Healthcare-associated Infections in a Neonatal Intensive Care Unit in Turkey.

Objective: To determine the incidence, risk factors, mortality rate, antibiotic susceptibility and causative agents of healthcareassociated infections (HAIs) in the Neonatal Intensive Care Unit. Design: Prospective, cohort. Setting: A 38-bed, teaching, referral, neonatal intensive-care unit. Participants: All patients in the neonatal intensive care unit who did not have any sign of infection at admission and remained hospitalized for at least 48 hours. Methods: The study was conducted between January 2009 and January 2011. Healthcare-associated infection was diagnosed according to the criteria of CDC. Risk factors for HAI were analyzed with univariate and multivariate regression analysis. Results: The incidence of HAI was found to be 16.2%. Blood stream infection was observed as the most common form of HAI (73.2%). The mortality rate was 17.3%. Antenatal steroid use, cesarean section, male gender, low birth weight, parenteral R E S E A R C H P A P E R INDIAN PEDIATRICS 951 VOLUME 49__DECEMBER 16, 2012 nutrition, percutaneous and umbilical catheter insertion, mechanical ventilation and low Apgar scores were found to be related with HAI (P<0.05). A 10% reduction in infection rate as a consequence of the application of a new total parenteral nutrition guideline was observed. Coagulase negative staphylococci (44. 4%) and Klebsiella pneumoniae (25.9%) were the most common etiologic agents isolated from cultures. Methicillin resistance of coagulase-negative staphylococci and ESBL resistance of Klebsiella pneumoniae were 72% and 44%, respectively. Conclusions: Antenatal steroid was found to be associated with HAI. Newly applied total parenteral nutrition guidelines reduced the attack rate of infection. Efforts should be focused on developing more effective prevention strategies to achieve better outcomes.

Abdominal mass in a neonate: hepatoblastoma.

A term neonate born to a 37 year old mother was admitted to our Neonatology Unit because of jaundice and abdominal distention. Gastrointestinal examination revealed abdominal distention and a palpable abdominal mass in right upper quadrant. After the initial radiological studies, it was clear that the mass originated from liver. At postnatal 15th day alfa-feto protein was found to be 60.500 ng/ml (normal level (2 week-1 month):9.452+/-12.610 ng/ml). While due to relatively high frequency in infancy and the type of contrast material enhancement in imaging studies suggested an infantile hemangioendothelioma (IHE), heterogenous nature of the lesion and high AFP levels were consistent with a hepatoblastoma (HB). Since accurate diagnosis could not be achieved by radiological studies a liver biopsy is performed. After the pathological examination of the tru-cut liver biopsy specimen, histomorphological and immunohistochemical findings were consistent with the epithelial component of an embryonal type hepatoblastoma.

Subacute sclerosing panencephalitis presenting as acute disseminated encephalomyelitis.

Subacute sclerosing panencephalitis (SSPE) is a chronic encephalitis of childhood and young adolescence due to persistent measles virus infection of the central nervous system. In majority of cases onset occurs from 5-15 years of age. In a nonimmunized population the average onset is 8 years. Children with SSPE had experienced natural infection with the rubeola virus at an early age, half before age 2 years. SSPE generally occurs 5-10 years after measles infection. In the early stages of the disease behavioral and personality changes is followed by myoclonic jerks and convulsions. In late stages dementia, stupor and coma develops. Diagnosis is achieved by typical clinical findings, measles antibody titer increase in cerebrospinal fluid (CSF) and serum, high amplitude, slow, sharp waves in EEG. Prognosis is poor and death ensues in about 3 yr after the diagnosis. Here it is presented a 7-years-old boy with involuntary movements in both hands, drop attacks while walking, ataxia and stupor. Due to suggestive radiological and clinical findings and a history of recent mumps infection he was thought to have acute disseminated encephalomyelitis initially and given treatment. But due to clinical deterioration and detection of anti measles IgG in serum and CSF, SSPE diagnosis was confirmed. With this SSPE case presenting initially as ADEM, the authors tried to emphasize that presentation of SSPE may clinically and radiologically be diverse and a thorough differential diagnosis is mandatory for a definite diagnosis.