Neonatal invasive fungal infection in England 2004-2010.

Rates of invasive fungal infection are highest among neonates, especially those of low birthweight. This study aimed to describe the current epidemiology of invasive neonatal fungal infections in a UK neonatal infection surveillance network. From 2004 to 2010 prospective multicentre surveillance was conducted by 14 neonatal units using a web-based database. Clinicians then completed a standardized pro forma for each positive fungal blood and/or cerebrospinal fluid culture. The overall incidence was 2.4/1000 neonatal unit admissions and was highest among babies <1000 g (extreme low birthweight, 18.8/1000). Only five infants (6%) were >1500 g. The majority of infections were caused by Candida albicans (59; 69%) and Candida parapsilosis (17; 20%); 33% of infants had received antifungal prophylaxis. Known risk factors (use of central venous catheter, parenteral nutrition, previous antibiotic use) were common among cases. The attributable case fatality rate was 21% (18/84). Extreme low birthweight infants remain at highest risk of invasive fungal infection and prophylaxis should be particularly considered for this group. The number needing to receive prophylaxis to prevent one case varies significantly among units, hence unit-specific decisions are required. Further research is still needed into the optimal empiric and therapeutic strategies.

Radionuclide studies in the evaluation of urinary tract infections.

OBJECTIVE: To estimate the prevalence of vesicoureteral reflux (VUR) and renal scarring in children presenting with culture proven urinary tract infections (UTI). DESIGN: Descriptive study. SETTING: Tertiary care hospital-based study. SUBJECTS: Thirty-two children with proven UTI were evaluated by means of an abdominal ultrasonogram (USG), Technetium-99m Dimercapto Succinic Acid (DMSA) scan and Direct Radionuclide Cystography (DRCG). A micturating cystourethrogram (MCU) was performed to rule out any structural abnormality and to grade VUR. RESULTS: A total of 64 renal units in 32 children were evaluated. DMSA scan showed scarring in 27 renal units (42.2%) in 16 patients. Bilateral renal scarring was more common in older (> 2 yr) children as compared to younger ones (89% Vs 43%; p < 0.05). USG detected abnormalities in 13 renal units (20.3%) in 7 cases. VUR was detected in 37.5% of children of all age group by DRCG. In contrast, MCU showed evidence of VUR in only 13/20 renal units with a sensitivity of 65% as compared to DRCG and did not pick up any additional VUR that could have been missed on the DRCG. Only 3/9 in < 2 yr, in contrast to 10/11 in > 2 yr were positive for VUR on MCU (p < 0.05). However, MCU detected evidence of cystitis in 3 children and a bladder diverticulum in one patient. CONCLUSION: Wherever available, DMSA scan should be considered as a part of the first line investigations in any patient presenting with UTI. DRCG can also be performed in the same sitting to screen for the presence of reflux particularly for girls.

Mortality rates as indicators of cross-cultural development: regional variations in the Third World.

"While infant mortality and the under 5 mortality rates are widely used as measures of development, the death rate among 1-4 year olds may be a more effective measure of socioenvironmental conditions affecting mortality, since this age group is less influenced by genetic and biological factors than infants. This article looks at the relationship between infant, under 5, and 1-4 mortality rates and level of development, immunization, information, access to drinking water and health services, and literacy rates among mothers for 78 less developed countries. The evidence suggests that socioenvironmental variables have greater degrees of correlation with age group 1-4 mortality than infant or under 5 mortality, pointing to the importance of this measure in cross-cultural research."