Adappa et al. wonder whether parents should be told that Curosurf and
Survanta are derived from pig and cow lung. But where does one stop? Most
capsules prescribed for older children and adults are made of gelatin - a
cheap source of collagen derived from cow or pigskin, or bone. Is it
equally patronizing not to tell our patients and their parents this?
Surely not.
I read with interest the article on weaning preterm infants by Marriott et al.[1] Authors of this article deserve congratulations for
conducting randomised controlled trial in an area with sparsity of
evidence and little research. The preterm weaning strategy (PWS) adopted
in this study showed benefits in terms of improved length growth velocity
between 0 and 12 months corrected gestational age (CG...
I read with interest the article on weaning preterm infants by Marriott et al.[1] Authors of this article deserve congratulations for
conducting randomised controlled trial in an area with sparsity of
evidence and little research. The preterm weaning strategy (PWS) adopted
in this study showed benefits in terms of improved length growth velocity
between 0 and 12 months corrected gestational age (CGA). This study also
demonstrated improved intake of energy, protein and carbohydrate at 6
months and iron at 12 months CGA. However, I would like to make following
comments, which need clarification.
Firstly, the mean gestational age of infants included in this study
is 31-32 weeks. Hence, this study has not looked at the most disadvantaged
group of extreme preterm infants (with birth weight <1 kg and <28
weeks gestation). It would be very interesting to see the effects of
similar PWS in extreme preterm infants, which may require a multi center
trial.
Secondly, study subjects were only followed up to 1 year of age.
Their follow up showed that the beneficial effects of increased energy,
protein and carbohydrate intake at 6 months CGA had already been lost by
12 months CGA with no significant difference between the two groups. More
over, although dietary intake of iron was significantly higher in the
intervention group at 12 months, this was not supported by haemoglobin,
serum ferritin and serum iron levels at 12 months CGA. It would have been
useful to look at the effects of PWS on the development at 6 and 12 months
of age.
Authors mention that significantly higher number of infants (29) in
the PWS group were given breast milk fortifier compared with 16 in control
group (p = 0.02). Additionally, authors compared only 16 infants in the
control group versus 27 in the PWS group at term (0 month CGA). I wonder
if these factors might have influenced the comparison of daily intakes of
energy, macronutrients and iron at term in the two groups.
There is evidence to support that preterm infants have special
nutritional requirements in the post discharge period due to number of
reasons including smaller size, reduced body stores of nutrients,
undermineralised bones, accumulated energy deficits and higher nutrient
requirements. A number of studies have looked at different randomized
diets (in preterm infants) in the neonatal period and their effects on
growth performance and bone mineralization in the longer term showing that
early diet had no influence on weight, height, head circumference or skin
fold thickness at 7.5-8 years [2] and does not effect the bone mass in
preterm infants at 8-12 years.[3] However, Lucas et al have exhibited the
beneficial effects of nutrient enriched discharge formula (with higher
protein to energy ratio) in preterm infants by demonstrating improved
verbal intelligence quotient scores at 7.5-8 years of age.[4] It would be
intriguing to follow up this cohort well into the childhood to see the
beneficial effects of PWS especially in terms of growth, development and
intelligence quotient.
References
(1) Marriott LD, Foote KD, Bishop JA, Kimber AC and Morgan JB
Weaning preterm infants: a randomised controlled trial
Arch Dis Child Fetal Neonatal Ed 2003;88:F302-F307.
(2) Morley R and Lucas A
Randomized diet in the neonatal period and growth performance until 7.5-8
years of age in preterm children. Am J Clin Nutr 2000;71:822-828
(3) Fewtrell MS, Prentice A, Jones SC, Bishop NJ, Stirling D, Buffenstein R,
Lunt M, Cole TJ and Lucas A
Bone mineralization and turnover in preterm infants at 8-12 years of age: The effect of early diet. J Bone Miner Res 1999;14:810-820.
(4) Lucas A, Morley R and Cole TJ
Randomised trial of early diet in babies and later intelligence quotient. BMJ 1998;317:1481-1487.
Neonatal long lines are essential part in the management of extremely
low birth babies and very sick babies. Technically to insert a longline
is not that difficult especially if attempted in the first few days but
often we have to accept suboptimal positions. Definitely use of long lines
have improved the outcome of babies weighing less than 1000grams and
postoperative cases.
Neonatal long lines are essential part in the management of extremely
low birth babies and very sick babies. Technically to insert a longline
is not that difficult especially if attempted in the first few days but
often we have to accept suboptimal positions. Definitely use of long lines
have improved the outcome of babies weighing less than 1000grams and
postoperative cases.
More than safety we regard the venous access very important in
premies. Our unit had incidences of cardiac tamponade and abdominal
perforation in babies with longlines. Interestingly the total parenteral
fluid extravasated into the peritoneal cavity following perforation of the
iliac vein had resulted in progressive abdominal distension and erythema
for nearly eight days. Interestingly, baby had never experienced
hypoglycemia. Abdominal distension was thought to be the result of
necrotizing enterocolitis for which the long line was inserted. On the 8th
day a necrotic area pointed over the abodomen near the umbilicus and on
removal of the eschar, lipid and nutriflex started oozing from the ulcer.
A diagnostic purge has confirmed the tip of the long line in the anterior
abdominal wall. Removal of the long line wasn’t difficult at all and the
anterior wall erythema and induration disappeared in 48 hours and ulcer
healed well in 5 days. The point I would like to make from the above
incident is that all these 8 days baby could maintain the blood sugar and
it showed that the parenteral nutrients were absorbed adequately through
peritoneum. This observation is well supported with the dealyed
presentation of the abdominal distension. It wont be surprising if
researchers come out in future with nutrients which can be given
intraperitoneal.
As long as we do not have any other routes to administer drugs,
volume expanders and parenteral nutrients for the extreme premature
babies, we have to take the risks related to neonatal long lines. In the
case of long lines, it is a necessity and hence safety will have a lower
priority. Parent consent is essential, like for any invasive procedures.
We read with interest the review of Neonatal meningitis by PT Heath et al.[1] Neonatal meningitis remains a very important cause of morbidity and
mortality. Group B streptococcus (GBS) remains the leading pathogen.[2]
We report a case of GBS meningitis that was a challenge for
management. A term baby born by normal vaginal delivery with birth weight
of 3.26 kg, presented at 5 days of age w...
We read with interest the review of Neonatal meningitis by PT Heath et al.[1] Neonatal meningitis remains a very important cause of morbidity and
mortality. Group B streptococcus (GBS) remains the leading pathogen.[2]
We report a case of GBS meningitis that was a challenge for
management. A term baby born by normal vaginal delivery with birth weight
of 3.26 kg, presented at 5 days of age with 24 hour history of fever and
seizures prior to admission. There were no antenatal risk factors. Full
septic screen was done.Hb-18.6gm/dl,WCC-8.25/cmm,CRP-177.
CSF was turbid,CSF Proteins-1.79gm/l,Glucose-0.3mmol/l [Blood glucose-
4.3mmol/l], WCC-4873/cmm-50% Polymorphs and 50% Lymphocytes. Baby was
commenced on intravenous antibiotics [cefotaxime and penicillin] in
appropriate high doses. Group B streptococcus, sensitive to these
antibiotics was isolated from both blood and CSF.Baby clinically improved
over next 2 days. Cranial ultrasound was normal. Antibiotic treatment was
prescribed for 3 weeks but was discontinued after 19 days because of
difficult venous access. Baby remained asymptomatic with normal physical
examination.
Repeat Blood culture after 2 days was sterile; there was improvement
in serial CRP. Lumbar puncture was not repeated, as baby was clinically
well. Baby was observed for further 24 hours after stopping antibiotic and
as he remained well, he was discharged home with follow up arrangements.
He was readmitted after 36 hours with signs of sepsis. Following full
septic screen, which included FBC, WCC, CRP, Blood culture and LP, he was
recommenced on intravenous antibiotics [penicillin and cefotaxime] in
appropriate high doses. Blood and CSF culture revealed GBS again.
Gentamicin was added as per sensitivity result. Subsequently he developed
seizures. CT scan of brain was normal but MRI scan revealed mild bilateral
subdural effusions. Repeat MRI scan one week later showed significant
improvement. His immunoglobulins and complement levels were normal. His
clinical examination was normal. Serial lumbar punctures were done in view
of persistent low CSF glucose levels [range-1.5-2.2], though repeat CSF
was sterile and showed improvement in white cell count and proteins.
Antibiotic treatment was continued for 6 weeks following consultation with
neurologist. Following discharge, baby remains well, developing normally
with no neurological deficit.
There are no controlled clinical studies to guide the recommended
duration of antibiotic therapy for neonatal meningitis. Standard textbooks
on neonatology recommend minimum 2 weeks of antibiotic therapy for GBS
meningitis and repeat lumbar puncture in the course of treatment to ensure
adequate response to antibiotics. However current practice differs from
centre to centre from this as per survey by Agarwal et al. We disagree
with recommendation of Schaad et al.[4]that if clinical response is
uneventful then it is unnecessary to repeat lumbar puncture at the end of
therapy.
We agree with author’s recommendation of repeating lumbar puncture
during course of treating meningitis to document CSF sterilisation but the
principal issues that require attention are the timing of lumbar puncture
and value of CSF biochemistry to guide management in the absence of
organisms in repeat lumbar puncture.
References
(1) P T Heath K Yusoff,C J Baker. Neonatal meningitis. Arch Dis Child Fetal Neonatal Ed 2003;88:F173-178.
(2) Holt DE,Halket S, J de Louvois,et al. Neonatal meningitis in England
and Wales:10 years on. Arch Dis Child Fetal Neonatal Ed 2001;84:F85-9.
(3) Agarwal R,Emmerson AJ.Should repeat lumbar punctures be routinely
done in neonates with bacterial meningitis? Results of a survey into
clinical practice. Arch Dis Child 2001;84:451-2.
(4) Schaad UB,Nelson JD,McCracken GH Jr.Recrudescence and relapse in
bacterial meningitis of childhood. Pediatrics 1981;67:188-95.
I congratulate Beardsall et al. on their impressive, albeit
retrospective collection of data.[1] Their important conclusion that
neither extra-atrial position of the catheter tip, nor imaging with
contrast, are reliable measures to prevent pericardial effusion (PCE)
means that we will have to live with this threat. This inevitably
redirects attention from the aspect of prevention to the ques...
I congratulate Beardsall et al. on their impressive, albeit
retrospective collection of data.[1] Their important conclusion that
neither extra-atrial position of the catheter tip, nor imaging with
contrast, are reliable measures to prevent pericardial effusion (PCE)
means that we will have to live with this threat. This inevitably
redirects attention from the aspect of prevention to the question of how
to guarantee optimal management, which may be the only way to reduce
mortality from this complication. As Beardsall et al. [1] focus on
epidemiology and prevention, an obvious wealth of data on the issue of
management has been hidden rather than fully exploited in the text and
Figure 1.
As stated by Menon 2, PCE is nearly always bloodless, probably
representing a pericardial accumulation of infusate. This gives the
opportunity not only to diagnose the condition simply by aspirating
typical infusate (with high glucose concentration, and turbidity in case
of lipid admixture) from the long line, obtaining a volume which by far
exceeds the dead space of the catheter; but it also allows us to reduce
the volume of the effusion without having to perform a pericardial tap
with its own risks. Since nearly two thirds of affected neonates present
with sudden cardiovascular collapse,[2] the time required to obtain an Xray and / or echocardiography to diagnose the condition may reduce the
chance of survival. The instinctive reaction to remove immediately the
long line responsible for the patient’s critical condition may not be
advisable in this situation. A preferable option would be to use the
catheter in its actual position to aspirate as much of the effusion as
possible, and thereafter to withdraw it until blood can be aspirated with
ease, indicating an intracardiac / intravascular (re-)position of its
tip, providing the option to use this line for central venous
administration of inotropes if required. This procedure can be
accomplished rapidly, does not interfere with resuscitation, and may
reduce the number of cases who ultimately need a pericardial tap.
Interestingly, Beardsall et al. reported that all cases treated
“conservatively” survived.[1]
Clearly, the data collected by Beardsall et al.[1] deserve to be
analysed in more detail in order to evaluate the success of different
management strategies. The resulting message could be more encouraging
than the preliminary conclusion that little else can be done to prevent
this life-threatening complication.
References
(1) Beardsall K, White DK, Pinto EM, Kelsall AWR. Pericardial effusion
and cardiac tamponade as complications of neonatal long lines: are they
really a problem? Arch Dis Child Fetal Neonatal Ed 2003;88:F292-295.
(2) Menon G. Neonatal long lines. Arch Dis child Fetal Neonatal Ed 2003;88:F260-262.
We agree with the editorial comment that we badly need to know where
long line tips are located (Phantoms 2004). However we cannot agree with the
phrase, “The approach reported by Evans et al seems to beat that from Odd
et al” the questions asked and the methodology of the two studies were
quite different.
Firstly, the outcome assessed in the paper by Evans et al [1] was the
identification...
We agree with the editorial comment that we badly need to know where
long line tips are located (Phantoms 2004). However we cannot agree with the
phrase, “The approach reported by Evans et al seems to beat that from Odd
et al” the questions asked and the methodology of the two studies were
quite different.
Firstly, the outcome assessed in the paper by Evans et al [1] was the
identification of the line tip, whilst the outcome in our study was
agreement regarding line tip location [2]. These are quite different
issues. We have previously shown that even when experienced observers are
confident that they can see the line tip there is only 72 % agreement
regarding tip location [3]. As the editorial stated, the line tip position
is the question we are faced with in clinical practice.
Secondly, in our study all three observers reported the images. In
the Evans study, two different pairs of observers assessed each method (1
& 3 for hard copy and 2 & 3 for computed images) with only
observer 3 assessing both modalities. Agreement between two observers is
likely to be greater that that between three.
Thirdly, the high percentage of line tips identified using digital
imaging may be biased by the fact that this figure is obtained when the
findings of two radiographs (hard and soft copy) are compared to a figure
obtained from review of a single radiograph (hard copy). The observer
already has an idea as to the location of the line tip when reviewing the
second image.
The Evans paper [1] is an important addition to the published
experience of computer image modification techniques for identification of
fine structures including long lines.[4] However this report of 95.6 %
rate of identification of the long line tip using soft copy imaging is in
contrast to the report by Soni et al [5] where the tip was identified by
three different observers in 63 %, 74 % and 96 % of images. Although the
published literature is supportive of the technique we concur with Evans
et al that that enthusiasm should be tempered until further rigorous
assessment is completed.
References
(1). Evans A, Natarajan J, Davies CJ. Long line positioning in
neonates: does computed radiography improve visibility? Arch Dis Child
Fetal Neonatal Ed 2004;89:F44-F45
(2). Odd DE, Page B, Battin MR, Harding JE. Does radio-opaque contrast
improve radiographic localisation of percutaneous central venous lines.
Arch Dis Child Fetal Neonatal Ed 2004;89:F42-F43
(3). Odd DE, Kuschel CA, Battin MR. Interobserver and intraobserver
variation in identifying neonatal longline position: an internet-based
survey. P76 Perinatal Society of Australia and New Zealand 7th Annual
Congress. 2003.
(4). Strickland NH. PACS (picture archiving and communication systems):
filmless radiology. Arch Dis Child 2000;83:82-86
(5).Soni N, Becker M, Dixon H, Miles R. Identification of the tip of long
lines using inversion of image technique on PACS. [e-letter] Arch Dis
Child 2002; 10 May
I read with great interest Adappa et al.’s letter.[1] I would like to add some comment on the perspective of
animal derived medication in Islam.
The essence of Islamic Laws is for the
protection of individual life, religion, mind, property and family.
Therefore in difficult circumstances, the rules are:
1. take the lesser
of the two evils,
2. necessity a...
I read with great interest Adappa et al.’s letter.[1] I would like to add some comment on the perspective of
animal derived medication in Islam.
The essence of Islamic Laws is for the
protection of individual life, religion, mind, property and family.
Therefore in difficult circumstances, the rules are:
1. take the lesser
of the two evils,
2. necessity allows the prohibited rule: “But if one is
compelled by necessity, neither creving nor transgressing - there is on
him no sin, for indeed God is Clement, Merciful” (Holy Quran-16:117).
Based on these principles:
(1) Receiving organs for transplantation (including cardiac valves) from
an animal source, including pig is permitted.
(2) Muslims allowed to consume medications which contain pig by-
products (e.g. insulin), if it is a life saving necessity, when non-pork
medicines are not available.
(3) Any chemical formula could originally have some prohibited
(haram) elements, but chemically all of those elements are altered, thus
producing different chemical characteristics
is permitted (e.g. most capsules are made from pork-derived gelatin).
(4) Pork derivatives are prohibited when taken through mouth or in
diet. But if they are used
for other implications (i.e. other than food and diet) they are not
prohibited (e.g. intratracheal porcine surfactant).
(5) According to Holy Quran to use all types of bovine-derived
medications is not preferred. The preparation of flesh including cow
derived ones is also important: “You are forbidden (to eat) that which
dies of it self, blood, and the flesh of swine; also any flesh dedicated
to any other than Allah. You are forbidden the flesh of strangled
(animals) and of those beaten or gpred to death; of those killed by a fall
or mangled by beasts of prey ...” (Holy Quran-5:3, also in 2:173, 6:145,
16:115)
Exogenous animal derived surfactans are chemically altered
preparations, and are used by intratracheal route for life saving
conditions. Therefore the use of animal-derivated surfactant is permitted
in Islam. Parents should be properly informed on scientific as well as the
religious aspects of animal-derived surfactant use.
Reference
(1) R Adappa, R Benson, S Oddie, and J Wyllie. Use of animal surfactant: should we seek consent? Arch Dis Child Fetal Neonatal Ed 2003;88:F-a351.
F. Tiker et al
[1] from Ankara have again drawn attention to
dehydration as the main factor leading to fever during the first week of
life and have listed the many investigations they considered necessary to
rule out more serious causes. Others in recent years have reported
similar findings and conclusions[2,3].
All have agreed that rehydration
leads to rapid resolution of the feve...
F. Tiker et al
[1] from Ankara have again drawn attention to
dehydration as the main factor leading to fever during the first week of
life and have listed the many investigations they considered necessary to
rule out more serious causes. Others in recent years have reported
similar findings and conclusions[2,3].
All have agreed that rehydration
leads to rapid resolution of the fever. However, I would like to suggest
that the term ‘dehydration fever’ is both a misnomer and misleading for
there is no evidence that the dehydration is the actual cause of the
fever. I have preferred for many years to use the label ‘hot baby
syndrome’ for this condition. Typically these babies are vigorous term
infants, two to four days old, that have received insufficient fluid
intake.
Insensible water loss, through breathing and skin, adds to the
dehydration. Because of thirst they become very restless, struggle against
their coverings and become overheated. Usually the problem is exacerbated
by an over-warm environment or too much clothing. Rather than immediately
resorting to a battery of invasive investigations, it is worth first
offering the infant clear fluids. If the response is vigorous and indeed
often frantic sucking, it is unlikely that the baby is seriously ill.
There is then a place for providing more clear fluids and a cooler
environment, coupled of course with watchful observation.
References
(1). Tiker, F., Gurakan, B., Kilicdag, H. and Tarcan A. Dehydration:
the main cause of fever during the first week of life. Arch. Dis. Child.
Fetal Neonatal Ed. 2004; 89: F373-376.
(2). Maayan-Metzger, A., Mazkereth, R. and Kuint J. Fever in healthy
asymptomatic newborns during the first days of life. Arch. Dis. Child.
Fetal Neonatal Ed. 2003; 88: F312-F314.
(3). Appleton, R.E. and Foo, C.K. Dehydration fever in the neonate:
a common phenomenon. Arch. Dis. Child. 1989; 64: 765-6.
We read the review article on neonatal meningitis by Heath and
colleagues with great interest.[1]
We would like to bring to notice
couple of issues that are of importance especially to the situation in
developing countries.
1.Firstly, cultures are positive only in a small proportion of cases of
meningitis in developing countries. This may be related to prior
antibiotic exposure that...
We read the review article on neonatal meningitis by Heath and
colleagues with great interest.[1]
We would like to bring to notice
couple of issues that are of importance especially to the situation in
developing countries.
1.Firstly, cultures are positive only in a small proportion of cases of
meningitis in developing countries. This may be related to prior
antibiotic exposure that is common, or poor microbiology services.[2]
The
diagnosis of culture negative meningitis in neonates, is however often
controversial. Newborns normally have cells (even polymorphs) and high
protein in their cerebrospinal fluid (CSF). What constitutes a deviation
from this normal range can be difficult to decide. What should one do if a
baby with suspected or blood culture proven sepsis has a minor abnormality
in only one of the CSF parameters? It has been suggested that CSF
analysis should be seen in totality, and even if one parameter is
positive, it should be treated as meningitis.[3,4]
2. Second, we do not agree with the author’s recommendation of repeating
the CSF examination after 24-48 hours. As mentioned above, if to begin
with, most of the cases of neonatal meningitis are culture negative,
repeating a lumbar puncture to see if the organism is still persisting
will not be of any value. Since, most of the cases of neonatal meningitis
are diagnosed on the basis of abnormalities in CSF cytology, protein and/
or sugar content, repeat lumbar puncture will only show the changes in
these parameters. It has been shown that cytologic and biochemical
abnormalities take time to normalize, despite appropriate and adequate
antibiotics.[4] The cell count may even go up on second day .[5] Also,
a quarter to one-third of lumbar punctures (LP) in neonates can be
traumatic or dry taps.[6] Moreover, the procedure carries the risk of
causing pain and hypoxemia in small babies, introduction of infection and
other complications like spinal epidermoid tumors and contamination of CSF
with bone marrow cells.
Hence, we believe that repeating a CSF examination after 24-48 hours
as a universal rule has more risks than benefits. It would be more
rationale to do a close clinical monitoring of the baby and do an
ultrasound examination of the head after 48-72 hours of treatment. LP
should be repeated around 48-72 hours if the baby is not recovering as
expected, or if ultrasound shows development of ventriculitis or other
complications. A survey of pediatricians and neonatologists by Agarwal et al.[7] showed that currently, most of them are not doing routine repeat
CSF examinations. Xavier and McCracken in a recent review recommended that
a repeat lumbar puncture should be done at 24–48 hours after admission if
a resistant pneumococcus has been isolated from the initial CSF culture,
and if the patient has not shown clear clinical improvement .[8]
References
(1) Heath P T, Yusoff NKN, Baker C J. Neonatal meningitis. Arch
Dis Child Fetal and Neonatal Edition 2003;88:F173-8.
(2) Kumar P, Verma IC. Antibiotic therapy for bacterial meningitis in
children in developing countries. Bull World Health Organ 1993;71:183-88.
(3) Schaad UB, Nelson JD, McCracken GH Jr. Recrudescence and relapse in
bacterial meningitis of childhood. Pediatrics 1981; 67:188–95.
(4) Volpe JJ. Neurology of the Newborn, 4th
Edition. Philadephia: WB Saunders, 2002; 774-812.
(5) Converse GM, Gwaltney JM Jr, Strassburg DA. Alteration of
cerebrospinal fluid findings by partial treatment of bacterial meningitis. J Pediatr 1973;83:220–225.
(6) Kumar P, Sarkar S, Narang A. Role of routine lumbar puncture in
neonatal sepsis. J Paediatr Child Health 1995;31:8-10.
(7) Agarwal R, Emmerson AJ. Should repeat lumbar punctures be routinely
done in neonates with bacterial meningitis? Results of a survey into
clinical practice. Arch Dis Child 2001;84:451–2.
(8) Saez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet 2003;361:2139-48.
These findimgs go strongly in favour of the dictum not to interfere
with "mother nature". Also it goes to prove that one must "treat the
patient not the biochemistry"
It helps us who may not have access to good biochemistry and
monitoring apart from clinical in managinr our newborns.
Dear Editor
Adappa et al. wonder whether parents should be told that Curosurf and Survanta are derived from pig and cow lung. But where does one stop? Most capsules prescribed for older children and adults are made of gelatin - a cheap source of collagen derived from cow or pigskin, or bone. Is it equally patronizing not to tell our patients and their parents this? Surely not.
Dear Editor
I read with interest the article on weaning preterm infants by Marriott et al.[1] Authors of this article deserve congratulations for conducting randomised controlled trial in an area with sparsity of evidence and little research. The preterm weaning strategy (PWS) adopted in this study showed benefits in terms of improved length growth velocity between 0 and 12 months corrected gestational age (CG...
Dear Editor
Neonatal long lines are essential part in the management of extremely low birth babies and very sick babies. Technically to insert a longline is not that difficult especially if attempted in the first few days but often we have to accept suboptimal positions. Definitely use of long lines have improved the outcome of babies weighing less than 1000grams and postoperative cases.
More than safety we...
Dear Editor
We read with interest the review of Neonatal meningitis by PT Heath et al.[1] Neonatal meningitis remains a very important cause of morbidity and mortality. Group B streptococcus (GBS) remains the leading pathogen.[2]
We report a case of GBS meningitis that was a challenge for management. A term baby born by normal vaginal delivery with birth weight of 3.26 kg, presented at 5 days of age w...
Dear Editor
I congratulate Beardsall et al. on their impressive, albeit retrospective collection of data.[1] Their important conclusion that neither extra-atrial position of the catheter tip, nor imaging with contrast, are reliable measures to prevent pericardial effusion (PCE) means that we will have to live with this threat. This inevitably redirects attention from the aspect of prevention to the ques...
Dear Editor
We agree with the editorial comment that we badly need to know where long line tips are located (Phantoms 2004). However we cannot agree with the phrase, “The approach reported by Evans et al seems to beat that from Odd et al” the questions asked and the methodology of the two studies were quite different.
Firstly, the outcome assessed in the paper by Evans et al [1] was the identification...
Dear Editor
I read with great interest Adappa et al.’s letter.[1] I would like to add some comment on the perspective of animal derived medication in Islam.
The essence of Islamic Laws is for the protection of individual life, religion, mind, property and family. Therefore in difficult circumstances, the rules are:
1. take the lesser of the two evils,
2. necessity a...
Dear Editor,
F. Tiker et al [1] from Ankara have again drawn attention to dehydration as the main factor leading to fever during the first week of life and have listed the many investigations they considered necessary to rule out more serious causes. Others in recent years have reported similar findings and conclusions[2,3].
All have agreed that rehydration leads to rapid resolution of the feve...
Dear Editor
We read the review article on neonatal meningitis by Heath and colleagues with great interest.[1]
We would like to bring to notice couple of issues that are of importance especially to the situation in developing countries.
1.Firstly, cultures are positive only in a small proportion of cases of meningitis in developing countries. This may be related to prior antibiotic exposure that...
Dear Editor
These findimgs go strongly in favour of the dictum not to interfere with "mother nature". Also it goes to prove that one must "treat the patient not the biochemistry"
It helps us who may not have access to good biochemistry and monitoring apart from clinical in managinr our newborns.
Well done!
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