RESUMO
A case of fatal echovirus 7 infection in a neonate which was probably acquired from the symptomatic mother and an outbreak of infection in a neonatal unit are described. The baby who died had extensive haemorrhagic necrosis of the brain, liver, adrenal glands and kidneys as well as disseminated intravascular coagulation. Three other babies and one member of staff were found to be infected. No other babies died. Human normal immunoglobulin was administered to all babies on the unit.
Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Echovirus/epidemiologia , Doenças do Prematuro/epidemiologia , Unidades de Terapia Intensiva Neonatal , Adulto , Inglaterra , Enterovirus Humano B/isolamento & purificação , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na GravidezRESUMO
In a multicentre case-control study of necrotising enterocolitis risk factors were found to vary with birthweight of cases. In very low birthweight cases the risk factors identified were those associated with prolonged or recurrent hypoxia (recurrent apnoea, respiratory distress, assisted ventilation, and umbilical artery catheterisation). In heavier birthweight infants the risk factors were, in contrast, related to hypoxia at birth (low 1 minute Apgar score and endotracheal intubation at birth) and umbilical vessel catheterisation used in exchange transfusions. Contradictory findings in published case-control studies carried out in the USA may be due to differences in patient populations and management policies. Hypoxia and umbilical vessel catheterisation should still be considered as risk factors for necrotising enterocolitis.
Assuntos
Enterocolite Pseudomembranosa/epidemiologia , Índice de Apgar , Peso ao Nascer , Cateterismo/efeitos adversos , Inglaterra , Enterocolite Pseudomembranosa/etiologia , Feminino , Humanos , Hipóxia/complicações , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Modelos Teóricos , Fatores de Risco , Artérias UmbilicaisRESUMO
The relationship between birthweight, gestation and obstetric and neonatal course was examined for 444 live births at 25-31 weeks gestation in 5 centres from 1982 to 1984 and comparative data were obtained from 121 infants below 32 weeks born in 1968-1972. The rate of 'interventive' deliveries by elective caesarean section, at this gestation, performed largely for conditions associated with poor intrauterine growth, has risen over 10-fold in the past decade, now accounting for 42% of deliveries at 30 weeks. This may explain in part a secular trend towards reduced birthweight for gestation in preterm infants. Electively delivered infants were significantly lighter than those delivered spontaneously and were responsible for substantial skewing and lowering of overall birthweight centiles. In contrast, the infant's sex, whether or not the infant survived following live birth, and whether gestational age was assessed by maternal dates or by clinical estimation (including ultrasound), all made no significant difference to birthweight centiles. A new birthweight centile chart is presented for infants less than 32 weeks, based only on spontaneous deliveries. This chart differs considerably from those commonly used in Britain and, we suggest, provides a realistic standard for identifying abnormal intrauterine growth.
