782
Berseth
6. Malagelada.J-R, Camilleri M, Stanghellini V. Manometric diagnosis of gastrointestinal motility disorders. New York: Theime, 1986:57. 7. McLain CR. Amniography studies of the gastrointestinal motility in human fetus. Am J Obstet Gynecol 1963;86:1079-87. 8. Bueno L, Ruckebusch Y. Perinatal development of intestinal myoelectrie activity in dogs and sheep. Am J Physiol 1979; 237:E61-7. 9. Bisset WM, Watt JB, Rivers RPA, Milla PJ. The motor response of the small intestine to milk feeds in preterm infants [Abstract ]. Dig Dis Sci t987;32:903. 10. lttman PI, Berseth C L Antral motility response to duodenal feeding in preterrn and term infants [Abstract]. Pediatr Res 1989;25:116A.
The Journal of Pediatrics November 1990
l l. Bisset WM, Watt JB, Rivers RPA, Milla PJ. Ontogeny of fasting small intestinal motor activity in the human infant. Gut 1988;29:453-88. 12. Morriss FH, Moore M, Weisbrodt NW, West MS. Ontogenic development of gastrointestinal motility. IV. Duodenal contractions in preterm infants. Pediatrics 1986;78: I 106-13. 13. Dunn L, Hulman S, Weiner J, Kleigman R. Beneficial effects of early hypocaloric enteral feeding on neonatal gastrointestinal function: preliminary report of a randomized trial. J PEDIATR 1988;112:622-9. 14. Kerlin P, Zinsmeister A, Phillips S. Relationship of motility to flow of contents in the human small intestine. Gastroenterology 1982;82:701-6.
Clinical and laboratory observations Postexposure prophylaxis for measles in a neonatal intensive care unit E. K. Subbarao, MBBS,MPH,Lucy Andrews-Mann, RNC, NNP, Sandra Amin, RN, Jordon Greenberg, MD, and Mary L. Kumar, MD From the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
Since 1986 the number of cases of measles reported to the Centers for Disease Control has increased. 1 Several states (including California, Texas, Illinois, and Ohio) reported large outbreaks of measles in 1989. 2 Measles is transmitted via aerosol; virus excretion from the respiratory tract peaks before the development of rash. 3 Patients are considered to be contagious 1 or 2 days before the onset of symptoms to 4 days after the appearance of a rash.4 In June 1989 we were faced with a measles exposure in a neonatal intensive care unit when a maculopapular rash developed in a pediatric house officer. We report our experience during this exposure and make recommendations for rubeola screening of employees with direct patient contact. Presented at the 1990 Annual Meeting of the Society for Pediatric Research, Anaheim, Calif. Submitted for publication March 28, 1990; accepted June 4, 1990. Reprint requests: M. L. Kumar, MD, Room 311, Research Building, MetroHealth Medical Center, 3395 Scranton Rd., Cleveland, OH 44109.
9/22/22877
METHODS Description of exposure. A 30-year-old pediatric house officer who was the only physician working overnight in a 35-bed N I C U attended to problems in the N I C U and the stepdown unit, attended several deliveries, and went on rounds with the physicians and nurse practitioners in the morning. He did not feel well and did not return to work for the next 2 days. He had previously worked in the outpatient Clinic and had examined several patients with rashes,
CF ELISA HAI IFA NICU
Complement fixation Enzyme-linked immunosorbent assay Hemagglutination inhibition lmmunofluorescence assay Neonatal intensive care unit
including two with possible cases of measles. Approximately 60 hours after his initial complaints of malaise, an erythematous maculopapular rash developed on his face and trunk and spread to his extremities. He had no conjunetival injec-
Volume 117 Number 5
Clinical and laboratory observations
Table I. Reasons for failure to test serologic status (A) or to administer immune globulin prophylaxis (B) to staff members Reason
A (n = 12)
B (n = 29)
Had natural disease 2 10 Received vaccine after 1980 6 8 On vacation 2 2 Contacted >6 days after 2* 9* exposure *Twoof the ninesubjectswho werecontactedtoo late for immuneglobulin prophylaxisrefusedtesting.
tion and minimal coryza and cough. Movement of his left shoulder was painful. A nasopharyngeal swab, stained for measles antigen by immunofluorescence, was negative, and on the second day of his rash (fifth day of illness), blood was drawn for serologic studies; a convalescent specimen was obtained 2 weeks later. Because we were in the midst of a local outbreak of measles and could not rule out measles on clinical grounds, we proceeded under the assumption that the house officer had measles. The NICU is a large room with four cubicles that are partitioned with room dividers. All babies in the N I C U on the night of exposure were cared for in incubators. There were 23 babies in the unit, and one had died of unrelated causes by the time the exposure was reported. Each of the remaining 22 babies had blood drawn for determination of measles antibody titers, and immune globulin (Gamastan), 0.25 ml/kg, was administered intramuscularly. A second sample of blood was drawn 48 hours later; one infant was discharged before collection of the second specimen and did not return. The 21 infants from whom paired sera were obtained were included in this study. Additional exposed infants were identified as follows: the house officer had attended eight deliveries that night; all infants were requested to return for immune globulin therapy, and five returned. A discharge examination was performed by the house officer on two infants; both returned and received immune globulin. The parents of these infants were offered immune globulin if they were in the same room as tile house officer on the night of exposure; eight of these adults, all
Berseth
6. Malagelada.J-R, Camilleri M, Stanghellini V. Manometric diagnosis of gastrointestinal motility disorders. New York: Theime, 1986:57. 7. McLain CR. Amniography studies of the gastrointestinal motility in human fetus. Am J Obstet Gynecol 1963;86:1079-87. 8. Bueno L, Ruckebusch Y. Perinatal development of intestinal myoelectrie activity in dogs and sheep. Am J Physiol 1979; 237:E61-7. 9. Bisset WM, Watt JB, Rivers RPA, Milla PJ. The motor response of the small intestine to milk feeds in preterm infants [Abstract ]. Dig Dis Sci t987;32:903. 10. lttman PI, Berseth C L Antral motility response to duodenal feeding in preterrn and term infants [Abstract]. Pediatr Res 1989;25:116A.
The Journal of Pediatrics November 1990
l l. Bisset WM, Watt JB, Rivers RPA, Milla PJ. Ontogeny of fasting small intestinal motor activity in the human infant. Gut 1988;29:453-88. 12. Morriss FH, Moore M, Weisbrodt NW, West MS. Ontogenic development of gastrointestinal motility. IV. Duodenal contractions in preterm infants. Pediatrics 1986;78: I 106-13. 13. Dunn L, Hulman S, Weiner J, Kleigman R. Beneficial effects of early hypocaloric enteral feeding on neonatal gastrointestinal function: preliminary report of a randomized trial. J PEDIATR 1988;112:622-9. 14. Kerlin P, Zinsmeister A, Phillips S. Relationship of motility to flow of contents in the human small intestine. Gastroenterology 1982;82:701-6.
Clinical and laboratory observations Postexposure prophylaxis for measles in a neonatal intensive care unit E. K. Subbarao, MBBS,MPH,Lucy Andrews-Mann, RNC, NNP, Sandra Amin, RN, Jordon Greenberg, MD, and Mary L. Kumar, MD From the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
Since 1986 the number of cases of measles reported to the Centers for Disease Control has increased. 1 Several states (including California, Texas, Illinois, and Ohio) reported large outbreaks of measles in 1989. 2 Measles is transmitted via aerosol; virus excretion from the respiratory tract peaks before the development of rash. 3 Patients are considered to be contagious 1 or 2 days before the onset of symptoms to 4 days after the appearance of a rash.4 In June 1989 we were faced with a measles exposure in a neonatal intensive care unit when a maculopapular rash developed in a pediatric house officer. We report our experience during this exposure and make recommendations for rubeola screening of employees with direct patient contact. Presented at the 1990 Annual Meeting of the Society for Pediatric Research, Anaheim, Calif. Submitted for publication March 28, 1990; accepted June 4, 1990. Reprint requests: M. L. Kumar, MD, Room 311, Research Building, MetroHealth Medical Center, 3395 Scranton Rd., Cleveland, OH 44109.
9/22/22877
METHODS Description of exposure. A 30-year-old pediatric house officer who was the only physician working overnight in a 35-bed N I C U attended to problems in the N I C U and the stepdown unit, attended several deliveries, and went on rounds with the physicians and nurse practitioners in the morning. He did not feel well and did not return to work for the next 2 days. He had previously worked in the outpatient Clinic and had examined several patients with rashes,
CF ELISA HAI IFA NICU
Complement fixation Enzyme-linked immunosorbent assay Hemagglutination inhibition lmmunofluorescence assay Neonatal intensive care unit
including two with possible cases of measles. Approximately 60 hours after his initial complaints of malaise, an erythematous maculopapular rash developed on his face and trunk and spread to his extremities. He had no conjunetival injec-
Volume 117 Number 5
Clinical and laboratory observations
Table I. Reasons for failure to test serologic status (A) or to administer immune globulin prophylaxis (B) to staff members Reason
A (n = 12)
B (n = 29)
Had natural disease 2 10 Received vaccine after 1980 6 8 On vacation 2 2 Contacted >6 days after 2* 9* exposure *Twoof the ninesubjectswho werecontactedtoo late for immuneglobulin prophylaxisrefusedtesting.
tion and minimal coryza and cough. Movement of his left shoulder was painful. A nasopharyngeal swab, stained for measles antigen by immunofluorescence, was negative, and on the second day of his rash (fifth day of illness), blood was drawn for serologic studies; a convalescent specimen was obtained 2 weeks later. Because we were in the midst of a local outbreak of measles and could not rule out measles on clinical grounds, we proceeded under the assumption that the house officer had measles. The NICU is a large room with four cubicles that are partitioned with room dividers. All babies in the N I C U on the night of exposure were cared for in incubators. There were 23 babies in the unit, and one had died of unrelated causes by the time the exposure was reported. Each of the remaining 22 babies had blood drawn for determination of measles antibody titers, and immune globulin (Gamastan), 0.25 ml/kg, was administered intramuscularly. A second sample of blood was drawn 48 hours later; one infant was discharged before collection of the second specimen and did not return. The 21 infants from whom paired sera were obtained were included in this study. Additional exposed infants were identified as follows: the house officer had attended eight deliveries that night; all infants were requested to return for immune globulin therapy, and five returned. A discharge examination was performed by the house officer on two infants; both returned and received immune globulin. The parents of these infants were offered immune globulin if they were in the same room as tile house officer on the night of exposure; eight of these adults, all
