Higher proportion of G2P[4] rotaviruses in vaccinated hospitalized cases compared with unvaccinated hospitalized cases, despite high vaccine effectiveness against heterotypic G2P[4] rotaviruses.

The overall vaccine effectiveness of the monovalent rotavirus vaccine in an observational, prospective, multicentre, hospital-based case-control study in Belgium (RotaBel) was 90%. However, rotavirus genotype and co-infecting pathogens are important parameters to take into account when assessing vaccine effectiveness. In this study we specifically investigated the effect of rotavirus genotypes and co-infecting pathogens on vaccine effectiveness of the monovalent vaccine. In addition, we also investigated the effect of co-infecting pathogens on disease severity. From February 2008 to June 2010 stool samples of rotavirus gastroenteritis cases of a random sample of 39 Belgian hospitals were collected and subsequently genotyped. Fisher's exact tests were performed to investigate the relationships between rotavirus genotype, co-infecting pathogens and disease severity. The vaccine effectiveness of a full series of the monovalent rotavirus vaccine against hospitalized rotavirus gastroenteritis caused by G1P[8] rotavirus strains was 95% (95% CI 77.5-98.7). Against G2P[4], the vaccine effectiveness was 85% (95% CI: 63.7-93.8). G4P[8]- and G3P[8]-specific vaccine effectiveness was 90% (95% CI 19.2-98.7) and 87% (95% CI -5.2 to 98.4), respectively. A post-hoc analysis showed that the genotype distribution was significantly related to the vaccination status (p <0.001), whereby G2P[4] strains were proportionally more prevalent in vaccinated cases than in unvaccinated cases. No statistical associations were found between co-infection status and vaccination status, Vesikari severity score or rotavirus genotype. The high vaccine effectiveness against the individual genotypes implies robust protection of the monovalent rotavirus vaccine against hospitalized rotavirus gastroenteritis caused by the major human rotavirus genotypes. The prevalence of G2P[4] requires continued monitoring.

[Neonatal type 1 pneumococcal meningitis and maternal septicemia]. / Méningite néonatale à pneumocoque de type 1 et septicémie maternelle.

The most common organisms in neonatal meningitis are group B streptococcus and Gram negative enteric bacteriae. Although Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae are the most frequent causes of meningitis in infancy and childhood, they are uncommon in newborns. We report one case of neonatal meningitis and maternal septicemia.

Neurological and neurobehavioural differences between preterm infants at term and full-term newborn infants.

A detailed neurological and neurobehavioural examination was done in 80 preterm infants of 27 to 35 weeks gestation in the first week of life and again at 40 weeks postmenstrual age, and in 40 appropriately-sized full-term infants on the first and fifth days of life. There were several consistent differences between the preterm infants reaching term and the newborn full-term infants. The preterm infants reaching 40 weeks showed less flexion in their posture, and less arm traction, arm recoil and leg recoil than the full-term infants on day 1, although this difference was less apparent by day 5. The preterm infants appeared not to develop the flexor tone of the full-term newborn. The preterm infants demonstrated better visual and auditory orientation and alertness than the full-term infants. The significance of these findings, both for initial neonatal examinations and for subsequent assessments, is evaluated.

Visual function in the preterm and fullterm newborn infant.

Visual function in the preterm newborn infant has been studied by the visual orientation (tracking) technique of the Brazelton neurobehavioural assessment, and by the pattern preference and fixation techniques of Frantz. Both these methods demonstrated the presence of discriminative visual function by 31 to 32 weeks gestation, which by 34 weeks reaches a maturity comparable to the pattern found in fullterm infants. Sequential studies at weekly intervals of preterm infants, ranging in gestation from 28 to 32 weeks, have shown a similar pattern of development of visual function to that of the newborn infant of equivalent postconceptional age. However, comparative studies of visual orientation and pattern preference in the same infants have not shown a close correlation. The assessment of visual function in the preterm newborn infant is a valuable milestone. Aberrations may reflect a dificit in visual function itself, a more broad-based deficit in neurological function, or possibly a response to a generalised illness.

A new approach to the neurological assessment of the preterm and full-term newborn infant.

A method has been developed for the neurological assessment of the newborn infant comprising a carefully selected series of neurological and neurobehavioral items. It is applicable to preterm as well as full-term infants within 24 hours of birth, and can also be repeated sequentially on the same infant. The whole examination is recorded directly on a single sheet which also contains detailed instructions and diagrams. Individual items are scored on a 5-point scale, but no attempt has been made to compute a single total score, as it was thought more advantageous to document a pattern for individual groups of signs. Pilot studies have already demonstrated its sensitivity to perinatal factors such as drugs, asphyxia and infection. The examination can be rapidly documented by residents with no special training in newborn neurology. This method should provide a practical and objective means of monitoring the neurological status of the newborn infant, and also a baseline for longitudinal studies of neurological function in the newborn and developing infant.