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L J Gerards

Publications and source records attributed to L J Gerards.

At least 19 recordsLinked to original sources
PubMed1992

[Diagnosis of infection in full-term infants born after prolonged status of ruptured membranes: clinical observation is sufficient].

We retrospectively studied our strategy in 80 full-term newborns, born more than 24 hours after rupture of amniotic membranes. Six patients developed clinical signs of sepsis, in four of them sepsis was proven by a positive blood culture. In all cases, clinical symptoms were the first sign of infection. Routine laboratory tests (CRP, leucocyte counts and differentiation, thrombocyte counts) and microbiological investigations (surface cultures, cord blood cultures) were not helpful for the diagnosis of infection at an early stage. These findings are in accordance with the literature. We conclude that after prolonged rupture of membranes with full-term newborns postnatal paediatric care can be limited to a close observation period of 48 hours. There is no need for any further routine investigation of infants without clinical signs of infection.

Bacterial Infections↗
PubMed1992

[Lithium poisoning in a newborn infant].

We describe a newborn with a lithium intoxication. Her mother used lithium during her entire pregnancy. The intoxication was successfully treated with an exchange transfusion.

Bipolar Disorder↗
PubMed1992

[Premature infants and hepatitis B vaccination. Study Group Prevention Neonatal Hepatitis B].

Since 1986 health authorities in the Netherlands advise to vaccinate preterm infants at similar age as term infants, without correction for their shortened gestational age. This advice was based on a study, which showed comparable immune responses after DTP vaccination in preterm and term infants. To assess the immunogenicity of hepatitis B vaccination not corrected for gestational age in preterm infants, we compared the antiHBs titer after hepatitis B vaccination in 44 preterm infants with the antiHBs titer in 829 term infants. More than 95% of the preterm infants developed an adequate immune response (> 10 IU/l antiHBs), irrespective the vaccination scheme which varied in vaccine dose, the number of vaccinations and the onset of the first vaccination. The percentage preterm infants with an antiHBs titer > 10 IU/l (98%) was not different of the corresponding percentage of term infants (98%). Similarly, no difference between preterm and term infants was observed when an antiHBs value of 100 IU/l was considered a positive response, neither when active immunisation started at month 0 or month 3. The geometric mean titre at 12 months of age was considered.

Gestational Age↗
PubMed1992

[Chylothorax in the neonatal period].

The data of 11 infants with chylothorax in the neonatal period, seven with congenital chylothorax and 4 infants with iatrogenic chylothorax are reported. Chylothorax in the neonatal period may cause birth asphyxia and serious respiratory problems. Among the infants with congenital chylothorax diagnosis can be established before birth by ultrasound technique, followed by optimal resuscitation to prevent asphyxia. In most of the cases, conservative treatment with continuous drainage and total parenteral nutrition is sufficient.

Cardiac Surgical Procedures↗
PubMed1990

Deficiencies in opsonic defense to pneumococci in the human newborn despite adequate levels of complement and specific IgG antibodies.

We studied the major determinants of opsonophagocytosis against Streptococcus pneumoniae serotypes 14 and 19 in paired cord/maternal sera from 27 healthy term and 24 preterm infants in an attempt to gain more insight in the susceptibility of newborns to pneumococcal infection. For both pneumococcal serotypes studied, opsonic activity in neonatal sera varied greatly, but was moderately to profoundly deficient when compared to paired maternal sera, both in preterm (34.5 and 34.9% of the activity in maternal serum, for serotypes 14 and 19, respectively, p less than 0.001 for both) and in term serum (43.5 and 52.7% of the activity in maternal serum, for serotypes 14 and 19, respectively, p less than 0.001 for both). The opsonic deficiency in preterm sera could be ascribed to a diminished level of the major opsonins for pneumococci, i.e. complement factor C3 deposited on the bacterial surface (69.5 and 66.2% of C3 deposition in maternal serum on serotypes 14 and 19, respectively, p less than 0.01 for both) and specific anticapsular IgG antibodies (48.5 and 14.1% of maternal levels for serotypes 14 and 19, respectively, p less than 0.001 for both). However, the opsonic defect in serum from term infants could not be explained in a similar way, because C3 deposition and specific anticapsular IgG levels were equal to the values found in the paired maternal sera. Therefore, we conclude that the opsonic defect in newborn serum for pneumococci cannot be solely explained by a deficiency in the major opsonins for these bacteria. A dysfunction in these opsonins seems to be a more likely explanation for the observed opsonic defect in the neonate.

Antibodies, Bacterial↗
PubMed1990

Pneumococcal septicemia in the newborn. A report on seven cases and a review of the literature.

This report summarizes the essential findings of seven cases of pneumococcal septicemia in the newborn and compares the data with those reported in the literature. It is emphasized that pneumococcal septicemia is a rare but highly lethal disease of the newborn. The clinical course strongly resembles early onset group B streptococcal disease. Epidemiological data suggest that the majority of infants are colonized near birth. Analogous to group B streptococcal sepsis, it seems rational to administer penicillin prophylaxis during labor to women with S. pneumoniae isolated from their genital tract to prevent vertical transmission and neonatal pneumococcal septicemia.

Female↗
PubMed1990

[Hepatitis B in children].

Central to immunization programmes is that hepatitis B virus infection in infancy is much more likely to result in the chronic carrier state than if infection occurs in adulthood. In areas of high endemicity like south-eastern Asia most infections occur when chronically infected women transmit hepatitis B virus to their newborns or when chronically infected children transmit the virus to other children. In the Netherlands, the endemicity is considered low; seroprevalence studies showed that 0.8% of the pregnant women are HBsAg-positive. To prevent mother to child transmission of hepatitis B a national immunization program has recently been implemented to prevent perinatal infection in approximately 450 neonates each year. Horizontal transmission of hepatitis B virus also seems possible in children since persistent carriers are found in (medical) centres and institutions for mentally handicapped. Since hepatitis B infections acquired during early childhood are likely to progress to chronicity and liver disease in adult life some risk factors for children in the Netherlands to contract hepatitis B infection are described and the immunization strategy is discussed.

Child↗
PubMed1988

Host defence to bacterial infection in the neonate.

Host defence to bacterial infection is mainly determined by opsonins, i.e., IgG antibodies and complement, and phagocytic cells, which co-operate to remove bacterial invaders from host tissues. Various studies have clearly documented distinct defects in both arms of host defence in the newborn period. Chemotaxis, i.e., directed migration of polymorphonuclear leukocytes (PMN) is impaired in the neonate. Phagocytosis of bacteria by neonatal PMN is normal, but post-phagocytic events, particularly metabolic activation and bacterial killing are impaired, the latter defect apparently due to diminished generation of reactive oxygen species. Both classical and alternative pathway activity of complement are mildly diminished (50-80% of adult values) in the term newborn, but are more severely decreased in the premature infant (20-40% of adult values in 28 to 36 weeks prematures). Opsonic activity of transplacentally-derived IgG when compared to maternal IgG is strikingly deficient against staphylococci and group B streptococci (GBS), in the latter case depending on the GBS serotype. Since opsonization is a key process in antibacterial defence, it is speculated that these opsonic defects of IgG may be an essential determinant of the neonate's susceptibility to disease due to these bacteria.

Bacterial Infections↗
PubMed1987

Antenatal ultrasonographic diagnosis of a congenital posterolateral diaphragmatic defect.

The antenatal ultrasonographic findings in a fetus with a left-sided congenital posterolateral diaphragmatic defect (CPLDD) are presented and discussed. Displacement of the heart towards the right and absence of a normally positioned fluid-filled stomach at repeated examinations are diagnostic. In the event of an intrathoracically displaced fetal stomach, which occurs in about 60% of the cases, a sonolucent area in the left chest may be found. In view of the dynamic nature of fetal stomach filling, more than one examination may be required to detect this feature. Antenatal recognition of congenital diaphragmatic hernia (CDH) has important consequences for perinatal management and can improve neonatal outcome.

Adult↗
PubMed1986

Thyroid-stimulating immunoglobulins and thyroid function tests in two siblings with neonatal thyrotoxicosis.

Thyroid function and serum TSI levels in two siblings with neonatal thyrotoxicosis are described. The first infant was treated with exchange transfusion and potassium iodide. The second infant was treated with intrauterine propylthiouracil followed by potassium iodide. In contrast to the first infant, the second infant had no clinical sign of neonatal thyrotoxicosis. He also had lower TSI levels with a biological half-life of 5 days. Only one of three assays showed some TSI activity in breast milk.

Adult↗
PubMed1985

Neonatal thyrotoxicosis treated with exchange transfusion and Lugol's iodine.

An infant with neonatal thyrotoxicosis was born to a mother who had become euthyroid after subtotal thyroidectomy for Graves' disease. Exchange transfusion resulted in a 50% decrease of serum thyroxine levels and thyroid stimulating immunoglobulins. After 10 days mild thyrotoxic signs reappeared with high serum thyroxine levels, which were treated successfully with Lugol's iodine for 4 weeks. TSI was undetectable at 7 weeks of age. TSI was present in breast milk.

Adult↗
PubMed1985

Early neonatal group B streptococcal disease: degree of colonisation as an important determinant.

During a period of 5 years (1 January 1977 to 1 January 1982) 145 infants colonised with group B streptococci (GBS) were admitted to the neonatal intensive care unit of the University Children's Hospital, Utrecht. In 87 of these infants (60%) vertical transmission of GBS was established; in 43 of these 87 infants (49%) the degree of colonisation was moderate to heavy. Early-onset (EO) GBS disease arose in 21 of 145 infants (attack rate: 14.5%). Of the 43 infants moderately to heavily colonised with GBS, however, 19 suffered from EO GBS disease (attack rate: 44.2%), whereas there were only two cases among the 44, lightly colonised infants (attack rate: 4.5%), a highly significant difference (P less than 0.0005). Similarly, probable sepsis (PS), defined as signs and symptoms of sepsis but without positive blood cultures, was observed significantly more often in moderately to heavily colonised infants (15/43, attack rate: 34.9%) compared with those lightly colonised (4/44, attack rate: 9.1%) (P less than 0.005). Infants moderately to heavily colonised with GBS at birth appear to have a significantly higher risk of developing serious GBS disease (EO or PS) than do infants only lightly colonised.

Adolescent↗