[FETAL DYSTROPHY].

Estimating the risk of in-hospital mortality in the newborn intensive care unit can provide important information for health-care providers, and illness severity scores have been devised to provide mortality risk estimates. Calculation of illness severity scores is time-consuming, and the information used to predict mortality is collected only for the first 12 to 24 h of life. A noninvasive continuous measure that uses information collected throughout the hospitalization and that requires no data entry could be less costly and more informative. We have previously shown that the abnormal heart rate characteristics (HRC) of reduced variability and transient decelerations accompany neonatal illness such as late-onset sepsis. We hypothesized that more frequent and severe abnormal HRC are associated with an increased risk of death. We tested this hypothesis in two ways. Using data on infants older than 7 d of age, we first determined the association of the HRC index with death in the next week. Second, we devised a cumulative HRC score and determined its association with in-hospital death. There were 37 deaths in the 685 patients. The major findings were 1) the HRC index showed highly significant association with death in the succeeding 7 d (receiver-operating characteristic area > 0.7, p < 0.001), and 2) the cumulative HRC was highly significantly associated with neonatal in-hospital mortality (receiver-operating characteristic area > 0.80, p < 0.001). In both analyses, HRC added information to birth weight, gestational age, and postnatal age (p < 0.01). The HRC index provides independent information about the risk of neonatal death in the upcoming 7 d, and the cumulative HRC is an estimate of the risk of in-hospital neonatal mortality.

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PubMed2004

Ciprofloxacin treatment in newborns with multi-drug-resistant nosocomial Pseudomonas infections.

OBJECTIVES: To evaluate the efficacy and acute side effects of ciprofloxacin treatment in newborns who developed nosocomial Pseudomonas aeruginosa infection. METHODS: Intravenous ciprofloxacin treatment was given to 30 newborns who developed nosocomial P. aeruginosa infection as proven by culture antibiogram results. Initial doses of 10 mg/kg/day were given and increased up to 40 mg/kg/day according to clinical response, laboratory and culture results. During therapy, complete white blood cell counts, urinalysis, liver and renal function tests were performed weekly. All patients were examined daily during treatment for possible symptoms of joint toxicity such as erythema and swelling. The patients were evaluated by general physical examination, with special attention to joints, 1 week after discharge. RESULTS: Two of the patients (6.6%) died due to pseudomonas infection, but the bacteria were successfully eradicated in 28 patients (93.4%). Four patients died from other causes. No laboratory abnormality related to ciprofloxacin was observed during treatment. Swelling and hyperemia of the joints were not encountered during treatment and the 1-week period after discharge. Ciprofloxacin-resistant P. aeruginosa isolates were not grown during the study. CONCLUSION: Ciprofloxacin treatment is effective in life-threatening multi-drug-resistant P. aeruginosa infections.

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