scholarly journals P037 Evaluating the introduction of dose banded cefotaxime using pre- filled syringes, for early onset sepsis on a neonatal unit

2019 ◽  
Vol 104 (7) ◽  
pp. e2.42-e2
Author(s):  
Suzannah Hibberd
Keyword(s):  
Early Onset ◽  
Electronic Prescribing ◽  
Drug Preparation ◽  
List Type ◽  
Nice Guideline ◽  
Batch Number ◽  
Early Onset Sepsis ◽  
Mandatory Requirement ◽  
Group A ◽  
Group B

BackgroundIn December 2017, cefotaxime doses for treatment of early onset sepsis were banded according to weight. The dose-banding only applies to neonates <7 days old. The implementation of pre-filled syringes (PFS) supplied by the Pharmacy Technical Services Unit coincided with the introduction of cefotaxime dose-banding.AimTo assess whether cefotaxime is prescribed according to the dose-banding guideline. To establish if batch numbers of PFS are reconciled on the electronic prescribing system (EPS). To determine whether introducing PFS has resulted in more neonates receiving the first dose of antibiotics within 1 hour of the decision to treat.MethodsAn EPS report was generated for 2 groups of patients. Group A received cefotaxime from April to June 2018, group B received cefotaxime from September to November 2017, before dose-banding was introduced. Data collected included: weight; dose; time of prescribing and time of administration for the first dose; whether a PFS was used and if the batch number was reconciled electronically. Patients transferred into the unit were excluded as they had started their antibiotics prior to transfer.Results95.3% of group A, (n=85), received doses in accordance with the guideline, two doses were prescribed according to weight. Out of the 95.3% eligible to receive PFS, 91.4% of PFS were documented on the EPS. It was unknown whether PFS were used for the remaining patients. 90.5% of the PFS batch numbers were reconciled, 8.1% were not reconciled and 1.4% had incomplete records. 81.2% of group A received the first dose of antibiotics ≤60 minutes from the point of prescribing in comparison to 76.6% in group B (n=94). 58.8% of group A and 42.6% of group B had doses administered ≤30 minutes after prescribing. Both groups had 5 patients that did not receive their first dose until >2 hours after prescribing.ConclusionThe majority of prescribers are using the dose- banding guideline. 91.4% of doses have been administered using PFS, thereby reducing nursing time used for IV drug preparation. In 8.6% it could not be determined whether a PFS was used although prescription templates had been used. The template includes a mandatory box to say if a PFS has been used, nurses cannot sign the drug administration if it is empty. An outcome from this study is that this discrepancy will be investigated by the electronic prescribing team. Nurses are recording batch numbers onto the EPS in 90.5% of cases. Nurses will be reminded to reconcile batch numbers and making it a mandatory requirement on the EPS will be investigated Having PFS available has led to more patients receiving their dose within 30 minutes and slightly more receiving their doses within 60 minutes. However similar numbers are still receiving their doses >60 minutes after prescribing. Next steps will be to examine cases where antibiotics are delayed and identify causes. A limitation of this study is that it does not take into account how long it takes the prescriber to write the prescription after making the decision to treat.ReferenceNational Institute for Health and Clinical Excellence. ( 2012) Neonatal Infection (early onset): antibiotics for prevention and treatment. NICE Guideline (CG149)

scholarly journals P28 Gentamicin-related incidents in neonates before and after the introduction of electronic prescribing and medicines administration (ePMA)

2020 ◽  
Vol 105 (9) ◽  
pp. e20.2-e21
Author(s):  
Kimberly Mak
Keyword(s):  
Early Onset ◽  
Reporting System ◽  
Neonatal Infection ◽  
Electronic Prescribing ◽  
List Type ◽  
Electronic Prescription ◽  
Blood Samples ◽  
Incident Reporting System ◽  
Early Onset Sepsis ◽  
Before And After

AimGentamicin is widely used to treat early neonatal sepsis as part of a regimen recommended by NICE.1 However, it is frequently implicated in clinical incidents relating to errors in prescribing and administration. This project aimed to evaluate whether the introduction of ePMA had an effect on the frequency and type of incidents that occur relating to the use of gentamicin in neonates.MethodA paper gentamicin prescription chart was used from July 2013 until the implementation of ePMA on 28th January 2019. Using ePMA, prescribers were encouraged to use a pre-set template for ‘neonatal early onset sepsis’, listing benzylpenicillin and gentamicin (in mg/kg). Prescribers had to input the date and time of the first dose, and the system would automatically calculate the dose and time of subsequent administrations. A visual cue was used by the system to signal to nurses that a dose was due. Data was extracted from our local incident reporting system between the periods of 1st July 2013 to 27th January 2019 (‘pre-ePMA’) and 28th January 2019 to 30th June 2019 (‘post-ePMA’), where ‘gentamicin’ was mentioned in the incident description under the ‘neonates’ specialty. The data was examined, categorised into ‘prescribing-related’, ‘administration-related’, or ‘other’ and within the former two, grouped into identified themes.ResultsPre-ePMA 55 incidents were reported (mean=9/year, range 6–16/year), of which 41 (75%) were deemed to have the potential to cause harm. 27 (49%) incidents were prescribing-related and 19 (35%) were administration-related. The rest of the incidents were classed as ‘other’ eg. mislabelling blood samples. The most common prescribing-related incidents were incorrect frequency intervals, accidental omission, incorrect dose, or failing to meet prescribing standards. The most common administration-related incidents were doses being given too early, too late or missed. Four incidents were reported in the 5-month period post-ePMA (2 prescribing-related, 1 administration-related, 1 other). All prescribing- and administration-related incidents were deemed to have the potential to cause harm. One incident was due to incorrect frequency (first dose was given before arrival and prescriber had to manually calculate interval), one incident related to unintended doses prescribed and given (only benzylpenicillin was indicated), and one administration incident from poor documentation (dose given but not signed for). Compared with the same 5-month period in 2018 (pre-EPMA), 1 more incident had been reported this year compared to the previous year where only 3 incidents were reported.ConclusionThe introduction of ePMA may not reduce the number of reported incidents relating to gentamicin in neonates. A longer period of study is needed to evaluate the effects of transitioning from paper to ePMA. Our results suggest that ePMA can eliminate or reduce the risk of some types of errors, but can also make no difference to others, and can create new types of system-related errors, which can still have the potential to cause harm. This is consistent with the outcomes of a similar study in 2016 in another centre.2ReferencesNational Institute for Health and Care Excellence (NICE). Neonatal infection (early onset): antibiotics for prevention and treatment. Manchester: NICE; 2012.Kitson G. Implementation of an electronic prescription chart for gentamicin for neonatal units and postnatal wards. Arch Dis Child, 2016;101e2.

scholarly journals Changes in incidence and etiology of early-onset neonatal infections 1997–2017 – a retrospective cohort study in western Sweden

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Margrét Johansson Gudjónsdóttir ◽  
Anders Elfvin ◽  
Elisabet Hentz ◽  
Ingegerd Adlerberth ◽  
Ingemar Tessin ◽  
...  
Keyword(s):  
Early Onset ◽  
Antimicrobial Prophylaxis ◽  
List Type ◽  
Neonatal Infections ◽  
Group B Streptococci ◽  
Gram Negative ◽  
Live Births ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Group B

Abstract Background The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017. To identify changes in incidence, etiology and mortality and compare to previous studies from the same area starting from 1975. Methods Observational epidemiological, retrospective study on infants 0–6 days of age with a positive culture in blood and/or cerebrospinal fluid between 1997 and 2017. A comparison was made of the incidence between 2008 and 2017 compared to 1997–2007. Changes in the incidence of infections due to Group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods were assessed from 1975. Results The total incidence, including both recognized pathogens and commensals as causative agents, was 1.1/1000 live births. The incidence declined from 1.4/1000 LB in 1997–2007 to 0.9/1000 LB in 2008–2017 but the case-fatality rate remained unchanged, (8/119 vs 7/90), at 7%. Among the 209 patients identified during 1997–2017 with sepsis or meningitis the most common organisms were Group B streptococci (40%, 84/209), S. aureus (16%, 33/209) and E. coli (9%, 18/209). The incidence of Group B streptococci infections went from 0.9/1000 live births 1987–1996 to 0.45/1000 live births 1997–2017 and all cases were within 72 h. The proportion of extremely preterm infants (< 28 weeks gestation) rose steadily during the study period but there was no rise in infections due to Gram-negative organisms. The spectrum of cultured organisms changed after 72 h as commensal organisms started to emerge. Conclusion There has been a decrease in the incidence of neonatal early-onset infections compared to previous studies in western Sweden. The incidence of GBS infections was not as low as in other reports. Further studies are needed to assess if screening-based intra partum antimicrobial prophylaxis instead of a risk factor-based approach for identifying candidates for intrapartum antimicrobial prophylaxis would be a better option for this study area. Key notes This study is one of the longest running follow-ups in the world, a follow-up of 43 years of early-onset neonatal infections.The incidence of early-onset GBS infections is higher in Western Sweden compared to other local reports.No difference in the incidence of early-onset GBS depending on the definition of early-onset being within 72 h or 7 days of life.

scholarly journals A comparative study between dexmedetomidine and dexamethasone as an intrathecal adjuvant for prevention of perioperative shivering in cesarean section

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohamed Abdul Mohsen Abdul Naiem Ismaiel ◽  
Omar Mohamed Taha El Safty ◽  
Ashraf El Sayed El-Agamy ◽  
Omar Mohamed Zafer Mohamed ◽  
Mohamed Mourad Mohsen Mohamed Ali
Keyword(s):  
Cesarean Section ◽  
Statistical Difference ◽  
Sensory Block ◽  
List Type ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background One of the most common problems in parturients receiving regional anesthesia during cesarean section is shivering. It usually interferes with the readings of the oxygen plethysmography (SpO2) and electrocardiogram (ECG). It expands the needs for oxygen and increases creation of carbon dioxide about four folds. The aim of this work is to compare the efficacy of dexamethasone and dexmedetomidine in prevention of perioperative shivering when added to hyperbaric bupivacaine intrathecally in cesarean sections (CS) and their effect on the intraoperative hemodynamics, intensity of the block, sedation, and postoperative analgesic requirement. Results Study included 60 obstetric patients who fulfilled all the inclusion criteria and were randomized into 2 equal groups, each consisting of 30 patients, namely group A (dexmedetomidine group) and B (dexamethasone group). Group A patients received 5 μg dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. Group B patients received 8 mg dexamethasone then 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. The comparison included assessment of intra- and postoperative hemodynamics, duration of surgery, assessment of sensory and motor block, assessment for shivering and sedation, and assessment of adverse events. This study showed that there were a small number of patients complaining of shivering (five patients in group A and seven patients in group B) with no statistical difference between both groups in the incidence and intensity of shivering. Time to two segment regression (minutes) was longer in group B compared to group A, and also, time to first analgesic rescue was longer in group B compared to group A. For sedation intensity, there was statistical difference between both groups as all patients in group A were sedated compared to six patients only in group B. There was no statistical difference between both groups as regards incidence of adverse effects. Conclusion We concluded that both drugs can be added safely to bupivacaine, and both dexmedetomidine and dexamethasone decreased the incidence and the intensity of shivering. Dexamethasone was found to prolong the duration of sensory block and delay opioid requirements post-operatively, while dexmedetomidine is more effective in sedating the patients intra- and postoperatively.

scholarly journals To screen or not to screen women for Group B Streptococcus (Streptococcus agalactiae) to prevent early onset sepsis in newborns: recent advances in the unresolved debate

2020 ◽  
Vol 7 ◽  
pp. 204993612094242
Author(s):  
Guduru Gopal Rao ◽  
Priya Khanna
Keyword(s):  
Risk Factor ◽  
Antimicrobial Resistance ◽  
Low Income ◽  
Streptococcus Agalactiae ◽  
Early Onset ◽  
Group B Streptococcus ◽  
Developed Countries ◽  
Low Income Countries ◽  
Early Onset Sepsis ◽  
Group B

Streptococcus agalactiae, also known as Group B streptococcus (GBS) is the commonest cause of early onset sepsis in newborns in developed high-income countries. Intrapartum antimicrobial (antibiotic) prophylaxis (IAP) is recognized to be highly effective in preventing early onset Group B sepsis (EOGBS) in newborns. The key controversy is about the strategy that should be used to identify mothers who should receive IAP. There are two strategies that are followed in developed countries: screening-based or risk-factor-based identification of women requiring IAP. The debate regarding which of the two approaches is better has intensified in the recent years with concerns about antimicrobial resistance, effect on newborn’s microbiome and other adverse effects. In this review, we have discussed some of the key research papers published in the period 2015–2019 that have addressed the relative merits and disadvantages of screening versus risk-factor-based identification of women requiring IAP. Although screening-based IAP appears to be more efficacious than risk-based IAP, IAP-based prevention has several limitations including ineffectiveness in prevention of late-onset GBS infection in babies, premature and still births, impact of IAP on neonatal microbiota, emergence of antimicrobial resistance and difficulties in implementing IAP-based strategies in middle and low income countries. Alternative strategies, principally maternal immunization against GBS would circumvent use of IAP. However, no licensed vaccines are currently available for use.

Circulating levels of adiponectin and leptin at 23–25 weeks of pregnancy in women with impaired placentation and in those with established fetal growth restriction

2008 ◽  
Vol 115 (7) ◽  
pp. 219-224 ◽  
Author(s):  
Makrina D. Savvidou ◽  
Alexandros Sotiriadis ◽  
Christine Kaihura ◽  
Kypros H. Nicolaides ◽  
Naveed Sattar
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Maternal Plasma ◽  
Second Trimester ◽  
Plasma Adiponectin ◽  
Normal Outcome ◽  
Group A ◽  
Group B ◽  
Circulating Levels

Adiponectin and leptin, two adipose-tissue-derived proteins, have been reported to be elevated in women with established PE (pre-eclampsia). The aim of the present study was to investigate whether alterations in adiponectin and leptin levels predate the development of PE and FGR (fetal growth restriction) in women at increased risk of these complications, as assessed by Doppler examination of the uterine arteries during the second trimester of pregnancy. We also sought to investigate the circulating levels of adiponectin and leptin in women with established severe early-onset FGR. The study included three groups of pregnant women at 23–25 weeks: Group A (n=44) with normal uterine artery Doppler waveforms, Group B (n=49) with abnormal Doppler waveforms and normal fetal growth at the time of the examination, and Group C (n=15) with established severe FGR and abnormal Doppler waveforms. All women had plasma adiponectin and leptin measured by sensitive immunoassays. In Group B, 19 women had a normal outcome, 17 delivered infants with FGR and 13 developed PE. The women who developed PE delivered smaller babies earlier than women with a normal outcome (P<0.001). There were no significant differences in adiponectin levels between any of the groups (overall P=0.3). Leptin concentrations, expressed as MoM (multiples of the median) of Group A, were higher in women in Group C, i.e. established severe FGR at 2.5 (1.2–2.7) MoMs (overall P<0.001), compared with all of the other groups and subgroups. In conclusion, we found that, in pregnancies complicated by severe early-onset FGR, the maternal plasma concentration of leptin is twice as high as in normal pregnancies. However, the second trimester levels of maternal plasma adiponectin and leptin in pregnancies that subsequently develop PE and/or FGR are not significantly different from normal and, consequently, it is unlikely that these markers will be useful as predictors of these pregnancy complications.

The Use of Blood Counts and Blood Cultures to Screen Neonates Born to Partially Treated Group B Streptococcus-carrier Mothers for Early-onset Sepsis

2011 ◽  
Vol 30 (10) ◽  
pp. 840-843 ◽  
Author(s):  
Saar Hashavya ◽  
Shmuel Benenson ◽  
Zivanit Ergaz-Shaltiel ◽  
Benjamin Bar-Oz ◽  
Diana Averbuch ◽  
...  
Keyword(s):  
Early Onset ◽  
Group B Streptococcus ◽  
Treated Group ◽  
Blood Cultures ◽  
Early Onset Sepsis ◽  
Group B

Comparison of the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with NICE guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis

2020 ◽  
Vol 105 (6) ◽  
pp. 581-586
Author(s):  
Rachel Morris ◽  
Steve Jones ◽  
Sujoy Banerjee ◽  
Andrew Collinson ◽  
Hannah Hagan ◽  
...  
Keyword(s):  
Early Onset ◽  
Risk Calculator ◽  
Kaiser Permanente ◽  
Nice Guideline ◽  
Early Onset Sepsis ◽  
Nice Guidance ◽  
Sepsis Risk ◽  
Cerebrospinal Fluid Culture ◽  
Management Recommendations ◽  
Fluid Culture

ObjectiveTo compare the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with National Institute for Health and Care Excellence (NICE) guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis (EOS).DesignRetrospective multicentre study.SettingFive maternity services in South West of England and Wales.Patients70 infants with EOS (<72 hours) confirmed on blood or cerebrospinal fluid culture.MethodsRetrospective virtual application of NICE and SRC through review of maternal and neonatal notes.Main outcome measureThe number of infants recommended antibiotics by 4 hours of birth.ResultsThe incidence of EOS ≥34 weeks was 0.5/1000 live births. Within 4 hours of birth, antibiotics were recommended for 39 infants (55.7%) with NICE, compared with 27 (38.6%) with SRC. The 12 infants advised early treatment by NICE but not SRC remained well, only one showing transient mild symptoms after 4 hours. Another four babies received antibiotics by 4 hours outside NICE and SRC guidance. The remaining 27 infants (38.6%) received antibiotics when symptomatic after 4 hours. Only one infant who was unwell from birth, died. Eighty-one per cent of all EOS infants were treated for clinical reasons rather than for risk factors alone.ConclusionWhile both tools were poor in identifying EOS within 4 hours, NICE was superior to SRC in identifying asymptomatic cases. Currently, four out of five EOS have symptoms at first identification, the majority of whom present within 24 hours of birth. Antibiotic stewardship programmes using SRC should include enhanced observation for infants currently treated within NICE guidance.

Early-onset neonatal infections in Australia and New Zealand, 2002–2012

2018 ◽  
Vol 104 (3) ◽  
pp. F248-F252 ◽  
Author(s):  
Tarun Singh ◽  
Elizabeth H Barnes ◽  
David Isaacs
Keyword(s):  
New Zealand ◽  
Incidence Rate ◽  
Early Onset ◽  
Group B Streptococcus ◽  
E Coli ◽  
Live Births ◽  
Early Onset Sepsis ◽  
Group B ◽  
Almost All ◽  
Over Time

BackgroundThe epidemiology of early-onset neonatal sepsis (EONS) varies over time, and requires regular surveillance.ObjectiveTo analyse data on EONS in Australia and New Zealand.MethodsRetrospective analysis of data collected longitudinally from multiple neonatal units from 2002 to 2012.ResultsOf 386 423 live births, 454 infants had EONS. The incidence rate of EONS was 1.20 per 1000 live births in 2002 and 0.83 in 2012, decreasing by 4% per year (95% CI 1% to 7%, p=0.007). Group B streptococcus (GBS) (37%) and Escherichia coli (25%) were the most prevalent organisms. The early-onset GBS (EOGBS) incidence rate was 0.43/1000 live births, with no evidence of change over time (p=0.3). Of EOGBS-infected babies, 62% were born at term compared with 8% with early-onset E. coli sepsis, p<0.0001. The mortality of E. coli early-onset sepsis (EOS) (25%) was higher than GBS (11%), but this difference in mortality was no longer significant after adjusting for gestation and birth weight. Mortality from EOS fell significantly over the study period (17% per year, 95% CI 10 to 24, p<0.0001).ConclusionsGBS was the most common cause of early sepsis, but the incidence was lower than prior to the introduction of intrapartum antibiotic prophylaxis, and remained steady over time. The mortality of early-onset E. coli sepsis was significantly higher than GBS sepsis, but this may have been because almost all babies with E. coli were born preterm, rather than a difference in virulence.

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