Early neonatal respiratory distress revealing meningitis caused by Streptococcus pneumoniae serotype 17F: a case report

Background: Streptococcus pneumoniae (S. pneumoniae) is the first leading cause of invasive diseases such as meningitis, bacteremia and pneumoniae in children. In this case we report an early neonatal respiratory distress revealing meningitis caused byS. pneumoniae Serotype 17F through vertical transmission, in the newborn of 3 hours of live. Case description: A male late preterm newborn was born by vaginal delivery at a gestational age of 34 weeks. At 3 hours of life, he was admitted for early moderate neonatal respiratory distress in the Neonatal Medicine and Resuscitation Service.Cerebrospinal fluid culture yielded S. pneumoniae belonging to serotype 17F while the blood culture was negative. The same pneumococcal serotype was recovered from the high vaginal swab of the mother. Both isolates were found susceptible to all tested antibiotics except tetracycline and chloramphenicol to which the strain was resistant. Antibiotherapy management of the child included ceftriaxone at 150mg/kg/day for 21 days, in combination with gentamycin at 5 mg/kg/day for 5 days. ciprofloxacin was added at 40mg/kg/day in two doses for a period of three weeks as the baby presented a hydrocephalus. Conclusion: This finding shows that clinical manifestations of neonatal pneumococcal meningitis may be atypical and/or misleading. Keywords: Streptococcus pneumoniae; neonatal meningitis; respiratory distress.

Congenital toxoplasmosis the overlooked disease: a case report

The causative agent of congenital toxoplasmosis (CT) is Toxoplasma gondii, an obligate intracellular parasitic protozoan presenting as a zoonotic infection distributed worldwide. Congenital toxoplasmosis may lead to abortion, intrauterine growth restriction, hepatosplenomegaly, jaundice and several neurological and ocular manifestations. The classic pathognomonic manifestations are the triad of intracranial calcifications, hydrocephalus and chorioretinitis. However, the majority of infected infants are asymptomatic at birth. Herein, we reported a case of severe CT in a late preterm newborn. Interestingly, the majority of the manifestations reported for CT were observed in this case. The high anti-toxoplasma antibodies (IgM and IgG) in the infant and his mother confirmed the diagnosis.

Cardiac and vascular health in late preterm infants

Adults who were born preterm are at increased risk of hypertension and cardiovascular disease in later life. Infants born late preterm are the majority of preterm births; however, the effect of late preterm on risk of cardiovascular disease is unclear. The objective of this study was to assess whether vascular health and cardiac autonomic control differ in a group of late preterm newborn infants compared to a group of term-born infants. A total of 35 healthy late preterm newborn infants, with normal growth (34–36 completed weeks’ gestation) and 139 term-born infants (37–42 weeks’ gestation) were compared in this study. Aortic wall thickening, assessed as aortic intima–media thickness (IMT) by high-resolution ultrasound, and cardiac autonomic control, assessed by heart rate variability, were measured during the first week of life. Postnatal age of full-term and late preterm infants at the time of the study was 5 days (standard deviation [SD] 5) and 4 days (SD 3), respectively. Infants born late preterm show reduced aortic IMT (574 μm [SD 51] vs. 612 μm [SD 73]) and reduced heart rate variability [log total power 622.3 (606.5) ms2 vs. 1180. 6 (1114.3) ms2], compared to term infants. These associations remained even after adjustment for sex and birth weight. Infants born late preterm show selective differences in markers of cardiovascular risk, with potentially beneficial differences in aortic wall thickness in contrast to potentially detrimental differences in autonomic control, when compared with term-born control infants. These findings provide pathophysiologic evidence to support an increased risk of hypertension and sudden cardiac death in individuals born late preterm.

Neonatal outcome of a giant placental chorioangioma in a late preterm newborn

Chorioangioma, the most common benign placental tumor, is found in 1% of placental pathology. Tumors greater than 4 cm are classified as giant and associated with multiple maternal and fetal complications. Authors are presenting a case report of a rare 16 cm giant chorioangioma, discovered at time of delivery, complicated with pregnancy induced hypertension and presenting with minimal fetal complication. This patient exhibited eventually a satisfactory perinatal outcome, complicated by severe anemia and thrombocytopenia requiring transfusion of blood products and bilateral, self-resolved spontaneous cephalohematomas. Chorioangiomas should be considered in the differential diagnosis of any newborn that presents with anemia.

Congenital chylous ascites: a case report

Due to the rarity of congenital chylous ascites and the lack of standards in diagnosis and therapy, this disease constitutes a medical challenge and individual therapy seems to be extremely important. A late preterm newborn with antenatally diagnosed ascites was born and chylous ascites was diagnosed after feeds were started. The baby was managed initially with nil per oral, parenteral nutrition and octreotide, followed by adding MCT formula feeds. Considering the rarity of neonatal chylous ascites and the non-uniformity in management plans and follow up, more case reports need to be published. Also, MCT formula, the main stay of management has to be discontinued as soon as possible with gradual introduction into breast feeds or normal newborn formula milk as long chain fatty acids are essential for optimal brain growth in newborns.

Profile of retinopathy of prematurity in late preterm newborn in a district level special newborn care unit of Eastern India

Background: The aim of this study was to analyse the incidence, severity and risk factors of retinopathy of prematurity in late preterm newborn at a district level SNCU in eastern India.Methods: The initial examination was carried out at 3 weeks of postnatal age or at 31weeks of post-conceptional age, whichever was later. Retinopathy was graded into stages and zones as per the ICROP classification. Those who had ROP were examined every week till regression occurred or till they reached criteria for laser treatment which was type I Prethreshold ROP as per ET ROP guideline. Risk factors for the development of ROP were determined by reviewing maternal and perinatal history and hospital case records.Results: 212 late ptreterm newborn were examined. The incidence of ROP in late preterm was 16.51% (35 out of 212 newborn). Incidence of stage I ROP was 6.60 % (14 newborn had stage I ROP). Incidence of stage II ROP was 6.60% (14 had stage II ROP). None had stage III ROP. 7 had APROP. Incidence of APROP was 3.30 %. 5 out of 14 newborns with stage II ROP (35.71%) required laser treatment. All newborn with APROP required both laser and Anti VEGF treatment. Overall 34.28% of late preterm with ROP required treatment. There was no difference in gestational age and birth weight in late preterm with and without ROP. There was significant difference in the duration of oxygen therapy in late preterm with and without ROP (6.657±2.531days vs 0.694±1.397 days, p<0.001). In stepwise logistic regression analysis-use and duration of oxygen, birth asphyxia and anemia were found to be significant risk factors of ROP in late preterm.Conclusions: ROP is common in late preterm newborn in developing country like India.