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[Intracranial hypertension in a newborn treated with quinolone]
Insights
Fluoroquinolones may be a last resort for neonatal infections, but can cause serious neurological issues like intracranial hypertension in newborns. This case highlights the importance of monitoring for adverse effects during treatment.
Area of Science:
- Neonatal Intensive Care Medicine
- Pediatric Infectious Diseases
- Clinical Pharmacology
Background:
- Fluoroquinolones lack administrative approval for pediatric use.
- Multidrug-resistant pathogens in neonatal intensive care units (NICUs) may necessitate fluoroquinolone use.
- Parenteral nutrition-dependent premature infants are a vulnerable population.
Observation:
- A premature infant with enterobacteria sepsis developed signs of intracranial hypertension.
- Intracranial hypertension emerged three days after initiating fluoroquinolone therapy.
- Symptoms resolved within 48 hours of discontinuing the fluoroquinolone.
Findings:
- Fluoroquinolones, while potentially life-saving for resistant infections, carry risks.
- Intracranial hypertension is a potential neurological adverse effect in neonates treated with fluoroquinolones.
- This is the first reported case of fluoroquinolone-associated intracranial hypertension in a newborn.
Implications:
- Careful consideration and monitoring are crucial when using fluoroquinolones in neonates.
- Neurological adverse effects, including intracranial hypertension, should be anticipated.
- Further research is needed to establish the safety profile of fluoroquinolones in pediatric populations.
Background:
Fluoroquinolones have not received administrative authorization for use in children, but because of multiresistant pathogens in neonatal intensive care, floroquinolones may be the only alternative.
Case Report:
A premature infant exclusively nourished by parenteral nutrition developed enterobacteria sepsis. Ceftazidine was given initially but resistance led to the prescription of fluoroquinolone. Signs of intracranial hypertension developed 3 days after onset of fluoroquinolone treatment and regressed 48 hours after its withdrawal.
Discussion:
The main potential adverse effects with fluoroquinone in the newborn are arthropathy, photosensitivity, discoloration of the teeth and neurological disorders. Intracranial hypertension is a known complication of nalidixic acid both in adults and children, but to our knowledge has not been previously with floroquinolone in the newborn.