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The chemotherapy of septicaemia in newborns differs fundamentally from that in older children or adults because, although newborns have a fully developed immunological system, the system has not yet "learned" to operate completely. Ultimately, optimal chemotherapy can only be found empirically. In this respect a few basic guidelines can be given however: 1. The initial therapy must bring the pathogen under control with a high degree of certainty, since a correction in therapy following pathogen indentification is usually too late. 2. Since the pharmacokinetics of antibiotics in newborns vary considerably, the minimal peak serum concentration observed should exceed the MIC of the pathogen. 3. In rapidly maturing newborns and premature babies the pharmacokinetics of each antibiotic must be known precisely. 4. Since in the individual case there can never be absolute certainty with respect to the three above-mentioned problems, combination therapy should be given at all times.

Antibodies were measured in 172 unselected neonates against mixed polyvalent antigens derived from E. COLI, Klebsiella, Ps. aeruginosa and Proteus spp. respectively, using a modification of the indirect haemagglutination technique according to Neter. 120 of these neonates with no evidence of infection served as controls. 6 out of 8 children with proven E. coli septicaemia had either raised titres or significant rises in titre. Five further neonates with septicaemia, four due to Klebsiella and one to Pseudomonas, had pathologically raised titres as well. 8 out of 12 neonates with clinically suspected septicaemia in whom no pathogen was isolated from the blood or cerebrospinal fluid had raised antibody titres. Following premature rupture of the membranes 2 out of 3 neonates who subsequently developed proven E. coli septicaemia had raised antibody titres against E. coli even on the first day of life. These results suggest that the measurement of antibody titres can be a valuable aid to the diagnosis of neonatal septicaemia.

Sera of 451 children with congenital diseases and 185 tumor patients were tested for BK virus-specific antibodies by hemagglutination inhibition and IgM-immunofluorescence tests. Compared to age-matched control groups, higher percentages and significantly elevated geometric mean titers of HI antibodies were found in all patient groups tested. Of children under six months of age with congenital diseases such as dysplasia, cerebral defects, and hyperbilirubinemia and hepatosplenomegaly, 4.2% (17/402) had BK virus-specific IgM antibodies. No positive sera were found in 68 control sera. Of tumor patients 5--15 years of age, 8.6% (16/185) had IgM antibodies to BK virus. In the control group, 30% (3/99) had them. Serial serum samples from 76 tumor patients treated with cytostatic drugs showed seroconversion in three cases. No relationship between certain clinical features and BK virus infection was noted. Isolation of BK virus was successful from urines of two infants with connatal defects, six patients suffering from malignant tumors, and four patients with inherited immunodeficiencies.

In addition to an innate functional dysmaturity of the neonate's immune system, operation, anaesthesia, and intensive care measures can significantly worsen this physiological immune deficiency. Given the fact that antimicrobial therapy as well as progress in intensive care of infected operated neonates and prematures did not significantly decrease the high mortality rate in this patient age group we began performing fresh-blood exchange transfusions as supportive immunotherapy in the treatment of neonatal septicaemia. Since indication for exchange transfusion has been adopted as early as septicaemia was suspected only 46% of the operated neonates (13 out of 28) died of their infection, compared to 82% of the patients (23 out of 28) who did not undergo exchange transfusion.

Since bacterial infection in newborns must be treated as specifically and as early as possible, it is important to confirm a diagnosis of suspected infection based on clinical symptoms and to take possible pathogens into consideration when choosing therapy. RDS and septicemia with Group B streptococci can present very similar clinical symptoms, but leucopenia on the first day of life is most probably an indication of septicemia with Group B streptococci. Septicemia caused by other pathogens, however, usually has a much later onset. In the days following birth a raised cardiothoracic index indicates RDS. Other differential criteria are being investigated.