Hemophagocytic lymphohistiocytosis (HLH) in a 25-year-old presenting with multisystem organ failure.

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of extreme inflammation caused by pathologic activation of the immune system. Diagnosis of HLH is challenging as the clinical presentation is similar to common medical entities such as sepsis. When a source of the extreme inflammation is not found, HLH should be considered in the differential diagnosis. In HLH, inflammatory markers such as soluble CD25 and ferritin levels are elevated. Ferritin assay is widely available at most institutions; a level greater than 10,000 is highly suggestive of HLH.2 Delayed diagnosis and failure to initiate cytotoxic chemotherapy will result in a fatal outcome.

Prevention of Neonatal Hypoglycemia With Oral Glucose Gel for High-Risk Newborns.

BACKGROUND: Neonatal hypoglycemia (glucose <47) is the most common metabolic problem in newborns (incidence 5% - 15%) and can cause adverse outcomes, even in the absence of noticeable symptoms. Oral glucose gel (OGG) is safe and effective for treatment of neonatal hypoglycemia. In order to reduce interventions such as intravenous (IV) dextrose administration and neonatal intensive care unit (NICU) transfer, in October 2017, we implemented a protocol in our Level 1 rural community hospital to identify newborns with asymptomatic hypoglycemia based on risk factors and treat them with OGG. Risk factors include large or small size for gestational age, maternal gestational diabetes, preterm and late preterm birth, and newborns requiring resuscitation. METHODS: Chart review was performed for all infants born at our hospital from October 1, 2016 through September 30, 2018. Data for year 1-the period before protocol implementation (October 2016- September 2017)-was compared to post implementation data from year 2 (October 2017-September 2018). RESULTS: There was a significant risk reduction in newborns requiring interventions due to hypoglycemia after protocol implementation (P = 0.029, Student t test). In year one, 7 of 310 total newborns required IV dextrose or NICU transfer related to neonatal hypoglycemia. In year two, 108 out of 250 total newborns were tested for asymptomatic hypoglycemia based on risk factors identified in the protocol. Of those tested, 31 newborns demonstrated hypoglycemia and received OGG. None of the 250 newborns required further associated interventions. CONCLUSION: Protocol-based hypoglycemia testing based on risk factors with subsequent OGG administration was effective in reducing the need for IV dextrose and NICU transfer from our Level 1 rural community hospital.