Successful treatment of persistent pulmonary hypertension of the newborn with bosentan

The sophisticated and expensive treatment modalities of persistent pulmonary hypertension of the newborn (PPHN), such as nitric oxide, are limited in developing countries. Alternative (less expensive) treatments are being sought and bosentan, an oral dual endothelin-1 receptor antagonist, may be an option for the treatment of PPHN. We report our experience of using bosentan in a neonate with severe PPHN.
Conclusion:  Bosentan may be a useful adjuvant therapy in neonates with PPHN, providing significant improvement in oxygenation, and thus may be particularly useful in the treatment of PPHN in countries with limited resources.     

Peritoneal dialysis-related peritonitis in southern Thailand

OBJECTIVE: To evaluate peritonitis in children receiving peritoneal dialysis (PD) in southern Thailand. PATIENTS AND METHODS: We reviewed the records of patients who received PD at the Department of Pediatrics, Prince of Songkla University from January 1994 to December 2003. RESULTS: Forty-six patients had PD performed for 228.6 patient-months. Their mean age was 9.5+/-4.8 years (range 3.0 months-16.7 years). Twenty-eight patients had complications with 61 episodes of peritonitis. The age, sex and causes of renal failure did not display any differences between patients who had or did not have peritonitis (p=0.2, 0.6 and 0.6, respectively). The first peritonitis occurrence was on average at 2.7+/-4.0 patient-months (median 0.4, range 0-12.5) following catheter insertion, with an average incidence rate of one infection per 3.5+/-4.8 patientmonths (median 1.0, range 0-23.2). The causative agents were both gram-positive and gram negative bacteria, and fungi at 24%, 44%, and 8% respectively (24% of the cultures did not grow). There was no significant difference in causative agents between home- and hospital-acquired peritonitis (p=1.0). CONCLUSION: PD-related peritonitis in this study occurred earlier and more often than in other studies, probably because all of our PDs were performed immediately after catheter insertion.     

Acute kidney injury and pneumothorax are risk factors for mortality in persistent pulmonary hypertension of the newborn in Thai neonates

Objectives: To describe the clinical characteristics, diagnostic methods, treatment modalities, and complications, and identify the mortality risk factors, of infants with short-term persistent pulmonary hypertension of the newborn (PPHN).

Methods: The clinical data of infants diagnosed with PPHN at Hat Yai Hospital from January 2010 to February 2014 were retrospectively reviewed. Cox proportional hazard regression analysis was performed to assess factors associated with mortality.

Results: The records of 119 infants were analyzed. Of these, 47 died giving an in-hospital mortality rate of 39.5%. The prevalence of PPHN (based on inborn births) was 2.8 per 1000 live births. The mean gestational age and birth weight were 39.1?±?1.6 weeks and 3044?±?563?g, respectively. Multivariate Cox regression analysis indicated that pneumothorax [adjusted hazard ratio (HR)?=?2.07 (95% CI 1.09–3.93)] and acute kidney injury [adjusted HR?=?2.99 (95% CI 1.59–5.61)] were factors associated independently with an increased risk for death, while infants who received total parenteral nutrition [adjusted HR?=?0.22 (95% CI 0.10–0.50)] had lower mortality.

Conclusion: A high mortality rate of PPHN was observed in this study. Significantly higher mortality was noted in infants complicated with pneumothorax and acute kidney injury.     

Septicemia, meningitis, and skull osteomyelitis complicating infected cephalhematoma caused by ESBL-producing Escherichia coli

An infected cephalhematoma is a rare condition in neonates. We report a case of an 18-day-old neonate who was diagnosed with an infected cephalhematoma caused by an extended spectrum beta-lactamase (ESBL)-producing Escherichia coli complicated with septicemia, meningitis, and skull osteomyelitis. He was successfully treated with meropenem and surgical incision and drainage. ESBL-producing E. coli may cause infection of a cephalhematoma in neonates.