518 The Journal of Emergency Medicine

The authors reviewed the records of 201 in- fants aged 3 days to 6 months who were hospi- talized for near-miss sudden infant death syn- drome @IDS) to determine if initial laboratory evaluation aided in establishing the diagnosis or altered therapy. Laboratory tests included electrolytes, BUN, creatinine, magnesium, cal- cium, glucose, and complete blood count. Most episodes of near-miss SIDS occurred during sleep and involved cyanosis, pallor, and decreased tone and required mild to vigorous stimulation or resuscitation. From the 1,278 initial laboratory studies performed, 276 (22%) results were outside the normal limits for age. The most common abnormalities were hyperchloremia (58% of infants tested), hyper- magnesemia (43Oro), hypobicarbemia (33Vo), and hyperkalemia (27%). Only six (0.5%) ab- normal values in four patients aided in diagno- sis or treatment; most of these were from in- fants symptomatic at presentation. Discharge diagnoses were apnea of undetermined etiolo- gy in 15 1 patients (75%), gastroesophageal re- flux in 24 infants (12%), seizure disorder in 11 (5%), pneumonia in seven (4070), aseptic men- ingitis and bronchiolitis in two infants each (1 To), and ventricular septal defect, atria1 sep- tal defect, tracheoesophageal fistula, and per- tussis in one infant each (0.5%). The authors conclude that a routine battery of laboratory investigations is rarely useful in the initial man- agement of infants with presumed near-miss SIDS. They suggest that further investigation is warranted on the role of depressed serum bicarbonate level as presumptive evidence of near-miss SIDS. [Bill Ahrens, MD]

Editor’s Note: This study supports the diffi- culty of identifying near-miss SIDS infants and emphasizes the importance of both obtaining a detailed history of the near-miss event and of a conservative policy of admission for cardiores- piratory monitoring and assessment.

0 PERCUTANEOUS RESPIRATION IN THE NEWBORN INFANT. Evans NJ, Rutter N. JPediatrics 1986; 108:282-286.

Twenty-seven newborn infants weighing be- tween 0.96 and 4.43 kg with gestational ages ranging from 27 to 40 weeks were studied to measure gas exchange across the skin using a closed cell attached to the upper abdomen into which saturated air was introducted. The con- sumption and excretion of p0, or pC0, was cal-

culated from the rate of the rise and fall of the measured gas and the rate of gas exchange cal- culated. Rate of gas exchange was strongly re- lated to gestational age. Infants less than 31 weeks gestation had higher rates of percuta- neous gas exhange than gestationally older in- fants; rates of gas exhange in these preterm infants were up to six times greater than that of term infants but fell rapidly over the first 2 weeks of postnatal life. Gas exchange correlat- ed well with skin water loss, suggesting that the epidermal barrier limits both processes. The authors estimate that during the early neonatal period, 13% of total resting body oxygen re- quirements could be obtained through the skin of an infant less than 31 weeks of gestation placed in 40% oxygen. They postulate that un- der certain limited circumstances, percuta- neous oxygen delivery may be a useful adjunct to other standard methods now used to sup- port the very ill preterm infant.

[Pamela Downey, MD]

Editor’s Note: As the authors imply, this is an unproven technique potentially useful as an adjunct to therapy in a small subgroup of pa- tients. The complications, cost, and invasive- ness of the technique, however, are negligible.

0 PASTEURELLA MULTOCIDA MENIN- GITIS IN INFANCY. Clapp DW, Kleiman MB, Reynolds JK, Allen SD. Am J Dis Child 1986; 140:444-446.

This article describes the rare occurrence of meningitis due to Pasteurella multocida, a pleomorphic Gram’s negative coccobaccillus, in two previously healthy infants following expo- sure to the oral secretions of domestic animals. Both infants, one aged 5 weeks and one aged 5 months, recovered fully without sequalae. P multocida is a common upper airway commen- sal of animals, existing in 55% of healthy dogs and 70% to 90% of healthy cats. Infection in humans usually follows animal bites or scratches; however, infection has been infre- quently reported following nontraumatic con- tact with the mucous membranes of animals. Of the 28 previously reported cases of P multo- cida meningitis, 12 occurred in children, ten of whom were less than 1 year of age. In eight of these 12 children, nontraumatic animal contact had occurred. The symptoms of P multocida meningitis are those typical of many types of purulent meningitis, ie, irritability, vomiting,

Abstracts 519

poor feeding, lethargy, and fever and are not specific to the organism. Treatment consists of intravenous ampicillin or penicillin for 14 days. Because of the occasional resistance of this or- ganism to these two antibiotics, the authors recommend treatment with a combination of ampicillin and chloremphenicol, the regimen, used for empiric initial treatment of purulent meningitis in infants and children, until anti- microbial susceptability tests are available.

[Elizabeth Hatfield, MD]

0 EPIDEMIC MEASLES IN CHICAGO IN 1983. Bennish M, Arnow PM, Beem MO, Do- veikis S. Am JDis Child 1986; 140:341-344.

This article evaluated the clinical and epi- demicologic features of 54 patients seen at Wy- ler Children’s Hospital in Chicago during a 1983 measles epidemic who had confirmed serologic evidence of the disease. In addition, results of serologic testing for measles in 204

patients who had been examined for suspected bacteremia during the immediate preepidemic period were reviewed. The most striking fea- ture of the epidemic was the age distribution of patients; 41 (76%) were less than 5 years old and 23 (43%) were less than 16 months of age. The age-specific attack rate among household contacts of patients with measles was 38% for those under 5 years of age compared with 3% for contacts aged 5 to 25 years (P< .OOl). The rate of immunity in preschool-aged children immediately before the epidemic was low; none of the patients less than 15 months of age had detectable antibody, and only 62% of those aged 16 months to 4 years had antibody present. These observations suggest that non- immunized preschool-aged children are impor- tant in the current epidemiology of measles. Improved immunization strategies are needed to control measles in this population.

[Elizabeth Hatfield, MD]