Clinical course of community-acquired respiratory syncytial virus pneumonia in newborns hospitalized in neonatal intensive care unit.

INTRODUCTION: Respiratory syncytial virus (RSV) is a major cause of pneumonia in infants worldwide. We aimed to evaluate the clinical course of community-acquired RSV pneumonia in newborns hospitalized in neonatal intensive care unit. MATERIALS AND METHODS: All the newborns diagnosed as pneumonia were prospectively evaluated for RSV infection between November 2010 and April 2011. Fifty-four specimens of nasopharyngeal secretions were tested in parallel with the RAT and the multiplex real time polymerase chain reaction (RT- PCR). Downes' score was used to assess the disease severity in patients with pneumonia. RESULTS: RAT has a sensitivity of 90% and a specificity of 78.5%, as the PCR technique target assay. Four of the patients with RSV pneumonia had secundum atrial septal defect (ASD) and all of four needed mechanical ventilation support. The first day Downes' score was positively correlated with time of intravenous fluid requirement (p= 0.001, r= 0.48), total oxygen need (p= 0.000, r= 0.63), and re-enteral feeding (p= 0.001, r= 0.46). Blood pH (p= 0.031, r= 0.46) were negatively correlated with Downes' score. The second day Downes' score was higher in patients with ASD than those of without ASD (3.8 ± 2.6 vs. 2 ± 1.1, p= 0.01). The most possible risk factor for longer hospital stay was the higher second day Downes' score (p= 0.02 OR: 1.9, CI 95% (1.1-3.2). All infants were discharged from hospital in a good health. CONCLUSION: RAT is sensitive and specific in detecting RSV infections in newborns. Physicians may use Downes' score for evaluation of disease severity in infants with RSV pneumonia. In these patients, ASD has increased the disease severity.

Can intrauterine death of a co-twin result in renal failure in the survivor?

Multiple pregnancies are characterized by significantly higher rates of intrauterine and perinatal morbidities and fetal death compared to singleton pregnancies. It is well known that the death of a co-twin during the second and third trimester can cause damage in the other fetus. Here we report two newborn cases presenting with renal failure probably caused by intrauterine death of their co-twins shortly before birth.

Non benign neonatal arrhythmias observed in a tertiary neonatal intensive care unit.

OBJECTIVE: To analyze non benign neonatal arrhythmias (NA) observed in a tertiary neonatal intensive care unit (NICU). METHODS: From June 2006 through July 2011, newborns admitted to the NICU for NA or diagnosed as NA after hospitalization were evaluated retrospectively. The newborns with non benign NA were included in the study. RESULTS: During the study period, the incidence of non-benign NA was 0.7 % (n = 55/7880). The mean age at diagnosis was 16.7 ± 1.8 d ranging from 1 d to 90 d. The most common type was supraventricular arrhythmia (SVT) with an incidence of 0.3 %. Univariate analyses showed that there were significant differences between the survived and died infants according types of congenital heart disease (CHD), electrolyte imbalance, and arrhythmias. The mortality rates were higher among infants with obstructive type left-to right shunt and common mixing type CHD. The most dangerous type of electrolyte imbalance was hyperkalemia. CONCLUSIONS: Many arrhythmias could not be noticed at neonatal period even in NICU, implying that it is increasingly important for the physician to be aware of the etiology, development, and natural history of these arrhythmias.