Dimitris Anagnostakis

Risk of infection associated with umbilical vein catheterization: A prospective study in 75 newborn infants

To determine the risk of infection created by catheterization of the umbilical vein per se, 75 jaundiced, but otherwise healthy, newborn infants subjected to exchange transfusion were studied. Twenty-three were given antibiotics because of premature rupture of membranes. Fifty-three percent of the umbilici were contaminated before the insertion of the catheter, even after a very careful cleansing procedure. Sixty-two percent of the catheters were colonized upon removal. Bacteria were isolated from 44.9% of blood specimens drawn via the catheter at the onset of ET, but only in 14% of blood specimens drawn in the same way at the end of the procedure. Seven newborn infants (10%) were found to be bacteremic 4-6 after ET; four of these infants were not treated and were able to eliminate the bacteremia. Systemic antibiotic therapy did not reduce the overall prevalence of colonization of cord and catheter of positive blood cultures pre- and postexchanges transfusion or the rate of bacteremia.

Eosinophilic gastroenteritis complicated with perforation and intussusception in a neonate.

Eosinophilic gastroenteritis (EG) is a disease characterized by marked eosinophilic infiltration of the gastrointestinal tract, an absence of vasculitis, and a peripheral eosinophilia in approximately 50% of patients (1). EG is included in a standardized diagnostic classification scheme of gastrointestinal diseases of infants and children resulting from adverse immunologic reactions to foods (1). Kaijser originally described this disorder in 1937. The prevalence of this disease in the general population is unknown. Clinical symptoms are related to the gastrointestinal region involved (esophagus, stomach, small intestine, colon) and to the predominant layer affected (mucosa, muscularis, serosa). Eosinophilic infiltration of the mucosal layer causes inflammation; that of the muscular layer leads to thickening and rigidity, provoking symptoms of obstruction; whereas infiltration of the serosa results in ascites (2). The disease is distinguished into allergic eosinophilic esophagitis, gastritis, or gastroenterocolitis according to the anatomic region affected (1). Eosinophilic infiltration of the gastric antrum is typical in eosinophilic gastritis or gastroenterocolitis and may result in gastric outlet obstruction (1). Intestinal perforation and intussusception are rare complications of the disease (3). Even though patients of all ages can be affected, a few cases of neonates with EG, without complications, have been reported (4–6). We describe a male neonate who presented typical symptoms of EG on the first day of life and whose condition was complicated by perforation of the antral wall and ileoileal intussusception.

Serum lipids in preterm infants fed a formula supplemented with nucleotides.

Background The effect of dietary nucleotides on lipid metabolism has been the subject of clinical studies with conflicting results. We measured serum triglycerides, total cholesterol (total-C), and lipoprotein cholesterol levels (HDL-C, LDL-C, and VLDL-C) in preterm neonates fed formula with and without nucleotide supplements. Methods This prospective, randomized, controlled study included 150 healthy preterm neonates (gestational age, 33.0 ± 1.9 weeks) matched for gestational age, birth weight, and gender. Subjects were assigned at birth to receive either a standard milk formula supplemented with nucleotides (group F-NT) or the same formula without nucleotides (group F). Serum was obtained before discharge (29.1 ± 10.0 days of life) and triglycerides, total-C, and HDL-C were determined enzymatically. LDL-C and VLDL-C were estimated by the Friedewald formula. For statistical analysis t test, Mann Whitney-U test, two-way ANOVA, and &khgr;2 test were used, as appropriate. The influence of several factors on serum lipid levels was evaluated by linear regression analysis. Results Serum triglycerides, total-C, and VLDL-C levels did not differ between groups. HDL-C levels (median; 25th–75th percentiles) were significantly higher (P < 0.001) in group F-NT (48.0 mg/dL; 40.5–57.0 mg/dL) than in group F (34.5 mg/dL; 27.2–44.0 mg/dL). On the contrary, LDL-C levels (median; 25th-75th percentiles) were significantly lower (P < 0.001) in group F-NT (39.0 mg/dL; 26.0–54.0 mg/dL) than in group F (65.0 mg/dL; 41.0–73.0 mg/dL). In the multiple regression analysis, nucleotide supplementation was identified as one of the controlled independent factors influencing serum HDL-C and LDL-C levels. Conclusions Preterm neonates fed from birth with formula supplemented with nucleotides have significantly higher HDL-C and lower LDL-C serum levels than do neonates fed unsupplemented formula. The clinical relevance of these results remains to be elucidated.

Late recurrence of herpes simplex virus meningoencephalitis in two infants

Abstract. Two infants with recurrence of herpes simplex virus (HSV) encephalitis are reported. Both patients developed HSV encephalitis during their neonatal period and were treated with iv acyclovir. Long-term oral acyclovir prophylaxis was given thereafter. At the age of 8 and 11 months respectively, both babies, while under oral acyclovir prophylaxis, presented a second episode of HSV encephalitis. An inadequate dose of suppressive oral acyclovir therapy may be responsible for the recurrence of encephalitis in these two babies. Conclusion: the present observations emphasise the need for very long follow-up of any infant who has suffered from neonatal herpes simplex virus encephalitis and the need for careful prospective controlled studies in order to define the appropriate treatment regimen (initial plus prophylaxis) for neonates with herpes simplex virus infections.

Hyperglycaemia and insulinopenia in a neonate with cystic fibrosis.

UNLABELLED Abnormal glucose tolerance is a frequent late complication of cystic fibrosis (CF), but the prevalence of CF-related diabetes mellitus (CFRD) in children less than 10 y old is less than 2%. The youngest child with CFRD reported to date was 6 mo of age. Insulinopenia is the primary cause of abnormal glucose tolerance/CFRD, but it is unknown whether it may begin in the neonatal period. We describe a case of a neonate with CF who presented with hyperglycaemia in the diabetic range and marked insulinopenia. Insulinopenia and impaired glucose tolerance were permanent findings at 6 and 15 mo of age. CONCLUSION This case suggests that abnormal glucose tolerance/diabetes may occur much earlier in the course of CF, even during neonatal age. Careful follow-up and further studies in CF infants could reveal that the real incidence of glucose intolerance and diabetes in this age group has been underestimated.

Risk Factors of Sensorineural Hearing Loss in Preterm Infants

D. Anagnostakis, MD, Neonatal Unit, First Department of Pediatrics, Athens University, ‘Agia Sophia’ Children’s Hospital, Athens 115 27 (Greece), Tel. +30 (01) 7794023, fax +30 (01) 7795762 Biol Neonate 1997;72:1-10 Concerning the Article by Borradori C, et al.: Dear Sir, We have read with great interest the excellent article by Borradori et al. [1]. The authors demonstrated in a case-control study an association of sensorineural hearing loss with prolonged mechanical ventilation and hospitalization. Such an association has also been reported by others [2, 3], and different explanations have been proposed: prolonged hospitalization and ventilation means that the baby’s condition is more severe, with resultant worse prognosis and poorer outcome [2]; preterm infants on long nasotracheal intubation are at risk of suppurative middle ear effusion [4]. However, none of these theories can explain entirely the association of increased incidence of hearing loss with prolonged ventilation and hospitalization. We believe that this association is due to a variety of factors among which the noise is of primary importance. Although Borradori and co-workers reported no association between hearing loss and environmental noise, the noise generated by mechanical equipment beside the baby’s ear is considerably higher than the environmental noise and is potentially hazardous to hearing. In a previous study, we have found a high noise level (51 ± 2.0 adjusted decibels; dBa) in our neonatal intensive care unit that persisted throughout the day; however, much higher levels (65 ± 1.3 dBa) were recorded beside the ears of babies during mechanical ventilation [5]. These noise levels are well above the level (50 dBa) that has been found to have a 25% probability of seriously affecting sleep in adults [6]. In addition, there is some evidence, at least in animals, that infants may be more susceptible to noise-induced hearing loss than adults [7]. Furthermore, a synergistic effect has been reported between ototoxic drugs and high noise levels on hearing loss in guinea pigs [8]. Finally, high noise levels may be hazardous in the presence of conditions such as hyperbilírubinemia, acidosis, or hypoxia which impair the hearing of infants. Douek et al. [9] presented clinical evidence supporting the assumption that incubator noise may be responsible for hearing loss in low birth weight infants. The data presented above seem to indicate that noise is a potential hazard to the hearing of low birth weight babies, especially those receiving ototoxic drugs and having hypoxia, acidosis, jaundice, and septicemia, conditions often encountered in such infants. Thus, in addition to the

Hyperglycaemia and insulinopenia in a neonate with cystic fibrosis: Clinical observations

Abnormal glucose tolerance is a frequent late complication of cystic fibrosis (CF), but the prevalence of CF‐related diabetes mellitus (CFRD) in children less than 10 y old is less than 2%. The youngest child with CFRD reported to date was 6 mo of age. Insulinopenia is the primary cause of abnormal glucose tolerance/CFRD, but it is unknown whether it may begin in the neonatal period. We describe a case of a neonate with CF who presented with hyperglycaemia in the diabetic range and marked insulinopenia. Insulinopenia and impaired glucose tolerance were permanent findings at 6 and 15 mo of age.