A prospective study of bacterial infections in the newborn

Neonatal bacterial infections were identified in 1675 consecutive liveborns in Pondicherry. Babies weighing less than 2000 gm at birth had higher incidence of major infections as compared to higher birth weight babies. Minor infections like pyoderma and conjunctivitis occurred with equal frequency in both the weight groups. Commonest organism isolated from neonates with minor infection wasStaphylococcus pyogenes. In cases of septicemia predominant organisms isolated wereKlebsiella, Salmonella, E. coli andPseudomonas aerugenosa, in descending order of frequency. Antibiotic sensitivity pattern of all the organisms showed high sensitivity to gentamycin (94.2%), chloramphenicol (70.3%) and kanamycin (67.3%) and poor sensitivity to streptomycin, tetracycline, ampicillin and penicillin.     

Hyperbilirubinaemia and bacterial infection in the newborn. A prospective study.

The incidence of bacterial infection associated with unexplained hyperbilirubinaemia was determined prospectively in 69 infants under 2 weeks of age. Blood and urine cultures were obtained from all patients, and 22 patients had their CSF cultured. Bacterial infection was documented in only 2 infants, who had asymptomatic Gram-negative urinary tract infection.     

A pediatric case of transfusion-related acute lung injury following bone marrow infusion

TRALI is a rare but serious complication associated with transfusion, and known to occur following infusion of all types of plasma-containing blood products. However, only one adult case of TRALI after allogenic marrow graft has been reported. In this study, we present a pediatric case possibly associated with allogenic marrow infusion. A 10-yr-old girl was referred to our hospital for the treatment of acute myeloid leukemia. She underwent allogenic bone marrow transplantation from her HLA-2-loci-mismatched mother. During conditioning, she suffered from bacterial sepsis, but it had improved with antibiotics until day 0 of transplantation. Two h after starting the marrow infusion, she developed severe hypoxia. We discontinued the infusion and started steroids, which improved her respiratory condition. However, she developed respiratory failure again after resuming infusion of the graft. Despite intensive care with mechanical ventilation, the patient died of endotoxin shock five days after transplantation. Although we could not identify the antibody which might have been involved in the respiratory distress, the clear temporal relationship between marrow infusion and respiratory distress suggested that similar acute lung injury to TRALI might have occurred following allogenic marrow infusion in the present case.     

Spectrum of respiratory distress syndrome in the newborn in North India: A prospective study

A prospective study over a 13 month period was carried out to determine the spectrum of respiratory distress syndrome (RDS) In the newborn. Of 1400 neonates, 116 developed RDS of which 67 were term and 49 preterm. The cases were categorised on the basis of clinical data and course, biochemical, radiologic and autopsy findings. Maximum number of cases (51.4%) were due to pneumonia and bronchopneumonia. Hyaline membrane disease was responsible for respiratory distress in 10 cases (86%). All infants were preterm with a negative shake test and all expired. Transient tachypnea was observed in 22 cases (19%), all of term gestation. Meconium aspiration was responsible in 14 cases (12.1%) and was commoner in term infants than preterm. Pneumothorax was seen in 2 cases.     

The effect of gestational age on intralipid tolerance in newborn infants.

Tolerance to intravenously administered Intralipid was studied in 18 newborn infants aged 4 to 8 days and gestation 27 to 40 weeks. Clearance of a bolus injection of Intralipid from plasma was an exponential function following first order kinetics. Less mature infants had a clearance rate less than half that seen in more mature infants. Free fatty acids rose more rapidly and were maintained above fasting levels throughout the study in the immature group, probably because of impaired utilization of free fatty acid. The slower clearance of Intralipid in immature infants may be related to lipoprotein lipase deficiency secondary to their limited adipose tissue mass.     

Subcutaneous fat necrosis of the newborn

We present the MRI findings in a case of subcutaneous fat necrosis of the newborn. To our knowledge, the MRI findings of this entity have not been reported. Subcutaneous fat necrosis of the newborn is an uncommon, benign process in full-term infants. Hypercalcemia may be a potentially life-threatening complication of this otherwise self-limiting process. Received: 30 December 1998 Accepted: 10 May 1999     

Abundance of endothelial nitric oxide synthase in newborn intrapulmonary arteries.

A monoclonal antibody to endothelial NOS (eNOS) was used to demonstrate the distribution and density of eNOS in the developing porcine lung. Lung tissue from large white pigs aged from less than 5 minutes to 3 months was immunostained and, using light microscopy, distribution of eNOS was assessed by a semiquantitative scoring system. At all ages eNOS was located on the endothelial cells of pulmonary and bronchial arteries and veins. Immunoreactivity for eNOS was greater in the larger, more proximal pulmonary arteries than at the periphery. In the lung of newborn pigs immunoreactivity for eNOS was present in arteries of all sizes but some showed no positive staining. At 2-3 days of age almost all arteries showed positive immunoreactivity. By 3 months of age the amount of eNOS had decreased and was less than that seen in the newborn. The highest level of eNOS was seen immediately after birth when the pulmonary arteries are dilating. eNOS may therefore play an important part in adaptation to extra-uterine life.     

Renal function in full-term newborns following neonatal asphyxia. A prospective study

A prospective study of full-term infants with neonatal asphyxia was performed to evaluate possible alterations in renal function. Twenty-one newborns with an Apgar score less than or equal to 3 at 1 minute after birth and a control group of 20 normal infants were included. Oliguria of 12 hours or more (less than 1 ml/Kg/h) during the first 24 hours after birth was considered indication for a volume challenge test and use of diuretic. The study of renal function was effected between 24 and 48 hours after birth for asphyxiated and control infants (Period I), and was repeated between 48 and 72 hours (Period II) for the asphyxiated group only. Intrinsic acute renal failure was diagnosed in two patients, one of whom died. In 10 cases, prerenal oliguria responded promptly to volume expansion with improvement of biochemical indices in Period II. In nine cases, urine volume was not altered, and all functional parameters were comparable with those of control.     

Hypoplasia of the lung in the newborn

Summary Hypoplasia of the lungs was observed in 13 cases (7.8 per cent) out of 165 autopsies performed at Medical College Hospital, Aurangabad. The associated malformation included anencephaly, diaphragmatic hernia, hydrocephalus, skeletal defects and renal agenesis. From the Department of Pathology, Medical College, Aurangabad.     

Effectiveness of low-dose continuous intravenous insulin infusion in diabetic ketoacidosis. A prospective comparative study.

Twenty pediatric patients with diabetic ketoacidosis were randomly assigned in equal numbers to receive insulin either as a low-dose continuous intravenous infusion or as high-dose intermittent subcutaneous injections. Blood was obtained hourly for determinations of total CO2, plasma glucose, and osmolality, and, in previously untreated patients, plasma insulin. Serum values of beta hydroxybutyrate, electrolytes, and acetone were monitored every two hours. Plasma insulin levels were in the therapeutically effective range with each method of administration. There were no statistically significant differences in rate of correction of ketoacidosis, rate of reduction of plasma glucose, or decline in plasma osmolality. The incidence and the severity of hypokalemia were increased in the patients receiving subcutaneous insulin. There was less variation in the rate of reduction of plasma glucose in the infusion group. Low-dose continuous intravenous infusion of insulin is at least as effective in treating diabetic ketoacidosis as the traditional high-dose intermittent subcutaneous injection of insulin and offers some definite advantages.     

Maternal predictors of subcutaneous fat in the term newborn

AIM: To determine the relative influences of some maternal factors on skinfold thickness. The effects of age, parity, height, body mass index (BMI) and pregnancy weight gain (PWG) of the mother on the subscapular skinfold thickness (SST) of the newborn were estimated, and compared with their effects on birthweight (BW), crown-heel length (CHL) and head circumference (HC). METHODS: A sample of 13, 972 healthy, term singletons was selected at the Clamart Maternity Hospital (France). Stepwise regressions were used to determine the most predictive maternal factors for each parameter in the newborn. The respective effects of the mother's age and parity on each newborn dimension were tested by analysis of variance. RESULTS: The SST is a singular parameter, influenced by the mother's BMI and PWG, but not by her height. In contrast, the main predictor of BW, CHL and HC is the height of the mother, and to a lesser extent her PWG and BMI. Parity and maternal age have a smaller effect, except on SST, and essentially between the first and second pregnancies. CONCLUSION: These results clearly separate SST from other newborn dimensions. The skinfold thickness depends only on the nutritional status of the mother, while other dimensions are markedly influenced by the genetic background. This study is the first to demonstrate the singularity of skinfold thickness in newborn infants as a marker of the mother's nutritional status.