Outbreak of skin and soft tissue infections in a hospital newborn nursery in Italy due to community-acquired meticillin-resistant Staphylococcus aureus USA300 clone.

BACKGROUND: Community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) is responsible for severe infections in previously healthy people acquired in the community in different areas of the world. AIM: To report an outbreak of CA-MRSA in a hospital newborn nursery in northern Italy in September-October 2010, its investigation and control measures. METHODS: The epidemiology of the outbreak is reported. The investigation included screening neonates, parents and staff for MRSA carriage. Molecular strain typing was performed on MRSA isolates. FINDINGS: The outbreak affected nine neonates with three severe infections. In addition, four mothers had postpartum mastitis, and three mothers and one father had skin infection. The outbreak strain belonged to the USA300 CA-MRSA clone. Asymptomatic carriage of the outbreak strain was found among neonates, parents and hospital staff. The implementation of appropriate infection control measures in the hospital terminated the outbreak. CONCLUSIONS: To our knowledge, this is the first report of a hospital outbreak caused by the USA300 CA-MRSA clone in Europe. It is important to reinforce infection control measures, particularly in high-risk groups, such as neonates, to prevent USA300 from becoming endemic in European hospitals.

Correlations between volume delivery (VTHF) in course of high frequency oscillatory ventilation (HFOV) and severity of respiratory distress.

The treatment of severe respiratory distress in infants (e.g. respiratory distress syndrome--RDS, meconium aspiration syndrome--MAS and pulmonary haemorrage) with HFOV can cause sometimes a volume delivery (VTHF) exceeding the anatomical dead space, with the possibility of an increased risk of volutrauma, implicated in the pathogenesis of chronic lung disease (CLD). The authors examined the possible correlations between VTHF and the severity of respiratory distress in order to limit the risk of ventilator-induced lung injury (VILI). Thirty-five infants in HFOV because of respiratory distress were studied. The median VTHF registered was 2.25 ml/Kg (range: 1.3-3.4) with a significant correlation to some parameters espression of severity of the respiratory distress: arterial/Alveolar ratio (a/AO2) (r = 0.519), oxygen index (OI) (r = 0.512) and mean airway pressure (MAP) (r = 0.543).

[QTc interval in newborns with gastroesophageal reflux treated with cisapride and ranitidine]. / Intervallo QTc in neonati con reflusso gastroesofageo (RGE) in terapia con cisapride e ranitidina.

Gastroesophageal reflux (GER) is very common in infants, especially in prematures and may be cause of gastrointestinal and cardiorespiratory symptoms. Cisapride, a prokinetic agent, is used in order to avoid the transient esophageal sphincter relaxation, but it is sometimes associated to transient prolongation of QT interval on EKG, especially with high dosage. The authors report the effects of cisapride therapy (0.8 mg/Kg/day) on QTc interval (QTc = QT interval corrected on heart frequency) in a pediatric population (50 infants) with GER. Results demonstrate the relatively safety of cisapride therapy at low dose also in the pediatric period.

[Epidemiology of accidents in childhood]. / Epidemiologia degli incidenti in età infantile.

Informations about accidental injuries to children were obtained by studying the records, of the year 1983, of the Emergency Department of the Buzzi children hospital of Milan. We have split our study in two periods (winter and summer) because of the different conditions (climatic and social) that we have. 16.858 children presented at hospital during the whole year for various reasons. In autumn-winter months (october-march) 8125 children were seen and 1177 (15%) attended hospital for accidental injury, while during the spring-summer period (april-september) 1790 out of 8733 (20%) children were seen for the same pathology. For each period age and sex of children injured, type and extent of injury and body-site affected by trauma have been evaluated. Males are involved more than females and accidents occurred most frequently during spring and summer time. Traumatic accident is the most frequently observed in both sexes, particularly wounds, contusions and head injuries. Trauma were in the majority of low entity and no death occurred in the population studied. We conclude that there is a need of a prospective epidemiological study, on a nation-wide basis, of childhood accidents in order to evaluate the extent of the problem and to get up prevention on the basis of the risk-factors.

[Neonatal septic osteoarthritis]. / L'osteo artrite settica neonatale.

The Authors report their experience related to 15 cases of neonatal osteo-arthritis which have occurred in the last seven years in the neonatal intensive care unit. Besides the traditional clinical picture, it is stressed that neonatal osteo-arthritis has recently acquired new interest for an etiologic shift of the pathogens and for the availability of new antimicrobial agents. The rational antibiotic treatment and the role of the coordinated medical and orthopedic therapy have been essential for the benign clinical course and for the long-term prognosis. It is concluded that in order to reduce this serious disease it is necessary to avoid every potential risk factor, to operate in rigorous aseptic conditions and to improve the environmental conditions of the neonatal intensive care units.

[Newborn infants of drug-addicted mothers. Review of the literature and report of personal cases]. / Il neonato da madre tossicomane. Rassegna della letteratura e presentazione della casistica personale.

The effects of drug addiction in perinatal period and its clinical, diagnostic and therapeutic problems have been considered. The authors reported five cases of newborns from addicted mothers. Neurologic symptoms were present in all cases, gastro-intestinal disturbances were present in two newborns. One presented with convulsions and died for severe hyaline membrane disease. One newborn was small for gestational age and one was premature. Treatment has been carried out successfully with diazepam and/or phenobarbital in four cases. The authors stress the importance for a careful methadone program during pregnancy in order to reduce prematurity and neurologic sequelae of the narcotic withdrawal syndrome.

C-peptide response to arginine stimulation in diabetic children.

The extent and the clinical significance of residual beta cell function has been evaluated by radioimmunoassay of C-peptide in 41 diabetic children in different stages of evolution, using an arginine tolerance test. In control subjects a significant rise of C-peptide levels occurred after the infusion with arginine. In patients at the onset of the disease and in patients not in the remission stage, C-peptide levels showed no increment and basal values were significantly lower than in healthy control children. Children during the remission phase showed basal and peak values not significantly different from controls. A positive correlation was found between highest CPR levels compared to basal CPR values and to the age at onset of diabetes; a negative correlation was found between the duration of the disease and insulin requirement.