[Characteristics of airway colonization in mechanically ventilated newborn infants]. / Le caratteristiche della colonizzazione delle vie aeree nel neonato ventilato meccanicamente.

This study was designed to define the pattern of airway colonization in mechanically ventilated neonates and to assess whether this is associated with clinical signs of infection and/or local or systemic inflammation. One hundred and fifty-seven bronchoalveolar lavages (BAL) were obtained from 40 intubated neonates for microbiologic and cytologic evaluation of the distal airway. Concomitantly with each BAL, clinical data and laboratory tests were recorded. Ninety-seven BAL were negative, whilst 56 (37%) yielded the growth of gram-positive bacteria (84%), gram-negative bacteria (6%), fungi (5%), or P. carinii (5%). Airway colonization occurred in 9 (22%) neonates within the first 72 hours of life and in 31 (78%) during the following days. S. aureus was the most commonly isolated organism (70%). Clinical signs of pulmonary infection were present in all cases of vertical colonization and in 35 (66%) of nosocomial transmission. Blood and BAL white cell counts were higher coincidentally with airway colonization (p = 0.13 and p = 0.57, respectively). Antibiotic treatment was changed on the basis of BAL culture results. Follow-up cultures of the BAL were obtained in 13 neonates in whom antibiotics were changed. Negative cultures were found in 8 of these neonates, and 50% of these cases showed clinical improvement. Further work is needed to assess the cost-benefit ratio of prophylactic antibiotic administration in intubated neonates and the possible advantage(s) of treating microorganisms colonizing the airway of these subjects.

[Purpura fulminans in the newborn. Report of two cases successfully treated with heparin and antithrombin III]. / La purpura fulminans nel neonato. Descrizione di due casi trattati efficacemente con eparina ed antitrombina III.

Purpura fulminans is a rare form of disseminated intravascular coagulation characterized by rapidly progressive purpuric lesions, hypotension and, in some cases, fever. In neonates, purpura fulminans usually develops following deficiency of anticoagulant protein C or S, although acquired forms have been described. The management of disseminated intravascular coagulation is still controversial, with some studies finding a positive effect of anticoagulants and others showing no effect or even a detrimental one. Therefore, at present, management is limited to the treatment of underlying disease and replacement of clotting factors. Personal experience is reported on the efficacy of heparin in combination with antithrombin III in the treatment of purpura fulminans in two preterm neonates who did not have inherited deficiency of protein C or S and developed the disease possibly following prolonged labor (36 hours) in the first case, and maternal neoplasia, in the second. Both neonates presented with widespread cyanotic areas rapidly evolving in purpuric lesions and hemorrhagic bullae. Laboratory tests (prolonged prothrombin and partial thromboplastin time, fibrinogen and antithrombin III concentrations below normal ranges, d-dimer highly positive) were consistent with disseminated intravascular coagulation. In both cases anticoagulant treatment with heparin (50 UI/kg in bolus followed by 15 UI/kg/h) and antithrombin III was associated with resolution of disseminated intravascular coagulation and prompt amelioration of the purpuric lesions, without apparent side effects.