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358-PA11 Candida albicans in bronchial aspirates in newborns requiring prolonged intubation due to pneumonia
Abstracts
Algtrie. 150 cas ont 6t6 hospitalists sur 4 anntes successives. Le diagnostic a repos6 sur la recherche minutieuse du syndrome de ptnttration qui a 6t6 retrouv6 98 fois. Le corps 6tranger 6talt radio-transparent 1 fois sur 2. La bronchoscopie a 6t6 pratiqude dans un double but diagnostic et thtrapeutique. Les auteurs insistent sur la prtcocit6 de ce geste qui doit ~tre encadr6 par une 6quipe multidisciplinaire: pneumologues, o.r.l., anesthtsistes, instrumentistes. La rtalisation de cet examen est dtterminante pour prdvenir la survenue d'tventuelles complications. Dans la sdrie 6tudite en retrouve: pneumopathies 52 cas, atdlectasies 44 cas, d.d.b. 46 cas. La nature vtgttale du corps 6tranger est prtpondtrante; cacahuttes 46 fois, pois-chiches 32 fois, petits jouets 25 fois... Les auteurs soulignent le rtle de la prtvention darts la survenue de ce redoutable accident chez l'enfant, avec implication des mddecins eux-m~mes au niveau de la famille, des E.P.U., et des mtdias.
135-PAll
Cystic fibrosis
Kosjerina-O~tri6, V., Kosjerina, Z., Djuri6, B., Pavlovid-Popovi6, Z., Pali6ko, Dj. Institute of Lung Diseases and Tuberculosis, Sremska Kamenica, Yugoslavia
The paper is a case report of a seventeen-year-old boy with cystic fibrosis. He was admitted to hospital due to cough, abundant mucopurulent expectoration, fever, profuse sweating, fatique and diarrhoea. Anamnestic and heteroanamnestic data gave evidence of frequent infections of upper respiratory system dating back to the early childhood. He also reported having been hospitalized several times due to pneumonia and sinus infection, of nasal polyps and occasional diarrhoea. He lagged behind his age in physical development. The chest radiogram revealed bilateral lung lesions in the shape of tiny stained infiltrates with lighted areas. Bronchoscopy finding was normal, while bronchobiopsy gave evidence for interstitial pneumonia. Open lung biopsy revealed inflammatory bronchioloectases and bronchiectases with suppurative bronchopneumonia. Aspergillus fumigatus was isolated from the lung tissue sample. Bacteriologic analysis of the sputum revealed Pseudomonas aeruginosa. Sweating test showed several times increased values of nitrogen and chlorine in sweat and the spermogram revealed aspermia. Lund's test was positive. The treatment was performed by amphotericin B, antibiotics according to the antibiogram, pancreas enzymes and vitamins accompanied by physical therapy, resulting in an improvement of the patient's health condition. After his discharge from hospital, the patient has been regularly controlled at the Institute.
246-PAll The factors of bad prognosis in neonatal pneumonia complicated by acute respiratory insufficiency Kasprzyk, J., Godula-Stuglik, U., Kasprzyk, G., Ziora, K. Neonatal Pathology Clinic, Zabrze, Poland
The aims of our work were: 1] estimation of results of
71
treatment in neonatal pneumonia, according to whether there exists perinatal risk factors, newborn diseases, biochemical and hematological complications; 2] determination of the usefulness of some methods of treatment. The study population included 33 newborns [mean BW 2064 g, mean GA 34 weeks] admitted in NICU in Zabrze. Prematurity was recorded in 76% cases. Mortality rate was 15%. Statistical study was based on the factor analysis and analysis of multiple regression. It was stated that such perinatal risk factors as pathology of delivery, low Apgar score, LBW and LGA [Factor 4 - ~ (regression coefficient) -- 0,436420; p (significance level) = 0,000045] influenced on unsuccessful treatment. Risk of death coexists with G r a m negative septicemia [E. coli ([3 = 0,255087; p = 0,003177), Proteus vulgaris ([3 = 0,253349; p = 0,000625)], leukopenia [~3 = -0,305144; p = 0,001711], high hemoglobin concentration [[3 = 0,166795; p = 0,024246] and increase of fibrinolytic activity [~ = 1,083219; p = 0,000000]. Continuous mechanical ventilation, continuous positive airway pressure, exchange transfusion [Factor 1 - [~ = 0,481842; p = 0,000000] and dopamine infusion [[3 = -0,160040; p = 0,042471] were more frequently administered in dead babies.
Candida albicans in bronchial aspirates in newborns requiring prolonged intubation due to pneumonia 358-PAll
Bursa, J., Godula-Stuglik, U., Gajewska, J. Neonatal Pathology Clinic, Zabrze, Poland
In NICU in Zabrze during 4 years (1991-94) 82% of neonatal pneumonia required prolonged artificial ventilation. Among them in 21 cases Candida albicans in bronchial aspirate was stated. The study population included 18 prematures (mean birth weight 1410 g, mean GA 30 weeks) and 3 term-SGA with mean Apgar score 3,7. The perinatal risk factors in all babies were shown. The infants were intubated for HMD (14), congenital pneumonia (4), septicemia (2) and brain injury (1). In all neonates bacteriological and fungal examinations of bronchial aspirates were made weekly. On mean 42 day of intubation Candida albicans in aspirates was recognized. Fluconazole was administered once daily in dose 5 mg/kg for mean 16 days. All children survived and aspirates were negative.
Conclusion: In mechanically ventilated newborns treated with antibiotics a mycological diagnosis should become a routine test. 376-PAll Etiologic aspects of pneumonia with atelectasis in children under age of three years Dilberovska, M., Petrovska, S., AIeksievski, B., Jakovski, L. Institute for Respiratory Diseases in Children, Skopje, Macedonia
At the period of 1991-1994 in the Department of Acute Respiratory Diseases in Children at our Institute we treated 51 children under 3 years with pneumonia with atelectasis.
Algtrie. 150 cas ont 6t6 hospitalists sur 4 anntes successives. Le diagnostic a repos6 sur la recherche minutieuse du syndrome de ptnttration qui a 6t6 retrouv6 98 fois. Le corps 6tranger 6talt radio-transparent 1 fois sur 2. La bronchoscopie a 6t6 pratiqude dans un double but diagnostic et thtrapeutique. Les auteurs insistent sur la prtcocit6 de ce geste qui doit ~tre encadr6 par une 6quipe multidisciplinaire: pneumologues, o.r.l., anesthtsistes, instrumentistes. La rtalisation de cet examen est dtterminante pour prdvenir la survenue d'tventuelles complications. Dans la sdrie 6tudite en retrouve: pneumopathies 52 cas, atdlectasies 44 cas, d.d.b. 46 cas. La nature vtgttale du corps 6tranger est prtpondtrante; cacahuttes 46 fois, pois-chiches 32 fois, petits jouets 25 fois... Les auteurs soulignent le rtle de la prtvention darts la survenue de ce redoutable accident chez l'enfant, avec implication des mddecins eux-m~mes au niveau de la famille, des E.P.U., et des mtdias.
135-PAll
Cystic fibrosis
Kosjerina-O~tri6, V., Kosjerina, Z., Djuri6, B., Pavlovid-Popovi6, Z., Pali6ko, Dj. Institute of Lung Diseases and Tuberculosis, Sremska Kamenica, Yugoslavia
The paper is a case report of a seventeen-year-old boy with cystic fibrosis. He was admitted to hospital due to cough, abundant mucopurulent expectoration, fever, profuse sweating, fatique and diarrhoea. Anamnestic and heteroanamnestic data gave evidence of frequent infections of upper respiratory system dating back to the early childhood. He also reported having been hospitalized several times due to pneumonia and sinus infection, of nasal polyps and occasional diarrhoea. He lagged behind his age in physical development. The chest radiogram revealed bilateral lung lesions in the shape of tiny stained infiltrates with lighted areas. Bronchoscopy finding was normal, while bronchobiopsy gave evidence for interstitial pneumonia. Open lung biopsy revealed inflammatory bronchioloectases and bronchiectases with suppurative bronchopneumonia. Aspergillus fumigatus was isolated from the lung tissue sample. Bacteriologic analysis of the sputum revealed Pseudomonas aeruginosa. Sweating test showed several times increased values of nitrogen and chlorine in sweat and the spermogram revealed aspermia. Lund's test was positive. The treatment was performed by amphotericin B, antibiotics according to the antibiogram, pancreas enzymes and vitamins accompanied by physical therapy, resulting in an improvement of the patient's health condition. After his discharge from hospital, the patient has been regularly controlled at the Institute.
246-PAll The factors of bad prognosis in neonatal pneumonia complicated by acute respiratory insufficiency Kasprzyk, J., Godula-Stuglik, U., Kasprzyk, G., Ziora, K. Neonatal Pathology Clinic, Zabrze, Poland
The aims of our work were: 1] estimation of results of
71
treatment in neonatal pneumonia, according to whether there exists perinatal risk factors, newborn diseases, biochemical and hematological complications; 2] determination of the usefulness of some methods of treatment. The study population included 33 newborns [mean BW 2064 g, mean GA 34 weeks] admitted in NICU in Zabrze. Prematurity was recorded in 76% cases. Mortality rate was 15%. Statistical study was based on the factor analysis and analysis of multiple regression. It was stated that such perinatal risk factors as pathology of delivery, low Apgar score, LBW and LGA [Factor 4 - ~ (regression coefficient) -- 0,436420; p (significance level) = 0,000045] influenced on unsuccessful treatment. Risk of death coexists with G r a m negative septicemia [E. coli ([3 = 0,255087; p = 0,003177), Proteus vulgaris ([3 = 0,253349; p = 0,000625)], leukopenia [~3 = -0,305144; p = 0,001711], high hemoglobin concentration [[3 = 0,166795; p = 0,024246] and increase of fibrinolytic activity [~ = 1,083219; p = 0,000000]. Continuous mechanical ventilation, continuous positive airway pressure, exchange transfusion [Factor 1 - [~ = 0,481842; p = 0,000000] and dopamine infusion [[3 = -0,160040; p = 0,042471] were more frequently administered in dead babies.
Candida albicans in bronchial aspirates in newborns requiring prolonged intubation due to pneumonia 358-PAll
Bursa, J., Godula-Stuglik, U., Gajewska, J. Neonatal Pathology Clinic, Zabrze, Poland
In NICU in Zabrze during 4 years (1991-94) 82% of neonatal pneumonia required prolonged artificial ventilation. Among them in 21 cases Candida albicans in bronchial aspirate was stated. The study population included 18 prematures (mean birth weight 1410 g, mean GA 30 weeks) and 3 term-SGA with mean Apgar score 3,7. The perinatal risk factors in all babies were shown. The infants were intubated for HMD (14), congenital pneumonia (4), septicemia (2) and brain injury (1). In all neonates bacteriological and fungal examinations of bronchial aspirates were made weekly. On mean 42 day of intubation Candida albicans in aspirates was recognized. Fluconazole was administered once daily in dose 5 mg/kg for mean 16 days. All children survived and aspirates were negative.
Conclusion: In mechanically ventilated newborns treated with antibiotics a mycological diagnosis should become a routine test. 376-PAll Etiologic aspects of pneumonia with atelectasis in children under age of three years Dilberovska, M., Petrovska, S., AIeksievski, B., Jakovski, L. Institute for Respiratory Diseases in Children, Skopje, Macedonia
At the period of 1991-1994 in the Department of Acute Respiratory Diseases in Children at our Institute we treated 51 children under 3 years with pneumonia with atelectasis.