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A set of monochorionic male twins presented with intestinal perforation. The smaller twin was diagnosed with necrotizing enterocolitis followed by sepsis, disseminated intravascular coagulation, and necrotizing fasciitis of the abdominal wall. The infant died on the fourth day after surgery, 16 days after birth. Surgical specimens and autopsy revealed a disseminated zygomycotic infection. Gastrointestinal zygomycosis followed by necrotizing fasciitis in premature infants is a rare condition and mimics necrotizing enterocolitis clinically. Necrotizing fasciitis after gastrointestinal zygomycosis in premature infants is considered a poor prognostic sign. Gastrointestinal zygomycosis should be considered in the differential diagnosis of necrotizing enterocolitis.

A sharp rise in intracranial pressure (ICP) was noted in a 6-year-old girl with Fontan circulation after surgical removal of a hematoma associated with intracranial hemorrhage. Inhalation of nitric oxide resulted in reduction of central venous pressure (CVP) and precipitous fall in ICP, which was otherwise resistant to conventional therapy. Specifically, the rate of fall of ICP (9 mm Hg) exceeded that of the CVP (3 mm Hg), indicating disproportionate CVP-ICP coupling. The present case provides not only a novel insight into cardio-cerebral interaction in Fontan physiology but also useful information regarding the treatment of Fontan patients in the setting of increased ICP.

Background: Extremely low birth weight infants (ELBWI) often suffer from severe hypotension in the early neonatal period. However, few previous studies have ever revealed plasma levels of vasoactive substances which regulate the cardiovascular system in ELBWI. Objective: To study plasma levels of vasoactive substances in ELBWI with hypotension during the first 24 h of life. Methods: 22 ELBWI with hypotension (gestational age 26.4 ± 1.9 weeks; birth weight 751 ± 135 g) were involved in the study. After initial volume therapy, the infants were arbitrarily divided into two groups depending on requirement of dopamine dosage: severe hypotension group (SH; dopamine >10 μg/kg/min, n = 9) and mild hypotension group (MH; dopamine ≤10 μg/kg/min, n = 13). Plasma levels of dopamine, norepinephrine, epinephrine, arginine vasopressin, and atrial natriuretic peptide were measured at admission and at 24 h after birth. Results: Infants in the SH group had higher plasma dopamine than infants in the MH group both at admission (median; range: 14,410; 224–46,770 vs. 7,900; 32–21,220 pg/ml, p < 0.05) and at 24 h (80,920; 494–146,100 vs. 25,680; 10,130–63,180 pg/ml; p < 0.05). The norepinephrine/dopamine ratio (median; range) was lower in the SH group than in the MH group at admission (0.3; 0.0–1.0 vs. 1.1; 0.1–25.1; p < 0.01). Plasma levels of atrial natriuretic peptide or arginine vasopressin were not different between the two groups. Conclusions: ELBWI with SH may have decreased conversion of dopamine to norepinephrine. We speculate that this mechanism may contribute to development of SH in ELBWI.