[Prospective study of Candida-related sepsis in the neonate]. / Estudio prospectivo de sepsis por Candida en el recién nacido.

OBJECTIVE: Our objective was to carry-out a prospective study of newborns with systemic candidiasis admitted to our Neonatology Unit in a teritiary hospital during the period of March 1994-September 1997. PATIENTS AND METHODS: To be included in the study the patient had to have Candida sp recovered from a normally sterile body fluid and clinical signs of sepsis. We analyzed perinatal and neonatal antecedents, risk factors, clinical course, diagnosis, treatment and outcome. RESULTS: The incidence of systemic candidiasis was 0.62% (14 newborns). Two were term infants and 12 preterm infants, 9 of which weighed less than 1500 g. All of the patients had as predisposing factors the use of broad spectrum antibiotics, prolonged intravascular catheterization and parenteral nutrition, while 64% had mechanical ventilation. The mean age at onset of sepsis was 22 days, with non-specific clinical presentation. Four infants were treated with intravenous amphotericin B and 9 with liposomal amphotericin B in association with fluconazole in one patient and with flucytosine and fluconazole in another. No adverse effects were observed. Mortality was 21%. C. parapsilosis was isolated in 7 cases and C. albicans in another 7 patients, with an important increase in C. parapsilosis in the last few years. CONCLUSIONS: Clinical suspicion of invasive candidiasis requires the removal of indwelling catheters and early initiation of systemic ungal therapy to reduce mortality. The increased incidence of species with more epidemic presentation like C. parapsilosis reinforce the importance of control measures such as handwashing for all personnel and aseptic management of intravascular catheters and solutions in order to prevent infections.

[Neonatal systemic candidiasis in the nineties]. / Candidiasis sistémica neonatal en los noventa.

OBJECTIVE: Retrospective study of newborns with systemic candidiasis during the period January 1990-March 1994 admitted to the Neonatology Unit at tertiary hospital. We analyzed the predisposing factors, clinical course, diagnosis, treatment and outcome. MATERIAL AND METHODS: Fourteen newborns were diagnosed of systemic candidiasis on the basis of positive blood culture associated with compatible clinical condition and/or involvement of any organ. All the patients had as predisposing factors the use of broad spectrum antibiotics, prolonged intravascular catheterization and parenteral nutrition, and 12 newborn infants had mechanical ventilation. RESULTS: Twelve newborns were preterm infants, 10 of them weighing less than 1.500 g and 2 were term infants who required abdominal surgery due to ileal atresia and omphalocele. The mean age at onset of systemic candidiasis was 40 days. Clinical presentation was indistinguishable from that of bacterial sepsis. C. albicans was isolated from the blood of 12 infants, from the urine of 6 infants and from the cerebrospinal fluid of two infants. Six infants were treated with intravenous amphotericin, one infant was treated with intravenous amphotericin B associated with oral flucytosine and two infants were treated with liposomal amphotericin. Six of the infants died one of them while still receiving antifungal therapy. CONCLUSION: Systemic candidiasis should be considered in any septic infant mainly preterm infant less than 1.500 g with predisposing risk factors. We truly believe that a high index of suspicion, rapid diagnosis, early initiation of systemic fungal therapy, and removal of indwelling catheters may markedly reduce the mortality and improve the prognosis associated with neonatal systemic candidiasis.

[Neonatal varicella: indications for the use of varicella-zoster specific immunoglobulin]. / Varicela neonatal: indicaciones para el uso de inmunoglobulina específica varicela-zoster.

Case reports from January-1986 through December-1988 of neonates born to women who develop varicella and neonates with household postnatal exposure are presented. Mother developed varicella in three cases (15 days before delivery, at delivery, 10 days after delivery), the last case was infected by direct exposure from his brothers. Only neonates with household contacts developed varicella. In every case varicella-zoster immunoglobulin a doses of 0.2 mg/kg/day from the three days was administered. Adding aciclovir intravenous a daily doses of 15 mg/kg/8h for seven days in neonates who developed varicella. Are propose considered a high risk group the neonates with postnatal exposure.

[Early detection of congenital luxation of the hip in 15,509 live newborn infants]. / Detección precoz de luxación congénita de cadera en 15.509 recién nacidos vivos.

This paper reports the results of hip examination screening in 15,509 alive newborns during the first 24 hours of life, carried out by the same trained person. Congenital dislocation incidence was 6.18%, with dislocated hips in 3.2% and instable hips in 2.4%. Primaparity was not a predisposing factor. There was a seasonal incidence with a peak in April. Late diagnosis rate was low, but not nil. We insist about the need for a careful hip examination in newborn performed by the same trained persons.