Asking the right questions of parents is extremely important, especially when dealing with alternative medical beliefs.

Cryoprecipitates are postulated to play a role in the pathogenesis of several vasculitic illnesses and infectious diseases. To investigate the presence of cryoprecipitates in Kawasaki syndrome, we studied sera from 25 children with acute Kawasaki syndrome. None of the subjects was treated with intravenous gamma-globulin. Cryoprecipitates were detectable in sera of 11 of 25 (44%) children studied. The mean (±SE protein concentration of the cryoprecipitates was 88.0 (±20.2) Mg/ml serum. Cryoprecipitates consisted primarily of IgG and IgM; no complement components were detected but highly sensitive methods were not used. The presence of cryoprecipitates in the serum of children with acute Kawasaki syndrome was associated with the subsequent development of coronary artery aneurysms detected by echocardiogram (P <0.05). There was no association between detectable cryoprecipitates and either peak platelet count or erythrocyte sedimentation rate. In one patient, measurement of cryoprecipitates in serial samples showed a reduction in concentrations that paralleled subsidence of disease activity. We speculate that cryoprecipitates may be a marker for increased risk of coronary aneurysm formation and may play a role in the pathogenesis of the cardiac disease in Kawasaki syndrome.

Twenty-nine dehydrated, well-nourished infants, who were 3 to 24 months of age and had acute gastroenteritis, were enrolled in a prospective randomized study that compared the safety, efficacy, and costs of oral vs intravenous rehydration. The study was designed to assess the use of a holding room in the emergency room for the outpatient rehydration of dehydrated infants. The oral solution that was used contained 60 mEq/L of sodium, 20 mEq/L of potassium, 50 mEq/L of chloride, 30 mEq/L of citrate, 20 g/L of glucose, and 5 g/L of fructose. Thirteen of 15 patients were successfully rehydrated orally as outpatients; two patients, who were subsequently discovered to have urinary tract infections, required hospitalization due to persistent vomiting. Orally rehydrated outpatients spent a mean of 10.7 hours in the holding room, as compared with intravenously rehydrated inpatients, who were hospitalized for a mean of 103.2 hours. Outpatient oral rehydration therapy was significantly less costly than inpatient intravenous therapy (+272.78 vs +2,299.50). Our results indicate that oral rehydration is a safe and cost-effective means of treating dehydrated children in an outpatient setting in the United States. The use of a holding room for observation in the emergency room can markedly decrease health care costs and unnecessary hospitalizations.

Sixty well-nourished, well-hydrated infants, 3 to 24 months of age with uncomplicated acute gastroenteritis, were enrolled in a prospective, randomized, double-blind study that compared the safety and efficacy of two oral solutions. The solutions differed primarily in the sodium concentration (60 v 30 mEq/L) and glucose concentration (2% v 5%). The mean serum sodium concentrations of the two groups did not differ significantly from each other at entry or at the end of the study period. In addition, there were no significant changes in the mean serum sodium concentration within each group at the end of the study period. No child in either group became hypernatremic. Our results indicate that a solution with a high concentration of sodium initially designed for the rehydration of dehydrated children also can be safely and effectively used as a maintenance solution for the treatment of well-hydrated children older than 3 months of age with acute gastroenteritis.

Substantial reduction of hospital duration and costs may be achieved with use of an antibiotic with very long serum half-life and enhanced activity against pathogens, allowing once-daily dosing. For that reason, we evaluated the efficacy of once-daily ceftriaxone (CTX) in 40 children with serious infections: meningitis (13), ventriculitis (2), pyelonephritis (7), osteomyelitis (6), arthritis (3), and others (9). Isolates were H. influenzae (9), E. coli (8), S. auveus (6), K. pneumoniae (3), salmonella (3), group A streptococci (3), and others (9). CTX was given IV or IM at 50 mg/kg; CNS infections were treated with a loading dose of 100 mg/kg followed by 80 mg/kg once-daily. 38/40 patients were completely cured by CTX; one patient with K. pneumonias ventriculitis had received intraventricular gentamicin briefly. One strain of B. thetaiotomicron was tolerant to CTX. Trough CTX serum levels were 3–10 μg/ml, while CSF levels were 3.5–15 μg/ml. Reactions included mild discomfort at IM sites (4), diarrhea (3), thrombocytosis (5), eosinophilia (4), mildly elevated liver enzymes (3), and leukopenia with neutropenia (2); all normalized after drug discontinuation. The high cure rate and minimal side effects suggest that once-daily CTX is safe and effective therapy for serious childhood infections. In the DRG era, use of a once-daily regimen combined with home health care or outpatient IV/IM therapy can result in savings of up to 90% of hospital costs.

Parental reports of night waking and sleep patterns were obtained for 141 normal 4- to 8-month-old infants from middle-class families. A group of infants was identified who had a past history of colic and who were perceived to have a current night waking "problem." These infants awoke more often than other infants and also had significantly briefer total sleep duration. Night waking was described as a problem in infant boys more often than in infant girls. A second group of infants who awoke frequently was reported to snore or mouth breathe when asleep. This group of infants did not have a past history of colic, was not perceived to have a night waking problem, and was not overly represented by boys. Ordinal position, father's education level, gender, and method of feeding did not affect reported sleep patterns.

We performed a prospective, randomized, double-blind, placebo-controlled clinical trial of dicyclomine hydrochloride using specific diagnostic criteria for infantile colic: spells of unexplained irritability, agitation, fussiness or crying lasting greater than or equal to 3 hours/day, occurring greater than or equal to 3 days/week, and continuing for greater than or equal to 3 weeks. Dicyclomine eliminated colic in 15 of 24 (63%) infants, whereas placebo was effective in six of 24 (25%) (corrected X2 = 5.42, P = 0.02). The study also addressed the hypothesis that parental distress caused by infantile colic affects subsequent temperament and sleep patterns. The data fail to document easier temperaments or longer sleep durations at 4 months in infants whose colic ceased during treatment.

This case control study of healthy children utilized parents' reports to determine whether behavioral, developmental, or academic problems were associated with signs of partial airway obstruction (snoring, difficult or labored breathing, and mouth breathing) during sleep. Results suggest an association between the signs of airway obstruction during sleep and problems when awake. Children with behavioral, developmental, or academic problems had a significantly later bedtime hour, briefer duration of total sleep, longer night awakenings, and an increased latency to sleep, as compared to children without those problems.

Thirty-nine children withHaemophilus influenzae type B (HITB) meningitis, who had received at least five days of oral chloramphenicol, were studied. All patients responded well to treatment. No relapses of meningitis occurred. Chloramphenicol levels in the cerebrospinal fluid (CSF) following oral administration of chloramphenicol palmitate were as high, or higher, than those following i. v. therapy with chloramphenicol succinate. In the patients studied, the route of administration of chloramphenicol had little effect on trough CSF levels.

A patient with mucocutaneous candidiasis and impaired polymorphonuclear leukocyte (PMN) chemotaxis is described. The patient's PMN chemotaxis was markedly decreased in the presence of autologous plasma but normal in control plasma. Cell-directed inhibitory activity was found in whole patient plasma as well as the 40% ammonium sulfate precipitate fraction of both the patient's and the control plasma. The inhibitor was heat stable, reversible, nondialyzable, eluted from DEAE cellulose with 0.005 M sodium phosphate buffer, and migrated with IgG on immunoelectrophoresis. The supernate from 40% ammonium sulfate-fractionated patient and control plasma contained a cell-directed enhancer of PMN chemotaxis that antagonized the cell-directed inhibitor activity. It is possible that the patient's chemotactic defect may be caused by imbalance between plasma factors that regulate chemotaxis.

Six strains of ampicillin-resistant Haemophilus influenzae type b were studied in vitro for synergy between ampicillin and nafcillin. The minimal inhibitory concentrations for these strains with 10(4) colony-forming units per ml were 6.25 to 12.5 microgram of ampicillin per ml and 6.25 to 25 microgram of nafcillin per ml. Studies with these agents demonstrated synergism against all six strains of H. influenzae type b. Most strains were inhibited by 0.78 microgram of nafcillin plus 0.78 microgram of ampicillin per ml. A child with osteomyelitis caused by H. influenzae type b was successfully treated with a combination of ampicillin and nafcillin. These data suggest that further studies assessing the synergistic effect of this drug combination against H. influenzae type b are warranted.