Ilio-psoas abscess in a neonate

A full-term, small-for-gestational-age, neonate was born 4 days after rupture of the membranes. On the 5th day of life, she developed sepsis due to Klebsiella pneumoniae. On the 18th day of life, the right hip was noted swollen with limited range of motion, but it was painless on passive movements. Ultrasonography revealed abscess of the right ilio-psoas muscle with normal appearance of the right hip joint. Surgical incision and drainage and antibiotic administration resulted in a gradual full recovery. Ultrasonography can confirm the diagnosis of this exceptional clinical entity in neonates, which is difficult to differentiate from septic arthritis of the hip.

Primary cutaneous aspergillosis in neonates: case report and review

A premature neonate (gestational age, 26 weeks) with multiple prematurity-related problems developed primary cutaneous aspergillosis due to Aspergillus fumigatus on the 30th day of life. The infection developed in an area that had been macerated by adhesive tape. During the infection, renovation of the hospital was in progress near the neonatal intensive care unit. The infection was cured with a short course of therapy with amphotericin B. Five cases of primary cutaneous aspergillosis in neonates have been previously reported in the English-language literature. We review these cases and discuss the risk factors and favorable outcome of the disease when treatment with amphotericin B is instituted.

Fetal varicella syndrome with manifestations limited to the eye

The manifestations of fetal varicella syndrome usually involve several organ systems, including skin, ocular, neurologic, gastrointestinal, and genitourinary. Although ocular anomalies have been reported to be as high as 68%, manifestations limited to the eyes is extremely rare. Herein we report the case of fetal varicella syndrome with no clinical signs other than esotropia and a chorioretinal scar.

Prenatal diagnosis of intracranial hemorrhage secondary to maternal idiopathic thrombocytopenic purpura: a case report

We describe a case of a fetus who developed intracranial hemorrhage at the beginning of the third trimester of the pregnancy, possibly secondary to maternal idiopathic thrombocytopenic purpura (ITP). To our knowledge, this is the first reported case of prenatal diagnosis of fetal intracranial hemorrhage occurring in association with maternal ITP. The intracranial hemorrhage was intra- and periventricular, with the development of posthemorrhagic hydrocephalus. Cesarean section was performed at 37 weeks of gestation. The mother did well but the newborn died 2 months later. The problem of ITP of the mother in relation to pregnancy and the effects on the fetus and the infant are discussed.

Prophylactic intravenous administration of immune globulin in preterm infants: effect on serum immunoglobulin concentrations during the first year of life

In a prospective study, serum IgG, IgA, IgM, and IgG subclass levels of 66 preterm infants (gestational age less than or equal to 34 weeks) were measured sequentially from birth to 12 months of life. Infants were divided into two groups, comparable for gestational age, birth weight, sex, and intensive care, on the basis of admission order: the treatment group, consisting of 33 infants who received intravenous immune globulin therapy (0.5 gm/kg at 10-day intervals) prophylactically, and the control group, consisting of 33 infants who did not receive. Twenty of the 33 treated infants received only one infusion and the remaining 13 received two to five infusions. The mean number of infusions per neonate was 1.96. Immunoglobulin measurements showed that the proportion of infants with an IgG level of greater than or equal to 7 gm/L on the tenth and thirtieth days of life was significantly higher in the treatment than in the control group (p less than 0.01). At the same ages, mean serum IgG, IgG1, and IgG2 concentrations were significantly higher in the treatment group (p less than 0.001). Thereafter levels in both groups fell progressively, reaching their lowest point between 3 and 5 months of age. During this period, profound hypogammaglobulinemia (IgG less than 2 gm/L) was observed in 3 of 33 treated and 11 of 33 untreated infants (p less than 0.05). By 3 months of age, mean serum total IgG concentrations were still significantly higher in treated than in untreated infants (p less than 0.05), but the IgG subclass concentrations were not. After the third month, no significant differences between the two groups were observed. Moreover, the sequentially measured serum IgA and IgM levels in the two groups remained comparable from birth to age 12 months. The IgG level at different ages from 3 to 12 months was not correlated with either birth weight or the number of infusions performed during the neonatal period (p greater than 0.1). We conclude that prophylactic intravenous administration of immune globulin to preterm infants with a birth weight of 1000 to 2000 gm, at a dose of 0.5 gm/kg every 10 days, results in maintenance of a satisfactory serum IgG level throughout the high-risk period for infections. Such treatment does not have a suppressive effect on subsequent serum immunoglobulin concentrations.

Cerebrocostomandibular syndrome in four sibs, two pairs of twins

We report four sibs, two pairs of twins, with cerebrocostomandibular syndrome (CCMS). The family history was negative. All four babies had the characteristic features of CCMS, including Pierre-Robin anomalad and rib dysplasia. Cerebral involvement was evident in two of the patients who had suffered perinatal asphyxia. The presence of the syndrome in all four sibs together with the negative family history in previous generations is consistent with Mendelian autosomal recessive inheritance with high penetrance.

Maternal indomethacin therapy in the treatment of polyhydramnios

Fifteen patients with polyhydramnios and clinical symptoms related to excess amniotic fluid volume were treated with indomethacin therapy that was started at a mean gestational age of 27.4 +/- 2.79 weeks and discontinued at a mean gestational age of 32.9 +/- 1.83 weeks. Patients were treated with 2.0 to 2.2 mg of indomethacin per kilogram of body weight per day, either orally or by rectal suppositories. No therapy was administered after 35 weeks, and the duration of therapy was no longer than 4 weeks. The majority of fluid reduction occurred within the first week of treatment. Subsequently, a smaller but steady reduction of fluid was observed. All patients were delivered after 38 weeks with a mean birth weight of 3543 +/- 586.3 gm. Examinations of newborns at birth and follow-up at 3 months, 6 months, and 1 year revealed no adverse effects of indomethacin administration.

Restoration of micturition using microelectric current in experimentally induced spastic urinary bladder in rabbits

The 29 rabbits used in this study were divided into three groups, A (A1 and A2), B, and C. In subgroup A1, 4 animals were used in order to verify whether the contact of an electrode to the sacral nerves results in some abnormality of voiding reflex. In subgroups A1 and A2 (4 animals each) we further studied the micturition function using three parameters: (i) urinary bladder fluoroscopy and radiography, (ii) cystomanometry, and (iii) electromyography of the pelvic floor muscles (external sphinter). In group B (9 rabbits) spastic paraplegia and micturition disturbances resulted from spinal cord compression that was induced by inserting a balloon catheter into the T11-T12 intervertebral foramen. In this group the parameters studied revealed a spastic urinary bladder in all animals. Finally, the 12 animals of group C were rendered paraplegic as described in group B, and microelectrodes were placed over the sacral nerves as in subgroup A1. By applying a specific sequence of sacral nerve stimulation we succeeded in satisfactory urinary bladder emptying as confirmed by the micturition parameters studied: The urinary bladder pressure decreased from 65 +/- 3 to 28 +/- 3 mm Hg. The pelvic floor muscle amplitude was lowered from 130 +/- 7 to 20 +/- 3 microV, and finally the radiological bladder size also decreased from 38 cm2 before voiding to 18 +/- 3 cm2 after voiding. These results indicate that microelectric current stimulation of the sacral nerves, when applied under a specific sequence, could rather satisfactorily restore micturition disturbances, at least in this experimental animal.

Prostaglandin E2 administration in infants with ductus-dependent cyanotic congenital heart disease

Prostaglandin E2 was administered to 22 newborns with ductus-dependent cyanotic congenital heart disease. Twelve patients had pulmonary atresia and ten simple dextrotransposition of the great arteries. Patients were classified into two groups: group 1 (n = 11) received prostaglandin E2 by the intravenous route (dose: 0.01-0.05 microgram/kg per min); group 2 (n = 11) received prostaglandin E2 by the oral route (dose: 35-65 micrograms/kg per 1-4 h). Treatment lasted for 1-90 days. All infants except one of group 2 showed a significant (greater than 10 Torr) increase in PaO2 following PGE2 administration. The mean increase in PaO2 was higher (P less than 0.01) in group 1 (21.8 +/- 1.7, Torr) than in group 2 (15.8 +/- 1.5, Torr). PaO2 fell significantly (P less than 0.01) in five patients of group 1 who continued treatment orally with satisfactory (greater than 30 Torr) levels in four of them. Severe side effects were observed only in group 1. The data show that similarly to prostaglandin E1 infusions, prostaglandin E2, given i.v. or orally, is useful in the management of infants with ductus-dependent cyanotic congenital heart disease. Oral prostaglandin E2, administration is less effective than i.v. infusions, but can be used for long-term, therapy being more convenient and causing minimal morbidity.

Improvement of cerebral circulation by extracorporal collateral between the femoral and the external carotid artery in experimentally induced ischaemia

The purpose of this study was to examine the effect of extracorporal collateral circulation (ECCC) between the femoral and the external artery (ECA) on the cerebral circulation, in experimentally induced ischaemia, in rabbits. The animals were divided in four groups. Seven animals (Group A) were used to determine the injection pressure (150-160 mmHg) at the ECA, necessary to achieve collateral circulation between ECA and internal carotid artery (ICA), after occlusion of ICA. Group B (8 rabbits) was the control group for establishing cerebral ischaemia (CI) by a) ligating the common carotid artery bilaterally, b) coagulating the right vertebral artery and c) exsanguinating the animal (removing 28-30 ml of blood). The induced ischaemia was studied by BP and PCO2 monitoring, CBF measurement, videomicroscopy of surface cerebral vessels, and finally macroscopic and microscopic examination of brain sections. In group C (8 animals)-moderate degree of CI-brain circulation improved in all animals after the application of the ECCC, installed at 135 min after the onset of CI. In 10 animals (group D) with severe and prolonged (225 min) CI, ECCC enhanced the brain circulation in eight animals to a variable degree.