ABSTRACT
BACKGROUND: Outbreaks of influenza A/H1N1/2009 in neonatal intensive care units (NICUs) have been reported only rarely. Annual vaccination of all healthcare workers (HCWs) against seasonal influenza is recommended but compliance is low and exposure to infected staff as the source of nosocomial outbreaks has been described. AIM: To report an outbreak of influenza A/H1N1/2009 in a tertiary level NICU that resulted in considerable morbidity. METHODS: When the first influenza case was identified, a prospective study was conducted and control measures were implemented to reduce the spread of infection throughout the NICU. Neonates who developed influenza were treated with oseltamivir, and exposed neonates were given prophylaxis with oseltamivir. FINDINGS: Two infected infants who were immature by gestational age and birth weight developed pneumonitis requiring respiratory support, and a third full-term neonate had a mild uncomplicated illness. No significant adverse effects were noted during antiviral treatment or prophylaxis. The investigation identified infected HCWs as the likely source of the outbreak. There was a very low influenza vaccination rate of 15% among nursing staff. CONCLUSION: Nosocomial influenza can cause considerable morbidity, especially in high risk neonates, and is readily transmissible in the NICU setting by unvaccinated staff members who contract influenza. To prevent outbreaks, in addition to infection control measures, the implementation of HCW vaccination is very important. Oseltamivir treatment was well-tolerated even among premature infants and appeared to be effective, because neonates with influenza had complete recovery and only one of those who received prophylaxis developed the infection.
Subject(s)
Cross Infection/epidemiology , Cross Infection/virology , Disease Outbreaks , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/epidemiology , Influenza, Human/virology , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Chemoprevention/adverse effects , Chemoprevention/methods , Cross Infection/drug therapy , Female , Humans , Infant, Newborn , Infection Control/methods , Influenza, Human/drug therapy , Intensive Care, Neonatal , Male , Oseltamivir/administration & dosage , Oseltamivir/adverse effects , Prospective Studies , Treatment OutcomeABSTRACT
Adequate vitamin D status during pregnancy is crucial to assure normal fetal skeletal growth and to provide the vitamin D needed for infants' stores. To determine the actual situation in Greece, we evaluated serum 25-hydroxyvitamin D (25[OH]D), calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (PTH), osteocalcin (OC), and calcitonin (CT) concentrations in 123 healthy mother-newborn pairs recruited from a public hospital of the sunny Athenian region. Blood samples were obtained from pregnant women at term and their neonates (cord blood). The study was conducted between June 2003 and May 2004. None of the mothers has been prescribed vitamin D supplements. Maternal 25(OH)D levels (16.4 [11-21.1] ng/mL) were significantly lower than umbilical venous blood concentrations (20.4 [13.9-30.4] ng/mL) (P < 0.001). A strong correlation was observed between maternal and infant 25(OH)D concentrations (r = 0.626, P < 0.001). Twenty-four (19.5%) mothers and 10 (8.1%) neonates had 25(OH)D <10 ng/mL. Pregnant women who delivered in summer and autumn reported higher levels of 25(OH)D (18.9 [12.9-23.3] ng/mL) than those who delivered in winter and spring (14.6 [10.1-18.5] ng/mL) (P = 0.006). Mothers with a darker phototype had lower levels of serum 25(OH) D than those with a fair phototype (P = 0.023). Umbilical venous blood Ca, P, OC, and CT levels were significantly higher than maternal venous blood levels (P < 0.001). PTH umbilical levels were lower than maternal levels (P < 0.001). Apparently, the abundant sunlight exposure in Athens is not sufficient to prevent hypovitaminosis D. Pregnant women should be prescribed vitamin D supplementations, and the scientific community should consider vitamin D supplementation of foods.
Subject(s)
Infant, Newborn/blood , Vitamin D Deficiency/blood , Vitamin D Deficiency/epidemiology , Vitamin D/blood , Adult , Alkaline Phosphatase/blood , Calcitonin/blood , Calcium/blood , Child Development/physiology , Cross-Sectional Studies , Dietary Supplements , Female , Greece/epidemiology , Hospitals, Public/statistics & numerical data , Humans , Infant, Newborn/growth & development , Osteocalcin/blood , Parathyroid Hormone/blood , Phosphorus/blood , Prenatal Care , Public Health/trends , Social Class , Surveys and Questionnaires , Vitamin D/administration & dosage , Vitamin D/analogs & derivatives , Vitamin D/physiology , Vitamin D Deficiency/prevention & controlABSTRACT
UNLABELLED: A 5-month-old girl presented with persistent dry cough, intermittent pyrexia and lymphocytosis, arthralgia, nodular skin lesions and an erythema nodosum-like rash. Chest CT scan revealed bilateral pulmonary infiltration. On the grounds of clinical and imaging findings, Gallium scanning and open lung biopsy were performed, providing evidence compatible with sarcoidosis. CONCLUSION: Despite what has previously been reported, sarcoidosis in infancy can present with pulmonary symptomatology.
