Subject(s)
Staphylococcal Scalded Skin Syndrome/diagnosis , Staphylococcal Scalded Skin Syndrome/drug therapy , Staphylococcus aureus/isolation & purification , Vancomycin/administration & dosage , Blood Chemical Analysis , Follow-Up Studies , Humans , Infant, Newborn , Infusions, Intravenous , Male , Radiography, Thoracic , Rare Diseases , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
BACKGROUND: Nearly 50 years ago, Wilson and Mikity described a syndrome (WMS) of chronic lung disease (CLD) in premature infants, characterized by early development of cystic interstitial emphysema (PIE), despite minimal ventilatory support. The validity of the diagnosis is currently unclear; now considered either an anachronism, part of BPD spectrum or included within various poorly defined diagnoses such as chronic pulmonary insufficiency of prematurity (CPIP). OBJECTIVES: To define clinically useful diagnostic criteria for WMS so its position in the spectrum of CLD of infancy can be established. METHODS: We studied nine patients who fulfilled WMS criteria, combining this data with a detailed review of the available literature. RESULTS: Despite minimal respiratory support at birth, all developed generalized or lobar cystic PIE by 3 weeks of age, followed by slow inflammatory progression over a further 2-3 months. Final outcome was variable but most were left with some degree of CLD. CONCLUSIONS: WMS is a rare but clearly identifiable syndrome with significant morbidity, predominantly affecting infants below 1,500 g birth weight. The earliest pathology appears to be alveolar air leak. Inflammatory activation induced by cystic interstitial air may cause the subsequent progressive respiratory disease. Management is supportive but should include investigation for pulmonary hypertension.
Subject(s)
Pulmonary Emphysema/diagnostic imaging , Pulmonary Emphysema/therapy , Chronic Disease , Female , Humans , Infant, Newborn , Infant, Premature , Male , Radiography , SyndromeABSTRACT
During an 18-month study period, teleconsultations were conducted by email between a neonatal intensive care unit at an urban teaching hospital in western India and a rural primary care centre 40 km away. There were email consultations about 182 newborn babies; these consultations comprised 309 messages sent from the primary care centre and 272 messages from the teaching hospital. The average reply time was 11.3 h. Thirty-eight babies were referred to the intensive care unit at the teaching hospital after these consultations. The remaining 144 babies were managed at the primary care centre. Telemedicine helped in the diagnosis, referral, treatment and follow-up of patients. The cost of the email service was estimated to be Rs12,000 and the savings in avoided transfer were estimated to be Rs546,000, a cost-benefit ratio of 1:45.
