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Further observations of epidemic diarrhea of the newborn; observation of a biphasic type of clinical course; therapeutic measures including prophylactic and therapeutic use of gamma globulin



Further observations of epidemic diarrhea of the newborn; observation of a biphasic type of clinical course; therapeutic measures including prophylactic and therapeutic use of gamma globulin



J. Pediat, 28: 407417



In an earlier outbreak of neonatal diarrhoea (Abst. 3688, Vol. 14), Anderson and Nelson recorded good results from correction of acidosis and maintenance of fluid balance. The same lines of treatment were applied in the outbreak described in this paper but the results were less favourable. Of 63 infants affected, 52 had a fairly characteristic clinical picture ranging from mild diarrhoea without other symptom to severe diarrhoea with acidosis, dehydration and prostration; 7 of these infants died. In the remaining 11, six of whom weighed less than 5 lb. 8 oz. at birth, the diarrhoea was recurrent; 9 of these collapsed suddenly and died within a few hours. This "biphasic" type of clinical course, with transient, incomplete, and deceptive "improvement" is regarded, therefore, as having a specially unfavourable prognosis. The epidemiological features of this outbreak were classic: insidious onset with difficulty in distinguishing mild digestive disorders from the infectious disease; a higher case mortality rate among premature infants; failure to control spread of the disease until the entire department was closed to admissions and thoroughly cleaned before it was re-occupied; failure to incriminate a specific micro-organism as the cause; and absence of characteristic post mortem findings. Search for a causal virus could not be undertaken. Loss of weight is stressed as an important symptom that may precede the onset of diarrhoea. The measures relied on for treatment were: maintenance of hydration, correction of acidosis, modified feeding and administration of aminoacid solution, plasma, and whole blood. Neithesulphonamides nor penicillin influenced the diarrhoea but both should be given in septicaemic cases. Gamma globulin, one injection of 5 ml. intramuscularly, was given to 28 patients, 14 with the disease and 14 who had been exposed but had not yet developed symptoms; 27 infants in the same nursery who did not receive the injection were observed as controls. In this dosage, the gamma globulin was without therapeutic or prophylactic effect, but it is suggested that its usefulness as an adjunct to other lines of treatment should be further explored, possibly with larger doses.

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Accession: 013718735

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PMID: 21023179


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