An infant with meningococcal arthritis of the hip

Meningococcus is a well known cause of meningitis and septicaemia. It is less well known as a cause of arthritis. This case report describes an infant with meningococcal arthritis and with further discussion of the role of meningococcal serogroup W135 in disease, as well as current and future immunisation strategies.     

Assessment and therapeutic possibilities in posthemorrhagic hydrocephalus of the newborn infant

Internal hydrocephalus follows intraventricular hemorrhage in about 10%. Progression is directly related to the degree of hemorrhage. Several studies confirmed that cerebral damage may occur without an increase of intracranial pressure or head circumference. Assessment and therapeutic consequences depend entirely on sonographic and clinical criteria. In our series, 40 of 135 neonates with intraventricular hemorrhage developed internal hydrocephalus. Therapy was necessary in 35 children, 11 died. Serial lumbar punctures were the most frequent therapeutic approach in 70% of the children. 40% required a shunt, usually a ventriculo-peritoneal system. In this group the proportion of Grade III and IV hemorrhage was high. In 25% external drainage for one week was necessary. 10% were treated with acetazolamide and furosemide. By this therapy shunt placement could be avoided in 9 children (69.2%), in the group with Grade III hemorrhage. In addition it was possible to postpone shunting to the third month on the average. 25 children were followed-up. 40% were normal or had a mild developmental delay. 60% were seriously handicapped. Poor neurodevelopmental outcome was related directly to hemorrhage Grade III and IV, therefore to brain damage in the early phase. To prevent additional lesions it should be emphasized that in infantile hydrocephalus best long-term results have been obtained if the process was controlled early rather than later.     

A new holder and surface MRI coil for the examination of the newborn infant hip

A special holder was developed for examination of the infant hip joint using MRI. This holder allows the infant hip joint to be examined both in a neutral position and in various defined functional positions. A special integrated surface coil, also developed for this purpose, provides the high spatial resolution required for assessment of the fine joint structures. Thirty infants were examined and the new device has proved useful in advanced hip dysplasia, therapy-resistant subluxation and luxation, and for operative therapy planning (reconstruction of the acetabular roof, redirectional osteotomies). Interpretation errors due to misprojection can be eliminated to a large extent since the holder allows standardized and reproducible positioning.     

Ultrasonography of the infant hip. Part IV: Normal development in the newborn and preterm neonate

Based on preterm and term infants studied by ultrasonography, and on anatomical sections of various gestational ages the physiological maturation of the hip joint is analysed. Current concepts of a linear growth pattern with an arrest immediately after delivery are confirmed. A more rapid growth and ossification of the acetabular edge than of the femoral head postpartum is suggested. To avoid overtreatment, knowledge of the normal range of development as seen in ultrasonography is mandatory.     

Acute necrotising fasciitis due to streptococcal infection in a newborn infant.

A 3-day-old baby girl developed septicaemia, meningitis, and necrotising fasciitis due to group A beta-haemolytic streptococcus, type M52, which was also cultured from the mother's cervix. Necrotising fasciitis is a severe infection of the skin and subcutaneous tissues with infarction, necrosis, and sloughing of the affected areas. Early recognition of this condition is essential so that appropriate treatment can be given.     

Purulent meningitis in the newborn infant.

The main clinical features of neonatal purulent meningitis are discussed on the basis of 19 neonatal cases. The liability to infection of preterm and dysmature babies and the role of Gram-negative bacteria in the aetiology of neonatal meningitis is emphasized. Pathological perinatal events should be regarded as predisposing factors. From the point of view of early diagnosis even the most discrete symptoms are of importance. The therapy of choice is early treatment with combinations of broad-spectrum antibiotics in high doses. Repeated electroencephalographic and immunologic examination provide a useful guideline in treatment and prognosis.     

Pulmonary pseudocysts in the newborn infant.

Five neonates who developed a pulmonary pseudocyst are reported. All infants had clinical hyaline membrane disease and were treated with continuous distending airway pressure. The pseudocysts developed between 39 hours and 7 days of age. In all but one pulmonary interstitial emphysema preceded or occurred together with the development of the pseudocyst. All babies went on to complete clinical recovery without surgical intervention. Radiologic documentation of the spontaneous resolution of the pseudocyst was obtained in three infants and occurred over three days, five days, and three months, respectively.