Hydrops fetalis caused by parvovirus B19 infection: case report and literature review.

An intrauterine parvovirus B19 infection can result in severe fetal anemia and hydrops fetalis, which can lead to death. A case of fetal hydrops, diagnosed at 31 weeks gestation, is reported Cordocentesis revealed fetal hemoglobin of 5 g/dL. Due to fetal distress 18 hours later, the baby was delivered by emergency cesarean section and died two days later. Characteristic intra-nuclear inclusions in nucleated red blood cells were found in histopathological examinations of the liver and placenta, which supported the diagnosis of parvovirus B19 infection. Literatures about parvovirus B19 infection, especially intrauterine infection, its effects on the fetus, methods of diagnosis and management, were reviewed.

Once-daily gentamicin dosing of 4 Mg/Kg/dose in neonates.

Since gentamicin is one of the most commonly prescribed antibiotics for culture-proven or suspected sepsis in neonates, interest has increased in refining dosing regimens for improved efficacy and decreased toxicity. Usually, 2.5 mg gentamicin/kg is infused twice daily, but its large volume of distribution, slow renal clearance and concentration-dependent character, suggests longer dosing intervals would be more appropriate. From a previous study, 22% of neonates who received a once-daily gentamicin dosage of 5 mg/kg/day had unacceptably high trough levels (i.e. > 2 microg/mL). The authors studied 105 neonates (of > or = 34 wk gestational age or > or = 2, 000 g body weight) admitted to the Neonatal Unit, Srinagarind Hospital, Khon Kaen University; at risk, or with clinical features of sepsis, receiving a once-daily gentamicin dosing of 4 mg/kg intravenously. Peak (i.e. efficacy) and trough (i.e. toxicity) serum gentamicin concentrations were collected on day 3 of therapy. On days 1 and 3, nephrotoxicity was evaluated from serum creatinine and ototoxicity by a hearing test. Neonates treated with 4 mg gentamicin/kg once-daily had a mean steady-state peak vs trough concentration of 7.33 (+/- 2.77) vs 0.99 (+/- 0.57) microg/mL, respectively. The peak serum concentration achieved a therapeutic level > 4 microg/mL in 102 neonates (97%), while 7 (6.67%) had an undesirable trough level (viz. > 2 microg/mL); notwithstanding, no nephrotoxic or ototoxic effects were identified. Gentamicin once-daily at 4 mg/kg/dose in neonates at > or = 34 wk gestation achieved appropriate trough levels. the regimen was convenient and did not increase renal or ototoxicity.

Once versus twice daily dose of gentamicin therapy in Thai neonates.

OBJECTIVE: To compare the peak and trough gentamicin concentrations in neonates after a once (ODD) vs. twice daily dosing (TDD) to establish the appropriate dosage for Thai neonates. MATERIAL AND METHOD: Neonates of gestational age > or = 34 weeks, or body weight > or = 2000 g, suspected of having bacterial infection were randomized to receive gentamicin intravenously, either 5 mg/kg every 24 hours or 2.5 mg/kg every 12 hours. The peak and trough serum gentamicin levels (SGLs) were measured. Serum creatinine cued nephrotoxicity. RESULTS: Neonates were evaluated and baseline characteristics between the groups were compared. The ODD and TDD group had a mean gentamicin peak and trough concentration of 10.1 +/- 3.0 vs. 7.8 +/- 2.0 microg/ml (p < 0.05) and 1.6 +/- 1.1 vs. 2.6 +/- 1.2 microg/ml (p < 0.05), respectively. The peak SGL of > or = 4 microg/ml was achieved in 100% vs. 96% of the ODD vs. TDD group, respectively. SGL troughs > or = 2 microg/ml were detected less often in the ODD group (22% vs. 68%, p < 0.05). Abnormal change in serum creatinine was not observed in either group. CONCLUSION: A once daily dose of gentamicin 5 mg/kg achieved a significantly higher peak SGL and safer trough than a twice-daily dose of 2.5 mg/kg albeit about a quarter of the ODD group had high troughs. A single daily dose of gentamicin 3.5-4 mg/kg/d in Thai neonates should be tested.

Tracheal agenesis: a case report.

Tracheal agenesis is a rare congenital anomaly and typically has fatal consequences. Associated congenital malformations are present in 90 per cent of cases, most frequently affecting the cardiovascular or gastrointestinal systems and the genitourinary tract. Affected infants lack prenatal symptoms and usually present with severe respiratory distress, absence of audible crying and difficult or impossible endotracheal intubation, leading to failed airway management and irreversible cerebral hypoxia. The authors report an infant with tracheal agenesis who presented with respiratory failure after birth. The clinical features, embryology and classification schemes are presented in the hope of increasing awareness, thus making earlier diagnosis possible and thereby improving survival.