Diagnostic value of anti-microbial peptide, cathelicidin in congenital pneumonia.

OBJECTIVE: To evaluate the diagnostic value of anti-microbial peptide (cathelicidin), LL-37, in congenital pneumonia and its relation to 25 hydroxycholecalciferol [(25 OH)D] status. METHODS: The study included 30 neonates with congenital pneumonia and culture proven sepsis admitted to neonatal intensive care unit of Ain Shams University and 30 healthy neonates as control group. All neonates were subjected to history taking, clinical examination and measurement of serum 25(OH)D and cathelicidin. RESULTS: Neonates with congenital pneumonia had significantly higher serum cathelicidin and lower serum 25(OH)D compared to controls. Serum cathelicidin was negatively correlated with Apgar score at 1 and 5 min and positively correlated with length of stay among patient group. CONCLUSION: Cut-off value of cathelicidin to diagnose congenital pneumonia was 17 pg/mmol with 93% sensitivity and 86% specificity. Neonates with congenital pneumonia had significantly high cathelicidin and low 25(OH)D suggesting a possible role of fetal 25(OH)D deficiency as predisposing factor for congenital pneumonia.

Neonatal septicaemia in the neonatal care unit, Al-Anbar governorate, Iraq.

Neonatal septicaemia is a major cause of morbidity and mortality in developing countries. We studied 118 neonates admitted to the main referral hospital in Al-Anbar with positive blood cultures. The incidence of neonatal septicaemia for babies born at this hospital was 9.2 per 1000 live births, and mortality was 28%. Staphylococcus aureus (39%), Klebsiella pneumoniae (30%) and Escherichia coli (21%) constituted 90% of all isolates. The isolates showed in vitro susceptibility to cefotaxime, chloramphenicol and gentamicin, but resistance to more commonly used antibiotics such as ampicillin and cloxacillin. We recommend initial gentamicin/cefotaxime combined therapy while awaiting culture and sensitivity test results. Our study highlights the importance of understanding the local epidemiology of neonatal septicaemia in formulating a rational antibiotics policy.

Bone and joint infection in neonates.

A retrospective study was done to review the clinical experience of septic arthritis and osteomyelitis in the newborns in our centre. Case records of all the neonates born from January 1989 to August 1994 and those admitted to outborn nursery from 1985 to 1993 were reviewed. Diagnosis of septic arthritis/osteomyelitis was made in the presence of relevant clinical signs and supported by positive culture from blood or joint fluid and abnormal X-ray or ultrasound findings. The incidence of septic arthritis and osteomyelitis among inborn babies was 1 in 1500. There were 25 neonates with mean gestational age 34.5 (range 27-40) weeks and mean birth weight 2269 (range 990-4750) gms. Limitation of movement (64%) and local swelling (60%) were commonest presentations. A total of 33 joints were involved in 25 babies. Eight babies (32%) had multiple joint involvement. Hip and knee were the most commonly involved joints (48% each). In 19 babies (76%) joint involvement occurred in association with a generalized septicemic illness while 6 babies (24%) had localised signs and symptoms. Joint aspirate was positive for gram stain or culture in 12 (48%) and 10 babies (40%) had positive blood culture. Klebsiella pneumoniae and Staphylococcus aureus were commonest isolates. Radiological changes were seen in 13 (52%) babies. All were treated with appropriate antibiotics and open surgical drainage was done in 5 (20%) cases. Bone and joint infections are important complications in sick septicemic neonates and need early diagnosis, appropriate management with antibiotics, surgical drainage in selected cases to prevent long term morbidity.

Neonatal empyema thoracis.

Empyema thoracis, a serious complication of pneumonia, fortunately remains a less common cause of respiratory distress in neonates. Only 14 cases of neonatal empyema thoracis have been described in the world literature. The condition is characterized by its rarity, inability to identify any consistent predisposing factors, uncertain pathogenesis, rapid course, lack of consensus on management and a high mortality. We describe here two cases of empyema aged 6 and 8 days caused by E. Coli and Klebsiella respectively. Out of them one survived. A brief review of literature follows the above account.

Omphalophlebitis and osteomyelitis associated with Klebsiella septicemia in a premature foal.

Gram-negative neonatal septicemia was diagnosed in a premature Standardbred colt. Clinical signs included lethargy, weakness, loss of suckle reflex, tachypnea, and injected mucous membranes. Sequelae included pneumonia, omphalophlebitis, septic arthritis, and osteomyelitis. Prepartum maternal uterine infection, premature delivery, abnormal parturition with premature fetal membrane separation, and failure of passive transfer of colostral immunoglobulins increased the foal's risk for developing sepsis. Treatment included administration of moxalactam disodium and cefadroxil. The clinical efficacy of cephalosporin antibiotics in the treatment of gram-negative sepsis is discussed.

Extramembranous pregnancy with amniorrhoea.

A case of extramembranous pregnancy is reported. From about the 10th week of pregnancy there was an intermittent loss of liquor amnii, which from about the 25th week, became continuous. The infant was born alive in the 31st week, but died 15 days later because of the respiratory distress syndrome. The placenta was circumvallate with short, thick membranes unable to cover more than a small part of the infant. The course of the pregnancy and the prognosis of the infant are discussed on the base of previous publications. Because of the poor prognosis for the infant it is suggested that interruption of the pregnancy should be considered in early cases of amniorrhoea.