TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) screening of small for gestational age and intrauterine growth restricted neonates: efficacy study in a single institute in Korea / 소아과

PURPOSE: Routine screening for toxoplasmosis, rubella, cytomegalovirus (CMV), and herpes simplex virus (TORCH) in intrauterine growth restriction (IUGR) and small for gestational age (SGA) neonates has become a common practice. However, the incidence of TORCH varies across countries, and the cost of TORCH testing may be disadvantageous compared to disease-specific screening. To evaluate the efficacy of TORCH screening, the medical charts of IUGR or SGA neonates born in a single institution in Bucheon, Korea from 2011 to 2015 were reviewed. METHODS: The clinical data of the 126 IUGR or SGA neonates were gathered, including gestational age, Apgar scores, neonatal sonographic findings, chromosome study, morbidities, developmental follow-up, and growth catch-up. Maternal factors including underlying maternal disease and fetal sonography were collected, and placental findings were recorded when available. TORCH screening was done using serum IgM, CMV urine culture, quantification of CMV DNA with real-time polymerase chain reaction, and rapid plasma reagin qualitative test for syphilis. Tests were repeated only for those with positive results. RESULTS: Of the 119 TORCH screenings, only one was positive for toxoplasmosis IgM. This result was deemed false positive due to negative IgM on repeated testing and the absence of clinical symptoms. CONCLUSION: Considering the incidence and risk of TORCH in Korea, the financial burden of TORCH screening, and the single positive TORCH finding in our study, we suggest disease-specific screening based on maternal history and the clinical symptoms of the neonate. Regarding CMV, which may present asymptomatically, universal screening may be appropriate upon cost-benefit analysis.

Case Report of Neonatal Proteus mirabilis Meningitis and Brain Abscess with Negative Initial Image Finding: Consideration of Serial Imaging Studies

Proteus mirabilis (P. mirabilis) meningitis in a neonate is rare, but its recognition is important because the disease progresses rapidly and has poor prognosis. A 4-day-old premature female infant born at 36 weeks and 5 days of gestation presented with symptoms of fever and icteric skin. Initial cerebrospinal fluid findings suggested bacterial meningitis, and treatment with antibiotics was started. On the third day, P. mirabilis growth was found in both blood and cerebrospinal fluid cultures and brain computed tomography revealed normal findings. The patient showed improved clinical symptoms, but brain magnetic resonance imaging on hospital day 18 revealed a brain abscess measuring 4.5×3.1×3.1 cm in the right frontal lobe. Cyst drainage was performed immediately and a catheter was inserted. Follow-up computed tomography revealed a tiny abscess remaining in the right frontal lobe, and follow-up magnetic resonance imaging later demonstrated marked interval regression in the size of the abscess. The patient was discharged on day 57 of hospitalization in good condition. Serial brain imaging should be considered in neonatal cases of P. mirabilis meningitis.