Pseudo-maple syrup urine disease due to maternal prenatal ingestion of fenugreek.

Fenugreek, maple syrup and the urine of maple syrup urine disease (MSUD) patients all share a characteristic odour originating from a common component, sotolone. Ingestion of fenugreek by mothers during labour resulted in a maple syrup-like odour in their newborn infants, leading to a false suspicion of MSUD.

Ectopic liver tissue within the umbilical cord.

A solid mass in the umbilical cord is a very rare finding. A neonate with isolated ectopic liver tissue found in the umbilical cord is reported. This is the first known such reported case.

Enterobacter sakazakii infection in the newborn.

UNLABELLED: Enterobacter sakazakii, a Gram-negative bacillus, previously known as "yellow pigmented Enterobacter cloacae", is a rare cause of neonatal infection. We describe the detailed clinical presentation of two cases in whom E. sakazakii was isolated in our neonatal service during the course of 1 mo. These include one case of sepsis and meningitis complicated by cerebral infarction, and one case of sepsis. In addition, three cases of intestinal colonization were identified. The source of the organism was thoroughly sought and was found to be a blender in the milk kitchen that was used for preparation of the reconstituted powdered milk formula. CONCLUSION: Our paper adds clinical and laboratory information about the disease spectrum caused by this relatively rare organism and emphasizes the importance of a thorough search for the source of the infection.

Neonatal bacteremia: patterns of antibiotic resistance.

OBJECTIVE: To determine the incidence and evaluate the antimicrobial-susceptibility patterns of bacterial infections in our neonatal units. DESIGN: Retrospective surveillance study. SETTING: The neonatal units of the Hadassah University Hospitals, Jerusalem, Israel. PATIENTS: All newborns admitted from January 1994 through February 1999. METHODS: The records of all patients with positive blood and cerebrospinal fluid cultures were reviewed. Bacteremia was considered early-onset (vertical) when occurring within the first 72 hours of life and late-onset (nosocomial) when occurring later. The prevalence and antibiotic-resistance patterns of vertically transmitted and nosocomially acquired strains were compared and studied over time. RESULTS: 219 of 35,691 newborn infants had at least one episode of bacteremia (6.13/1,000 live births). There were 305 identified organisms, of which 21% (1.29/1,000 live births) were considered vertically transmitted and 79% nosocomially acquired. The most common organism causing early-onset disease (29.2%) was group B streptococcus (0.38/1,000 live births), whereas coagulase-negative staphylococci (51%) were the most prevalent in late-onset disease. All gram-positive bacteria were susceptible to vancomycin. Most gram-positive organisms other than staphylococci were susceptible to ampicillin. Gram-negative organisms represented 31% of all isolates. Generally, there was a trend of increasing resistance to commonly used antibiotics among nosocomially acquired gram-negative organisms, compared to those vertically transmitted, with statistically significant differences for ampicillin and mezlocillin (P<.05 and P<.01, respectively). Over the years, a trend toward an increasing resistance to antibiotics was observed among gram-negative organisms. CONCLUSIONS: The trend of increasing bacterial resistance to commonly used antibiotics necessitates the implementation of a rational empirical treatment strategy, based on local susceptibility data, reserving certain agents for emerging resistant pathogens.

Aquagenic urticaria in a child.

A healthy 3-year-old boy developed acute urticaria five minutes after exposure to tap water in different areas of Jerusalem. Physical examination and baseline laboratory evaluation were within normal limits. The clinical picture and possible mechanisms of aquagenic urticaria are reviewed. This is the youngest patient to be reported.