Optimum needle length for DPT inoculation of indian infants

Correct placement of the injected DPT vaccine into the deep muscular layers decreases the local reactions, including the sterile abscess formation. However, recommendations on size of the needle to be used and the angle of injection are not easily available, are not uniform and are based on case reports. The only study based on scientific data of ultra-sonographic measurement of fat layer and muscle layer thickness of thigh of only 24 infants of 4 months age covers only American children. (Hick et al,Pediatrics 1989; 84: 136–37). In the present study, we have produced similar data on 215 Indian children belonging to all those age groups in which DPT vaccinations are given. Mean thickness of skin + fat layer in the middle one-third of the anterolateral aspect of thigh was 1.03±0.23 cm, 1.04±0.21 cm, 0.95±0.19 cm and 1.06±0.27 cm in the age groups of 6–12 weeks (Groups I), 13–18 weeks (Group II), 19–24 weeks (Groups III) and 18±1 month (Group IV) respectively. These age groups correspond to the timings of first 3 primary doses and the first booster dose of the DPT vaccine in our immunization clinic. Mean thickness of all the soft tissues together at the same site were 1.87±0.35, 2.17±0.38, 2.07±0.39 and 2.07±0.26 cm respectively for the groups I to IV. Calculations with 25, 20 and 15 mm long needles injected at an angle of 45° and 90° to the thigh surface show that success rates would be best with 15 mm needle injected at 90° angle (actual depth of penetration 15 mm) or a 20 mm needle injected at 45° angle (actual depth of penetration 14.1 mm). Success rates in the four groups with 15 mm needle at 90° angle would be 88.5%, 93.2%, 90.5% and 90.5% respectively, and with 20 mm needle at 45° angle would be 92.3%, 93.1%, 90.5% and 90.5% respectively. Thus, 20 mm needle at 45° or 15 mm needle at 90° inserted to their full length at the mid anterolateral thigh of the child are recommended for field trials to confirm that they indeed reduce the incidence of subcutaneous sterile abscess formation and other local reactions.     

Response of preterm infants to diphtheria-tetanus-pertussis vaccine

The American Academy of Pediatrics recommendation that immunization of preterm infants with diphtheria-tetanus-pertussis (DTP) vaccine should begin at 2 months after birth, regardless of gestational age, is based on limited data. A prospective study was conducted to determine the immunogenicity and safety of DTP vaccine in preterm infants. One hundred ten preterm and 146 full term infants received doses of DTP at 2, 4 and 6 months after birth. Adjusted analysis of the antibody responses indicated that after three doses mean titers among preterm infants to each vaccine component were comparable to those of full term infants. Adjusted analysis of the incidence of adverse events indicated that the risk of adverse events in preterm infants was not significantly higher than that in full term infants. DTP vaccine is immunogenic and safe in preterm infants when the series is initiated at 2 months after birth, and this study supports the current recommendation of the American Academy of Pediatrics.     

Response of preterm infants to diphtheria-tetanus-pertussis immunizations

To establish guidelines for the routine use of diphtheria, tetanus, and pertussis (DTP) vaccine in preterm infants, we quantitated antibody responses of preterm infants to DTP and determined the nature and extent of side effects. Twenty-five preterm infants were immunized with 0.5 ml DTP vaccine at routine intervals. Term infants served as controls. Immediately before each immunization and 2 months after the third, DTP-specific antibodies were quantitated. Clinical side effects were determined by parental report. After the second immunization, 100% of preterm infants had evidence of specific antibody production against diphtheria, tetanus, and pertussis. The incidence of side effects was low, but irritability was significantly more common in preterm infants after the second immunization. These observations suggest that the initiation of primary immunization with DTP in preterm infants need not be delayed beyond 2 months of age.     

Primary care physicians' knowledge about diphtheria-tetanus-pertussis immunizations in preterm infants.

Preterm infants often receive their diphtheria-tetanus-pertussis (DTP) immunizations on a delayed schedule or in reduced dosage. Since primary care physicians (PCPs) immunize many preterm infants, the purpose of this study was to describe PCPs' knowledge about the use of DTP immunizations in preterm infants. Among the 479 PCPs who completed the questionnaire, 84% of pediatricians and 60% of family physicians correctly identified chronologic age as a criterion for initiating DTP immunizations in preterm infants. However, nearly 45% of PCPs linked this with other criteria such as a minimum weight requirement. Family physicians' answers differed from the recommendations more often than pediatricians' answers. The answers of pediatricians and family physicians who completed residency greater than 20 years ago differed from the recommendations more often than those who completed training less than or equal to 20 years ago. The answers of PCPs with fewer than five preterm infants in their practices differed from the recommendations more frequently than the answers of those with five or more preterm infants in their practices. Educational interventions are needed to bring PCPs' knowledge and practices into compliance with the American Academy of Pediatrics recommendations concerning DTP immunizations for preterm infants.     

Ventilatory pattern following diphtheria-tetanus-pertussis immunization in infants at risk for sudden infant death syndrome

To evaluate the effects of diphtheria-tetanus-pertussis (DTP) immunization on the ventilatory pattern during sleep in infants at increased risk for sudden infant death syndrome (SIDS), we performed overnight pneumograms (recordings of ventilatory pattern and electrocardiogram) on 30 control infants, 46 infants with unexplained apnea, and 33 subsequent siblings of SIDS victims the night before and the night following a DTP immunization. Pneumograms were quantitated for total sleep time, longest apnea (in seconds), total duration of apneas longer than 6 s (in minutes), and total periodic breathing (in minutes). Following the DTP immunization there was no significant change in any criterion quantitated on pneumograms from any group except for a decrease in periodic breathing in the unexplained apnea group. We conclude that DTP immunization does not increase abnormalities of the ventilatory pattern as recorded by the pneumogram technique in infants at increased risk for SIDS.     

Comparison of acellular and whole-cell pertussis-component diphtheria-tetanus-pertussis vaccines in infants. The APDT Vaccine Study Group

In a multicenter, double-blind, randomized, longitudinal study, 252 children received licensed Lederle diphtheria-tetanus toxoids and pertussis vaccine adsorbed (DTP) at 2, 4, and 6 months of age, and 245 children received a DTP vaccine with the Lederle/Takeda acellular pertussis component (APDT) at the same ages. Both groups of children received APDT vaccine at 18 months of age. After each of the first three immunizations, APDT vaccine recipients had fewer local and systemic reactions than did DTP vaccinees. Reactions after the 18-month APDT vaccination were minimal in severity regardless of the vaccine previously received. Antibody responses to lymphocytosis-promoting factor and agglutinogens were more pronounced in DTP recipients; however, APDT recipients had a better serologic response to filamentous hemagglutinin, and responses to the 69K protein were equivalent. This APDT vaccine produces fewer reactions than the standard whole-cell DTP vaccine. The protective significance of the serologic responses to the APDT vaccine is unknown, but the greater response to filamentous hemagglutinin and equivalent response to the 69K protein compared with those to DTP vaccine seem promising.     

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目的探讨灭活卡介苗经皮接种治疗婴幼儿哮喘的临床疗效。方法选择2001-07—2003-03于湖南省人民医院就诊的85例年龄9个月至3岁的哮喘婴幼儿,应用随机数目表法将来院就诊的患儿分为治疗组45例(应用灭活卡介苗组)和对照组40例。观察治疗前后免疫球蛋白E(IgE)、嗜酸性阳离子蛋白(ECP)、白细胞介素-4(IL-4)、γ-干扰素(IFN-γ)、纯结核蛋白衍生物(PPD)试验、哮喘的发作程度的变化及疗效的评价。结果与对照组比较,治疗组患儿IL-4、IFN-γ,ECP、PPD的变化有统计学意义(P<0·05),哮喘发作程度、临床疗效差异也存在显著性意义(P<0·01),临床总有效率为86.67%。结论灭活卡介苗经皮接种有明显的治疗作用,可作为防治婴幼儿哮喘的有效方法之一。     

Palpebral fissure length in normal infants

Somatometric data on the size of palpebral fissure have been presented on 211 normal infants. The palpebral fissure length was derived from the inner canthal and outer canthal distances measured at different age levels. The size of palpebral fissure at birth (1.79 +/- 0.17 cm) is 76.8% of the value attained by it at 4-6 months age (2.33 +/- 0.09 cm), and 76.2% of the size at 10-12 months age (2.35 +/- 0.10 cm). Values for inner canthal and outer canthal distances measured at birth are also presented. The data provided are expected to assist objective evaluation of disorders affecting the size of palpebral fissure during infancy.     

Sternum length, torso length, and internipple distance in newborn infants

In order to define standards for sternal length, torso length, and internipple distance in the newborn infant, 198 term and preterm infants (27 to 41 gestational weeks) were examined. In every case, the gestational age was determined chronologically and clinically. Sternal and torso length and internipple distance were measured by two observers using standard measurement techniques. Normal values are presented by plotting the mean +/-2 SD for each gestational week v the gestational age.     

Growth of weight, length and crown-rump length of Malaysian infants and pre-school children

126 Malaysian children, 65 boys and 61 girls from higher income families were followed-up regularly from birth to six years of age in the University Hospital, Kuala Lumpur. Their physical growth, development, dietary and illness patterns were measured at each visit. The study confirms the observations of previous studies that boys are, on the average, heavier and taller than girls and that Asians are smaller in size with relatively shorter legs compared with children of European ancestry. These racial differences are due to a combination of genetic and environmental differences. Since there are genetic differences in the size and shape of children, standards applicable to the specific population should be used to obtain the best results when assessing the health of an individual child. The growth charts presented in this paper can be used as standards to monitor the growth of Asian infants and pre-school children.     

Knee-heel length measurement in healthy preterm infants.

AIM: To examine the reproducibility of crown-heel length measurement; the precision and reproducibility of knee-heel length measurement; and the association between the two in healthy preterm infants. METHODS: Paired crown-heel and knee-heel lengths were measured on 172 occasions by three observers in 43 preterm infants between 205 and 458 days of postconceptional age. RESULTS: Crown-heel length (CHL) measurement was highly reproducible, with a coefficient of variation (CV) of 0.41%. Knee-heel length (KHL) measurement was relatively precise (CV 0.78%), but less reproducible (intra-observer CV 1.77%, intra-observer CV 2.11%), especially in larger infants. The association between KHL and CHL was not consistent and varied with age. KHL was a poor predictor of CHL, with a 95% predictive interval of +/- 27.5 mm. CONCLUSIONS: KHL was less reproducible than CHL, especially in larger infants, and a poor predictor of CHL.     

Ultrasonic evaluation of kidney length in term and preterm infants

Kidney length was evaluated by ultrasound in 132 healthy neonates with gestational ages from 27 to 42 weeks and birth weights from 790 to 4200g. A highly significant correlation was found between the length of the kidneys and gestational age or birth weight.