Background: A wide range of drugs are commonly used to treat bronchiolitis, but evidence of their effectiveness is limited. Objectives: To investigate the efficacy of ipratropium bromide and salbutamol in the treatment of patients with moderate-severe bronchiolitis. Methods: Sixty-nine infants with moderate-severe bronchiolitis hospitalized at their first episode of wheezing or crepitations in the chest were enrolled in a prospective, double-blind, placebo-controlled trial. Patients were randomly assigned to receive nebulized salbutamol, ipratropium bromide or placebo. Main outcome measures were changes in oxygen saturation rates and clinical scores and duration of hospitalization. Results: In the bronchodilator groups, clinical scores were better compared to the placebo group at 30 min (8.4 ± 1.3 vs. 7.5 ± 0.8, p < 0.05). Bronchodilator groups had also significantly lower clinical scores (7.3 ± 1.2 vs. 5.9 ± 1.1, p < 0.0001, and 5.3 ± 1.4 vs. 4.5 ± 1.6, p = 0.006, respectively) and higher oxygen saturation rates compared to the placebo group at 8 and 24 h (89.6 ± 2.4 vs. 94.3 ± 4.4, and 92.2 ± 2.6 vs. 95.9 ±4.4, respectively, p < 0.0001). Improvement rates and duration of hospitalization were not statistically different among groups. Conclusions: Clinical scores and oxygen saturation levels improved more rapidly in the bronchodilator groups than in the placebo group up to 24 h, but these drugs did not have a sufficient effect to change the natural course of the disease.

A 28-week-old preterm infant with a birth weight of 1250 g had a broken segment of umbilical vein catheter (UVC) lodged in the right atrium. It was observed that a 7-cm fragment of catheter had migrated to the right atrium through the inferior vena cava. The catheter was successfully retrieved by fluoroscopically guided percutaneous cardiac catheterization, using a cobra catheter and snare wire, without complication. Fracture and embolization of UVC is a rare but serious complication. Presently described was a case of fractured and embolized UVC in a very low-birth-weight preterm infant, and its successful retrieval via percutaneous endovascular approach.

No abstract

Case summaryA 28-day-old girl was presented at our hospital because of weakness and poor appetite since shortly after birth, failure to thrive, and a history of urinary infection. The infant was born at full term with a birth weight of 4,035 g. Prenatal, natal, and family history was unremarkable. Both parents were healthy and nonconsanguineous. She had been breastfed since birth; however, she never fed well and did not regain her birth weight. Because 20-25 leukocytes/high power field was shown in urine microscopic examination and 100,000 colonies/ml of Klebsiella pneumoniae were grown in the urine specimen collected in a perineal bag, she was admitted to another hospital at the 10th day of life and treated with cefotaxime for 7 days. There was no clinical improvement after discharge, and leukocyturia persisted.On admission to our neonatal unit, her weight was 4,160 g, her anterior fontanelle slightly depressed, the mucous membranes and the skin dry and pale, and the amount of subcutaneous fat had decreased. Neurologic examination revealed generalized hypotonia with no eye contact. The rest of her physical examination was normal. Results of the laboratory studies included a hemoglobin concentration of 13.0 g/l; hematocrit value of 46.5%, leukocyte count of 14.0×10 9 /l with 55% neutrophils, and platelet count of 216×10 9 /l. The venous blood pH measurement was 7.17, pCO 2 21.2 mmHg, pO 2 51 mmHg, HCO À 3 9.7 mmol/l, base excess −20 mmol/l, and the anion gap (AG) was 10.3 mmol/l. Her blood chemistry showed sodium 139 mEq/l, potassium 3.10 mEq/l, chloride 126 mEq/l, glucose 96 mg/dl, blood urea nitrogen 20 mg/dl, creatinine 0.7 mg/dl, calcium 14.6 mg/dl, ionized calcium 2.1 mmol/l, phosphorus 7 mg/dl, magnesium 1.2 mg/dl, alkaline phosphatase 142 IU/l, parathyroid hormone 4.06 pg/ml (normal <8 pg/ml), and 25-OH vitamin D 24 ng/ml (normal 20-40 ng/ml). Blood ammonia concentration was 247 μg/dl (normal 0-86 μg/dl). Serum C-reactive protein, liver enzymes, albumin, bilirubin, partial thrombin time, and partial tissue thromboplastin time were all in the normal range. Urine analysis revealed a pH of 8.0, with negative nitrite, glucose, protein, blood, and ketones and 2+ leukocyte esterase. Urine cultures obtained at admission and follow-up were found to be sterile. Microscopic examination showed 20-30 white blood cells/high power field. The urine AG (uAG) was +20 mmol/l. After bicarbonate therapy, the urinary minus blood pCO 2 gradient was found to be 10.5 mmol/l (normal >20 mmol/l). Spot urine calcium-to-creatinine ratio was 3.8 (normal <2.4 mmol/mmol). On ultrasound examination, bilateral medullary nephrocalcinosis was detected.