Diffuse pneumocephalus caused by neonatal Enterobacter cloacae meningitis

Abstract

Objectives: To investigate the recollections of parents consenting for their infants to be research subjects and determine their views about the need for consent. Subjects: Parents of 154 sick newborn infants enrolled in a randomised trial in the early neonatal period. All parents had given written consent and received printed information. Methods: A questionnaire and accompanying letter was sent to the parental home 18 months later. Nonresponders were sent a further questionnaire and letter. Results: Response rate was 64% (99/154). Some respondents (12%) did not remember being asked to consent to their baby joining a study, and a further 6% were unsure. Most of the respondents (79%) were happy, 13% neutral, and 8% unhappy with their decision to give consent. None felt heavy pressure to agree. Entering the trial caused 24% of respondents to feel more anxious, 56% neutral, and 20% less anxious about their baby. Most of the respondents (83%) would be unhappy to forgo the consent process for trials passed by the institutional ethics committee. Conclusions: A significant proportion of parents who give written consent for a trial in the early neonatal period do not later remember having done so. Parents who have had experience of neonatal research would be unhappy for their baby to be enrolled in a study that had ethics committee approval without their consent being obtained. W ritten consent from someone with parental responsibility is generally required before any child is enrolled in a clinical trial. Although it may safeguard the child's best interests, it is associated with many difficulties. Concern is expressed about the additional stress placed on parents.1 The ability of parents to process information and make informed decisions under these circumstances is questioned.2 Alternatives to the consent process have been proposed, 3 4 but these may be unacceptable to the parents whose consent would otherwise be sought.5 Serious concerns about the integrity of the consent process may be raised later, based on individual recollections.6 7 There are few data on the experiences of real parents who have been approached for consent. Snowdon et al 8 interviewed the parents of 21 infants who were enrolled in the ECMO trial. 9They found that some were unsure whether their babies were in a trial or not. In the Euricon study, 10 five of 200 parents could not remember being asked to give consent for a trial. We aimed to determine from parents whether they remembered being asked to give consent for a research study and how they felt the research had affected their experience as parents of a sick infant. PATIENTS AND METHODSThe subjects were the parents of 199 infants entered into a randomised controlled trial of pulmonary function testing which was conducted in the Simpson Memorial Maternity Pavilion, Edinburgh between August 1991 and June 1993. 11 In all cases the parents were given a printed information sheet and a detailed verbal description of the trial by a single individual (BS). Whenever possible, both parents were...

Otogenic Pneumococcal Meningitis with Pneumocephalus

“…Intracranial air is more frequently seen as a result of trauma, surgery, congenital defects or, rarely, the presence of gas-producing anaerobic bacteria (15). Pneumocephalus has, however, been reported in neonates with Enterobacter and Citrobacter meningitis (16,17).…”

MRI appearance of multifocal Enterobacter cloacae abscesses in a preterm neonate

“…Prompt recognition and treatment is essential with these organisms as their anaerobic nature can result in pneumocephalus. Several cases of diffuse pneumocephalus diagnosed by head ultrasound and CT in E. cloacae meningitis have been reported [6,25,26], though pneumocephalus was not present in this case. Another case of E. cloacae meningitis resulted in severe systemic infection, herniation of the frontal lobes through the anterior fontanel (seen on CT) and death within 72 h of admission [22].…”

“…With its poorly developed immune system, the neonate is particularly prone to developing brain abscesses with particular organisms having a predilection for adherence to and migration across brain endothelium [1][2][3]. Gram negative, facultatively anaerobic rods such as Citrobacter and Enterobacter species are known to cause a profound meningitis, multifocal lobar bacterial abscesses (particularly in neonates) and can rapidly produce gas resulting in pneumocephalus [4][5][6]. In one case series of the related organism, Citrobacter koseri, a 50% mortality was reported and even higher morbidity rates were noted [7].…”

Neonatal Pneumocephalus Secondary to Acinetobacter Meningitis

“…Common causes include trauma and neurosurgical interventions but can occur with central nervous system (CNS) infections (due to gas production with bacterial proliferation) [2]. It is usually self-limiting but, in few cases, can progress to cause tension pneumocephalus, resulting in poor neurological outcome [3]. Majority of the cases resolve with conservative management, while surgery is reserved for those who have associated raised intracranial pressure, recurrent episodes, and persistence beyond 1 wk [4].…”