosas variables han resultado influyentes, pero la poca variabilidad que explican hace pensar que puede haber todavía muchas que no se han analizado. Entre las variables conocidas, debería considerarse la ansiedad materna, ya que es una de las pocas modificables y, por tanto, potencialmente reducibles. No es un problema que deba abordarse a corto plazo. La condición de hiperutilizador tiende a mantenerse constante, y ser hiperfrecuentador durante la infancia puede condicionar la utilización de servicios al alcanzar la edad adulta. Nuestros esfuerzos deben dirigirse a intentar modificar el comportamiento de estos niños, y por tanto de sus familias, lo que redundaría en una reducción de la presión asistencial de las consultas y mejoraría la calidad asistencial (AU)
Subject(s)
Humans , Primary Health Care , Referral and Consultation , Patients/psychology , Health Services Misuse , Causality , Incidence , Epidemiologic FactorsABSTRACT
OBJECTIVE: We report the results of survival and incidence of neurodevelopmental sequelae in a group of 249 infants treated in our hospital between 1986-91, whose birth weight was under 1,500 grams. METHOD: We perform a follow-up at corrected ages of 3, 6, 10, 18, 36 months and 5 years thought results only included children followed until 18. Sequelae were classified in three groups, according to the disability degree. RESULTS: Survival resulted to be 69.87% (174), 38.7% for the group under 1,000 grams and 84.7% for those over 1,000 grams. Sequelae were present in 22.6% (11.6% moderate and 10.9% severe). The incidence of severe sequelae was very different on basis of the birth weight, 25.8% for children under 1,000 grams, 13.9% for 1,000-1,249 grams and 1.6% for 1,250-1,500 grams. CONCLUSIONS: Intracranial haemorrhage, hyperbilirubinemia, assisted ventilation and persistence of ductus arteriosus were significantly associated sequelae. We didn't find differences with respect to multiple pregnancy, seizures, sepsis or neonatal hypoxia.
Subject(s)
Infant, Very Low Birth Weight , Female , Follow-Up Studies , Gestational Age , Humans , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Pregnancy , Prognosis , Retrospective StudiesABSTRACT
We have studied a population of 60 children with acute diarrhea. In order to evaluate the benefit of lactose suppression from the diet on the clinical course of the disease, these children were randomly assigned to either the control group or the experimental group. No differences were found in respects to the duration of the illness (lactose containing formula 4.8 +/- 2 days vs lactose free formula 4.4 +/- 3.1 days). Similarly, body weight change did not change significantly (12.5 +/- 235.8 gr vs 55.9 +/- 238.0 gr, t-test non-significant). Children fed with the lactose free diet voided less frequently than did children in the control group (12.8 +/- 10.5 vs 19.8 +/- 9.5 times; p < 0.01). This difference disappeared when only invasive diarrheas were considered (26.6 +/- 12 vs 21.5 +/- 9.5 voidings; t-test nonsignificant). Finally, only 2 of the 32 cases fed with lactose containing formula showed clinical intolerance to lactose. Therefore, we conclude that in patients with mild-to-moderate acute diarrhea, the resumption of feeding should be undertaken with the same formula that they were previously fed, restricting the use of lactose free formulas to selected cases and to those children in whom a standard milk made symptoms reappear.
Subject(s)
Diarrhea, Infantile/drug therapy , Infant Food , Lactose/administration & dosage , Acute Disease , Body Weight , Chi-Square Distribution , Diarrhea, Infantile/epidemiology , Diarrhea, Infantile/physiopathology , Feces/chemistry , Feces/microbiology , Humans , Hydrogen-Ion Concentration , Infant , Treatment FailureABSTRACT
The cases of 131 newborns with positive blood cultures have been reviewed. These children were born in our hospital between 1985 and 1990. We found that the incidence of sepsis was 4.3/1000 newborns. Early neonatal sepsis was the most frequent, representing 58% of the cases. Late sepsis in hospitalized infants represented 1.34% of the cases. Streptococcus B was the microorganism most frequently isolated (26.7%), followed by S. epidermidis (19.8%), E. coli (13.7%) and S. aureus (10.68%). In over 50% of the cases of early sepsis, maternal-fetal risk factors were present. Mortality was 7.6%, with half of these cases due to Streptococcus B.
Subject(s)
Sepsis/microbiology , Cross Infection , Escherichia coli Infections/epidemiology , Escherichia coli Infections/microbiology , Female , Humans , Incidence , Infant, Newborn , Male , Sepsis/epidemiology , Sepsis/etiology , Spain/epidemiology , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Streptococcal Infections/epidemiology , Streptococcal Infections/microbiology , Streptococcus agalactiae/isolation & purificationABSTRACT
We report the case of a 13 month old male infant with visceral leishmanisis. The clinical picture was suggestive of kala-azar, but a bone marrow aspirate was negative, so treatment was not started. During the course of the process an urinary infection was documented and therapy with aminoglycosides was begun. At this time we observed that hepato--and spleno--megaly diminished and then disappeared and clinical manifestations improved. We later received a positive serology for Leishmania donovani. We review the medical literature in respect to this therapeutic possibility.
