Isolated congenital tuberculosis otitis in a preterm infant

We report an unusual case of localized congenital tuberculosis otitis in a preterm infant. Unlike disseminated congenital cases, the manifestations of localized otitis are associated with a triad of signs: (i) regional lymphadenopathy in the absence of typical systemic features of tuberculosis; (ii) delayed onset of presentation; and (iii) refractory otitis unresponsive to conventional antimicrobial agents. The need for greater diligence in looking for neonatal tuberculosis is emphasized, especially in an ethnic or socioeconomic environment where the disease is prevalent. Congenital tuberculosis, otitis, preterm
PC Ng, Department of Paediatrics, Level 6, Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong Kong     

The effect of iron in formula milk after 6 months of age

Ninety two normal birthweight infants aged 6 months entered a double blind controlled trial which compared a follow on formula milk with no added iron against the same formula milk containing 1.2 mg of iron per 100 ml. There was no significant difference in the social class or demographic characteristics of the two treatment groups or in the proportion of each group completing the trial. There was no difference between the two groups in the quantity of milk taken but the amounts taken lessened between 6 and 18 months of age. There was no difference between the two groups with respect to mean haemoglobin and median serum ferritin at 6, 9, 12, 15, and 18 months of age. Very few infants developed iron deficiency anaemia in either group but there was a tendency for serum ferritin levels to fall between 6 and 18 months of age in both groups. The results suggest that iron added to follow on milk was not an important source of dietary iron in the infants studied.     

Relation of age, race, and allotype to immunoglobulin subclass concentrations

Concentrations of IgG1, IgG2, and total IgG were measured by a solid phase radioimmunoassay in sera from 36 healthy adults and 114 healthy children. As expected, IgG2 and total IgG had a positive correlation with age in children. In addition to age, several other factors were associated with significant differences in serum subclass concentrations. Female children had higher concentrations of IgG1 than males, and black subjects had significantly higher concentrations of IgG1, IgG2, and total IgG than whites. Although Km(1) and Gm(23) immunoglobulin allotypes had no relation to subclass concentrations when tested as single factors, the Km(1) allotype interacted significantly with race so that Km(1)-positive black children had higher IgG2 concentrations than other subjects. Our findings may explain, in part, recent observations of an association of the Km(1) allotype with altered immune responses of blacks to certain vaccines containing bacterial polysaccharides. In addition, our data indicate the need to control factors such as sex, race, and allotype in studies of subclass concentrations or immune responses.     

Survey on the management of febrile seizures

A survey regarding the management of the child with febrile seizures was mailed to 10 000 child neurologists, neurologists, pediatricians, and family and general practitioners. The response rate varied by specialty; overall, slightly more than half the physicians responded. One third or less of physicians prescribed anticonvulsive therapy only at the time of febrile illness, although this practice was much less common among recent graduates. If children had lengthy or focal seizures, the majority of physicians in all specialties either prescribed long-term treatment or referred for consultation. Long-term daily anticonvulsant therapy was prescribed most frequently by child neurologists and least often by general practitioners, who most often referred for consultation. Rate of hospitalization also differed according to specialty. The results of the survey indicate that the management of a child with febrile seizures may differ depending on the specialty of the attending physician.     

The clinical assessment of a child's social and physical environment during health visits

The quality of a child's home environment plays a critical role in long-term developmental status. The Pediatric Review and Observation of Children's Environmental Support and Stimulation (PROCESS) Inventory was developed to clinically assess aspects of the child's physical environment and the parent-child interaction during a health supervision visit. The final version was used with 76 mother-child pairs by two pediatricians. The Home Observation for Measurement of the Environment (HOME) Inventory was performed within 3 weeks on all pairs, and a laboratory observation of parent-child interaction was completed with 30 of the pairs. Correlations of the PROCESS with the HOME Inventory and parent-child interaction were 0.84 and 0.86 (less than 0.001), respectively. These significant correlations persisted while controlling for family income and education. When high and low scores of the HOME Inventory known to correlate with positive and negative developmental outcomes were cross-tabulated with PROCESS scores, low scores on the PROCESS identified 77% of low HOME Inventory scores and high scores on the PROCESS identified 95% of the high HOME Inventory scores. The PROCESS provides pediatricians a brief, easy-to-score, clinically useful, reliable, and valid method to measure children's home environments.     

Human leukocytic antigens in autoimmune sensorineural hearing loss

Susceptibility to many autoimmune diseases is associated with inheritance of certain Human Leukocytic Antigens (HLA), determinants which have become diagnostic or prognostic markers. In this study of HLA antigen frequencies among patients with autoimmune sensorineural hearing loss, 39 patients with this otologic disorder were typed for HLA-A, B, C, and DR antigens. A significant increase of Cw7 occurred in 51% of patients compared to 21% of 627 matched controls (relative risk, 3.95). Trends towards increased frequencies of Cw4, B35 and reduced frequency of DR4 were also observed. These data suggest a possible immunogenetic predisposition to this otologic disorder. The presence of Cw7 may facilitate the diagnosis of autoimmune sensorineural hearing loss.     

Epididymitis in children and adolescents. A 20-year retrospective study

We identified 35 patients who had epididymitis from 1965 to 1984 by hospital chart review. The common clinical presentation was swelling, pain, and erythema. Twenty-two patients had onset of symptoms within 24 hours of hospital admission. Surgery was performed in 31 patients, 22 of whom had cultures taken from the epididymis at the time of surgery. Bacterial agents were recovered from cultures of 13 patients: coagulase-negative staphylococci were identified in nine patients. In two patients, a polymicrobic cause was found. Six patients had associated urologic abnormality. Three patients had concurrent urinary tract infection. Urologic investigation should be undertaken in children younger than 2 years old and in older patients with recurrent episodes suspected to be due to reflux of urine and associated genitourinary abnormality.     

Epidemiologic markers of pediatric infections caused by coagulase-negative staphylococci

Several epidemiologic markers (species, slime production and antimicrobial susceptibility) were examined for 256 isolates of coagulase-negative staphylococci (C-S) obtained from clinical specimens in a 1-year period. The medical records of the 169 pediatric patients from whom the C-S were obtained were reviewed and divided into infected (N = 11) and uninfected (N = 158) groups. The phenotypic traits of strains associated with infection included: (1) slime production (P = 0.014); (2) slime-positive Staphylococcus epidermidis (P = 0.002); and (3) resistance to penicillin (P = 0.03), oxacillin (P less than 0.001), clindamycin (P = 0.003), chloramphenicol (P less than 0.001) and trimethoprim/sulfamethoxazole (P less than 0.001). Infected patients were significantly older (P = 0.006) than uninfected patients. Simultaneous isolation of the same strain of C-S from the aerobic and anaerobic bottles of a single blood culture increased the probability of sepsis (P = 0.004). The combination of these patient and laboratory data may be useful in determining the clinical significance of C-S recovered from pediatric patients.     

Bioavailability of dietary urea nitrogen in the infant

Because the human body has no enzymes capable of hydrolyzing urea, nitrogen from this source becomes bioavailable only by release of ammonia from urea by bacterial hydrolysis in the intestines, with subsequent absorption and utilization of ammonia. To explore extent to which urea ingested in milk becomes bioavailable, we fed di-15N-urea (both nitrogen atoms in the form of the stable isotope 15N) and determined urinary excretion of di-15N-urea (excreted without having become bioavailable) and mono-15N-urea (urea containing only one atom of 15N and therefore reflecting excretion of absorbed ammonia). The largest percentage of the ingested di-15N-urea was excreted promptly in the urine still in the form of di-15N-urea. We conclude that most of the urea ingested by a normal infant is not bioavailable.