Neonatal Fever Research Articles

Infantile-onset multisystem inflammatory disease: A differential diagnosis of systemic juvenile rheumatoid arthritis

We describe four unrelated children with neonatal maculopapular rash, fever, arthritis, hepatosplenomegaly, lymphadenopathy, eye involvement, and neurologic symptoms. Radiographs of the joints were surprisingly similar, showing an abnormal epiphyseal and metaphyseal appearance. These clinical and radiologic findings allowed us to include these children in a very peculiar syndrome described as infantile-onset multisystemic inflammatory disease. A chondrosarcoma developed in one of our patients. (J Pediatr 1997; 130:551-6)

NEONATAL FEVER ASSOCIATED WITH HEPATITIS B VACCINE † 951

Objective: Since January 1992 routine active Hepatitis B vaccination on the first day of life is undertaken for all infants born in Israel. We investigated whether the immunization was associated with increased infants with unexplained neonatal fever who underwent ”sepsis work up“ and received IV antibiotic treatment. Study design: We undertook a retrospective chart review of inborn full-term infants from 1991 to 1992 in whom a diagnosis of temperature regulation disorder or antibiotic injection was recorded. Two groups of infants were compared: The non-vaccinated group - infants born in 1991 who did not receive hepatitis B vaccine. The vaccinated group - infants born in 1992 who were immunized against hepatitis B during their first day of life. ”Unexplained fever“ was defined as a temperature of > 38°C in the first three days of life without sepsis, dehydration, maternal fever or respiratory distress. Results: The incidence of unexplained fever in the vaccinated group, 35 infants out of 5910 (0.6%) was significantly higher than in the non vaccinated group, 14 infants out of 5010 (0.28%) (p < 0.005); There was however no difference in the incidence of ”explicable“ fever in the two groups. The excess of unexplained neonatal fever was associated with increase in the use of intravenous antibiotic therapy and prolonged hospitalization. Conclusions: The introduction of routine Hepatitis B immunization in newborn infants appears to be associated with an excess of infants with unexplained neonatal fever and consequently with increased length of hospitalization and intravenous antibiotic therapy. In view of the low carrier rate of hepatitis B in Israel, we suggest that in the low risk subjects the first Hepatitis B vaccine be deferred to a later age, and combined with the other immunizations given at the Maternal and Infant Welfare Centers. High risk mothers should be evaluated prenatally and infants of Hepatitis B carriers should be vaccinated soon after birth as is currently recommended.

Neonatal typhoid fever.

Typhoid fever occurs in children less than 2 years of age but is thought to be a mild, often unrecognized illness. Neonatal typhoid fever is a rare but often life-threatening illness, uniformly fatal in the preantibiotic era. Vertical intrauterine transmission from a typhoid-infected mother is implicated in neonatal typhoid fever. Ten cases at a rural African hospital are presented. Three patients died with two deaths associated with empiric management inappropriate for Salmonella typhi. A second clinical presentation in the neonate is asymptomatic persistent excretion. Infants < or = 3 weeks old may also be infected from an exogenous source and have severe disease. Where typhoid is endemic S. typhi should be considered as a cause of sepsis neonatorum and appropriate antibiotics included in empiric therapy.

Avoiding Neonatal Death: An Intervention Study of Umbilical Cord Care

During a study of pregnancy in a poor rural tropical area, a high prevalence of neonatal fever and umbilical cord infection was detected. Interim analysis showed that this was associated with subsequent development of neonatal sepsis. Therefore an intervention was introduced in two stages. In the first stage, acriflavine spirit and new razor blades were supplied to mothers, along with instructions for use, through antenatal clinics. In the second stage, when excessive cord bleeding was reported, umbilical cord clamps were added to the pack. The packs were associated with reduction of serious morbidity in the neonatal period. The study demonstrates the importance of umbilical cord care in the aetiology of life threatening neonatal morbidity in village births in a developing country and the effect of a simple intervention in reducing morbid episodes in the neonate.

Tick-borne relapsing fever in a premature infant

Relapsing fever is caused by the Borrelia species of spirochetes. Louse-born epidemics of the disease may occur but the endemic disease is usually transmitted to humans by the bite of an infected tick (Ornithodorus). Transplacental infection was suggested more than 75 years ago (1) but has been rarely documented (2). We describe a case of neonatal relapsing fever where maternal infection was the probable cause of the premature delivery and infection in the infant.

Neonatal mycoplasmaemia: Mycoplasma hominis as a significant cause of disease?

A full-term baby boy had respiratory distress, fever and pneumonia within 20 h of birth. Isolation of Mycoplasma hominis from blood taken after 20 h and 11 days was accompanied by an antibody response. Although chlamydial IgM antibody was detected, chlamydial infection probably did not cause the pneumonia. Penicillin was ineffective but treatment with gentamicin, and particularly tetracycline, was associated with slow improvement. Mycoplasma hominis should be considered as a cause of respiratory disease and fever in neonates.

Fever and trace metal changes in endotoxin-challenged neonates.

During infections, plasma Fe and Zn generally fall, while body temperature and plasma Cu rise. However, infected neonates usually do not develop fever during the first week of postnatal life. While fever could not be evoked in neonatal guinea pigs by 2 micrograms/kg of S. enteritidis endotoxin until they were 8 days old, their plasma levels of Fe and Zn were lowered significantly from birth; plasma Cu tended to increase from 2 days postnatally. These results indicate that, contrary to the refractoriness to endotoxin of the fibrific system, the ability to alter trace metal levels exists from birth. Thus, fever and trace metal levels are not necessarily coupled for host defense during infection.

Neonatal relapsing fever due to transplacental transmission of Borrelia

Neonatal relapsing fever due to transplacental transmission of Borrelia