Journal of Neonatal-Perinatal Medicine - Volume 1, issue 4

Authors: Brook, Itzhak

Article Type: Research Article

Abstract: The awareness of the role of anaerobic bacteria in neonatal bacteremia and sepsis has increased in recent years. The incidence of recovery of anaerobes in neonatal bacteremia varies between 1.8% and 12.5%. Of the 179 cases reported in the literature, 73 were due to Bacteroides spp. (69 were the Bacteroides fragilis group), 57 Clostridium spp. (mostly Clostridium perfringens), 35 Peptostreptococus spp., 5 Propionibacterium acnes, 3 Veillonella spp., 3 Fusobacterium …spp, and 2 Eubacterium spp. Predisposing factors were perinatal maternal complications (especially premature rupture of membranes and chorioamnionitis), scalp abscess, prematurity, and necrotizing enterocolitis. Organisms similar to those isolated in blood were concomitantly recovered in lung aspirates and cerebrospinal and peritoneal fluids. The overall mortality noted is 26% and is highest with B. fragilis group (34%). Inappropriate choice of antimicrobial therapy was often a contributory factor to mortality. Correction of underlying pathology, surgical drainage, and the use of proper antimicrobials are critical to successful resolution of the infection. Penicillin G is the drug of choice for anaerobic infection other than one due to beta-lactamase-producing anaerobic Gram negative bacilli. Antimicrobials useful for therapy these organisms include clindamycin, metronidazole, chloramphenicol, a carbapenem, and the combination of a penicillin plus a beta-lactamase inhibitor. Show more

Keywords: Anaerobic bacteria, bacteremia, septicemia, newborns

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 201-208, 2008

Authors: McPherson, Christopher | Gal, Peter | Smith, McCrae | Wilder, William | Richter, Scott | Ransom, J. Laurence | Carlos, Rita Q. | Dimaguila, Mary Ann V.T. | Wimmer Jr., John E.

Article Type: Research Article

Abstract: Objectives: To examine any association of necrotizing enterocolitis (NEC) and intestinal perforation (IP) in very low birth weight neonates with indomethacin treatment, cumulative dose or maximum plasma concentrations. Methods: This is a retrospective 9-year cohort study of very low birth weight infants (< 1500 grams) admitted to our neonatal intensive care unit. The incidence of NEC and IP in infants who received indomethacin for a PDA (N = 228) were compared to control infants who did not have …PDA and received no indomethacin (N = 628). Factors which were statistically significant in a univariate analysis were then included in a logistic regression model to determine their significance. Results: NEC occurred in 14 (6.1%) indomethacin-treated infants compared to 47 (7.5%) control infants. When the incidence of NEC or IP was restricted to events occurring within 14 days of indomethacin, 4 infants (1.7%) had NEC. IP occurred in 14 (6.1%) indomethacin-treated infants, but 10 had concurrent steroid therapy. IP also occurred in 4 (0.6%) controls. Multivariate logistical regression revealed a lower risk of NEC with indomethacin. The risk for NEC and IP is not increased with higher INDO doses or INDO concentrations. Conclusions: Indomethacin treatment for PDA does not increase NEC risk, and may decrease the risk. Indomethacin treatment is associated with an increased risk of IP, especially when combined with systemic glucocorticoids. Show more

Keywords: Indomethacin, necrotizing enterocolitis, intestinal perforation, neonates, patent ductus arteriosus

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 209-216, 2008

Authors: Saker, Firas | Kesler, Karen | Rosanbalm, Shane | Morris, Amy | Kapik, Barry | Hetherington, Seth

Article Type: Research Article

Abstract: Objective: To evaluate vancomycin use during late-onset sepsis evaluation in very low birth weight infants (VLBW). Study design: Data on late-onset sepsis and antibiotic use, including vancomycin containing regimens, were analyzed and reported from 53 neonatal intensive care units participating in a randomized placebo-controlled trial of Veronate® for VLBW infants. Results: Of 505 infants enrolled in the study, 387 (77%) had at least one evaluation for late-onset sepsis. Of these infants, 108 …(28%) had one or more positive blood cultures. Two hundred thirty-three (60%) infants evaluated for late-onset sepsis received empiric vancomycin. Twenty-one of 33 neonatal intensive care units included vancomycin as empiric therapy more than 50% of the time. Conclusions: Vancomycin exposure rates for first evaluations of late-onset sepsis are high. Strategies to optimize antibiotic use should minimize consequences of late-onset sepsis while limiting antibiotic pressure for development of resistance. Show more

Keywords: Neonatal sepsis, vancomycin, staphylococcal sepsis

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 217-220, 2008

Authors: Hodor, Leah Greenspan | Tioseco, Jennifer A. | Revenis, Mary E. | McCarter, Robert | Rais-Bahrami, Khodayar

Article Type: Research Article

Abstract: Introduction: Pediatric inpatient populations, including neonates, are at increased risk for clinically significant and/or potentially life-threatening medical errors. Computerized physician order entry (CPOE) holds the promise of reducing medication errors. Special attention must be paid to the match between the specialized needs of the population and the detailed capabilities provided by a CPOE system. As we transitioned from a system designed and developed by a team of pediatric/neonatal sub-specialists for the Children's …National Medical Center (CNMC) NICU (TPN 2000) to a more general and adult medicine-based CPOE system (Abacus system, Baxa Corporation, CO), we compared the number and severity of medical errors between the two systems. Method: In Phase I, we reviewed two hundred randomly selected daily TPN orders using the TPN 2000 system, for the number and severity of errors. Specific variables included calcium to phosphorus ratio, osmolality, total calories and dextrose concentration in relation to types of vascular access. Parameters of expected normality were established. Errors were identified and categorized into clinically significant, serious and potentially life-threatening. After 6 months of training on the Abacus system, Phase II began with a review of an additional 200 randomly selected TPN orders from the new system. Results: The most common error was the calcium to phosphorus ratio which accounted for a 4% increase in the number of potentially life-threatening errors (11% errors in TPN 2000 vs. 18% errors in Abacus). Error rates for osmolality were 8.5% during Phase I vs. 0% in phase II. Total calories and dextrose rate errors were not statistically different. Osmolality and dextrose concentration in relation to access showed a 100% improvement in errors in both categories with Abacus vs. the TPN 2000 system. Conclusion: CPOE has the potential to reduce medical errors in the neonatal population. However, a 4% increase in potentially life-threatening errors in calcium to phosphorus ratio seen in our study may support our contention that the sub specialist physicians' input is absolutely essential to the Health Informaticians when designing a new CPOE, modifying an existing one or evaluating and certifying a commercially available or custom developed CPOE system. Show more

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 221-224, 2008

Authors: Lattimore, Keri A. | Vazquez, Delia M. | Barks, John D. | Bhatt-Mehta, Varsha

Article Type: Research Article

Abstract: Background: Hypotension is a common problem in infants born prematurely and is associated with significant adverse events including increased risk for death, IVH, and adverse neurodevelopment. It has been postulated that relative or absolute adrenocortical insufficiency may be partly responsible for hypotension. This has lead to the widespread use of hydrocortisone as treatment for refractory hypotension. Several studies have documented the ability of hydrocortisone to increase blood pressure in the hypotensive newborn, …but there is a paucity of information regarding its long term effect on neurodevelopment. Objective: In 2001, our neonatology group established a protocol for the administration of hydrocortisone for the treatment of hypotension refractory to inotropes. The primary aim of this study is to evaluate neurodevelopment at 12 months corrected age (CGA) as assessed by the Mental development Index and Psychomotor development Index (MDI/PDI) components of the Bayley Scales of Infant Development (BSID). Design/methods: Retrospective matched case-control study of VLBW infants treated with hydrocortisone according to protocol (n = 17) between 2002 and 2005 and BSID score at 12 months corrected age (CGA). Infants were matched on birth weight (BW), ± 300g and none/mild IVH (grades 0, I, II) versus severe (grades III, IV). Results: Hydrocortisone exposed infants were significantly different from the no HC group in gestational age (GA), SNAPPE-II, inotrope score, incidence of PDA , days of mechanical ventilation, and ROP surgery. GA, SNAPPE-II, PDA, and ventilation days were independently significantly correlated with the primary outcome of MDI/PDI. Inotrope score was also significantly correlated with MDI. These variables were included as confounders in the multiple linear regression models. HC use was not a significant predictor of MDI (p = 0.7604) or PDI (p = 0.5593) after adjusting for GA, Inotrope score, SNAPPE-II, ventilator days and PDA by multiple linear regression. Conclusions: HC was not a significant predictor of MDI/PDI scores at 12 months CGA when controlling for a large number of predictors of abnormal neurodevelopment. Show more

Keywords: Hypotension, hydrocortisone, Bayley, very low birth weight, neurodevelopment

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 225-232, 2008

Authors: Al-Alaiyan, Saleh | Saidy, Khaled | Al-Hazzani, Fahad

Article Type: Research Article

Abstract: Objective: To examine the rate of retinopathy of prematurity in infants with severe Rhesus Hemolytic Disease of the Newborn (Rh HDN). Study design: This is a case-control study that involved 33 premature infants with severe Rh HDN were compared to another 33 premature infants without the disease. All infants underwent routine eye examinations by a senior ophthalmologist. Data collected from the records of all patients included demographic data and complications of prematurity. Results: Ten and 2 …infants were diagnosed to have retinopathy of prematurity in the severe Rh HDN and the control groups, respectively, with a statistically significant difference (P = 0.0108). There were no statistically significant differences between patients and their controls in terms of birth weight, gestational age, sex, duration of oxygen therapy, and neonatal complications. A comparison between all infants with ROP and those without ROP showed that there were statistically significant differences in gestational age equal or less than 27 weeks' gestation, presence of patent ductus arteriosus, respiratory distress disease, duration of oxygen therapy and bronchopulmonary dysplasia. Another comparison was performed between infants with retinopathy of prematurity and those without ROP in the severe Rh HDN group showed that the number of intrauterine transfusions was more among infants who developed ROP (P = 0.002). In addition there was no statistically significant difference between the two groups in respect to exchange and simple transfusions. Conclusion: Premature infants with severe Rh HDN were found to be at risk of developing retinopathy of prematurity more than infants without the disease. Show more

Keywords: Premature infants, retinopathy of prematurity, rhesus isoimmunization, blood transfusion

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 233-237, 2008

Authors: Swamy, Ravi | Gupta, Samir | Singh, Jaideep | Donn, Steven M. | Sinha, Sunil K.

Article Type: Research Article

Abstract: Objective: To study the consistency of tidal volume delivery and the respiratory parameters in babies randomized to either volume-controlled ventilation (VCV) or time-cycled, pressure-limited ventilation (TCPLV). Methods: 90 babies between 24 to 32 weeks' gestation who formed part of the original controlled trial comparing VCV vs TCPLV were studied. As a part of the study protocol, these babies were continuously monitored for key respiratory parameters. Hourly recording of these parameters was obtained for 78 …hours or until extubation if it occurred earlier. Consistency of tidal volume delivery and other parameters such as PIP, PEEP, Paw, Cdyn, Ve & FiO_{2} were compared using the Student's t-test with a two-tailed significance level of ⩽0.05. Results: Complete datasets were available on 86 babies, 45 on VCV and 41 on TCPLV. The mean expired tidal volume was slightly higher, and the mean FiO_{2} was lower in the VCV group compared to TCPLV. This was also associated with a higher PIP in VCV compared to TCPLV (16.9 cmH_{2} O vs. 15.3 cmH_{2} O, p = 0.033). However, VCV was associated with significantly higher variability of peak inspiratory pressure and significantly less variability of tidal volume delivery (0.87 mL/kg vs 1.12 mL/kg, p = 0.009). Conclusions: Despite targeting identical exhaled tidal volumes, VCV was associated with consistent tidal volume delivery compared to TCPLV. This may have significance to clinical practice and future research. Show more

Keywords: Volume ventilation, tidal volume, preterm, weaning, respiratory distress syndrome

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 239-243, 2008

Authors: Dahlstrøm, Berit | Esbensen, Ying | Blom, Peter | Bukholm, Geir

Article Type: Research Article

Abstract: The aim of this study was to develop an assay method for determination of down stream gene expression in endothelial cells from human decidual tissue preserved in an RNA-conserving buffer. Human decidual tissue was collected and preserved in RNAlater. The tissue samples were dissected and passed through a mechanical tissue disaggregator, incubated with CD31-coated paramagnetic beads and the attached cells were extracted. RNA isolated from the enriched cells proved to be conserved with good quality and …a genome RNA-microarray was successfully performed. The method provides an alternative for studying in vivo gene expression in endothelial cells from human decidual tissue. Show more

Keywords: HEEC, endothelial cells, in vivo gene expression, cell isolation, RNA degradation

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 245-251, 2008

Authors: Gad, Ashraf | Shah, Shetal

Article Type: Research Article

Keywords: Immunization/vaccination, NICU, premature infant

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 253-255, 2008

Authors: Attar, Mohammad A. | Ruiz, Robert E. | DiPietro, Michael A.

Article Type: Research Article

Abstract: We describe the case of an infant born prematurely at 32 weeks, who had mild respiratory distress syndrome and required brief support with mechanical ventilation. He was breathing room air by day six. At two weeks of age, he had worsening respiratory distress and pneumothorax. The infant had persistent hyperinflation and cystic changes in left lung along with clinical respiratory distress. He recovered quickly following a left lobectomy on day 40. Histo-pathologic evaluation of the resected …tissue was compatible with pulmonary lymphangiectasia. We also discuss the clinical and histopathological limitations in distinguishing unilobar lymphangiectasia from persistent interstitial emphysema. Show more

Keywords: Emphysema, interstitial, infant, congenital, lung, respiratory, prematurity, persistent

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 257-260, 2008

Article Type: Other

Citation: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 4, pp. 261-271, 2008