789 Contrasts in Cake of Childhood Asthma. By Physicians and Mothers

Abstract

Hospital, Cept pediatrics, Johannesburg, South Af'rica.-W e examined t h e relationship between AS and biochemical asph using 2 observers (obs ). Obs 1 was aware of antepartun history, obs 2 exposed t o t h e i n f a n t a t t h e time of delivery. Obs changed r o l e s a f t e r every 10th delivery. Independent AS'S were assigned a t 1 and 5 mins. W i n g t h e i r 5 minute period of observation, obs predicted outcome a s : normal; grade Ia asph (2 of pH q , 2 0 , bicarb <16mol/l, base d e f i c i t >10 ); grade I b ( I a + >5 mins t o spontaneous r e s p i r a t i o n ) ; grade I1 ( I b + c l i n i c a l s i g n s ;seizures, lethargy, e t c ). Cord blood gas (CBG) was taken a t delivery and l a t e r compared with AS and predicted outcome. Thirty f i v e term d e l i v e r i e s were studied. Using t h e above c r i t e r i a , 10 were Ia asph on subsequent CBG analysis; 3 were Ib; 22 were normal. The correlation c o e f f i c i e n t f o r interobserver AS was 1-2.97 a t 1 and 5 mins, and obs agreed on predicted outcome i n 97% of cases. However, obs correctly predicted only 25% of asph and 62% of normals. The obs A S correlated with delivery room s t a f f assessment of need f o r positive pressure resuscitation (PPR). All obs AS'S of 6 a t 1 min had PPR vs only 2 of 26 with AS a, however CBG r e s u l t s suggest t h a t PPR was f o r primary apnea i n 55%. W e conclude : 1 ) the previously demonstrated poor correlation between AS and biochemical asph is not improved by an awareness of antenatal events; 2 ) neither AS nor apparent need f o r PPR a r e r e l i a b l e indicators of asph; 3 ) strict defini t i o n is required i n s t u d i e s reporting long term outcome of In most published studies an etiology has been defined i n less than half of cases of vulvovaginitis i n prepubertal g i r l s . NSV,a synergistic infection involving Gardnerella vaginalis and anaerobic bacteria, i s a common cause of vaginitis in adults, but has not been described i n children. W e studied 17 g i r l s , age 2-11 y n . wash specimen was a r e a e d . diagnosed if t k wash contained "clue c e l l s " and gave off a fishy odor when 10% KOH was added.W e were able t o makea microbial diagnosis in 11/17 (65%) pts: Hence, we studied differences between pediatricians' perceptions and parents' r e p o r t s of hane -g-t of childhood a s h . 46 pediatricians f r m ttm wban teaching h o s p i t a l s were asked to estimate the proportion of parents who employed s p e c i f i c m g -t techniques. Appropriateness of mnagement was tested in a rand m sample of families seeking care f o r a c h i l d with acute asthma (n=148) in an urban emergency room. Pediatricians tended t o overestimate the s p e c i f i c medical knowledge possessed by families: pediatricians estimated that 30% of parents could count respiratory rate, wllereas only 11% of families possessed t h i s knowledge (pC.001); m t r i c i a n s estimated t h a t 48% of p a t i e n t s attended an a l l e r g y c l i n i c b u t only 19% a c t u a l l y d i d (p(-05).Hayeve...