Kidney injury owing to Streptococcus pneumoniae infection in critically ill infants and children: report of four cases.

Streptococcus pneumoniae sepsis has high morbidity, particularly if complicated by renal injury. Four patients with S. pneumonia invasive infections complicated by renal disorders are presented. The first case was an 18-month-old girl with pneumococcal empyema complicated by haemolytic uraemic (HUS) syndrome. She made a full recovery after mechanical ventilation, inotropic support and haemodiafiltration. The second was a 4-year-old boy who presented with acute post-infectious glomerulonephritis associated with bilateral pneumococcal pneumonia. He too made a complete recovery. The third was a newborn girl with pneumococcal meningitis complicated by acute respiratory distress syndrome and acute renal failure. The fourth patient was an 8-month-old boy with pneumococcal pneumonia and meningitis complicated by HUS and with fulminant thrombotic thrombocytopenic purpura. Despite full support including mechanical ventilation and haemodiafiltration, he died 4 days after admission. On follow-up, all three survivors recovered completely from their pulmonary symptoms and had normal renal function and cardio-circulatory status in the mid-term.

Early erythropoietin influences both transfusion and ventilation need in very low birth weight infants.

OBJECTIVE: The primary outcome measure of this study was the ability of rHuEPOα therapy to reduce transfusion needs, whereas secondary outcome measures were NICU-LOS and ventilation need. METHODS: All babies with BW <1250 g and GA <30 were eligible. Thirty premature neonates were enrolled in the study (10 treated, 20 controls). rHuEPOα was administered as 300 IU/kg/dose 3 times/week subcutaneously. Iron, folic acid and Vitamin E supplementation were administered in both groups. Hematologic variables and blood sampling were recorded during the study. RESULTS: In rHuEPO group, only four (40%) premature infants required a transfusion, averaging 0.4 ±â€Š0.52 transfusions/pts. A total of 23 transfusions were administered to controls; 11 (55%) infants received one transfusion at least, 55% required multiple transfusions. The average number of transfusions/pts was statistically different (1.15  ±â€Š 1.46 vs. 0.4 ±â€Š0.52; p = 0.02), as the cumulative number of transfused patients (55% vs. 40%; p<0.001). NICU stay was not statistically different, whereas ventilation-free days were increased in EPO group (p<0.05). CONCLUSIONS: R-Hu-EPO treatment in first post-natal weeks markedly enhanced erythropoiesis in severely premature infants compared with matched controls, with a significant impact on transfusion needs. EPO group experienced also a reduction of ventilation time and, possibly, a decreased occurrence of clinical BPD.

[The growth of the low-birth-weight neonate: assessment at 3 years]. / Accrescimento del neonato di basso peso: valutazione a 3 anni.

Follow-up studies of low-birth-weight (LBW) neonates have shown a high incidence of growth failure in the first years of life. We evaluated the growth attainment (weight, length and head circumference) in 182 LBW neonates discharged from our Intensive Care Unit between 1982-84 and included in a 3 years follow-up program. The aim of the study is to analyze the correlation between gestational age (GA) and subsequent growth failure. Neonates included in the study were divided in 4 groups (G) according to GA: I G < or = 30 weeks GA; II G = 31-33 weeks GA; III G = 34-36 weeks GA; IV G > or = 37 weeks of gestational age. Growth was evaluated at 40 weeks GA on the basis of Lubchenco and Battaglia centiles, and thereafter at 12, 24 and 36 months according to Scalamandrè greeds. Subnormal weight (< 10 degrees centile) was still evident at 3 years of age in 16.7% of the most premature babies (group I), in 6.2% of babies born between 31 and 33 weeks GA (group II), in 7.1% of babies in group III and in 16.6% of LBW babies born at term of gestation (group IV). Length measurements were satisfactory in PT babies as none of them showed a length < 10 degrees centile by 24 months of age. On the contrary, in the term LBW neonates group 15.6% of babies still showed subnormal length at 3 years of age. Head circumference remained < 10 degrees centile in 16.6% in the I group, in 6.2% in the II group, 21% in the III group and 30% in the IV group.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of oral iodide therapy on neonatal hyperthyroidism caused by maternal Graves' disease.

OBJECTIVE: To verify the efficacy of oral iodide therapy in treating a case of early neonatal hyperthyroidism due to maternal Graves' disease. METHODS: We report a case of neonatal hyperthyroidism which occurred in a 2,650-gram, female baby, born at 39 weeks' gestational age (GA) to a 30-year-old mother affected by Graves' disease and treated with thionamides (propylthiouracil) from the 20th week of gestation. A fetal goiter, due to maternal therapy, had been observed by ultrasound scan at 31 and 35 weeks of gestation, with contemporary low cord thyroid hormone levels. Two intra-amniotic injections of levothyroxine were then performed at 34 and 36 weeks of gestation, which led to a significant reduction of fetal goiter and to normalization of cord thyroid hormone levels. The neonatal clinical course was characterized by symptoms of hyperthyroidism from the 2nd to 3rd days of life (irritability, tachycardia, tachypnea, hyperphagia), mostly during feeding. Oral treatment with potassium iodide (KI, 8 mg x 3 times a day) was started at 23 days of life. RESULTS: Treatment with KI led to a significant reduction of neonatal clinical symptoms and to a normalization of hormone levels within 4 days of therapy. The treatment was discontinued in 13th week of life because of neonatal well-being and normal hormone levels. CONCLUSIONS: We believe that KI therapy is effective in treating neonatal hyperthyroidism and does not cause suppression of neonatal thyroid activity, which is possible using antithyroid drugs like thionamides.