ABSTRACT
The inadvertent administration of a concentrated vancomycin solution to a 47 day-old premature male twin resulted in extremely high vancomycin levels and altered renal function. A 1.5 volume exchange transfusion did not change the measured vancomycin level. Multiple doses of oral activated charcoal, 1 g/kg, were administered beginning 5 h after the exchange transfusion. A calculated half-life of vancomycin before the exchange transfusion was 35 h. The half-life after the exchange transfusion and during charcoal administration was calculated to be 12 h. The only apparent adverse effect of this vancomycin overdose was reversible nephrotoxicity. The infant's hearing, tested by brainstem auditory responses, was normal. The higher volume of distribution of vancomycin in infants may preclude removing significant amounts of this drug by exchange transfusion. Gastrointestinal dialysis with activated charcoal warrants consideration in cases of vancomycin overdose in neonates.
Subject(s)
Charcoal/administration & dosage , Exchange Transfusion, Whole Blood , Vancomycin/poisoning , Charcoal/therapeutic use , Creatinine/blood , Drug Overdose/therapy , Ear Diseases/prevention & control , Half-Life , Humans , Infant , Kidney Diseases/prevention & control , Male , Vancomycin/blood , Vancomycin/pharmacokineticsABSTRACT
Diffuse neonatal hemangiomatosis is an often fatal disorder characterized by widespread capillary hemangiomas of the skin and visceral organs. Ultrasound and computed tomographic scans may be useful in determining the extent of visceral disease. The organs most commonly affected are the gastrointestinal tract, brain, liver, and lung. Complications include high-output cardiac failure, gastrointestinal bleeding, hydrocephalus, and consumption coagulopathy. Despite therapy with corticosteroids, the mortality rate is high.
Subject(s)
Hemangioma/congenital , Neoplasms, Multiple Primary/congenital , Skin Neoplasms/congenital , Brain Neoplasms/pathology , Facial Neoplasms/pathology , Female , Hemangioma/blood , Hemangioma/drug therapy , Humans , Infant, Newborn , Liver Neoplasms/pathology , Methylprednisolone/therapeutic use , Mouth Neoplasms/pathologySubject(s)
Esophageal Perforation/therapy , Infant, Newborn, Diseases/therapy , Intubation, Intratracheal/adverse effects , Enteral Nutrition , Esophageal Perforation/diagnostic imaging , Esophageal Perforation/etiology , Female , Humans , Infant, Newborn , Mediastinal Emphysema/therapy , Pneumothorax/therapy , Posture , RadiographyABSTRACT
An unusual case of a one-day-old infant with significant left ventricular outflow obstruction produced by a pedunculated fibroma is described. The clinical findings were indistinguishable from severe valvular or subvalvular aortic stenosis. The tumor was difficult to detect by echocardiography. It produced an echo-free widening of the left ventricular outflow tract. Left ventricular cineangiography clearly demonstrated a mobile mass beneath the aortic valve.
Subject(s)
Aortic Valve Stenosis/diagnosis , Fibroma/congenital , Heart Neoplasms/congenital , Heart Ventricles , Aortic Valve Stenosis/etiology , Cineangiography , Echocardiography , Female , Fibroma/diagnosis , Fibroma/diagnostic imaging , Fibroma/surgery , Heart Neoplasms/diagnosis , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/surgery , Heart Ventricles/surgery , Humans , Infant, NewbornABSTRACT
Twenty neonates with a suspected intracranial hemorrhage were studied by computed tomography (CT). The exact site and extent of the hemorrhage in all infants were clearly demonstrated on serial CT scans. In intraventricular hemorrhage, a dense subependymal halo lined the ventricular system and could be recognized for up to 2 weeks. Discrete hemorrhage adjacent to the ventricular system also appeared as discrete nodules rather than as a diffuse hemorrhage. Blood in the ventricular system could be recognized up to 2 weeks when there were blood-cerebrospinal fluid levels. Hydrocephalus was a common sequela and was readily detectable before a measurable change in head size.
