Background: Ventilator-associated pneumonia (VAP) develops in mechanically ventilated patients 48 hours after putting the patients on the ventilator. VAP is the second most common nosocomial infection in neonatal intensive care units (NICU). Objectives: The current study was conducted to determine the rate, microbiological characteristics and outcome of VAP in neonates admitted in the NICU of Shohada-e-Tajrish Hospital. Patients and Methods:A prospective cross-sectional study was conducted from Oct 2009 to Sep 2010, on all neonates receiving mechanical ventilation for more than 48h in the NICU. Clinical and paraclinical data were documented and tracheal secretions were collected by nonbronchoscopic bronchoalveolar lavage (NB-BAL) method for the smear and culture. Colony count and antibiograms were done on all culture-positive specimens. Results: From 103 patients admitted In the NICU, a total of 66 patients were intubated for 48h or more. VAP occurred in 33.3% of the mechanically ventilated neonates. Microorganisms associated with VAP included: Klebsiella species in 68.1%, Acinetobacter spp. and Enterococcus spp. in 13.6%, and Candida spp. in 4.5%. Lower gestational age and birth weight, longer duration of hospital stay and prolonged ventilator need had a significant relationship with VAP. Mortality rate was 6.8% in the ventilated infants without VAP, while 22.7% of the neonates who developed VAP, died. Conclusions: VAP was common in mechanically ventilated infants in the NICU of the hospital and was associated with increased mortality. Further studies are needed to investigate the prevention of VAP in mechanically ventilated neonates.

This case study highlights an atypical presentation of KD and the need to maintain a high level of awareness of physicians in order to diagnose and treat this potentially life-threatening condition promptly.Introduction: Kawasaki disease (KD) is an acute systemic vasculitis, of unknown etiology, that mainly affects infants and young children. Although originally thought to be a benign illness, KD may prove fatal, especially if the diagnosis is delayed due to a nonclassic presentation. Case presentation: Here, we present the case of a 4-year-old girl with a history of prolonged fever. Her physical examination and echocardiography revealed aneurysmal dilatation of the coronary arteries and myocarditis in the absence of other principal features of KD. This patient was diagnosed as having KD and responded very quickly to a high dose of intravenous immunoglobulin therapy. Discussion: This case study highlights congestive myocarditis as an atypical presentation of KD and the need to maintain a high level of awareness of this problem, in order to diagnose and treat this potentially life-threatening condition promptly.

This case study highlights an atypical presentation of KD and the need to maintain a high level of awareness of physicians in order to diagnose and treat this potentially life-threatening condition promptly. Introduction:Kawasaki disease (KD) is an acute systemic vasculitis, of unknown etiology, that mainly affects infants and young children. Although originally thought to be a benign illness, KD may prove fatal, especially if the diagnosis is delayed due to a nonclassic presentation. Case presentation: Here, we present the case of a 4-year-old girl with a history of prolonged fever. Her physical examination and echocardiography revealed aneurysmal dilatation of the coronary arteries and myocarditis in the absence of other principal features of KD. This patient was diagnosed as having KD and responded very quickly to a high dose of intravenous immunoglobulin therapy. Discussion: This case study highlights congestive myocarditis as an atypical presentation of KD and the need to maintain a high level of awareness of this problem, in order to diagnose and treat this potentially life-threatening condition promptly.

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