Selective neonatal BCG vaccination.

AIMS: To assess the implementation of the "Selective Neonatal BCG Immunisation Policy", and to study the causes of non-compliance, or failure of uptake of BCG immunization. METHODS: The Birth Register data were used to generate a list of babies born in the catchment area of Basildon and Thurrock NHS Trust between 1 January 2001 and 31 December 2001 who were eligible for BCG immunization. The Community Child Health computer was used to generate information about their BCG immunization status. RESULTS: 201 children were included in the study. One hundred and seventy-one children had received BCG immunization in the neonatal period, out of which 169 had received it before discharge from the hospital. Two children were immunized in the community in the neonatal period. Thus, 85% of the newborns eligible for BCG immunization received their vaccination in the neonatal period. CONCLUSIONS: The current "Neonatal BCG Immunisation Policy" is effective, and there is a high uptake of the vaccine in the neonatal period within the hospital itself. Newborn infants who do not receive BCG immunization in hospital rarely get immunized in the community.

Idiopathic interstitial pneumonitis in children: a national survey in the United Kingdom and Ireland.

Interstitial lung disease (ILD) of unknown etiology in immunocompetent patients is rare in children. A national survey was carried out in the United Kingdom and Ireland over a 3-year period in order to identify prevalence, age distribution, histopathology, natural history of the illness, and response to current treatment.Forty-six cases were identified, including 29 males and 17 females. Seventy-six percent presented in the first year of life. Nine (16%) occurred within four families. Conventional treatment with pulsed methylprednisolone, prednisolone, or hydroxychloroquine, singly or in combination, resulted in an excellent response in 65% of cases. Seven children died (15%). The recurrence risk for further children within the same family to develop ILD is estimated to be approximately 10%. The prevalence rate of this condition in the United Kingdom and Ireland during the period of study for children aged 0-16 years is estimated to be 3.6 cases/million.

Breastfeeding patterns in Fujairah, United Arab Emirates.

The rate of breastfeeding initiation and continuation through the first 6 months of life were assessed via interview and telephone follow-up in a prospective study of 130 mothers who consecutively delivered in hospital in Fujairah, UAE. The rate of initiation (83.2 per cent) and continuation at 2 months (72.6 per cent) was not significantly different from earlier studies. However, the rate of breastfeeding at 6 months (46.9 per cent) was lower than a 1992 study (p = 0.02). There were no significant associated factors with not breastfeeding at discharge from the maternity hospital and 2 months later. However, a significant inverse relationship with the level of general education of the mother for breastfeeding at 6 months was found, which is in contradistinction to Western countries where the rate of breastfeeding rises with increasing general education. This has implications for the type and targeting of future breastfeeding education programmes.

Comparison of two strip test methods of whole blood glucose measurement in the neonatal period.

UNLABELLED: The aim of this study was to compare the performance and accuracy of the BM Strip test used in conjunction with Reflectance photometry, and the new non-wipe strip test (Advantage) against a reference plasma glucose method. In total, 114 newborns consecutively admitted to the Neonatal Unit over a 6 mo period were enrolled into the study. Each newborn had their venous blood glucose measured by the BM Strip test and Advantage glucometer and the venous haematocrit was also determined. Plasma glucose was measured in the laboratory by the hexokinase method. The mean difference between the BM Strip test and plasma glucose was significantly less than the corresponding value for the Advantage glucometer (0.312, 95% confidence interval (CI) 0.11-0.51 vs 0.766, 95% CI 0.57-0.95], although the limits of agreement between both methods and plasma glucose were wide. Haematocrit did not influence significantly the accuracy of either test. CONCLUSION: The new Advantage glucose meter does not offer any advantage over the BM Strip test. Owing to the wide limits of agreement of both methods compared with plasma glucose, their clinical value is limited in the neonatal period.

Comparison of EML 105 and advantage analysers measuring capillary versus venous whole blood glucose in neonates.

AIM: Near-patient blood glucose monitoring is an essential component of neonatal intensive care but the analysers currently used are unreliable and inaccurate. The aim of this study was to compare a new glucose electrode-based analyser (EML 105) and a non-wipe reflectance photometry method (Advantage) as opposed to a recognized laboratory reference method (Hexokinase). We also investigated the effect of sample route and haematocrit on the accuracy of the glucose readings obtained by each method of analysis. METHODS: Whole blood glucose concentrations ranging from 0 to 3.5 mmol/l were carefully prepared in a laboratory setting and blood samples from each respective solution were then measured by EML 105 and Advantage analysers. The results obtained were then compared with the corresponding plasma glucose reading obtained by the Hexokinase method, using linear regression analysis. An in vivo study was subsequently performed on 103 neonates, over a 1-y period, using capillary and venous whole blood samples. Whole blood glucose concentration was estimated from each sample using both analysers and compared with the corresponding plasma glucose concentration estimated by the Hexokinase method. Venous blood was centrifuged and haematocrit was estimated using standardized curves. The effect of haematocrit on the agreement between whole blood and plasma glucose was investigated, estimating the degree of correlation on a scatterplot of the results and linear regression analysis. RESULTS: Both the EML 105 and Hexokinase methods were highly accurate, in vitro, with small proportional biases of 2% and 5%, respectively. However, in vivo, both study analysers overestimated neonatal plasma glucose, ranging from at best 0.45 mmol/l (EML 105 venous) to 0.69 mmol/l (EML capillary). There was no significant difference in the agreement of capillary (GD = 0.12, 95% CI, [-0.32,0.08], p = 0.2) or venous samples (GD = 0.05, 95% CI. [0.09, 0.19], p = 0.49) with plasma glucose when analysed by either study method (GD = glucose difference between study analyser and reference method) However, the venous samples analysed by EML 105 estimated plasma glucose significantly better than capillary samples using the same method of analysis (GD = 0.24, 95% CI. [0.09,0.38], p < 0.01). The relationship between haematocrit and the resultant glucose differences was non-linear with correlation coefficients of r = -0.057 (EML 105 capillary), r = 0.145 (EML 105 venous), r = -0.127 (Advantage capillary) and r = -0.275 (Advantage venous). There was no significant difference in the effect of haematocrit on the performance of EML 105 versus Advantage, regardless of the sample route. CONCLUSION: Both EML 105 and Advantage overestimated plasma glucose, with no significant difference in the performance of either analyser, regardless of the route of analysis. Agreement with plasma glucose was better for venous samples but this was only statistically significant when EML 105 capillary and venous results were compared. Haematocrit is not a significant confounding factor towards the performance of either EML 105 or Advantage in neonates, regardless of the route of sampling. The margin of overestimation of blood glucose prohibits the recommendation of both EML 105 and Advantage for routine neonatal glucose screening. The consequences include failure accurately to diagnose hypoglycaemia and delays in the instigation of therapeutic measures, both of which may potentially result in an adverse, long-term, neurodevelopmental outcome.

The inaccuracy of venous and capillary blood glucose measurement using reagent strips in the newborn period and the effect of haematocrit.

The purpose of this study was to compare the accuracy of capillary and venous reagent strip tests (RST) against a reference plasma glucose method, and to assess the impact of haematocrit. One hundred and eighty infants admitted to the Neonatal Unit had blood glucose measured by reagent strip tests using capillary and venous blood samples. Venous plasma glucose was assayed by the Hexokinase method. Each infant had a venous haematocrit performed in the Neonatal Unit. Comparable inaccuracies were noted with both capillary and venous reagent strip tests at all levels. The mean difference between capillary RST and plasma glucose was 0.058 mmol/l (S.D. 1.39). The corresponding mean venous RST plasma glucose difference was 0.138 mmol/l (S.D. 0.96). The two means were statistically different from each other (P = 0.024), but this difference disappeared if the comparison was made only in babies with a PCV of 35-55%. At higher haematocrits (PCV >55%, N= 96) the mean difference between venous RST and plasma glucose was significantly more than the mean difference between capillary RST and plasma glucose (0.018 versus 0.295. P = 0.002). Hence the higher the haematocrit the more inaccurate the venous RST. This study confirms the limited value of reagent strip tests in the assessment of blood glucose in the neonatal period. It suggests that venous RST may be more inaccurate in comparison to capillary and that high haematocrits have a greater effect on venous RST than capillary RST.

Deletion of chromosome 18 with cardiomyopathy.

A female child is described with deletion of chromosome 18 and cardiomyopathy. The clinical features and treatment of the case are described, and the literature of chromosome 18 reviewed.

Use of rapid dipstick tests to exclude urinary tract infection in children.

Children presenting with symptoms attributable to urinary tract infection (UTI) are not uncommonly referred to paediatric departments for assessment. The aim of this study was to evaluate the use of rapid dipstick tests in the diagnosis of urinary tract infection in children. Urine was collected from 375 children admitted to a general paediatric ward, in whom UTI was a possibility on clinical grounds. Of these, 124 were less than one year old. Urine was tested with a dipstick for the presence of nitrite and leucocyte esterase. Bacterial culture and examination for white cells, red cells and other formed elements were performed. The results of the dipstick tests, microscopy and culture were correlated with the clinical details. Combination of a negative dipstick test for nitrite and leucocyte esterase showed a negative predictive value for UTI of 96.9% and a specificity of 98.7%. In children less than a year old these values were 96.7% and 99.2% respectively. The leucocyte esterase strip test showed a negative predictive value for pyuria of 94.3% with a specificity of 86.9%. In children less than a year old these values were 93.1% and 84.4% respectively. The use of dipsticks for the detection of urinary nitrate and leucocyte esterase in daily clinical practice is recommended. In children, the absence of both nitrite and leucocyte esterase in urine indicates that UTI is unlikely; however, positive dipstick tests for nitrite and/or leucocyte esterase are not specific indicators of UTI, and should not be used in place of laboratory examination. The dipstick method is most likely to be useful as a screening test to exclude UTI in children, but may be less suitable for infants. It should not be used to diagnose urinary tract infection.

Comparison of two methods of measurement of whole blood glucose in the neonatal period.

The purpose of this study was to compare the performance and accuracy of the HemoCue B-Glucose photometer system and reagent strip tests used in conjunction with reflectance photometry against a reference plasma glucose method. One hundred consecutive babies admitted to the neonatal unit over a 6-month period were enrolled in the study. Each baby had a heelprick capillary glucose measured by HemoCue and reagent strip tests. At the same time venous plasma glucose and haematocrit were measured. The mean difference between the reagent strip test and plasma glucose was significantly less than the corresponding value for the HemoCue (0.015 +/- 1.41 vs 0.837 +/- 1.565 mmol l-1, mean +/- SD); however, the agreement limits between both methods and plasma glucose were wide. No significant effect of haematocrit was detected on either method. The HemoCue photometer does not offer any advantage over the widely used reagent strip tests in the neonatal period. However, the limits of agreement of both methods compared with plasma glucose are too wide to be clinically acceptable in the neonatal period.

Isolated aplasia of the anterior pituitary gland with unusual associations.

A male infant was found to have cleft lip and palate with micropenis at birth. He suffered recurrent episodes of hypoglycaemia in the first 3 days. CT scan showed possible incomplete division of the frontal lobes and endocrinological investigations confirmed hypopituitarism. He developed renal and respiratory failure and died at the age of 10 days. Post mortem showed an absent adenohypophysis, an intact neurohypophysis, absent olfactory tracts and polysplenia.