The time interval from ACS administration to delivery differs per indication. Women with VBL are most often over treated. The timing of the first ACS course should be improved.
Although a leukemoid reaction is a well-recognized phenomenon in the neonatal intensive care unit, transient extreme hyperleukocytosis in premature infants is rare. The exact mechanism is still unclear and several hypotheses are documented in the literature. In this case report, we describe 2 dichorionic diamniotic premature twins, of whom the 2 girls had extreme hyperleukocytosis, whereas their siblings did not, emphasizing the potentially important role of the sex in this phenomena.
Objective To describe a case of generalised bullous impetigo caused by methicillin-resistant Staphylococcus aureus (MRSA) in new born. Observation A masculin infant was born at full term pregnancy to a healthy mother by cesarian section because of rupture of membranes and acute fetal distress. He was normal within 48 h of life and C reactive protein (CRP) was negative, so he was discharged from the hospital. He presented at the age of 3 days erythematous pultaceous lesions of the face without fever. He was hospitalised at the age of 5 days. On examination, we noted on his face, neck and back multiple shallow erosions and flaccid pus-filled bullae, varying in size.Investigations including complete hemogram, renal function tests and CRP had results within normal limits. A smear from a pustular lesion and blood culture were done. The infant was started on intravenous oxacillin (100 mg/kg/day) and gentamicin (5 mg/kg/day). The culture of the two samples was positive for MRSA which was resistant to kanamycin and fusidic acid. Antibiotic therapy was modified by vancomycin and pristinamycin for total treatment duration of 14 days. The outcome was favourable with rapid regression of skin lesion. Search by PCR of the mecA gene and the gene encoding Panton-Valentine Leukocidine was positive for the 2 strains of MRSA isolated from blood culture and pustule. Conclusion Community-acquired, methicillin-resistant Staphylococcus aureus infections are increasing among children. Early diagnosis and appropriate antimicrobial therapy improve outcomes. Background and aims Antiviral therapy with Valganciclovir, a relatively new but potentialtoxic oral drug, is recommended to prevent further hearing deterioration in infants with (congenital) CMV infection. Viral load monitoring can possibly beused as indicator for effective treatment. Methods A retrospective cohort study (2005)(2006)(2007)(2008)(2009)(2010) in a third level neonatal intensive care unit. Neonates ≤32 weeks of gestational age (GA) with CMV infection treated with oral Valganciclovir (30 mg/kg/day) were included. Time interval (days) to reach CMV viral load below detection level (<250 copies/ml) and assumed therapeutic level (<10.000 copies/ml) were determined. Toxicity was measured by plasma trough levels (target 0.2-1 mg/L), thrombocytopenia (< 100 Â 10 9 /L) and leukopenia (< 5 Â 10 9 /L). Results Data of 6 infants, median gestational age 25 +2 (range 25 +1 -28 +4 ) weeks, 2 with congenital and 4 with postnatal infection, were analysed. Time interval between start of therapy and viral load below detection level was 25-54 days and below therapeutic level 10-31 days. 28/37 plasma samples were in the normal range, 3/37 above and 6/37 under the target concentration. Mild transient leukopenia (4.5 Â 10 9 /L) occurred in 1 infant. No thrombocytopenia occurred. Conclusions A dosage of 30 mg/kg/day Valganciclovir in premature infants with CMV infection provided a fairly rapid decrease of CMV viral load in urine, without causing serious short term toxicity.
PO-0523 TOXICITY AND...
Cytomegalovirus (CMV) infection is the most important cause of mental retardation and sensorineural hearing loss. Antiviral treatment with valganciclovir, a relatively new but potential toxic oral drug, is recommended to prevent further hearing deterioration. In this retrospective cohort study we evaluated the relation between the dose of valganciclovir and the reduction of CMV viral load, as well as the toxicity. All neonates with gestational age <32 weeks with CMV infection treated with oral valganciclovir (30 mg/kg/day) were included. Time interval to reach CMV viral load below detection level (<250 copies/ml) was determined. Toxicity was measured by plasma trough levels, thrombocytopenia and leukopenia. Data of 6 infants, median gestational age 252 weeks, were analyzed. Time interval between start of therapy and viral load below detection level was 25 -54 days. In total, 37 through plasma samples were analyzed. Of these, 28 were in the normal range, 3 above and 6 under the target concentration. Mild transient leukopenia occurred in 1 infant. No thrombocytopenia occurred. Conclusion: Antiviral treatment of CMV infection with oral valganciclovir results in adequate plasma through levels. Also, a progressive reduction of viral load in the urine below detection level was reached within 25 -54 days, without serious short time side effects.
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