It was observed that, although the majority of viral respiratory infections had a favorable course, some patients presented a serious and prolonged clinical manifestation, especially when there was concomitant bacterial infection.

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RESUMO -A sepse, no período neonatal, está associada com a presença de fatores de risco para infecção e com o estado imunológico do recém-nascido.OBJETIVO. Verificar, em recém-nascidos com fatores de risco para infecção, o papel da proteína C reativa (PCR) 1 em 1991, é de uma resposta sistêmica à infecção manifestada pelo menos por duas das seguintes condições: hipotermia, hipertermia, taquipnéia e taquicardia, e, laboratorialmente, por alterações na contagem de leucócitos no sangue, dispensando a positividade da hemocultura.O quadro laboratorial de sepse, no período neonatal, permanece muito difícil, e o isolamento de um microorganismo no sangue, no líquor (LCR), na urina ou em qualquer outro local fechado constitui o exame mais específico para o diagnóstico de infecção, embora com alguns inconvenientes, o principal deles sendo o período de incubação da cultura de até 72 horas. Com esse período de incubação, 98% das culturas positivas serão identificadas, com exceção de alguns Staphylococcus coagulase negativos, anaeróbios e fungos 2 . Squire et al.3 , em 1979, mostraram que somente 82% dos RNs com infecção sistêmica comprovada por culturas post-mortem e achados de necropsia tinham culturas positivas in vivo. Visser e Hall 4 relataram que 15% dos RNs com diagnóstico de meningite e com cultura de líquor positiva tinham hemocultura negativa. Portanto, a negatividade da hemocultura não exclui infecção sistêmica.A cultura de urina deve sempre ser colhida de punção suprapúbica para evitar contaminação. É uma técnica relativamente difícil e o crescimento bacteriano demora o mesmo tempo que as outras culturas como a do LCR 5 . Os métodos para detectar a presença de antí-

-Citrobacter diversus is closely related to brain abscess in newborn infants. We describe a case of brain abscess by this bacteria in a newborn infant and his clinical and cranial computed tomographic evaluation until the fourth month of life and discuss therapeutic management of this patient.KEY WORDS: infancy, brain abscess, Citrobacter diversus.Abscesso cerebral por Citrobacter diversus na infância: relato de caso RESUMO -Citrobacter diversus é a bactéria mais associada a abscessos cerebrais durante o período neonatal. Descrevemos um caso de abscesso cerebral por esta bactéria em um recém-nascido e sua evolução clínica e tomográfica até o quarto mês de vida. São discutidos aspectos diagnósticos e terapêuticos desta grave infecção do recém-nascido. PALAVRAS-CHAVE: infância, abscesso cerebral, Citrobacter diversus.Although not common in the neonatal period, brain abscesses have a high mortality rate and appear as complication of neonatal meningitis in 1.3 to 4.0% of patients. In neonates the progression of the disease may be insidious, with clinical manifestations resembling other neurological pathologies of the neonatal period, such as congenital hydrocephalus. The high frequency and death rates of brain abscesses caused by Citrobacter diversus makes clear the need for an early diagnosis and treatment.In this article we discuss the case of an infant with a brain abscess by Citrobacter diversus, his outcome, and a review of the literature on this pathology. CASEGRT, 47 days old, male, admitted in the neonatal intensive care unit (NICU) in 07/27/97. Obstetrical history: full term infant, uncomplicated gestation, delivered by elective cesarean section with unruptured membranes, Apgar scores of 9 (1 st minute) and 9 (5 th minute). Personal history: birth weight 3,420 g, height 48 cm, head circumference (HC) 34 cm, thoracic circumference 33 cm; discharged from the maternity hospital after 3 days.Admitted in a pediatric clinic at the age of 46 days, with a one day history of poor feeding, nausea, irritability, lethargy and fever (37.7 o C), and signs of respiratory distress, raised anterior fontanel and enlarged HC (42.3 cm). A complete blood count was done with hemoglobin level 7,0 g/dl, hematocrit 21%, white blood cell count (WBC) 14,900/mm 3 with 80% neutrophils (9% band cells) in the differential. A spinal tap was performed

An increase in the survival of neonates with antenatal diagnosis of malformations was achieved by the recent technical advances in neonatal intensive care units. The aim of this article is to describe the experience with neonatal arterial hypertension, in newborns with nephro-urological malformations, in a tertiary care referral Nursery, in a period of 4 years. Newborn medical records from the Nursery Annex to the Maternity of Hospital das Clinicas, School of Medicine, University of Sao Paulo, with the diagnosis of nephro-urological malformations and systemic arterial hypertension (SAH) at hospital discharge, in a period from January 1999 to January 2003, were retrospectively analysed. Among 10.278 live newborns in the studied period, 15 (0.15%) newborns were compatible with our inclusion criteria. Of these 15 newborns, 12 (80%) were male and three were premature (20%). In relation to aetiology, 13 (87%) showed urological malformations, 1 (6%) chronic renal insufficiency secondary to kidney dysplasia and one (6%) autosomal recessive polycystic kidney disease. SAH control was achieved with monotherapy in eight patients (53%), five patients (33%) needed an association of two drugs (calcium-channel blocker and angiotensin converting enzyme (ACE) inhibitor), one child used three types of antihypertensive drugs (calcium-channel blocker, ACE inhibitor and hydrochlorothiazide) for pressoric control and one child's blood pressure (BP) was controlled exclusively by peritoneal dialysis. The incidence of nephro-urological malformations in our service during the studied period was 0.89%. SAH incidence among these newborns was 19%. Our data reinforce previous studies pointing to the necessity to consider children with nephro-urological malformations as a risk group for SAH, who should have the BP evaluated since the neonatal period.

RESULTS: The incidence of bronchopulmonary dysplasia was 6.5% (Group I) and 30% (Group II), P = .07. A decrease in growth was detected in Group I compared with Group II (change in weight: Group I -47 g/week, Group II -85.5 g/week, P = .06; change in head circumference: Group I -0.75 cm/week, Group II -1 cm/week, P = .05).CONCLUSION: Use of corticosteroids in very low birth weight infants dependent on mechanical ventilation during the first 10 to 14 days of life did not affect the respiratory evolution and occurrence of bronchopulmonary dysplasia, but the velocity of growth was reduced.KEYWORDS: Corticosteroids. Very low birth weight newborn. Bronchopulmonary dysplasia.

A 13-year-old girl with cirrhosis and cyanotic heart disease was admitted with a three-day history of pneumonia. The chest roentgenogram revealed left-sided pleural effusion and cultures from the pleural fluid yielded Listeria monocytogenes. The authors discuss the epidemiologic, clinical, and pathophysiological aspects of L. monocytogenes pneumonia and its association with cirrhosis.

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