Methicillin-Resistant Staphylococcus aureus Pneumatoceles in a Neonate With Sotos Syndrome : A Case Report.

BACKGROUND: Necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus can lead to the formation of pneumatoceles in the lungs. Standard treatment guidelines are not available due to the rarity of pneumatoceles in neonates. CLINICAL FINDINGS: Baby H. required prolonged respiratory support and supplemental oxygen to maintain appropriate oxygen saturation parameters for infants more than 34 weeks' gestation corrected. He was found to have multiple pneumatoceles in both lungs on different radiological modalities. PRIMARY DIAGNOSIS: Baby H. was a former 32.2-week gestation male infant diagnosed with pneumonia caused by necrotizing methicillin-resistant Staphylococcus aureus leading to pneumatocele formation in both lungs. INTERVENTIONS: Baby H. was managed with aggressive antibiotic therapy and then was conservatively managed until he received a tracheostomy tube on day of life (DOL) 75 to prepare for discharge home. OUTCOMES: Baby H. was discharged from the neonatal intensive care unit (NICU) on DOL 113 with a tracheostomy tube for prolonged mechanical ventilatory support and a gastrostomy tube for nutrition. Numerous follow-up appointments with specialists have occurred since discharge. PRACTICE RECOMMENDATIONS: While methicillin-resistant Staphylococcus aureus pneumatoceles are uncommon in the NICU setting, it is important for neonatal care providers to be aware of the causes and treatment choices currently available. Although conservative therapy is commonly utilized, it is important that nurses learn other available management strategies such as the ones highlighted in this article to best advocate for their patients.

Central Precocious Puberty in an Infant with Sotos Syndrome and Response to Treatment

Sotos syndrome (SS) is characterized by overgrowth, distinctive facial appearance, and learning disability. It is caused by heterozygous mutations, including deletions of NSD1 located at chromosome 5q35. While advanced bone age can occur in some cases, precocious puberty (PP) has only been reported in three cases previously. Here, we reported a case of SS diagnosed in the infancy period with central PP. The discovery of potential factors that trigger puberty is one of the central mysteries of pubertal biology. Depot gonadotropin-releasing hormone analogs constitute the first-line therapy in central PP (CPP), which has proven to be both effective and safe. In our cases, leuprolide acetate at maximum dose was not successful in controlling pubertal progression, and cyproterone acetate (CPA) was added to therapy, with successful control of pubertal progression. In some specific syndromes with PP, such as SS, treatment can be challenging. CPA may be an asset for effective treatment.

Dornase alpha inhalations as a treatment option for recurrent lower respiratory tract infections in a child with Sotos syndrome.

Recurrent episodes of lower respiratory tract infections (LRTIs) are a rare complication of muscular hypotonia in patients with Sotos syndrome. We report on a male child suffering from repeated LRTIs including bronchitis, pneumonia, and atelectasis during infancy despite inhalations with salbutamol and fluticasone combined with manual chest percussion therapy. After initiation of dornase alpha inhalations in addition to the current treatment, we observed an improvement in the respiratory symptoms as well as a reduction in the rate of hospitalizations and in the occurrence of LRTIs. We assume that dornase alpha inhalations, in combination with airway clearance techniques, reduced the viscosity of airway secretions and by this improved mucociliary clearance and coughing efficiency.