THE JOURNAL OF PEDIATRICS
www.jpeds.com
17. Boccia D, Stolfi I, Lana S, Moro ML. Nosocomial necrotizing enterocolitis outbreaks: epidemiology and control measures. Eur J Pediatr 2001; 160:385-91. 18. Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the national institutes of health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005;116:1353-60. 19. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 g. J Pediatr 1978;92:529-34. 20. Screening examination of premature infants for retinopathy of prematurity. Section on Ophthalmology, American Academy of Pediatrics, American Academy of Ophthalmology American Association for Pediatric Ophthalmology and Strabismus. Pediatrics 2006;117:572-6. 21. Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of disease. Curr Prob Pediatr 1987;17:213-88. 22. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128-40.
Vol. 164, No. 1 23. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285-91. 24. Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005;116:595-602. 25. Krediet TG, van Lelyveld N, Vijlbrief DC, Brouwers HA, Kramer WL, Fleer A, et al. Microbiological factors associated with neonatal necrotizing enterocolitis: protective effect of early antibiotic treatment. Acta Paediatr 2003;92:1180-2. 26. Stone HH, Kolb LD, Geheber CE. Bacteriologic considerations in perforated necrotizing enterocolitis. South Med J 1979;72:1540-4. 27. Cole CR, Hansen NI, Higgins RD, Bell EF, Shankaran S, Laptook AR, et al. Eunice Kennedy Shriver. National Institute of Child Health and Human Development’s Neonatal Research Network. Bloodstream infections in very low birth weight infants with intestinal failure. J Pediatr 2012;160:54-9.e2. 28. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health-care associated infection and criteria for specific types of infection in the acute care setting. Am J Infect Control 2008;36:309-32.
50 Years Ago in THE JOURNAL OF PEDIATRICS Congenital Syphilis: A Laid Ghost Walks Woody NC, Sistrunk WF, Platou RV. J Pediatr 1964; 64:63-67
W
oody et al describe 4 infants with congenital syphilis. The authors express concern that the falling incidence of this infection had rendered house staff unable to readily diagnose it. Some of the offered pearls are a bit overstated in the context of today’s medicine—for example, the article quotes this “old clinical aphorism: suspect venereal disease in .the tattooed man.” By and large, however, the article provides a serviceable overview, as the babies displayed many of the protean characteristics of congenital syphilis, including rash, snuffles, anemia, lymphadenopathy, and periostitis. The first recorded outbreak of syphilis occurred in 1495 among French troops laying siege to Naples, and from there it spread rapidly throughout Europe, with many countries blaming their rival neighbors for its origin. In reality, it is likely that this dreadful disease was imported to Europe from the New World by Christopher Columbus’ crew members. The infection remained unabated for centuries and was not contained in the industrialized world until the introduction of penicillin after World War II, after which there was a dramatic drop in new cases. In 1999, with US incidence at a historic nadir, the Centers for Disease Control and Prevention (CDC) announced a strategic plan to eliminate syphilis from the country altogether. Despite this, national incidence rates increased again during the first decade of the new millennium, largely among gay men. During the same decade, however, the annual number of cases of congenital syphilis reported to the CDC stayed relatively even, ranging between the high 300s and the mid 400s, a far cry from the 17 600 babies identified when national statistic were first collected in 1941 and the approximate 4000 figure when the article by Woody et al was published. Is the end of syphilis indeed near, at least in the US? Perhaps a more durable medical aphorism than the one quoted above is that sexually transmitted infections are extraordinarily hard to completely control, and in 2006 the CDC reframed the eradication plan, implying that it will be a long, gradual process. Hence, it is probable that house staff in 2014 still will encounter the occasional infant with symptomatic congenital syphilis, but that rapid recognition will continue to be confounded by its rarity and its multifarious manifestations. Philip Toltzis, MD Hadassah Medical Center Jerusalem, Israel http://dx.doi.org/10.1016/j.jpeds.2013.08.008
66
Bizzarro, Ehrenkranz, and Gallagher
www.jpeds.com
17. Boccia D, Stolfi I, Lana S, Moro ML. Nosocomial necrotizing enterocolitis outbreaks: epidemiology and control measures. Eur J Pediatr 2001; 160:385-91. 18. Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the national institutes of health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005;116:1353-60. 19. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 g. J Pediatr 1978;92:529-34. 20. Screening examination of premature infants for retinopathy of prematurity. Section on Ophthalmology, American Academy of Pediatrics, American Academy of Ophthalmology American Association for Pediatric Ophthalmology and Strabismus. Pediatrics 2006;117:572-6. 21. Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of disease. Curr Prob Pediatr 1987;17:213-88. 22. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128-40.
Vol. 164, No. 1 23. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285-91. 24. Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005;116:595-602. 25. Krediet TG, van Lelyveld N, Vijlbrief DC, Brouwers HA, Kramer WL, Fleer A, et al. Microbiological factors associated with neonatal necrotizing enterocolitis: protective effect of early antibiotic treatment. Acta Paediatr 2003;92:1180-2. 26. Stone HH, Kolb LD, Geheber CE. Bacteriologic considerations in perforated necrotizing enterocolitis. South Med J 1979;72:1540-4. 27. Cole CR, Hansen NI, Higgins RD, Bell EF, Shankaran S, Laptook AR, et al. Eunice Kennedy Shriver. National Institute of Child Health and Human Development’s Neonatal Research Network. Bloodstream infections in very low birth weight infants with intestinal failure. J Pediatr 2012;160:54-9.e2. 28. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health-care associated infection and criteria for specific types of infection in the acute care setting. Am J Infect Control 2008;36:309-32.
50 Years Ago in THE JOURNAL OF PEDIATRICS Congenital Syphilis: A Laid Ghost Walks Woody NC, Sistrunk WF, Platou RV. J Pediatr 1964; 64:63-67
W
oody et al describe 4 infants with congenital syphilis. The authors express concern that the falling incidence of this infection had rendered house staff unable to readily diagnose it. Some of the offered pearls are a bit overstated in the context of today’s medicine—for example, the article quotes this “old clinical aphorism: suspect venereal disease in .the tattooed man.” By and large, however, the article provides a serviceable overview, as the babies displayed many of the protean characteristics of congenital syphilis, including rash, snuffles, anemia, lymphadenopathy, and periostitis. The first recorded outbreak of syphilis occurred in 1495 among French troops laying siege to Naples, and from there it spread rapidly throughout Europe, with many countries blaming their rival neighbors for its origin. In reality, it is likely that this dreadful disease was imported to Europe from the New World by Christopher Columbus’ crew members. The infection remained unabated for centuries and was not contained in the industrialized world until the introduction of penicillin after World War II, after which there was a dramatic drop in new cases. In 1999, with US incidence at a historic nadir, the Centers for Disease Control and Prevention (CDC) announced a strategic plan to eliminate syphilis from the country altogether. Despite this, national incidence rates increased again during the first decade of the new millennium, largely among gay men. During the same decade, however, the annual number of cases of congenital syphilis reported to the CDC stayed relatively even, ranging between the high 300s and the mid 400s, a far cry from the 17 600 babies identified when national statistic were first collected in 1941 and the approximate 4000 figure when the article by Woody et al was published. Is the end of syphilis indeed near, at least in the US? Perhaps a more durable medical aphorism than the one quoted above is that sexually transmitted infections are extraordinarily hard to completely control, and in 2006 the CDC reframed the eradication plan, implying that it will be a long, gradual process. Hence, it is probable that house staff in 2014 still will encounter the occasional infant with symptomatic congenital syphilis, but that rapid recognition will continue to be confounded by its rarity and its multifarious manifestations. Philip Toltzis, MD Hadassah Medical Center Jerusalem, Israel http://dx.doi.org/10.1016/j.jpeds.2013.08.008
66
Bizzarro, Ehrenkranz, and Gallagher
