Journal of paediatrics and child health
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The importance of lumbar puncture (LP) as part of the evaluation of suspected neonatal sepsis is assessed, as it may be the only positive diagnostic test in about 10% of septic babies with meningitis but negative blood cultures. However, LP may compromise respiratory function, and the interpretation of cerebrospinal fluid (CSF) may not be straightforward. ⋯ The clinical setting and the probability of meningitis are important determinants of the likely value of LP. For asymptomatic neonates with obstetric risk factors for sepsis, and for babies with early-onset respiratory distress alone, LP may be delayed and only performed later if blood cultures are positive. This is because hundreds of LP will be needed to diagnose a single case. However, infants with suspected late-onset sepsis should have an immediate LP because finding Gram-negative bacilli or fungi in the CSF will affect treatment choices.
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J Paediatr Child Health · Dec 1994
Incidence of apnoea and bradycardia in preterm infants following triple antigen immunization.
Ninety-seven preterm infants were immunized with diphtheria-tetanus-pertussis (DTP) prior to discharge from hospital. The mean gestational age at birth was 28.1 weeks (range 24-34) and the mean age at immunization was 80.6 days (range 44-257). Nineteen (20%) infants developed apnoea or bradycardia within 24 h of immunization. ⋯ Two infants who developed concurrent upper respiratory tract infections required additional oxygen and one of them was treated with oral theophylline. In general, it is safe practice to immunize preterm infants with DTP unless otherwise contraindicated. However, it is recommended that cardiorespiratory function is monitored after immunization in very preterm infants who had prolonged ventilatory support and/or chronic lung disease.
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The aim of this study was to review the frequency of decisions to withdraw treatment from neonates who had died in a large neonatal intensive care unit, the reasons for these decisions, and the procedures followed. A 12 month retrospective review of medical and nursing records was undertaken. ⋯ It is concluded that withdrawal of treatment resulting in death occurs frequently in the neonatal intensive care service of National Women's Hospital, Auckland, New Zealand, but is usually a recognition of the inevitable. Truly elective withdrawal of treatment is uncommon in the immature infant, but does occur in the context of multiple abnormalities or severe birth asphyxia, where it follows a formal procedure.
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Under-reporting of asthma and inappropriate management at school can hamper a child's academic progress. The aim of this study was to assess asthma reporting and crisis management, following implementation of a Primary School Asthma Programme. The intervention covered 12 primary schools with 5093 students in an area of high unemployment with a large proportion of the community from a non-English background. ⋯ School Asthma Crisis Plans were completed appropriately by the child's doctor and parents and returned by 68% of the students with asthma. Teachers' asthma knowledge and confidence with the management of acute asthma at school improved following asthma education workshops. It was concluded that asthma reporting and acute crisis management of asthma at school can be achieved by a programme undertaken by school medical services.