Medical consumption and socioeconomic effects of infection with respiratory syncytial virus in The Netherlands.

OBJECTIVE: To calculate both medical consumption and socioeconomic effects related to hospitalization for respiratory syncytial virus (RSV) infection in the Netherlands. METHODS: During the winter seasons of 1998 to 2000, parents of all patients hospitalized for RSV in three secondary care hospitals were asked to fill out questionnaires focusing on the 2 weeks before hospitalization, the period in hospital and the 2 weeks after discharge. The questions concerned workdays lost, level of education and current profession, extra childcare needed, consultation by the family physician and drugs prescribed and costs of travelling. RESULTS: Seventy-three children were hospitalized. Median age was 79 days (range, 9 to 537 days), and median weight was 5,295 g (range, 3130 to 10,600 g). Three children were born preterm. Parents had 2 (range, 0 to 6) telephone contacts with the family doctor; the child was seen 2 (range, 0 to 4) times before hospitalization. Parents lost 0.5 workday before hospitalization. Duration of hospitalization was 5 days median (range, 1 to 12 days). Parents lost 1.5 (range, 0 to 9) workdays during hospitalization and drove 118 (range, 6 to 550) miles to visit their child. In the period after discharge expenses were negligible. Calculation of all parameters into currency resulted in a total amount of $2,200 per child hospitalized for RSV. Workdays lost, costs for travelling and consultation of family doctors resulted in $295 per child. CONCLUSIONS: RSV infections necessitating hospitalization in a secondary care hospital have remarkable effects on parental expenses, parental absence from work and medical consumption. On top of the hospital-related costs 15% should be added for parental expenses and socioeconomic costs.

Primarily infected cephalhematoma and osteomyelitis in a newborn.

Cephalhematomas are subperiosteal blood collections occurring in newborns secondary to trauma at birth. They develop within a few days and are subsequently resorbed. Infection of a cephalhematoma is unusual and caused most often by colonization of the hematoma during bacteremia or by direct inoculation secondary to trauma. Less than 10 patients with primary infection of the hematoma, in the absence of a positive blood culture, complicated by osteomyelitis have been described. We report a newborn with a primarily infected cephalhematoma complicated by parietal bone osteomyelitis.

Spinal osteomyelitis caused by Proteus mirabilis in a child.

Osteomyelitis due to Proteus mirabilis is rare. Spinal osteomyelitis caused by this organism has only been described in adults. This is the first paediatric case of P. mirabilis vertebral osteomyelitis.

Atypical cellulitis due to group B streptococcus.

In a minority of late-onset Group B streptococcal (GBS) cases in neonates, facial or buccal cellulitis has been described. We report a case of sepsis with GBS, in which an atypical cellulitis in the inguinal area was seen as presenting symptom.

[Diagnosis in recurrent bacterial meningitis; a literature study]. / Diagnostiek bij recidiverende bacteriële meningitis; een literatuurstudie.

Recurrent bacterial meningitis can be caused by different mechanisms. In order to make the diagnostics more efficient, we studied literature to find these underlying mechanisms. Two groups could be identified: group I, patients with a congenital or posttraumatic defect in the bones of the skull and group II, patients with a deficiency of a component of complement. The patients in group I were much younger at the time of their first meningitis and suffered more often from otitis, rhinorrhoea and deafness diagnosed before the first meningitis. Streptococcus pneumoniae was most frequently cultured in the cerebrospinal fluid, the group with complement deficiency showed Neisseria meningitidis almost exclusively. Family history revealed more members with infections caused by neisseriae spp. Although it was difficult to diagnose the bony defects, physical examination, radiography and high resolution CT scanning of the skull were helpful. Age, history, physical examination and cerebrospinal fluid culture were the most helpful in diagnostic factors.

[Risks of diazepam in newborn infants]. / Risico's van diazepam bij pasgeborenen.

In children there is a good effect of diazepam on convulsions after intravenous or rectal administration. This is not the case in neonates. We describe a newborn to whom diazepam was given because of a convulsion and who exhibited serious side effects: coma, hypotonia and feeding difficulties. We point out the risks of using diazepam in neonates.