Infection of Cronobacter sakazakii ST1 Producing SHV-12 in a Premature Infant Born from Triplet Pregnancy.

Cronobacter sakazakii can cause severe life-threatening invasive infections in neonates, with a high mortality rate mostly associated with powdered infant formula consumption. The study describes a fatal C. sakazakii infection in premature infant fed only with expressed human milk. Despite the identification of etiological factor from patient's blood, the epidemiological investigation, including mother's skin, hospital surfaces, milk expressing devices, and milk samples, did not show bacterial contamination. The infection was caused by C. sakazakii ST1, being one of the leading genotypes reported in invasive infections. The phylogenetic analysis of the international collection of the ST1 organisms allowed us to identify the isolate as a member of the main cluster. The pathogenic potential of the isolate was augmented by the presence of IncFIB-like molecule representing virulence plasmids of pESA-3 family. Isolate presented ESBL phenotype associated with blaSHV-12 gene harboured by IncX3 plasmid. The described case gave valuable information to genetics of Cronobacter, and also urges the need of wider whole-genome sequencing implementation as a part of diagnostic procedure.

The impact of chorionicity and the type of twin growth on the early neonatal outcome in twin pregnancies - 20 years of experience from one tertiary perinatal center.

OBJECTIVE: Twin pregnancies are associated with higher neonatal mortality and morbidity. Growth discordance and monochorionicity are among the factors that worsen the course of pregnancy. The study aimed to assess neonatal conditions and mortality in relation to growth type and chorionicity. MATERIALS AND METHODS: Data from 820 pregnant women with twin pregnancies and their 1640 newborns were analyzed. The Apgar score and umbilical artery blood pH, as well as the rate of complications, were compared between dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twins with symmetric and discordant growth. The Student's t-test and the Pearson chi-square test were used for comparisons. RESULTS: There were 576 (70.2%) DCDA pregnancies, including 421 (73.1%) with symmetric growth and 155 (26.9%) with discordant growth, and 244 (29.8%) MCDA pregnancies, including 110 (45.1%) with symmetric growth and 134 (54.9%) with discordant growth. A significantly greater percentage of twins with discordant growth occurred in women older than 34 years than in those that were younger. An Apgar score of ≤7 was significantly more common among MCDA discordant twins, while an arterial umbilical blood pH of <7.2 was more common among MCDA twins with symmetric growth. Early neonatal deaths (n = 29; 1.8%), respiratory disorders, and a birth weight of <1500 g were significantly more common in MCDA twins than in DCDA twins. CONCLUSION: MCDA twins with growth discordance are burdened with a higher risk of neonatal morbidity and mortality than symmetric DCDA twins. Chorionicity and growth discordancy are important determinants of the outcome of twin pregnancy.

Parenteral nutrition solution in cerebrospinal fluid in preterm newborn - a case report and review of the literature.

INTRODUCTION: Percutaneously inserted central venous catheters (epicutaneo-cava-catheter - ECC) are widely used in neonatal intensive care, facilitating the parenteral nutrition and the treatment of critically ill newborns. This invasive procedure is regarded as safe and associated with low complication rate. Possible life-threatening complications may result from malpositioning of ECC. Paraspinal misplacement of ECC is one of the most serious complications. CASE PRESENTATION: The authors report a case of misplacement of ECC inserted via left saphenous vein for intravenous feeding. A plane radiograph performed after the procedure showed the line tip at L3-L4 level, supposed to indicate location of the catheter in the vena cava inferior. Three days later, the infant developed neurologic symptoms (lethargy, hypotonia, seizures). Lumbar puncture revealed milky fluid containing parenteral nutrition solution. The infusion was stopped. X-ray with contrast showed the catheterization of the left ascending lumbar vein draining the vertebral venous plexuses. The contrast was highlighting the epidural space. The line was immediately removed resulting in improvement in patient's condition and resolution of all neurological symptoms. There was no sequela of this infiltration and the baby had an uneventful recovery. Follow-up at the age of 12 months showed normal development. CONCLUSIONS: A percutaneous catheter inserted via a lower limb may inadvertently enter the ascending lumbar vein. As previously reported, a catheter inserted via the left lower limb is a risk factor of this malposition. The life-threatening complications may be avoided by careful verification of ECC position (lateral x-ray, contrast examination). Plain radiography alone may not be sufficient for tip localization.

Neonatal outcome from triplet interval delayed delivery: a case report.

In the past decades, we have observed a large increase in the number of multifetal pregnancies, which is mainly associated with the introduction of assisted reproductive techniques. Even though neonatal intensive care of very premature infants has improved significantly, the risk of mortality and long-term morbidity is still much higher among these newborns. A longer interdelivery period may reduce perinatal mortality and morbidity. The authors report the case of a delayed interval delivery in trichorionic, triamniotic triplet pregnancy. After the labor of the first fetus in the 22nd week of gestation, a 75-day interval was achieved before the delayed delivery. To save the surviving fetuses, the umbilical cord was ligated at the cervical level immediately after the first delivery. The patient received antibiotics, tocolytics, and corticosteroids. A baby boy who weighed 1750 g and a girl who weighed 1700 g were successfully delivered by cesarean section in the 33rd week of pregnancy. The babies were discharged home at the age of 28 days. A follow-up examination 20 weeks later showed that their neurological development was normal and without any major problems. The maternal postpartum course was uneventful; the patient stayed in hospital taking care of the babies.

[Evaluation of diagnostic value of procalcitonin (PCT) as a marker of congenital infection in newborns]. / Ocena wartosci oznaczania prokalcytoniny jako wykladnika zakazenia wrodzonego u noworodków.

UNLABELLED: Systemic bacterial infections still remain one of the major causes of neonatal morbidity and mortality. Early detection of neonatal sepsis can be difficult, because the first signs of the disease may be unspecific and similar to symptoms of other non-infectious processes. Procalcitonin became a new, sensitive marker of bacterial infections in newborns. The aim of our study was to assess the value of PCT as a diagnostic and prognostic tool of neonatal maternofetal infections. We also tried to estimate normal ranges of PCT in uninfected newborns. MATERIAL AND METHODS: 74 newborns, born in the Department of Obstetrics and Gynaecology, University of Medicine of Wroclaw, then hospitalized in the Department of Neonatology entered the study. They were divided into 2 groups: group 1-29 neonates with recognized materno-fetal infection, group 2-45 newborns without infection. In both groups blood samples to measure PCT concentrations were obtained by venipuncture on the 1st, 2nd, 3rd, 5th and between the 10th and 14th day of life (in the group of infected neonates) Sera were stored at -40 degrees C before analysis. PCT was determined using an immunoluminometric assay (BRAHMS Diagnostica). RESULTS: Serum procalcitonin values were significantly higher in the infected group than in the uninfected neonates (p < 0.001). The most significant differences were noted on the 2nd and 3rd day of life (p < 0.0001). After the treatment had been finished, the PCT levels in both groups were not statistically different. CONCLUSIONS: PCT is a useful tool in early diagnosing and monitoring the course of early-onset infections in neonates, particularly when blood cultures obtained from neonates remain negative. The decreasing concentrations of PCT level in children treated due to infection, indicate successful treatment and may help one to take a decision on termination of antibiotic therapy.

[Role of IVIG in modern neonatology]. / Rola IVIG we wspólczesnej neonatologii.

A newborn presents capacity to respond to specific antigens, but his immune system is still immature. Deficiency of immune function in the neonate is concerned with both innate and acquired immunity and provides to higher morbidity and mortality at this age of life. Therefore many multicentral studies on this field are performed. In the first part of the paper the authors present the development of humoral response and the role of immunoglobulins in infections of fetuses and newborns. The second part contains current views on immunoglobulin therapy in these children.