Monitoring the treatment of sepsis with vancomycin in term newborn infants.

UNLABELLED: A prospective study was conducted to determine if standardized vancomycin doses could produce adequate serum concentrations in 25 term newborn infants with sepsis. PURPOSE: The therapeutic response of neonatal sepsis by Staphylococcus sp. treated with vancomycin was evaluated through serum concentrations of vancomycin, serum bactericidal titers (SBT), and minimum inhibitory concentration (MIC). METHOD: Vancomycin serum concentrations were determined by the fluorescence polarization immunoassay technique, SBT by the macro-broth dilution method, and MIC by diffusion test in agar. RESULTS: Thirteen newborn infants (59.1%) had adequate peak vancomycin serum concentrations (20 - 40 mg/mL) and one had peak concentration with potential ototoxicity risk (>40 microg/mL). Only 48% had adequate trough concentrations (5 - 10 mg/mL), and seven (28%) had a potential nephrotoxicity risk (>10 microg/mL). There was no significant agreement regarding normality for peak and trough vancomycin method (McNemar test : p = 0.7905). Peak serum vancomycin concentrations were compared with the clinical evaluation (good or bad clinical evolution) of the infants, with no significant difference found (U=51.5; p=0.1947). There was also no significant difference between the patients' trough concentrations and good or bad clinical evolution (U = 77.0; p=0.1710). All Staphylococcus isolates were sensitive to vancomycin according to the MIC. Half of the patients with adequate trough SBT (1/8), also had adequate trough vancomycin concentrations and satisfactory clinical evolution. CONCLUSIONS: Recommended vancomycin schedules for term newborn infants with neonatal sepsis should be based on the weight and postconceptual age only to start antimicrobial therapy. There is no ideal pattern of vancomycin dosing; vancomycin dosages must be individualized. SBT interpretation should be made in conjunction with the patient's clinical presentation and vancomycin serum concentrations. Those laboratory and clinical data favor elucidation of the probable cause of patient's bad evolution, which would facilitate drug adjustment and reduce the risk of toxicity or failing to achieve therapeutic doses.

Vancomycin monitoring in term newborns: comparison of peak and trough serum concentrations determined by high performance liquid chromatography and fluorescence polarization immunoassay.

INTRODUCTION: Peak and trough serum concentrations of vancomycin were determined in term newborn infants with confirmed or suspected Staphylococcus sp sepsis by high performance liquid chromatography and flourescence polarization immunoassay. OBJECTIVE: To statistically compare the results of the high performance liquid chromatography and flourescence polarization immunoassay techniques for measuring serum vancomycin concentrations. METHODS: Eighteen peak and 20 trough serum samples were assayed for vancomycin concentrations using high performance liquid chromatography and flourescence polarization immunoassay from October 1995 to October 1997. RESULTS: The linear correlation coefficients for high performance liquid chromatography and flourescence polarization immunoassay were 0.27 (peak, P = 0.110) and 0.26 (trough, P = 0.1045) respectively, which were not statistically significant. CONCLUSION: There was wide variation in serum vancomycin concentrations determined by high performance liquid chromatography as compared with those determined by flourescence polarization immunoassay. There was no recognizable pattern in the variability; in an apparently random fashion, the high performance liquid chromatography measurement was sometimes substantially higher than the flourescence polarization immunoassay measurement, and at other times it was substantially lower.

Brain abscess by citrobacter diversus in infancy: case report.

Citrobacter diversus is closely related to brain abscess in newborn infants. We describe a case of brain abscess by this bacteria in a newborn infant and his clinical and cranial computed tomographic evaluation until the fourth month of life and discuss therapeutic management of this patient.

Endocardite bacteriana como complicaçäo de sepse neonatal: relato de caso / Bacterial endocarditis as a complication of neonatal sepsis: a case report

Os autores relatam um paciente com 11 dias de vida, internado em Unidade de Terapia Intensiva Neonatal devido a múltiplas malformações congênitas, apresentando sepse e endocardite bacteriana. Entre os fatores de risco para endocardite foram destacados o cateterismo venoso central, hemocultura com crescimento de Staphylococcus aureus e ventilação mecânica. O diagnóstico foi realizado no 61§ dia de internação devido a presença de febre persistente e aparecimento de sopro cardíaco sistólico. O ecocardiograma mostrou trombo em átrio direito, medindo 1,9 x 0,7mm sendo realizada antibioticoterapia e ressecção cirúrgica, com melhora clínica. No 125§ dia de internação ocorreu óbito devido à sepse e abscesso cerebral. Na necrópsia não foram observados malformações cardíacas. Os autores concluem ser de grande importância o conhecimento das complicações potenciais das técnicas invasivas utilizadas em recém-nascidos criticamente doentes. A suspeita clínica de endocardite deve ser realizada em todos os neonatos com sepse, internados em Unidade de Terapia Intensiva Neonatal por tempo prolongado.

[Bacterial endocarditis as a complication of neonatal sepsis: case report]. / Endocardite bacteriana como complicação de sepse neonatal--relato de caso.

The authors reported on a 11 day-old child, admitted in Neonatal Intensive Care Unit for multiple congenital malformations, who had sepsis and bacterial endocarditis. Among the risk factors for endocarditis were outstanding: the central venous catheterism, hemoculture with growth of Staphylococcus aureus and mechanical ventilation. The diagnosis was made in the 61st day after admission owing to the presence of persistent fever and appearance of systolic murmur. The echocardiogram revealed a thrombus in the right atrium measuring 1.9 x 0.7 mm. Antibiotic therapy and surgical resection being performed, with clinical improvement. On the 125st day after admission the patient died owing sepsis and cerebral abscess. At necropsy, heart malformations were not observed. The authors concluded to be very important the knowledge of the potential risks of invasive procedures currently used to care for critically ill newborns. The clinical suspicion of endocarditis should be considered in all neonates with sepsis and receiving intensive care for long time.

[Neonatal Streptococcus pyogenes meningitis and sagittal sinus thrombosis: case report]. / Meningite neonatal por Streptococcus pyogenes e trombose de seio sagital. Relato de caso.

We report a case of Streptococcus pyogenes meningitis in a 18 days year-old-girl with clinical course complicated by sagittal sinus thrombosis. Some aspects of the pathogenesis, treatment and follow-up of the disease are discussed. The world increase of serious streptococcal infections in the last 10 years, probably will become neonatal Streptococcus pyogenes meningitis more frequent in the future and it is important to be alert for the precocious diagnosis and the possible complications of that potentially lethal infection.

A case-control study of histological chorioamnionitis and neonatal infection.

The authors report a prospective study of the correlation between histopathological alterations in the placenta and the umbilical cord and neonatal infection in 223 newborns. The pathological studies were specifically concerned with the presence of infection as shown by a polymorphonuclear infiltrate at these sites. Inflammatory lesions were demonstrated in 26.9% of specimens and were highest in those with prolonged premature rupture of membranes and in the least mature placentas. Among the cases of histological chorioamnionitis, only 23.3% of infants had documented infection. Neonatal infection was diagnosed in 7.2% of the newborns and was 10 times more frequent in preterm newborns. Among the cases of infected newborns, 87.5% of placentas had histological chorioamnionitis. Pneumonia and septicemia were the most frequent conditions found among infected newborns. There was a strong correlation between histological chorioamnionitis and neonatal infection. The data obtained in this investigation suggest that histological chorioamnionitis is an important indicator of neonatal infection.

[Bacterial meningitis in the neonatal period. Clinical evaluation and complications in 109 cases]. / Meningite bacteriana no período neonatal. Evolução clínica e complicações em 109 casos.

Bacterial meningitis has special clinical features in the newborn infant. Major complications and sequelae result from the infectious involvement of the CNS in the majority of these children. We studied 109 newborn infants with bacterial meningitis accompanied from January 1977 to April 1987. The mortality rate was 34.8%. Perinatal risk factors were not found. The majority (80.5%) were term newborn infants. The main signs at admission were convulsion (53.2%), bulging fontanel (37.6%) and apnea (20.2%), and the main symptoms were neurosensorial depression (64.2%), nursing refuse (64.2%), fever (50.5%) and irritability (35.8%). Complications during hospitalization were ventriculitis (34.9%), inappropriate antidiuretic hormone secretion syndrome (27.5%), subdural collection (8.3%), brain abscess (4.6%) and brain infarction (2.8%). Inappropriate antidiuretic hormone secretion syndrome and ventriculitis were closely associated with high mortality. Seventy one children survived: 44 (62%) had gross abnormalities at the neurologic examination, and 29 (40.8%) developed hydrocephalus. Neurological follow-up of these children is important. Prognostic can change along the course of long time follow-up.

[Neonatal bacterial meningitis: etiological agents in 109 cases during a 10 year period]. / Meningite bacteriana neonatal. Agentes etiológicos em 109 casos durante período de dez anos.

The etiology of purulent meningitis was investigated in 109 newborn infants admitted in a neonatal intensive care unit throughout a ten year period. Bacterial pathogens were isolated from the CSF in 57 (52.2%) neonates. There was a predominance of Gram-negative bacilli isolated in 38 (34.9%) neonates. Gram-positive cocci were isolated from CSF in only 12 (11.0%) neonates. Microorganisms associated with nosocomial septicemia and meningitis in neonates--Klebsiella sp, Salmonella sp. Enterobacter sp, Pseudomonas sp, Flavobacterium meningosepticum and Serratia marcescens--were responsible for presumptive etiology in 38 (49.3%) among 77 patients with positive cultures in "closed sites". They were isolated from 22 (57.0%) neonates with prior hospitalization but only from 12 (34.3%) neonates coming directly from their households (chi 2 = 4.08; p < 0.05). The mortality rate was significantly higher in patients with positive CSF cultures (47.4%) in comparison to patients with negative cultures (18.4%) (X2 = 5.01; p < 0.05). It is possible to conclude that Gram-negative bacilli, many of them of hospital origin, are the major pathogens in this study. An improvement on neonatal health care and a scrupulous control of neonatal nosocomial infections are recommended.

[Parenteral feeding by peripheral veins in prolonged diarrhea of newborn infants]. / Nutrição parenteral por veias periféficas na diarréia prolongada do recém-nascido.

The authors studied 20 newborns with prolonged diarrhea treated with parenteral nutrition by peripheral veins. All the children survived, increased weight and stopped diarrhea. The authors concluded that the method was efficient and without serious complications, and quite simple for management in hospital that assist areas of poor communities.

Folatos, vitamina B 12 e vitamina E na gestacao e no periodo neonatal. / Folates, vitamin B 12 and vitamin E in pregnancy and neonatal period

Os autores fazem extensa revisao bibliografica e apresentam sua propria casuistica acerca da situacao dos folatos, vitamina B 12 e vitamina E durante a gestacao e o periodo neonatal. Sao analisadas as diversas condicoes em que a suplementacao dessas vitaminas e indicada para o recem-nascido pre-termo, especialmente a vitamina E

Nutricao parenteral por veias perifeficas na diarreia prolongada do recem-nascido. / Parenteral nutrition by peripheral veins in prolonged diarrhea of newborn infants

Foram estudadas 20 criancas com diarreia prolongada, durante o periodo neonatal, tratadas atraves da tecnica de nutricao parenteral por veia periferica. Todas elas sobreviveram com ganho de peso, e superaram a diarreia. Os autores concluem pela sua eficacia, reduzido numero de complicacoes e a sua vantagem, como metodo simples aplicavel em hospitais que atendem a populacao e comunidades carentes em paises em desenvolvimento

Insuficiencia renal aguda no recem-nascido: analise de 7 casos. / Acute kidney insufficiency in newborn infant: analysis of 7 cases

Os autores apresentam a analise clinica e laboratorial de 7 recem-nascidos com o diagnostico de insuficiencia renal aguda, estudados na Secao de Recem-Nascidos Externos do Instituto da Crianca do Hospital das Clinicas. Sao comentados as indicacoes, tecnica e resultados da dialise peritoneal. Em 5 casos, o disturbio funcional relacionou-se a desidratacao e/ou choque e/ou septicemia, e em 2 casos a processo organico