IV. Effects of Silver Nitrate Prophylaxis on Mother-Infant Relationship

The effects of silver nitrate versus Hexarginum on maternal behaviour during care and breast-feeding were examined in a double-blind study of 65 mother-infant pairs. Observations and interviews took place on day 4 or 5 post partum. A follow-up interview was conducted 6–8 weeks later. The Neonatal Perception Inventories (Broussard) were used on both occasions. Mothers of infants in the silver nitrate group had significantly less eye contact with their newborns during breast-feeding than those in the Hexarginum group. This difference was even greater for mothers with complicated deliveries. Since eye-contact behaviours were infrequent, the results should be judged with caution. The maternal attitude towards the child, delivery, and post-partum care as expressed at 4–5 days and at 6 weeks did not differ between the groups. The frequency of breast-feeding at 6 weeks was similar. Eye prophylaxis was administered about 2 hours after birth and rooming-in was practised in the maternity wards. It is discussed whether the postponed Credé prophylaxis and other contact-facilitating routines contributed to lessen possible adverse effects of the silver nitrate prophylaxis.     

III Effects of Silver Nitrate Prophylaxis on Visual Alertness in Neonates

In a series of investigations we have studied whether silver nitrate used as prophylaxis against neonatal gonococcal ophthalmia has mainly positive or negative consequences. In this study 39 newborns, randomly divided into three groups given silver nitrate or the less irritating Hexarginum or physiological saline (placebo) as prophylaxis were studied. The eye drops were administered two hours after delivery. The groups were observed on days 2 and 4 post partum. The soothing effect and the effect on visual alertness were compared between the groups when infants were lifted from supine position to the shoulder. On day 2 infants in the silver nitrate group showed less alertness and scanning behaviour than did children in the Hexarginum and saline groups. There were no indications that the chemical conjunctivitis caused by silver nitrate interfered with soothability on either day 2 or day 4 or with visual stimulation on the fourth day of life. The design of the study permitted parental eye contact with the infant during the first two hours of life. It is still an open question whether or not silver nitrate administered within a few minutes after delivery, which would prevent the early eye contact, would have any long-lasting effects on visual alertness or on parent-infant relationship.     

II Antibacterial Effects of Silver Nitrate as Used for Credé Prophylaxis and of a Colloidal Silver Compound - Hexarginum

Silver nitrate as prophylaxis against gonococcal ophthalmia neonatorum (GON) is still compulsory in many countries, although disputed. In Sweden it is proposed that the use of silver nitrate be discontinued as there is now effective treatment available and because of the present epidemiological situation and good neonatal care. In some communities, however, the socioeconomic situation is such as to justify a continued use of prophylaxis against GON. Therefore it was decided to try Hexarginum (AgNo₃+CH₃NH₂), a colloidal silver compound as an alternative, which is less irritating than silver nitrate. The antibacterial effect in vitro of silver nitrate and Hexarginum on Neisseria gonorrhoeae, Staphylococcus aureus, Streptococcus agalactiae, Diplococcus pneumoniae and Haeomophilus infruenzae was compared. Both compounds were found to be very active in killing gonococci. The effectiveness against other species was varying, H. intluenzae being more rapidly killed than the Gram-positive cocci. Hexarginum was consistently less active than silver nitrate by 1–4 dilution steps. It was also tested whether silver nitrate and Hexarginum inhibited the adhesion of gonococci to epithelial cells. Some inhibition was found by silver nitrate although the difference was not significant. The effect by which silver nitrate acts as a prophylactic agent against GON is probably more complex than merely depending on the antibacterial effect; any other compound must be evaluated carefully before it can be recommended as an alternative prophylactic agent against GON.     

Epidemiological Aspects of P-fimbriated Escherichia coli IV. Extraintestinal E. coli Infections before the Age of One Year and Their Relation to Fecal Colonization with P-fimbriated E. coli

ABSTRACT. In two retrospective studies we have found outbreaks of E. coli pyelonephritis and septicemia to be due to nosocomial spread and fecal colonization with virulent E. coli strains in the neonatal ward of Danderyd Hospital. The incidence of extraintestinal E. coli infections before the age of one year was therefore prospectively studied in all children born at Danderyd Hospital during two and a half years ( n =7963). The number of infections was correlated to the previous fecal colonization with P-fimbriated E. coli. During this study we found no outbreaks of E. coli infections. The incidence of E. coli pyelonephritis before the age of one year was 0.6–0.7%, which we propose to be a baseline incidence. This corresponds well with the low incidence of fecal colonization with P-fimbriated E. coli found among these children. Fecal colonization with P-fimbriated E. coli during this non-epidemic period had no predictive value for the individual child for the later development of pyelonephritis.     

Studies on Fc Receptor Bearing T Cells in Infectious and Immunological Diseases of Children: Part 1. Fc Receptor Bearing T Cells in Rubella and Other lnfectious Diseases

Receptors for the Fc portion of IgG (FcR) has been demonstrated on a small population of T cells using various reagents such as aggregated IgG and erythrocyte-antibody rosette. The immunological role of T cells bearing the FcR (Ty cells) is still unestablished, but the possibility to be suppressor and/or killer has been suggested. In the present study, Ty cells were detected by using double rosette formation consisting of sheep red blood cell (SRBC) and chicken erythrocyte sensitized with IgG (chick-EA). In order to clarify the effects of virus on T cells, the ratio of Ty cells to total T cells was estimated in cases of infectious diseases and discussed. The ratio of Ty cells to total T cells was increased in cases of rubella and measles, however, did not show significant difference in cases of bacterial and mycoplasma infections. This may suggest that the Ty cells reflect the appearance of killer to the virus infected target cells, which is known as one of the important host defence mechanisms against viral infection. The haemagglutination inhibition (HI) antibody titer of rubella and the ratio of Ty cells examined on the 14th day of illness showed statistical inverse correlation (n=22, p<0.05). This may suggest that the Ty cells function as suppressor in vivo, at least on the 14th day of illness.     

Effects of insulin pump vs. injection treatment on quality of life and impact of disease in children with type 1 diabetes mellitus in a randomized, prospective comparison

Objective:  Effects of pump treatment vs. four times daily injections were explored in children with diabetes with regard to quality of life and impact of disease as well as adverse effects and parameters of metabolic control.
Methods:  An open, parallel, randomized controlled prospective comparative study lasting 14 months was completed by 38 type 1 children with diabetes (age 4–16 yr) following a 3.5-months run-in phase. Standardized quality-of-life Pediatric Quality of life Inventory (PedsQL) and impact of disease scores were obtained every 3.5 months as well as regular medical parameters. Parallel treatment group data and longitudinal within-patient data were analysed for each treatment modality.
Results:  Within-patient comparisons of the two treatment modalities showed significant improvement in PedsQL and impact scores after pump treatment. Treatment group comparisons did not show significant improvement. Pump treatment resulted in decreased symptomatic hypoglycaemia and lowered haemoglobin A1c by 0.22% after run in.
Conclusions:  Within-patient comparison suggests that metabolic control, frequency of severe hypoglycaemia (a threefold decrease), quality of life and impact of disease scores are improved by pump treatment in comparison to regular treatment with four daily insulin injections.