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Biomedical subjects

D Isaacs

Publications and source records attributed to D Isaacs.

At least 91 records · Page 5Linked to original sources
PubMed1996

Late-onset infections of infants in neonatal units.

OBJECTIVE: To examine regional variations in the incidence of late-onset neonatal infections in Australian and New Zealand neonatal units. METHODOLOGY: A longitudinal, prospective surveillance study of systemic sepsis (septicaemia or meningitis) in 11 neonatal units: 10 in the Australian States of the Northern Territory, New South Wales, Queensland, Victoria and Western Australia, and 1 in Christchurch, New Zealand. The results are reported of late-onset neonatal infection (defined as sepsis after 48 h) for the second year of prospective surveillance, data being collected from 1 October 1992 to 30 September 1993. RESULTS: Data were available on 24535 live births in Australia, representing approximately 10% of all live births in the country. There were 320 episodes of sepsis in Australian units affecting 294 babies. One hundred of these episodes (31%) were early-onset; 3.0% of babies admitted to six tertiary care neonatal units attached to maternity hospitals developed late sepsis, and this rate did not differ between units. The proportion of babies infected was inversely related to birthweight: 22.6% of babies under 1OOOg, but 0.6% over 2000g. Coagulase negative staphylococci were the commonest cause of late-onset sepsis. There were 26 episodes of S. aureus septicaemia, of which only one was due to MRSA. Meningitis occurred in 13 babies (5.9%) with late-onset sepsis. The mortality from late-onset sepsis was 7.7%. CONCLUSIONS: Coagulase-negative staphylococci are the commonest cause of late-onset sepsis of babies in neonatal units. There were no major regional differences in the incidence of, or the organisms causing, late sepsis.

Australia↗
PubMed1996

Accelerated schedule of hepatitis B vaccination in high-risk youth.

OBJECTIVE: To perform a feasibility and immunogenicity study of an accelerated schedule of hepatitis B immunization for high-risk youth. METHODOLOGY: High-risk adolescents attending a youth health centre and nearby youth refuges were immunized with Engerix-B recombinant vaccine, 20 micrograms intramuscularly, at 0, 2 and 6 weeks. Serology was performed prior to immunization and 3 months after the third dose. RESULTS: Forty-two subjects (27 female) aged 13-20 years entered the study. Two (4.8%), already hepatitis B virus (HBV) seropositive, were excluded. Thirty-six of 40 subjects had one or more risk factors for HBV. Participants were often elusive, needing multiple attempts to establish contact. Twenty (50%) of the 40 completed three immunizations and all 14 studied developed anti-hepatitis B surface titres of > 100 mlU/mL (geometric mean titre 630 mlU/mL, 95% confidence intervals 309-1290). CONCLUSIONS: High-risk youth can be immunized against hepatitis B successfully using an accelerated schedule, but compliance is difficult.

Adolescent↗
PubMed1996

"On the spot' vaccination: does it work?

OBJECTIVE: To trial and evaluate a system of "on the spot' vaccination for children up to the age of 15 years in the Early Childhood Centres of the Central Sydney Area Health Service, at the Royal Alexandra Hospital for Children and in a number of general practices in the area. METHODOLOGY: A brief questionnaire was used to collect data from parents and health care professionals about the child's vaccination status and vaccines given "on the spot'. RESULTS: Over an 8 week period in August-September 1993, 5162 questionnaires were completed; 71% of children were up to date with their vaccination. If Haemophilus influenzae type b vaccine, which had been introduced only 2 months before commencement of the study, was excluded, 84% of the children were up to date. A total of 441 children were given 663 vaccinations "on the spot'. Very few children were too ill to be vaccinated (6%). However, only 30% of those who needed vaccination "on the spot' actually received it (441 of 1480), and only 41% (24 of 58) of a subset of those who were not vaccinated were known to have complied 1 month later. Children attending Early Childhood Centres were younger than children attending general practices or the hospital. CONCLUSIONS: A high proportion of children who attended for routine or acute health care had vaccinations overdue (30%). If this scheme could be continued and expanded it would have an important impact on vaccination coverage, and hence on the incidence of vaccine-preventable diseases.

Child↗
PubMed1996

Acyclovir for the prevention and treatment of varicella zoster in children, adolescents and pregnancy.

Varicella causes a mild, self-limiting childhood disease that may reactivate years later as shingles. In immunocompromised patients with altered cell mediated immunity, and rarely in healthy individuals, varicella results in a life-threatening infection. The antiviral drug, acyclovir, substantially reduces the mortality and risk of severe disease in these groups of patients. Early commencement of acyclovir is recommended for children with both varicella and altered cell mediated immunity, newborns during the first 2 weeks of life, preterm infants in the neonatal nursery, and severe varicella or shingles (including ocular zoster) in any patient, as well as during pregnancy. Acyclovir may be considered in children with serious cardiopulmonary disease or chronic skin disorders where varicella may exacerbate the underlying disease or increase the risk of secondary bacterial sepsis. Acyclovir, however, is not recommended for healthy individuals without severe disease, as a prophylactic agent against varicella, for asthmatics receiving aerosolized or low-dose oral steroids and/or as treatment of the post-varicella syndromes. When acyclovir is prescribed it should be given intravenously to those with severe disease, those at risk of dissemination and in children younger than 2 years of age.

Acyclovir↗
PubMed1996

Human herpesvirus-6 infections.

HHV-6 is ubiquitous in the community, appears to be acquired early in life, and has been proved to cause the clinical syndrome of exanthem subitum, and rarely to cause encephalitis. Like other herpesviruses, HHV-6 is capable of establishing latent infection and reactivating under a variety of stimuli. Improved diagnostic techniques have led to increased recognition of HHV-6 in the presence of many diseases, but much of the evidence for an aetiological role is inconclusive. There is accruing evidence for possible pathological roles in the immunocompromised host, but the evidence is less convincing for the range of associations otherwise listed for the normal host at the present time.

Child↗
PubMed1995

Systemic bacterial and fungal infections in infants in Australian neonatal units. Australian Study Group for Neonatal Infections.

OBJECTIVE: To examine the pattern and incidence of sepsis occurring in neonatal units in Australia. DESIGN: A one-year prospective study of babies with systemic sepsis within 48 hours of birth (early-onset sepsis) or after this time (late-onset sepsis) in seven Australian neonatal units. Systemic sepsis was defined as clinical sepsis, plus either positive bacterial or fungal culture of blood and/or cerebrospinal fluid, or group B streptococcal antigen detected in the urine. RESULTS: There were 241 episodes of sepsis, affecting 234 babies. One quarter (61) were early-onset, a rate of 2.2 per 1000 live births. Group B streptococcus (GBS) was the commonest cause of early-onset sepsis, with a rate of 1.3 per 1000 live births. The incidence of early-onset GBS sepsis was lower at a hospital which screened for maternal carriage and used intrapartum antibiotic prophylaxis for all carriers. The rate of late-onset sepsis was 4.4 per 1000 live births and coagulase-negative staphylococci were the commonest cause. Meningitis occurred in 23% of babies with early-onset and in 10% with late-onset sepsis. The mortality from early-onset sepsis was 15%, and from late-onset sepsis was 9%. There were no major regional variations, other than for GBS. CONCLUSIONS: The incidence of and mortality from neonatal sepsis is comparable to other countries, and shows no major regional variation. The use of intrapartum antibiotics may reduce the incidence of neonatal GBS sepsis. There are no previous comparable data on neonatal infections in Australia.

Australia↗
PubMed1995

Bronchiolitis.

Explore the source record for details and available documents.

Bronchiolitis, Viral↗
PubMed1995

Clinical and diagnostic features of osteomyelitis occurring in the first three months of life.

We report a retrospective study of 94 infants, ages < 4 months, who underwent investigation for possible osteomyelitis during a 9-year period. Of the 30 babies with proven osteomyelitis (radiographic changes or positive bone cultures or positive blood cultures plus a compatible clinical picture), 17 were preterm artificially ventilated babies and 4 were full term infants receiving intensive care. An etiologic organism was isolated from 28: methicillin-susceptible Staphylococcus aureus, 16; methicillin-resistant S. aureus (MRSA), 7; Escherichia coli, 3; and group B Streptococcus, 2. MRSA occurred exclusively in the preterm group. Osteomyelitis was multifocal in 40% and associated with septic arthritis in 47%. The long bones were frequently affected (80%) whereas the flat bones were often sites of clinically silent disease. Twenty-five (83.3%) of the 30 babies with proven osteomyelitis had focal clinical signs or evidence of disseminated staphylococcal disease. Only 10 were febrile. Four of 27 babies investigated because of positive blood cultures for S. aureus but no focal signs had osteomyelitis, as did only 1 of 27 babies with suspected sepsis but no focal signs. The sensitivity of 99mTc bone scanning was 84%, specificity 89%, positive predictive value 79% and negative predictive value 92%. The addition of gallium scanning (in 39 of the 94 infants) improved the respective figures to 90, 97, 93 and 95% and was useful in interpreting equivocal bone scans.

Arthritis, Infectious↗
PubMed1995

Predicting the outcome of symptomatic congenital cytomegalovirus infection.

The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. The mortality of symptomatic congenital CMV infection is about 30%.

Brain↗
PubMed1995

Use of simple clinical parameters to assess severity of bronchiolitis.

OBJECTIVE: To determine whether simple clinical parameters could be used to predict the severity of acute bronchiolitis and the need for supplemental oxygen therapy. METHODOLOGY: A prospective study, performed in a tertiary care paediatric hospital. Seventy-one infants under 15 months of age with a clinical diagnosis of acute bronchiolitis were examined on admission. Clinical parameters were recorded, and each infant was re-examined after approximately 12 and 24 h. All infants were examined by one medical student and, when possible, by a doctor, the two being unaware of each other's findings. Parameters recorded included respiratory and heart rates and presence of wheeze, crackles, intercostal recession, sternal retraction and/or cyanosis. The outcome measure was the need for supplemental oxygen, as determined by the independent caring medical team, on the basis of pulse oximetry and clinical judgement. RESULTS: Forty (56%) of the 71 babies required supplemental oxygen. All cyanosed babies required supplemental oxygen, but only 9 (21%) were cyanosed on admission. Intercostal recession (relative risk RR 2.55; 95% CI 1.28, 5.08) and sternal retraction (RR 1.60; 95% CI 1.06, 2.42) predicted the need for supplemental oxygen with moderate accuracy. Interobserver agreement was only fair for most parameters, but was poor for intercostal recession and good for cyanosis. CONCLUSIONS: Simple clinical parameters may help predict the need for oxygen therapy in acute bronchiolitis, although further studies are required to define suitable clinical criteria. Such criteria are extremely important in developing countries where oxygen is a scarce resource.

Bronchiolitis↗
PubMed1995

Neonatal systemic candidiasis.

Systemic candidiasis is notoriously difficult to diagnose in neonates; however, it is frequently described and has a high mortality and morbidity. It is particularly likely to occur in extremely low birthweight babies, especially those receiving long-term parenteral nutrition and antibiotics. The clinical features are non-specific. Thrombocytopenia occurs in almost all cases of systemic candidiasis, but also in about half the cases of bacterial sepsis. Empirical antifungal therapy should be considered more readily for high-risk, clinically septic, thrombocytopenic babies.

Antifungal Agents↗
PubMed1995

Lumbar puncture in suspected neonatal sepsis.

OBJECTIVE: 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. CONCLUSION: 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.

Humans↗
PubMed1995

Prevention of neonatal group B streptococcal sepsis: is routine antenatal screening appropriate.

Four strategies for prevention of early onset neonatal group B streptococcal (GBS) sepsis were considered: A: routine antenatal screening for GBS vaginal carriage at 26-28 weeks' gestation and intrapartum antibiotic prophylaxis for all carriers; B: screening as above and prophylaxis only for carriers with risk factors for sepsis; C: prophylaxis for all women with risk factors; D: as for C plus screening at 37 weeks' gestation and prophylaxis for carriers. The outcomes considered for each option were: the proportion of women given prophylaxis; the risk of anaphylaxis; cases of neonatal GBS sepsis and deaths prevented; costs of screening, prophylaxis and of acute care of remaining cases. Published local and overseas studies of neonatal GBS sepsis, effectiveness of antenatal screening and prophylaxis and estimated costs were evaluated. Any of the proposed strategies can prevent a significant proportion of cases of neonatal GBS sepsis and a strategy for prevention of neonatal group B streptococcal sepsis should be part of routine obstetric practice. Strategy C is simple, effective, inexpensive and avoids unnecessary antibiotic use; it is recommended particularly when antenatal care is provided mainly in community or private practice. Strategy A (using vaginal and rectal swabs for screening) could prevent more cases, but at greater cost which could be justified only if protocols can be properly implemented and monitored.

Australia↗
PubMed1995

Family vs career: nursing student discourses.

This empirical study of first year nursing students examines their perspectives on nursing as a career, family commitments and the influence of gender equity issues on their future life goals. This paper returns to and reflects on what the students have to say as they attempt to give meaning to their lives, goals and experiences. What emerges are a plurality of meanings and competing discourses as the students negotiate and make sense of their world as nursing students.

Adaptation, Psychological↗