Effect of domperidone on the QTc interval in premature infants

OBJECTIVE

To evaluate the effect of domperidone use on corrected QT interval in premature infants.

STUDY DESIGN

A prospective study of premature infants receiving domperidone was included in this study. A baseline electrocardiogram was obtained just before and 3, 7 and 14 days after initiation of domperidone. Corrected QT was considered prolonged if it exceeded the upper limit for age.

RESULT

A total of 40 premature infants were enrolled in this study. The mean birth weight of 1109+/-332 g, mean gestational age of 28.8+/-2.4 years and mean age at the onset of domperidone were 32.8+/-2 days. No difference in corrected QT interval was observed between just before and 3, 7 and 14 days after the start of the treatment. Two infants had corrected QT interval prolongation without any clinical side effect that resolved spontaneously.

CONCLUSION

Our experience suggests that domperidone administered cautiously in modest doses does not result in arrhythmias or conduction defects in premature infants statistically. Additional data are needed to give optimal advice regarding the safety of domperidone treatment in premature infants.

H-type tracheoesophageal fistula in an extremely low birth weight premature neonate: appearance on magnetic resonance imaging

Many diagnostic methods have been used to establish the diagnosis for a suspected H-type tracheoesophageal fistula (TEF). In case of a strong assumption of an H-type fistula, besides all standard diagnostic work-up tools a more aggressive combined approach is advisable. However, in a critically ill premature infant, conventional invasive investigations could not be performed as being potentially hazardous and not always easy to achieve. We describe the unique imaging features of an H-type TEF on magnetic resonance imaging (MRI). Our case demonstrates that MR images could be used for diagnosis, and localization of an H-type TEF could be detected safely and accurately in a sick preterm infant.

Cardiac involvement in Sydenham's chorea: clinical and Doppler echocardiographic findings

Sydenham's chorea is often encountered in pure form, but it may also occur in association with carditis. Recently, it has been reported that silent, mild valvular regurgitation has been encountered in patients with rheumatic fever manifested by isolated polyarthritis and pure chorea. We studied 22 children with Sydenham's chorea to determine clinical and subclinical heart involvement at the time of the initial diagnosis. Ages of the patients ranged from 6-19 y (mean 13.14+/-3.0), and the female/male ratio was 3.4:1. All patients were evaluated by clinical and echocardiographic examination with respect to heart involvement. Carditis was detected in only 5 of 22 patients (23%) by auscultation. Clinical valvular involvement was determined: mitral regurgitation in three and combined mitral and aortic regurgitation in two. The frequency of valvular involvement increased significantly to 63% 2(14/22) after adding silent mitral regurgitation detected by colour Doppler echocardiography (chi2=7.50, p=0.0062). We found that clinically inaudible, but echocardiographically significant, mild valvular regurgitation was frequent in patients with pure chorea. It is concluded that colour Doppler echocardiography may be useful in detecting silent valvular regurgitation and in deciding the duration of prophylaxis.

Intravenous immunoglobulin in the treatment of Salmonella typhimurium infections in preterm neonates

The purpose of this study was to determine the role of intravenous immunoglobulin (IVIG) administration in preterm neonates with S. typhimurium infection. A randomized trial of 47 preterm neonates with intestinal or extraintestinal S. typhimurium infection was performed. Neonates were randomly divided into two groups: 22 neonates were only given cefoperazone (group 1); 25 neonates were given cefoperazone plus IVIG (group 2). IVIG was given at a dose of 500 mg/kg on days 1, 2, 3, and 8 after entry into the study. Following treatment, bacteremia, complications, mortality rate, recovery time, and duration of antimicrobial therapy were evaluated in two groups. Bacteremia was found in 31.4% in group 1 and 8% in group 2 (P < .05); complications developed in 81.8% in group 1 and 16% in group 2 (P < 0.01); mortality was 40.9% in group 1 and 12% in group 2 (P < .05). Recovery took 15 days in group 1 and 8 days in group 2 (P < .01). The duration of antimicrobial therapy was 20 days in group 1 and 14 days in group 2 (P < .01). We conclude that IVIG treatment in combination with antibiotics in preterm neonates with S. typhimurium infection reduces the complications, mortality rate, and duration of therapy.

Neonatal sepsis in Turkey: the comparison between penicillin plus aminoglycoside and ampicillin plus third-generation cephalosporin chemotherapies

Bacterial infections during the neonatal period continue to be a major cause of neonatal morbidity and mortality in developing countries. In this study the etiological and clinical features and treatment regimens of 73 neonates with sepsis and suspected sepsis have been analysed. In contrast to developed countries, staphylococci were found to be still common etiological agents and the treatment regimen of ampicillin plus third-generation cephalosporin was highly effective.

Relation between the intestinal flora and diaper dermatitis in infancy

In this study, 40 patients with diaper dermatitis and 20 healthy infants were investigated. Mycological and bacteriological cultures were obtained from affected and healthy skin areas and stool specimens. Candida albicans was isolated simultaneously in 37 out of 40 patients subjected to mycological examination of skin lesions and stool specimen cultures. Of 34 Gram-stained smears from the skin lesions, 27 revealed Candida in hyphal form. In the control group, C. albicans was not grown from the diaper area. No significant difference was observed in the growth of bacteria from the skin with or without lesions (p greater than 0.05). In conclusion, C. albicans-infection originating from the gastrointestinal tract, plays a major role in diaper dermatitis. Thus, a Gram-stained smear can be used as a practical method in early diagnosis.

[Relationship between neonatal group B streptococcal colonization and the maternal urogenital and anorectal system carrier state]

In pregnant women, the main reservoirs of group B streptococci are rectum and urethra. The mother's birth canal and the newborn infant easily contact the organisms from these sites. We studied 40 women and their newborn babies to determine the relation between the maternal carriage and the neonatal group B streptococcal colonization. Vaginal, urethral and rectal swabs obtained from all pregnant women during labor. Within a few minutes after birth and on day 4 of life swab specimens were also taken from the external auditory canal, throat and umbilicus of the infants. The overall maternal carriage rate was found to be 10.0 percent. The frequency of transmission to the neonates was found to be 25.0 percent among maternal carriers. In early neonatal period, the colonization rate of group B streptococci was found to be 2,5 percent among the newborn population.