SEARCH · Search PubMed

Results for “Neonatal”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,189 records · Page 66Linked to original sources

PubMed1985

Erythrocyte vitamin E is oxidized at a lower peroxide concentration in neonates than in adults.

Erythrocytes of neonates and adults were incubated with increasing concentrations of H2O2 in the presence of a catalase inhibitor and in the absence of glucose; the pattern of oxidation of vitamin E was analyzed in relationship to that of glutathione, hemoglobin, and polyunsaturated fatty acids (PUFA), and in relationship to hemolysis. The changes of these various parameters were analyzed in function of H2O2 concentration and in relation to incubation time, and were compared in erythrocytes from neonates and adults. In the absence of H2O2, erythrocyte glutathione and tocopherol levels were similar in neonates and adults, despite fourfold lower serum vitamin E level in neonates; alpha-tocopherolquinone, methemoglobin, and malonyldialdehyde (MDA) were not detectable. At 0.375 mmol/L of H2O2, glutathione was completely oxidized. Erythrocyte alpha-tocopherol remained unchanged up to 0.75 mmol/L of H2O2, then decreased linearly, with increasing H2O2 concentrations to 10% of its initial value at 1.5 mmol/L of H2O2 in erythrocytes from neonates, whereas those from adults required 2.0 mmol/L of H2O2 (P less than .05) for the same level of oxidation. The formation of alpha-tocopherolquinone appeared inversely related to the decrease of alpha-tocopherol. The incubation time did not influence the level of vitamin E oxidation. MDA was generated autocatalytically and resulted in hemolysis at 1.5 mmol/L of H2O2 in erythrocytes from neonates and at 3.5 mmol/L of H2O2 in erythrocytes from adults (P less than .001). After four hours of incubation, MDA reached a plateau at a greater level (365 +/- 46 nmol/L) in cells of neonates than in those of adults (208 +/- 37 nmol/L/mL) (P less than .001). Hemoglobin was oxidized in the same pattern in erythrocytes of neonates and adults, and 90% of it was oxidized at 0.625 mmol/L of H2O2. In conclusion, in the experimental conditions used, oxidation of glutathione precedes that of vitamin E, and tocopherol is the last antioxidant to be consumed before the autocatalytic generation of MDA. Differences in the pattern of vitamin E oxidation, MDA generation, and hemolysis in erythrocytes from neonates and adults may be due to a lower erythrocyte vitamin E-PUFA ratio in neonates.

Adult↗

PubMed1982

[Fundamental and clinical studies of cefotaxime in neonates and immature infants].

Cefotaxime (CTX) was used in the treatment and prophylaxis of infections in neonates and immature infants. The following results were obtained. 1. Mean serum concentrations (bioassay) 30 minutes after a single intravenous injection of about 20 mg/kg of CTX were 44.5 mcg/ml in neonates and 47.2 mcg/ml in immature infants aged 0-3 days, 45.8 mcg/ml in neonates and 56.4 mcg/ml in an immature infant aged 4-7 days and 40.6 mcg/ml in neonates and 38.1 mcg/ml in immature infants aged 8 or more days. Six hour values were respectively 10.9 mcg/ml, 17.0 mcg/ml, 4.6 mcg/ml, 13.4 mcg/ml, 3.8 mcg/ml and 2.7 mcg/ml. 2. Mean serum concentration half-lives were 3.0 hours in neonates and 3.2 hours in immature infants aged 0-3 days, 1.8 hours in neonates and 3.2 hours in an immature infant aged 4-7 days, and 1.5 hours in neonates and 1.6 hours in immature infants aged 8 or more days. 3. Urinary recovery rates were 0.8-78.0% for 0-6 hours after treatment. 4. Adequate clinical efficacy can be expected by the intravenous injection of CTX in doses of 20 mg/kg 2 times daily, every 12 hours, in neonates and immature infants aged 0-3 days, 20 mg/kg 3 times daily, every 8 hours, in neonates and immature infants aged 4-7 days, and 20 mg/kg 3 to 4 times daily, every 6-8 hours, in neonates and immature infants aged 8 or more days. 5. The clinical efficacy of CTX was good in all 4 cases of sepsis (including suspected case), excellent in 1 case of urinary tract infection, and good in all 4 cases of fever of unknown origin for a cure rate of 100%. 6. Adverse reactions were not noted in any cases.

Bacterial Infections↗

PubMedDate not supplied

Serological evidence of Ureaplasma urealyticum infection in neonatal respiratory disease.

Since up to 80 percent of pregnant women and 30 percent of neonates may be colonized with genital mycoplasmas, it is difficult to determine whether true infection occurs. The antibody responses to eight serotypes of U. urealyticum were assessed in mothers and infants in 21 cases of neonatal respiratory disease (RD) and 24 normal cases. Among the normal population of mothers and infants, a titer of greater than or equal to 1:32 occurred in 0.25 percent (1/394). In mother-infant paired titers, a fourfold difference occurred in 2.6 percent (5/192). Among 54 RD neonates, 55.6 percent had a titer of greater than or equal to 1:32 compared to only 4.2 percent of normal neonates (p less than .001). Fourfold elevations in antibody titers of greater than 1:32 were observed in the neonate in 52.4 percent of RD cases compared to 0 percent of 24 normal pairs (p less than .001) and in 28.6 percent of mothers of RD neonates compared to 0 percent in normal cases (p = .013). We observed that 43.3 percent of RD neonates with titers greater than or equal to 1:32 died compared to 16.6 percent of RD neonates exhibiting no elevation of antibody response over the maternal level. Among the six who died, 66.7 percent of neonates and 16.7 percent of their mothers had elevated titers, compared to 33.3 percent of 15 surviving infants and 40.0 percent of their mothers. These elevated antibody responses strongly support the concept that U. urealyticum causes infection in the perinatal period in association with neonatal respiratory disease. Since the elevation in titers was detected close to delivery in many cases, the infection may occur in utero.

Adult↗

PubMed1982

Large-for-gestational-age neonates: anthropometric reasons for shoulder dystocia.

From 1960 to 1980 at Memorial Hospital Medical Center--Miller Children's Hospital, the mean birth weight for term-size neonates increased from 3381 to 3458 g inspite of increases in ethnic groups known to have smaller neonates. More significantly, the incidence of macrosomic neonates (birth weight greater than 4000 g) increased from 7.0 to 10.7%. Because of this marked increase in the incidence of neonatal macrosomia, prospective study was designed to characterize the macrosomic neonate anthropometrically. The results of this study revealed that neonates experiencing shoulder dystocia had significantly greater shoulder-to-head and chest-to-head disproportions than did macrosomic neonates delivered by cesarean section for failed progress in labor or macrosomic neonates delivered without shoulder dystocia. In addition, neonates of diabetic mothers also showed significantly greater shoulder-head and chest-head size differences than did neonates of nondiabetic mothers of comparable weight. These data suggest that antenatal ultrasonic measurements to compare chest-head size difference in fetuses suspected to be macrosomic and in diabetic pregnancies could be of value in selecting patients for the appropriate route of delivery.

Adult↗

PubMedDate not supplied

The importance of extreme prematurity and low birthweight to US neonatal mortality patterns: implications for prenatal care and women's health.

OBJECTIVE: In order to frame the appropriateness of neonatal mortality reduction efforts that begin only after pregnancy is recognized, this study examined the relative contributions of different gestational age and birthweight groups to total neonatal mortality and to racial disparities in neonatal mortality in the United States. METHODS: Using the national linked birth/infant death data set for the 1988 cohort, the relative contributions of different birthweight and gestational age groups to national neonatal mortality rates were calculated. The relative contributions of these groups to the racial disparity in neonatal mortality were also assessed. RESULTS: Very low birthweight infants (< 1,500 g) accounted for 1.2% of all births, but 64.2% of all neonatal deaths. The very low birthweight rate for whites was 0.93%, while that for blacks was 2.79% with the contribution of this group to neonatal mortality higher for blacks than whites. Infants less than 1,000 g contributed more than 80% of the racial disparity in neonatal mortality. CONCLUSION: Neonatal mortality patterns in the United States have become highly dependent on infants with gestational ages that approach the second trimester. Preventing neonatal mortality by enhancing care only after pregnancy has been recognized, therefore, may be limited. Strategies that link prenatal care to broader initiatives to improve the health of women regardless of pregnancy status may be more effective.

Cohort Studies↗

PubMedDate not supplied

Natural antipig xenoantibody is absent in neonatal human serum.

BACKGROUND: Discordant xenotransplantation represents an attractive alternative to allotransplantation in light of the current shortage of donor organs suitable for heart allotransplantation. Unfortunately, discordant xenotransplantation is still limited by hyperacute rejection, a process thought to be mediated by natural antixenodonor antibodies. On the basis of our previous findings that cytotoxic natural xenoantibodies are immunoglobulin M in nature and that natural immunoglobulin M xenoantibodies are barely detectable in neonatal baboon serum, we postulated that immunoglobulin M xenoantibodies may be absent from newborn human serum. METHODS: Neonatal human sera were obtained from the cord blood of normal term infants and pooled. Pooled adult human sera were used as a control. A whole cell enzyme-linked immunosorbent assay and a complement-mediated cytotoxicity assay were performed to determine the binding and cytotoxicity of these xenoantibodies to pig aortic endothelial cells and pig lymphocytes. RESULTS: Neonatal human sera did not show binding of immunoglobulin M xenoantibodies to pig aortic endothelial cells or lymphocytes. However, low level binding of immunoglobulin G xenoantibodies was detected to pig endothelial cells and lymphocytes. In contrast, adult human sera showed significant binding of both natural immunoglobulin M and G xenoantibodies to pig aortic endothelial cells and lymphocytes. In addition, adult human immunoglobulin M xenoantibodies bound with similar avidity to both cultured adult and neonatal pig aortic endothelial cells. Although neonatal human sera were not cytotoxic to target cells, adult sera were cytotoxic to both pig aortic endothelial cells and pig lymphocytes. Our findings indicate that neonatal human sera lack natural antipig immunoglobulin M xenoantibodies, and therefore, neonatal human serum is not cytotoxic to pig endothelial cells or lymphocytes. Like adult pig endothelial cells, neonatal pig endothelial cells may also express similar membrane xenoantigens recognized by natural immunoglobulin M xenoantibodies. CONCLUSIONS: The absence of cytotoxic natural immunoglobulin M xenoantibodies in the neonate suggests that discordant xenotransplantation may be feasible in the neonate.

Adult↗

PubMed1994

Perinatal hypothyroidism impairs the normal transition of GLUT4 and GLUT1 glucose transporters from fetal to neonatal levels in heart and brown adipose tissue. Evidence for tissue-specific regulation of GLUT4 expression by thyroid hormone.

GLUT1 and GLUT4 glucose transporter expression is highly regulated in muscle and adipose tissue during perinatal life. Here we have investigated the role of thyroid hormones in the regulation of GLUT4 induction and GLUT1 repression associated to neonatal development. Perinatal hypothyroidism markedly impaired GLUT4 protein induction in heart. This effect was heart specific, and a greater expression of GLUT4 was detected in brown adipose tissue from neonatal hypothyroid rats compared with controls. These changes in GLUT4 protein expression were not detected in brown adipose tissue or heart when hypothyroidism was induced in adult rats. These results indicate that GLUT4 induction during perinatal life is highly sensitive to thyroid hormones in both heart and adipose tissue. Perinatal hypothyroidism was characterized by decreased cardiac GLUT4 mRNA concentrations. T3 injection caused a marked increase in cardiac levels of GLUT4 mRNA in hypothyroid neonates. Thus, in 13-day-old hypothyroid rats, GLUT4 mRNA levels increased 3-fold 1 h after T3 injection. Under these conditions, retinoic acid also caused a rapid increase in cardiac GLUT4 mRNA levels from hypothyroid neonates. In addition, cardiac levels of GLUT4 protein markedly increased in fetuses and in neonates 24 h after T3 injection. These findings suggest that a direct effect of thyroid hormones is the promotion of cardiac GLUT4 gene expression. GLUT1 protein expression was markedly enhanced in brown adipose tissue and heart during neonatal hypothyroidism as well as in hypothyroidism induced in adult rats. This was concomitant to greater levels of GLUT1 mRNA in hearts from hypothyroid neonates. Immunofluorescence analysis indicated that cardiomyocytes from hypothyroid pups contained an enhanced level of GLUT1 protein. Furthermore, T3 injection caused a decrease in cardiac levels of GLUT1 mRNA in hypothyroid neonates. These results indicate that thyroid hormone manipulation leads to inverse regulation of GLUT1 and GLUT4 glucose transporter gene expression in the neonatal heart. We conclude that thyroid hormones play a pivotal role controlling the transition of glucose transporter carriers from fetal to neonatal levels in heart and brown adipose tissue.

Adipose Tissue, Brown↗

PubMed1994

An analysis of the cost-effectiveness of selected protocols for the prevention of neonatal group B streptococcal infection.

OBJECTIVE: To determine the expected neonatal outcome in a hypothetical obstetric population with various screening and intrapartum management protocols for the prevention of neonatal group B streptococcal infections. METHODS: We used decision analysis to investigate the performance of various antenatal and intrapartum group B streptococcal screening protocols combined with selective or universal intrapartum antibiotic prophylaxis in preventing neonatal early-onset group B streptococcal disease. Population characteristics, screening test performance, and treatment efficacy profiles were abstracted from previous investigations. RESULTS: In the absence of screening or treatment, the estimated neonatal attack rate and mortality rate were 3.6 and 0.60 cases per 1000 neonates, respectively. Universal antenatal screening at 26-28 weeks' gestation and selective intrapartum prophylaxis (treatment of colonized women with risk factors) or nonselective prophylaxis (treatment of all colonized women) had attack rates of 1.64 and 1.08 and mortality rates of 0.21 and 0.18 cases per 1000 neonates, respectively. Rapid intrapartum screening and selective prophylaxis had an estimated attack rate of 1.92-2.58 and a mortality rate of 0.26-0.40 cases per 1000 neonates, with results dependent upon the time required to attain test results. Similarly, rapid intrapartum screening and nonselective prophylaxis had an attack rate of 1.44-2.30 and a mortality rate of 0.24-0.38 cases per 1000 neonates. Empirical prophylaxis of all women delivering prematurely, regardless of culture status, had an attack rate of 2.40 and mortality rate of 0.36 cases per 1000 neonates. CONCLUSIONS: Under ideal circumstances, antenatal group B streptococcal screening at 26-28 weeks' gestation with vaginal-rectal cultures and subsequent intrapartum prophylaxis is associated with lower projected neonatal attack and mortality rates than protocols using rapid intrapartum screening methods. However, in a non-research population, difficulties frequently encountered with antenatal screening procedures may minimize these differences.

Clinical Protocols↗

PubMed1993

[Nutritional status of vitamin D in mothers and neonates of Ushuaia and Buenos Aires].

Serum levels of calcium, phosphorus, total alkaline phosphatase (AP) and 25 hydroxyvitamin D (250HD) were measured at the end of the winter in Group 1 (Ushuaia, latitude 55 degrees S): 16 women (24-48 hs postpartum serum blood) and 20 neonates (cord blood) and in Group 2 (Buenos Aires, latitude 34 degrees S) 21 women (24-48 hs postpartum serum blood) and their 21 neonates (cord blood). The neonatal serum calcium and phosphorus were higher and the neonatal serum AP and 250HD level were lower than maternal levels in both groups (Table 1 and 2). Serum levels of 250HD were diminished (< 8 ng/ml) in 62% of the mothers and 81% of the neonates of Ushuaia and in 24% of the mothers and 16% of the neonates of Buenos Aires (figure 1). Neonatal serum 250HD levels correlate with maternal serum 250HD levels in the paired group of Buenos Aires (r = 0.65, p < 0.003) (Figure 2). In Ushuaia the serum 250HD levels (X +/- SD) in neonates (3.9 +/- 2.7 ng/ml) and in mothers (6.3 +/- 4.8 ng/ml) were lower than in Buenos Aires (neonates: 11.3 +/- 6.0 ng/ml and mothers: 14.4 +/- 8.4 ng/ml, p < 0.001). Maternal serum calcium levels were lower in Ushuaia (8.7 +/- 0.8 mg/dl) than in Buenos Aires (9.2 +/- 0.4 mg/dl) (p < 0.05). In conclusion, 1) In Ushuaia pregnant women and their neonates had a deficient nutritional state of vitamin D. Preventive administration of vitamin D would probably be beneficial.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Impairment of chemoattractant-stimulated hexose uptake in neonatal neutrophils.

Neonatal neutrophils (polymorphonuclear leukocytes [PMN]) exhibit a well-documented deficiency in chemotaxis, the nature of which has not been fully elucidated. To determine whether impaired ability of neonatal PMN to increase hexose uptake in response to chemoattractants could contribute to this defect, we compared uptake of 2-deoxy-D-glucose (2-DOG) in stimulated versus resting PMN from neonates (cord blood) and healthy adults. Compared with unstimulated values; N-formyl-methionyl-leucyl-phenylalanine (fMLP) (optimal at 10 nmol/L) caused a threefold to fourfold increase in 2-DOG uptake by adult PMN. Unstimulated 2-DOG uptake by neonatal PMN was slightly higher than that for adult cells, but fMLP caused only a minimal (less than twofold) increase, and optimally stimulated uptake was significantly lower than for adult PMN (P < .01 for adult versus neonatal stimulated uptake; n = 6). Findings were similar when ionomycin or C5a was used as a stimulus. Optimal fMLP stimulation of adult PMN was associated with a marked decrease in the Km for 2-DOG uptake, from 0.74 +/- 0.11 to 0.23 +/- 0.03 mmol/L (delta Km = -0.51 +/- 0.12 mmol/L; n = 6). In contrast, there was relatively little fMLP-induced change in the Km for uptake of 2-DOG by neonatal PMN (from 0.44 +/- 0.04 mmol/L to 0.32 +/- 0.019 mmol/L n = 6); delta Km = -0.12 +/- 0.04 mmol/L; P = .011 for adult versus neonatal delta Km. Stimulation with fMLP was not accompanied by a significant change in the Vmax for 2-DOG uptake with either adult or neonatal PMN, and the respective values for Vmax were similar. We conclude that the chemoattractant-induced increase in hexose uptake by PMN is deficient in neonates compared with adults and that this deficiency involves mechanisms that determine the Km for this process. This impairment may contribute to defective chemotaxis in neonatal PMN.

Adult↗

PubMed1995

Carnitine in neonatal nutrition.

Experimental evidence from several investigators suggests that carnitine is a conditionally essential nutrient for neonates. If carnitine is a conditionally essential nutrient for the neonate, most neonates on total parenteral nutrition in the United States are not receiving adequate nutritional support. The metabolic functions of carnitine are varied and important in several aspects of neonatal physiology. All neonates receiving breast milk receive dietary carnitine and most neonates receiving enteral infant formulas receive dietary carnitine at a level similar to that of the breast-fed neonate. However, most neonates on total parenteral nutrition receive no dietary carnitine. Investigators have been testing the working hypothesis that carnitine is a conditionally essential nutrient for the neonate for many years. This review discusses (1) data supporting the hypothesis, (2) reasons why it has not been either proved or disproved by now, and (3) the author's view of a prudent approach to dietary carnitine supplementation of neonates.

Age Factors↗

PubMedDate not supplied

Labor pain before elective cesarean section reduces neonatal respiratory distress.

Neonatal respiratory distress is a major complication of elective Cesarean section. To clarify the effect of preceding labor on the incidence of respiratory distress, we studied 45 term neonates who were born with labor and 85 term neonates who were born without labor. Transient tachypnea of the newborns accounted for the majority of respiratory distress in term neonates. Respiratory distress occurred less frequently in term neonates delivered after the onset of labor compared to those delivered before the onset of labor (11.1% vs. 31.8%, p < 0.002). Neonatal respiratory distress syndrome (RDS) occurred in 4 of 85 (4.7%) term neonates delivered before the onset of labor. In contrast, none of the 45 term neonates born after the onset of labor developed RDS (p = 0.02). Awaiting the onset of labor appears to be beneficial in preventing neonatal RDS for term neonates delivered by elective Cesarean section.

Adult↗

PubMedDate not supplied

The risk of periventricular-intraventricular hemorrhage with vacuum extraction of neonates weighing 2000 grams or less.

OBJECTIVE: The objective of this retrospective study was to test the hypothesis that vacuum extraction of neonates with a birth weight < or = 2000 gm is associated with an increased risk of periventricular-intraventricular hemorrhage (PV-IVH). STUDY DESIGN: One hundred sixty-eight neonates weighing < or = 2000 gm were entered into this case control study. Fifty-six neonates delivered by silicone-rubber vacuum comprised the study group. For every infant born by vacuum-assisted delivery, two spontaneously delivered neonates served as controls (n = 112) and were matched for best obstetric gestational age (within 1 week), delivery date within 1 year, and birth weight < or = 2000 gm. Maternal and neonatal medical records were reviewed for demographic variables, antenatal complications, indication for vacuum-assisted delivery, neonatal birth weight, Apgar scores, umbilical cord blood gas values, and neonatal morbidity including the incidence of PV-IVH. All perinatal outcome variables were compared between the vacuum-assisted and spontaneously delivered groups. RESULTS: Both groups were similar with regard to maternal age, parity, antepartum complications, gestational age at delivery, neonatal birth weight, and gender. Both groups were also similar with regard to the incidence of 1-minute Apgar score < 5, small for gestational age, cephalhematoma, birth trauma, respiratory distress syndrome, hyperbilirubinemia, and sepsis. There was a significant increased incidence of 5-minute Apgar scores < 7 in the vacuum-assisted group (p = 0.04). No significant difference was observed in the incidence of PV-IVH grades 1 through 4 (21.4% vacuum group vs 16.1% control group, odds ratio 1.42, 0.58 to 3.45). CONCLUSION: Indicated use of the silicone-rubber vacuum to assist vaginal delivery of neonates weighing < or = 2000 gm does not appear to be associated with an increased risk of PV-IVH or other neonatal complications.

Case-Control Studies↗

PubMed1999

Audiologic evaluation of neonates with severe hyperbilirubinemia using transiently evoked otoacoustic emissions and auditory brainstem responses.

OBJECTIVES: To audiologically clarify the lesion site and to test the reliability of transiently evoked otoacoustic emissions (TEOAEs) in hearing screening of hyperbilirubinemic neonates. STUDY DESIGN: Eleven neonates with severe hyperbilirubinemia who had exchange transfusion in the neonatal intensive care unit of an academic hospital over a 3-year period were included in this study. They were tested with auditory brainstem response (ABR) and TEOAEs after exchange transfusion during hospitalization or at an immediate follow-up visit after discharge. Follow-up ABR tests were performed when infants showed significant hearing loss. METHODS: ABR and TEOAE tests were performed on the 11 neonates with severe hyperbilirubinemia after exchange transfusion. Follow-up ABR tests were carried out in 3-month intervals in the four neonates who showed abnormal or no response on initial ABR. RESULTS: Four neonates showed abnormal or no response and the other seven demonstrated normal response in ABR. All 11 neonates passed TEOAEs. Two neonates showed improvement in auditory function at 3- or 6-month follow-up ABR. CONCLUSION: The results of this study indicate that the site of lesion in hearing loss caused by hyperbilirubinemia may be at the retrocochlear location while the cochlea remains intact. TEOAEs may have limitations in evaluation of hearing in the neonates with hyperbilirubinemia.

Brain Stem↗

PubMed2001

Bacteremia, central catheters, and neonates: when to pull the line.

OBJECTIVES: Physicians who treat neonates who become bacteremic while dependent on central venous catheters face a serious and common dilemma. We sought 1) to evaluate the relationship between central venous catheter removal and outcome in bacteremic neonates, 2) to determine species of bacteria that are associated with an increased risk of infectious complications if the central catheter is not removed promptly, and 3) to provide evidence-based recommendations for central catheter management. METHOD: A retrospective cohort study of all neonates who had central venous access and developed bacteremia between July 1, 1995, and July 31, 1999, was conducted in the Duke University neonatal intensive care unit. RESULTS: The outcome for patients in whom the central catheter was not removed within 24 hours of organism identification was significantly worse (odds ratio = 9.8) than it was for those whose catheters were removed promptly. For patients who were infected with Staphylococcus aureus or with nonenteric Gram-negative rods, delayed removal of the central catheter was associated with complicated bacteremia. Catheter sterilization was attempted in 27 neonates who were infected with enteric Gram-negative rods; only 10 of these infants retained their catheters without infection-related complications. Infants who had 4 consecutive blood cultures that were positive for coagulase-negative staphylococcus (CoNS) were at significantly increased risk for end-organ damage and death, compared with infants who had 3 or fewer positive blood culture for CoNS (odds ratio = 29.58). CONCLUSIONS: Bacteremic infants experienced fewer infection-related complications when the central catheter was removed promptly. One positive blood culture for S aureus or a Gram-negative rod warrants central line removal in a neonate. Clinicians who are faced with a neonate who has 1 positive culture for CoNS may attempt medical management without central catheter removal, but documentation of subsequent negative blood cultures is crucial. Once a neonate has 3 positive blood cultures for CoNS, the central catheter should be removed.central line, neonate, bacteremia, bacteria, umbilical catheter, Broviac, percutaneous.

Bacteremia↗

PubMed2006

Evaluation and development of potentially better practices to improve pain management of neonates.

OBJECTIVE: Despite increased knowledge, improved options, and regulatory mandates, pain management of neonates remains inadequate, promoted by the ineffective translation of research data into clinical practice. The Neonatal Intensive Care Quality Improvement Collaborative 2002 was created to provide participating NICUs the tools necessary to translate research, related to prevention and treatment of neonatal pain, into practice. The objective for this study was to use proven quality improvement methods to develop a process to improve neonatal pain management collaboratively. METHODS: Twelve members of the Neonatal Intensive Care Quality Improvement Collaborative 2002 formed an exploratory group to improve neonatal pain management. The exploratory group established group and site-specific goals and outcome measures for this project. Group members crafted a list of potentially better practices on the basis of the available literature, encouraged implementation of the potentially better practices at individual sites, developed a database for sharing information, and measured baseline outcomes. RESULTS: The goal "improve the assessment and management of infants experiencing pain in the NICU" was established. In addition, each site within the group identified local goals for improvement in neonatal pain management. Data from 7 categories of neonates (N = 277) were collected within 48 hours of NICU admission to establish baseline data for clinical practices. Ten potentially better practices were developed for prioritized pain conditions, and 61 potentially better practices were newly implemented at the 12 participating sites. Various methods were used for pain assessment at the participating centers. At baseline, heel sticks were used more frequently than peripheral intravenous insertions or venipunctures, with substantial variability in the number of avoidable procedures between centers. Pain was assessed in only 17% of procedures, and analgesic interventions were performed in 19% of the procedures at baseline. CONCLUSIONS: Collaborative use of quality improvement methods resulted in the creation of self-directed, efficient, and effective processes to improve neonatal pain management. Group establishment of potentially better practices, collective and site-specific goals, and extensive baseline data resulted in accelerated implementation of clinical practices that would not likely occur outside a collaborative setting.

Analgesics, Opioid↗

PubMed1998

Variation among neonatal intensive care units in narcotic administration.

OBJECTIVES: To compare rates of narcotic administration for medically treated neonates in different neonatal intensive care units (NICUs) and to compare treated and untreated neonates to assess whether narcotics provided advantages or disadvantages for short-term outcomes, such as cardiovascular stability (ie, blood pressure and heart rate), hyperbilirubinemia, duration of respiratory support, growth, and the incidence of intraventricular hemorrhage. STUDY DESIGN: The medical charts of neonates weighing less than 1500 g, admitted to 6 NICUs (A-F), were abstracted. Neonates who had a chest tube or who had undergone surgery were excluded from the study, leaving the records of 1171 neonates. We modeled outcomes by linear or logistic regression, controlling for birth weight (<750, 750-999, and 1000-1499 g) and illness severity (low, 0-9; medium, 10-19; high, > or =20) using the Score for Neonatal Acute Physiology (SNAP), and adjusted for NICU. RESULTS: Narcotic use varied by birth weight (<750 g, 21%; 750-999 g, 13%; and 1000-1499 g, 8%), illness severity (low, 9%; medium, 19%; and high, 37%), day (1, 11%; 3, 6%; and 14, 2%), and NICU. We restricted analyses to the 1018 neonates who received mechanical ventilation on day 1. Logistic regression, adjusting for birth weight and SNAP, confirmed a 28.6-fold variation in narcotic administration (odds ratios, 4.1-28.6 vs NICU A). Several short-term outcomes also were associated with narcotic use, including more than 33 g of fluid retention on day 3 and a higher direct bilirubin level (6.8 micromol/L higher [0.4 mg/dL higher], P = .03). There were no differences in weight gain at 14 and 28 days or mechanical ventilatory support on days 14 and 28. Narcotic use was not associated with differences in worst blood pressure or heart rate or with increased length of hospital stay. CONCLUSIONS: Our study found a 28.6-fold variation among NICUs in narcotic administration in very low-birth-weight neonates. We were unable to detect any major advantages or disadvantages of narcotic use. We did not assess iatrogenic abstinence syndrome or long-term outcomes. These results indicate the need for randomized trials to rationalize these widely differing practices.

Birth Weight↗

PubMed1996

Evaluation of an automated auditory brainstem response infant hearing screening method in at risk neonates.

UNLABELLED: An automated auditory brainstem response (ABR) method-the ALGO-1 Plus- has been developed for hearing screening in healthy neonates. The aim of this study was to test the validity of this automated ABR screening method in at-risk neonates in a neonatal intensive care unit. Two hundred and fifty at-risk neonates were selected for screening according to the criteria of the American Joint Commerce on Infant Hearing. All 250 neonates were screened with the ALGO-1 Plus for bilateral hearing loss. When two consecutive screenings pointed to bilateral hearing loss ("refer") further audiological investigations were performed and where necessary therapeutic measures were taken. All children who "passed" the screening unilateral or bilateral enrolled in a nationwide behavioural screening programme at the age of 9 months as well as in a 6-monthly follow up programme documenting speech and language development. A total of 245 (98%) neonates passed the ALGO-1 screening, 230 (92%) at the first attempt and 15 (6%) at the second attempt. Five (2%) were referred with bilateral hearing loss. One of these died of congenital rubella shortly after screening and bilateral congenital hearing loss of > 35 dB was confirmed in the other 4. None of the infants who passed the screening were discovered to have moderate to severe bilateral hearing loss (> 40 dB) with behavioural screening (n = 183/233) or at follow up (n = 233/233). In this study, all at-risk neonates with bilateral congenital hearing loss were detected with ALGO-1 Plus screening. No false-negatives were discovered. CONCLUSION: The ALGO-1 Plus infant hearing screener can be used as a valid automated ABR-screener to detect hearing loss in at-risk neonates in a neonatal intensive care setting.

Evoked Potentials, Auditory, Brain Stem↗