Screening pregnant women for group B streptococcus infection between 30 and 32 weeks of pregnancy in a population at high risk for premature birth.

OBJECTIVE: To assess the benefits of a chemoprophylaxis program based on screening women for group B streptococcus (GBS) infection between 30 and 32 weeks of pregnancy in a population with a high rate of premature births. METHODS: From 1995 to 2011, 24 950 women were screened for GBS infection between 30 and 32 weeks of pregnancy at Markusovszky Teaching Hospital, Szombathely, Hungary. Those who tested positive, and those who tested negative but were at risk of infecting their newborns, underwent intrapartum prophylaxis. Neonatal outcomes were compared with those of a historical cohort that underwent no screening or treatment, and with those published in CDC/ACOG guidelines recommending screening closer to term. RESULTS: There were 63 infected newborns (0.2%) in the study cohort, and 1 of 8 with sepsis died. There were 149 infected newborns (0.7%) in the historical cohort, and 29 of 31 with sepsis died. CONCLUSION: Screening women early in a population with a high rate of premature births may simplify preterm labor management. It results, however, in a higher incidence of early onset neonatal GBS disease than when screening is done closer to term.

[Screening and treatment for retinopathy of prematurity at the Markusovszky County Hospital, (experience of 20 years: 1989-2009]. / Koraszülöttek retinopathiaszûrése és annak eredményei a Vas Megyei Markusovszky Kórházban (20 év tapasztalatai: 1989 és 2009 között végzett vizsgálatok alapján).

The aims of this study was to obtain the frequency and therapy of retinopathy of prematurity (ROP) in Markusovszky Teaching Hospital, Szombathely, Hungary. A population based study on ophthalmological status of preterm infants was performed, between 01.01.1989 and 01.01.2009. During the study period, ophthalmological status was detected in 543 premature infants. Among them, 34 children (6.3%) suffered from retinopathy of prematurity, and all of them were bilateral. ROP occurred in the highest rate (23/78 cases, 29.5%) at the birth weight of lower than 1000 grams, but frequency was only l.2% (2/169 cases) between weight 1250-1500 grams. Spontaneous recovery was observed in 19 eyes of 10 cases. The frequency of spontaneous resolution was 40% and 50% in the group of larger birth weight: between 1251-1500 grams and weight > or = 1500 grams, but on the other hand, complete recovery was only 26% (6/23 cases) below 1000 grams of birth weight. "Threshold retinopathy" (stage 3 plus), that needed therapy was detected in 25 children's 49 eyes. Cryotherapy was performed in both eyes of 16 children (32 eyes), laser photocoagulation was performed in 9 patients (16 eyes). ROP regressed after cryotherapy in 26 eyes, but in 6 eyes symptoms progressed to stage 5. After laser photocoagulation, recovery was observed in 16 eyes; this therapy was not successful in only one case. According to our experiences, stage 5 ROP developed only in two patients' both eyes, and in 1-1 eye of three children, during the 20 years of study. Our ophthalmological screening program proved that providing cryopexia or laser photocoagulation in time, severe visual impairment of retinopathy can be prevented. In spite of the few number of patients, this population based investigation with a long duration (20 years) offers new data in Hungarian ROP epidemiology.

[Manifestations of systemic mycoses and related infections in the central nervous system]. / Szisztémás mycosisok és hasonló infekciók központi idegrendszeri manifesztációi.

UNLABELLED: In daily practice mycotic infections of the CNS have become more and more frequent. The main causes are the wide-ranging use of corticosteroids, immunosuppressive, cytostatic drugs and antibiotics, the spreading of AIDS, the increasing number of surviving immature newborns. To illustrate the diagnostic difficulties, the authors report several cases. CASE REPORTS: 1. Multifocal hemorrhagic infarcts of the brain, caused by generalized aspergillosis in mantle cell malignant lymphoma. 2. Cerebral microabscesses, caused by systemic candidiasis in a premature infant. 3. Fatal actinomycosis, mimicking a space occupying tumour in the thigh and with an abscess in the brain, radiologically indicated as a metastasis. The cause of death was actinomycotic pneumonia. 4. A successfully treated and recovered patient with recurrent pneumonia and multiplex brain abscesses, caused by filamentous microorganism of a Nocardia species revealed by histological examination of the neurosurgical specimen. DISCUSSION AND CONCLUSIONS: We have to be aware for the development of the mycotic and related infections of endangered patients. Aspergillosis and candidiasis play the most significant role in the involvement of the central nervous system. Actinomycosis and nocardiosis are more sensitive to treatment, so their diagnosis is of life-saving importance. The therapeutic chances of high risk patients with aspergillosis and candidiasis will be definitively better, if the infection is recognized and appropriately treated before the involvement of the CNS.

[Severe visual impairment and blindness in children in the past 15 years in county Vas--in the context of Vision 2020]. / Gyermekkori gyengénlátás és vakság az elmúlt 15 évben Vas megyében-- a Vision 2020 program tükrében.

AIM: To investigate the causes of severe visual impairment and blindness in children. METHODS: A retrospective view of data of children under 16 years over a 15 years period, from 1990 to 2004 was performed. RESULTS: 49 visually impaired children were found. The aetiological factors were: congenital anomalies (coloboma iridis, aniridia, coloboma papillae, hypoplasia papillae, albinism, corneal opacities) 7, congenital cataract 4, retinal degenerations (macular degeneration, Stargardt, retinal degeneration, achromatopsia, retinal ablation) 8, retinopathy of prematurity 5, other eye disorders (uveitis chr., glaucoma, retinoblastoma, nystagmus + hypermetropia, myopia) 8, neurological/cerebral diseases (hydrocephalus, tumor, M. Recklinghausen, xanthogranuloma juvenile, meningoencephalitis, unknown) 13 cases. The visual impairment was diagnosed under one year in more than half of the children. CONCLUSIONS: In the context of Vision 2020 the priorities for action to reduce childhood blindness in our county are: developing neonatal care can reduce ROP and cerebral visual pathway impairment. Prevention of intrauterine infections is an other possibility for the reduction of blindness in children.

[Histologic chorioamnionitis is associated with cerebral palsy]. / Az intrauterin fertozés és a szülés körüli agysérülé sek közötti összefüggés.

OBJECTIVE: The objective of this study was to determine the interaction between histologic chorioamnionitis and unexplained neonatal cerebral palsy among low-birth-weight infants. METHODS: 105 preterm infants delivered under 1500 g between 2000-2004 were studied. The clinical data, the neonatal neuroimaging, the laboratory results finds and the histopathologic features of fetal parts (placenta, umbilical cord and membranes) were evaluated. RESULTS: During the study period cerebral palsy were detected in 7.6% (8/105) of the newborns. The frequency of silent histologic chorioamnionitis was 39.7% (31 cases). The rate of caesarean section was 80.9% (72/89 deliveries), and elective operation was made in 51 cases (70.1%). In a logistic regression analysis controlling for confounding factors, compared with data on uninfected infants, histologic chorioamnionitis was significantly associated with risk of unexplained cerebral palsy (p = 0.006). There was also significant interaction between the maternal genital infections and chorioamnionitis (p = 0.024), and the maternal infections and positive smear of neonatal gastric aspirates (p = 0.033). There was no significant association between of intrapartum distress, the maternal genital infections, the prematurity and the maternal complications (hypertension, preeclampsia, diabetes mellitus, IUGR). Neither mechanic nor hypoxic ischaemic encephalopathy were demonstrated. CONCLUSION: Intrauterine exposure to maternal infection was associated with a marked increase in risk for cerebral palsy in infants of birth weight less than 1500 g.