Breastfeeding practices in an area of high HIV prevalence in rural South Africa.

Unlabelled: Exclusive breastfeeding (EBF) from 0 to 6 mo of age is recommended by the World Health Organization as the optimal feeding method for infants, including infants of human immunodeficiency virus (HIV)-infected women from developing countries who choose to breastfeed. EBF may be associated with less risk of postnatal HIV transmission than mixed feeding, but is still uncommonly practised for reasons that are poorly understood. This study aimed to assess EBF rates and the impediments to EBF in a South African rural area of high HIV prevalence where most mothers are unaware of their status.

Analysis of sequence diversity at the highly polymorphic Cpgp40/15 locus among Cryptosporidium isolates from human immunodeficiency virus-infected children in South Africa.

Cryptosporidium sp. is a significant cause of diarrheal disease, particularly in human immunodeficiency virus (HIV)-infected patients in developing countries. We recently cloned and sequenced several alleles of the highly polymorphic single-copy Cryptosporidium parvum gene Cpgp40/15.

Free formula milk for infants of HIV-infected women: blessing or curse?

There is vigorous controversy around whether HIV-infected women in developing countries should choose formula or breastfeeding for their infants. Formula eliminates HIV transmission but incurs risk of increased mortality, whereas breastfeeding has multiple benefits but entails risk of HIV transmission. International guidelines are available but need to be strengthened.

Subdural hematoma in term infants.

Subdural hematomas are uncommon in term infants. The study objectives were to evaluate risk factors for and clinical significance of small subdural hematomas observed on computerized tomography. During a 3-year period, 26 near-term and term nonasphyxiated infants were found to have a subdural hematoma on computed tomography.

Diagnosis of Streptococcus pneumoniae lower respiratory infection in hospitalized children by culture, polymerase chain reaction, serological testing, and urinary antigen detection.

A prospective study of 154 consecutive high-risk hospitalized children with lower respiratory infections was conducted to determine the clinical utility of a pneumolysin-based polymerase chain reaction (PCR) assay compared with blood and pleural fluid cultures and serological and urinary antigen tests to determine the incidence of Streptococcus pneumoniae. Whole blood, buffy coat, or plasma samples from 67 children (44%) tested positive by PCR. Sensitivity was 100% among 11 promptly tested culture-confirmed children and specificity was 95% among control subjects.

Feeding mode, intestinal permeability, and neopterin excretion: a longitudinal study in infants of HIV-infected South African women.

Exclusive breast feeding has been associated with a lower rate of mother-to-child HIV transmission than breast feeding plus other foods. To obtain further information on biologic outcomes of different feeding modes, we examined 272 infants of HIV-infected South African women at ages 1, 6, and 14 weeks. At each visit information about infant diet and morbidity was collected and infants underwent a lactulose/mannitol dual sugar intestinal permeability test.

The effect of antenatal vitamin A and beta-carotene supplementation on gut integrity of infants of HIV-infected South African women.

Background: Vitamin A is important for protection against diarrhea, and supplements may benefit gut function of infants of HIV-infected mothers.

Methods: We studied 238 infants of HIV-infected South African women participating in a randomized, double-blind, placebo-controlled trial of vitamin A during pregnancy (1.5 mg retinyl palmitate and 30 mg beta-carotene daily) plus 60 mg retinyl palmitate at delivery.

Catheter-related thrombosis in children with cancer.

Objective: The prevalence of asymptomatic catheter-related thrombosis of the upper venous system in children with cancer has not been determined. We evaluated patients with cancer and implantable central venous catheters (ports) for this complication.

Study Design: Children with cancer undergoing port removal were eligible for this study.

The use of gated cine phase contrast and MR venography in achondroplasia.

Objects: Foramen magnum and jugular foramen stenosis, well-known problems in achondroplasia, may result in brain stem compression and venous outflow obstruction, respectively. We studied a series of children with achondroplasia using gated cine phase contrast (PC) CSF flow studies to evaluate CSF dynamics across the foramen magnum and MR venography (MRV) to depict obstructed venous drainage.

Methods: Ten patients (9 months to 11 years, mean 2.

MR venography in children with complex craniosynostosis.

Purpose: Chronic venous hypertension due to jugular foramen stenosis has been proposed as an etiology for the hydrocephalus and tonsillar herniation seen in some patients with complex craniosynostosis. We report the use of MR venography (MRV) to evaluate venous outflow obstruction in this clinical setting.

Materials And Methods: We studied 17 patients, (ages 4 months to 34 years; mean 7.

Surveillance protocol for the detection of intracranial abnormalities in premature neonates.

Objective: To determine the optimal timing of cranial ultrasound scans (USs) for identifying preterm neonates weighing less than 1500 g at birth who develop intracranial complications of prematurity.

Design/setting: Observational study at an urban county hospital.

Methods: Serial USs from neonates with less than 1500-g birth weight (BW) admitted to the neonatal intensive care unit between January 1995 and December 1996 were reviewed by a pediatric neuroradiologist in a blinded random manner.

Midface anomalies in children.

A variety of congenital midface anomalies occur in children. High-resolution computed tomography (CT) and magnetic resonance (MR) imaging have proved helpful in determining the nature and extent of dysplasia, thereby facilitating treatment planning. A classification system has been developed that groups these anomalies into four categories based on embryogenesis and anatomic location.

Vitamin A supplementation of South African children with severe diarrhea: optimum timing for improving biochemical and clinical recovery and subsequent vitamin A status.

Background: Vitamin A has well-recognized benefits for prevention of diarrhea, but the impact of therapeutic doses given during diarrhea on biochemical and clinical outcomes is less clear. We investigated these potential therapeutic benefits within a study of the optimum time for vitamin A supplementation to promote vitamin A status.

Methods: Young children with severe diarrhea were randomized to receive 60 mg of retinol as retinyl palmitate during acute diarrhea or once symptoms had resolved, usually after 5 to 8 days.

Idiopathic ischemic cerebral infarction in childhood: depiction of arterial abnormalities by MR angiography and catheter angiography.

Background And Purpose: We report our experience with MR imaging, MR angiography, and catheter angiography in children with acute idiopathic cerebral infarction and suggest that catheter angiography may still play an important role in this setting.

Methods: During the past 8 years, 18 children with idiopathic cerebral infarction underwent MR imaging and catheter angiography; 17 were also studied with MR angiography. MR imaging was done within 34 hours after onset of hemiplegia or seizures or both.

Coexistent holoprosencephaly and Chiari II malformation.

Chiari II malformations and holoprosencephaly have been considered to be brain malformations that differ with respect to teratogenic insult, embryologic mechanism, and morphology. We herein describe coexistent Chiari II malformation and holoprosencephaly that occurred in a viable infant. A review of the literature regarding Chiari II malformations and holoprosencephaly suggests that a disturbance to the mesenchyme in early embryologic life may be the cause of both malformations.

Contrast venography in young haemophiliacs with implantable central venous access devices.

To assess the risk of deep vein thrombosis in haemophiliacs with long-term central venous catheters, we studied haemophiliacs followed at our centre with implantable venous access devices (ports) in place for > 6 months. Medical records were reviewed for a history of catheter-related complications. Each patient was examined for physical stigmata of thrombosis.

Surgical lessons learned from the Shigella dysenteriae type I epidemic.

An epidemic of Shigella dysenteriae type I is spreading through Africa. It is a particularly infectious and virulent form of dysentery which can cause clinical confusion with other endemic diseases and may present to the surgeon as a result of its complications. A total of 140 children with Shigella dysenteriae type I presented to the paediatricians at King Edward VIII Hospital in 1995; 35 were referred to the surgeons because of abdominal tenderness, distension, peritonitis or perforation.

The use of early postoperative MR in detecting residual juvenile cerebellar pilocytic astrocytoma.

Purpose: We compared visibility of residual juvenile cerebellar pilocytic astrocytomas (JPAs) on early postoperative and follow-up MR studies to determine whether early postoperative MR imaging has a valid role as a baseline study.

Methods: We reviewed the MR images of 21 consecutive children who had undergone resection of cerebellar JPA. The diagnosis of residual tumor was made on the basis of nodular enhancement that corresponded to enhancing tumor on the preoperative MR studies and/or nonenhancing nodular T2 signal that corresponded to nonenhancing tumor.

Post-dysenteric hemolytic uremic syndrome in children during an epidemic of Shigella dysentery in Kwazulu/Natal.

We report 81 of 107 cases of hemolytic uremic syndrome (HUS), admitted between July 1994 and February 1996, following an outbreak of Shigella dysenteriae type 1 dysentery in Kwazulu/Natal. All patients, excluding 1, were black with a mean age of 38 months (range 1-121); 50 (61.7%) were males.