I read with interest Gatrad and Sheikh’s articles on “Muslim birth
customs”(2001;84:F6-F8) and “Medical ethics and Islam” (2001;84:72-75). It
quite interesting to find some more references (presented as sura:
verse) related to pediatric ethics in the Holy Quran.
On organ transplantation “Whoever killed a human being … should be
looked upon as though he had killed all mankind; a...
I read with interest Gatrad and Sheikh’s articles on “Muslim birth
customs”(2001;84:F6-F8) and “Medical ethics and Islam” (2001;84:72-75). It
quite interesting to find some more references (presented as sura:
verse) related to pediatric ethics in the Holy Quran.
On organ transplantation “Whoever killed a human being … should be
looked upon as though he had killed all mankind; and that whoever saved a
human life should be regarded as though he had saved all mankind” (5: 32).
On the basis of this Quranic text, organ transplantation is encountered in
may Islamic countries.
On motherhood According to the Holy Quran, the mothers of infants
born after in vitro fertilization and embryo transfer are the women who
give birth, not the women who give ovum: “Their mothers are those only
gave birth to them” (58: 2).
On termination of pregnancy According to the Holy Quran, if a
mother’s health is treated by continuation of a pregnancy, then
termination of pregnancy is allowed. “None should be charged with more
than one can bear. A mother should not be allowed to suffer on account of
her child, nor should a father on account of his child” (2: 233; see also
2: 185 and 2: 195).
On breast-feeding According to the Holy Quran “The mothers shall
give suck to their offsprings for two complete years” (2: 233). However,
“If they both (mother and father) decide on weaning, by mutual consent and
after due consultation, there is no blame on them” (2: 233).
The mother who cannot and is not able to breast-feed her infant, can
give her baby to a wet-nurse to breast-feed, after mutual consent between
the father and mother: “If you support financially the wet-nurse, there is
no blame on you” (2: 233).
The father should protect the lactating mother from any conditions
which might affect the breast-feeding and Islam forces fathers to provide
finances for breast-feeding mothers who are divorced: “To provide food and
clothing is an obligation of the father” (2: 233).
MURAT YURDAKÖK
Department of Pediatrics
Hacettepe University Faculty of Medicine
Ankara, Turkey
We read with interest the report of Rechner et al [1] regarding the use of the HemoCue haemoglobinometer on their neonatal unit. The development and use of accurate microsample techniques could make an important contribution in reducing transfusion requirements of multiply bled infants, time spent by junior staff in obtaining, labelling and chasing results of formal laboratory samples and laboratory costs...
We read with interest the report of Rechner et al [1] regarding the use of the HemoCue haemoglobinometer on their neonatal unit. The development and use of accurate microsample techniques could make an important contribution in reducing transfusion requirements of multiply bled infants, time spent by junior staff in obtaining, labelling and chasing results of formal laboratory samples and laboratory costs.
In a study of 52 paired blood samples (24 arterial, 15 capillary and 13 venous) from 16 infants of various gestational ages we compared haemoglobin, sodium, potassium and bilirubin results obtained from our haematology (Celldyne 3500 analyser, Abbott Laboratories, Illinois, USA) and biochemistry (Advia 1650 analyser, Bayer, Newbury, UK) laboratories with those from the blood gas analyser (ABL 735, Radiometer, Copenhagen) used on our neonatal unit. The volume of blood required for laboratory testing was 0.5-1ml, whereas that for the blood gas analyser was 0.1ml.
There was no significant difference between the mean results from the laboratory and the blood gas analyser for haemoglobin, sodium, potassium, and bilirubin using two-sample t-test. In addition there was a high degree of correlation between the two sets of results for haemoglobin and sodium, and to a lesser degree for potassium and bilirubin (Table 1).
We agree with Rechner and colleagues that instruments such as the HemaCue may be useful in reducing the volume of blood taken from infants. However, for those units with a blood gas analyser capable of measuring haemoglobin and electrolytes, to achieve this may not require the purchase of new equipment, rather, as in our case, the appreciation of an existing piece. Perhaps the greatest hurdle to cross is that of staff trust in a result from a non-laboratory source. This can be achieved with education. Units should also address the appropriateness of ‘routine’ blood taking, which is often performed with little thought as to why.
References:
(1) Rechner IJ, Twigg A, Davies AF, Imong S. Evaluation of the HemoCue compared with the Coulter STKS for measurement of neonatal haemoglobin. Arch. Dis. Child. Fetal Neonatal Ed 2002;86:F188-F189.
Table 1: Mean haemoglobin, sodium, potassium and bilirubin
measurements for laboratory and blood gas analyser results, with correlations.
Mean result (range) p-value
*g/l
†mmol/l
Correlation between gas analyser and laboratory result:
Co-efficient
(95% CI)
p-value.
We report a case of a term baby with feeding difficulties related to
possible maternal Paroxetine use. A baby boy was born at 39 weeks
gestation by a normal delivery. He did not have any respiratory effort at
birth but had a good heart rate and needed bag and mask ventilation. At 3
hours of age he was admitted from the labour ward because of hypoglycemia
and disinterest in feeding. He was started on antibiot...
We report a case of a term baby with feeding difficulties related to
possible maternal Paroxetine use. A baby boy was born at 39 weeks
gestation by a normal delivery. He did not have any respiratory effort at
birth but had a good heart rate and needed bag and mask ventilation. At 3
hours of age he was admitted from the labour ward because of hypoglycemia
and disinterest in feeding. He was started on antibiotics after a partial
septic screen, as there were ruptured membranes for 26 hours. No
laboratory evidence of infection was found.
He continued to remain lethargic, mildly hypotonic with poor head
control and not at all interested in feeding. There was no irritability or
jitteriness. Cranial ultrasound and metabolic screen were negative. At day
8 he was reviewed by speech and language therapist who observed very
little reaction to teat in the mouth. She suggested a cherry topped teat
to stimulate the back of the tongue and to rub the teat around the side of
the gums, to use dummy during spoon feeds. Despite all these strategies
and repeated reviews he continued to remain disinterested in sucking
requiring tube feeds. Progress with feeding was extremely slow however by
day 21 at discharge he had a good rhythmic suck. When reviewed in clinic
at 5 weeks of age he was reportedly feeding very well, was developmentally
normal and demonstrated a good weight gain
Mother had been on Paroxetine 20 mg once a day in pregnancy for
obsessive-compulsive disorder. Nijhuis et al[1] report irritability,
lethargy and need for tube feeding in a prem baby and irritability and
jitteriness have been described in full term neonates but this degree of
feeding difficulty in a term neonate is very unusual and prompted us to
fill in a report on suspected adverse drug reaction (yellow card) and
submit it to the Committee on Safety of Medicines.
Jayesh Bhatt
Specialist Registrar in Paediatrics
Robert C Coombs
Consultant Neonatologist
Special Care Baby Unit
Northern General Hospital
Sheffield S5 7AU, UK
References
(1) Nijhius IJM, Kok-van Rooji, Bosschaart AN. Withdrawal reactions of a premature neonate after maternal use of paroxetine. Arch Dis Child Fetal Neonatal Ed 2001;84:F77-78.
We thank Professor Dellagrammaticas for his comments on our study.
[1] Dellagrammaticas et al. [2] hypothesised that the combination of the
prone posture and the 45 degree head up tilt position could facilitate
diaphragmatic activity. We however, propose that the improvement in
oxygenation seen in the head up tilt position1 was more likely to be due
to a change in lung volume. In the head up...
We thank Professor Dellagrammaticas for his comments on our study.
[1] Dellagrammaticas et al. [2] hypothesised that the combination of the
prone posture and the 45 degree head up tilt position could facilitate
diaphragmatic activity. We however, propose that the improvement in
oxygenation seen in the head up tilt position1 was more likely to be due
to a change in lung volume. In the head up tilt position, the weight of
the abdominal contents on the diaphragm is reduced, tending to increase
functional residual capacity.[3] In contrast, ultrasonographic
examination [4] has demonstrated that the diaphragm was significantly
thicker at end expiratory volume in the prone rather than the supine
position, which is likely to result in reduced diaphragm strength.
Indeed, we demonstrated [1] Pimax (a measure of respiratory muscle
strength) was lower in the prone compared to the supine position and the
supine posture with 45° head tilt.
Anne Greenough MD FRCP FRCPCH DCH
Academic Head of Paediatrics
Children Nationwide Professor of Neonatology and Clinical Respiratory
Physiology
Gabriel Dimitriou MD
Lecturer in Perinatology
References
(1) Dimitriou G, Greenough A, Pink L, McGhee A, Hickey A, Rafferty GF.
Effect of posture on oxygenation and respiratory muscle strength in
convalescent neonates. Arch Dis Child 2002;86:F147-50.
(2) Dellagrammaticas Hd, Kapetankis J, Papadimitriou M, Kourakis G.
Effect of body tilting on physiological functions in stable very low birth
weight neonates. Arch Dis Child 1991;66: 429-32.
(3) Thoresen M, Cowan F, Whitelaw. Effect of tilting on oxygenation
in newborn infants. Arch Dis Child 1988;63: 315-7.
(4) Rehan VK, Nakashima JM, Gutman A, Rubin LP, McCool FD. Effects of
supine and prone position on diaphragmatic thickness in healthy term
infants. Arch Dis Child 2000;83:234-8.
The need for a conservative approach to hyponatraemia in preterm neonates
was emphasised in a recent issue.[1] It was interesting to note that chasing
hyponatraemia (serum sodium: 124 mmol/l) during hyperglycemia requiring
insulin infusion in a 1060g neonate was associated with fluid retention
and patent ductus arteriosus (PDA). The maximum serum sodium levels
achieved were 136 mmol/l (Maximum sodium supplemen...
The need for a conservative approach to hyponatraemia in preterm neonates
was emphasised in a recent issue.[1] It was interesting to note that chasing
hyponatraemia (serum sodium: 124 mmol/l) during hyperglycemia requiring
insulin infusion in a 1060g neonate was associated with fluid retention
and patent ductus arteriosus (PDA). The maximum serum sodium levels
achieved were 136 mmol/l (Maximum sodium supplements: 15 mmol/day).
We wish to emphasise that spurious hyponatraemia is well known during
hyperglycemia and hypertriglyceridemia.[2] Elevation of serum glucose
levels induces a translocation of water from the intracellular fluid to
the extracellular compartment sufficient to reduce serum sodium.[2]
Correction factor of Katz states that the serum sodium level decreases by
1.6 mmol/l for each 5.6 mmol/l increase in glucose level.[2] Hyponatraemia
during hypertriglyceridemia is a method dependent artifactual reduction of
serum sodium concentration resulting from displacement of a portion of a
water phase of the plasma by lipid. This problem (which may be observed
with flame emission spectrometry) can be avoided by using a sodium
selective electrode without dilution.[2]
Hyperglycemia and hypertriglyceridemia are common in extremely low birth
weight (ELBW) neonates - the group at highest risk for chronic lung disease
(CLD) and symptomatic PDA.[3] The incidence of hyperglycemia in very
premature neonates ranges from 20% to 86% and is at least 18 times greater
in Extremely low birth weight (ELBW) neonates. The consequences of
chasing such spurious hyponatraemia in neonates at risk for CLD and PDA
can not be overemphasised.
MS Mohan SK Patole
Department of Neonatology Kirwan Hospital for Women
Townsville QLD 4817, Australia
Tel: 61-7-47-739252, Fax: 61-7-47-730320
References
(1) Manzar S. Chasing hyponatraemia in preterm infants. Arch Dis Child Fetal
Neonatal Ed 2000;83:F160-4.
(2) Oster JR, Singer I. Hyponatremia, hyposmolality, and hypotonicity. Arch Intern Med 1999;159:333-6.
(3) Georgieff MK. Nutrition. In: Neonatology, Pathophysiology, and
Management of the Newborn, 3rd edn. Avery G, ed. Philadelphia: JB
Lippincott, 1999:363-94.
I thank Professors Halliday and Lappin for their riposte.[1] They
suggest that I wish to describe the control of intracellular iron as "post-translational". That is an incorrect reading of my earlier response,
where I described the control as "translational".[2]
In their original article (and I quote) "Simultaneously, in a highly
coordinated process IRPs bind to the 5' end of the ferritin gene an...
I thank Professors Halliday and Lappin for their riposte.[1] They
suggest that I wish to describe the control of intracellular iron as "post-translational". That is an incorrect reading of my earlier response,
where I described the control as "translational".[2]
In their original article (and I quote) "Simultaneously, in a highly
coordinated process IRPs bind to the 5' end of the ferritin gene and
prevent its transcription when iron is scarce."
This is not what occurs, and it is important to understand that the
control exists with the translation of the mRNA. Translational
dysregulation is gaining prominence as the unifying molecular mechanism in
a varied and important group of disorders.
These are the so-called translational pathophysiologies, which
include hereditary thrombocythaemia, familial susceptibility to melanoma
and hereditary hyperferritinaemia with cataract. Translational disorders
may also be implicated in Alzheimers disease, and in familial
predisposition to other malignancies, and I would refer interested readers
to an excellent review article by Cazzola and Skoda.[3]
I am still therefore of the belief that translational control is the
best description. Post-transcriptional control is not incorrect, but does
not help to identify at what level the regulation is occurring.
Dr PR Reynolds
Department of Immunology
Division of Paediatrics, Obstetrics and Gynaecology
Imperial College School of Medicine
Hammersmith Hospital
London W12 0NN, UK
References
(1) Halliday HL, Lappin TRJ. Newborns have unique confounding factors regarding the TfR-F ratio - Authors' response [Rapid Response]. Arch Dis Child 24 January 2001. http://adc.bmjjournals.com/cgi/eletters/fetalneonatal;84/1/F40#EL3
(2) Reynolds P. Newborns have unique confounding factors regarding the TfR-F ratio [Rapid Response]. Arch Dis Child 12 January 2001. http://adc.bmjjournals.com/cgi/eletters/fetalneonatal;84/1/F40#EL2
(3) Cazzola M, Skoda RC. Translational pathophysiology: a novel
molecular mechanism of human disease. Blood 2000;95:3280-8.
We were interested to read the article of Dollberg et al[1] about the
haematological indices in large for gestational age (LGA) infants. In the
mentioned article the absolute normoblast count, packed cell volume, and
corrected white blood cell count were found to be significantly higher in
the LGA infants.
Leptin, a recently discovered protein hormone, encoded by the ob
gene, has been shown to be...
We were interested to read the article of Dollberg et al[1] about the
haematological indices in large for gestational age (LGA) infants. In the
mentioned article the absolute normoblast count, packed cell volume, and
corrected white blood cell count were found to be significantly higher in
the LGA infants.
Leptin, a recently discovered protein hormone, encoded by the ob
gene, has been shown to be important in the regulation of body fat
content, feeding behaviour, and energy homeostasis.[2] To date, a great
number of newborn studies have concentrated on the relation of leptin and
fetal growth. Significant associations between umblical cord serum leptin
and birth weight and body mass index have been well documented.[3-5]
Varvarigou et al[3] have reported that LGA infants had higher leptin
levels. Koistinen[4] and recently Ng et al[5] found the leptin levels to
be correlated with birth weight. Leptin was also reported to be involved
in haemotopoiesis.[6] The leptin receptor OB-R/B219 is expressed in
haematopoietic tissues and leptin stimulates directly the haematopoietic
precursors.[6] It alone can increase the number of macrophage and
granulocyte colonies and, together with erythropoietin, act
synergistically to increase erythroid development.[6]
According to the
article of Dollberg et al,[1] the increased haematological indices observed
in LGA infants were supposed to be due to relative intrauterine hypoxia.
Hypoxia was shown to increase leptin secretion significantly in a human
trophoblastic cell line (BeWo cells).[7]
In the light of all these findings, it may be thought that the
increased haematological indices observed in LGA infants might be related
to leptin.
Dr Didem Aliefendioglu
Dr Tugba Gursoy
Dr Ayse T Aslan
Social Security Children’s Hospital
Neonatology Unit
Ankara, TURKEY
References
(1) Dollberg S, Marom R, Mimouni FB, Yeruchimovich M. Normoblasts in
large for gestational age infants. Arch Dis Child Fetal Neonatal Ed 2000;83:F148-9.
(2) Zhang Y, Proenca R, Maffei M, Barone M, Leopold L, Friedman J.
Positional cloning of the mouse obese gene and its human homologue. Nature
1994;372:425-32.
(3) Varvarigou A, Mantzoros CS, Beratis NG. Cord leptin concentrations in
relation to intrauterine growth. Clin Endocrinol 1999;50:177-83.
(4) Koistinen HA, Koivisto VA, Andersson S, Karonen SL, Kontula K, Oksanen
L, Teramo KA. Leptin concentration in cord blood correlates with
intrauterine growth. J Clin Endocrinol Metab 1997;82:3328-30.
(6) Mise H, Sagawa N, Matsumoto T, Yura S, Nanno H, Itoh H, Mori T,
Masuzaki H, Hosoda K, Ogawa Y, Nakao K. Augmented placental production of
leptin in preeclampsia: possible involvement of placental hypoxia. J Clin
Endocrinol Metab 1998;83:3225-9.
(7) Ng PC, Lam CWK, Lee CH, et al. Leptin and metabolic hormones in
infants of diabetic mothers. Arch Dis Child Fetal Neonatal Ed 2000;83:F193-7.
We enjoyed the article on practical management of hyperinsulinism by
Aynsley-Green et al.[1] The article re-emphasises the importance of
accurate
measurement of blood glucose and insists on an accurate laboratory method
and not a bedside screening test for diagnosing hypoglycaemia. In certain
situations, the use of a bed-side test will be unavoidable, eg, if there
will be a long delay before a l...
We enjoyed the article on practical management of hyperinsulinism by
Aynsley-Green et al.[1] The article re-emphasises the importance of
accurate
measurement of blood glucose and insists on an accurate laboratory method
and not a bedside screening test for diagnosing hypoglycaemia. In certain
situations, the use of a bed-side test will be unavoidable, eg, if there
will be a long delay before a laboratory result can be obtained, in
general practice, home visits or during transport. In many hospitals bed-
side tests are used to identify high-risk babies with suspiciously low
values who need accurate laboratory measurements of blood glucose.
Most rapid bedside blood glucose measuring devices have been
validated in the range above 2.6 mmol/L, using adult blood. We conducted a
study to test the accuracy of 2 commonly used bedside methods of glucose
estimation in the clinically important range of 0.5 - 4 mmol/L, using
neonatal cord blood with a haematocrit over 0.5.
Cord blood samples were allowed to stand for varying periods of time
to allow the glucose levels to fall in the range of 0.5 - 4mmol/L. 103
samples were analysed simultaneously in duplicate by a) Cobas hexokinase
method in the laboratory, b) Hemacue and c) Precision Q.I.D.
Using the laboratory hexokinase method as the standard, the
sensitivity and
specificity of Precision Q.I.D. for detecting hypoglycaemia (blood glucose
less
than 2.6mmol/L) were 86% and 89% respectively; and for Hemacue were 83%
and 100%. On average, blood glucose by Precision Q.I.D. was 0.21 mmol/L
(standard deviation 0.32 mmol/L) higher than the hexokinase method on
paired samples in this low range. Blood glucose by Hemacue was on average
0.34 mmol/L (standard deviation 0.23 mmol/L) higher than the hexokinase
method.
Both these bedside methods tend to slightly overestimate the blood
glucose in
relation to the standard laboratory method. Our study suggests that in
situations where bedside glucose is the only available estimate of blood
glucose, a value of over 3.0mmol/L would be needed to confidently exclude
hypoglycaemia.
Nilesh Mehta
Clinical Fellow, Paediatric Intensive Care Unit
St. Mary's Hospital, London W2, UK
Janet Stone
Principal Clinical Scientist in Paediatrics Bristol Royal Infirmary, Bristol BS2, UK
Andrew Whitelaw (author for correspondence)
Professor of Neonatal Medicine St. Michael's Hospital, Bristol BS2, UK
Reference (1) Aynsley-Green A, Hussain K, Hall J et al. Practical management of
hyperinsulinism in infancy. Arch Dis Child 2000;82:F98-107.
Those who believe that urine stained clothes will diminish the power
of prayer and that circumcision will prevent such staining, are entitled
to their opinion. The assertions that male circumcision decreases the incidence
of cancer of the penis cannot however go unchallenged.
It is quite clear that circumcision does not prevent cancer of the penis.[1-...
Those who believe that urine stained clothes will diminish the power
of prayer and that circumcision will prevent such staining, are entitled
to their opinion. The assertions that male circumcision decreases the incidence
of cancer of the penis cannot however go unchallenged.
It is quite clear that circumcision does not prevent cancer of the penis.[1-13] Moreover, it
appears to be ineffective in reducing the incidence of cancer of the penis.[14-15] In men who have
been circumcised, cancer of the penis would appear to affect the circumcision
scar and be less amenable to conservative treatment.[16]
Thus what may be a religious belief, would also seem to be a medical myth.
There is universal freedom to manifest religious beliefs, but this may
be limited to protect the rights and freedoms of others. Religious customs
should be practiced by officers of a religion in a religious context and
not be medical practitioners who are not qualified to deliver religious
ritual. Medical practice should be evidence based.
Male circumcision causes a high rate of complications.[17]
This would appear to be the case even when done in hospital by a medical
practitioner.[18] It also removes normal specialised,
functional tissue.[19-20]
In view of these facts, and the fact that Islam does not require the hygienic
purposes attributed to circumcision until the child matures and begins to
offer prayers, it would seem appropriate to leave it until the child is
of sufficient age and maturity to consent in his own right.
References
Maden C, Sherman KJ, Beckmann AM, Hislop
TG, Teh CZ, Ashley RL, Daling JR. History of circumcision, medical conditions,
and sexual activity and risk of penile cancer. J Natl Cancer Inst 1993;85:19-24.
Pec J Jr, Pec J Sr, Plank L, Plank J, Lazarova Z, Kliment J. Squamous
cell carcinoma of the penis. Analysis of 24 cases. Int Urol Nephrol 1992;24:193-200.
Aynaud O, Ionesco M; Barrasso R. Penile intraepithelial neoplasia.
Specific clinical features correlate with histologic and virologic findings.
Cancer 1994;74:1762-7.
Rogus BJ. Squamous cell carcinoma in a young circumcised man. J Urol 1987;138:861-2.
Windahl T, Hellsten S. Laser treatment of localized squamous cell carcinoma
of the penis. J Urol 1995;154:1020-3.
Cupp MR, Malek RS, Goellner JR, Smith TF, Espy MJ. The detection of
human papillomavirus deoxyribonucleic acid in intraepithelial, in situ,
verrucous and invasive carcinoma of the penis. J Urol 1995;154:1024-9.
Boczko S, Freed S. Penile carcinoma in circumcised males. N Y State
J Med 1979;79:1903-4.
Leiter E, Lefkovitis AM. Circumcision and penile carcinoma. N Y State
J Med 1975;75:1520-2.
Onuigbo WI. Carcinoma of skin of penis. Br J Urol 1985;57:465-6.
Korczak D, Siegel Y, Lindner A. [Verrucous carcinoma of the penis]
Harefuah 1989;117:436-7.
Girgis AS, Bergman H, Rosenthal H, Solomon L. Unusual penile malignancies
in circumcised Jewish men. J Urol 1973;110:696-702.
Koriech OM. Penile Shaft Carcinoma In Pubic Circumcision. Br J Urol 1987;60:77.
Cold C, Storms MR and Van Howe RS Carcinoma
in situ of the penis in a 76-year-old circumcised man. J Fam Pract 1997;44:407-10.
We read with interest the study by Holt et al,[1] which provides very useful data regarding the current status of neonatal meningitis in England and Wales, where it appears that the incidence of the disease has remained practically unchanged. In a retrospective study of 72 cases of Gram negative bacterial meninitis (GNBM) in term neonates from a single centre in Greece, covering a 15-year period,[2] we too did no...
We read with interest the study by Holt et al,[1] which provides very useful data regarding the current status of neonatal meningitis in England and Wales, where it appears that the incidence of the disease has remained practically unchanged. In a retrospective study of 72 cases of Gram negative bacterial meninitis (GNBM) in term neonates from a single centre in Greece, covering a 15-year period,[2] we too did not observe a significant yearly variation or trend. With respect to antibiotic regimen, since 1983 we have been using third generation cephalosporins (cefotaxime except for the few cases of Pseudomonas meningitis where ceftazidime was used) in combination with amikacin for the treatment of GNBM. Survival of our term neonates with this disease was 97.2%.
However, before attributing any improvements solely to antibiotics used, other factors should be taken into account. We would like to stress the importance of such a factor which could influence prognosis, namely the time interval between onset of symptoms and institution of appropriate therapy. This is not frequently reported. In the report by Anderson and Gilbert[3] symptoms had been noted for more than two days in 50% of their cases before the diagnosis of meningitis was made, while in the study by Unhanand et al[4] the mean interval between symptoms and diagnosis was 1.7 days. It is worth commenting that in that study 8% of their neonates with GNBM had nuchal rigidity.
In our series of term neonates[2] this interval was less than 14 hours and no baby, the vast majority of whom had been admitted from home, had received antibiotics prior to admission to our Unit, reflecting the attitude of primary care physicians who advised hospital evaluation.
In the study by Holt et al[1] the aforementioned time interval is not mentioned, which we think it would of importance to know, particularly as the relatively high death rate due to gram negative enteric bacilli found in their study continued. Also in the same study 21% of neonates admitted from home had received antibiotics in the 48 hours preceding hospital admission, figure which was no different compared with their previous study.[5] Presumably these were term or near term neonates and it would be interesting to know in what way if any, these antibiotics had influenced diagnosis and/or outcome. We think there is a potentially important issue here.
Should primary care physicians prescribe antibiotics to neonates in the immediate postnatal period, particularly when there is no readily identifiable site of bacterial infection and/or no appropriate investigations have been performed? We sould be grateful for the authors' comments on these issues.
Dr H D Dellagrammaticas MD, FRCPCH
Dr N Iacovidou MD
NICU, 2nd Department of Paediatrics
University of Athens
Aglaia Kyriakou Children's Hospital
115 27 Athens, Greece
References
(1) Holt DE, Halket S, de Louvois J, Harvey D. Neonatal meningitis in England and Wales: 10 years on. Arch Dis Child Fetal Neonatal Ed 2001;84:F85-9.
(2) Dellagrammaticas HD, Christodoulou Ch, Megaloyanni E, Papadimitriou M, Kapetanakis J, Kourakis G. Biol Neonate 2000;77:139-146.
(3) Anderson SG, Gilbert GL. Neonatal gram nefative meningitis. A 10 year review with reference to outcome and relapse of infection. J Pediatr Child Health 1990;26:212-16.
(4) Unhanand M, Mustafa M, Mc Cracken GH, Nelson JD. Gram-negative enteric bacillary meningitis. A twenty-one year experience. J Pediatr 1993;122:15-21.
(5) de Louvois J, Blackburn J, Hurley R, Harvey D. Infantile meningitis in England and Wales: a two year study. Arch Dis Child 1991;66;603-7.
I read with interest Gatrad and Sheikh’s articles on “Muslim birth customs”(2001;84:F6-F8) and “Medical ethics and Islam” (2001;84:72-75). It quite interesting to find some more references (presented as sura: verse) related to pediatric ethics in the Holy Quran.
On organ transplantation
“Whoever killed a human being … should be looked upon as though he had killed all mankind; a...
We read with interest the report of Rechner et al [1] regarding the use of the HemoCue haemoglobinometer on their neonatal unit. The development and use of accurate microsample techniques could make an important contribution in reducing transfusion requirements of multiply bled infants, time spent by junior staff in obtaining, labelling and chasing results of formal laboratory samples and laboratory costs...
We report a case of a term baby with feeding difficulties related to possible maternal Paroxetine use. A baby boy was born at 39 weeks gestation by a normal delivery. He did not have any respiratory effort at birth but had a good heart rate and needed bag and mask ventilation. At 3 hours of age he was admitted from the labour ward because of hypoglycemia and disinterest in feeding. He was started on antibiot...
Dear Editor
We thank Professor Dellagrammaticas for his comments on our study. [1] Dellagrammaticas et al. [2] hypothesised that the combination of the prone posture and the 45 degree head up tilt position could facilitate diaphragmatic activity. We however, propose that the improvement in oxygenation seen in the head up tilt position1 was more likely to be due to a change in lung volume. In the head up...
The need for a conservative approach to hyponatraemia in preterm neonates was emphasised in a recent issue.[1] It was interesting to note that chasing hyponatraemia (serum sodium: 124 mmol/l) during hyperglycemia requiring insulin infusion in a 1060g neonate was associated with fluid retention and patent ductus arteriosus (PDA). The maximum serum sodium levels achieved were 136 mmol/l (Maximum sodium supplemen...
I thank Professors Halliday and Lappin for their riposte.[1] They suggest that I wish to describe the control of intracellular iron as "post-translational". That is an incorrect reading of my earlier response, where I described the control as "translational".[2]
In their original article (and I quote) "Simultaneously, in a highly coordinated process IRPs bind to the 5' end of the ferritin gene an...
We were interested to read the article of Dollberg et al[1] about the haematological indices in large for gestational age (LGA) infants. In the mentioned article the absolute normoblast count, packed cell volume, and corrected white blood cell count were found to be significantly higher in the LGA infants.
Leptin, a recently discovered protein hormone, encoded by the ob gene, has been shown to be...
Dear Editor,
We enjoyed the article on practical management of hyperinsulinism by Aynsley-Green et al.[1] The article re-emphasises the importance of accurate measurement of blood glucose and insists on an accurate laboratory method and not a bedside screening test for diagnosing hypoglycaemia. In certain situations, the use of a bed-side test will be unavoidable, eg, if there will be a long delay before a l...
Those who believe that urine stained clothes will diminish the power of prayer and that circumcision will prevent such staining, are entitled to their opinion. The assertions that male circumcision decreases the incidence of cancer of the penis cannot however go unchallenged.
It is quite clear that circumcision does not prevent cancer of the penis.[1-...
We read with interest the study by Holt et al,[1] which provides very useful data regarding the current status of neonatal meningitis in England and Wales, where it appears that the incidence of the disease has remained practically unchanged. In a retrospective study of 72 cases of Gram negative bacterial meninitis (GNBM) in term neonates from a single centre in Greece, covering a 15-year period,[2] we too did no...
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