Challenges in Managing a Case of Neonatal Listeriosis in Portugal.

A male neonate was born at 34 weeks due to spontaneous labor with associated fetal distress and meconium-stained amniotic fluid. The neonate presented with septic shock and congenital pneumonia shortly after birth and later neurological symptoms. Listeria monocytogenes was identified in blood samples, but with negative urine and cerebrospinal fluid cultures. The neonate required assisted ventilation for a period of 10 days and received high-dose and long-term antibiotic therapy. Despite the fact that the mother denied an infectious risk for listeriosis infection, she developed mild respiratory symptoms. Her microbiological investigation was negative, although it did not include placental samples. Vertical transmission in this case was presumed but not confirmed. The newborn was discharged asymptomatic at day 26 of life and has presented normal developmental evolution until present, at eight months old. Listeria monocytogenes is a classic but relatively rare cause of neonatal sepsis and meningitis. This case describes a clinically successfully managed case with no possible epidemiological link and illustrates the challenges in managing cases of a public health disease. In neonatal listeriosis, communication between Neonatology and Obstetrics departments, as well as with public health, is vital, and long-term follow-up is crucial to identify possible neurological sequelae.

Cardiopulmonary complications in a patient with bezoar.

We report a case of a 17-year-old institutionalised male with a medical history of fragile X syndrome, bilateral congenital glaucoma, cataracts and pica disorder. He was transferred to our paediatric intensive care unit owing to respiratory failure and hypotension. On transoesophageal echocardiogram, he presented left atrium compression. A CT of the thorax and mediastinum revealed an unknown heterogeneous material in the lumen of the stomach and oesophagus, with a lung parenchyma suggestive of alveolar foreign material. Endoscopic evaluation showed diaper fragments inside the oesophagus and stomach. Fragmentation and suction of diaper material was made. Medical treatment was performed with inotropic support, conventional mechanical ventilation and antibiotics.

Cardiogenic shock in a neonate.

We describe a case of a healthy male full-term neonate, 21 days old, admitted to the emergency room, presenting a severe cardiovascular collapse with an initial sinus rhythm. The first diagnostic hypothesis was of septic shock, having antibiotics, fluid resuscitation, inotropic drugs and ventilatory support started immediately. After achieving haemodynamic stability, a new cardiovascular collapse occurred with supraventricular tachycardia (SVT). The latter was successfully treated and the neonate did not suffer any organ damage. Cardiogenic shock should be considered despite being a much rarer cause of shock in neonates. SVT is promptly diagnosed when a cardiorespiratory monitor is available; however, the intermittent occurrence of the tachycardia episodes makes this diagnosis more difficult to recognise and manage.