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PubMedDate not supplied

Delays in immunizations of high-risk infants during the first two years of life: special care for the high-risk infant should not mean special immunization schedules.

Because experience in our newborn intensive care unit follow-up clinic since 1982 suggested that immunizations of newborn intensive care unit graduates in the first 2 years of life were inappropriately delayed, questionnaires were sent to families and to the four categories of primary care providers (family practitioners, pediatricians, local health clinics, and neonatalogists) in our region to assess immunization rates and practices. Delays in the first diphtheria, tetanus, and pertussis immunization and the polio vaccine were greater the less the birth weight and less the gestational age of the infant. Delays in subsequent immunizations were considerable and did not correlate with gestational age. A substantial proportion of primary care providers are not immunizing infants in compliance with the American Academy of Pediatrics recommendation, but some improvement is seen when the time period 1982 to 1986 is compared with 1987 to 1991.

Female↗
PubMed1994

Clinical implications of NSAID pharmacokinetics: special populations, special considerations.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the centerpiece of pharmacologic therapy for most rheumatic disorders and related conditions, and as such are used in great numbers. These drugs are relatively safe and effective, but the pharmacokinetics of NSAIDs can be substantially altered in certain groups of patients, including the elderly and patients with renal and hepatic disease. In these patients, the risk of NSAID toxicity is increased. An understanding of NSAID pharmacokinetics in these groups can help physicians to adjust therapeutic regimens in order to limit the potentially serious complications of long-term NSAID therapy. The author discusses the age-related physiologic changes that may affect the various areas of drug pharmacokinetics and ways in which NSAIDs may interact with other drugs. Risk assessment and monitoring methods are also discussed.

Absorption↗
PubMed1993

Pneumonia in the elderly. Special considerations in a special population.

Bacterial infections of the lower respiratory tract in the elderly may not be as atypical in presentation as traditional wisdom once held. Recent studies indicate that more than one in three elderly patients have fever, cough, and leukocytosis; nevertheless, some elderly patients present with none of the features typically associated with pneumonia. An important and consistent clinical difference between younger and older patients is the broader range of bacterial respiratory pathogens found in the elderly, including gram-negative bacilli such as Haemophilus influenzae, Proteus mirabilis, and Moraxella catarrhalis. Little is gained by the initial use of narrow-spectrum antibiotic therapy, and much may be lost. Parenteral third-generation cephalosporins and oral fluoroquinolones are active against the major pathogens and can be used for empirical broad-spectrum therapy. Recent trials indicate that results are equally good with agents of either type. Perhaps a third of elderly patients with pneumonia do not require or benefit from hospitalization. The availability of excellent new broad-spectrum oral antimicrobial agents makes treatment at home or in a nursing home an attractive way to avoid the costs and many complications of hospitalization for acute care of these frail patients.

Aged↗
PubMed1995

Special feeds for special infants: 2. Feeding the preterm baby.

Individual babies may differ considerably in the way in which feeds can be introduced, the problems they encounter while this is going on, their final feed requirements and the need for supplementation. Sucking and swallowing reflexes are poorly developed before 32-34 weeks' gestation. Respiratory illness is probably the main reason for delay in the start of milk feeding. Immediate aims are to prevent hypoglycaemia and provide normal fluid requirements, if necessary by IV infusion or tube feeding. Preterm babies have large energy requirements. The mother's breast milk is the best milk with which to begin feeding. If a formula milk is given, it should be a preterm, low birth weight formula which supplies extra energy, protein and minerals, not a standard formula intended for babies at term.

Feeding Behavior↗