Biomedical subjects

M R Reale

Publications and source records attributed to M R Reale.

4 recordsLinked to original sources

PubMed1999

Epidemiology and control of vancomycin-resistant enterococci in a regional neonatal intensive care unit.

BACKGROUND: After the occurrence of two cases of bloodstream infection with vancomycin-resistant enterococci (VRE) in our regional neonatal intensive care unit, we studied the epidemiology of VRE and applied extensive infection control measures to the unit to control VRE transmission. METHODS: Infection control measures applied to the unit included weekly surveillance for VRE colonization; education; cohorting of VRE-positive, VRE-negative and VRE-exposed babies with separate personnel and equipment for each group; use of gowns and gloves on room entry; and hand washing before and after each patient contact. Risk factors for VRE colonization were determined with a stepwise logistic regression model. RESULTS: Thirty-three (40.2%) babies became colonized with VRE. The VRE colonization rate was reduced from 67% to 7% after implementation of infection control measures. Prolonged antimicrobial treatment and low birth weight were significantly associated with an increased risk of VRE colonization. CONCLUSION: VRE can spread rapidly among newborns in a regional neonatal intensive care unit. Strict infection control measures can reduce the rate of VRE colonization among neonates.

Anti-Bacterial Agents↗

PubMed1997

Obstetric antecedents of intraventricular hemorrhage and periventricular leukomalacia in the low-birth-weight neonate.

OBJECTIVE: Neonatal intraventricular hemorrhage and periventricular leukomalacia have a strong correlation with eventual neurologic deficit. Our objective was to correlate obstetric factors with the development of these lesions. STUDY DESIGN: Seven hundred forty-five consecutive inborn neonates with birth weights from 500 to 1750 gm were divided into three clinical groups: premature rupture of membranes, refractory preterm labor with intact membranes, and delivery initiated by the physician for maternal or fetal indications. Neonatal neurosonography was performed on days 3 and 7 of life and results were described as normal or abnormal. Abnormal scans included intraventricular hemorrhage seen within 3 days and echodense or echolucent periventricular leukomalacia seen within 7 days of life. Major abnormalities included intraventricular hemorrhage grades 3 and 4, intraventricular hemorrhage with periventricular leukomalacia, and echolucent periventricular leukomalacia. Abnormal scans were correlated with groups of origin and clinical and histologic chorioamnionitis. RESULTS: Abnormal scans occurred in 33% of cases of premature rupture of membranes and in 38.9% of cases of preterm labor compared with 17.7% of physician-initiated cases (p < 0.000001). Major lesions occurred in 17.6% of cases of premature rupture of membranes, 21.4% of cases of preterm labor, and 1.1% of physician-initiated cases (p < 0.0000001). Clinical chorioamnionitis occurred in 19.7% of cases of premature rupture of membranes, 11.9% of cases of preterm labor, and 1.1% of physician-initiated cases (p < 0.001) and was associated with a significant increase in the incidence (p < or = 0.005) and severity (p < or = 0.007) of these lesions. Histologic chorioamnionitis occurred in 59.9% of cases of premature rupture of membranes, 43.2% of cases of preterm labor, and 8% of physician-initiated cases and did not correlate significantly with the incidence or severity of abnormal scans. These findings were independent of gestational age. CONCLUSIONS: The incidence and severity of intraventricular hemorrhage and periventricular leukomalacia were significantly increased in premature rupture of membranes and preterm labor compared with the physician-initiated cases. Clinical chorioamnionitis increased the incidence and severity of these lesions.

Cerebral Hemorrhage↗

PubMed1995

Endothelin-1 levels in the maternal-fetal dyad.

The aim of this study was to determine the distribution of ET-1 levels in the term maternal-fetal dyad. We also compared the levels of ET-1 between umbilical vessels and assessed the effect of labor on the concentration of ET-1. The ET-1 levels were measured in plasma from 18 term maternal-infant pairs. Amniotic fluid ET-1 levels were also measured in 9 of these pregnancies. The ET-1 levels were determined by radioimmunoassay (RIA) after extraction of plasma using Sep-Pak C18 cartridges. There were no significant differences in the ET-1 levels between the umbilical artery and vein. However, there were significant differences in the umbilical artery concentration in women who labored when compared with those delivered without labor (6.0 +/- 1.1 vs. 2.7 +/- 0.7 pg/ml; t test, p = 0.022). ET-1 levels were lowest in the maternal plasma (0.9 +/- 0.2 pg/ml) and highest in the amniotic fluid (83 +/- 15 pg/ml). Assuming that elevated plasma ET-1 levels reflect increased bioactivity, the higher mean ET-1 levels in the cord vessels and in the amniotic fluid when compared to maternal levels suggest a role for ET-1 in the regulation of the fetoplacental circulation and in the constriction of blood vessels in the uterus after parturition. The higher levels of ET-1 in the umbilical artery of women who underwent labor implies that ET-1 is released as a result of the stress of labor.

Amniotic Fluid↗

PubMed1977

Congenital cutaneous candidiasis.

Three newborn infants are described in whom a generalized maculopapular rash was observed at birth or soon after. The eruption rapidly became vesicular, and in one infant it became bullous, and was followed in each case by extensive desquamation. Candida albicans was demonstrated on direct smear and on culture from the skin vesicles, and evidence of an intrauterine infection with this organism was detected on histologic examination of the placenta in at least two of the cases. Agglutinating antibodies to Candida were present in the sera of all three infants, though these may have reflected transplacental passage of maternal antibody.

Candidiasis, Cutaneous↗