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Tuberculosis (TB)

TB is an infectious disease caused by tubercle bacilli. Infection may occur anywhere in the body, but the lung is the most common site. After the airborne tubercle bacilli are inhaled, they generally multiply in the lungs, sometimes reaching the bloodstream via the lymphatic system and passing to other areas of the body. TB may develop either immediately (most often the case in infants and adolescents) or after a period of latency. Symptoms may include fever, cough, night sweats, weight loss, and breathing difficulty. The most common methods of diagnosis include a history of exposure to someone diagnosed with TB, the Mantoux (PPD) skin test, chest x-ray, and sputum smear/culture. However, diagnosis in newborns and young infants can be difficult.

There has been a recent resurgence of TB in the United States, especially among children under 5 years of age. Some possible reasons for this increase may include a shift in the incidence of TB from the elderly population to the 25- to 44-year-old (i.e., child-bearing) population, the lack of screening programs for high-risk children (e.g., children in poverty, new immigrant children), lack of funds for public health investigation of possible carriers, and the coexistence of TB with HIV infection in some areas of the Nation.

Although it generally involves at least a 9-month course of medication, early treatment has a high success rate. Nevertheless, the extent of the disease and the recent emergence of drug-resistant TB strains have made it essential to consult an infectious disease expert whenever TB infection is suspected.

Research suggests that there is no racial predisposition to TB. However, the incidence of TB is especially high among impoverished populations with a high rate of substance abuse.

TB can be transmitted from mother to infant through breast feeding. A mother who is receiving treatment for TB should not breast feed because the medications are not contained in breast milk in sufficient quantities to destroy the TB organisms that are passed on to the child.

It is important that high-risk groups, including new immigrants and individuals living in poverty, receive an annual PPD test. Thus, professionals need to acquaint themselves with the prevalence of TB within their particular service areas and contact their local public health departments for assistance in treatment and followup protocols, if necessary.

Fetal Alcohol Syndrome (FAS)

Alcohol consumption during pregnancy may result in a pattern of birth defects known as FAS. The diagnosis of FAS is based on three factors: prenatal and postnatal growth retardation, including low birth weight and microcephaly (abnormally small head); CNS abnormalities, including intellectual impairment, developmental delays, behavior dysfunction, and neurological abnormalities; and abnormalities of the face. Children with a confirmed history of prenatal alcohol exposure, who display some of the symptoms associated with FAS but who do not meet all of the diagnostic criteria, are diagnosed with Fetal Alcohol Effect (FAE). As the child matures, problems with learning, attention, memory, and problem solving are common, along with incoordination, impulsiveness, and hyperactivity.

Facial characteristics associated with FAS include small eyes, short eye openings, epicanthic folds, flat upturned nose, indistinct philtrum (groove in the midline of the upper lip), thin upper lip, crossed eyes, droopy eyelids, and malformation of the external ear.

Careful monitoring of growth as well as screening for any additional physical problems that may accompany either FAS or FAE is required for all affected children so that appropriate services can be provided.

Involvement in an early intervention program designed for children with special needs is also recommended for children who exhibit developmental delays.

Sudden Infant Death Syndrome (SIDS)

Children who have been prenatally exposed to drugs may have an increased risk of dying from SIDS. SIDS, sometimes called "crib death," is defined as the sudden death of an infant under 1 year of age that remains unexplained after autopsy, investigation of the death scene, and review of the case history. In the United States, SIDS is the leading cause of death in infants between 1 and 12 months of age. SIDS may have multiple causes, and it is almost impossible to predict when it will occur. Children who die from SIDS commonly exhibit no other sign of illness immediately prior to their death.

Home apnea/cardiac monitoring is recommended for preterm infants who experience recurrent apnea and for full-term infants who present with severe acute life-threatening episodes (ALTEs), sometimes referred to as "near-miss SIDS."

The decision to institute home monitoring should be based on medical assessment and reached in collaboration with the caregiver. There is no guarantee that SIDS can be prevented, and it can occur in spite of appropriate monitor use.

Caregivers of children who require apnea monitors must be able to perform cardiopulmonary resuscitation (CPR).

Tags: Addictions, Tuberculosis

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