[PAGID] Attached umbilical cord in 8 week old

[Conley, Mary-Ellen]

Hi Chris,
You have done an excellent job of stirring up the pot with interesting cases.  With your 8 week old baby, I would use time to help point you in the right direction.  I agree with several people that prolonged retention of the cord may not have much meaning unless the stump shows clear signs of infection.  A viral infection followed by a bacterial infection doesn't give you a clear lead.  If the child has siblings at home, he may have been unlucky.  His fall in growth percentiles may be because he has been acutely ill and may be because he is not destined to be a very big guy.  I would see him every 4 weeks and tell the mom to call with problems.

As to your CGD patient with cystitis, I agree with the pro-steroids stance.  In our patient with granulomatous cystitis, we tried to taper him off steroids twice.  One time we went very slowly, over a year.  We failed.  Now he looks and feels very well on 10 mg every other (he weighs 22 kg).  He has had normal growth.  We follow by ultra sound.

Again a reminder - please sign with your full name, your city (institution) and country.  We are a delightfully internatiional group and it is fun to get to know each other.  Thanks
Mary Ellen






Mary Ellen Conley, MD
Department of Immunology
St. Jude Children's Research Hospital
332 N. Lauderdale
Memphis, TN 38105-2794
FAX  901-495-3977
TEL  901-495-2576


-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Berger, Melvin
Sent: Thursday, March 06, 2008 8:33 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] Attached umbilical cord in 8 week old

According to the Chapter by Sergio Rosenzweig et al in the 5th Ed of Stiehm's textbook (pg 633), this pattern has been seen in E-selectin deficiency.

In the paper by Novack, et al, (Am J Dis Child 142: 220-3, 1988) normal babies had separations as late as 45 days, but 56 is stretching it.

Mel Berger

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Chris Seroogy
Sent: Wednesday, March 05, 2008 2:53 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] Attached umbilical cord in 8 week old

Dear Colleagues:

I saw an 8 week old FT male in clinic this week with a solidly attached umbilical stump.  He has had two hospitalizations for pneumonia.  One at 3 weeks (documented RSV) and the second bilateral infiltrates responsive to antibiotics 2 weeks ago with documented resolution.  His weight is at the 10%ile and down from birth (25-50%ile).  Normal immunoglobulins, normal T, B and NK cell numbers.  Initially with the second hospitalization he was slightly neutropenic (ANC 1000) and this has normalized.  He has never had a leukocytosis on numerous CBCs.  His flow for CD18 and CD11b is normal.  I intend to send DHR.  It seems he needs more PMN functional studies, but I am perplexed by the lack of leukocytosis.  I welcome any thoughts.  Regards, Chris


Chris Seroogy, M.D.

Assistant Professor

Dept. of Pediatrics

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