Polycythemia as a cause of seen. Many vessels in the muscular layers the results of a study of the incidence necrotizing enterocolitis were partially or completely obliterated by of oropharyngeal gonorrhea in our clin- recent thrombi. ic population and a review of all cases To the editor: Many conditions have In the neonate an increased hema- of DGD in our teaching hospitals in been reported to be causally related to tocrit is the most important factor the past 3 years. the occurrence of necrotizing enterocol- causing increased blood viscosity. When During a recent investigation of the itis in neonates. Recently we treated a the hematocrit rises above 72% the effectiveness of an oral probenecid- baby girl with necrotizing enterocolitis increase in viscosity is exponential.1 caused by polycythemia. amoxicillin suspension in the treatment Blood viscosity increases as the rate of of uncomplicated gonorrhea, throat The infant was born to a primiparous shear decreases; hence, in the micro- swabs were taken routinely before 26-year-old woman whose uneventful preg- vasculature sludging occurs when there treatment in an attempt to isolate N. nancy terminated at the 39th week. The is slow flow, with resulting impairment gonorrhoeae. One heterosexual male infant weighed 2098 g. She was the second of tissue oxygenation and a tendency had positive cultures from both urethral and smaller twin and was delivered vagin- to microthrombus formation.2 In our and throat swabs. Two urethral swabs ally as a breech presentation. At birth she patient the extreme polycythemia may obtained after treatment gave negative was flaccid and blue, requiring resuscita- have been related to the infant's being cultures; unfortunately swabs of the tion with oxygen by bag and mask. Her small for gestational age. The neonatal throat were not taken on this occasion. length was 46 cm and her head circum- asphyxia, which perhaps contributed to ference, 31 cm; both measurements were, Two weeks later the patient presented like her birth weight, below the 3rd the initial ischemic insult to the bowel, with the classic stigmata of DGIY but percentile. may also have resulted in increased admitted no sexual re-exposure. A At 4 hours of age she was transferred polycythemia.3 urethral swab was obtained and the to the neonatal intensive care unit of the If any of the symptoms and signs patient given probenecid and procaine Montreal Children's Hospital. On arrival reported as being associated with poly- penicillin intramuscularly, followed by she was plethoric, jittery and hypertonic. cythemia in the neonate, such as ple- a 7-day course of ampicillin given Her blood glucose value was 29 mg/dL. thora, cyanosis, hypoglycemia, cardio- orally. Cultures of the pretreatment Intravenous administration of 10% glu- megaly, respiratory distress,4 or central urethral swab as well as the post-treat- cose in water resulted in substantial im- provement of her symptoms. Her hemo- nervous system manifestations of leth- ment urethral and throat swabs were globin value was 21.5 g/dL and the venous argy, jitteriness or seizures, had per- negative for N. gonorrhoeae. sisted, we would have treated our hematocrit, 76%. Early oral feedings with Review of inpatient charts at Vic- formula supplying 20 Cal/oz (3 kJ/mL) patient by partial exchange transfusion. were well tolerated, and 10 feeds had been This experience suggests that, even if toria, University and St. Joseph's hos- given by 34 hours of age, when she began pitals, London, Ont. revealed 12 cases symptoms are not present, early partial of DGD - 9 in females and 3 in to vomit. Four hours later she was lethar- exchange transfusion with plasma or gic and had slight periumbilical erythema. males. Throat swabs had been taken Her abdomen was soft and not distended; an appropriate electrolyte solution is prior to therapy in seven cases; cultures bile-stained fluid was obtained by suction- advisable in newborn infants with poly- were positive for N. gonorrhoeae in ing the stomach. Abdominal radiographs cythemia to avoid the serious complica- three - two heterosexual males and showed pneumoperitoneum with pneuma- tions of hyperviscosity.5 one female. In the female, cultures of tosis intestinalis. There was by now ob- TANIA GUNN, MB, CH B, FRCP[C] all material tested (blood, joint aspirate, vious cellulitis of the left abdominal wall. EUGENE OUTERBRIDGE, MD, CM, FRCP[C] and endocervical and throat secretions) The hematocrit was now 85%; the leuko- Department of newborn medicine cyte count, 3.3 x 109/L; and the platelet Montreal Children's Hospital were positive; in one male both blood count, 92.0 x 109/L. Montreal, PQ and throat secretions, and in the other Laparotomy disclosed multiple perfora- only throat secretions yielded positive tions of the necrotic hepatic and splenic References cultures. flexures of the colon. Subtotal colectomy 1. GROSS GP, HATHAWAY WE, MCGAUGHAY HR: Hyperviscosity in the neonate. I Pedlair 82: This is a small series; nevertheless it was performed. Culture of peritoneal fluid 1004, 1973 produced a growth of Enterococci. 2. DIETERFASS L: Blood viscosity, internal fluid- is impressive that in three of four hete- ity of the red cell dynamic coagulation and Her postoperative course was in keeping the critical capillary radius as factors in the rosexual males seen locally the throat physiology and pathology of the circulation was the probable source for DGD. In with generalized abdominal infection and and micro-circulation. Med I Aust 1: 688, ascending cholangitis. On the 2nd post- 1968 conjunction with data from the study 3. PHILIP AGS, YEa AB, Rosy M, et al: operative day focal seizures involving the Placental transfusion as an intra-uterine phe- by Weisner and associates1 this suggests right arm occurred. These were controlled nomenon in deliveries complicated by foetal that the throat may indeed be a major distress. Br Med 1 2: 11, 1969 with phenobarbital. Multifocal epilepto- 4. GATTI RA, MUSTER AT7 COLE RB, et al: source for DGD, as it is for dissemin- genic abnormalities were evident on elec- Neonatal polycythemia with transient cyanosis ated meningococcal disease, and in- and cardiorespiratory abnormalities. .1 Pediatr troencephalograms. Subsequent examina- 69: 1063, 1966 dicates the importance in any suspected tions showed gradual improvement in this 5. LEAKE RD, THANOPOULOS B, NEIBER R: Hy- manifestation. perviscosity syndrome associated with necro- case of DGD of taking a throat swab tizing enterocolitis. Am I Dis Child 129: before treatment to attempt to culture At 16 weeks of age a colocolic anas- 1192, 1975 tomosis was performed. Parenteral therapy N. gonorrhoeae. with gentamicin and ampicillin was con- T.W. AUSTIN, MD, FRCP tinued for a total of 20 weeks; three at- Oropharyngeal gonorrhea: W. YANG, MD tempts to discontinue antibiotic therapy F.M. PArrIsoN, PH D, D5 C, MD disseminated gonococcal disease Venereal diseases clinic during this period were followed by fever Victoria Hospital and clinical deterioration. At 6 months of Department of medicine To the editor: Weisner and colleagues1 University of Western Ontario age the child's growth was catching up. described a population of heterosexual London, Ont. Pathologic examination of the surgical males with disseminated gonococcal specimen revealed several perforations of disease (DGD) in whom only cultures the colon and many areas of ulceration References and erosion of the mucosa. Microscopic from oropharyngeal swabs were posi- tive for Neisseria gonorrhoeae. This I. 'Wais.aa PJ, TRONcA E, BONIN P, et al: examination showed that some areas were Clinical spectrum of pharyngeal gonococcal completely necrotic; in others the mucosa suggests that, on occasion, the throat infection. N Engi I Med 288: 181, 1973 2. HOLMES KK, COUNTS GW, BEATY NM: was infiltrated with polymorphs. In the may serve as the source of disseminated Disseminated gonococcal infection. Ann In- submucosa, areas of gas infiltration were disease. We add to their observations tern Med 74: 919, 1971 438 CMA JOURNAL/SEPTEMBER 3, 1977/VOL. 117