The Impact of Late Onset Arterial Hypotension on Respiratory Outcome in Extremely Premature Infants

Abstract Background Group B Streptococcus (GBS) is the leading cause of invasive neonatal disease in the industrialized world. We aimed to genomically and phenotypically characterise invasive GBS isolates in Slovenia from 2001 to 2018 and contemporary colonising GBS isolates from screening cultures in 2018. Methods GBS isolates from 101 patients (invasive isolates) and 70 pregnant women (colonising isolates) were analysed. Basic clinical characteristics of the patients were collected from medical records. Antimicrobial susceptibility and phenotypic capsular serotype were determined. Whole-genome sequencing was performed to assign multilocus sequence types (STs), clonal complexes (CCs), pathogenicity/virulence factors, including capsular genotypes, and genome-based phylogeny. Results Among invasive neonatal disease patients, 42.6% (n = 43) were females, 41.5% (n = 39/94) were from preterm deliveries (< 37 weeks gestation), and 41.6% (n = 42) had early-onset disease (EOD). All isolates were susceptible to benzylpenicillin with low minimum inhibitory concentrations (MICs; ≤0.125 mg/L). Overall, 7 serotypes were identified (Ia, Ib, II-V and VIII); serotype III being the most prevalent (59.6%). Twenty-eight MLST STs were detected that clustered into 6 CCs. CC-17 was the most common CC overall (53.2%), as well as among invasive (67.3%) and non-invasive (32.9%) isolates (p < 0.001). CC-17 was more common among patients with late-onset disease (LOD) (81.4%) compared to EOD (47.6%) (p < 0.001). The prevalence of other CCs was 12.9% (CC-23), 11.1% (CC-12), 10.5% (CC-1), 8.2% (CC-19), and 1.8% (CC-498). Of all isolates, 2.3% were singletons. Conclusions A high prevalence of hypervirulent CC-17 isolates, with low genomic diversity and characteristic profile of pathogenicity/virulence factors, was detected among invasive neonatal and colonising GBS isolates from pregnant women in Slovenia. This is the first genomic characterisation of GBS isolates in Slovenia and provides valuable microbiological and genomic baseline data regarding the invasive and colonising GBS population nationally. Continuous genomic surveillance of GBS infections is crucial to analyse the impact of IND prevention strategies on the population structure of GBS locally, nationally, and internationally.

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The Mortality of Extremely Premature Infants and the Impact on the Overall Neonatal Mortality Rate [20C]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000483369.56863.f0 ◽

2016 ◽

Vol 127 ◽

pp. 31S

Author(s):

Horatio S. Falciglia ◽

William K. Brady ◽

Ronald Merkel ◽

Vickie Glover ◽

Angela N. Fellner

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Premature Infants ◽

Neonatal Mortality Rate ◽

The Impact

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The Impact of Vaginal Delivery in Premature Infants Weighing Less Than 1,251 Grams

Obstetrics and Gynecology ◽

10.1097/01.aog.0000177745.51638.d3 ◽

2005 ◽

Vol 106 (3) ◽

pp. 641 ◽

Cited By ~ 4

Author(s):

Anwar H. Nassar ◽

Elie M. Hobeika ◽

Ihab M. Usta

Keyword(s):

Vaginal Delivery ◽

Premature Infants ◽

The Impact

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Multidisciplinary management of patients with pubic osteomyelitis, a rare but serious complication after surgery and radiation therapy for advanced gynaecological cancer

BMJ Case Reports ◽

10.1136/bcr-2020-236289 ◽

2021 ◽

Vol 14 (1) ◽

pp. e236289

Author(s):

Ilse Haveman ◽

Anne M van Altena ◽

Charlotte PA Verschuren ◽

Johanna WM Aarts

Keyword(s):

Radiation Therapy ◽

Multidisciplinary Approach ◽

Late Onset ◽

Wound Dehiscence ◽

Vulvar Pain ◽

Vaginal Carcinoma ◽

Pelvic Area ◽

The Impact

Pubic osteomyelitis is a rare and often late-onset complication of radiation therapy and surgery for vulvar and vaginal carcinoma. It typically presents with vulvar pain, fever, vaginal discharge and/or gait disorders. Pubic osteomyelitis is often accompanied by fistulas or wound dehiscence in the pelvic area. Its accurate diagnosis and treatment are challenging and require a multidisciplinary team effort. In our patients, multiple combined surgical procedures, long-term antibiotic treatment and days to weeks of hospital admission were necessary to treat pubic osteomyelitis. We emphasise the importance of timely and adequate diagnosis and multidisciplinary approach resulting in a course of treatment that is as effective as possible, limiting the impact on quality of life, which is generally high in this group of patients.

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The impact of music therapy in late-moderate premature infants, on their parents and their environment, in a Spanish neonatal intermediate care unit.

Music and Medicine ◽

10.47513/mmd.v13i4.764 ◽

2021 ◽

Vol 13 (4) ◽

Author(s):

María Jáñez ◽

María Jesús Del Olmo ◽

Cintia Rodríguez

Keyword(s):

Music Therapy ◽

Premature Infants ◽

Therapy Session ◽

Environmental Response ◽

Positive Interaction ◽

Activation Level ◽

Live Music ◽

Quasi Experimental ◽

The Impact ◽

Reducing Stress

The aim of this study is to determine whether a live music therapy session during parent holding had an effect on physiological and comfort outcomes of late-moderate preterm infants, on their parents, and on the ward environment. This is a quasi-experimental study of a cohort of 44 preterm / adult pairs exposed to a music therapy session in the first two weeks after birth. There were 3 moments of observation (before, during, and after the intervention), at which heart rate (HR), oxygen saturation (O2-sat), the infant’s behavioral-emotional activation level, and the environmental response were measured. A statistically significant increase was observed in O2-sat (p<.001) after the intervention, as well as a decrease in HR (p<.001). Personal and environmental stress was observed to decrease (p<.001). A music therapy session in the Neonatal Unit at the time of interaction between parents and premature infants was found to be useful in reducing stress and promoted a positive interaction between parents and infants.

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Tocopherol Efficacy and Safety for Preventing Retinopathy of Prematurity: A Randomized, Controlled, Double-Masked Trial

PEDIATRICS ◽

10.1542/peds.79.4.489 ◽

1987 ◽

Vol 79 (4) ◽

pp. 489-500 ◽

Cited By ~ 1

Author(s):

Dale L. Phelps ◽

Arthur L. Rosenbaum ◽

Sherwin J. lsenberg ◽

Rosemary D. Leake ◽

Frederick J. Dorey

Keyword(s):

Premature Infants ◽

Retinopathy Of Prematurity ◽

Plasma Levels ◽

Late Onset ◽

Retinal Hemorrhage ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Late Onset Sepsis ◽

Prospective Monitoring

To test the efficacy and safety of vitamin E in preventing retinopathy of prematurity, 287 infants with birth weights of less than 1.5 kg or gestational ages of less than 33 weeks were enrolled within 24 hours of birth in a randomized, double-masked trial of IV, followed by oral, placebo v tocopherol (adjusted to plasma levels of 3 to 3.5 mg/dL). In the 196 infants completing ophthalmic follow-up, tocopherol did not prevent retinopathy of prematurity of any stage (28% placebo treated v 26% tocopherol treated) or moderately severe retinopathy of prematurity (8% placebo treated v 11% tocopherol treated). Cicatricial sequelae were not significantly different (1/97 placebo treated v 3/99 tocopherol treated), with one placebo-treated infant and one tocopherol-treated infant having retinal detachments. Among all 232 infants examined, those treated with tocopherol had more retinal hemorrhage than placebo-treated infants (8/121 placebo treated v 16/111 tocopherol treated), and retinal hemorrhage correlated positively (P < .01) with plasma levels of tocopherol after the first 2 weeks of age. Prospective monitoring of morbidity including late-onset sepsis, necrotizing enterocolitis, etc revealed no differences between groups except that grades 3 and 4 intraventricular hemorrhage occurred more frequently in infants weighing less than 1 kg at birth who had received tocopherol (14/42, 33%) v those who had received placebo (4/43, 9%) (P < .02). Our data do not support the use of tocopherol for prophylaxis against retinopathy of prematurity in premature infants and suggest that IV tocopherol treatment starting on day 1 may increase the incidence of hemorrhagic complications of prematurity, particularly in infants with birth weights of less than 1 kg.

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Optimized Detection of Central Apneas Preceding Late-Onset Sepsis in Premature Infants

10.1109/embc46164.2021.9629528 ◽

2021 ◽

Author(s):

Gabriele Varisco ◽

Deedee Kommers ◽

Xi Long ◽

Zhuozhao Zhan ◽

Marina M. Nano ◽

...

Keyword(s):

Premature Infants ◽

Late Onset ◽

Late Onset Sepsis ◽

Central Apneas

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The prognostic impact of RAS on overall survival following liver resection in early versus late-onset colorectal cancer patients

British Journal of Cancer ◽

10.1038/s41416-020-01169-w ◽

2020 ◽

Author(s):

Alexandre A. Jácome ◽

Timothy J. Vreeland ◽

Benny Johnson ◽

Yoshikuni Kawaguchi ◽

Steven H. Wei ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Liver Resection ◽

Age Of Onset ◽

Negative Impact ◽

Late Onset ◽

Linear Regression Analysis ◽

Multidisciplinary Treatment ◽

Prognostic Impact ◽

The Impact

Abstract Background The impact of molecular aberrations on survival after resection of colorectal liver metastases (CLM) in patients with early-age-onset (EOCRC) versus late-age-onset colorectal cancer (LOCRC) is unknown. Methods Patients who underwent liver resection for CLM with known RAS, BRAF and MSI status were retrospectively studied. The prognostic impact of RAS mutations by age was analysed with age as a categorical variable and a continuous variable. Results The study included 573 patients, 192 with EOCRC and 381 with LOCRC. The younger the age of onset of CRC, the greater the negative impact on overall survival of RAS mutations in the LOCRC, EOCRC, and ≤40 years (hazard ratio (HR), 1.64 (95% confidence interval (CI), 1.23–2.20), 2.03 (95% CI, 1.30–3.17), and 2.97 (95% CI, 1.44–6.14), respectively. Age-specific mortality risk and linear regression analysis also demonstrated that RAS mutations had a greater impact on survival in EOCRC than in LOCRC (slope: −4.07, 95% CI −8.10 to 0.04, P = 0.047, R2 = 0.08). Conclusion Among patients undergoing CLM resection, RAS mutations have a greater negative influence on survival in patients with EOCRC, more so in patients ≤40 years, than in patients with LOCRC and should be considered as a prognostic factor in multidisciplinary treatment planning.

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Early Tracheostomy Is Associated With Shorter Ventilation Time and Duration of ICU Stay in Patients With Myasthenic Crisis—A Multicenter Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066620967646 ◽

2020 ◽

pp. 088506662096764

Author(s):

Klemens Angstwurm ◽

Amelie Vidal ◽

Henning Stetefeld ◽

Christian Dohmen ◽

Philipp Mergenthaler ◽

...

Keyword(s):

Myasthenia Gravis ◽

Late Onset ◽

Retrospective Chart Review ◽

Health Condition ◽

Myasthenic Crisis ◽

Early Tracheostomy ◽

Ventilation Time ◽

Data Rates ◽

Multicenter Analysis ◽

The Impact

Background: Myasthenic crisis (MC) requiring mechanical ventilation (MV) is a rare and serious complication of myasthenia gravis. Here we analyzed the frequency of performed tracheostomies, risk factors correlating with a tracheostomy, as well as the impact of an early tracheostomy on ventilation time and ICU length of stay (LOS) in MC. Methods: Retrospective chart review on patients treated for MC in 12 German neurological departments between 2006 and 2015 to assess demographic/diagnostic data, rates and timing of tracheostomy and outcome. Results: In 107 out of 215 MC (49.8%), a tracheostomy was performed. Patients without tracheostomy were more likely to have an early-onset myasthenia gravis (27 [25.2%] vs 12 [11.5%], p = 0.01). Patients receiving a tracheostomy, however, were more frequently suffering from multiple comorbidities (20 [18.7%] vs 9 [8.3%], p = 0.03) and also the ventilation time (34.4 days ± 27.7 versus 7.9 ± 7.8, p < 0.0001) and ICU-LOS (34.8 days ± 25.5 versus 12.1 ± 8.0, p < 0.0001) was significantly longer than in non-tracheostomized patients. Demographics and characteristics of the course of the disease up to the crisis were not significantly different between patients with an early (within 10 days) compared to a late tracheostomy. However, an early tracheostomy correlated with a shorter duration of MV at ICU (26.2 days ± 18.1 versus 42.0 ± 33.1, p = 0.006), and ICU-LOS (26.2 days ± 14.6 versus 42.3 ± 33.0, p = 0.003). Conclusion: Half of the ventilated patients with MC required a tracheostomy. Poorer health condition before the crisis and late-onset MG were associated with a tracheostomy. An early tracheostomy (≤ day 10), however, was associated with a shorter duration of MV and ICU-LOS by 2 weeks.

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