Reported here is a cluster of infections due to a nitrate-negative variant of Enterobacter sakazakii, which occurred among premature neonates at the Hadassah Hospital, Mount Scopus, Jerusalem, in December 1999-January 2000. Pulsed-field gel electrophoresis showed cluster isolates to be identical but unrelated to previous systemic isolates recovered in 1993 and 1998. The organism was not isolated from infant formula powder, but it was recovered from prepared formula and from a kitchen blender. Elimination of the environmental focus, a change to factory-prepared infant formula, and isolation of affected infants terminated the event. Faecal carriage of Enterobacter sakazakii was observed for up to 18 weeks, emphasising the potential for cross-infection.

Maximal flows at functional residual capacity (VmaxFRC) from partial expiratory flow-volume (PEFV) curves (achieved with rapid compression of the chest) were obtained on 11 healthy newborn babies. Mean VmaxFRC, size corrected by dividing absolute values by measured thoracic gas volume, was 1.90 TGV's/s. Specific upstream conductances were high, and the cross-sectional area of the flow-limiting segment was estimated to be approximately 0.30 cm2 in the three infants on whom recoil pressures at FRC were also measured. The cross-sectional area of the major bronchi in the neonate is approximately 0.26-0.30 cm2. PEFV curves were convex to the volume axis. Many of the neonates increased their flows while breathing a helium-oxygen gas mixture. These results suggest 1) size-corrected flows are higher in the neonate than in older children or adults; 2) the site of the flow-limiting segment at FRC during maximal expiratory maneuvers is in large proximal airways, similar to the adult; and 3) the relationship of airway size to parenchymal size may be similar in neonates and adults or, in fact, airways may be larger, relative to parenchyma, in neonates. These physiological data do not support the hypothesis, based on pathological studies, that peripheral airways are disproportionately smaller (when compared with central airways) in infants than in adults.

Enterobacter sakazakii, a Gram‐negative bacillus, previously known as “yellow pigmented Enterobacter cloacae,” is a rare cause of neonatal infection. We describe the detailed clinical presentation of two cases in whom E. sakazakii was isolated in our neonatal service during the course of 1 mo. These include one case of sepsis and meningitis complicated by cerebral infarction, and one case of sepsis. In addition, three cases of intestinal colonization were identified. The source of the organism was thoroughly sought and was found to be a blender in the milk kitchen that was used for preparation of the reconstituted powdered milk formula. Conclusion: Our paper adds clinical and laboratory information about the disease spectrum caused by this relatively rare organism and emphasizes the importance of a thorough search for the source of the infection.

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The uncertainty regarding the future well-being of very low birth weight infants is a source of considerable anxiety for parents, even after discharge from the hospital. We identify factors related to postdischarge anxiety levels of parents of 65 infants. Infant's weight relative to gestational age; the presence of central nervous system complications; informational support; and a warm, caring attitude by hospital staff explained 35% of the variance in mothers' anxiety levels. Father's age, infant's gender, perception of the infant as problematic, and the availability of child care support explained 33% of the variance in fathers' anxiety levels. Practice implications, including both identification of high-risk groups and interventions aimed at bringing about change in specific factors, are discussed.