Initial Bath Research Articles

NURSERY ROUTINES AND STAPHYLOCOCCAL COLONIZATION OF THE NEWBORN

Staphylococcal colonization was studied in a newborn nursery for 6½ years. Culture of the nares of each infant at the time of discharge was found to be a simple, effective monitor. The average rate of 4.1% demonstrates that a low rate can he maintained for an extended period of time. Hexachlorophene bathing of infants and handwashing by personnel between the handling of infants appear to be the critical elements of staphylococcal control. Neither the modification of infant bathing to the extent of deferring the initial bath until the attainment of thermal homeostasis, nor of handwashing to the extent of eliminating brushes resulted in increased colonization. It was also possible to eliminate certain traditional elements of nursery routine-the wearing of caps, masks, hair nets, and gowning except when handling an infant outside an incubator-and to allow medical students and parents fret access to the nurseries, all without an increase in colonization. Elaborate nursery precautions are not only expensive but may also discourage physicians from giving optimal care to ill infants; judicious changes in nursery technique may be made, as long as there is careful surveillance of bacterial colonization and infection.

NURSERY ROUTINES AND STAPHYLOCOCCAL COLONIZATION OF THE NEWBORN

Staphylococcal colonization was studied in a newborn nursery for 6½ years. Culture of the nares of each infant at the time of discharge was found to be a simple, effective monitor. The average rate of 4.1% demonstrates that a low rate can he maintained for an extended period of time. Hexachlorophene bathing of infants and handwashing by personnel between the handling of infants appear to be the critical elements of staphylococcal control. Neither the modification of infant bathing to the extent of deferring the initial bath until the attainment of thermal homeostasis, nor of handwashing to the extent of eliminating brushes resulted in increased colonization. It was also possible to eliminate certain traditional elements of nursery routine-the wearing of caps, masks, hair nets, and gowning except when handling an infant outside an incubator-and to allow medical students and parents fret access to the nurseries, all without an increase in colonization. Elaborate nursery precautions are not only expensive but may also discourage physicians from giving optimal care to ill infants; judicious changes in nursery technique may be made, as long as there is careful surveillance of bacterial colonization and infection.

Studies on golden hamsters during cooling to and rewarming from body temperatures below 0 degrees C. I. Observations during chilling, freezing and supercooling.

Hamsters narcotized by chilling in closed vessels to colonic temperatures between + 20 and + 15°C were subsequently cooled by immersion in melting ice and finally in fluid at — 3 to —14° C. Breathing ceased at colonic temperatures between + 6 and +2°C , and heart beats were arrested between + 2.5 and + 0.8°C. During immersion in sub-zero baths some of the animals froze progressively while the colonic temperature stabilized at a plateau between — 0.6 and — 1.0°C. The intra-thoracic temperature reached the same level shortly after. The cerebral temperature dropped to a slightly lower level. The subcutaneous tissues were several degrees colder than the internal organs. Other hamsters became supercooled and the trunk and extremities remained flaccid while the colonic temperature continued to fall, in some instances to as low as — 5 or — 6°C. The temperature in other regions fell in parallel; the thorax was approximately 2°C warmer and the brain and subcutaneous tissues 2°C colder than the colon. Supercooling was terminated in some animals by spontaneous crystallization accompanied by an abrupt rise in the temperature of the colon and other parts to the levels characteristic of freezing within them. The tendency to supercool was greater among hamsters which had previously ingested propylene glycol than among those on a normal diet. It was also influenced by the body temperature of animals at the time of immersion in sub-zero baths and on the initial bath temperature. The results of resuscitating frozen and supercooled animals will be described in part II.

DYE ACCESSIBILITY OF RAYON AND SYNTHETIC FIBERS

Dye accessibility of fiber depends on the magnitudes of the following factors:1. The surface area through which the dye passes into the fiber.2. The speed by which the dye migrates in the fiber.3. The inner volume υ (cc. per lg dry fiber) in which the dye exists.4. The dissociation energy E of the dye-fiber-complex.As (1) and (2) can be calculable when E is known, the author starts the studies from obtainingE. When in the hot and very dilute direct dye solution the sizes of the dye particles are very small and homgeneous, there holds the next relation. (dissociation energy of a dye particle from the dyed fiber) (cal/ particle) Here k: Boltzmann's constant, T: absolute temperature, m0: number of dye particles in the initial dye bath, m: number of dye particles in the equilibrium reaching dye bath, υ: volume of the dye bath.The dyeing experiments are as follows.Materials to be dyed; viscose rayon, cuprammonium rayon, Vinylon (appolyvinylformal fiber), and polyvinylalcohol fiber. Temperature: 80°C Period: 3 hrs. Liquor ratio: 1/250. Dyes: Benzopurpurine 4BKX Chrysophenine NS Naphthamine Blue 12B (all purified). Dye concentration: 0.001%(Wt) (Benzopurpurine 0.003%) NaCl concentration: 0.001%(Wt) (Benzopurpurine 0.0003%) The results are:Under the same dyeing condition E of Vinylon is found to be greater than that of cellulose fiber. but smaller than that of polyvinylalcohol fiber.

Care of the skin of the newborn infant—prevention of infection

Summary During the last two and one-half years 1,734 newborn infants havebeen cared for without any initial cleaning or bathing and without further bathing or oiling of the skin during their stay in the hospital (ten to fourteen days). The decreased incidence of skin irritations and almost total lack of pyodermia have been truly gratifying.

PROPHYLAXIS OF IMPETIGO NEONATORUM

In 1928 Chadwell 1 reported three years of extraordinary success in the prevention of impetigo among the new-born in a large maternity service. The method hinged on a single inunction of each infant with 5 per cent ointment of ammoniated mercury following an initial soap and water bath. On the following days sterile cottonseed oil was applied to impregnate all follicles completely with the drug. While numerous other institutions have adopted the plan, we feel that the success of the method in our hands merits a report urging a more widespread adoption of this simple and inexpensive procedure. At the Elizabeth Steel Magee Hospital there are between two and three thousand births annually. Impetigo has been present intermittently and at times in epidemic form in the nurseries since the opening of the institution. From reports and observation of other large maternity services, we feel that the incidence of impetigo mentioned

FEVER IN THE NEW-BORN

The material for this paper has been secured from the hospital records of the new-born in three maternity nurseries, one covering a period of two years and the other two a period of one year each. The temperature of the babies was taken twice daily, at 9 a. m. and at 4 p. m., by rectum, the thermometer being inserted 1½ inches (3.81 cm.) for a two minute period. If fever developed, the temperature was taken every three hours until a normal temperature was reached and maintained. The rectal temperature of a new-born baby varies 3 or 4 degrees during the first four or five hours following birth, as shown in table 1. This is dependent, first, on the type of delivery, and second, on the length of time during which the infant is exposed. The initial bath of water at a temperature of 100 degrees nearly always causes a