OBJECTIVE: To compare a 4-day course of antibiotic therapy to a 7-day course in selected term and near-term neonates with pneumonia. METHODS: The diagnosis of pneumonia was made in neonates admitted to the normal Newborn Nursery (NBN) who later had signs of respiratory distress and whose chest radiographs were consistent with pneumonia. Infants were excluded if any of the following was present: moderate or thick meconium-stained amniotic fluid, prior antibiotic therapy > 24 hours, or need for supplemental oxygen > 8 hours. Infants who were asymptomatic after 48 hours of antibiotic therapy were prospectively randomized to a 4-day group (n = 35) or a 7-day group (n = 38). Infants in the 4-day group were observed in the hospital for 24 hours following cessation of antibiotics and were seen in follow up within several days of discharge. RESULTS: The groups were comparable with regard to demographic factors, duration of rupture of membranes, and incidence of maternal chorioamnionitis. Median postnatal age at the time of identification of respiratory distress symptomatology was 19 hours (range 0.5 to 55 hours) in the 4-day group and 12 hours (range 1 to 72 hours) in the 7-day group. No study infants had a positive blood culture. Mean reduction in length of hospitalization was 2.1 days, with estimated savings of greater than US$700 per shortened hospitalization. Two infants in the 4-day group developed tachypnea during the 24-hour observation period. However, no infants were rehospitalized for sepsis or pneumonia following discharge. With 95% confidence, the true rate of success for the 4-day group was at least 92%. CONCLUSION: Four days of antibiotic therapy plus a 24-hour period of observation for selected cases of neonatal pneumonia appears to be comparable to 7 days of therapy. It is important to note that newborns in our institution receive a single dose of penicillin soon after birth as part of our group B streptococcal sepsis prophylaxis program, and all infants in this study received prophylaxis prior to the onset of respiratory symptoms. Furthermore, only infants who were asymptomatic after 48 hours of antibiotic therapy were included in this study, and a 24-hour observation period at the end of the 4-day course was required. These qualifications should be taken into account before use of this approach is considered, and additional studies are necessary to further establish its safety and benefits.

Anti-Bacterial Agents↗

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Service-learning for graduate students.

Although service-learning is gaining momentum in academic settings across the country, it has not been described as a feature of graduate education. This project incorporated a ten-hour service requirement into a unit on theories of nurse caring as part of a course for graduate nursing students, Theories and Concepts of Nursing. The authors describe the service-learning experience, as well as the extensive class reflection process and written synthesis with caring theory and the University mission after completion of the service.

Altruism↗

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The relationship between symptoms of chronic disease and dependence.

A total of 2705 people aged 60 years and over were sent a postal questionnaire requesting information about the symptoms of four common conditions--exertional chest pain, chronic productive cough, breathlessness, and exertional pain in the calves. These were elicited using a standardized questionnaire. The effect of these symptoms on the dependence of those suffering them was assessed in relation to a series of activities associated with normal daily living. There was a consistent rank order in the activities that people were unable to perform for the different symptoms studied, but this order altered with increasing severity and multiple symptoms. There was a consistency about the activities which changed order. It is suggested that symptoms and their associated dependence need to be assessed in relation to each other, using simple scaling systems by professional service personnel, managers/, and planners, in order to bring together the therapeutic rehabilitative, and social aspects of health needs. These are felt to be vital before decisions about service development can be made.

Activities of Daily Living↗

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The art of the deal.

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Communication↗

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Ultrasound diagnosis of exomphalos: a case report.

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Adult↗