The purpose of this study was to evaluate the clinical characteristics and pregnancy outcomes of twin and singleton pregnancies complicated by preterm premature rupture of membranes (PROM) and to compare the groups to evaluate for differences in these areas. In this retrospective study, patients with a gestational age of < 36 weeks admitted between 1993 and 1996 with PROM were evaluated for their clinical characteristics and pregnancy outcomes. Twin and singleton pregnancies were compared and the results were evaluated for significant differences. Patients with lethal fetal anomalies, clinical chorioamnionitis at presentation, or fetal distress at presentation were excluded from analysis. Liberal use of tocolysis was provided to both groups of patients, as were serial doses of betamethasone and vitamin K. Twenty-eight sets of twins and 119 singleton pregnancies were included in the analysis. Differences were noted with respect to twin and singleton pregnancies for both latency period (4.26 days vs 8.6 days, P < 0.001) and birthweight (1,464 vs 1,698 g, P < 0.03). The birthweight for twins was an average of the pair. No differences were noted with respect to gestational age at time of rupture, maternal age, gravidity, parity, race, tocolytic use, steroid use, prophylactic antibiotics, or sexually transmitted diseases. The incidence of chorioamnionitis showed a trend for a higher occurrence in singleton pregnancies. The latency period for twin pregnancies complicated by preterm PROM is shorter than for singleton pregnancies. The incidence of chorioamnionitis may be higher in singleton pregnancies, but this may be related to their longer latency period. A knowledge of these differences may be of benefit when counseling these patients.

Adult↗

PubMedDate not supplied

Effects of smoking, alcohol, and drugs of abuse on the outcome of "expectantly" managed cases of preterm premature rupture of membranes.

We evaluated the outcome of pregnancies complicated by preterm premature rupture of membrane (PROM) in order to determine if tobacco, alcohol, or illicit drug usage were associated with alterations in pregnancy or neonatal outcome. Comparisons in outcome were made with respect to tobacco, alcohol, and/or illicit drug usage. Comparisons were made with gestational age (GA) of PROM, GA of delivery, latency period (LP), maternal age, initial cervical exam (by speculum), age, race, tocolytic use, chorioamnionitis, and birthweight. Student's t-test, Mann-Whitney test, and Chi-square analysis were used to evaluate for significant differences (significance set at P < 0.05). A total of 119 charts were evaluated. Differences were noted with respect to smokers vs. nonsmokers for latency period (6.0 days vs. 9.4 days, P < 0.03), age (29.1 years vs. 24.8, P < 0.001), and gravidity (4.2 vs. 2.8, P < 0.005). Differences were noted for use of alcohol and age (29.9 vs. 25.2, P < 0.006). Differences were also noted for the use of illicit drugs and the following variables: age (30.0 vs. 24.9, P < 0.001), gravidity (4.7 vs. 2.5, P < 0.006), latency (6.2 vs. 9.0, P < 0.009), and parity (2.6 vs. 1.2, P < 0.01). A difference was noted with respect to cocaine and latency period (5.8 vs. 9.0, P < 0.01), age (31.2 vs. 24.8, P < 0.001), gravidity (4.8 vs. 2.9, P < 0.01), and parity (2.6 vs. 1.2, P < 0.03), and the use of tocolytics (22% vs. 55.4%, P < 0.02). These relationships held after multivariate analysis was performed. There were no associations among use of tobacco, alcohol, drugs of abuse, or cocaine and respiratory distress syndrome, intraventricular hemorrhage, or necrotizing enterocolitis. The use of tobacco during pregnancy appears to shorten the latency period in pregnancies complicated by PROM. Cocaine abuse also appears to shorten the latency period. These shortened latency periods could potentially contribute to increased neonatal morbidity. Larger studies evaluating this are needed.

Adult↗

PubMedDate not supplied

Use of recombinant human erythropoietin (EPO-alfa) in a mother alloimmunized to the Js(b) antigen.

Erythropoietin (EPO) is a glycoprotein hormone and the principal regulator of erythropoiesis in the fetus, newborn, and adult. EPO-alfa is erythropoietin manufactured by recombinant human DNA technology (rhEPO). After counseling, a pregnant woman with anti-Js(b) in her serum was started on rhEPO (600 U/Kg, biweekly) to prevent anemia secondary to serial donations of her blood for fetal transfusions. After a total of 25 rhEPO infusions and autologous donation of 8 units of whole blood, maternal hemoglobin prior to the elective cesarean section at 37 weeks was 11.3 gm/dL. Serum EPO concentration was determined in paired maternal and fetal blood samples, before ultrasound guided intravascular transfusions, in this alloimmunized Js(b)-negative and another Rh(D) alloimmunized pregnancy to determine possible correlations between maternal and fetal serum EPO. rhEPO prevented anemia in a patient who donated 8 units of blood from 18-37 weeks of pregnancy without inducing adverse biological effects such as hypertension or thrombotic complications in the placenta. Data presented in this study suggest that EPO does not cross the human placenta.

Adult↗

PubMedDate not supplied

Echocardiographic diagnosis of Candida endocarditis of the tricuspid valve and of the right atrium in a young infant.

Systemic candidiasis developed in a seven-week-old premature baby after 6 weeks treatment with antibiotics for suspected septicemia. At that time the echocardiogram showed a dense layer of echoes posteriorly to the anterior tricuspid leaflet during atrial systole. The diagnosis of Candida endocarditis with vegetations on the tricuspid valve and with right atrial thrombus secondary to the Candida infection was verified by autopsy.

Anti-Bacterial Agents↗

PubMedDate not supplied

Determination of cocaine and its major metabolite, benzoylecgonine, in amniotic fluid, umbilical cord blood, umbilical cord tissue, and neonatal urine: a case study.

Explore the source record for details and available documents.

Amniotic Fluid↗

PubMedDate not supplied

Social competence and behavioral problems of pediatric survivors of burns.

Sixty children (35 boys, 25 girls) with burns were surveyed at least 1 year after burn injury to assess the behavior problems and difficulties with competency that they were having. The Child Behavior Checklist, the Youth Self Report, and the Teacher Report Form developed by Achenbach were administered to obtain standardized measures of behavior and competence. The mean values for these scales were in the normal range for each age and sex. However, the Child Behavior Checklist revealed a statistically significant (p < 0.05) increase in problems and decrease in competency for most age groups and both sexes when compared with the reference population. In contrast, the Teacher Report Form and the Youth Self Report revealed very few differences from the reference population. The burn size (15% to 20% total body surface area, 35% to 50% total body surface area, and > 70% total body surface area) did not account for any of the group differences. Further studies involving detailed clinical interviews and other standardized measures are needed to understand the discrepancies between the Child Behavior Checklist and the other scales.

Adolescent↗

PubMedDate not supplied

Psychosocial sequelae of pediatric burns involving 80% or greater total body surface area.

Important questions for pediatric burn care specialists relate to the quality of life for those children who survive the most severe burn injuries. This study examines the psychological adjustment of 25 children who survived injuries > or = 80% total body surface area and the impact of such injury on the families. Data were analyzed from the most recent assessment, with the Child Behavior Checklist, Teacher Report Form, Piers-Harris Children's Self-Concept Scale, Parenting Stress Index, and a parental questionnaire designed by the authors. As a group, the children's behavioral problems as reported by both parents and teachers were within normal limits. Measures of parental stress, however, clearly differentiated the burn population. These parents attributed more stress to characteristics of their children. Children with > or = 80% TBSA burns develop positive feelings about themselves and appear no more troubled than a comparable group of nonburned children. The impact on the families is significant, however, and must be considered of consequence in the rehabilitation of the burned child.

Adaptation, Psychological↗

PubMedDate not supplied

Efficacy of school reentry programs.

Evaluation of school reentry programs are rarely reported, and statements of the value of reentry programs are usually based on anecdotal information. No known reports of empiric data support claims of positive benefit for burned children. This article reports a multifaceted effort to evaluate the effectiveness of one reentry program involving three approaches: (1) questionnaire answered by the school contact person after reentry program, (2) interviews with a random sample of patients (n = 58) and parents (n = 44) 1 to 5 years after burn, and (3) assessment of patients' behavior problems by teachers on a standardized behavior checklist comparing 10 patients who had a school reentry program involving videos to introduce them to their classmates with 10 patients who were matched for age, sex, and total body surface area burned and had no reentry program beyond phone contact. Results indicate that school reentry programs are popular with teachers and parents. This pilot effort involving empiric data failed to demonstrate a positive effect on the adjustment of the child.

Adaptation, Psychological↗

PubMedDate not supplied

Competence and physical impairment of pediatric survivors of burns of more than 80% total body surface area.

Children who survive massive burn injuries are challenged by the physical sequelae of their injuries as they return to normal daily routines. The purpose of this study was to assess the impact of physical impairment on the competence of such children as they pursued their lives. It was hypothesized that children who survive burn injuries of more than 80% total body surface area would be less competent than their unburned peers, and that competence would decrease with increased physical impairment. Competence for the 19 patients was assessed by parental report using the Child Behavior Checklist and by the patient's self-report on the Youth Self-Report. Physical impairment scores were calculated from range of motion measurements of upper and lower extremities according to AMA guidelines. Competence scores for the sample were within normal ranges. Physical impairment was significantly related to competence only in the area of activity on both the Child Behavior Checklist and the Youth Self-Report.

Activities of Daily Living↗

PubMedDate not supplied

American Burn Association/Shriners Hospitals for Children burn outcomes questionnaire: construction and psychometric properties.

To develop a standardized, practical, self-administered questionnaire to monitor pediatric patients with burns and to evaluate the effectiveness of comprehensive pediatric burn management treatments, a group of experts generated a set of items to measure relevant burn outcomes. Children between the ages of 5 and 18 years were assessed in a cross-sectional study. Both parent and adolescent responses were obtained from children 11 to 18 years old. The internal reliability of final scales ranged from 0.82 to 0.93 among parents and from 0.75 to 0.92 among adolescents. Mean differences between parent and adolescent were small; the greatest difference occurred in the appearance subscale. Parental scales showed evidence of validity and potential for sensitivity to change. In an effort to support the construct validity of the new scales, they were compared with the Child Health Questionnaire and related to each other in clinically sensible ways. These burn outcomes scales reliably and validly assess function in patients with burns, and the scales have been developed in such a way that they are likely to be sensitive to change over time.

Activities of Daily Living↗

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Physical and psychologic rehabilitation outcomes for pediatric patients who suffer 80% or more TBSA, 70% or more third degree burns.

Advances in medical management have dramatically decreased the mortality of children with massive burn injuries, which raises many questions about the expected quality of life for these young survivors. In this article, we address this issue by examining the functional and psychological adaptation of 41 young survivors with 88% mean total body surface area (TBSA) burns and 85% mean third degree TBSA burns. Patient scores were compared with normative data on standardized psychological measures of adjustment and on performance of age appropriate activities of daily living (ADL) skills. Thirty-three of the 41 patients (80%) were independent in basic ADL skills. Eighty-six percent of the patients who were aged 10 years and older were independent in advanced ADL skills. Patients with amputated fingers were significantly more dependent in ADL skills than those without amputations (P < .05). Mean psychosocial adjustment scores were within normal limits and were not significantly related to functional independence in ADL skills.

Activities of Daily Living↗

PubMedDate not supplied

Coming to terms: parents' response to a first cancer recurrence in their child.

The purpose of this study was to explore, using grounded theory, the process experienced by parents who are dealing with the first recurrence of cancer in their child. The sample of 33 guardians (27 mothers, 1 grandmother, and 5 fathers) was drawn from three pediatric oncology settings. Data were collected through interviews, observations, and medical record review. Thirteen parents were interviewed to validate first the evolving and, later, the complete study findings. Four interactive components emerged: regulating shock, situation monitoring, alternating realizations, and eyeing care-limiting decisions. The overall organizing construct induced from these components was labeled "coming to terms." This construct represents the parents' efforts to overcome shock and despair to make wise decisions about treatment while accepting that the outcome if beyond their control, and to help their child have the optimal chance for cure while preparing for the child's possible death.

Adaptation, Psychological↗

PubMedDate not supplied

Identification of clinical strains of Candida albicans by DNA fingerprinting with the polymerase chain reaction.

DNA polymorphisms generated by the polymerase chain reaction (PCR) were used to differentiate clinical isolates of Candida. This PCR method employed single primers that were originally designed as hybridization probes for DNA fingerprinting experiments to probe minisatellite and microsatellite DNA sequences. To evaluate this procedure, 35 isolates from 20 patients in several intensive care units and 12 isolates obtained from the oral cavities of healthy dental patients were fingerprinted. The PCR-fingerprint patterns of isolates of Candida albicans from the immunocompromised patients revealed fewer differences than isolates from the dental service. Multiple isolates from different body sites of the same patients revealed that patients may harbour isolates of Candida with the same or different PCR-fingerprints. Since this method is generally simpler and faster than established methods of biotyping medically important yeasts, PCR-fingerprinting may prove useful for the surveying of large numbers of pathogens for epidemiological studies.

Base Sequence↗