In this study, we investigated the antibacterial effects of bilirubin on certain Gram-negative bacteria using both agar dilution and liquid microdilution methods. Twenty-five strains each of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa strains, isolated from various clinical samples in the medical microbiology laboratory of our hospital, were evaluated. Stock solutions of bilirubin (5 mg, 10 mg, and 15 mg/dl) (AppliChem, GmbH, Darmstadt, Germany) were prepared for agar dilution method. Aliquots of bilirubin stock solutions were added to liquid brain heart infusion medium in sterile microplates for liquid dilution methods. The average bilirubin MICs were 61.44, 62.72, ≥ 64.00, and ≥ 64.00 μg/mL for E. coli, K. pneumoniae, A. baumannii, and P. aeruginosa. In agar and liquid dilution methods, all tested bacteria grew at all bilirubin concentrations used. Bilirubin had no in vitro antibacterial effect on E. coli, K. pneumoniae, A. baumannii, or P. aeruginosa.
A preterm female infant presents with respiratory distress and sternal cleft associated with a skin defect (Fig).Surfactant was given after intubation and placed on mechanical ventilation. She was noted to have superior sternal cleft associated with a skin defect on the sternal and abdomen skin (Figure). Echocardiography revealed a ventricular septal defect and atrial septal defect. Cranial and abdominal ultrasonography results were normal.The diagnosis of aplasia cutis congenita was made.Aplasia cutis congenita (ACC) is defined as the congenital absence of skin. ACC represents a heterogeneous group of disorders that may occur in isolation or in conjunction with various syndromes. There is no single underlying cause. It is usually detected at birth and most commonly affects the scalp as a solitary lesion. The type of lesion may be classified into 1 of 9 groups. The features of these groups are presented in the Table.There was sternal cleft associated with ACC in our case. These findings are consistent with group 4. This category encompasses ACC that overlies any embryologic malformations, such as sternal cleft.Diagnosis of ACC is made based on the physical appearance of the infant’s skin. No specific laboratory test is needed. Chromosome analysis may be indicated if a pattern of abnormalities suggests a genetic disorder. Elevated α-fetoprotein levels in maternal serum and amniotic fluid, as well as elevated acetylcholinesterase levels in amniotic fluid, have been reported as possible early signs of ACC. However, these tests are neither sensitive nor specific and not currently used for diagnosis.Treatment for cases of ACC is usually conservative. Local therapy includes gentle cleansing and the application of bland ointment or topical antibiotic ointment to prevent desiccation of the defect. Antibiotics are only indicated if overt signs of infection are noted. When lesions are a bit larger on the scalp, such as larger than 3 to 4 cm, treatment may be controversial. Some authors continue to recommend conservative wound care; however, others advocate for more aggressive therapy, such as surgical correction, because of the risk of complications.JoDee M. Anderson, MD, MEd, Assistant Editor, Visual Diagnosis, Video Corner; Associate Professor, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Oregon Health & Science University, Portland, OR.
Maternal smoking is considered to be a risk factor for low birth weight. It is hypothesized that alteration in leptin concentration may be associated with reduced fetal growth. In this study, we assess the effect of smoking during pregnancy on maternal and neonatal serum leptin concentrations, and also on breast milk leptin levels. When the infants were brought to routine physical examination at 7 days old, blood samples and breast milk specimens were taken for leptin measurement from mothers who smoked during pregnancy and their newborns. Nonsmoking mothers and their infants were recruited randomly over the same period as a control group. Maternal age, number of pregnancy, weight of the mothers, birth weight, and gestational age of the infants were similar in both groups (p > 0.05). There was no significant difference between groups in maternal serum and breast milk leptin levels (p = 0.14 and p = 0.96, respectively). However, serum leptin levels were found significantly lower in neonates born to smoking mothers compared with infants born to nonsmoking mothers (p = 0.02). Our findings suggest that maternal smoking dose not have an effect on maternal serum and breast milk leptin levels but decreases neonatal serum leptin concentration independent of birth weight.
The authors describe a case of pulmonary endarteritis and subsequent embolization to the lungs as a complication of a patent ductus arteriosus (PDA). Although 2-dimensional echocar diography has been shown to be of great value in the diagnosis of patients with infective endocarditis, echocardiographic detection of vegetation within the pulmonary artery and subsequent embolization to the lung is extremely rare and, to our knowledge, has been previ ously reported only in a few cases. In brief, our case not only shows the importance of echocar diography in making this rare diagnosis but also emphasizes the role of echocardiography as an effective means of following up such a case.
A 4-day-old male infant presents to the neonatal intensive care unit with jaundice that was noticed initially yesterday and gradually has increased. He was delivered at term after an uncomplicated pregnancy, with a birthweight of 2.8 kg. The parents are first-degree cousins, and the family history is unremarkable. The baby is being breastfed. The prenatal history is not well-known.
Physical examination reveals an active, jaundiced male infant whose axillary temperature is 97.2°F (36.2°C), heart rate is 156 beats/min, respiratory rate is 35 breaths/min, and blood pressure 60/35 mm Hg. His weight is 2.9 kg (10th percentile), length is 50 cm (50th percentile), and head circumference 35 cm (50th percentile). Examination of his eyes reveals yellow sclera, and the entire body is icteric. Cardiovascular examination reveals a regular heart rate and rhythm, with no murmurs. The lungs are clear to auscultation bilaterally. His liver is palpable 4 cm below the costal margin. Findings on the remainder of the physical examination are normal.
Laboratory results are as follows: serum total bilirubin, 21.04 mg/dL (369.8 mcmol/L) with a direct bilirubin of 2.06 mg/dL (35.2 mcmol/L); serum aspartate aminotransferase, 38 U/L; alanine aminotransferase, 19 U/L; gamma glutamyl transferase, 744 U/L (normal, 13 to 147 U/L); alkaline phosphatase (AF), 520 U/L (normal, 150 to 400 U/L); creatinine, 0.4 mg/dL (35.4 mcmol/L); urea, 30 mg/dL (10.7 mmol/L); sodium, 149 mEq/L (149 mmol/L); potassium, 4.6 mEq/L (4.6 mmol/L); and negative C-reactive protein. A complete blood count demonstrates hemoglobin, 18 g/dL (180 g/L); hematocrit, 52.9% (0.529); white blood cell count, 10 × 103 …
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