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PubMedDate not supplied

[Pharmacokinetics of netilmicin in neonates].

UNLABELLED: Our goal was to perform a pharmacokinetic analysis of netilmicin to develop the optimum dosage regimen of this antibiotic in premature neonates hospitalized in Neonate Intensive Care Unit of the Institute of Mother and Child in Warsaw. MATERIALS AND METHODS: The pharmacokinetics of netilmicin was studied in 80 neonates, divided for analysis into three groups according to gestational age: group I - 10 full-term neonates (b.w. 3225 +/-502 g); group II - 35 premature neonates between 29-32 weeks (b.w. 1134+/-311 g); and group III - 35 premature neonates between 23-28 weeks (b.w. 910 +/-243 g). The whole studied group of neonates was initially given i.v. netilmicin every 24 h, then the dosing interval for the safety reasons was prolonged to 48 h in the premature group. The neonates received netilmicin in the following doses: group I - mean dose 6.2 +/-0.42 mg/kg; group II - 5.911+/-0.529 mg/kg and group III - 6.014+/-0.313 mg/kg. Serum netilmicin concentrations were determined by fluorescence polarization immunoassay (FPIA) - TD(x)FL(x) (Abbott). RESULTS: The mean of pharmacokinetic parameters for groups I, II, and III were defined respectively: t(0.5) (h): 7.14+/-1.88, 12.68+/-4.26, 15.98+/-5.9; AUC0-( (microg x h/ml): 149+/-41, 303+/-100, 401+/-172; Cl/kg (l/h/kg): 0.748+/-0.24, 0.371+/-0.13, 0.289+/-0.1; MRT0-( (h): 6.3+/-2.8, 10.8+/-6.3, 15.5+/-9.3; V(dss) (l/kg): 0.75+/-0.24, 0.59+/-0.52, 0.44+/-0.19. The obtained mean netilmicin serum concentrations (microg/ml) were: once-a-day dosage: C(max) - 10.25+/-2.616 (group I), 12.2+/-2.65 (group II), 12.9+/-2.77 (group III); C(min) - 1.158+/-0.657 (group I), - 2.65+/-1.02 (group II), 3.23+/-1.42 (group III); once-a-48 h dosage: C(max) - 11.7+/-1.09 (group II), 13.9+/-6.53 (group III); C(min) - 1.09+/-0.64 (group II), 1.74+/-0.98 (group III). CONCLUSIONS: 1. All the calculated pharmacokinetic parameters in the premature neonate groups (group II and III) significantly differs from the parameters calculated for full-term neonates. 2. Significant correlations were obtained between birth weight, gestational age and all the calculated pharmacokinetic parameters in all the groups of neonates. 3. The obtained results indicated that the use of the dosing schedule of netilmicin with the dose intervals of 48 h in premature neonates should guarantee adequate peak and trough levels without the need of routine monitoring of each patient in the premature neonate group except the very low weight neonates. Detection of the specific sensitivity of lymphocytes T during the diagnosis of food allergy.

Anti-Bacterial Agents↗
PubMed1994

Up-regulation of murine neonatal T helper cell responses by accessory cell factors.

We previously found that lymph node T cells from 4-day-old, naive neonatal mice show diminished Th1-like responses. Neonatal T cells produced low levels of IL-2 and proliferated poorly in response to soluble anti-CD3 stimulation. However, neonatal T cells resembled Th2 cells (or primed adult T cells) in that they produced large amounts of IL-4. Here, we have investigated the importance of accessory cell signals in the diminished Th1-like responses of neonatal T cells. Anti-CD28 mAb greatly augmented IL-2 production by neonatal T cells in response to plate-bound anti-CD3 Ab. In response to soluble anti-CD3 mAb plus accessory cells, exogenous accessory cell-derived cytokines were sufficient to restore neonatal responses to adult-like levels. In the presence of exogenous IL-6, IL-4 production by neonatal T cells was largely unchanged whereas IL-2 production was dramatically increased, reaching the high levels produced by adult T cells. In addition, the presence of exogenous IL-6 enhanced the proliferation of neonatal T cells to adult levels. IL-6 also had marked effects on the capacity of neonatal T cells to respond to secondary stimuli. In the absence of exogenous IL-6, neonatal T cells responded poorly to secondary stimulation. This lack of responsiveness was not overcome by the addition of IL-2 or by stimulation with phorbol ester and calcium ionophore. When IL-6 was present during the primary stimulation, neonatal T cells, like adult T cells, produced high levels of IL-4 and proliferated extensively in response to secondary stimuli. Thus, IL-6 was sufficient to restore both the primary and secondary responses of neonatal T cells to mature, adult-like levels. These results imply that neonatal T cells have a greater requirement for accessory cell signals than do adult T cells and may have important bearing in overcoming neonatal T cell immunodeficiencies in vivo.

Animals↗
PubMed1994

Revised reference ranges for circulating neutrophils in very-low-birth-weight neonates.

OBJECTIVE: Healthy very-low-birth-weight neonates (VLBW, < or = 1500 g) exhibit a high incidence of neutropenia according to Manroe's reference ranges for neutrophil indices. Since these reference ranges may be inappropriate for VLBW neonates, we determined the reference ranges for circulating peripheral neutrophils in VLBW neonates between birth and 28 days of age. METHODS: Serial, timed peripheral white blood cell counts (n = 1788) were prospectively obtained between birth and 28 days from 193 inborn, VLBW neonates delivered between January 1 and December 31, 1990. Data were divided into neutrophil counts obtained prior to (n = 630) and after (n = 1158) 60 hours of age. After excluding counts from neonates with perinatal and/or neonatal complications, values from "normal" neonates were compared to Manroe's reference ranges. Where indicated new ranges were developed. RESULTS: Although immature neutrophil (ATI) and immature:total neutrophil (I:T) values were within Manroe's reference ranges (P > .1) throughout the neonatal period, 67% of total neutrophil values (ATN) obtained prior to 60 hours of age were outside (P < .001) and 95% were considered neutropenic. Newly developed ATN reference ranges for VLBW neonates have a wider range of distribution compared to Manroe's results, primarily reflecting a decrease in the lower boundary. ATN values between 61 hours and 28 days also differed (P < .001), and new ranges had upper and lower boundaries of 6000 and 1100/mm3, respectively. Maternal hypertension was associated with neonatal neutropenia (P < .001) without abnormalities of ATI or I:T prior to day 3 of life; however, neutrophilia predominated after day 7. Between birth and 28 days > 70% of ATN values were abnormal in neonates with apnea, neutrophilia occurring in > 90% of counts; I:T values, however, were normal between 61 hours and 28 days. CONCLUSIONS: Normal preterm VLBW neonates have ATN reference ranges that differ significantly from that for larger, older neonates, demonstrating the effects of development on neutrophil dynamics. The predictability of neonatal infection using these new reference ranges requires additional study.

Humans↗
PubMed1993

Electrographic seizures in preterm and full-term neonates: clinical correlates, associated brain lesions, and risk for neurologic sequelae.

Electrographically confirmed seizures in preterm and term neonates were compared with respect to clinical correlates, incidence, associated brain lesions, and risk for neurologic sequelae. Over a 4-year period, 92 neonates from a neonatal intensive care unit population of 4020 admissions at a large obstetric hospital with 40,845 livebirths had electrographically confirmed seizures. Sixty-two neonates were preterm and 30 were full-term for gestational age. Chi-square calculations were used to compare the two groups. While the incidence of seizures for all neonates admitted to a neonatal intensive care unit was 2.3%, outborn neonates were more likely to have seizures than inborn neonates. Preterm neonates of < or = 30 weeks gestational age had a seizure frequency of 3.9%, which was significantly higher than that of older preterm neonates and full-term neonates. Clinical criteria contemporaneous with electrographic seizures were noted in only 28 (45%) of 62 preterm, and 16 (53%) of 30 full-term neonates. Subtle seizures coincident with electrographically confirmed seizures were the most predominant clinical type for both term and preterm neonates (71% and 68%, respectively). The distribution of clonic, myoclonic, and tonic seizures was also similar for both groups. Autonomic signs coincident with electrographically confirmed seizures (ie, blood pressure, heart rate, oxygenation, respiration changes) were more frequently observed in preterm than full-term neonates with subtle seizures; 7 (37%) of 19 compared with 1 (6%) of 16. Electrical seizures without clinical correlates were noted more frequently than electroclinical seizures for both populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticonvulsants↗
PubMed1999

Prediction by maternal risk factors of neonatal intensive care admissions: evaluation of >59,000 women in national managed care programs.

OBJECTIVE: Managed care plans have adopted risk assessment tools as part of pregnancy disease state management strategies to assist in reducing poor pregnancy outcomes and related costs. We evaluated the relationships of maternal risk factors to determine which pregnancy risk factors were associated with neonatal intensive care unit (levels II and III) admission. STUDY DESIGN: Risk assessments were performed through perinatal telephone interviews of nurses with 59, 861 pregnant women during 1996 and 1997 calendar years as part of managed care maternity risk screening and education programs. A series of 3 interviews was conducted, at 17 weeks and 28 weeks average gestational age and at 2 weeks post partum. Univariate chi(2) analysis was performed on >50 historical and pregnancy risk factors to determine the associations with neonatal intensive care unit admission. Significant factors were included in a stepwise logistic regression model. Receiver operating curves were generated for the use of significant factors in a risk scoring system in the prediction of neonatal intensive care unit admission, and the percentages of neonatal intensive care unit days attributable to significant risk factors were calculated. RESULTS: Among the participants most women (90%) had their prenatal visit during the first trimester. The mean maternal age was 30.2 +/- 5.2 years, with 74% of women reportedly of white ethnicity, 86% married, and 44.3% primigravid. The mean gestational age at birth decreased with increasing number of fetuses from singletons to quadruplets. The chi(2) analysis identified 26 significant risk factors associated with neonatal intensive care unit admission. Of these, 14 remained significant by logistic regression. Multiple gestation, preterm premature rupture of membranes, diabetes, abruptio placentae, pregnancy-induced hypertension, and preterm labor were independently associated with at least a 3-fold risk of neonatal intensive care unit admission. A modeled risk scoring system that used these and other significant factors was poorly predictive of neonatal intensive care unit admission. However, an analysis of neonatal intensive care unit length of stay attributable to significant risk factors concluded that 19% of all neonatal intensive care unit days in this population were associated with multiple gestations. Furthermore, 85% of neonatal intensive care unit days were the result of infant lengths of stay >/=1 week. CONCLUSION: This analysis of a managed care population showed similar risk factors to those traditionally associated with neonatal intensive care unit admission. Although many of these risk factors are not preventable, identification of neonatal intensive care unit admission risks with a screening program may be of use for focusing interventions, and earlier identification of these factors may allow maximum impact of interventions. Importantly, a reduction in the incidence of higher-order multiple gestations might help to reduce neonatal intensive care unit admissions and costs.

Adult↗
PubMedDate not supplied

The effect of introduction of minimal standards of neonatal care on in-hospital mortality.

A retrospective study was done to assess the effect on in-hospital neonatal mortality of a series of interventions in neonatal care in the highlands of Papua New Guinea. Between 1995 and 1997, prior to the interventions, the mortality among neonates admitted to the Goroka Hospital Special Care Nursery was 18% and two-thirds of very low birthweight (1-1.5 kg) neonates died. The interventions began in December 1997 and were aimed at reducing mortality among all neonates and particularly among those with very low birthweight. Compared to the 30-month period prior to the interventions, the in-hospital neonatal mortality in the 30-month period after the interventions began was 44% lower (relative risk (RR) 0.56, 95% confidence interval (CI) 0.45-0.69). After adjustment for a higher number of neonates <1500 g in the pre-intervention period, the relative risk was 0.59 (0.48-0.74). The mortality in the intervention phase for very low birthweight babies was 56% lower (RR 0.44, 95% CI 0.30-0.65) and for moderate low birthweight (1.5-2 kg) 50% lower (RR 0.50, 95% CI 0.28-0.90). Mortality was also significantly lower in the intervention phase in neonates with a diagnosis of septicaemia or pneumonia (RR 0.36, 95% CI 0.19-0.67), but there were no differences in mortality from birth asphyxia, meconium aspiration or extremely low birthweight (<1 kg). We estimate that in the 30 months after beginning the interventions 82 neonatal deaths that would previously have occurred were avoided. The costs of the improvements in technology described are estimated at US$445 (K1000) per life saved, but substantial training and improved supervision of staff and other human factors may have been more important than equipment. Apnoea monitors were the single most important technology introduced. A similar evaluation of the effect of minimal standards should be done without the use of incubators and overhead heaters, as these are costly and may be dangerous when used by less experienced operators. The 33 neonatal deaths that we estimate were avoided each year because of the interventions represent less than 10% of all neonatal deaths in the province. Although this study provides justification for increasing the technology for supportive neonatal care and training in medium-sized hospitals in rural areas in developing countries, estimates of cost-effectiveness must be compared with other interventions that will effectively lower neonatal mortality, both in and out of hospitals.

Clinical Protocols↗
PubMedDate not supplied

[Teaching neonatal resuscitation at public hospitals in Brazilian state capitals].

OBJECTIVE: To analyze the teaching of neonatal resuscitation offered by Brazilian public hospitals to undergraduate doctors and nurses, pediatric residents and neonatal fellows. METHODS: This cross-sectional multicenter study included 36 hospitals in 20 Brazilian State capitals during June/2003. Local coordinators collected data regarding what the institutions offer to undergraduate doctors and nurses, pediatric residents and neonatal fellows in terms of neonatal resuscitation training and practical activities in neonatal delivery room care. Descriptive analysis was performed. RESULTS: Twenty-three of the 36 institutions had undergraduate doctors: at 13 of them students had clinical activities in the delivery room, 12 offered neonatal resuscitation training, and at two of the 13 hospitals, interns cared for neonates in the delivery room without specific training. Twenty-three of the 36 hospitals had undergraduate nurses: at eight of them students had clinical activities in the delivery room and at seven of them nursing students cared for neonates in the delivery room without specific training. Twenty-seven of the 36 institutions had pediatric residence programs: at all of them, trained residents cared for neonates in the delivery room, but the training was heterogeneous: theoretical training (2-3 hours) at four institutions and theoretical and practical training (4-64 hours) at 23. Additionally, 15 had neonatal fellowship programs: at all of these, trained fellows cared for neonates in the delivery room, but the training was heterogeneous: theoretical training (2 hours) at one hospital and theoretical and practical training (3-68 hours) at 14. CONCLUSION: Formal neonatal resuscitation training is insufficient during medical and nursing graduation and heterogeneously offered to pediatric residents and neonatal fellows.

Brazil↗
PubMed1993

Effects of repeated application of emollient cream to premature neonates' skin.

OBJECTIVE: Emollient cream moisturizers are often used on premature newborns in neonatal intensive care units without accurate knowledge of the risks or benefits to the neonate. DESIGN: We prospectively compared premature neonates treated with a water-in-oil emollient cream for up to 16 days to untreated premature neonates. SETTING: The study was completed in a neonatal intensive care unit on neonates admitted for respiratory distress and/or possible sepsis. PATIENTS: Thirty-four neonates, between 29 and 36 weeks estimated gestational age, entered the study. INTERVENTIONS: One-half of the neonates were treated twice a day with an water-in-oil emollient cream, and the other half served as controls. OUTCOME MEASURES: The skin condition of the neonates' hands, feet, and abdomen was evaluated on entering the study and twice a week. Fungal cultures and quantitative bacterial cultures were obtained from the axilla and abdomen on entering the study and twice a week. RESULTS: The mean gestational age of the treated neonates was 32.3 weeks, whereas the mean gestational age of the control neonates was 32.5 weeks. The neonates treated with emollient cream demonstrated statistically less dermatitis of their hands (day 2 through day 11), their feet (day 2 through day 16), and their abdomen (day 7 through day 11). Fungal cultures and quantitative bacterial cultures of the abdomen and axilla were equivalent in both groups. CONCLUSIONS: These studies document that emollient cream moisturizer therapy of premature neonates decreases dermatitis without changing the microbiological flora.

Emollients↗
PubMed1998

Neonatal early-onset Escherichia coli disease. The effect of intrapartum ampicillin.

BACKGROUND: Maternal intrapartum ampicillin has been recommended for the prevention of neonatal group B streptococcal disease. OBJECTIVES: To assess the effect of this practice, if any, on neonatal early-onset Escherichia coli infection and to delineate the clinical characteristics of infected neonates. PATIENTS AND METHODS: All neonates with early-onset E coli infection who were born at Cook County Children's Hospital, Chicago, Ill, from January 1, 1982, through December 31, 1993, were identified from a microbiological register of all neonatal bacteremias and infections. Because intrapartum ampicillin use increased in our hospital since 1988, infection and case fatality rates from 1982 through 1987 (period 1) were compared with data from 1988 through 1993 (period 2). We studied maternal risk factors, clinical characteristics of infected neonates, and microbiological sensitivities of E coli isolates. RESULTS: Early-onset E coli infection was diagnosed in 30 of 61,498 live births. The overall infection rate (0.49 per 1000 live births) did not change significantly during the 2 time periods (0.37 per 1000 live births during period 1 vs 0.62 per 1000 live births during period 2, P = .21; chi 2 test); however, there was an increase in the infection rate in neonates weighing between 1501 and 2500 g. Infected neonates had a clinical syndrome that was indistinguishable from early-onset group B streptococcal infection; respiratory distress was the single most frequent finding in 73% (22/30) infected neonates. An increase in the proportion of infections caused by ampicillin-resistant E coli was observed during period 2 (12/18) compared with period 1 (3/12, P = .03; Fisher exact test). During period 2, 61% (11/18) of mothers of infected neonates received intrapartum ampicillin compared with 17% (2/12; P = .02) during period 1. Overall, a higher proportion of neonates born to ampicillin-treated women had ampicillin-resistant infection (12/13 vs 3/17; P < .001). Mothers of 10 of 15 neonates with ampicillin-resistant infection had received more than 2 doses of intrapartum ampicillin. The difference between the prevalence of intrapartum fever in mothers with sensitive organisms (40%, or 6/15) and resistant organisms (93%, or 14/15) was also significant (P = .003). All 6 early-onset E coli-related deaths were due to ampicillin-resistant organisms; 4 of the 6 mothers received intrapartum ampicillin. CONCLUSIONS: We have shown a shift of early-onset E coli infection from a less fulminant disease caused by ampicillin-sensitive organisms to a more fulminant disease caused by ampicillin-resistant organisms. Increased use of maternal intrapartum ampicillin therapy may account for these changes. In the absence of evidence for group B streptococcal disease, clinicians should consider the possibility of ampicillin-resistant E coli infection in critically ill neonates born to women with a history of intrapartum fever and treatment with intrapartum ampicillin.

Age of Onset↗
PubMed2003

Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates.

BACKGROUND: Despite an increasing awareness regarding pain management in neonates and the availability of published guidelines for the treatment of procedural pain, preterm neonates experience pain leading to short- and long-term detrimental effects. OBJECTIVE: To assess the frequency of use of analgesics in invasive procedures in neonates and the associated pain burden in this population. METHODS: For 151 neonates, we prospectively recorded all painful procedures, including the number of attempts required, and analgesic therapy used during the first 14 days of neonatal intensive care unit admission. These data were linked to estimates of the pain of each procedure, obtained from the opinions of experienced clinicians. RESULTS: On average, each neonate was subjected to a mean +/- SD of 14 +/- 4 procedures per day. The highest exposure to painful procedures occurred during the first day of admission, and most procedures (63.6%) consisted of suctioning. Many procedures (26 of 31 listed on a questionnaire) were estimated to be painful (pain scores >4 on a 10-point scale). Preemptive analgesic therapy was provided to fewer than 35% of neonates per study day, while 39.7% of the neonates did not receive any analgesic therapy in the neonatal intensive care unit. CONCLUSIONS: Clinicians estimated that most neonatal intensive care unit procedures are painful, but only a third of the neonates received appropriate analgesic therapy. Despite the accumulating evidence that neonatal procedural pain is harmful, analgesic treatment for painful procedures is limited. Systematic approaches are required to reduce the occurrence of pain and to improve the analgesic treatment of repetitive pain in neonates.

Analgesics↗
PubMed2001

Perinatal mortality and morbidity. Comparison between maternal transport, neonatal transport and inpatient antenatal treatment.

The purpose was to assess differences in neonatal morbidity and mortality between maternally transferred, neonatally transferred and inborn neonates. We evaluated a continuous series of all antenatal transported infants (ATI, n=247) and postnatal transported infants (PTI, n=34) to the NICU and all preterm inborns (NTI, n=120) delivered at the University Hospital of Vienna. Data collected included sociodemographic, obstetrical and neonatal data. Mild neonatal morbidity was defined as RDS, BPD, ROP, PDA, NEC or IVH I-II, whereas severe neonatal morbidity was defined as the presence of PVL or IVH III-IV. Data were analyzed statistically using the Spearman correlation Coefficient, the Kruskal-Wallis test, and a multivariate model. There was a substantial gain in gestational age from transfer to delivery in the ATI group and from admission to delivery in the NTI group (2.1 and 5.6 weeks, respectively). The neonatal survival rate was 88.7% in the ATI and 97.5% in the NTI group. No neonate died in the PTI group; there was a significantly higher percentage of severe neonatal morbidity than in the ATI group (11.8% vs. 4.9%). We could not observe a significant difference with respect to the risk of death among the three study groups. There was a strong trend towards higher probability of severe neonatal morbidity in the NTI group. The risk of severe neonatal morbidity is much higher in the PTI-group (rel. risk 0.19, 0.06). Antenatal transfer guaranteed a significantly better neonatal outcome concerning severe neonatal morbidity than postnatal transport, and compared favorably with inborn admissions, even given the higher gestational age and birth weight in the NTI-group.

Adult↗
PubMed1996

Increased macrophage-colony stimulating factor levels in neonates with perinatal complications.

OBJECTIVE: To examine whether perinatal complications induce the production of macrophage-colony stimulating factor (M-CSF), we have compared M-CSF levels in the cord blood between normal neonates and neonates with complications. METHODS: The M-CSF levels were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: In 54 normal neonates, the M-CSF level was 1859 +/- 287 U/ml (mean +/- S.D.), being significantly higher than the serum M-CSF level in normal adults (697 +/- 132 U/ml). Compared with M-CSF levels in normal neonates, significantly higher levels were evidenced in neonates with perinatal complications including premature rupture of the membranes, neonatal asphyxia, meconium staining of the amniotic fluid and maternal anemia. However, no difference in M-CSF concentrations was observed irrespective of complication types; furthermore, the M-CSF level was highly correlated with the leukocyte counts in the neonates with complications, but not in normal neonates. Incidentally, CRP levels were within normal limits in most of these neonates, CONCLUSION: M-CSF levels in the cord blood from neonates with premature rupture of the membranes, neonatal asphyxia, meconium staining of the amniotic fluid and maternal anemia were significantly higher than those in the cord blood sampled from normal neonates. The stress given to neonates may account for the higher M-CSF levels rather than infections.

Birth Weight↗
PubMed2006

A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis.

BACKGROUND: The optimal number of blood cultures needed to document sepsis in an ill neonate has undergone little critical evaluation. Multiple site cultures may improve pathogen detection if intermittent bacteremia occurs, or if a low density of bacteria is present in the blood. We hypothesized, however, that bacterial clearance is slower and bacteremia more continuous in septic neonates, so that a single site blood culture should be sufficient to accurately document true septicemia. OBJECTIVE: To determine the need for multiple site blood cultures in the evaluation of neonates for sepsis. DESIGN/METHODS: Clinical data were prospectively collected for 216 neonates who had 269 pairs of blood cultures taken from two different peripheral sites for the evaluation of possible sepsis. A minimum of 1 ml of blood was obtained from the two peripheral sites within 15-30 min of each other. Based on prior retrospective data, we determined that 203 infants would need to have two site blood cultures to demonstrate a significant improvement in pathogen detection at an alpha of 0.05 and a beta of 0.20 (80%) power. RESULTS: A total of 186 culture pairs were taken for evaluation of early-onset sepsis in 186 neonates, while 83 pairs were drawn for evaluation of late-onset sepsis in 43 neonates. In all, 21 neonates from the late-onset group were evaluated more than once, and 12 neonates were evaluated for both early- and late-onset sepsis. In all, 20 (9.2%) of 216 neonates had 22 episodes of culture-proven sepsis at a median age of 18 days. All neonates with positive cultures had the same organism with a similar sensitivity pattern obtained from the two different peripheral sites. The other 196 study neonates had negative blood cultures from both sites. The single episode of early-onset sepsis was caused by Listeria monocytogenes, while all remaining episodes were late-onset with the following organisms: Staphylococcus epidermidis (7), methicillin-resistant Staphylococcus aureus (MRSA) (3), combined MRSA and Candida albicans (2), Candida albicans alone (2), late-onset Group B beta-hemolytic Streptococcus (GBS) (2), Klebsiella pneumoniae (2), Enterococcus fecalis (1), Escherichia coli (1), and Serratia marcescens (1). Since no infant grew organisms from only one of the two sites, the data indicate that the diagnosis of sepsis would have been made correctly in all infants with a single site culture. CONCLUSIONS: Two site blood cultures for the initial evaluation of neonatal sepsis do not have a better yield in pathogen detection. Sepsis in neonates can be detected with no loss of accuracy with a single site blood culture with blood volume of>or=1 ml.

Bacteremia↗
PubMedDate not supplied

[Cerebral hemorrhage and periventricular leucomalacia in preterm neonates after intravenous tocolysis with fenoterol: results of postnatal ultrasound examination].

BACKGROUND: This study tested whether tocolysis with beta-adrenergic agonists (Fenoterol) had an effect on the frequency of cerebral lesions in preterm neonates. PATIENTS AND METHODS: Head ultrasound scans of preterm neonates who were born after long-term (> 24 h) tocolysis were compared with scans of preterm neonates without preceding tocolysis. The gestational and neonatal data were analyzed retrospectively. RESULTS: Preterm neonates after (n = 102) and without (n = 101) tocolysis were subdivided into three groups according to their gestational age (23 - 28 wk: n = 41; 29 - 33 wk: n = 66; 34 - 36 wk: n = 96). Within these groups, no significant differences were found with respect to birth weight, rate of cesarean section, or pulmonary morbidity. Preterm babies < 28 weeks of gestation from the control group had lower Apgar scores (after 1 and 5 minutes, respectively) and arterial umbilical cord pH values. Intravenous tocolysis did not lead to an increase in pseudocystic periventricular leucomalacia (PVL) or intracerebral hemorrhage (ICH) in any of the subgroups studies. However, cerebral lesions were found in preterm neonates after tocolysis who exhibited signs of infection (29 - 33 wk: PVL n = 2; 23 - 28 wk: ICH n = 1) and in preterm neonates without tocolysis who had undergone fetal hypoxia or abruptio placentae (29 - 33 wk: PVL n = 4; antenatal terminal vein bleeding n = 1; 23 - 28 wk: PVL n = 2; terminal vein bleeding n = 5; posterior cerebral artery bleeding n = 1). When compared to preterm neonates of 34 - 36 weeks of gestation, the risk of infection was increased 4-fold in neonates of 29 - 33 weeks of gestation (odds ratio 5.43, 1.10 - 26.83) and 10-fold in neonates of 23 - 28 weeks of gestation (odds ratio 20.50, 3.65 - 115.03). Chorioamnionitis also was a more common finding in preterm neonates < 28 weeks of gestation. CONCLUSION: Preterm neonates who were born after intravenous long-term (> 24 h) tocolysis with Fenoterol do not exhibit an increase in periventricular leucomalacia or intracranial hemorrhage. The occurrence of cerebral lesions in these patients merely depends on their degree of immaturity and on the presence or absence of perinatal infection. In preterm neonates without tocolysis, brain lesions are mainly associated with hypoxic events.

Cerebral Hemorrhage↗
PubMed1992

Gastric-outlet obstruction induced by prostaglandin therapy in neonates.

BACKGROUND: An infusion of prostaglandin E1 is widely used to maintain patency of the ductus arteriosus in neonates with congenital heart disease. After gastric-outlet obstruction was recognized in several infants who received prostaglandin E1, we studied the association between the drug and this complication. METHODS: We evaluated all neonates who received prostaglandin E1 in our hospital between October 1, 1989, and September 30, 1991, for clinical, radiologic, or pathological evidence of acute gastric-outlet obstruction. RESULTS: Of the 74 neonates evaluated, 65 had no signs of gastric obstruction and were considered normal; 5 had clinical and radiologic or pathological evidence of gastric obstruction consistent with the presence of antral mucosal hyperplasia. The remaining four neonates had clinical signs of gastric obstruction, but no radiologic or pathological examinations were performed. The 5 neonates with antral hyperplasia had received prostaglandin E1 for longer periods (mean [+/- SD] duration, 569 +/- 341 hours) than the 65 normal neonates (54 +/- 58 hours, P less than 0.001) or the 4 neonates with clinical signs of gastric obstruction (119 +/- 60 hours, P less than 0.05). The cumulative dose of prostaglandin E1 was higher in the neonates with antral hyperplasia (2982 +/- 1392 micrograms per kilogram of body weight) than in the normal neonates (279 +/- 270 micrograms per kilogram, P less than 0.001) or the neonates with signs of gastric obstruction (528 +/- 306 micrograms per kilogram, P less than 0.01). In two neonates with antral hyperplasia, the cessation of therapy lessened the gastric-outlet obstruction. CONCLUSIONS: The administration of prostaglandin E1 to neonates can cause gastric-outlet obstruction due to antral hyperplasia. Neonates who receive prostaglandin E1 at recommended doses for more than 120 hours should be closely monitored for evidence of antral hyperplasia.

Alprostadil↗
PubMed1996

Neonatal rotavirus infection in Bangladesh: strain characterization and risk factors for nosocomial infection.

BACKGROUND: Rotavirus (RV) diarrhea is an important cause of childhood morbidity and mortality in Bangladesh and is responsible for 24% of hospital admissions for diarrhea in children from 3 months to 2 years of age. However, the prevalence of neonatal RV infections and characteristics of RV strains infecting neonates have not been explored in Bangladesh. METHODS: We investigated neonates at six hospitals in Bangladesh to determine the prevalence of neonatal RV infection, to identify risk factors for infection and to characterize neonatal RV strains by reverse transcription-polymerase chain reaction. RESULTS: Of 381 neonates screened at 6 hospitals 61 of 146 infants (42%) at 2 hospitals in Dhaka were RV-positive. Of these 62% were detected within the first 5 days of life. We found an increased risk for neonatal RV infection among infants whose mothers reported no handwashing during care of the neonate (P = 0.03). Analysis of RV strains in enzyme-linked immunosorbent assay-positive specimens identified P[6]G4 and P[6]G1 genotypes to be most common; 7% (2 of 27) of strains were nontypable. A concurrent analysis of RV strains circulating in Bangladesh suggested that RV genotypes infecting neonates had a distinct P genotype, because most community strains were P-nontypable compared with neonatal strains, which carried the P[6] genotype. CONCLUSIONS: Hospitalized neonates in Dhaka have increased risk for infection with RV as early as the first week of life with strains having the unusual P[6] genotype. Our findings confirm studies in India showing that neonatal RV infection can be common and may occur with strains distinct from those circulating in the community. Neonatal RV infections could alter a child's response to the RV vaccine as well as the calculation of RV vaccine efficacy in these populations.

Bangladesh↗
PubMed2005

Neonatal cutaneous fungal infections.

PURPOSE OF REVIEW: Cutaneous fungal infections are not uncommon in newborns and are seen in premature or otherwise immunocompromised neonates as well as in healthy full-term neonates. Healthy newborns can develop clinical manifestations as a result of infection with Candida species or as a result of skin colonization with Malassezia species; cutaneous infection with other fungal pathogens is rare. Immunocompromised and premature neonates, however, are susceptible to infection with opportunistic pathogens and are also at higher risk for invasive infection with common pathogens such as Candida. This review discusses the fungal species associated with cutaneous fungal infection in neonates, emphasizes the relevant clinical features, and also reviews the use of newer antifungal agents, including lipid-associated amphotericin B, voriconazole, and caspofungin. RECENT FINDINGS: Neonatal cutaneous infections with opportunistic fungal pathogens, including Aspergillus and the Zygomycetes, have been reported with increasing frequency as advances in neonatal care have improved the survival rate in very low birthweight neonates. Although these infections are frequently fatal, survival in some neonates has been reported with the use of aggressive surgical debridement and systemic antifungal therapy. Newer antifungal agents, including voriconazole and caspofungin, show promise in the treatment of potentially fatal fungal infections in neonates. SUMMARY: Cutaneous fungal infections in neonates range from generally benign conditions such as congenital candidiasis and neonatal cephalic pustulosis to potentially fatal infections with opportunistic pathogens in very low birthweight or immunocompromised neonates. The prompt recognition and appropriate treatment of cutaneous fungal disease in neonates is critical to the prevention of adverse outcomes.

Amphotericin B↗
PubMed2006

[Identification of a new at-risk neonatal population by using Peruvian intrauterine growth curves].

OBJECTIVES: To quantify the increase in small for gestational age (SGA) neonates by using Tacna-Peru intrauterine growth curves and to study associated risk factors. MATERIAL AND METHODS: From 1995 through 2000 15,739 neonates were studied at the Hipolito Unanue Tacna Hospital by applying both Lubchenco and Tacna-Peru intrauterine growth curves; the additional SGA neonates identified by the Peruvian curves were classified as "new SGAs", and their risk factors were studied. The Perinatal Computer System, odds ratio and chi square test were used in the statistical analysis. RESULTS: When Lubchenco's and the Peruvian curves were applied, the percentage of large for gestational age (LGA) neonates decreased from 15.6 to 9.5 %, that of adequate for gestational age (AGE) neonates was similar at 83.2 and 81.3 % and that of SGA neonates increased from 1.2 to 9.2 %; these changes were statistically significant. The Tacna-Peru curves identified 1,448 SGA neonates, while Lubchenco's curves identified 189. The difference of 1,259 neonates (8 % of the total population) corresponded to the group of "new SGA neonates". Risk factors were multiple pregnancy, heart disease, hypertensive disease of pregnancy, primiparity, and urinary infection; risks included increased morbidity, nutritional metabolic abnormalities, infections, congenital defects, moderate depression, and neonatal mortality. CONCLUSIONS: The results of the present study confirm that Lubchenco curves overestimate the number of LGA neonates and underestimate that of SGA neonates and are not suitable for use in Peruvian neonates. The new SGA group showed high morbidity and mortality. We recommend that perinatologists design and use curves specific to their populations.

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