No abstract

An outbreak of sepsis and meningitis caused by group B streptococcus occurred in three very low birthweight infants. To prevent further nosocomial transmission, immune globulin and ampicillin sodium were administered intravenously to other very low birthweight infants. After this prophylaxis, no other infants were involved in this outbreak. Immuno‐ and chemoprophylaxis may be considered as procedures to prevent nosocomial infection for very low birthweight infants.

Amrinone has not only vasodilative effects, but definite positive inotropic effects in infants with heart failure.

Background: Coronary aneurysms (CAA) appear around Day 10 of Kawasaki syndrome (KS). Enhanced perivascular echo brightness (PEB) is not widely accepted as a marker of vasculitis. To explore its utility in early diagnosis of KS, we examined interobserver agreement (IOA) and prevalence. Working definition: Appearance of bright broad echoes surrounding the coronary lumen extending for at least 1 cm along the artery, as compared to thin parallel echoes representing normal coronary artery walls distinct from the surrounding. Methods: IOA: 20 randomly mixed PEB positive and negative studies were reviewed blindly by 6 pediatric cardiologists after they were coached on the definition. Mean % IOA and 95% confidence intervals (CI) were calculated for presence/absence of PEB in right and left coronary arteries (RCA, LCA). Prevalence: 50 consecutive KS pts' echoes were reviewed for PEB and concomitant or subsequent coronary ectasia or aneurysm (CAE or CAA). Results: IOA: Overall IOA was 79.2% (95% CI: 74.4, 84.0). For RCA and LCA, IOAs were 76.7% (70.2, 83.1) and 81.7 (74.6, 88.7), respectively. Prevalence: 28/50 pts (56%) showed PEB in one or both CAs in the first echo. 13 and 4 of those (26% and 8%) showed CAE and CAA, respectively. PEB without CAE/CAA was noted on Day 7.2 ϩ 4.24 (m ϩ sd); PEB with CAE or CAA was noted on Day 9.29 ϩ 5.77 (NS). PEB was noted in 11/18 (61%) typical KS pts (TKS), in 11/14 (79%) atypical KS pts (AKS) and in 4/14 (29%) possible KS pts (PKS) (pϭ0.025). All pts who later developed CAA or CAE initially showed PEB. All PEB-negative pts remained free of CAA or CAE. Conclusions: (1) PEB is a sufficiently objective finding. (2) PEB is detectable in majority of pts before Day 10. (3) PEB precedes CAE or CAA in some pts. Background: Severe myocarditis leading to heart failure is a specific entity complicating the acute phase of Kawasaki disease (KD) in children. Clinical course and response to therapy appear to differ in those children with myocarditis requiring inotropic treatment. Objective: To characterize specific clinical, laboratory and imaging findings in patients with severe myocarditis and delineate their response to therapeutic intervention. Methods: A 3 year retrospective chart review of all patients seen at the HSC (1998HSC ( -2001 with the diagnosis of KD plus severe myocarditis was performed. The demographic features, clinical, lab and imaging findings and response to treatment were analyzed. Results: 5 patients (3female/ 2male) with a mean age at onset of 3.4years (range 1.5 to 4.4yrs) met diagnostic criteria for KD. In addition all children had significant fatigue, severe tachycardia (mean HR161/min) and hypotension (5/5 Ͻ10.perc.). Lab testing revealed elevated ESR (mean 105mm), anemia (mean HGB 112g/l), hypocalcemia (mean ion.Ca 0.99mmol/l) and hypoalbuminemia (mean 26g/l). All children received 2 doses of IVIG (2g/kg/dose). In addition to non-responsiveness to IVIG clinical signs of heart failure were aggravated (tachycardia: mean HR 195/min) supported by diagnostic findings of hem...