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Biomedical subjects

F Shann

Publications and source records attributed to F Shann.

At least 91 records · Page 5Linked to original sources
PubMed1988

Acute epiglottitis: a different approach to management.

Between January 1979 and October 1986, 349 patients with epiglottitis were admitted to the Royal Children's Hospital, Melbourne, Australia. Forty-five (13%) patients were not intubated, 291 (83%) were managed by nasotracheal intubation and spontaneous respiration without sedation, three (1%) received continuous positive airway pressure, and ten (3%) were ventilated. The 294 patients who were not ventilated were intubated for a mean of 18 +/- 9.5 (SD) h; 90% were extubated within 24 h. Criteria for extubation included resolution of fever (less than 37.5 degrees C), passage of time (12 to 16 h), and improvement in the general appearance of the child. Laryngoscopy was not performed before extubation. Providing there is always a doctor present who can reintubate if accidental extubation occurs, routine use of sedation, paralysis and mechanical ventilation, and pre-extubation laryngoscopy are not required for the management of children with uncomplicated epiglottitis, and their use may prolong the period of intubation.

Acute Disease↗
PubMed1987

Serum concentrations of penicillin after intramuscular administration of procaine, benzyl, and benethamine penicillin in children with pneumonia.

Serum concentrations of penicillin were measured in 37 children with pneumonia. The mean serum concentration of penicillin was greater than 1.0 microgram/mL for 11 hours after intramuscular administration of 48,000 U/kg benethamine penicillin compound (nine children), for 26 hours after 48,000 U/kg aqueous procaine penicillin (10 children), and for 40 hours after 79,000 U/kg aqueous procaine penicillin (seven children). After intramuscular administration of 35,000 U/kg benzyl penicillin in 11 children, the serum concentration was 13.3 +/- 7.4 micrograms/mL (mean +/- SD) 30 minutes after the injection, and 4.9 +/- 3.2 micrograms/mL after 3 hours. Our findings lend support to the World Health Organization recommendation that children with mild pneumonia in developing countries be given daily intramuscular injections of 50,000 U/kg aqueous procaine penicillin.

Child↗
PubMed1987

Effect of heparin concentration and infusion rate on the patency of arterial catheters.

In a prospective randomized controlled trial involving 470 arterial catheters in 470 children, we studied the effect of changing either the concentration or the flow rate of a heparin infusion. Although catheters tended to remain patent longer with a flow rate of 2 ml/h rather than 1 ml/h, the difference was not statistically significant. Increasing the heparin concentration from 1 to 5 U/ml significantly prolonged catheter patency.

Arteries↗
PubMed1987

The dangers of premature extubation after severe birth asphyxia.

The records of all 91 neonates with asphyxia who were referred to the Royal Children's Hospital in 1982 and 1983 were reviewed and information was obtained on their subsequent neurological outcome. Thirty children had been extubated after their initial resuscitation, before transfer to the Royal Children's Hospital; 21 of these children had been extubated despite the fact that they had taken more than 5 min to take their first breath, and 11 (52%) of them died (while none of the nine infants who breathed within 5 min died). A paediatrician was involved with two-thirds of the 21 children who were extubated despite having more than 5 min to breathe. Twelve children required cardiac massage; seven of them were extubated and then reintubated before transfer, and six of the seven infants died. These findings suggest that many paediatricians are not aware of the importance of continuing ventilatory support in neonates who have suffered a severe asphyxial insult. Asphyxiated babies who require cardiac massage, and babies who do not start breathing within 5 min of birth, should not be extubated as soon as they have established regular respiration; they should remain intubated and be transferred to an intensive care unit.

Asphyxia Neonatorum↗
PubMed1986

Pneumonia associated with infection with pneumocystis, respiratory syncytial virus, chlamydia, mycoplasma, and cytomegalovirus in children in Papua New Guinea.

Paired serum samples were collected from 94 children with pneumonia admitted to Goroka Hospital, Papua New Guinea. All but three of the children were aged 1-24 months. Only nine children were malnourished, with weight for age less than 70% of the Harvard median (three had weight for age less than 60% of the Harvard median). Pneumocystis carinii antigen was detected in the serum of 23 children. Twenty two children had serological evidence of recent infection with respiratory syncytial virus. Five children were probably infected with Chlamydia trachomatis at the time of the study, and there was less convincing serological evidence of current infection in a further 11 children. Five children showed a fourfold rise in antibody to Mycoplasma pneumoniae. Although only one child showed a fourfold rise in antibody to cytomegalovirus, 86 children had this antibody. No child showed a fourfold rise in antibody to Ureaplasma urealyticum or Legionella pneumophila. P carinii, respiratory syncytial virus, C trachomatis, M pneumoniae, and cytomegalovirus may be important causes of pneumonia in children in developing countries.

Child, Preschool↗
PubMed1985

Chloramphenicol alone versus chloramphenicol plus penicillin for bacterial meningitis in children.

367 children with cerebrospinal-fluid findings suggestive of bacterial meningitis were randomised to receive either chloramphenicol alone by intramuscular injection, or chloramphenicol plus penicillin by intravenous injection. Sequential analysis showed no difference in mortality between the two treatments. 48 (26%) of the 183 children in the chloramphenicol alone group died, and 49 (27%) of the 184 children in the chloramphenicol plus penicillin group died. In children with bacterial meningitis chloramphenicol alone given by intramuscular injection is as effective as chloramphenicol plus penicillin given intravenously.

Bacterial Infections↗
PubMed1985

Chloramphenicol alone versus chloramphenicol plus penicillin for severe pneumonia in children.

748 children with severe pneumonia in three hospitals in Papua New Guinea were randomised to receive intramuscular injections of either chloramphenicol alone or chloramphenicol plus penicillin. Sequential analysis showed no difference between the two treatments. 48 (13%) of the 377 children in the chloramphenicol alone group died, and 3 (0.8%) were changed to different treatment. 62 (17%) of the 371 children in the chloramphenicol-plus-penicillin group died, and 6 (1.6%) were changed to different treatment. The difference in failure rates (death or withdrawal for change of treatment) was 4.8% +/- 5.2% (+/- 95% confidence limits). In children with severe pneumonia, treatment with chloramphenicol alone is as effective as treatment with chloramphenicol plus penicillin.

Child↗
PubMed1985

Absorption of chloramphenicol sodium succinate after intramuscular administration in children.

Because it is thought that chloramphenicol is poorly absorbed after intramuscular administration, we compared blood levels of chloramphenicol after intramuscular administration with those after intravenous administration in children with a variety of diagnoses. Fifty-seven children were studied on 62 occasions while they were receiving chloramphenicol sodium succinate (25 mg of chloramphenicol per kilogram of body weight) intramuscularly every six hours. The peak level of chloramphenicol was 19.5 +/- 5.99 micrograms per milliliter (mean +/- S.D.) in 11 children after the first dose and 31.4 +/- 12.99 micrograms per milliliter in 51 children after two or more doses. The lowest peak level after intramuscular administration was 13 micrograms per milliliter, which is in the therapeutic range of 10 to 30 micrograms per milliliter. Thirteen children were studied on 17 occasions while they were receiving chloramphenicol sodium succinate (25 mg of chloramphenicol per kilogram) intravenously every six hours. The peak level of chloramphenicol was 19.4 +/- 6.37 micrograms per milliliter in eight children after the first dose and 28.2 +/- 11.09 micrograms per milliliter in nine children after two or more doses. The area under the serum level curve was not significantly different after intramuscular and intravenous administration. We conclude that chloramphenicol sodium succinate is well absorbed after intramuscular administration. This route is cheaper, it demands less staff time, and it does not carry the risks of sepsis and overhydration associated with intravenous therapy.

Absorption↗
PubMed1985

Pharmacokinetics of quinine in children.

Serum quinine concentrations were measured in seven children after intravenous infusion of quinine dihydrochloride, in eight children after intramuscular injection of quinine dihydrochloride, and in six children after nasogastric administration of a solution of quinine dihydrochloride. The mean (+/- SD) half-life of quinine was 11.1 +/- 4.8 hours, and the volume of distribution was 1.39 +/- 0.37 L/kg. To attain a serum level of 10 microgram/ml quinine, we suggest that children with severe malaria be given a loading dose of 20 mg/kg quinine dihydrochloride parenterally, followed by 7.5 mg/kg every 8 hours. Once recovery begins, quinine sulphate 10 mg/kg may be given orally every 8 hours. Serum concentrations should be monitored, if possible, because they vary greatly from person to person. Quinine is rapidly and completely absorbed after either intramuscular or nasogastric administration.

Child↗
PubMed1985

Hyponatraemia associated with pneumonia or bacterial meningitis.

Serum sodium concentrations were measured in 93 children with pneumonia or bacterial meningitis on their admission to hospital. Hyponatraemia (sodium value 134 mmol/l or less) was present in 33 (45%) of the 73 children with pneumonia, and in 10 (50%) of the 20 children with bacterial meningitis. Increased secretion of antidiuretic hormone is common in children with pneumonia, as well as in children with meningitis. The maintenance fluid requirement in these children is usually about 50 ml/kg/per day, and children with hyponatraemia caused by water overload need even lower fluid intakes. In developing countries, most children with pneumonia and meningitis should be managed without intravenous fluid treatment.

Bacterial Infections↗