BACKGROUND:Congenital cytomegalovirus infection (CMVc) affects 0.7%–6% of recent births. Among its clinical manifestations are low weight and length at birth.
OBJECTIVE:Describe the growth patterns ...of children with CMVc in their early years.
METHODS:Observational, multicenter study of patients with CMVc. Anthropometric data were collected during the first 2 years of life and compared with World Health Organization standards.
RESULTS:Anthropometric characteristics of 383 children with CMVc were studied, of which 198 (51%) were symptomatic at birth. At birth, 9% were small for gestational age (SGA) in terms of their weight and length and 17% had microcephaly. At 24 ± 3 months, 10% had a weight and length ≤2 SD, and 13% a head circumference ≤2 SD. Of those who were SGA at birth, at 24 ± 3 months >20% remained at ≤2 SD of their weight and length. Conversely, 75% of children with low weight or length at 24 ± 3 had not been SGA at birth. 20% of infants with microcephaly at birth remained with microcephaly, and 10% of those without microcephaly developed it at 24 ± 3 months. The average growth rate in length and weight was normal. Patients who were symptomatic at birth, premature and with motor and neurocognitive impairment had a significantly higher risk of low weight and length at 24 ± 3 months.
CONCLUSION:Around 10% of children with CMVc are at ≤2 SD in weight, length and head circumference at 24 ± 3 months. The lack of adequate growth is associated with symptoms at birth, prematurity and motor and neurocognitive impairment. Growth impairment could be incorporated into the symptomatic spectrum of CMVc.
Aim
This study evaluated using urine dipstick tests with the clean‐catch method to screen for urinary tract infection (UTI) in febrile infants under 90 days of age.
Methods
We carried out a ...comparative diagnostic accuracy study of infants under 90 days old, who were studied for unexplained fever without any source, in the emergency room of a hospital in Madrid from January 2011 to January 2013. We obtained matched samples of urine using two different methods: a clean‐catch, standardised stimulation technique and catheterisation collection. The results of the leucocyte esterase test and nitrite test were compared with their urine cultures.
Results
We obtained 60 pairs of matched samples. A combined analysis of leukocyte esterase and, or, nitrites yielded a sensitivity of 86% and a specificity of 80% for the diagnosis of UTIs in clean‐catch samples. The sensitivity of leukocyte esterase and, or, nitrites in samples obtained by catheterisation were not statistically different to the clean‐catch samples (p = 0.592).
Conclusion
Performing urine dipstick tests using urine samples obtained by the clean‐catch method was an accurate screening test for diagnosing UTIs in febrile infants of less than 90 days old. This provided a good alternative to bladder catheterisation when screening for UTIs.
To evaluate the accuracy of diagnosing urinary tract infections using a new, recently described, standardized clean-catch collection technique.
Cross-sectional study of infants <90 days old admitted ...due to fever without a source, with two matched samples of urine obtained using two different methods: clean-catch standardized stimulation technique and bladder catheterization.
Sixty paired urine cultures were obtained. The median age was 44-days-old. Seventeen percent were male infants. Clean-catch technique sensitivity was 97% (95% CI 82% to 100%) and specificity was 89% (95% CI 65% to 98%). The contamination rate of clean-catch samples was lower (5%) than the contamination rate of catheter specimens (8%).
The sensitivity and specificity of urine cultures obtained using the clean-catch method through the new technique were accurate and the contamination rate was low. These results suggest that this technique is a valuable, alternative method for urinary tract infection diagnosis.
Ventilatory settings were adjusted in volume control to achieve a tidal volume of 480 ml (6 ml/kg), positive end-expiratory pressure of 5 mmHg and respiratory rate (RR) of 14/min. A further arterial ...blood gas analysis showed a pH of 7.35, PaCO 2 of 43.8 mmHg and partial pressure of oxygen of 368 mmHg on a fraction of inspired oxygen (FiO 2 ) of 0.5.
Objective To assess whether dexamethasone (DXM) decreases the time to recovery in patients with parapneumonic pleural effusion. Study design This was a multicenter, randomized, double blind, ...parallel-group, placebo-controlled clinical trial of 60 children, ranging in age from 1 month to 14 years, with community-acquired pneumonia (CAP) and pleural effusion. Patients received either intravenous DXM (0.25 mg/kg/dose) or placebo every 6 hours over a period of 48 hours, along with antibiotics. The primary endpoint was the time to recovery in hours, defined objectively. We also evaluated complications and adverse events. Results Among the 60 randomized patients (mean age, 4.7 years; 58% female), 57 (95%) completed the study. Compared with placebo recipients, the patients receiving DXM had a shorter time to recovery, after adjustment by severity group and stratification by center (hazard ratio, 1.95; 95% CI, 1.10-3.45; P = .021). The median time to recovery for patients receiving DXM was 68 hours (2.8 days) shorter than patients receiving placebo (109 hours vs 177 hours; P = .037). In exploratory subgroup analysis, the median time to recovery for patients with simple effusion receiving DXM was 76 hours (3.1 days) shorter than for patients with simple effusion receiving placebo ( P = .017). The median time to recovery for patients with complicated effusion receiving DXM was 14 hours (0.5 days) shorter than for patients with complicated effusion receiving placebo ( P = .66). The difference in the effect of DXM in the 2 severity groups was not statistically significant ( P = .138 for interaction). There were no significant differences in complications or adverse events attributable to the study drugs, except for hyperglycemia. Conclusion In this trial, DXM seemed to be a safe and effective adjunctive therapy for parapneumonic pleural effusion. Trial registration ClinicalTrials.gov : NCT01261546.
Objective To compare the incidence and epidemiology of bacteremic community-acquired pneumonia (CAP) in the setting of changes in 13-valent pneumococcal conjugate vaccine (PCV13) coverage. Study ...design In the region of Madrid, universal immunization with the PCV13 started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. We performed a multicenter surveillance and case-control study from 2009-2014. Cases were hospitalized children with bacteremic CAP. Controls were children selected 1:1 from next-admitted with negative blood cultures and typical, presumed bacterial CAP. Results Annual incidence of bacteremic CAP declined from 7.9/100 000 children (95% CI 5.1-11.1) in 2009 to 2.1/100 000 children (95% CI 1.1-4.1) in 2012. In 2014, 2 years after PCV13 was withdrawn from the universal vaccination program, the incidence of bacteremic CAP increased to 5.4/100 000 children (95% CI 3.5-8.4). We enrolled 113 cases and 113 controls. Streptococcus pneumoniae caused most of bloodstream infections (78%). Empyema was associated with bacteremia ( P = .003, OR 3.6; 95% CI 1.4-8.9). Simple parapneumonic effusion was not associated with bacteremia. Incomplete PCV immunization was not a risk factor for bacteremic pneumonia. Conclusions High rate of PCV13 immunization was associated with decreased incidence of bacteremic CAP; this incidence increased when rate of immunization fell. Empyema (but not parapneumonic pleural effusion) was associated with bacteremia.
To describe a tuberculosis outbreak in a primary school arising from a secondary case.
Contact study and clinical study of exposed patients. Chest x-ray, gastric aspirate processing, and clinical ...evaluation of all children with a positive tuberculin skin test (TST) were recorded. Differential diagnosis between tuberculosis disease (TB) and latent tuberculosis infection (LTI).
Two groups were identified: one of higher exposure to the index case (> 6 hours/day, for 3 months; n=17 children) and one of sporadic exposure (< 6 hours/day; n=82 children). Clinical or bacteriological criteria for diagnosing TB were seen in 6 out of 17 (35%) highly exposed children. Four of them had clinical or radiological criteria. The other two children were asymptomatic and had a normal chest X ray, but had a positive gastric aspirate for M. tuberculosis. The overall infection rate (TB+LTI) was 94%. One child out of 82 (1.2%) sporadically exposed children had radiological criteria for TB. Staff latent infection rate was 15%. Apart from the index case, there were no other tuberculosis cases among the staff. Relative risk (RR) of exposed children was 28.5 (95% CI: 3-250).
Prolonged exposure to a baciliferous patient may infect almost every child exposed in closed groups. It can also cause a high attack rate. In this scenario, routine gastric aspirate may be considered for all children with a positive TST. It may identify early subclinical TB with an increased probability of isolating the M. tuberculosis. The potential benefit of this isolation may reach the entire cohort.
OBJECTIVE: To evaluate the accuracy of diagnosing urinary tract infections using a new, recently described, standardized clean-catch collection technique. METHODS: Cross-sectional study of infants 90 ...days old admitted due to fever without a source, with two matched samples of urine obtained using two different methods: clean-catch standardized stimulation technique and bladder catheterization. RESULTS: Sixty paired urine cultures were obtained. The median age was 44-days-old. Seventeen percent were male infants. Clean-catch technique sensitivity was 97% (95% CI 82% to 100%) and specificity was 89% (95% CI 65% to 98%). The contamination rate of clean-catch samples was lower (5%) than the contamination rate of catheter specimens (8%). CONCLUSIONS: The sensitivity and specificity of urine cultures obtained using the clean-catch method through the new technique were accurate and the contamination rate was low. These results suggest that this technique is a valuable, alternative method for urinary tract infection diagnosis. 19 references
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