Fulminant early-onset neonatal sepsis due to Streptococcus pneumoniae: Case report and review of the literature.

Streptococcus pneumoniae is a rare cause of neonatal sepsis, and it is associated with significant morbidity and a very high fatality rate. The infection is usually acquired intrapartum, from the colonization of the maternal genital tract. Most affected neonates have an early-onset presentation of symptoms, usually within the first 48 hours after birth, which is similar to other causes of neonatal sepsis such as Streptococcus Agalactiae or Escherichia Coli. However, the virulence seems to be higher for Streptococcus pneumoniae, which has in addition a higher infant invasion/ maternal colonization ratio than Streptococcus Agalactiae. Pneumococcal vaccination has not resulted in a significant decline of neonatal cases. Many cases included ours, involved serotypes not present in the vaccine. Other strategies to protect these infants are necessary. We describe a late preterm infant with a fatal, early-onset sepsis caused by Streptococcus Pneumoniae serotype 28 A. Maternal vaginal culture grew the same bacteria.

[Oxytocin and syndrome of inappropriate secretion of antidiuretic neonatal hormone. Case report of early severe hyponatremia and literature review]. / Oxitocina y sindrome de secreción inapropiada de hormona antidiurética neonatal. Reporte de un caso de hiponatremia severa temprana y revisión de la bibliografia.

This is a clinical case presentation of a full term newborn infant who suffered severe hyponatremia and early seizures, associated with maternal fluid overload with electrolyte free solutions and high doses of oxytocin for labor augmentation. Although this condition has been recognized since the 1960's with isolated reports, this particular case has features that needs further investigation, not only for the unsually severe hyponatremia, but most importantly we think, for the prominent signs of fluid retention, the infant had, that suggest excessive antidiuretic activity probably due to oxytocin. These findings are consistent with syndrome of inappropriate secretion of antidiuretic hormone. Although until now there is no proof that oxytocin by itself produces this syndrome. We think the association is possible in certain clinical circumstances, such as those found in this case. We also, briefly discussed the pathophysiology of perinatal hyponatremia, the neonatal treatment of this condition and the current guidelines for the women in labor. Hyponatremia should not be considered a benign condition, since in the neonate, it may affect brain function.

The use of sildenafil in persistent pulmonary hypertension of the newborn.

We evaluated the effectiveness of sildenafil in the treatment of neonatal pulmonary hypertension. We performed a double-blind randomized clinical trial in 51 full-term infants with persistent pulmonary hypertension confirmed by Doppler echocardiography. Patients were divided in two groups: 20 infants in group A received placebo when the oxygenation index was >20, and 31 infants in group B received 3 mg/kg of oral sildenafil every 6 hours. Arterial blood gases were taken at 1, 4, 7, 13, 19, and 25 hours after treatment was started. Main outcome measures were oxygenation changes, time on mechanical ventilation, and mortality. Both groups were comparable in general variables as well as in illness severity. We observed better oxygenation parameters after 7 hours of sildenafil treatment, but no significant changes were found in the placebo group. Mortality was higher in the placebo group (40%) than in those infants who received sildenafil (6%; P = 0.004), although no difference was found in time on mechanical ventilation between groups. Our results confirm that sildenafil may be a useful adjuvant therapy for term infants with pulmonary hypertension in centers lacking inhaled nitric oxide and extracorporeal membrane oxygenation.

Leptin, insulin, and glucose serum levels in large-for-gestational-age infants of diabetic and non-diabetic mothers.

BACKGROUND: It has been suggested that hyperleptinemia could be caused by hyperinsulinemia in infants of diabetic mothers (IDMs). AIM: To compare leptin, insulin, and glucose levels in large-for-gestational-age (LGA) and appropriate-for-gestational-age (AGA) infants. METHODS: A cross-sectional study was conducted in IDMs, infants of non-diabetic mothers (INDM) and AGA infants. RESULTS: Seventy-seven newborns were studied (11 IDM, 16 INDM, and 50 AGA infants). Leptin levels were significantly higher in LGA infants than in the AGA group and a trend for higher levels in IDM than NIDM was observed. Insulin levels and insulin resistance were significantly higher in IDMs. Glucose levels were lower in both groups of LGA infants. CONCLUSIONS: We found insulin resistance, hyperinsulinism and hyperleptinemia in IDMs, and the trend of higher leptin levels in IDMs than INDMs shows that leptin could be related to insulin resistance in these infants.

Congenital candidiasis: a rare and unpredictable disease.

We present a full-term female infant with congenital candidiasis characterized by extensive vesicular and pustular skin lesions associated with pneumonia and severe respiratory distress that appeared during the first hours after birth. The patient was born by cesarean section with no history of rupture of membranes. The mother had a vaginal discharge 3 weeks before delivery. The diagnosis was made by culture of pustular fluid, which grew Candida albicans. Systemic cultures were negative. The infant required a very brief course of conventional mechanical ventilation in spite of impressive and extensive lung infiltrates on the chest radiograph. She made a very quick clinical recovery although it is remarkable that antifungal treatment with amphotericin B was begun very late in her clinical course at the time when she was showing obvious signs of major improvement. Current management guidelines strongly recommend specific therapy for infants with invasive congenital candidiasis or with burn-like extensive dermatitis even without lung involvement. We are not suggesting any change in these recommendations; however, at least in our patient, when amphotericin B was started, she was clearly recovering; it seems possible that her disease although extensive might have experienced an unusual spontaneous regression. This case can provide further insights into this unusual neonatal infection.

Complicaciones agudas en neonatos de término con asfixia perinatal severa / Acute complications in newborns with severe perinatal asphyxia

En un grupo de 50 recién nacidos de término, con asfixia grave al nacer, definida por un pH de arteria umbilical igual o menor de 7.10, se evaluaron las complicaciones sistémicas agudas, los antecedentes perinatales y se correlacionó el pH de cordón con la calificación de Apgar. En 56 por ciento de los casos, no se detectó la asfixia antes del nacimiento; la causa más frecuente de ella fue el trabajo de parto o periodo expulsivo prolongado, seguida del desprendimiento prematuro de placenta. El riñón y el sistema nervioso central se afectaron en casi la mitad de los casos; un 24 por ciento de los neonatos tuvieron enfermedad pulmonar grave, un porcentaje similar tuvo afectación cardiovascular y 44 por ciento tuvo hipocalcemia. No hubo correlación entre calificación de Apgar y pH de cordón. La mortalidad fue de 22 por ciento y su causa principal fue la Hipertensión Pulmonar persistente

Perforaciones intestinales espontáneas en recién nacidos: una forma de enterocolitis necrosante / Spontaneous intestinal perforations in newborn infants: a form of necrotizing enterocolitis

El presente estudio incluyó doce recién nacido prematuros con perforaciones gastrointestinales "espontáneas", estudiados retrospectivamente durante tres años. Se encontró que le problema fue más frecuente en niños extremadamente prematuros con síndrome de dificultad respiratoria y persistencia de conducto arterioso. Se hizo correlación anatomo patológiuca con las biopsias o estudios post-mortem y se sugiere que las perforaciones intestinales "espontáneas" probablemante representan una forma de enterocolitis necrosante. perforación intestinal; enterocolitis necrosante; recién nacido

Candidiasis sistémica / Systemic candidiasis

Se presenta el análisis de 15 pacientes con candidiasis sistémica (CS) en una unidad de cuidado intensivo neonatal, dos de ellos diagnosticados en autopsia. La mayoría fueron productos pretérmino con peso menor de 2000 g, estancia hospitalaria prolongada y tuvieron antecedentes de catéter umbilical o venoso central, alimentación parenteral, asistencia a la ventilación, infecciones bacterianas a distintos niveles y uso de múltiples antimicrobianos. Los sitios de donde se aisló Candida albicans con más frecuencia fueron orina y sangre. Como tratamiento se empleó amfotericina, ketoconazole o ambos y la sobrevida fue del 60%, la cual es aceptable y similar a estudios recientes. Se considera que el diagnóstico de CS es difícil y a veces tardía. Debe sospecharse en un neonato pretérmino con uno o más de los factores predisponentes y que además presente signología de septicemia y no responda a los antimicrobianos o bien, se le demuestre el hongo en orina o en cualquier otro sitio