Neonatal cutaneous disseminated aspergillosis in a preterm extremely-low-birth-weight infant with favourable outcome at 3-year follow-up: a case report

Invasive disseminated neonatal aspergillosis is an uncommon disease, with only scattered reports in literature in the last few years. Here we report on a 25-week gestational age, 730 g at birth preterm female infant who developed on day-of-life 10 multiple cutaneous exhulcerative lesions in her right arm, trunk and abdomen. Early recognition and diagnosis of these lesions as a due to cutaneous initial symptom of cutaneous disseminated aspergillosis, as well as prompt treatment with Liposomal amphotericin B + Itraconazole, secured successful recovery from the systemic infection. Skin lesions healed without any surgical treatment. The infant was discharged in good health. Long-term follow-up at three years of age revealed normality of all neurodevelopmental and cognitive parameters. To our knowledge, this is one of the very few cases of survival, free from sequelae, for a preterm infant affected by neonatal cutaneous disseminated aspergillosis.     

Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis

Background. Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection. Objective. We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis. Materials and methods. We retrospectively reviewed 28 imaging-guided percutaneous biopsies of the lungs of 24 children with suspected pulmonary aspergillosis. Twenty-two were being treated for malignancy and two for congenital immunodeficiency; 15 had received bone-marrow transplants. The accuracy of the percutaneous lung biopsy was determined by subsequent surgical resection, autopsy, or clinical course. Results. Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in culture. The remaining 18 biopsies revealed no fungi. No patient had progressive aspergillosis after negative biopsy. Invasive pulmonary mold was detected by percutaneous biopsy with 100 % (10/10) sensitivity and 100 % (18/18) specificity. Percutaneous biopsy results influenced the surgical decision in 86 % (24 of 28) of the cases. Bleeding complicated the biopsy in 46 % (13/28) and hastened one death. Conclusion. Percutaneous biopsy of the lung is an accurate technique for the diagnosis of invasive pulmonary aspergillosis and correctly determines which immunosuppressed pediatric patients would benefit from therapeutic pulmonary resection. Received: 18 August 2000 Accepted: 2 November 2000     

Neuropathologic findings in short-term survivors of intraventricular hemorrhage

Intraventricular hemorrhage (IVH) occurs in 31% to 43% of infants weighing less than 1500 g. Intraventricular hemorrhage is rarely an isolated lesion at autopsy. To document associated cerebral abnormality, 24 brains of infants with a diagnosis of IVH and who survived for at least one week were examined. The diagnosis was verified in 20 infants. Choroid plexus hemorrhage and brain calcification had been misdiagnosed as IVH in two infants and in two other infants, IVH was not evident at autopsy. Eleven infants (46%) had choroid plexus hemorrhage. Twenty-two infants (92%) had additional cerebral abnormalities: periventricular leukomalacia, brainstem necrosis, hydrocephalus, or cerebellar necrosis. This study demonstrates that IVH is rarely an isolated abnormality in the preterm infant brain. The associated brain lesions should be considered in attempts to prevent or treat IVH and their presence should be suspected during clinical assessment of survivors.     

Antenatal onset of haemorrhagic and/or ischaemic lesions in preterm infants: prevalence and associated obstetric variables

AIM—To assess the prevalence of an antenatal onset of haemorrhagic and/or ischaemic lesions in preterm infants; to identify possibly related obstetric risk factors.METHODS—A prospective cohort study was made of 1332 infants born at less than 34 completed weeks, using cranial ultrasound, for the presence of antenatal brain lesions (group A) involving the periventricular white matter (PVWM) or central grey matter. Entry criteria were presence of (i) cysts in the PVWM < 7 days; (ii) increased PVWM echogenicity < 6 hours, confirmed to be white matter necrosis at post mortem examination; (iii) a unilateral porencephalic cyst< 3 days; (iv) an intraventricular haemorrhage with unilateral parenchymal involvement < 6 hours; and (v) symmetrical areas of increased echogenicity in the thalami, confirmed to be areas of calcification on post mortem examination. Group B consisted of infants with a normal early neonatal ultrasound scan with subsequent development of the lesions mentioned above.RESULTS—Twenty four cases met the entry criteria for group A: 17 died and five of the seven survivors developed cerebral palsy at follow up. Of the whole cohort, 156 (11.7%) infants died and in 63 (40.3%) of these a large ultrasound lesion was present. In 17 (26.9%) cases this lesion was considered to be of antenatal onset. Sixty eight of the 1176 (5.8%) survivors developed cerebral palsy and this was attributed to antenatal onset in five (7.3%). A comparison of the obstetric risk factors between the infants in group A and B, who either died or developed cerebral palsy, showed a significant difference in gestational age between the two groups (30.9 vs 28.9 weeks; p<0.001). Prolonged rupture of membranes was significantly more common in group B (p=0.03), while an ominous cardiotachogram was significantly more common in group A (p=0.01), and this remained significant following logistic regression analysis.CONCLUSIONS—Although these data suggest that most preterm infants did not develop their brain lesions in utero, an antenatal onset was not uncommon, especially in those with PVWM lesions, who did not survive the neonatal period.     

Agreement of invasive versus non‐invasive blood pressure in preterm neonates is not dependent on birth weight or gestational age

Purpose: Blood pressure constitutes an important parameter in the assessment of the cardiovascular status in preterm infants. Invasive arterial blood pressure (IBP) is considered the ‘gold‐standard’, but non‐invasive blood pressure (NIBP) is used frequently in preterm infants. The aim of this prospective study was to compare mean IBP and mean NIBP arterial blood pressure measurements in three subsets of preterm infants (>1500 g; 1000–1500 g, and <1000 g, and >31 weeks, 28–31 weeks, and <28 weeks of gestation). Methods: Prospective, simultaneous assessment of both IBP and NIBP measurements in 50 preterm neonates at 6, 12, 18, 24 h after birth in a tertiary University centre. Results: Mean gestational age was 26.7 ± 2.2 (24–32) in group I (n= 18), 29.6 ± 2.0 (27–34) in group II (n= 19) and 32.2 ± 1.9(30–36) weeks in group III (n= 13), respectively; mean birth weight was 777 ± 161 (495–995), 1251 ± 154 (1010–1490) and 2010 ± 332 (1590–2550) g. Mean IBP and mean NIBP increased significantly during the first 24 h of life in all three sub‐groups (P < 0.01); IBP and NIBP measurements were significantly correlated, and showed good agreement, irrespective of birth weight and gestational age. Conclusions: Although IBP monitoring is considered the ‘gold standard’, NIBP values showed good agreement with those obtained invasively irrespective of gestational age and birth weight. We conclude that NIBP monitoring constitutes an important parameter in the assessment of the cardiovascular status even in extremely low birth weight infants.     

The clinical presentation of preterm cerebellar haemorrhage

The objective of this study was to evaluate clinical symptoms and findings on cranial ultrasound (CUS) in preterm infants with cerebellar haemorrhage through retrospective analysis of all preterm infants with a postnatal CUS or MRI diagnosis of cerebellar haemorrhage admitted in a tertiary care centre between January 2002 and June 2009. Fifteen infants were identified; median gestational age was 25 2/7 weeks and median birth weight 730 g. We discerned six types of haemorrhage: subarachnoid (n = 3), folial (n = 1), lobar (n = 9, of which 4 bilateral), giant lobar (n = 1, including vermis) and contusional (n = 1). Especially in infants with lobar cerebellar haemorrhage, CUS showed preceding or concurrent lateral ventricle dilatation, mostly without intraventricular haemorrhage (IVH). Thirteen infants suffered from notable, otherwise unexplained motor agitation in the days preceding the diagnosis. In conclusion, motor agitation may be a presenting symptom of cerebellar haemorrhage in preterm infants. Unexplained ventriculomegaly can be a first sign of cerebellar haemorrhage and should instigate sonographic exploration of the cerebellum.     

Incidence of apnoea and bradycardia in preterm infants following triple antigen immunization

Ninety-seven preterm infants were immunized with diphtheria-tetanus-pertussis (DTP) prior to discharge from hospital. The mean gestational age at birth was 28.1 weeks (range 24-34) and the mean age at immunization was 80.6 days (range 44–257). Nineteen (20%) infants developed apnoea or bradycardia within 24 h of immunization. The infants who developed apnoea and/or bradycardia had a younger gestational age at birth than those who did not (P= 0.03), were artificially ventilated for longer (P= 0.01) and were more likely to have a diagnosis of chronic lung disease (P= 0.006). In the majority of infants these events were not clinically significant. Two infants who developed concurrent upper respiratory tract infections required additional oxygen and one of them was treated with oral theophylline. In general, it is safe practice to immunize preterm infants with DTP unless otherwise contraindicated. However, it is recommended that cardiorespiratory function is monitored after immunization in very preterm infants who had prolonged ventilatory support and/or chronic lung disease.     

早产儿侵袭性真菌感染的防治

侵袭性真菌感染是早产儿致死和致残的重要原因,近年来,国内相关报道日益增多.该文对早产儿侵袭性真菌感染的国内外发生现状及诊断、治疗和预防方面的进展作一简要介绍.     

Intussusception in preterm infants: case report and literature review

Intussusception is an extremely rare disorder in preterm infants. An infant of 29 weeks gestational age with this condition is reported and a retrospective analysis of 17 previously reported cases presented. In the reviewed preterm infants, risk factors for intussusception seemed to be multifactorial. Clinical features included severe abdominal distension (17/17), gastric aspirates (13/17), commonly bilious, bloody stools (10/17) and rarely a palpable abdominal mass (5/17). Diagnostic features were signs of small bowel obstruction on the abdominal radiographs. Signs and symptoms were similar to those seen in necrotizing enterocolitis, therefore difficulties in establishing a correct diagnosis led to an average delay of 7 days between the onset of symptoms and abdominal surgery, increasing the risk of developing a compromised bowel. Conclusion The differential diagnosis of an intussusception should be considered in preterm infants with acute abdominal distension and tenderness. Received: 7 September 1998 / Accepted in revised form: 17 March 1999     

早产儿血清S100B蛋白与脑损伤的关系

目的：探讨血清S100B蛋白在早产儿脑损伤中的变化及意义。方法：47名早产儿纳入本研究,根据影像学MRI和头颅B超检查结果分为无脑损伤组（20 例）、非脑白质损伤组（14例）和脑白质损伤组（13例）。留取生后＜24 h、72 h及7 d的血清样本,采用酶联免疫吸附测定法（ELISA）双抗体夹心法测定S100B蛋白水平。结果：脑白质损伤组和非脑白质损伤组出生后24 h、72 h及7 d血清S100B蛋白水平均明显高于无脑损伤组（P＜0.05）,且脑白质损伤组血清S100B蛋白水平在各监测时间点明显高于非脑白质损伤组（P＜0.05）。结论：脑损伤早产儿生后7 d内血清S100B蛋白水平增高,提示血清S100B蛋白可以作为一种脑损伤的早期敏感标志物,对于临床早产儿脑损伤特别是脑白质损伤的诊断更有意义。     

Periventricular leucomalacia and neurodevelopmental outcome in preterm infants.

During an 18 month period, 120 preterm infants of 34 weeks'' gestation or less were prospectively examined for periventricular leucomalacia (PVL) by cerebral ultrasound. Neurological and developmental assessment was carried out at 18 months of age corrected for prematurity in 82 surviving neonates. The developmental outcome (Griffiths development quotient) was above 80 and similar in infants with normal scans (n = 41), isolated periventricular-intraventricular haemorrhage (n = 13), and post-haemorrhagic hydrocephalus (n = 4), and no major handicap was diagnosed in these groups. By contrast, the prognosis was variable and poorer in infants with PVL (n = 24) and depended on the extent and site of the lesion. Infants with frontal PVL (n = 13) developed normally. Major sequelae (n = 8) were closely related to frontal-parietal PVL and frontal-parietal-occipital PVL and could be ascribed to the presence of cysts as well as to a persistent hyperechogenic ultrasonographic PVL appearance. A relation between size and site of the lesion and type and severity of the handicap was established.     

Visual performance in preterm infants with brain injuries compared with low-risk preterm infants

Background

Neonatal brain injuries are the main cause of visual deficit produced by damage to posterior visual pathways. While there are several studies of visual function in low-risk preterm infants or older children with brain injuries, research in children of early age is lacking.

Aim

To assess several aspects of visual function in preterm infants with brain injuries and to compare them with another group of low-risk preterm infants of the same age.

Study design and subjects

Forty-eight preterm infants with brain injuries and 56 low-risk preterm infants.

Outcome measures

The ML Leonhardt Battery of Optotypes was used to assess visual functions. This test was previously validated at a post-menstrual age of 40 weeks in newborns and at 30-plus weeks in preterm infants.

Results

The group of preterm infants with brain lesions showed a delayed pattern of visual functions in alertness, fixation, visual attention and tracking behavior compared to infants in the healthy preterm group. The differences between both groups, in the visual behaviors analyzed were around 30%. These visual functions could be identified from the first weeks of life.

Conclusion

Our results confirm the importance of using a straightforward screening test with preterm infants in order to assess altered visual function, especially in infants with brain injuries. The findings also highlight the need to provide visual stimulation very early on in life.     

Non-invasive blood pressure monitoring in preterm infants receiving intensive care

It is essential to have regular, accurate blood pressure (BP) monitoring of sick preterm infants. Invasive direct arterial BP measurements are often recommended, but it was our clinical experience that such measurements may not be possible in all infants. We therefore assessed the proportion of infants receiving neonatal intensive care in whom reliable arterial BP measurements could be made, the accuracy of a non-invasive method (Doppler technique) and established a reference range of BP results related to postnatal age using this non-invasive technique. Arterial catheters were established in 44 infants (study population) of the 45 in whom access was attempted. Median gestational age was 27 weeks and birth weight 949 g. Over the 1st week, however, arterial catheters had to be removed because of complications or improving respiratory status. From those catheters that remained in situ, accurate measurements were not always possible because of damping; by day 7 only 22 catheters remained in situ and 14% of the arterial waveforms were damped. Doppler systolic BP measurements correlated well with the accurate (non-damped) arterial results (r=0.96,P<0.01). Systolic blood pressure was measured on all 44 infants daily for the 1st week using the Doppler technique and increased linearly with increasing postnatal age (r=0.92,P<0.01) from a mean of 41.7 mm Hg on day 1 to 49.3 on day 7. We conclude that Doppler non-invasive BP monitoring is a useful method for regular monitoring of sick preterm neonates as it can be applied accurately, unlike direct arterial monitoring, to all patients.     

Component concentrations and activation of the complement system in neonatal illness: A preliminary study of necrotizing enterocolitis

Determinations of C3, C4, and C5 concentrations by radial immunodiffusion, and assays for the activation products of C3, C3c and C3d by counter-immunoelectrophoresis, were performed on 80 infants. Seven nonbacteremic preterm infants with necrotizing enterocolitis (NEC) or probable NEC (PNEC) were found at the time of diagnosis to have a significantly lower mean concentration of C3 (P<0.05, 1-tailed) without C3 activation when compared to other noninfected preterm infants. Ten full-term and 63 preterm infants were studied prospectively during the first days of life, and were then followed for the postnatal development of localized or systemic infection. Assays for the detection of C3 activation products were negative in all these infants. Four preterm infants who developed PNEC after 5 or more days without clinical illness had low original concentrations of complement components. The pathogenesis of NEC may not involve primarily complement activation, and susceptibility to this condition may be related to pre-existing deficiencies in complement component concentrations relative to gestational age, or to defective activation of C3 in the presence of certain bacterial species and strains.This investigation was supported in part by a grant (RR-00081) from the General Clinical Research Centers Program of the Division of Research Resources, National Institutes of Health, and by a grant from the Kroc Foundation to John J. Miller, III     

早产儿侵袭性真菌感染的预防和治疗

新生儿,特别是早产儿是侵袭性真菌感染的高危人群,造成早产儿相关疾病的发病率和病死率的增加,如何预防和治疗侵袭性真菌感染,减少其对早产儿的损伤,成为新生儿科医生关注的热点.本文主要对早产儿侵袭性真菌感染的预防和治疗作重点阐述.     

双胎输血综合征早产儿合并心脏发育异常的临床分析

目的 探讨双胎输血综合征（TTTS）早产儿合并症发生情况,分析TTTS受血者合并心脏发育异常的临床情况及预后。方法 对2009年6月至2012年12月收治的17对确诊TTTS的早产儿进行回顾性分析。结果 TTTS早产儿供血者体重（1.4±0.6 kg）较受血者体重（1.9±0.6 kg）明显减轻（P结论 TTTS受血者心脏瓣膜病变和心肌病变合并症发生率高,受血者应该尽早完善胎儿超声心动图,评估心功能,早期治疗以改善预后。     

新生儿生后血清神经元特异性烯醇化酶浓度的动态变化

目的 了解新生儿生后血清神经元特异性烯醇化酶(NSE)的浓度变化.方法 选取无窒息史、无神经系统疾病史的20 例足月儿及同期出生的30 例早产儿作为研究对象.30 例早产儿中,晚期早产儿和早期早产儿各15 例.应用电化学发光法测定新生儿生后第1、3、7 天血清NSE 浓度.10 例正常成人作为对照组.结果 足月儿组与两个早产儿组出生后血清NSE 含量均随日龄增加而逐渐降低(PPP结论 新生儿生后早期血清NSE 含量高于成人正常参考值,且与出生胎龄与日龄有关,故应根据胎龄与日龄确定新生儿血清NSE 的参考值,不应以成人指标界定其值正常与否.     

Brain positron emission tomography in preterm and term newborn infants

Objective

To study the clinical values of positron emission tomography (PET) in preterm and term newborn infants through observing brain glucose metabolism by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET.

Method

To observe the brain ¹⁸F-FDG PET imaging in 9 term and 7 preterm newborn infants in the same condition after administration of 0.1 mCi/kg ¹⁸F-FDG.

Result

The brain ¹⁸F-FDG PET imaging showed that the uptake of ¹⁸F-FDG was relatively more in the thalamus, and less in the cerebral cortex in preterm and term newborn infants. The uptake of ¹⁸F-FDG of cerebral cortex in preterm infants was less than that in term infants, so the structure of brain ¹⁸F-FDG PET imaging was a little fainter in preterm neonates as compared with that in term newborns.

Conclusion

¹⁸F-FDG PET imaging could show different glucose metabolisms of brain in preterm and term infants. Brain ¹⁸F-FDG PET imaging might be a useful tool for estimating the brain function in newborn infants, and its clinical values need further investigation.     

枸橼酸咖啡因治疗对呼吸暂停早产儿早期肺功能的影响

目的探讨枸橼酸咖啡因治疗早产儿呼吸暂停(AOP)对患儿早期肺功能的影响。方法 40例AOP患儿随机分为氨茶碱治疗组(20例)和咖啡因治疗组(20例)。2组患儿均在生后出现呼吸暂停时在经鼻持续气道正压通气(NCPAP)辅助通气的基础上给予氨茶碱或枸橼酸咖啡因治疗,停药后行肺功能检测,比较两组之间肺功能的变化。结果治疗后咖啡因治疗组潮气量、每分通气量、达峰时间比、达峰容积比、潮气呼吸呼气峰流速及75%、50%、25%潮气量时呼吸流速均高于氨茶碱治疗组(P0.05);咖啡因治疗组用氧时间、NCPAP使用时间均低于氨茶碱治疗组(P0.01)。与氨茶碱治疗组比较,咖啡因治疗组用药7d后呼吸暂停发生频率明显减少(P0.01)。结论枸橼酸咖啡因治疗AOP可以改善患儿早期肺功能,减少呼吸暂停的发生。     

Intestinal blood-flow velocity in uncomplicated preterm infants during the early neonatal period

Background. Intestinal blood-flow changes after birth. Objective. To elucidate the factors influencing intestinal blood-flow velocity in preterm infants during the early neonatal period. Materials and methods. We measured blood-flow velocity in the superior mesenteric artery by pulsed Doppler US in 44 uncomplicated infants with a gestational age of less than 34 weeks and from 1 to 6 days of age. Results. Time-averaged mean blood-flow velocity significantly increased with age from 1 to 6 days old. There was a significant correlation of time-averaged mean blood-flow velocity with birth weight at 1, 2, 4, 5 and 6 days of age and with the amount of enteral feeding from 4 to 6 days of age. Multivariate analysis showed that partial correlation of time-averaged mean blood-flow velocity with birth weight at 2 days of age and that with the amount of enteral feeding at 5 days of age were significant. End-diastolic blood-flow velocity was significantly lower at 1 day of age in infants with patent ductus arteriosus than those without it. Conclusions. Age, birth weight, the amount of enteral feeding and patent ductus arteriosus are included in the determinants of intestinal blood-flow velocity in preterm infants. Received: 27 February 1998 Accepted: 30 November 1998