American journal of diseases of children (1911)
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We studied the usefulness of the barium enema to rule out Hirschsprung's disease (congenital megacolon) in the evaluation of infants with constipation. Results from barium enemas in 58 constipated infants and children who underwent rectal suction biopsies to rule out aganglionosis were evaluated in retrospect for the presence of a transition zone, delayed evacuation of barium, and colonic anatomic abnormalities. As expected, the presence of a transition zone was most accurate in predicting Hirschsprung's disease. ⋯ Barium enemas did not reveal any additional colonic anatomic defects other than a transition zone to account for constipation in our study group. These results demonstrated that the barium enema is not a specific enough screening procedure to rule out Hirschsprung's disease in the unobstructed infant. Rectal suction biopsy is diagnostic and should be performed as the procedure of choice in those infants suspected of having Hirschsprung's disease.
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Bronchiolitis is a common lower respiratory tract illness in infants and has substantial acute morbidity and sequelae. To identify risk factors for bronchiolitis, a case-control study was conducted in which 53 subjects who had bronchiolitis were matched with two controls who had no bronchiolitis in infancy. In multivariate analysis, direct effects of passive smoking and older siblings achieved statistical significance. ⋯ Among infants without a family history of asthma, bronchiolitis may develop in 46% of infants if there is both an older sibling and exposure to smoke. Exposure of infants to cigarette smoke might diminish more rapidly if clinicians and parents were aware of such high risks. Efforts to reduce morbidity from bronchiolitis in infants might best be directed at the reduction of smoking in families with previous children, particularly if there is a family history of asthma, and at methods that protect infants from respiratory virus carried by siblings.
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Child neglect is the most prevalent form of maltreatment; more children die of neglect than of abuse. Neglect has been found to be more prevalent than physical abuse among the population of children with chronic illnesses. Data from a retrospective chart review illustrate the ways in which neglect affected 61 children with chronic illnesses. ⋯ More than half (37) of the reports resulted in change of custody for these children. All of these children suffered from short-term morbidity and some from long-term morbidity due to neglect. Neglect can be a serious and consequential problem for children with chronic illness.
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Comparative Study
Development and severity of palatal grooves in orally intubated newborns. Effect of 'soft' endotracheal tubes.
A prospective, blinded study of neonates orally intubated with either standard or "soft" endotracheal tubes included 57 infants in the standard "hard" tube group and 46 infants in the soft tube group. Infants were further divided by birth weights above and below 1,000 g. ⋯ Neither the incidence nor the severity of palatal groove formation was influenced by the use of the soft tube. However, in three cases the soft tube had to be abandoned due to technical difficulties with intubation.
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From August 1980 through July 1984, 19 neonates had sepsis due to Haemophilus influenzae. Onset of disease occurred within 48 hours after birth of all the neonates. One neonate was born at term and 18 were born prematurely, including seven neonates born before 28 weeks' gestation. ⋯ In 14 cases, isolates were biotyped yielding eight with biotype II, four with biotype III, and one each with biotypes IV and V. Neonatal sepsis due to nontypable H influenzae is now nearly as common as sepsis due to group B Streptococcus. Both organisms produce diseases with many features in common, especially fulminant courses with respiratory distress and pneumonia, and often have a fatal outcome.