A Chryseobacterium meningosepticum colonization outbreak in a neonatal intensive care unit.

PURPOSE: To report the epidemiologic, bacteriologic, and clinical features of a Chryseobacterium meningosepticum outbreak in a neonatal intensive care unit (NICU) of a referral teaching hospital. PATIENTS AND METHODS: From April to October 2002, a strain of C. meningosepticum was isolated from four neonates in the NICU. All neonates were colonized in the endotracheal tubes and respiratory secretions, but none of them progressed to clinical infection. Multiple samples were obtained for cultures. RESULTS: Pulsed-field gel electrophoresis (PFGE) of isolates showed them to be representatives of a single strain. Environmental surveillance did not reveal the C. meningosepticum source. None of the neonates received specific treatment. The outbreak was only controlled by reinforcement of the usual measures and no additional colonization/infection was confirmed for more than a year after the last case. CONCLUSION: This study suggests that C. meningosepticum colonization in neonates does not necessarily lead to infection and that such colonization outbreaks may be controlled with emphasis on the standard precautions.

Spontaneous intestinal perforation in a full-term infant: association with infection.

The term spontaneous intestinal perforation suggests a perforation in the gastrointestinal tract of a newborn of no demonstrable cause. Only a few cases have been described in full-term newborns. The aetiology and pathogenesis of the disease are unknown although multiple theories have been proposed. Some authors suggest ischemia as the most likely cause. Conditions associated with fetal or neonatal hypoxia are important antecedents for this emerging distinct entity. We present a case of a spontaneous, intestinal perforation in a full-term neonate with urinary tract infection. There was no clinical evidence of necrotizing enterocolitis or bowel obstruction. Radiological images revealed a pneumoperitoneum. An emergency explorative laparotomy was performed. A localized linear perforation was identified in the transverse colon. Pathological examination of the resected specimens failed to reveal any etiology for the perforation. The neonate recovered rapidly, with no gastrointestinal complications. In our case none of the factors which have previously been associated with intestinal perforation could be implicated. We suggest that focal intestinal perforation is possibly the result of infection. Further studies, including careful recording of cases and close histopathological examination of resected specimens, are required in order to provide more information and improve our understanding of the aetiology of this rare occurance.

Neonatal screening for developmental dysplasia of the hip on the maternity wards in Crete, Greece. correlation to risk factors.

OBJECTIVE: To evaluate the effects of ultrasound examination of newborns in early detection and management of developmental dysplasia of the hip (DDH), and its correlation to known risk factors. The incidence of DDH in newborns throughout the general population of Crete has also been investigated. METHODS: From 1996 to 2000, 6,140 full-term newborns were examined in the Maternity Department of the University Hospital. All received standard assessments, with their medical history recorded, and a physical examination performed on the first and the fifth postpartum days. Ultrasonography of both hips using the Graf technique was performed on the 15th day after birth on both high-risk newborns and those with any clinical suspicion of DDH. Treatment was initiated according to the Graf classification. RESULTS: Ultrasound examination was performed on 220 newborns (3.58%). Ultrasound findings were positive in 65 neonates (10.83 per 1,000). Twenty-one neonates whose clinical examination was normal, but who underwent ultrasound because of the presence of risk factors had pathological findings on the hip sonography (32.30%) CONCLUSION: The incidence of DDH in Crete is estimated to be 10.83 per 1,000; higher than in the rest of Greece. Medical and family histories and clinical examination play an important role in the diagnosis of hip instability. Selective ultrasonography for all infants with risk factors, and those with clinical abnormality of the hip, is an adjunctive tool which aids early diagnosis and offers higher control in the results of treatment.

Infantile myofibromatosis with visceral involvement and complete spontaneous regression.

Infantile myofibromatosis is an unusual mesenchymal disorder characterized by the proliferation of tumors in the skin, muscle, bone, and viscera. Two types can be distinguished; the solitary type, defined by the presence of one nodule in the skin, muscle, bone or subcutaneous tissue; and the multicentric type which can be divided into two sub-types. In the first sub-type the lesions are multicentric but without visceral involvement, while in the second, visceral involvement is present. The prognosis of the disease depends on whether visceral involvement is present. Solitary and multicentric nodules without visceral involvement usually have excellent prognosis with spontaneous regression of lesions within 1 to 2 years of diagnosis. On the other hand, visceral lesions are associated with a significant morbidity and mortality, resulting from vital organ obstruction, failure to thrive, or infection. Death in these cases often occurs at birth, or soon after, and is usually due to cardio-pulmonary or gastrointestinal complications. The case being reported here, is that of a female newborn who had multiple skin, subcutaneous tissue, skeletal muscle, bone, and lung lesions immediately after bith. At the age of three years, the child is in good health, her psychomotor development is in accordance with her age group, and the lesions have completely regressed. This is a case of the multicentic type of infantile myofibromatosis with visceral involvement, where all lesions have spontaneously regressed. This is a rarity since the prognosis in the majority of such cases is poor.

Association between duration of neonatal hospital stay and morbidity in the first month of life.

The morbidity of 506 healthy full-term newborns was studied in the first month of life in relation to the time they stayed in the hospital. The average time for the newborns who were born by vaginal delivery was 73.3+/-11.7 hours, while for those who were born by cesarean section it was 135+31.5 hours. Thirty-seven newborns presented health problems during the neonatal period (7.3%) and only 2% needed hospital readmission. The commonest problem in the newborns we studied was jaundice which appeared from the fourth to sixth day of life. During the second fortnight the commonest problems were infections of the respiratory tract. From the results of our study it is obvious that only a small percentage of readmissions could have been avoided if the original stay in hospital had been prolonged.

Breast feeding--when nature fails to satisfy.

Human milk is the ideal source of nutrition for the healthy neonate. Milk from the mother whose diet is sufficient will supply the necessary nutrients. It is a considerable problem to discern if the milk supply is the adequate quantity for the infant. If the infant's water and caloric needs are not met for several days, signs and symptoms of hypernatremic dehydration >10% may develop. This report presents a case of a 15-day-old, breast-fed infant who developed significant hypernatremic dehydration.

Evaluation of the micro-erythrocyte sedimentation rate in relation to hemoglobin and hematocrit in newborn infections.

The reliability of micro-erythrocyte sedimentation rate (mESR) was studied for its value in the diagnosis of infections in 37 healthy newborns and in 37 with infections. The mESR values amount to 5.1 +/- 4.3 mm/h in healthy newborns. In newborns with infection, mESR values were found to be clearly higher, that is 22.7 +/- 9.9 mm/h. An important relationship between that of the mESR value and the hemoglobin (Hb) and packed cell volume (PCV) levels was revealed. For evaluation of the diagnostic value of the parameters of infection that have been studied, the Odds ratio was used. As with other similar inflammation indices, mESR should always be interpreted in combination with clinical findings in newborns with infections.

Multimodal cancer chemotherapy during the first and second trimester of pregnancy: a case report.

This paper reports treatment with combined chemotherapy during pregnancy. A 39-year-old woman with breast cancer was given adjuvant chemotherapy including cyclophosphamide, methotrexate and 6-fluorouracil from the 6th to the 24th week of gestation. The possibility of teratogenic effects on the fetus was explained to the patient however she refused to terminate the pregnancy. A 30-week male infant with only a minor malformation was delivered. The authors reviewed the literature regarding chemotherapeutic agents given during the first trimester of pregnancy. Most cytotoxic drugs have teratogenic effects on experimental animal subjects. However, actual data on human fetuses are sparse because of the variety of therapeutic regimens and the rarity of administering chemotherapy during pregnancy. The long-term effects of exposure to cytotoxic drugs in utero, needs further research.

Anemia due to massive chronic foetomaternal hemorrhage.

We report a case of massive chronic foetomaternal hemorrhage. The labor course was uncomplicated. The newborn presented with pallor. tachypnea, and moderate hepatosplenomegaly. The initial hemoglobin was 6.5 g/dl. The Kleihauer-Betke stain on a maternal blood sample was 12%, which is equivalent to 540 ml of fetal blood in the maternal circulation. A clot in the umbilical vein was demonstrated sonographically. The possible association of foetomaternal hemorrhage with umbilical vein thrombosis is discussed.