Opsonic defense to Staphylococcus epidermidis in the premature neonate.

The determinants of opsonic defense to Staphylococcus epidermidis were studied in 47 premature newborns. Opsonic activity for S. epidermidis in serum from premature newborns proved to be proportional to gestational age (r = .664, P less than .001). The level of IgG antibodies to staphylococcal peptidoglycan in neonatal sera was similarly proportional to gestational age (r = .604, P less than .001). However, all opsonic activity of premature neonatal serum proved to be heat labile, i.e., dependent on activation of complement. Thus, no heat-stable, IgG-dependent opsonic activity to S. epidermidis was detected in any of the preterm sera, despite the presence of IgG antibodies to peptidoglycan. Further studies with purified IgG isolated from paired sera from term neonates and their mothers revealed that at similar concentrations the opsonic activity to S. epidermidis of neonatal, transplacentally derived IgG was only 26% of the activity of maternal IgG, a finding that may explain the absence of heat-stable opsonic activity in preterm newborns.

Trisomy 10 mosaicism in a newborn boy; delineation of the syndrome.

The fifth case of trisomy 10 mosaicism is presented. Only in cultured fibroblasts this mosaicism was found, while peripheral lymphocytes revealed a normal karyotype. In comparison with the literature, trisomy 10 mosaicism syndrome is further delineated compromising of failure to thrive, high forehead, hypertelorism, mongoloid eye slant, blepharophimosis, dysplastic, large ears, retrognathia, long slender trunk, marked plantar and palmar furrows, cardiopathy and early death.

Partial trisomy 11q due to paternal t(11q;18p); further delineation of the clinical picture.

We describe an eleven-months-old girl with a partial trisomy 11q due to a paternal t(11;18)(q142;p1131). Clinical symptoms include severe psychomotor retardation, microcephaly, cleft palate, large, beaked nose, micrognathia, short hands and proximally placed thumbs. Moreover, a partial agenesis of the callosal body and a perineal mid-line malformation are present. The clinical picture of the index case is compared with relevant findings in patients with a partial trisomy (11q) and partial monosomy (18p) (Aksu 1977).

Severe pulmonary interstitial emphysema of the right lung treated by selective intubation of the left main bronchus.

As an alternative to surgical treatment, we have selectively intubated the left main bronchus in children with severe pulmonary interstitial emphysema (PIE) of the right lung. Within 12-24 h the unilateral hyperinflation disappeared. We propose that when conservative treatment of unilateral PIE fails, contralateral SBI should be tried before surgical intervention, leading to loss of functioning tissue, is undertaken.

Septicemia due to coagulase-negative staphylococci in a neonatal intensive care unit: clinical and bacteriological features and contaminated parenteral fluids as a source of sepsis.

During the years 1979 to 1981 we experienced an increasing incidence of septicemia due to coagulase-negative staphylococci in the neonatal intensive care unit (NICU). A detailed analysis was performed for the 1981 NICU population. More than 90% of cases occurred in premature infants of low birth weight (less than 2500 g). All septicemic infants were receiving intravenous therapy and total parenteral nutrition (TPN) solutions had been administered to nearly 80% just before or during the septic episode. A case-control study performed for the 1981 NICU population, which included 26 proved cases of coagulase-negative staphylococcal septicemia and 26 matched controls, did not uncover any differences in underlying diseases or modes of treatment between cases and controls. However, the infusion of contaminated TPN fluids was identified as a significant risk factor. Random bacteriological checks of TPN fluids revealed that nearly 20% of these solutions were contaminated, mainly with coagulase-negative staphylococci. The incidence of staphylococcal septicemia in infants who had received contaminated TPN fluids was 10-fold higher than in infants who had received sterile solutions (P less than 0.0005). The majority of coagulase-negative staphylococci isolated from the blood cultures from the NICU were multiply resistant to antibiotics although all isolates were susceptible to cephalothin. Treatment, consisting of removal or replacement of the intravenous devices and the administration of cephalothin and fresh plasma, was universally successful.

Analysis of bacterial infections in a neonatal intensive care unit.

An analysis was made of all cases of infection among 181 neonates admitted to the neonatal intensive care unit (NICU) during one year. Twenty-four per cent had an infection on admission; their infections correlated with prolonged ruptured membranes and the degree and site of colonization. The predominant organisms found in perinatal infections were Staphylococcus aureus, Group B streptococci and Escherichia coli. Thirty per cent acquired a hospital infection. This correlated with the length of the period of instrumentation. The majority of the hospital-acquired infections was caused by Gram-positive cocci (micrococci, Staph. saprophyticus, Staph. aureus, forming 65 per cent of the total), E. coli and Pseudomonas aeruginosa. Most hospital infections were nosocomial and not auto-infection. The outcome of the neonates with hospital infection was good, except for those with pseudomonas infection. Acquisition of hospital infection prolonged the period of hospitalization up to twice that required for neonates without infection.