RT-PCR detection of respiratory pathogens in newborn children admitted to a neonatal medium care unit.

BACKGROUND: This study aimed to determine the prevalence of respiratory pathogens among newborns admitted to a neonatal medium care unit (NMCU) and to identify clinical predictors. METHODS: A 1-y observational study was performed of neonates admitted to an NMCU in Amsterdam, The Netherlands. Nasopharyngeal samples were collected for the detection of respiratory viruses and bacteria by real-time PCR (RT-PCR). Cycle threshold (Ct) values were provided to estimate viral load. Predictors for the presence of study pathogens were identified. RESULTS: From October 2010 through September 2011, 334 neonates (median age 1.3 d, 53.6% male) were included. Overall, 37 respiratory pathogens were detected in 34 children (10.2%): parainfluenza-1 (n = 9), human rhinovirus (n = 7), parainfluenza-3 (n = 6), respiratory syncytial virus (RSV, n = 6), Streptococcus pneumoniae (n = 3), adenovirus (n = 2), human coronavirus (n = 2), influenza A (n = 1), and bocavirus (n = 1). Neonates with higher viral loads (Ct <35; n = 11) were more often clinically ill than those with lower viral loads (Ct ≥35; n = 23). Two variables significantly contributed to the detection of study pathogens: age (odds ratio (OR) 1.21 for each day older; 95% confidence interval 1.12-1.30) and rhinorrhea (OR 6.71; 95% confidence interval 1.54-29.21). CONCLUSION: Respiratory pathogens seem to play a role in neonates admitted to an NMCU. The influence of respiratory pathogen detection on clinical management remains to be determined.

[Venous thrombosis as a first sign of SLE]. / Veneuze trombose als eerste signaal van SLE.

BACKGROUND: Venous thrombosis in children is rare. In adolescents it may be the first manifestation of a chronic disease such as systemic lupus erythematosus (SLE). CASE DESCRIPTION: An obese 12-year-old girl visited the Obesity Clinic and mentioned pain in her right calf. Some time before her arrival she spent time in bed with a respiratory infection. Deep vein thrombosis was diagnosed by ultrasonography. Radiography showed an infiltrate, laboratory tests showed elevated inflammatory parameters, and thrombophilia testing showed a Factor V Leiden mutation as well as the presence of lupus anticoagulants. During her stay she developed haematological, immunological and clinical signs of SLE. CONCLUSION: The cause of venous thrombosis in children is usually multifactorial. Despite the presence of obvious risk factors, it is important to follow adolescents with thrombosis and to be alert for any signs of an underlying systemic disease.

[A newborn with tachypnea]. / Een aterme neonaat met tachypneu.

A neonate developed a tachypnea 2 hours after his birth. Blood measurements showed low infectious parameters and a respirator acidosis. The x-ray showed a pneumomediastinum. A spontaneous pneumomediastinum is rare in newborns, causes can be underlying lung diseases or mechanical ventilation. The treatment prognosis is good; spontaneous recovery without treatment is common.