Relatedness of strains of methicillin-resistant coagulase-negative Staphylococcus colonizing hospital personnel and producing bacteremias in a neonatal intensive care unit.

The emergence of methicillin-resistant coagulase-negative Staphylococcus as a major bacterial pathogen in neonatal intensive care units has stimulated interest in the epidemiology of spread of the organism. During a 12-month "epidemic" of bacteremias with methicillin-resistant coagulase-negative Staphylococcus we compared the characteristics of bacteremic and personnel nasally-carried strains by traditional and biomolecular methods. Sixty-two percent of neonatal intensive care unit nurses were colonized with methicillin-resistant coagulase-negative Staphylococcus with similar speciation to bacteremic strains.

Birth weights of infants of black and white mothers without pregnancy complications.

An analysis of 10,159 normal spontaneous vaginal deliveries was performed to examine racial differences in mean birth weight of infants whose mothers were without antepartum or intrapartum medical complications of pregnancy. The study was limited to black and white infants of low-income mothers who were inborn, singleton, and weighed greater than or equal to 500 gm at birth. High-risk maternal transfer patients and patients with hypertension, toxemia, bacteriuria, pyelonephritis, renal failure, diabetes, anemia, polyhydramnios, oligohydramnios, prolapsed cord, vaginal bleeding, placenta previa, abruptio placentae, prolonged rupture of membranes, maternal fever on admission, amnionitis, sexually transmitted diseases, or fewer than five prenatal care visits were excluded.

Differences in black and white infant birth weights: the role of maternal demographic factors and medical complications of pregnancy.

In a retrospective study of 18,631 deliveries among women of low income, we examined the association of racial disparities in mean birth weight with population differences in maternal demographic characteristics and antepartum-intrapartum medical complications. The study population consisted of inborn, nonreferred, singleton, low-income patients delivered on the nonprivate service after at least five prenatal care visits. Repeat cesarean sections were not included.

Multiple rhabdomyomatous mesenchymal hamartomas of skin.

A case of multiple rhabdomyomatous mesenchymal hamartomas is presented. The patient is a black male infant, the product of an uncomplicated term gestation and delivery. At birth, there were numerous polyps distributed over the periorbital and periauricular areas bilaterally.

Factors influencing the relationship between a newborn assessment of gestational maturity and the gestational age interval.

This study examines the correlation and agreement between the calculated 'gestational interval' from the date of last menstrual period (LMP) and the Ballard newborn assessment of gestational maturity. It then investigates selected maternal socio-demographic, prenatal, intrapartum and infant factors which may account for differences between these two gestational age determination methods. Single live-born deliveries (n = 10,794) were selected from a 1982-1986 medical university perinatal information data system for analysis.

Intrahepatic encystment of umbilical vein catheter infusate.

Massive hepatomegaly in a 2.1 kg female infant, with an indwelling umbilical vein catheter for total parenteral nutrition, occurred on the 10th day of life. Ultrasound and computed tomography studies revealed a large hepatic cyst filled with the catheter infusate.

Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit.

Between October 1985 and August 1986, 49 isolates of methicillin-resistant Staphylococcus aureus (MRSA) were obtained from 26 neonates in the neonatal intensive care unit (NICU) at the Medical University Hospital, Charleston, SC. Sites of MRSA isolation were the respiratory tract (33%); nasopharynx (12%); gastrointestinal tract (12%); eye (8%); blood (6%); and catheter tips, wounds, or umbilicus (29%). Very low birth weight was a significant risk factor for MRSA acquisition.

Median cleft of the upper lip associated with lipomas of the central nervous system and cutaneous polyps.

An unusual combination of three rare developmental anomalies, ie, complete median cleft lip, cutaneous polyps, and midline lipomas of the central nervous system, was discovered in a male newborn. Inguinal hernia, cryptorchidism, and clinodactyly of the fifth fingers were other features. His mother was found to have clinodactyly, antimongoloid slant to her palpebral fissures, and computed tomography (CT) scan evidence of asymptomatic hydrocephaly.

High levels of group-specific component (vitamin-D-binding protein) in the cerebrospinal fluid of infants aged less than 2 months.

Because of the possible involvement of group-specific component (Gc) or vitamin-D-binding protein in the immunological functions of mononuclear cells and the increased risk of central nervous system infections in early infancy, we studied Gc levels in the cerebrospinal fluid (CSF) of children. CSFs were examined for the Gc concentration using ELISA and rocket immunoelectrophoresis, with purified Gc as standard. The results showed a significant inverse correlation (p less than 0.

Renal failure and other serious sequelae of epinephrine toxicity in neonates.

Epinephrine has numerous potent pharmacologic actions with protean manifestations. We have described a patient in whom inadvertent intra-aortic administration of a large dose of racemic epinephrine produced serious adverse effects, including hypertension, acidemia, tachycardia, and protracted but reversible renal failure. In view of the ubiquitous use of epinephrine in neonatal intensive care, we hope that this report heightens awareness of its more serious and potentially fatal toxic effects.

Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization.

Serratia marcescens (SM) produced a prolonged outbreak in a neonatal intensive care unit of high level gastrointestinal colonization (10(9) SM/g feces) which in the early part of the outbreak predisposed to respiratory infection. The early outbreak featured a strain of SM carrying a 54 X 10(6) dalton conjugative plasmid which mediated resistance to gentamicin, tobramycin and beta-lactam agents. The second part of the outbreak involved primarily gastrointestinal colonization with SM strains that were plasmid-free.

Effect of neonatal cerebrospinal fluid on monocyte chemotaxis.

We have reported in our previous study that macrophages constitute 58% of the total number of white cells in noninfected neonatal cerebrospinal fluid (CSF). CSF macrophages are probably derived from blood monocytes. To explain their predominance, we compared the chemotactic response of monocytes from cord and adult blood to neonatal (NCSF) and non-neonatal spinal fluids (NNCSF).

Primary renal candidiasis in two preterm neonates. Report of cases and review of literature on renal candidiasis in infancy.

Primary renal candidiasis and hydronephrosis were diagnosed in two premature neonates in whom systemic hypertension developed. The clinical course in these patients and in 16 patients with renal candidiasis described in the literature indicated that prematurity, use of broad-spectrum antibiotics, and use of intravenous (IV) catheters are predisposing factors. Anuria and flank mass were the initial manifestations in the reviewed cases.

Brain calcification in severely stressed neonates receiving parenteral calcium.

Morphologic evidence for calcium salts within the brains of severely stressed neonates at autopsy correlated to the mean daily parenteral dose of calcium gluconate (P less than 0.01). Survival analysis indicated that parenteral administration of calcium contributed a negative effect to predicted survival (P less than 0.

Multimodal assessment of human brain calcification with respect to parenteral calcium gluconate in stressed neonates.

Parenteral calcium may augment the degree of calcification within brains of human neonates (p less than 0.01). This observation is supported by histochemistry, atomic absorption of ashed brain, selected area diffraction, and energy dispersive microanalysis.

Maternal risk factors in infants with very low birth weight.

To determine whether maternal risk factors associated with the delivery of very low birth weight infants under 1501 g are different from those associated with low birth weight infants of 1501 to 2500 g, prenatal data on 12,247 deliveries were evaluated. The sample contained 302 very low birth weight infants. Maternal race, age, height, weight, gravidity, parity, past pregnancy performance, and pregnancy complications were analyzed.

Gluteal necrosis with foot-drop. Complications associated with umbilical artery catheterization.

A newborn infatn developed gluteal necrosis and foot-drop associated with umbilical artery catheterization. Clinical course of the infant's illness illustrates that the etiology was multifactorial, being related to the site of catheter tip placement, hypotension, and infusion of hypertonic glucose and other drugs via umbilical catheter.

Effect of tolazoline on persistent hypoxemia in neonatal respiratory distress.

Twenty-seven infants with respiratory distress and hypoxemia of noncardiac etiology were treated with tolazoline. Thirteen infants had hyaline membrane disease and 14 had respiratory distress attributable to causes other than hyaline membrane disease. An immediate response to tolazoline, a rise in PaO2 of 15 torr or more within 15 min, was seen in 11 infants in the hyaline membrane disease group and in eight infants of the other group.