Study of Nosocomial Infection of Rotavirus in Preterm and Full-term Neonates

PURPOSE: The present study was designed to investigate rotavirus infection by comparing clinical characteristics of the nosocomial infection of rotavirus between preterm and full-term neonates. METHODS: The subjects were admitted from May to December, 1996. In 71 preterms, 44 were Rotazyme positive, 27 were negative, and in 321 full-terms, 64 were Rotazyme positive, 257 were negative. We studied the rate of positive Rotazyme ELISA test and positive symptoms. We compared clinical manifestations and parameters between both groups. Stools were examined with occult blood, stool culture and Rotazyme ELISA tests. RESULTS: The rate of nosocomial rotavirus infection in neonates was 27.6% and increased as the neonates matured. Rotazyme positive rate is not significantly related to sex, birth weight and symptoms with necrotizing enterocolitis(NEC) between preterm and full-term neonates. But, jaundice developed more frequently in Rotazyme positive groups. When the neonates matured, they had longer durations of positive symptoms and positive Rotazyme tests. Also they had shorter onset times of positive symptoms and positive Rotazyme tests. Positive symptoms rate was 74.0% in total, 95.5% in preterm and 59.4% in full-term. Abdominal distension, jaundice and NEC increased significantly in preterms. CONCLUSION: Rotavirus can be a significant pathogen in preterms more than in full-terms. Neonates suffering from suspected sepsis should be investigated for rotaviral infection. A new oral vaccine and oral immunoglobulin is needed for eradicating rotavirus infection in the nursery. Further studies about isolations, infection pathways, immune responses and treatment of rotavirus are needed.

Retrospective 3-year Clinical Study of Enterobacter Bacteremia in Neonatal Intensive Care Unit

PURPOSE: Enterobacter is one of the important organisms in neonatal intensive care unit. We reviewed the clinical characteristics, underlying diseases, invasive procedures during admission, mortality and antibiotic sensitivity of Enterobacter infection in NICU. METHODS: We retrospectively reviewed 21 neonatal patients whose blood cultures yielded Enterobacter between June 1994 and June 1997 at Dongguk University Hospital. RESULTS: Blood cultures were positive in 62 from 2,025 neonates and 21 was Enterobacter. The clinical spectrums were diverse such as sepsis (85%), pneumonia, disseminated intravascular coagulopathy and necrotizing enterocolitis. The underlying conditions upon admission were composed of prematurity (38%), hyaline membrane disease (38%), jaundice, sepsis and pneumonia. The procedures used during admission were endotracheal intubation (57%), mechanical ventilation (57%), umbilical vessel catheterization, gastric tube inserition, total parenteral nutrition and exchange transfusion. The antibiotic sensitivity was as follows : ampicillin (0%), ceftriaxone (0%), amikacin (55%), gentamicin (85%), ciprofloxacin (100%), imipenem (100%). Overall mortality was 26.5%. Mortality was significantly high in cases of leukopenia (P< or = 0.01), thrombocytopenia (P< or = 0.01) and use of inappropriate antibiotics (P< or = 0.01). CONCLUSION: Enterobacter is an important organism in the cause of nosocomial infection in NICU and has a high rate of mortality. Enterobacter infection was associated with prolonged hospitalization, invasive procedures and preceding antibiotics. Commonly used antibiotics such as penicillin and cephalosporin would be inappropriate for the treatment of Enterobacter infection. We consider the use of gentamicin or imipenem to be far more effective in the initial therapy of Enterobacter infection.

A Case of Neonatal Hyperthyroidism with Unilateral Ear Anomaly

Neonatal hyperthyroidism is a very rare disorder occurring typically in the offspring of patients with Graves' disease or chronic thyroiditis. It is caused by the transplacental passage of thyroid stimulating antibodies (TSAb) from the mother to the fetus. There has been few reports of neonatal hyperthyroidism associated with congenital anomalies. We experienced a case of neonatal hyperthyroidism with unilateral microtia and agenesis of external auditory canal in a female neonate born to a mother who had euthyroid but with a thyroid stimulating antibody. The patient was presented with unusual alertness, tachycardia, tachypnea, watery diarrhea, periorbital swelling and exophthalmos. Diagnosis was made by thyroid function tests and TSAb. She was treated with Lugol solution, PTU and propranolol. New she is 6 months old and in good condition with no symptoms of hyperthyroidism.