Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic dis...Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic disease, who presented with BBS and who has developed neurological manifestations of kernicterus with magnetic resonance images showing basal ganglia abnormalities, is presented. In this patient, the total serum bilirubin (TSB) concentration ranged from 18.0 to 22.8 mg/dl (306 to 388 μmol/l) and the bilirubin/albumin (B/A) ratio was 6.0 (mg/g) (6.8 is the value at which an exchange transfusion should be considered). The case presented is important due to the fact that kernicterus appeared after an exchange transfusion was performed when the TSB level reached 22.8mg/dl (388 μmol/l) on 6th day of life while the haematocrit was 30%. From this case and fromother cases reported in the literature, we must stress that, even if the level at which hyperbilirubinemia poses a threat remains undefined, BBS may constitute an additional risk of developing kernicterus. Conclusion: The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn-mesoporphyrin.展开更多
Objectives: To evaluate the benefit of fluconazole prophylaxis in preventing i nvasive fungal infection in very low birth weight (VLBW) infants with central va scular access. Study design: A 3-year baseline period (19...Objectives: To evaluate the benefit of fluconazole prophylaxis in preventing i nvasive fungal infection in very low birth weight (VLBW) infants with central va scular access. Study design: A 3-year baseline period (1998 to 2000)was compare d with a subsequent 3-year period (2001 to 2003) during which a different proto col for preventing invasive fungal infection was used. All infants with a birth weight < 1500 g and with central vascular access were eligible for the study. Fl uconazole (Diflucan R)was administered for 28 days at a dose of 6 mg/kg every th ird day during the first week and daily after the first week. Results: There wer e no significant differences between the baseline and the fluconazole groups in demographic characteristics or risk factors for fungal infection. Fungal infecti on developed in 9 of the infants in the baseline group and in none of those in t he fluconazole group (P = .003). A trend of decreasing mortality rate between th e 2 groups (12.6%vs 8.1%; P = .32) was observed but was not statistically sign ificant. No adverse effects of fluconazole therapy were documented. Conclusions: Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants.展开更多
文摘Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic disease, who presented with BBS and who has developed neurological manifestations of kernicterus with magnetic resonance images showing basal ganglia abnormalities, is presented. In this patient, the total serum bilirubin (TSB) concentration ranged from 18.0 to 22.8 mg/dl (306 to 388 μmol/l) and the bilirubin/albumin (B/A) ratio was 6.0 (mg/g) (6.8 is the value at which an exchange transfusion should be considered). The case presented is important due to the fact that kernicterus appeared after an exchange transfusion was performed when the TSB level reached 22.8mg/dl (388 μmol/l) on 6th day of life while the haematocrit was 30%. From this case and fromother cases reported in the literature, we must stress that, even if the level at which hyperbilirubinemia poses a threat remains undefined, BBS may constitute an additional risk of developing kernicterus. Conclusion: The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn-mesoporphyrin.
文摘Objectives: To evaluate the benefit of fluconazole prophylaxis in preventing i nvasive fungal infection in very low birth weight (VLBW) infants with central va scular access. Study design: A 3-year baseline period (1998 to 2000)was compare d with a subsequent 3-year period (2001 to 2003) during which a different proto col for preventing invasive fungal infection was used. All infants with a birth weight < 1500 g and with central vascular access were eligible for the study. Fl uconazole (Diflucan R)was administered for 28 days at a dose of 6 mg/kg every th ird day during the first week and daily after the first week. Results: There wer e no significant differences between the baseline and the fluconazole groups in demographic characteristics or risk factors for fungal infection. Fungal infecti on developed in 9 of the infants in the baseline group and in none of those in t he fluconazole group (P = .003). A trend of decreasing mortality rate between th e 2 groups (12.6%vs 8.1%; P = .32) was observed but was not statistically sign ificant. No adverse effects of fluconazole therapy were documented. Conclusions: Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants.
