Neutropenia associated with cloxacillin and other semisynthetic penicillins in children

Five children treated with high dose of semisynthetic penicillin for three to four weeks developed neutropenia [< 1.5 x 10[9]/L]. All patients were on cloxaxillin. In addition, three patients received ampicillin, and one received piperacillin therapy for the same duration. All patients developed neutropenia 15 to 23 days following therapy and resolved 8 to 95 days after discontinuation of the penicillin. One patient developed serious perianal necrotizing fascitis as a complication of neutropenia. The red blood cell count and platelets were normal in all patients. Bone marrow aspiration performed on two patients revealed a maturation arrest of the granulocyte precursor. A complete cell count and differential should be monitored during high dose penicillin therapy

Balloon dilation of a restrictive interatrial communication in a two-month-old infant with mitral atresia

The Rashkind technique is the standard procedure for enlarging an interatrial communication in infants with complex cyanotic congenital heart disease. However, there are major limitations to the procedure in patients with a thick interatrial septum. For these patients, blade atrial septostomy is an alternative procedure. We describe a case of a sick, 50-day-old infant with mitral atresia who required an urgent atrial septostomy. The small size left atrial cavity precluded the use of blade septostomy. We dilated the atrial septum with a standard angioplasty balloon catheter. Balloon dilation was performed with a 10-mm diameter balloon catheter inflated at maximal diameter for a 10-second period. After dilation, there was an increase of the arterial saturation from 10% to 80% as well as an increase of the left-to-right flow as judged by color Doppler. At two-months follow-up, the patient was clinically well and Doppler echocardiographic studies demonstrated the persistence of the iatrogenic atrial septal defect