Fluconazole prophylaxis administered to VLBW neonates in 4- to 6-week courses after birth does not lead to the emergence of natively fluconazole-resistant Candida spp.

Background : It is controversial whether thrombocytopenia is suggestive of one (or more) causative agents of neonatal sepsis: a low platelet count has been related in turn to Gram-positive, Gram-negative or fungal sepsis. Methods : A retrospective, cohort study on 514 very low-birthweight (VLBW) neonates admitted over a 9 year period to a large tertiary neonatal intensive care unit (NICU) in Italy was carried out. Through database search, data on platelet counts, sepsis, clinical course, and microbiological culture were collected and analyzed. Statistical analysis was performed to look for signifi cant association between thrombocytopenia and sepsis caused by different (Gram-positive, Gram-negative or fungal) organisms. Results : Sepsis diagnosed on microbiological criteria occurred in 197 of 514 VLBW neonates (38.3%), and thrombocytopenia (at least one fi nding of platelet count <80 000/mm 3 ) was detected in 34 (17.2%) of the 197 septic infants. Thrombocytopenia occurred in 10 of 51 neonates with fungal sepsis (19.6%), and in 24 of 146 with bacterial sepsis (16.4%; P ϭ 0.37). The difference was not signifi cant when clustering for sepsis caused by Gram-positive (nine thrombocytopenic of 51 with Gram-positive sepsis, 17.6%; P ϭ 0.40) and Gram-negative organisms (15/95, 15.7%; P ϭ 0.22), or when considering only coagulase-negative Staphylococcus sepsis (6/37, 16.2%; P ϭ 0.25). Conclusions : In contrast with previous reports, thrombocytopenia might not be an organism-specifi c marker of sepsis. Caution should be maintained in relating a low platelet count to any infectious agent (or group of agents) in preterm VLBW neonates.

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BackgroundThe principal aim of this study was to identify the lowest nodule diameter and the SUVmax capable of characterizing lung nodules in pediatric patients with bone sarcoma.ProcedureEighteen consecutive bone sarcoma patients (M/F = 11:7; mean age 14 years) with suspicious lung lesions at CT were enrolled. Overall, 63 lung nodules with a mean diameter of 3.35 mm (range 1.2–39.8 mm) were investigated. 18F‐FDG PET was performed according to standard procedure using a hybrid PET/CT system and results were compared with histology and/or clinical/radiological follow‐up. For each lesion, we evaluated SUVmax, SUVratio to the mediastinal blood pool and maximum nodule diameter.ResultsOf the 63 nodules, 32 proved to be benign and 31 malignant. On a visual basis, 18F‐FDG PET had an accuracy of 88.9%, a sensitivity of 90.3%, a specificity of 87.5%, a PPV of 87.5%, and a NPV of 90.3%. ROC curve analysis of SUVmax for all nodules showed a value around 1 (>1.09) to be capable of differentiating metastases from benign lesions: sensitivity and specificity were 90.3% and 93.8%, respectively (accuracy 92.1%). Similar analysis revealed a cut‐off value around 1 (>0.83) for SUVratio (sensitivity and specificity were 90.3% and 90.6%, respectively) and a cut‐off value of ca. 6 mm (>5.8 mm) for nodule diameter (sensitivity and specificity of 90.3% and 81.3%, respectively).Conclusions18F‐FDG PET/CT is an accurate modality for the metabolic characterization of lung nodules in the pediatric population with bone sarcoma, and a SUVmax (or SUVratio) >1 is capable of discriminating malignant from benign lesions. Pediatr Blood Cancer 2012; 59: 1206–1210. © 2012 Wiley Periodicals, Inc.

This case-control study of full-term newborns with presumed or proven bacterial infection compared the efficacy, safety and tolerability of switch antibiotic therapy and traditional completely intravenous antibiotic administration. there were 36 newborns treated with switch therapy (i.v. ampicillin + sulbactam combined with i.v. amikacin for 3 days followed by oral cefpodoxime proxetil for 5 days); there were 72 full-term newborns with the same characteristics as controls who received i.v. ampicillin + sulbactam combined with i.v. amikacin for 3 days followed by i.v. ampicillin + sulbactam alone for a further 5 days. the results showed that full-term newborns with presumed or proven bacterial infection initially treated with intravenous antibiotics can be switched to oral antibiotics after 3 days' therapy if physical and laboratory data indicate the disappearance of infection, thus significantly reducing the length of stay in the neonatal intensive care unit and significantly increasing breastfeeding, without having any negative clinical impact.