Effect of gestational age on the epidemiology of late-onset sepsis in neonatal intensive care units - a review

2017 ◽  
Vol 15 (10) ◽  
pp. 917-924 ◽  
Author(s):  
Elsa Da Palma Afonso ◽  
Stijn Blot
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Neonatal Intensive Care Units ◽  
Late Onset Sepsis

scholarly journals Invasive devices as risk factors for neonatal sepsis in neonatal intensive care units

2020 ◽  
Vol 9 (12) ◽  
pp. e27891211048
Author(s):  
Juliana Barbosa Schwab ◽  
Erildo Vicente M¨¨¨¨¨¨uller ◽  
Elisa Donalisio Teixeira Mendes ◽  
Pollyanna Kássia de Oliveira Borges ◽  
Taís Ivastcheschen
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Mortality Rate ◽  
Intensive Care Units ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Neonatal Intensive Care Units ◽  
Late Onset Sepsis ◽  
The Impact

This study aimed to evaluate the impact of invasive devices as risk factors for the development of neonatal sepsis in Neonatal Intensive Care Units. Hospital-based retrospective cohort study performed in two Neonatal Intensive Care Units in Ponta Grossa, Paraná, Brazil. Documentary data were collected through consultation of electronic medical charts of all patients admitted to two hospitals and of the patients with diagnosis of sepsis in another hospital. Health conditions at admission and outcomes were evaluated. Frequencies of the reasons for admission and the outcomes were calculated. In the association analysis, exposure variables were calculated with odds ratio and confidence intervals (95%). The frequency of sepsis was 39%, and 45.7% of the cases were of early-onset sepsis and 54.3% of late-onset sepsis. The mortality rate associated with sepsis was 9.9%. The use of invasive devices was observed to increase by 6 times the risk of neonatal sepsis. Peripherally inserted central catheter and phlebotomy were the devices causing higher risk. The high incidence of late-onset sepsis, its association with the use of invasive devices and the higher mortality rate among newborns with sepsis suggest the presence of fragilities in neonatal care and the need to seek alternatives of neonatal approach to avoid new cases of neonatal sepsis and consequent death.

scholarly journals Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units

2018 ◽  
Vol 102 (12) ◽  
pp. 1711-1716 ◽  
Author(s):  
Ahmet Yagmur Bas ◽  
Nihal Demirel ◽  
Esin Koc ◽  
Dilek Ulubas Isik ◽  
İbrahim Murat Hirfanoglu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Relative Weight ◽  
Neonatal Intensive Care Units ◽  
Screening Criteria ◽  
Prospective Multicentre Study

BackgroundTo evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition.MethodsA prospective cohort study (TR-ROP) was performed between 1 April 2016 and 30 April 2017 in 69 neonatal intensive care units (NICUs). Infants with a birth weight (BW)≤1500 g or gestational age (GA)≤32 weeks and those with a BW>1500 g or GA>32 weeks with an unstable clinical course were included in the study. Predictors for the development of ROP were determined by logistic regression analyses.ResultsThe TR-ROP study included 6115 infants: 4964 (81%) with a GA≤32 weeks and 1151 (19%) with a GA>32 weeks. Overall, 27% had any stage of ROP and 6.7% had severe ROP. A lower BW, smaller GA, total days on oxygen, late-onset sepsis, frequency of red blood cell transfusions and relative weight gain were identified as independent risk factors for severe ROP in infants with a BW≤1500 g. Of all infants, 414 needed treatment and 395 (95.4%) of the treated infants had a BW≤1500 g. Sixty-six (16%) of the treated infants did not fulfil the Early Treatment for Retinopathy of Prematurity requirements for treatment.ConclusionsScreening of infants with a GA≤34 weeks or a BW<1700 g appears to be appropriate in Turkey. Monitoring standards of neonatal care and conducting quality improvement projects across the country are recommended to improve neonatal outcomes in Turkish NICUs.Trial registration numberNCT02814929, Results.

scholarly journals Population Pharmacokinetics of Cefepime in the Neonate

2005 ◽  
Vol 49 (7) ◽  
pp. 2760-2766 ◽  
Author(s):  
Edmund Capparelli ◽  
Christine Hochwald ◽  
Maynard Rasmussen ◽  
Amy Parham ◽  
John Bradley ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Fourth Generation ◽  
Neonatal Intensive Care Units ◽  
Pharmacokinetic Parameters ◽  
Population Pharmacokinetic ◽  
Beta Lactamase ◽  
Postconceptional Age

ABSTRACT Newborn infants cared for in neonatal intensive care units may develop nosocomial infections. Cefepime, a “fourth-generation” cephalosporin (i.e., with activity against virtually all of the chromosomal-beta-lactamase-producing and many extended-spectrum-beta-lactamase-producing organisms), provides excellent activity against many gram-negative pathogens resistant to expanded-spectrum cephalosporins currently used to treat neonatal infections. The purpose of this study was to determine the pharmacokinetics of cefepime in this population to optimize dosing and minimize potential adverse events. Premature and term infants <4 months of age hospitalized in two neonatal intensive care units were studied. Limited pharmacokinetic (PK) sampling occurred following a dose of cefepime at 50 mg/kg of body weight infused over 30 min. Population pharmacokinetic parameters were determined using the program NONMEM. Fifty-five infants were enrolled. Their average (± standard deviation) gestational age at birth was 30.5 ± 5.3 weeks, and their average postnatal age at PK evaluation was 14.5 ± 14.7 days. In the final PK model, cefepime clearance (CL) was strongly associated with serum creatinine (SCr) (CL [ml/min/kg] = 0.26 + 0.59/SCr). The volume of distribution for infants with a postconceptional age of <30 weeks was larger than that for infants with a postconceptional age of >30 weeks (0.51 versus 0.39 liter/kg, respectively). The Bayesian analysis-predicted cefepime trough concentration at a dose of 50 mg/kg every 12 h for infants ≤14 days of age was 29.9 ± 16.6 μg/ml. Cefepime, dosed at 30 mg/kg/dose every 12 h for infants less than 14 days of age, regardless of gestational age, should provide antibiotic exposure equivalent to or greater than 50 mg/kg every 8 h in older infants and children.

scholarly journals Pathogens distribution and antimicrobial resistance in bloodstream infections in twenty-five neonatal intensive care units in China, 2017–2019

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jing Liu ◽  
Zengyu Fang ◽  
Yonghui Yu ◽  
Yanjie Ding ◽  
Zhijie Liu ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Bloodstream Infections ◽  
Neonatal Intensive Care Units ◽  
Late Onset Sepsis ◽  
Resistance Rates

Abstract Background Overcrowding, abuse of antibiotics and increasing antimicrobial resistance negatively affect neonatal survival rates in developing countries. We aimed to define pathogens and their antimicrobial resistance (AMR) of early-onset sepsis (EOS), hospital-acquired late-onset sepsis (HALOS) and community-acquired late-onset sepsis (CALOS) in 25 neonatal intensive care units (NICUs) in China. Study design This retrospective descriptive study included pathogens and their AMR from all neonates with bloodstream infections (BSIs) admitted to 25 tertiary hospitals in China from January 1, 2017, and December 31, 2019. We defined EOS as the occurrence of BSI at or before 72 h of life and late-onset sepsis (LOS) if BSI occurred after 72 h of life. LOS were classified as CALOS if occurrence of BSI was ≤ 48 h after admission, and HALOS, if occurrence was > 48 h after admission. Results We identified 1092 pathogens of BSIs in 1088 infants from 25 NICUs. Thirty-two percent of all pathogens were responsible for EOS, 64.3% HALOS, and 3.7% CALOS. Gram-negative (GN) bacteria accounted for a majority of pathogens in EOS (56.7%) and HALOS (62.2%). The most frequent pathogens causing EOS were Escherichia coli (27.2%) and group B streptococcus (GBS; 14.6%) whereas in CALOS they were GBS (46.3%) and Staphylococcus aureus (41.5%). Klebsiella pneumoniae (27.9%), Escherichia coli (15.7%) and Fungi (12.8%) were the top three isolates in HALOS. Third-generation cephalosporin resistance rates in GN bacteria ranged from 9.7 to 55.6% in EOS and 26% to 63.3% in HALOS. Carbapenem resistance rates in GN bacteria ranged from 2.7 to 31.3% in HALOS and only six isolates in EOS were carbapenem resistant. High rates of multidrug resistance were observed in Klebsiella pneumoniae (60.7%) in HALOS and in Escherichia coli (44.4%) in EOS. All gram-positive bacteria were susceptible to vancomycin except for three Enterococcus faecalis in HALOS. All-cause mortality was higher among neonates with EOS than HALOS (7.4% VS 4.4%, [OR] 0.577, 95% CI 0.337–0.989; P = 0.045). Conclusions Escherichia coli, Klebsiella pneumoniae and GBS were the leading pathogens in EOS, HALOS and CALOS, respectively. The high proportion of pathogens and high degree of antimicrobial resistance in HALOS underscore understanding of the pathogenesis and emphasise the need to devise effective interventions in developing countries.

Surveillance swabbing for MRSA on neonatal intensive care units – is weekly nasal swabbing the best option?

2012 ◽  
Vol 13 (4) ◽  
pp. 120-124 ◽  
Author(s):  
Donovan Duffy ◽  
Mehdi Garbash ◽  
Mike Sharland ◽  
Nigel Kennea
Keyword(s):  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Birth Weight ◽  
Intensive Care Units ◽  
Gestational Age ◽  
Optimal Strategy ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Nasal Swabs ◽  
Surveillance Specimens

Most paediatric meticillin resistant Staphylococcus aureus (MRSA) infections occur in neonatal units, but evidence for ongoing MRSA surveillance is lacking and practice varies. The aim of this study was to determine the optimal strategy for neonatal MRSA screening according to swab site, gestational age and birth weight. MRSA detection on simultaneous weekly nasal and groin surveillance swabs and suspected infected sites was determined for all admissions to a tertiary neonatal unit over eight years. Twenty one thousand, seven hundred and thirty six surveillance specimens were examined (3,784 admissions). Infants colonised with MRSA were smaller and of lower gestational age compared with uncolonised infants ( p<0.0001). Infants initially positive on groin swabs alone (13/68; 19%) were of significantly greater gestational age and weight at birth compared with infants initially positive on nose swabs/both nose and groin swabs (55/68; 80%). Infants initially identified on groin swabs were all subsequently detected on nasal swabs or discharged within two weeks of age. 18/86 (21%) of MRSA cases were initially detected on swabbing suspected infected sites. Surveillance swabbing identified 43% of infants before MRSA bacteraemia. Eighty five per cent of colonised infants would be detected by weekly nasal swabs and by swabbing suspected infected sites. Groin swabs detect a small number of bigger mature babies who are discharged before two weeks of age.

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