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The normal ranges for the micro-erythrocyte sedimentation rate (ESR) in neonates have been established. The use of the micro-ESR technique as an aid to the diagnosis of neonatal infection has been assessed. This test is both simple and quick, needs a heel prick only and appears to have considerable value in predicting the presence of infection in neonates.
Neither human immune globulin nor human mononuclear leukocytes (containing lymphocytes and monocytes) from herpes simplex virus (HSV) seronegative adult donors could protect infant C57BL/6 mice from a lethal HSV infection. In contrast, a combination of 5 X 10(6) leukocytes and a subneutralizing dose of antibody protected the mice. Leukocytes (5 X 10(6) or 1 X 10(7)) from neonatal humans and antibody could not mediate this protection. This is the first correlation between defective human neonatal leukocyte antibody-dependent cellular cytotoxicity (ADCC) in vitro and defective human neonate leukocyte-antibody protection against HSV infection in vivo in mice.
Twenty preterm infants were randomly assigned to receive either a general-purpose intravenous amino acid solution or a neonatal formula at 1.5 gm/kg/day with 50 nonprotein energy calories for 1 week. Both groups demonstrated similar rates of weight gain and similar liver function test results, but comparison of changes from baseline amino acid values disclosed significant intergroup differences for levels of plasma glycine, taurine, valine, and methionine after 7 days of infusion. Comparison of plasma aminograms of study patients with those of normally growing, enterally fed preterm infants showed that infants who received the neonatal solution had similar amino acid profiles, with the exception of low plasma concentrations of tyrosine and elevated concentrations of threonine. The general-purpose solution, as compared with findings in historic enteral controls, produced low plasma valine, tyrosine, and taurine levels, and elevated levels of glycine and methionine. Advantages with the neonatal amino acid solution include reductions in plasma glycine and methionine levels, plus the provision of taurine. Providing tyrosine remains a problem.
In the child cardiocentre in Prague 5-Motol in 1977-1993 a total of 420 neonates with critical inborn heart disease were operated. Obstructive defects of the left heart were found in 178 children, obstructive defects of the right heart in 87, defects with a left-right shunt with pulmonary hypertension in 75, conotruncal malformations in 73 and various operations were made in 7 children. Complete repair of the defect was achieved in 281 neonates, incl. 104 where extracorporeal circulation was used. Palliative operations were made in 139 children. Early mortality during the entire period was 26%, whereby a decrease from 40% to 16% was recorded during the last three years. At present it is possible to repair permanently critical inborn heart disease in the majority of neonates. This is made possible in particular by early non-invasive diagnosis, treatment with prostaglandins E in duct-dependent critical heart disease, optimal time for and selection of most suitable surgery, microsurgical technique, miniaturization of extracorporeal circulation and the method of deep hypothermia.
Group B streptococci are considered an important etiological agent of sepsis and meningitis in neonates and, particularly, in premature infants. There is a close correlation between colonization with these bacteria and the frequency of symptomatic infection. It is estimated that symptomatic infections occur in 1.0% of colonised neonates. The purpose of this work was to investigate the frequency of neonate colonization with group B streptococci for determination of the risk of symptomatic infection.
BACKGROUND: Intraamniotic infection may be caused by a wide variety of microorganisms. Significant maternal and neonatal morbidity have been associated with both subclinical and clinical infection. CASE: We identified a case in which Pseudomonas aeruginosa was isolated as the cause of intraamniotic infection, fulminant neonatal sepsis and neonatal death. CONCLUSION: Though P aeruginosa is an unusual cause of intraamniotic infection, it is important because of its high virulence.
A discussion of neonatal hypoglycemia was held on 18 November 1995 as a satellite symposium of the 40th Annual Meeting of Japan Society for Premature and Newborn Medicine and continued in closed session of 19 November to address neonatal hypoglycemia in the 21st century. This represented a 30-year follow-up of a discussion of carbohydrate and energy metabolism in the newborn held in Tokyo on 10 November 1965. This follow-up was prompted by the incredible advances in clinical care in perinatal medicine and in basic knowledge in the neurosciences, neonatal physiology and metabolism that have occurred in Japan and around the world throughout these 3 decades.
AIM: The neonatal resuscitation program (NRPG) was first introduced in our hospital to replace the traditional resuscitation (TR) program in 1993. TR has been in existence in China for a long time. The implementation of NRPG was timely in reducing the number of infant mortality and also to disseminate to the many hospitals in China which are still practising TR. METHOD: A perspective study of 4,751 newborns with 366 asphyxiated babies in a period of 2 years was carried out. A previous sample of 1,722 live births under the TR program was compared as a controlled group statistically. RESULTS: From August 1993 to August 1995, when NRPG was exclusively implemented in our hospital, only 16 newborns died within 7 days, out of 4,751 births (3.4%) with 2 deaths in the delivery room. Seventeen newborns died within 7 days out of 1,722 births (9.9+) in the TR group, with 10 deaths in the delivery room. From the data shown, it can be clearly seen that perinatal neonatal mortality rate was reduced almost 3 times after NRPG was implemented (chi(2) = 10.54, p < 0.01). The follow-up results of 21 cases of severe asphyxia at 2 months--1 year of age were normal except for one with cerebral palsy. CONCLUSIONS: Our study showed that NRPG was indeed a very effective and feasible technique during the delivery process in the reduction of neonatal mortality. It is important to disseminate widely the knowledge and technique of NRPG in places where TR is still being widely practiced especially in developing countries.
BACKGROUND: Endotracheal intubation in the neonate is painful and is associated with adverse physiological effects. Some premedication regimens have been shown to reduce these effects, but the optimal regimen is not yet determined. METHOD: Data on semi-elective intubations were prospectively collected in the neonatal intensive care unit over a six month period. Patients received 20 microg/kg atropine, 200 microg/kg mivacurium (a non-depolarising muscle relaxant) followed by 5 microg/kg fentanyl. RESULTS: Thirty three patients were electively intubated during this time period. The primary reason for intubation was surfactant administration (53%). Median (range) birth weight, gestational age, and age at intubation were 1360 g (675-4200), 29 weeks (25-38), and 33 hours (1-624) respectively. Twenty two of the infants were intubated on the first attempt. Median duration from initial insertion of the laryngoscope to successful intubation was 60 seconds (15 seconds to 20 minutes). In 18 cases, the first attempt was by a trainee with no previous successful intubation experience, 10 of whom intubated within two attempts. Muscle relaxation occurred at a mean (SD) of 94 (51) seconds, and mean (range) time to return of spontaneous movements was 937 seconds (480-1800). Intubation conditions were scored as excellent using a validated intubation scale. CONCLUSION: Effective analgesia can be administered and intubation performed with some brief desaturations, even when junior personnel are being taught their first intubation. In this first report of mivacurium for intubation in the newborn, effective bag and mask ventilation was easily achieved during muscle relaxation and was associated with excellent intubation conditions, permitting a high success rate for inexperienced personnel.
A dependency scale has been devised for the assessment of the needs of neonates for nursing time. It has been validated by work studies which have shown that non-surgical babies can be grouped into one of two categories: high dependency babies generating a mean (SD) 25 (5) minutes and low dependency babies generating 12 (3) minutes of nursing work per hour, when the work is averaged out over the whole shift. Any one of five simple and unambiguous criteria serve as robust markers for identifying more than 95% of babies regularly generating more than 15 minutes of nursing work per hour. The scale is simpler, can be applied more rapidly, and with greater consistency, than other currently available neonatal dependency scales. Additional allowance needs to be made for miscellaneous activity not attributable to individual babies, for the occasional baby who requires almost continuous undivided nursing attention, for the possibility of new admissions, and for the provision of an emergency interhospital transport service. A formula is suggested by which safe staffing levels for any given nursing shift can be determined, based upon the number of babies present and their dependency levels as determined by the scale.
AIM: To analyse variations in rates of severe retinopathy of prematurity (ROP) among neonatal intensive care units (NICUs) in the Australian and New Zealand Neonatal Network (ANZNN), adjusting for sampling variability and for case mix. METHODS: 25 NICUs were included in the study of 2105 infants born at less than 29 weeks in 1998 and 1999, who survived to 36 weeks post-menstrual age and were examined for ROP. The observed NICU rates of severe ROP were adjusted for case mix using logistic regression on gestation, weight for gestational age and sex, and for sampling variability using shrinkage estimates. The corrected rate in the best 20% of NICUs was identified and NICU variations in rates were compared with those in 2000-1. RESULTS: The overall (unadjusted) rate of severe ROP in the NICUs was 9.6% (interquartile range 5.4-12.8%). After adjusting for both case mix and sampling variability there remained significant variation among the NICUs. 20% of NICUs had a rate of severe ROP </=5.9%. Variation in rates among NICUs showed a similar pattern in both time periods. If the overall network rate was reduced to 5.9%, the 20th centile of the adjusted rates, there would be 79 fewer cases in a 2 year period, in contrast with 26 fewer if rates in the two units with excess rates improved to the average. CONCLUSIONS: Considerable variation in rates of severe ROP among NICUs remained after adjustment for case mix and sampling variability. These data will facilitate investigation of potentially better practices associated with a reduced risk of severe ROP.
Acinetobacter is one of the organisms responsible for nosocomial infections in intensive care, neurosurgery, burn and hemodialysis units. There are only a few reports on Acinetobacter infections in neonatal intensive care units. Over a 31 month period, nine cases of Acinetobacter sepsis occurred in our unit, with four deaths. There was a cluster of four cases within 3 days. In this study the English literature on this pathogen is reviewed and it is suggested that Acinetobacter should be added to the list of organisms causing severe nosocomial infection in neonatal intensive care units.
This article discusses the application of mass spectroscopy, a technology that may have great potential for screening neonatal brain injury. This approach is anticipated to become increasingly important in neonatal and perinatal research and newborn care during the next few years.
A recent survey was conducted on stimulation of mothers and babies during pregnancy and the neonatal period. The survey was responded to by 82 neonatology staff members from Neonatal Intensive Care Units (NICUs) at hospitals in the United States. Some forms of stimulation were extremely common including (1) skin-to-skin following birth in the delivery room (83% of hospitals); (2) containment (swaddling and surrounded by blanket rolls) in the NICU (86%); (3) music in the NICU (72%); (4) rocking in the NICU (85%); (5) kangaroo care (98%); (6) non-nutritive sucking during tubefeedings in the NICU (96%); and (7) breastfeeding in the NICU (100%). Other forms of stimulation occurred less frequently including (1) pregnancy massage (19%); (2) labor massage (30%); (3) the Doula (assistant who comforts during labor and delivery) (30%); (4) waterbeds in the NICU (23%); and (5) preterm infant massage in the NICU (38%).
Agreement on criteria for defining nosocomial infections is essential when surveillance is intended for quality assurance. The CDC criteria for patients < 12 months old were compared with locally developed criteria for neonates in a 10-month study of nosocomial infections in a Berlin University hospital. Six hundred and seventy-seven neonates were observed prospectively for 11,936 patient days. The overall nosocomial infection incidence rate was 13.2%. Because of the observed strength of agreement between the CDC and local criteria for central line-associated primary bloodstream infections and for ventilator-associated pneumonias (recommended by the NNIS system for inter-hospital comparisons) and the preference of the clinicians for the local criteria, we decided to use the latter for an ongoing surveillance system which nonetheless would retain the possibility for comparison with NNIS-data.
OBJECTIVE: The objective of this study was to determine the efficacy of mild hypothermia via selective head cooling as a neuroprotective therapy in term infants with perinatal asphyxia. STUDY DESIGN: Full-term newborns who had 5 min Apgar scores <6, first arterial blood gas pH<7.10 or BD>15 mEq/l, and with the clinical signs of encephalopathy were enrolled within 6 h after birth. Patients were randomized to receive mild hypothermia treatment via selective head cooling for a total of 72 h or receive routine treatment as a control. Brain hypoxic-ischemic injury was quantified based on the head computed tomographic scan (CT scan) at postnatal age 5-7 days and a Neonatal Behavioral Neurological Assessment (NBNA) score at 7-10 days of life. RESULTS: A total of 58 patients (30 hypothermia, 28 control) completed the study. Hypothermia was well tolerated in this study and attenuated the hypoxic-ischemic brain injury due to perinatal asphyxia. Head CT scan demonstrated moderate to severe hypoxic-ischemic changes in only 4/30 cases from the hypothermic group. In contrast, 18/28 cases in the control group showed moderate to severe hypoxic-ischemic changes (chi (2)=15.97, P<0.01). Brain hypothermia also significantly improved the NBNA score (32+/-2 in the hypothermic group vs 28+/-3 in the control group, P<0.01). CONCLUSIONS: Our results suggest that selective head cooling may be used as a neuroprotective therapy in term neonates with perinatal asphyxia. A long-term follow-up study is needed to further validate the results of this study.
BACKGROUND: Many patients with cystic fibrosis are malnourished at the time of diagnosis. Whether newborn screening and early treatment may prevent the development of a nutritional deficiency is not known. METHODS: We compared the nutritional status of patients with cystic fibrosis identified by neonatal screening or by standard diagnostic methods. A total of 650,341 newborn infants were screened by measuring immunoreactive trypsinogen on dried blood spots (from April 1985 through June 1991) or by combining the trypsinogen test with DNA analysis (from July 1991 through June 1994). Of 325,171 infants assigned to an early-diagnosis group, cystic fibrosis was diagnosed in 74 infants, including 5 with negative screening tests. Excluding infants with meconium ileus, we evaluated nutritional status for up to 10 years by anthropometric and biochemical methods in 56 of the infants who received an early diagnosis and in 40 of the infants in whom the diagnosis was made by standard methods (the control group). Pancreatic insufficiency was managed with nutritional interventions that included high-calorie diets, pancreatic-enzyme therapy, and fat-soluble vitamin supplements. RESULTS: The diagnosis of cystic fibrosis was confirmed by a positive sweat test at a younger age in the early-diagnosis group than in the control group (mean age, 12 vs. 72 weeks). At the time of diagnosis, the early-diagnosis group had significantly higher height and weight percentiles and a higher head-circumference percentile (52nd, vs. 32nd in the control group; P=0.003). The early-diagnosis group also had significantly higher anthropometric indexes during the follow-up period, especially the children with pancreatic insufficiency and those who were homozygous for the deltaF508 mutation. CONCLUSIONS: Neonatal screening provides the opportunity to prevent malnutrition in infants with cystic fibrosis.
PURPOSE: Interdisciplinary team members interact with infants to facilitate progressive physiologic stability. The focus of the physical therapist's role is promotion of sensorimotor development in infants born preterm. The aim of this review was to examine evidence for physical therapist practice in the neonatal intensive care unit (NICU) as it relates to developmental intervention (DI) for infants born prematurely and to present the evidence of physical therapy techniques used in the NICU. SUMMARY OF KEY POINTS: A literature review was performed resulting in identification of 26 articles that examined specific developmental intervention techniques. The articles were critiqued based on their design. Twelve articles were rated highly, indicating that sensory techniques implemented by physical therapists appear to be an appropriate and effective component of DI. The general consensus was that there is a lack of large, well-controlled, randomized studies in this area of pediatric outcome research. CONCLUSIONS: Neonatal physical therapy falls under the umbrella of DI. There is substantial agreement about the benefits of DI, but the multimodal and interdisciplinary nature of the evidence limits the ability to identify the effectiveness of any one healthcare professional in the provision of DI in the NICU.