ORIGINAL ARTICLES
April 2014 14. Evans N, Kluckow M. Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996;74:F88-94. 15. Evans N, Malcom G. Practical echocardiography for the neonatologist [CD]. Sydney, Australia: Royal Prince Alfred Hospital; 2007. 16. De Waal KA, Evans N, Osborn DA, Kluckow M. Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns. Arch Dis Child Fetal Neonatal Ed 2007;92:F444-8.
17. De Waal K, Evans N, Van der Lee J, Van Kaam A. Effect of lung recruitment on pulmonary, systemic, and ductal blood flow in preterm infants. J Pediatr 2009;154:651-5. 18. Abdel-Hady H, Matter M, Hammad A, El-Refaay A, Aly H. Hemodynamic changes during weaning from nasal continuous positive airway pressure. Pediatrics 2008;122:e1086-90. 19. De Paoli AG, Lau R, Davis PG, Morley CJ. Pharyngeal pressure in preterm infants receiving nasal continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 2005;90:F79-81.
50 Years Ago in THE JOURNAL OF PEDIATRICS Prevention of Rheumatic Fever: Limitations Saslow MS, Vietal AG. J Pediatr 1964;64:552-6
ased on the study by Cantazero et al1 from the 1950s, it is widely accepted, including by a 2009 American Heart Association statement (endorsed by the American Academy of Pediatrics), that treating streptococcal pharyngitis as late as 9 days from onset is sufficient to prevent rheumatic fever.2 In 3 centers (Chicago, Toronto, and Denver), Saslow and Vietal examined the temporality of infections reported by patient history with the development of episodes of acute rheumatic fever. Although the majority of infections indeed occurred between 10 and 35 days before the episode of rheumatic fever, they found that 109 of 485 episodes (22.5%) occurred between 1 and 9 days from a respiratory infection, and that 59 episodes (12.2%) occurred simultaneously with the infection. Thus, they concluded that the “9-day rule” is incorrect, and that streptococcal pharyngitis must be treated as soon as suspected to prevent rheumatic fever. This study had substantial limitations, however, primarily the authors’ assumption that the respiratory infections were caused by streptococcus, without bacteriologic confirmation. In addition, there was the potential for reporting bias. Thus, their conclusion was not based on definitive evidence. In a summary of several studies, Markowitz3 reported that one-third of patients with rheumatic fever had no history of previous respiratory symptoms. An alternative explanation for the findings of Saslow and Vietal may be that patients had an asymptomatic streptococcal infection before the respiratory infection reported by the patients, and that many of the respiratory infections reported were not caused by streptococcus. Regardless of the explanation, the threshold for performing throat cultures (both rapid testing and conventional cultures) should be low in endemic areas of rheumatic fever. Patients and families should be urged to undergo cultures with even mild throat symptoms or if a family member or close friend has streptococcal pharyngitis.
B
Philip J. Hashkes, MD, MSc Pediatric Rheumatology Unit Shaare Zedek Medical Center Jerusalem, Israel
References
http://dx.doi.org/10.1016/j.jpeds.2013.10.010
1. Catanzaro FJ, Stetson CA, Morris AJ, Chamovitz R, Rammelkamp CH Jr, Stolzer BL, et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med 1954;17:749-56. 2. American Heart Association, Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement. Circulation 2009;119:1541-51. 3. Markowitz M. Eradication of rheumatic fever: an unfulfilled hope. Circulation 1970;41:1077-84.
The Effects of Nasal Continuous Positive Airway Pressure on Cardiac Function in Premature Infants with Minimal Lung Disease: A Crossover Randomized Trial
729
April 2014 14. Evans N, Kluckow M. Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996;74:F88-94. 15. Evans N, Malcom G. Practical echocardiography for the neonatologist [CD]. Sydney, Australia: Royal Prince Alfred Hospital; 2007. 16. De Waal KA, Evans N, Osborn DA, Kluckow M. Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns. Arch Dis Child Fetal Neonatal Ed 2007;92:F444-8.
17. De Waal K, Evans N, Van der Lee J, Van Kaam A. Effect of lung recruitment on pulmonary, systemic, and ductal blood flow in preterm infants. J Pediatr 2009;154:651-5. 18. Abdel-Hady H, Matter M, Hammad A, El-Refaay A, Aly H. Hemodynamic changes during weaning from nasal continuous positive airway pressure. Pediatrics 2008;122:e1086-90. 19. De Paoli AG, Lau R, Davis PG, Morley CJ. Pharyngeal pressure in preterm infants receiving nasal continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 2005;90:F79-81.
50 Years Ago in THE JOURNAL OF PEDIATRICS Prevention of Rheumatic Fever: Limitations Saslow MS, Vietal AG. J Pediatr 1964;64:552-6
ased on the study by Cantazero et al1 from the 1950s, it is widely accepted, including by a 2009 American Heart Association statement (endorsed by the American Academy of Pediatrics), that treating streptococcal pharyngitis as late as 9 days from onset is sufficient to prevent rheumatic fever.2 In 3 centers (Chicago, Toronto, and Denver), Saslow and Vietal examined the temporality of infections reported by patient history with the development of episodes of acute rheumatic fever. Although the majority of infections indeed occurred between 10 and 35 days before the episode of rheumatic fever, they found that 109 of 485 episodes (22.5%) occurred between 1 and 9 days from a respiratory infection, and that 59 episodes (12.2%) occurred simultaneously with the infection. Thus, they concluded that the “9-day rule” is incorrect, and that streptococcal pharyngitis must be treated as soon as suspected to prevent rheumatic fever. This study had substantial limitations, however, primarily the authors’ assumption that the respiratory infections were caused by streptococcus, without bacteriologic confirmation. In addition, there was the potential for reporting bias. Thus, their conclusion was not based on definitive evidence. In a summary of several studies, Markowitz3 reported that one-third of patients with rheumatic fever had no history of previous respiratory symptoms. An alternative explanation for the findings of Saslow and Vietal may be that patients had an asymptomatic streptococcal infection before the respiratory infection reported by the patients, and that many of the respiratory infections reported were not caused by streptococcus. Regardless of the explanation, the threshold for performing throat cultures (both rapid testing and conventional cultures) should be low in endemic areas of rheumatic fever. Patients and families should be urged to undergo cultures with even mild throat symptoms or if a family member or close friend has streptococcal pharyngitis.
B
Philip J. Hashkes, MD, MSc Pediatric Rheumatology Unit Shaare Zedek Medical Center Jerusalem, Israel
References
http://dx.doi.org/10.1016/j.jpeds.2013.10.010
1. Catanzaro FJ, Stetson CA, Morris AJ, Chamovitz R, Rammelkamp CH Jr, Stolzer BL, et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med 1954;17:749-56. 2. American Heart Association, Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement. Circulation 2009;119:1541-51. 3. Markowitz M. Eradication of rheumatic fever: an unfulfilled hope. Circulation 1970;41:1077-84.
The Effects of Nasal Continuous Positive Airway Pressure on Cardiac Function in Premature Infants with Minimal Lung Disease: A Crossover Randomized Trial
729
