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Guillain-Barr syndrome is a neurological condition characterized by paralysis, which becomes progressively worse. Although its cause is unknown, the condition usually becomes manifest after a viral infection, surgery, cancer and vaccination. Three children developed Guillain-Barr syndrome after routine Haemophilus influenzae vaccination. A 19-month-old girl with difficulty walking had a polyribosylribitol phosphate linked to diphtheria toxoid (PRP-D) vaccine, the vaccine given to prevent Haemophilus influenzae type b infections, at a well-child care visit. Although she had received other vaccines without incident, her inability to walk a few steps was investigated further. Examination of the patient's brain by computerized tomography (CT), the use of detailed cross-sectional X-rays used to visualize internal structures, yielded nothing unusual. Electromyography, recording the electrical activity in the muscle, revealed abnormal nerve functioning. The patient was discharged after three treatments with plasmapheresis, a process of removing the plasma portion of blood and replacing it with other fresh or frozen plasma, which improved nerve functioning somewhat. In a second case, a 20-month-old girl had a well-child visit, received routine vaccination, and several days later developed progressive muscle incoordination, and had episodes of screaming during sleep, coughing, gagging and difficulty swallowing. Test results were normal, but difficulty walking and swallowing continued. Two months later she was able to walk and run. In a third case report, a 33-month-old girl with leg weakness and uncoordinated muscle movements reported unusual crying during sleep after routine PRP- D vaccination. Two months later neurological evaluation was normal. The association between the PRP-D vaccine and Guillain- Barr syndrome has not been clearly established in this study and results should be conservatively interpreted. The incidence is assumed to be rare given the large number of vaccinations currently administered.

• In 27 pediatric oncology patients (median age, 2 years) undergoing chemotherapy for malignant tumors, Silastic Broviac catheters were placed to provide vascular access. The catheters were in place for a total of 174 patient-months. There were 14 episodes of Broviac catheter-related bacteremia or fungemia that occurred in six patients: one patient had six bacteremic episodes, one patient had four episodes, and four patients each had one bacteremic episode. Cultures of blood drawn from the Broviac catheter were positive in all instances, and in 12 of 14 samples drawn from the peripheral vein. The most common initial symptoms were fever and chills. The species causing the infections were Enterobacter cloacae (three cases), Staphylococcus epidermidis (three cases), Staphylococcus aureus (three cases), Klebsiella pneumoniae (two cases), Escherichia coli (two cases), Pseudomonas dentrificans, Pseudomonas aeruginosa, and Candida tropicalis. Antimicrobials administered through the catheter cured the infection in ten of the 11 cases in which they were used.(Am J Dis Child 1982;136:679-681)