Pantoea agglomerans septicemia in three newborn infants.

Pantoea infections are rare in humans, especially in neonates. Infections are usually associated with plant thorn injury or outbreaks traced to contaminated parenteral nutrition, intravenous anesthetics or packed erythrocytes. Between 1st of January 1994 and 1st of June 2005, 125 of 6383 patients (2%) in a 24-bed level III NICU became colonized with Pantoea agglomerans. Three newborns exhibited late-onset Pantoea agglomerans septicemia and died. Sporadic cases of Pantoea agglomerans septicemia have not been reported in neonatal intensive care so far.

Persistent pulmonary hypertension of the newborn with transposition of the great arteries.

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) in patients with transposition of the great arteries (TGA) is reported to be a high-risk and often therapy-resistant condition, associated with a high mortality. However, data on its incidence and prognosis are scarce and originate mostly from the era before introduction of inhaled nitric oxide (iNO) therapy for PPHN. METHODS: This is a retrospective study of consecutive newborns with TGA, admitted to a tertiary cardiac and neonatal intensive unit over a 10-year period. In this period, iNO therapy was available. RESULTS: Fourteen out of 112 patients with TGA (12.5%) presented with associated PPHN. The PPHN occurred more frequently in patients with TGA and intact ventricular septum (IVS) compared with those with TGA and ventricular septal defect (13 out of 83 patients versus one out of 29 patients, respectively; p = 0.06, Fisher exact test). Of those newborns, six presented with severe PPHN, whereas eight presented with mild-to-moderate PPHN. Despite currently available treatment modalities, including iNO, four out of 14 patients died before corrective surgical procedures were considered to be an option (TGA/PPHN preoperative mortality 28.6%). These included three out of six patients (50%) with severe PPHN and one out of eight (12.5%) with mild-to-moderate PPHN. CONCLUSIONS: The combination of TGA with PPHN is a serious and often fatal condition. It may jeopardize the usually favorable outcome of newborns with TGA. Despite the introduction of iNO therapy, the combination of TGA and PPHN remains a condition with unacceptable high mortality (in our series). Additional treatment strategies need to be investigated.