Background:Bacterial sepsis is one of the major causes of mortality in newborn infants. Mortality increases when sepsis is associated with neutropenia.Materials and Methods:We conducted a prospective, randomized, double-blind, placebo-controlled trial of recombinant human granulocyte colony-stimulating factor on preterm neonates (gestational age (GA) <34 weeks) with sepsis and absolute neutrophil count (ANC) of <1500 cells/mm3. Mortality, duration of Neonatal Intensive Care Unit (NICU) stay, hematological parameters (ANC, platelet count, and total leukocyte count) were compared between the two groups. The GCSF group (n=39) received GCSF intravenously in a single daily dose of 10 μg/kg/day in a 5% dextrose solution over 20-40 min for three consecutive days, while the control group (n=39) received placebo of an equivalent volume of 5% dextrose.Results:Baseline demographic profile among the two groups was comparable. Mortality rate in the GCSF group was significantly lower than in the control group (10% vs. 35%; P<0.05). By day 3 of treatment, ANC in the GCSF group was significantly higher (3521±327) compared to 2094±460 in the control group, with P value being <0.05. Duration of NICU stay also decreased significantly in the GCSF group.Conclusion:The administration of GCSF in preterms with septicemia and neutropenia resulted in lower mortality rates. Further studies are required to confirm our results and establish this adjunctive therapy in neonatal sepsis.
Biotinidase is a ubiquitous mammalian cell enzyme occurring in liver, serum and kidney. It cleaves biotin from biocytin, which is a cofactor for biotin dependent enzymes, namely the human carboxylases. Biotinidase deficiency is associated with a wide spectrum of neurological, dermatological, immunological and ophthalmological abnormalities. This is a case of a 3-year-old boy presenting with delayed developmental milestones, tachypnea, progressively increasing ataxia, alopecia and dermatitis, all which dramatically responded to high doses of biotin.
Kawasaki disease is a systemic vasculitis, sometimes presenting atypically in infancy, often leading to a late diagnosis, and resulting in devastating consequences. We report a 2-month-old baby presenting with fever of unknown origin. Echo showed giant aneurysms in all three coronary arteries with intraluminal thrombus in one artery that required thrombolysis and anticoagulation.
Neonatal fungal endocarditis (FE) remains a rare condition associated with prematurity. It often puts us in diagnostic and therapeutic dilemma as there are no specific guidelines. We described our successful journey with a 26 days old neonate with aspergillus endocarditis responding to multidisciplinary approach with surgical resection and intravenous antifungals.
Adenoviruses are DNA viruses that typically cause mild self-limited disease mostly involving the respiratory tract, gastrointestinal tract or conjunctiva. Typical respiratory symptoms include fever, pharyngitis, tonsillitis, cough, and sore throat but rare associations with severe disease such as myocarditis have been reported. Current treatment options are limited to usage of intravenous immunoglobulins (IVIGs) or antiviral agent Cidofovir, however usage of the latter is limited due to reports on drug induced adverse reactions. In this case report we describe an infant with severe myocarditis in whom Adenovirus was revealed to be the identifiable cause. The infant was treated with IVIG which is believed to act as an immunomodulatory agent. The infant recovered completely. Our conclusion is that patients with myocarditis caused by adenovirus are likely to benefit from early treatment with IVIGs.
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