26 September 2005
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
One question did come up. My daughter had purchased pedia-lite. She did not refrigerate the bottle or throw it out in 48 hours. She did not see that on the label. Could this have caused what is happening with the baby? He has not had any pedia-lite for over a week now. Could this have caused these long-term effects?
-Denise
Dear Denise: It is unlikely the Pedialyte is causing a problem since it is sterile to begin with; however, if the infant is still symptomatic, this information should be conveyed to the pediatrician who can decide if another stool culture is warranted.
Soy is not hypoallergenic. If the baby is truly allergic, an improvement with a hypoallergenic formula will take a week or two since the soy must first be eliminated from the intestines, and then the intestines need time to heal. Should there be no improvement, the baby should see a pediatric gastroenterologist.
Sincerely,
Dr. Warren
-TS
Dear TS: Infants who get adequate dietary iron in formula should not be iron deficient, but it could depend on what the baby's iron stores were to begin with. The anemia may not be secondary to iron deficiency, but since it's a common cause, many pediatricians elect to treat with iron before doing any additional diagnostic tests.
Sincerely,
Dr. Warren
-CC
Dear CC: The most likely source of a Group B strep infection is the birth canal. Therefore, it is likely that there was a problem with the initial test in which your wife's culture was negative, unless the test was done far enough in advance of the delivery that your wife acquired the organism after the test. Just as group B strep can colonize the genital tract of healthy individuals, it can also colonize the intestinal tract. Approximately 6% of infants with group B strep infections are exposed to the group B strep after delivery. The source can be other adults or even other newborns who have been colonized by group B strep. This points out the importance of careful hand washing between handling infants. Serious infections can cause a variety of complications. According to Behrman: Nelson Textbook of Pediatrics, 15th ed., Copyright © 1996 W.B. Saunders Company
The mortality rate for early-onset GBS [group B strep] disease ranges from 10 to 20%; the mortality rate is highest in very low-birthweight infants and in those with septic shock or a delay in instituting antimicrobial therapy. Because of increased awareness, earlier diagnosis and treatment, and the increased use of intrapartum chemoprophylaxis by obstetricians, the incidence and mortality rates from GBS early-onset disease appear to have declined.If your newborn does well on antibiotics, since the infection was caught early, he didn't have meningitis, and he has not yet had any complications, he should recover without any permanent consequences. The treatment should be sufficient to prevent recurrence.The mortality rate from GBS-associated persistent fetal circulation has dramatically decreased owing to the use of extracorporeal membrane oxygenation. Neurologic sequelae after meningitis are severe in 20-30% of cases and include mental retardation, quadriplegia, repeated uncontrollable seizures, hypothalamic dysfunction, cortical blindness, hydrocephalus, bilateral deafness, and hemiplegia. Additional neurodevelopmental sequelae are noted in 15-25% of patients and include mild mental retardation, mild cortical atrophy, a stable seizure disorder, delay in receptive and expressive speech and language development, and other learning disabilities.
Sequelae of focal infections (arthritis, osteomyelitis) are usually localized and are not as significant as those associated with sepsis and meningitis.
Sincerely,
Dr. Warren
-CC
P.S.: Thank you so much for the previous information.Dear CC: The treatment of group B strep sepsis (blood infection) which your son has is the same as the treatment for group B strep meningitis except that the antibiotics must be continued intravenously for 10 to 14 days for meningitis. Early disease with group B strep is usually not associated with meningitis which occurs more commonly with late disease (after the babies have left the nursery, around 2 weeks of age). If the baby had seizures as part of his symptoms you would have reason to be concerned about meningitis. Since the baby has been treated, meningitis will not show up later. If the baby is doing well at this time, there is no additional action to be taken with regard to the possibility of meningitis. If the baby did have undiagnosed meningitis which was treated successfully, you would not know if there were any complications until the baby began to show developmental lags or was not responding appropriately to you.
Given the quick institution of therapy and the fact that it was early disease, it is most likely that your baby did not have meningitis and will do well; however, since the question of meningitis cannot be answered, it might be reasonable to test the baby's hearing early on. If there is any hearing loss the baby would benefit from early intervention.
Sincerely,
Dr. Warren
Thanks.
Best Regards
-Mr and Mrs AR
Dear Mr. and Mrs. AR: Breast feeding may sometimes contribute to persistence of physiologic jaundice, the jaundice that normally occurs in newborns. It is not dangerous and therefore not a reason to discontinue nursing; however, your doctor may be trying a period off nursing to see if the jaundice will resolve. If that does work, it can avoid further diagnostic evaluation. The problem is that any prolonged time off the breast can make it difficult to get the baby back on the breast. Therefore, the trial off breast should be kept brief, and Mom must pump her breasts in order to keep her milk flowing.
Sincerely,
Dr. Warren
Any comments on the above said statements?
Take care
-R
Dear R: Apparently I misunderstood your previous question, as I thought it was your infant who was jaundiced, rather than your wife. Hepatitis A is not transmitted in breast milk. Your wife certainly should continue nursing as long as she is not too ill; however, until she is fully recovered, she should wash her hands well before each time she handles the baby just to make sure the baby does not become exposed to the hepatitis A.
Sincerely,
Dr. Warren
-MW
Dear MW: Objects like swallowed coins usually pass through the intestines within a few days. If the parents don't see a coin pass, it has most likely passed out buried in stool. If the coin had not passed, it would cause obstructive symptoms of abdominal pain and vomiting. If a child has such symptoms after swallowing a coin, an abdominal x-ray will easily determine if the coin has passed, and its location if not.
It is highly unlikely that your daughter's rashes have anything to do with swallowing the penny.
Sincerely,
Dr. Warren
-TAT
Dear TAT: Since the surgeon who removes adenoids is usually and ENT specialist, he should have advised you regarding the necessity of placing tubes. It is not done as a matter of course when the adenoids are removed. If your daughter has had persistent middle ear fluid for more than 4 months, and if her hearing has been adversely affected, or if she has had recurrent ear infections in spite of adequate treatment with antibiotics, then she may require tubes.
Sincerely,
Dr. Warren
Dear Readers: One additional thought since I gave the above answer. Young infants may have middle ear problems due to enlarged adenoids. Often the ENT will remove the adenoids in an effort to solve the problem before resorting to tubes.Sincerely,
Dr. Warren
-ECS
Dear ECS: The tingling in your daughter's leg suggests that there is pressure on a nerve or that the blood supply to the nerve is compromised. This need not be serious, but the cause of the symptoms must be investigated.
Sincerely,
Dr. Warren
They have been jibber-jabbering from an early age between themselves, which I understand is normal,;;;;could we have some info. on this pls?
Thank you.
-Granny B
Dear Granny B: Twins may experience some language delays if they were premature. In addition, since some twins learn to communicate with each other using their own language, that may also interfere with normal language development. The bottom line is that significant delays in language development are not the norm for twins. Even if they are not acquiring normal language because of their own language or twin-twin interactions, that is not desirable. By 4 years of age children should be using language to communicate. They're only a year away from kindergarten. They need to get started on doing what all other kids do. I would suggest a speech/language evaluation and speech therapy for them.
Sincerely,
Dr. Warren
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