Periventricular leukomalacia in a preterm neonate with early onset Capnocytophaga sepsis

Capnocytophaga sputigena is a slow-growing, capnophilic, gram negative, anaerobic, fusiform bacilli residing in oropharyngeal cavity of mammals. In humans, it causes localized periodontal infections and sporadic invasive infections in immunocompromised persons. Infrequently, it does cause chorioamnionitis and perinatal infections and is generally of lower morbidity risk in fetus and neonates. We describe a rare case report of early-onset neonatal Capnocytophaga sepsis with culture negative meningitis in preterm infant who developed early cystic periventricular leukomalacia in second week of life. Though neonatal Capnocytophaga infection is probably under-reported due to its fastidious nature and subclinical infection in mother, this case reminds that Capnocytophaga may be responsible for some occult cases of early neonatal septicemia, and that the organism may be more virulent in premature neonates with possibility of development of periventricular leukomalacia and neurological morbidities.

Hyperinsulinemic Hypoglycemia in Infancy: Current Concepts in Diagnosis and Management.

Purpose: Molecular basis of various forms of hyperinsulinemic hypoglycemia, involving defects in key genes regulating insulin secretion, are being increasingly reported. However, the management of medically unresponsive hyperinsulinism still remains a challenge as current facilities for genetic diagnosis and appropriate imaging are limited only to very few centers in the world. We aim to provide an overview of spectrum of clinical presentation, diagnosis and management of hyperinsulinism. Methods: We searched the Cochrane library, MEDLINE and EMBASE databases, and reference lists of identified studies. Conclusions: Analysis of blood samples, collected at the time of hypoglycemic episodes, for intermediary metabolites and hormones is critical for diagnosis and treatment. Increased awareness among clinicians about infants “at-risk” of hypoglycemia, and recent advances in genetic diagnosis have made remarkable contribution to the diagnosis and management of hyperinsulinism. Newer drugs like lanreotide (long acting somatostatin analogue) and sirolimus (mammalian target of rapamycin (mTOR) inhibitor) appears promising as patients with diffuse disease can be treated successfully without subtotal pancreatectomy, minimizing the long-term sequelae of diabetes and pancreatic insufficiency. Newer insights in understanding the molecular and histological basis and improvements in imaging and surgical techniques will modify the approach to patients with congenital hyperinsulinism.

Radial Artery Pseudoaneurysm in a Neonate with Hemophilia A.

Background: Pseudoaneurysm formation is a rare complication of arterial puncture. Case characteristics: 3-week-old male developed an enlarging mass over the anterior aspect of left wrist following radial arterial puncture. Observation: Doppler ultrasonography revealed mass to be left radial arterial pseudoaneurysm. Subsequent presentation of ecchymoses and investigations confirmed factor VIII deficiency (Hemophilia A). Outcome: Pseudoaneurysm removed with primary end to end anastomosis. Patient is presently on regular factor VIII replacement therapy. Message: Hemophilia A can present as pseudoaneurysm in neonatal period.