Late-onset neutropenia: defining limits of neutrophil count in very low birth weight infants.

OBJECTIVE: To evaluate the incidence, onset, duration, characteristics and importance of late-onset neutropenia (defined as absolute neutrophil count<1500 µl(-1) at 3 weeks of age or later) in a group of very low birth weight (VLBW) infants. STUDY DESIGN: Routine complete blood cell counts (CBCs) obtained from VLBW infants over a period of 7 years were gathered retrospectively, including those of newborns with weekly CBCs taken over a duration of at least 3 weeks. Data were obtained from between January 2003 and December 2009. RESULT: CBCs of 399 newborns were included. Values were obtained from birth to 36 weeks of postnatal age. Late-onset neutropenia was observed in 259 cases (65%). Neutropenic infants had a mean of 0.5 weeks lower gestational age. Late-onset neutropenia was more frequent in children with intraventricular hemorrhage but not in patients who received erythropoietin. The median age of neutropenia onset was 7 weeks in extremely low birth weight infants and 6 weeks in VLBW infants. The fifth percentile of neutrophils between weeks 3 and 4 was 1280 µl(-1) and between weeks 13 and 15 was 500 µl(-1). The average duration was 2 weeks with normalized values after 18 weeks. CONCLUSION: A neutrophil count <1500 µl(-1) after the third week of life is frequently observed in VLBW infants and should not be used as a lower reference limit. The fifth percentile varies according to postnatal age from around 1300 µl(-1) in week 4 of life, decreasing to a nadir of 500 µl(-1) between 3 and 4 months of age. Values normalize in the first year of life.

Primoinfección postnatal por Citomegalovirus (CMV) asociada a lactancia matena en pacientes de riesgo / Post-natal cytomegalovirus (CMV) primo-infection associated to materna breastfeeding in patients at risk

Introducción. Los prematuras son un grupo de alto riesgo para las infecciones por citomegalovirus (CMV). La lecha materna (virolactia) es probablemente la principal fuente de esta infección viral. Material y métodos. Se ha estudiado la presencia de CMV en la leche de las madres de niños prematuros con sospecha de infección viral. El diagnóstico se ha realizado mediante una PCR comercial cualitativa y el cultivo celular Shell-vial. Resultadlos. De los 20 niños estudiados, 8 (49%) presentaron alguna transfusión sanguínea. De ellos, en 6 (75%) la leche materna fue positiva por PCR. En los 2 (25%) restantes se consideró la sangre como causa de infección. De los 12 (60%) no transfundidos, en 7 (58,3%) la leche materna fue positiva por PCR y en 5 (41,7%) negativa. Delos 20 casos estudiados, en 13 (65%) la leche materna fue positiva por PCR frente a CMV. Conclusiones. La leche materna (lactancia) parece ser la principal causa de las primoinfecciones postnatales por CMV en los niños de riesgo (AU)

Introduction. Preterm infants are at greater risk of cytomegalovirus (CMV) infection. Breast milk (virolactia) is probably the main source of this infection. Material and methods. We have studied the presence of CMV in breast milk in the mothers of premature patients with suspected viral infection. The diagnosis was performed using a commercial qualitative PCR and the shell-vial cell culture. Results. Of the 20 children studied, 8 (40%) had a blood transfusion. Of them in 6 (75%) breast milk was positive by PCR. In the other 2 (25%) was considered as a cause of blood infection. Of the 12 (60%) not transfused, 7 (58,3%) breast milk was PCR positive in 5 (41,7%) negative. Of the 20 cases studied, 13 (65%) breast milk was PCR positive for CMV. Conclusions. Breast milk (breastfeeding) seems to be the leading cause of postnatal CMV primary infections in children at risk (AU)

Conjuntivitis postnatal en un paciente premature causada por cytomegalovirus / Cytomegalovirus induced postnatal conjunctivitis in a premature patient

El citomegalovirus (CMV) constituye en la actualidad el principal virus causante de infecciones congénitas, neonatales y perinatales en la población pediátrica sana. La conjuntivitis por CMV es una entidad muy poco frecuente apenas recogida en la literatura. Se presenta ocasionalmente en niños inmunodepremidos con procesos leucémicos. También se ha podido detectar la presencia de CMV en las lágrimas de pacientes con mononucleosis por CMV, enfermos de SIDA y pacientes sometidos a trasplante renal. Se presenta un caso de conjuntivitis neonatal en un paciente con presencia del virus en el tracto respiratorio y orina. Debido a que el proceso inflamatorio y el aislamiento viral sólo se detectó en un ojo, se postula la posibilidad de que el proceso de autoinoculación a través de las manos del paciente sea la causa del proceso (AU)

Cytomegalovirus (CMV) is actually the principal viral etiological agent of congenital, neonatal and perinatal infections in healthy pediatric patients. The conjunctivitis caused by CMV is an infrequent pathology described in the literature. This entity has been occasionally described inimmunossuppresed children with leukemic processes. The virus could be detected in the tears of CMV mononucleosis children, AIDS patients and patients with kidney transplants. We report a neonatal CMV conjunctivitis in a child with this virus in the respiratory tract and urine. Because the inflammatory process and the viral isolation could be detected in one eye only, we postulated that the auto-inoculation, with hands, could be the cause of the conjunctivitis process (AU)

Evolución de los grupos de edad y edad media de los pacientes pediátricos infectados por los virus gripales A y B durante el periodo 1995-2005 / Evolution of the age groups and mean age of the pediatric patients infected by influenza virus A and B during the period 1995-2005

Se ha realizado un estudio prospectivo sobre la evolución de los diferentes grupos de edad y edad media de los pacientes pediátricos (0,05). El subtipado de los virus influenza A ha demostrado que 271 (86,8%) pertenecían al subtipo H3 y 41 (13,2%) al subtipo H1 (p<0,05). La edad media de los pacientes estudiados ha sido de 20,7 meses (intervalo 11 días y 15 años). El 73,8% de los pacientes presentaron una edad situada entre 0-2 años (p<0,05), 14,1% entre 2-5 años, 6,1% entre 6-10 años y 6% entre 11-15 años. El porcentaje medio de pacientes entre 0-5 meses ha sido el 24,8% (intervalo 11,1%-47,3%)y de entre 6-23 meses del 29,9% (intervalo 13,6-58,6%). La circulación del virus influenza B/Hong Kong/330/01 en la temporada 2003-2004 determinó unincremento significativo de la edad media de los pacientes (55,2 meses). La posible aplicación de las nuevas recomendaciones para la vacuna antigripal (mujeres embarazadas en el segundo-tercer trimestre y niños sanos entre 6-23 meses) podría determinar una disminución teórica del 65,2% de todos los casos de infección gripal

We report a prospective study about the evolution of different age groups and median age in pediatric patients (under 15 years) with influenza infection detected in ten consecutive flu epidemics (1995-2005). All respiratory samples were submitted to antigen detection and influenza A and B viral isolation (MDCK cell culture). In this period we studied 10.937 respiratory samples; 4.6% were positive for influenzaciruses (3.5% influenza A and 1.1% influenza B). We studied 414 patients, 234 (56,5%) boys and 180 (43.5%) girls. We detected 312 (75.4%) patients with influenza A and 102 (24.6%) with influenza B (p>0.05). The influenza A subtypes detected were 271 (86.8%) H3 and 41 (13.2%) H1 (p<0.05). The median age of patients was 20.7 months (range 11 days to 15 years (pz0.05)), 14,1% between 2-5 years, 6,1% between 6-10 years and 6% between 11-15 years. the median percentage of patients between 0-5 months was 24.8% (range 11.1%-58.6%). The circulation of influenza B/Hong Kong/330/01 virus in the period 2003-2004 was the main cause of increase in the median age of patients (55.2 months). The application of new anti-flu vaccination recommendations (pregnant women second-third trimester and healthy young children between 6-23 months) could theoretically decrease the 65.2% of all pediatric patients with influenza virus infections

Presentation, clinical course, and outcome of the congenital form of myotonic dystrophy.

We report the clinical experience of 18 patients with the congenital form of myotonic dystrophy, the majority of whom were diagnosed during the neonatal period and monitored from 5 to 14 years. Prematurity associated with congenital myotonic dystrophy gives rise to the severest clinical manifestations. Among them, respiratory involvement is common and is the leading cause of death in the neonatal period. Weakness and foot deformities secondary to muscle involvement are the predominant clinical features of this group of patients from birth to age 3 or 4 years. Once muscle strength improves, learning disabilities and behavioral disturbances become the main clinical problems. All our patients, when tested after 5 years of age, had intelligence quotients under 65, clearly below the average intelligence quotient of their mothers (IQ = 80). There is no relationship between the degree of mothers' and patients' disease. No patient has presented problems with routine immunizations, and no complications were observed in the 7 patients who underwent surgery under general anesthesia. Among the surviving patients, no correlation can be established between severity of disease in the neonatal period and the magnitude of sequelae as teenagers. Mental and behavioral disturbances are the factors which mainly influence the long-term management and prognosis of this cohort of individuals.