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.

Plasma ascorbate and ceruloplasmin levels in Thai premature infants.

BACKGROUND: Free radicals have been implicated in the pathogenesis of some complications among premature infants. Even though ascorbate is an important anti-oxidant in human plasma, it can also act as a pro-oxidant at high concentrations in the presence of metal ions, which causes oxidative damage in premature infants. OBJECTIVE: To determine plasma ascorbate and ceruloplasmin levels in premature infants (and their mothers) and full-term infants and to compare between groups. MATERIAL AND METHOD: Premature (n = 27) and full-term infants (n = 24) and the mothers of the premature infants (n = 13) admitted to Srinagarind Hospital, Khon Kaen University, Thailand, were enrolled in the study. Plasma ascorbate and ceruloplasmin levels were determined and compared among various clinical presentations. RESULTS: Plasma ascorbate has negative correlation with gestational age of infants. Its level on day 1 of the premature infants was significantly higher than full-term group (52.62 vs 39.00 micromol/L) and then decline after birth. Premature infants receiving oxygen therapy had lower plasma ascorbate than premature infants without oxygen therapy (p = 0.017). Plasma ascorbate in premature infants who died was higher than in those that survived (p = 0.029). Premature infants with poor outcomes had a higher ratio of plasma ascorbate to ceruloplasmin than those with good outcomes (p < 0.05). CONCLUSION: This study shows that high plasma ascorbate and low ceruloplasmin levels are associated with poor outcomes of premature infants; that is, ascorbate can act as either an anti-oxidant or a pro-oxidant.

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.

Newborn screening for congenital hypothyroidism in Khon Kaen University Hospital, the first three years, a preliminary report.

Between January 2000 and December 2002, 9,558 of 10,868 live births at Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand, were screened for congenital hypothyroidism (CH). Dried blood spot thyroid stimulating hormone (TSH) was collected at age 48 hours or older. The cut-off TSH level for recall test was > 25 mu/L. Serum thyroxine (T4), Free T4 and TSH were performed during the confirmatory test. Six of 24 infants recalled for confirmatory thyroid function tests had abnormal tests. Primary CH was confirmed in 3 infants and thyroxine treatment was given. Two of the three infants had thyroid dysgenesis, one had normal thyroid gland. Three infants showed borderline CH from the confirmatory test, only one had borderline CH from the second confirmatory test and also received thyroxine treatment. Twenty infants with false positives during the screening and confirmatory tests were regularly followed-up for growth, development and thyroid function tests. The incidence of primary CH in this sole tertiary care government hospital in Northeast Thailand was 1:3,186. Routine newborn CH screening would ensure early detection and treatment.