RESUMEN
Neonatal herpes simplex virus (HSV) infection is usually acquired at birth, although a few infants have had findings suggestive of intrauterine infection. We describe 13 babies who had clinical manifestations of intrauterine HSV infection, including skin lesions and scars at birth (12), chorioretinitis (eight), microcephaly (seven), hydranencephaly (five), and microphthalmia (two). All infants had combinations of these defects. Infection was proved by viral isolation in each case; all isolates were HSV-2. Two infants died during the first week of life; 10 of the surviving infants had severe neurologic sequelae, and one infant was blind. Four mothers experienced an apparent primary genital HSV infection, and one had recurrent infection, at varying times during gestation. The remaining women denied a history of symptoms of genital HSV infection. These findings indicate that intrauterine HSV infection can occur as a consequence of either primary or recurrent maternal infection and has severe consequences for the fetus.
Asunto(s)
Anomalías Múltiples/etiología , Enfermedades Fetales/etiología , Herpes Simple/transmisión , Complicaciones Infecciosas del Embarazo , Adolescente , Adulto , Sistema Nervioso Central/anomalías , Coriorretinitis/etiología , Método Doble Ciego , Femenino , Enfermedades Fetales/tratamiento farmacológico , Herpes Simple/tratamiento farmacológico , Humanos , Recién Nacido , Masculino , Microftalmía/etiología , Embarazo , Pronóstico , Recurrencia , Anomalías CutáneasAsunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Cefoperazona/uso terapéutico , Fibrosis Quística/complicaciones , Meticilina/uso terapéutico , Penicilinas/uso terapéutico , Derrame Pleural/tratamiento farmacológico , Ticarcilina/uso terapéutico , Tobramicina/uso terapéutico , Adolescente , Adulto , Niño , Quimioterapia Combinada , Femenino , Humanos , Masculino , Resistencia a las Penicilinas , Infecciones por Pseudomonas/tratamiento farmacológico , Distribución Aleatoria , Factores de TiempoRESUMEN
Meconium aspiration syndrome often produces respiratory failure in the neonate. We utilized the multiple inert gas elimination technique to study the effects on respiratory and inert gas exchange of the application of positive end expiratory pressure or continuous infusion of tolazoline HCl. The application of PEEP, with the optimal level of PEEP defined for each animal, produced a decrease in AaDO2 and pulmonary shunt, without an increase in blood flow to low VA/Q areas, or an increase in dead space. Tolazoline infusion, at 2 mg/kg/hour, had no apparent effect on AaDO2 or shunt, or magnitude of low VA/Q regions. Tolazoline therapy was associated with an increase in heart rate and a decrease in systemic blood pressure. We conclude that immediate postaspiration application of PEEP, but not of tolazoline, will diminish pulmonary shunt without creating low VA/Q areas, and therefore will improve gas exchange in MAS.