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PubMed1993

A phase I trial of fazarabine in refractory pediatric solid tumors. A Pediatric Oncology Group study.

Fazarabine is a synthetic analog of cytosine arabinoside and 5-azacytidine that incorporates structural features of both compounds. Xenograft studies showed good activity against a variety of transplanted tumors. Initial studies in adults employed both a continuous infusion schedule and a daily bolus x 5 schedule. Myelotoxicity, especially neutropenia, was dose-limiting, with excessive myelotoxicity seen on the daily bolus x 5 at 72 mg/M2/day. Since short infusions may be administered in Ringer's lactate rather than either dimethylsulfoxide or dimethylacetamide required for continuous infusion, this study examined a daily x 5 schedule in children with refractory solid tumors. The initial dosage was 30 mg/M2/day, 80% of the maximum tolerated dosage in adults, with subsequent 30% dosage escalations. A total of 18 patients were enrolled, with a wide spectrum of pediatric solid tumors. Myelosuppression was the only significant toxicity, and was excessive at 78 mg/M2/day. Therefore, on this bolus regimen, 65 mg/M2/day for 5 days was the maximum tolerated dosage. One patient with medulloblastoma had stable disease for 65 days. No other responses were seen.

Antineoplastic Agents↗
PubMed2000

Incidence of surgical site infections in pediatric patients: a 3-month prospective study in an academic pediatric surgical unit.

During a 3-month period 259 pediatric surgical procedures in 236 patients were followed for the development of surgical site infections (SSI): 17 sites became infected, an overall infection rate of 6.6%. The incidence in our study was therefore higher than expected. As expected, the infection rate increased according to wound contamination: dirty sites had a SSI rate of 30%. Emergency procedures, operation duration over 1 h, and inpatients showed a statistically significant higher risk of developing SSI. Although there were differences between males and females, individual surgeons, and the use of antibiotic prophylaxis, these differences were not statistically significant.

Ambulatory Surgical Procedures↗
PubMed2005

Review of tonsillar lymphoma in pediatric patients from the pediatric oncology group: what can be learned about some indications for microscopic examination?

Financial considerations have led to suggestions that routine microscopic evaluation of tonsils and adenoids is neither cost effective nor clinically indicated. However, the possibility of tonsillar lymphoma must be carefully weighed when making institutional policy decisions. One way to find an appropriate algorithm for pathologic examination is to examine the characteristics of biopsy-proved tonsillar lymphomas. To investigate the clinicopathologic characteristics of tonsillar lymphoma, we performed a retrospective analysis of patients who had non-Hodgkin lymphoma (NHL) and large-cell or Burkitt lymphoma involving the tonsils and adenoids and were registered on Pediatric Oncology Group (POG) protocols. Seventy-seven (9%) of 832 POG cases of NHL involved the tonsils and adenoids. Review of the pathology reports available from 29 of these cases revealed that NHL was incidentally discovered by pathologic examination in only 5 cases, all of which had clinical evidence of unilateral tonsillar enlargement or size discrepancy by gross examination. The other 24 cases indicated a clinical suspicion of tonsillar cancer, as judged by a preoperative diagnosis or by a request for frozen-section examination. We conclude that in most cases there is a clinical suspicion of tonsillar NHL at the time of gross examination. With routine cases, we predict that the use of comparative organ weights, a clinical impression of tonsillar asymmetry, and review of clinical history will increase the recognition of tonsillar lymphoma when "gross-only" protocols are employed for specimen handling.

Adenoids↗
PubMed1992

Atypical tuberculosis in the pediatric patient: implications for the pediatric surgeon.

Atypical species of mycobacteria (AMB) are now the most common cause of granulomatous lymphadenopathy. It is important for pediatric surgeons to be aware of this disease, because excision is the mainstay of therapy. We have reviewed the experience with this disease in Alberta by reviewing the records of the Provincial Laboratory of Public Health from 1979 to 1990. This facility reviews all tuberculosis cultures for the province. A total of 74 cases of infection caused by AMB were identified in patients under the age of 15. Complete records were available for 53 of these cases. These infections were characterized by a short history (11.2 weeks) of remarkably nontender regional lymphadenopathy (usually cervicofacial, 45/50) in young (average age, 13.6 months), caucasian (48/53) children. Attempts to treat these lesions by incision and drainage or drug therapy were unsuccessful (12/12 failed), whereas primary excision was successful in 33 of 37 cases. Secondary excisions were also successful in 16 of 16 cases where required. The annual rate of AMB over the study period was 1.21 cases per 100,000 children; the rate of M tuberculosis lymphadenopathy was 0.3 per 100,000. In the absence of specific risk factors for human tuberculosis (family history, native Indian or Asian ethnic origin) AMB is the most likely cause of prolonged painless lymphadenopathy and should be treated early by complete excision.

Adolescent↗
PubMed1993

Factors associated with serum cholesterol level in a pediatric practice. Cholesterol screening in a pediatric practice.

The associations between age, sex, height, Quetelet index, blood pressure, and serum cholesterol level were examined among 1406 routinely screened children, aged 4 to 19 years, in a pediatric practice. After adjustment for sex and age, height and Quetelet index were associated with serum cholesterol levels. Quetelet index was shown by multiple linear regression to be positively related to cholesterol levels (b = 0.780, P < 0.01), but the predictive value of screening based on an elevated Quetelet index was marginal. Clustering of elevated serum cholesterol level, Quetelet index, and systolic blood pressure was observed. Familial aggregation of cholesterol levels was demonstrated using analysis of variance for 742 children from 342 families included in the regression analysis (F341,400 = 1.56, P < 0.0001). The intraclass correlation coefficient, a measure of familial aggregation, was 0.205 (P < 0.0001). Age, sex, height, Quetelet index, and familial aggregation accounted for 10.6% of the variance in serum cholesterol levels. Siblings of children with high cholesterol levels are a high-yield group in cholesterol screening.

Adolescent↗
PubMed2006

Epidemiologic surveillance of Clostridium difficile diarrhea in a freestanding pediatric hospital and a pediatric hospital at a university medical center.

To describe the epidemiology of Clostridium difficile in children, we cultured stool specimens from patients at the Children's Hospital Central California, Madera, CA (CHCC, n = 676) and at the University of California Davis Medical Center Pediatric Hospital, Sacramento, CA (UCDMC-PH, n = 301) for C. difficile, and toxins A and B genes and strain identity of the isolates were determined by polymerase chain reaction assays. A higher percentage of patients from UCDMC-PH were culture positive (148/301, 49%) and colonized with toxigenic strains (45/301, 15%) compared with CHCC (colonized = 178/676, 26%; toxigenic = 96/676, 14%, P < or = .001). Multiple logistic regression analysis showed decreased colonization with inpatient status (odds ratio [OR] = 0.64; 95% confidence interval [CI] = 0.46, 0.89; P = .007) and use of H-2 antagonists (OR = 0.55; 95% CI = 0.36, 0.84; P = .006), whereas underlying conditions (colonization: OR = 1.42; 95% CI = 1.02, 1.96; P = .04; toxin positive: OR = 1.60; 95% CI = 1.04, 2.44; P = .03) and exposure to > or =2 antiinfectives (colonization: OR = 1.56; 95% CI = 1.10, 2.20; P = .01; toxin positive: OR = 1.71; 95% CI = 1.10, 2.66; P = .02) increased colonization. Most isolates appear to be community acquired, although molecular analysis suggests some nosocomial transmission at UCDMC-PH. These data suggest that the epidemiology of colonization with C. difficile in children is different than previously reported.

Carrier State↗
PubMed2005

Underdiagnosis of pediatric obesity and underscreening for fatty liver disease and metabolic syndrome by pediatricians and pediatric subspecialists.

OBJECTIVES: To evaluate how often general pediatricians, pediatric endocrinologists, and gastroenterologists diagnose children as overweight and how often interventions are provided, including nutritional counseling and screening for nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome. STUDY DESIGN: The study was a retrospective chart review of outpatient visits at 2 academic hospitals. RESULTS: A total of 2256 patient visits were analyzed, including 715 visits by overweight children. Of those 715 visits, 31% resulted in a diagnosis of overweight. Diagnosis of overweight and nutritional counseling were least likely to occur during gastroenterology visits (22% and 13%, respectively, P < .01). Screening for metabolic syndrome was most likely to occur during endocrinology visits (34%; P < .01). Screening for NAFLD was most likely to occur during gastroenterology visits (23%; P < .01). Children age < 5 years and those with a body mass index percentile (BMI%) of 85% to 94% were least likely to receive diagnosis and intervention for overweight. CONCLUSIONS: The majority of overweight children were not diagnosed and did not receive relevant and recommended evaluations and interventions. Specific attention should be focused on providing diagnosis and interventions for overweight children, especially those age < 5 years and with a BMI% of 85% to 94%.

Adolescent↗
PubMed2006

New insight into rectal function in pediatric defecation disorders: disturbed rectal compliance is an essential mechanism in pediatric constipation.

OBJECTIVE: To evaluate rectal sensitivity in patients with pediatric constipation (PC) and nonretentive fecal soiling (FNRFS) using pressure-controlled distention (barostat). STUDY DESIGN: Thresholds for rectal sensitivity (first sensation, urge to defecate, and pain), and rectal compliance were determined using a barostat. RESULTS: A total of 69 patients with PC (50 males; mean age, 10.9 +/- 2.2 years) and 19 patients with FNRFS (15 males; mean age, 10.0 +/- 1.9 years) were compared with 22 healthy volunteers (HVs) (11 males; mean age, 12.7 +/- 2.6 years). Sensitivity thresholds were not significantly different among the 3 groups. Rectal compliance was increased in 58% of the patients with PC (P < .0001 vs HVs). Rectal compliance did not differ between patients with FNRFS and HVs. Children with PC with abnormal rectal function required significantly larger rectal volumes at urge to defecate. CONCLUSIONS: Increased compliance is the most prominent feature in patients with PC. Because of higher compliance in these children, larger stool volumes are required to reach the intrarectal pressure of the urge to defecate. Children with FNRFS have normal rectal function.

Adolescent↗
PubMed1998

Pediatric bronchioloalveolar carcinoma: a favorable pediatric malignancy?

Primary pulmonary tumors are infrequent in children. Bronchioloalveolar carcinoma has been documented rarely in the pediatric population. Before this report, there have been only three cases of bronchioloalveolar carcinoma in patients less than 16 years of age. Our two cases represent two of the youngest cases (ages 6 and 15 years) reported with bronchioloalveolar carcinoma. They illustrate many of the typical findings of this disease including clinical presentation, diagnostic difficulty, and better prognosis compared with other pulmonary malignancies. This neoplasm appears to have a favorable outcome in childhood.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1998

Infant pediatric liver transplantation results equal those for older pediatric patients.

METHODS: From July 1984 to July 1995, 99 pediatric patients underwent 127 orthotopic liver transplants (OLT) at the University of Wisconsin Children's Hospital. The patients were divided into four groups according to age at time of transplant: group I, 0 to 6 months (n = 20); group II, 6 to 12 months (n = 18); group III, 1 to 2 years (n = 10); and group IV, 2 to 18 years (n = 51). A retrospective analysis was performed to compare these four groups with regard to preoperative indications and demographics, intraoperative technique, complications, and survival. All patients were followed up for 2 to 13 years. RESULTS: Biliary atresia was the most common indication for OLT in all four groups. The average waiting period varied from 19+/-18 days for group I to 44+/-64 days for group IV. Reduced-size liver transplant (I, 41%; II, 52%; III, 28%; IV, 21%), split-liver transplant (I, 0%; II, 7.4%; III, 17%; IV, 2.9%), or whole-liver transplant techniques were used. Although postoperative Intensive Care Unit stay was longer for the 0- to 6-month-old patients (I, 20+/-64; II, 7.6+/-9; III, 13+/-17; IV, 6.8+/-14 days), the total hospital stay (I, 43+/-63; II, 33+/-34; III, 32+/-20; IV, 29+/-31 days) was similar for all patients. The incidence of hepatic artery thrombosis (I, 19%; II, 19%; III, 27%; IV, 16%), biliary tract complications (I, 4.8%; II, 15%; III, 20%; IV, 14%), and retransplantation (I, 9.5%; II, 41%; III, 33%; IV, 14%) were not significantly different between the four groups. Portal vein thrombosis (I, 9.5%; II, 11%; III, 6.6; IV, 0%) and primary nonfunction (I, 9.5%; II, 7.4%; III, 0%; IV, 3.1%) occurred more frequently in the 0- to 6-month and 6- to 12-month groups, however, the 1-, 5-, and 10-year survival rate for patients (I, 85%, 79%, 79%; II, 89%, 74%, 74%; III, 80%, 80%, 80%; IV, 84%, 75%, 75%, respectively) and primary liver allografts (I, 69%, 69%, 69%; II, 72%, 72%, 63%; III, 70%, 70%, 70%; IV, 71%, 57%, 57%, respectively) were not significantly different (P = .98 and P = .83). CONCLUSION: These results demonstrate that OLT can be effectively performed on infants of all ages and that OLT should not be delayed because of age.

Adolescent↗
PubMed2002

Up-front centralized data review and individualized treatment proposals in a multicenter pediatric Hodgkin's disease trial with 71 participating hospitals: the experience of the German-Austrian pediatric multicenter trial DAL-HD-90.

BACKGROUND AND PURPOSE: A systematic procedure for up-front centralized data review and the set-up of individualized treatment proposals was integrated prospectively into the German-Austrian multicenter trial DAL-HD-90 for pediatric Hodgkin's disease (HD) in order to introduce local radiotherapy according to the individual patient's spread of disease within a combined-modality treatment. This paper investigates the feasibility of such a procedure and its impact on the final definition of the extent and stage of disease as well as on the choice of treatment. PATIENTS AND METHODS: Between October 1990 and July 1995, 578 children and adolescents <18 years (259 girls, 319 boys, median age 12.9 years) with HD were enrolled into the HD-90 trial. After clinical and pathological staging (66.4/33.6%), patients were allocated to treatment groups (TG) 1 'early stage', TG2 'intermediate stage', or TG3 'advanced stage'. All groups underwent two cycles of OPPA (vincristine, prednisone, procarbazine, doxorubicin) (girls) or OEPA (E, etoposide) (boys) for induction chemotherapy. TG2 and TG3 continued on as two or four cycles, respectively, of COPP (C, cyclophosphamide). Low-dose local radiotherapy was given to the initially involved sites, with radiation doses of 25 Gy in TG1/TG2, and 20 Gy in TG3. All documentation forms, radiographs, and chest and abdominal computed tomography (CT) scans were centrally reviewed, addressing in particular the individual patient's extent and stage of disease. This review and the set-up of individualized treatment proposals were in the hands of the study coordinator, one additional pediatrician and two radiation oncologists and radiologists at the study center. During a time slot of at least 8 weeks (two cycles of standard chemotherapy in all three TGs) the individualized treatment proposals were to be sent to the participating hospital. RESULTS: Complete sets of documentation from 564/578 patients (97.6%) were submitted sufficiently early to the study center. A total of 285 out of 574 chest radiographs, 468 out of 553 chest CT scans and 421 out of 548 abdominal CT scans were available from 71 hospitals. A total of 564 individualized treatment proposals were worked out by the review group and sent to the hospitals before radiotherapy began. Re-analysis of images and documentation forms, including laboratory and clinical data, resulted in a revision of stage in 115/571 patients (20.1%) and of TG in 76/571 patients (13.3%). A total of 67/76 patients were shifted into a higher TG, 60 patients on account of additionally detected extralymphatic involvement, five patients because of additionally detected lymph node involvement and two patients due to clinical data which had to be classified as B-symptoms. A total of 9/76 patients were shifted into a lower TG; in three patients extranodal disease and in six patents local lymph node involvement could not be confirmed. CONCLUSIONS: The up-front centralized review of patient data and consecutive set-up and delivery of individualized treatment proposals for almost every patient are feasible within a large multicenter trial. Sufficient time and manpower at the study center are needed for the review process and the set-up of individualized treatment proposals. Such a procedure has a significant impact on the homogeneity of stage definition, allocation to TG, and individualized treatment proposals.

Adolescent↗
PubMed1999

Blocks and other techniques pediatric surgeons can employ to reduce postoperative pain in pediatric patients.

Painful experiences, such as circumcision without the benefit of anesthesia, during the neonatal period may induce lifelong behavior changes in infants and children. By inference, this is probably true for other painful experiences encountered during childhood. It is much easier to prevent the establishment of pain than it is to eradicate it once it has become firmly established. As "captain of the ship," there are three very basic things a pediatric surgeon can do to reduce postoperative discomfort in your young patients. First, whenever possible, allow caudal blocks or other forms of regional anesthesia, such as penile or ilioinguinal-iliohypogastric nerve blocks, to be performed on your patients. Second, always use timed analgesics and avoid PRN orders. Last, know how to use two analgesics well, one narcotic and one non-narcotic. Be completely familiar with their uptake, distribution, and elimination half-lives. This article presents a review of the efficacy and safety of caudal blocks, and the use of ilioinguinal/iliohypogastric, "splash," and penile blocks as alternative techniques for providing perineal analgesia. In addition, the most current and efficacious dosage regimen for the rectal administration of acetaminophen (40.0 mg/kg after induction of anesthesia, then 20.0 mg/kg every 6 hours for the first 24 postoperative hours) is presented. Additionally, the novel use of intravenous methadone (0.2 to 0.3 mg/kg) to provide intense and protracted narcotic analgesia is discussed.

Acetaminophen↗
PubMed1999

Prognostic value of cerebrospinal fluid cytology in pediatric medulloblastoma. Swiss Pediatric Oncology Group.

BACKGROUND: Although the demonstration of leptomeningeal dissemination is the most important predictor of poor outcome in children with medulloblastoma, there is lack of consensus on the prognostic value of a positive cerebrospinal fluid (CSF) cytology (i.e., stage M1). PATIENTS AND METHODS: Eighty-six pediatric medulloblastoma patients treated in Switzerland between 1972-1991 were retrospectively studied regarding the influence of M-stage on prognosis. 39 were M0, 13 M1, 15 Mx, 17 M2, and 2 M3. RESULTS: Five- and 10-year overall survival rates were 76% and 54% for M0, 68% and 50% for Mx, 36% and 25% for M1, and 22% and 22% for M2-3 (P < 0.001), respectively. No significant survival differences were observed between M1 and M2-3 patients. Among 26 patients with only postoperative CSF cytologies, seven were positive. Their outcome was similar to that of six preoperatively staged M1 and significantly different from that of M0 patients (P = 0.001). In 14 patients both pre- and postoperative CSF cytology was performed. Total agreement was observed between the pre- and postoperative results (six positive and eight negative). Among the 19 M2-3 patients CSF cytology was positive in eight, negative in five, and unknown in six. CONCLUSIONS: A positive CSF cytology either pre- or postoperatively predicts for a poor outcome, similar to that observed in stage M2-3 patients. A postoperative cytology is likely to be concordant with cytologic results obtained preoperatively, and seems to have the same prognostic significance. A negative cytology, however, does not exclude a more advanced stage.

Adolescent↗
PubMed1999

Intensive high-dose asparaginase consolidation improves survival for pediatric patients with T cell acute lymphoblastic leukemia and advanced stage lymphoblastic lymphoma: a Pediatric Oncology Group study.

This study was designed to test the hypothesis that high-dose asparaginase consolidation therapy improves survival in pediatric patients with T cell acute lymphoblastic leukemia and advanced stage lymphoblastic lymphoma. Five hundred and fifty-two patients (357 patients with T cell acute lymphoblastic leukemia (ALL) and 195 patients with advanced stage lymphoblastic lymphoma) were enrolled in POG study 8704 (T-3). Treatment included rotating combinations of high-dose myelosuppressive chemotherapy agents proven to be effective in T cell ALL in other POG group-wide or local institutional protocols (including vincristine, doxorubicin, cyclophosphamide, prednisone, asparaginase, teniposide, cytarabine and mercaptopurine). After achieving a complete remission (CR), patients were randomized to receive or not receive high-dose intensive asparaginase consolidation (25,000 IU/m2) given weekly for 20 weeks by intramuscular injection. Intrathecal chemotherapy (methotrexate, hydrocortisone and cytarabine) was given to prevent CNS disease, and CNS irradiation was used only for patients with leukemia and an initial WBC of >50,000/microl or patients with active CNS disease at diagnosis. CR was achieved in 96% of patients. The high-dose asparaginase regimen was significantly superior to the control regimen for both the leukemia and lymphoma subgroups. Four-year continuous complete remission rate (CCR) for the leukemia patients was 68% (s.e. 4%) with asparaginase as compared to 55% (s.e. 4%) without. For the lymphoma patients, 4-year CCR was 78% (s.e. 5%) with asparaginase and 64% (s.e. 6%) in the controls. The overall one-sided logrank test had a P value <0.001 favoring asparaginase, while corresponding values were P = 0.002 for ALL and P = 0.048 lymphoblastic lymphoma. Toxicities were tolerable, but there were 18 failures due to secondary malignancies (16 with non-lymphocytic leukemia or myelodysplasia). Neither WBC at diagnosis (leukemia patients) nor lymphoma stage were major prognostic factors. We conclude that when added to a backbone of effective rotating agents, repeated doses of asparaginase during early treatment improve the outcome for patients with T cell leukemia and advanced stage lymphoblastic lymphoma.

Adolescent↗
PubMed2005

Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS).

BACKGROUND: Elevated blood pressure (BP) is frequent in children on long-term dialysis therapy. However, the prevalence of hypertension and status of BP control in these patients are lacking. Using the North American Pediatric Renal Transplantation Cooperative Study database, we determined the prevalence of hypertension and assessed risk factors for elevated BP during long-term dialysis therapy in children. METHODS: The study cohort included 3,743 patients (age, 0 to 21 years). Uncontrolled hypertension is defined as BP equal to or greater than age-, sex-, and height-specific 95th percentiles; controlled hypertension was considered in children who were administered antihypertensive medications, but had BP less than the 95th percentile. RESULTS: A total of 76.6% of patients had either uncontrolled (56.9%) or controlled (19.7%) hypertension at baseline. Normotensive children at baseline had significant BP increases, whereas hypertensive children at baseline had significant BP decreases during the first year of dialysis therapy. BP did not change significantly after 1 year of dialysis therapy; 51% of patients had uncontrolled hypertension after 1 year of maintenance dialysis therapy. Logistic regression analysis shows that baseline hypertensive status and use of BP medications are both large significant risk factors for subsequent hypertension. Other risk factors include young age, acquired cause of renal failure, black race, initiation of dialysis therapy in 1992 to 1997, and hemodialysis as a mode of renal replacement therapy. CONCLUSION: Hypertension is very prevalent and difficult to control in children on dialysis therapy. Results also suggest that the initial months on maintenance dialysis therapy might be the window of opportunity when careful monitoring and aggressive management of hypertension would allow achieving BP control in these patients.

Adolescent↗
PubMedDate not supplied

[The role of S100B-protein in neonatology, pediatric intensive care, and pediatrics].

During the last years neuromonitoring with various biochemical markers such as S100B protein has been introduced into the clinical settings of neonatal and pediatric intensive care. Several investigations have been undertaken to correlate S100B protein concentrations to the diagnosis and prognosis of neonates and children with severe cerebral disorders. This articles gives a review on the current knowledge, indications and limitations on the use of S100B protein after non-traumatic and traumatic brain injury in neonates and children.

Adolescent↗
PubMed1992

Current concepts in pediatric burn care: the biology of cultured epithelial autografts: an eight-year study in pediatric burn patients.

An 8-year histopathological study of skin regeneration and wound healing in 22 pediatric patients treated with cultured epithelial autografts (CEA) grafted to full-thickness burn wounds excised to muscle fascia is reported. Biopsies of CEA have been analyzed by light microscopic, immunohistochemical, morphometric, electron microscopic and ultrastructural immunolabelling techniques and compared to controls of meshed split-thickness autograft (MSTA) interstices at comparable times postgrafting. At transplantation, CEA are undifferentiated and lack both granular and cornified cell layers. By 6 days postgrafting, CEA differentiate all normal epidermal strata but lack rete ridges. De novo formation of a confluent basal lamina and mature hemidesmosomes is complete by about 3 weeks. Anchoring fibrils appear sparse and immature (as in MSTA controls) compared to normal skin until about 6-12 months. CEA develop rete ridges and a neodermis with normal stromal and vascular organization at about 6-12 months, whereas MSTA interstice controls do not. At 4-5 years, elastin expression is also observed in the CEA neodermis, completing the dermal regeneration process. Normal epidermal differentiation is maintained long-term. These long-term results indicate that CEA regenerate a stable normal epidermis and are capable of inducing dermal regeneration from wound bed connective tissue.

Adolescent↗
PubMed1994

Epidemiology of pediatric meningitis caused by Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis in Israel: a 3-year nationwide prospective study. Israeli Pediatric Bacteremia and Meningitis Group.

In a 3-year nationwide prospective study on pediatric meningitis caused by Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis in Israel, 1258 invasive infections with a known focus were observed. Meningitis was found in 482 (38%): 56%, 16%, and 76% of all infections by H. influenzae type b, S. pneumoniae, and N. meningitidis, respectively. The incidence of meningitis during the first year of life was 67.1, 17.5, and 9.5/100,000 for H. influenzae type b, S. pneumoniae, and N. meningitidis, respectively, and in children < 5 years old it was 18.5, 5.3, and 5.2. Extrapolated for a population in which 100,000 live births occur yearly, 2097 hospital days were required. The case fatality rate was 2.2%, 5.9%, and 6.3% for H. influenzae type b, S. pneumoniae, and N. meningitidis, respectively. Boys were affected significantly more often than girls, but mortality was higher among girls. On the basis of the observed serotypes and age distribution, even with optimal vaccine development in the next 5 years, it is not likely that > 50% of all cases will be prevented.

Age Distribution↗