Infant Sleep Position and the Sudden Infant Death SyndromeCarolan, Patrick L.; Moore, James R.; Luxenberg, Michael G.
doi: 10.1177/000992289503400801pmid: 7586905
A questionnaire survey was conducted to assess the impact of the April 1992 American Academy of Pediatrics Task Force Statement, "Infant Positioning and SIDS," on the routine advice provided by pediatricians in Minnesota to families with newborn infants regarding sleep practices, including sleep position. There was a trend toward more discussion between all pediatric practice groups and families regarding infant sleep practices following the AAP Sleep Position Statement (P<0.001-0.003). Prone sleep recommendations ranged from 9.2% for newborn infants to 21.4% for infants 6 months of age. Recommendations for the supine or lateral sleep positions predominated at all infant ages. Pediatricians in private practice were more likely to identify the AAP Statement as establishing a medicolegal standard (P<0.05). We conclude that the 1992 AAP Statement has had a significant impact on the routine advice provided to families regarding infant sleep practices, including infant sleep position.
The Timing of SIDS Deaths in Premature Infants in an Urban PopulationLipsky, Caren L.; Gibson, Eric; Cullen, James A.; Rankin, Kathleen; Spitzer, Alan R.
doi: 10.1177/000992289503400802pmid: 7586906
Previous reports have demonstrated that premature infants are at greatly increased risk for sudden infant death syndrome (SIDS). Although only 9% of infants are born at less than 36 weeks' gestation, 20% of SIDS victims are former premature infants. The objective of this study was to characterize the time course of SIDS in premature infants and to determine why SIDS occurs at such a high rate in this patient population. A database of all cases of SIDS in Philadelphia from 1987 through 1991 was used to establish the time course for SIDS deaths in term and preterm infants. Gestational age was established by Dubowitz exam. To evaluate distinctly different age groups, infants from 32-36 weeks were excluded from analysis. Age at death and postconceptional age of death were compared for both groups. Data are described in weeks (mean ± SEM), and analyzed using unpaired t-test and log-rank test to compare survival rate between term and preterm infants. A significant difference (P<0.01) was noted in age at death of term versus preterm infants. No difference was found in postconceptional age of death. The survival rates were also different (P<0.001). Preterm infants showed a much wider distribution in age of death from SIDS. The term infants followed the classic SIDS curve. By 32 weeks' postnatal age, 95% of all SIDS had taken place in the term group, but only 75% in the preterm group. The age at death for SIDS differs in the preterm infant. These data reinforce the concept of prolonged vulnerability of preterm infants to SIDS. Survival of greater numbers of premature infants makes it increasingly important to focus efforts for SIDS prevention in this group for a longer period of time.
The Management of Prepubertal Children with GonorrheaChristian, Cindy W.; Pinto-Martin, Jennifer A.; McGowan, Karin L.
doi: 10.1177/000992289503400803pmid: 7586907
To determine whether test-of-cure cultures are necessary for prepubertal children diagnosed with Neisseria gonorrhoeae, we examined the records of all 66 patients <10 years old seen at Children's Hospital of Philadelphia over a 7.5-year period (1987-1994) diagnosed with gonorrhea. Ninety-eight percent had genital discharge on examination. All children with genital gonorrhea were symptomatic, but only 10% of children with rectal gonorrhea and 20% with pharyngeal infection were symptomatic. Seventy-seven percent of children were treated with ceftriaxone. Of these, 72% returned for test-of-cure cultures. Ninety-three percent of children had complete resolution of physical symptoms at test-of-cure, and all follow-up cultures were negative for N. gonorrhoeae. Our data suggest that most prepubertal children with gonorrhea are symptomatic at initial presentation and are cured after recommended treatment with ceftriaxone. The Centers for Disease Control and Prevention recommendations for obtaining test-of-cure cultures in young children with gonorrhea are unnecessary, potentially harmful, and should be revised.
Gonococcal and Chlamydial Genitourinary Infections in Symptomatic and Asymptomatic Adolescent WomenBiro, Frank M.; Rosenthal, Susan L.; Kiniyalocts, Melissa
doi: 10.1177/000992289503400804pmid: 7586908
To determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae endocervical infections in a group of adolescent women, gynecologic histories and evaluations were done on symptomatic and asymptomatic adolescent women presenting for pelvic examinations in an urban, hospital-based, adolescent clinic. C. trachomatis and N. gonorrhoeae cultures and three nonculture diagnostic tests for chlamydia (two ELISA assays and one DNA-probe) were performed on each patient. Patients were 12 to 21 years of age (mean 17.0); 53% were African-American, and 47% were Caucasian. Two hundred twenty-eight women were asymptomatic and 249 women had symptoms. There were 64 cases of chlamydia and 19 cases of gonorrhea; an additional 11 patients had both chlamydia and gonorrhea. Approximately one third of patients with chlamydia, gonorrhea, or both had asymptomatic disease, an important reservoir of infection.
Time of Onset of Necrotizing Enterocolitis in Newborn Infants with Known Prenatal Cocaine ExposureLopez, Susanna L.; Taeusch, H. William; Findlay, Richard D.; Walther, Frans J.
doi: 10.1177/000992289503400805pmid: 7586909
Cocaine exposure can lead to diminished gut-blood supply and thereby contribute to the pathogenesis of necrotizing enterocolitis (NEC). Investigating the hypothesis that NEC occurs at a younger age in cocaine-exposed infants, we reviewed 1,284 neonatal intensive care admissions. Infants with NEC were divided into cocaine-exposed and cocaine-nonexposed groups, each subdivided into two birth-weight groups, using 1,500 g as the cutoff weight. Time of onset of NEC for each infant was determined and survival curves for the cocaine-exposed and nonexposed groups were calculated using their birth-weight subdivision. Hazard function curves were done. Neonatal risk factors in both groups were compared. Twelve percent (28/231) of cocaine-exposed infants developed NEC stage II or III versus 3% (34/1053) in the nonexposed group (P<0.05). Eight percent of cocaine-exposed and 2% of nonexposed survivors had NEC by day 7 versus 20% and 5% by day 28 after birth (P<0.05). Infants >1,500 g were at risk for NEC until day 8 only, whereas infants ≤1,500 g had both an early and continuing risk for NEC with a biphasic pattern of onset. The accentuated peak in early-onset NEC may be attributed to antenatal cocaine exposure, while late-onset NEC in the ≤1,500 g group probably relates to a variety of pathogenetic factors.