scholarly journals Advances in the Treatment of Mycoses in Pediatric Patients

2018 ◽  
Vol 4 (4) ◽  
pp. 115 ◽  
Author(s):  
Elias Iosifidis ◽  
Savvas Papachristou ◽  
Emmanuel Roilides
Keyword(s):  
Antifungal Therapy ◽  
Invasive Candidiasis ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Empiric Therapy ◽  
Antifungal Prophylaxis ◽  
Neonatal Intensive Care Units ◽  
First Line ◽  
Fluconazole Resistance ◽  
High Incidence

The main indications for antifungal drug administration in pediatrics are reviewed as well as an update of the data of antifungal agents and antifungal policies performed. Specifically, antifungal therapy in three main areas is updated as follows: a) Prophylaxis of premature neonates against invasive candidiasis; b) management of candidemia and meningoencephalitis in neonates; and c) prophylaxis, empiric therapy, and targeted antifungal therapy in children with primary or secondary immunodeficiencies. Fluconazole remains the most frequent antifungal prophylactic agent given to high-risk neonates and children. However, the emergence of fluconazole resistance, particularly in non-albicans Candida species, should be considered during preventive or empiric therapy. In very-low birth-weight neonates, although fluconazole is used as antifungal prophylaxis in neonatal intensive care units (NICU’s) with relatively high incidence of invasive candidiasis (IC), its role is under continuous debate. Amphotericin B, primarily in its liposomal formulation, remains the mainstay of therapy for treating neonatal and pediatric yeast and mold infections. Voriconazole is indicated for mold infections except for mucormycosis in children >2 years. Newer triazoles-such as posaconazole and isavuconazole-as well as echinocandins, are either licensed or under study for first-line or salvage therapy, whereas combination therapy is kept for refractory cases.

Fungal infections in neonates

2017 ◽  
Author(s):  
Adilia Warris
Keyword(s):  
Invasive Candidiasis ◽  
Neonatal Intensive Care ◽  
Fungal Infections ◽  
Invasive Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Extremely Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants ◽  
Optimal Dosing ◽  
Neurodevelopmental Impairment

Fungal infections in the neonatal population are caused predominantly by Candida species and invasive fungal disease mainly affects extremely low birth weight infants. The vast majority of Candida infections are due to C. albicans and C. parapsilosis, while the more fluconazole-resistant Candida species are only sporadically observed. Invasive candidiasis typically occurs during the first month of life and presents with non-specific signs of sepsis. Despite antifungal treatment, 20% of neonates developing invasive candidiasis die and neurodevelopmental impairment occurs in nearly 60% of survivors. Antifungal prophylaxis reduces the incidence in neonatal intensive care units with high rates of invasive candidiasis (>10%). Amphotericin B, fluconazole, micafungin, and caspofungin can be used to treat neonatal candidiasis, although optimal dosing for fluconazole and the two echinocandins has not yet been established.

Device-associated pneumonia of very low birth weight infants in Polish Neonatal Intensive Care Units

2016 ◽  
Vol 61 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Jadwiga Wójkowska-Mach ◽  
T. Allen Merritt ◽  
Maria Borszewska-Kornacka ◽  
Joanna Domańska ◽  
Ewa Gulczyńska ◽  
...  
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants

Unsuspected Hyperosmolality of Oral Solutions Contributing to Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants

PEDIATRICS ◽  
1977 ◽  
Vol 60 (4) ◽  
pp. 535-538
Author(s):  
DIANA M. WILLIS ◽  
JOANN CHABOT ◽  
INGEBORG C. RADDE ◽  
GRAHAM W. CHANCE
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants ◽  
Umbilical Vessel ◽  
Causative Factors ◽  
Nutritional Studies

In recent years necrotizing enterocolitis (NEC) has become a major problem in neonatal intensive care units. Recent incidences as high as 8% in all infants with a birth weight less than 2.5 kg and 14% in those with a birth weight less than 1.5 kg have been reported from one center.1Despite intensive searches for possible causative factors, no definite entity has been identified, but asphyxia,2 circulatory changes associated with exchange transfusion,3 umbilical vessel catheterization,4 immature immune status,5infection,6-8 and hypertonic feedings9 have all been implicated. In the course of a series of nutritional studies involving thriving very-low-birth-weight infants we

Fluid and Electrolyte Problems of Infants of Very Low Birth Weight

1992 ◽  
Vol 3 (3) ◽  
pp. 698-704
Author(s):  
Shyang-Yun Pamela Shiao
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Fundamental Problem ◽  
Neonatal Intensive Care Units ◽  
Fluid Restriction ◽  
Electrolyte Balance ◽  
Complex Phenomenon ◽  
Survival Status

Advances in providing care for infants of very low birth weight have improved their survival status. Because the fundamental problem for these infants is physical immaturity, the balance of fluids and electrolytes is a complex phenomenon to assess and manage. In managing the major problems of fluid and electrolyte balance for these infants, the controversy of fluid restriction versus fluid replenishment has persisted to the present. Thus, the challenge of managing fluid and electrolyte therapy remains to be conquered in the next decade, providing chances for nurses’ to expand their role in neonatal intensive care units. They will become more involved and will take on supervisory roles in managing the fluid and electrolyte balance of these infants

Empiric Antifungal Therapy with Amphotericin B in the Era of Fluconazole Prophylaxis: a Cohort Study in Adults with Acute Myeloid Leukemia Treated within An Institutional Antifungal Policy.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1390-1390
Author(s):  
Anita Adams ◽  
Tamana Hafid ◽  
Kari Kolm ◽  
Jolanta Jeziorowska ◽  
Deborah C Marcellus ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Fungal Infection ◽  
Amphotericin B ◽  
Induction Chemotherapy ◽  
Antifungal Therapy ◽  
Empiric Therapy ◽  
Best Supportive Care ◽  
Antifungal Prophylaxis ◽  
Second Line ◽  
Fluconazole Prophylaxis

Abstract Abstract 1390 Poster Board I-412 Purpose: To determine whether fluconazole prophylaxis was effective in decreasing the need for parenteral empiric antifungal therapy in patients with acute myeloid leukemia (AML) and persistent febrile neutropenia or suspected fungal infection at our center. Background: Prophylaxis with fluconazole in patients with severe chemotherapy-related neutropenia has been found to be beneficial in decreasing the need for parenteral antifungal therapy, and preventing superficial and invasive fungal infections and fungal infection-related mortality (Bow et al., Cancer 2002;94:3230-3246). Methods: The records of all patients at our hospital who presented with AML from January 1999 to July 2009 were reviewed retrospectively. As of September 2005 we adopted an institutional antifungal policy consisting of routine antifungal prophylaxis with fluconazole followed by amphotericin B as the first line parenteral agent in the event of persistent fever despite broad spectrum antibiotics or suspected fungal infection. The policy included criteria for switching from amphotericin B to a second line agent (caspofungin) for continued empiric therapy or another agent depending on clinical or laboratory data or suspicion of a particular pathogen. Explicit criteria were also developed for switching to a second line agent including baseline renal function or change in renal function while receiving amphotericin B or other adverse effects such as significant infusion reactions or electrolyte disturbances. Fluconazole was given at a dose of 400 mg daily starting with induction chemotherapy and continued until blood count recovery or switch to parenteral antifungal agent. Results: We identified a total of 170 patients with a median age of 61 years (range 18-89 years), 53 % were female and the median follow-up time was 187 days (range 2-2549 days). Baseline cytogenetics grouped patients into poor risk (40%), standard risk (39%) and favorable risk (10%) categories, with 11% unknown or inconclusive. Two-thirds of patients had de-novo AML. Twenty-four percent of patients did not receive induction chemotherapy and were treated with best supportive care, leaving 130 patients who received induction chemotherapy. Overall median survival for chemotherapy treated patients was 409 days, compared with 44 days for patients treated with best supportive care. The majority of patients (77%) who received chemotherapy were treated with standard induction consisting of 3 days of an anthracycline and 7-10 days of continuous infusion cytarabine. Of the patients treated with induction chemotherapy, 65% received prophylaxis with fluconazole and 32% did not, the remainder received prophylaxis with other antifungal agents. The use of prophylactic fluconazole coincided with implementation of our antifungal policy. Of patients who were treated with fluconazole prophylaxis, 62% required parenteral antifungal therapy and 38% did not. Of patients who did not receive fluconazole prophylaxis 56% required parenteral antifungals and 44% did not. These differences relating to receiving fluconazole prophylaxis were not statistically significantly different. For those patients requiring empiric antifungal therapy, they received a median of 18 days of fluconazole (range 3-156 days). Of the 56 patients who were treated with amphotericin B as empiric therapy, 59% were changed to another agent due to renal effects (42%), fever (27%) or other adverse effects (21%). Switching off amphotericin B occurred after a median of 7.5 days (range 0-59 days). Fifty-six percent of patients received caspofungin as the second line agent while the policy was in effect. Conclusion: Based on our retrospective analysis of the practical use of antifungal prophylaxis within our institutional antifungal policy, fluconazole prophylaxis did not decrease the need for empiric parenteral antifungal therapy. The majority of patients treated with empiric amphotericin B were switched to a second line agent, mostly due to intolerance or adverse effects. Disclosures: No relevant conflicts of interest to declare.

Holding the Very Low Birth Weight Infant: Skin-to-Skin Techniques

2005 ◽  
Vol 24 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Theresa Kledzik
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infant ◽  
Skin To Skin

Skin-to-skin holding has been reported as a valuable intervention for preterm infants for over a decade. However, many neonatal intensive care units are not practicing this therapy and cite lack of protocols and techniques as a barrier. This article describes in detail the nursing considerations and techniques involved to successfully implement skin-to-skin holding for very low birth weight, technology-dependent infants. NICU protocols can be derived from this article.

scholarly journals Critérios clínicos e insumos utilizados no banho de recém-nascidos pré-termo de muito baixo peso

2020 ◽  
Vol 11 (2) ◽  
Author(s):  
Samara Cecilia Sabino Pereira Da silva ◽  
Elizandra Cassia Da Silva Oliveira ◽  
Ana Virginia Rodrigues Verissimo ◽  
Katia Maria Mendes ◽  
Regina Celia De Oliveira
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Tap Water ◽  
Neonatal Intensive Care Units ◽  
Clinical Criteria ◽  
Terapia Intensiva

Objetivo: identificar os critérios clínicos e insumos utilizados para a administração do primeiro banho em recém-nascido prematuro de muito baixo peso internado em unidades de terapia intensiva neonatal.Métodos: estudo descritivo, com abordagem quantitativa. Com base no Método Canguru/Ministério da saúde, realizado em cinco unidades de terapia intensiva neonatal; população composta por 82 profissionais da equipe de enfermagem. Resultados: os critérios clínicos não apontados na avaliação foram 19,5% para a saturação de oxigênio, 23,2% frequência cardíaca e 29,3% frequência respiratória. Os insumos utilizados na realização do primeiro banho: água de torneira aquecida 56,1%, com controle bacteriológico 52,4%, sabão líquido 89,0%, com pH neutro em 76,8%. Conclusão: a não observância dos sinais clínicos e os insumos inadequados para a realização do banho do recém-nascido prematuro de muito baixo peso pode colocar em risco a segurança do paciente; emergindo adequações para fortalecimento da prática clínica da enfermagem.Descritores: Recém-Nascido de Muito Baixo Peso; Unidades de Terapia Intensiva Neonatal; Enfermagem Neonatal; Banhos. Objective: To identify the clinical criteria and inputs used for the administration of the first bath in a very low birth weight premature newborns in neonatal intensive care units. Methods: descriptive study, with a quantitative approach based on the Kangaroo/Ministry of Health Method, carried out in five neonatal intensive care units; population composed of 82 professionals from the nursing team. Results: The clinical criteria not mentioned in the evaluation were 19.5% for oxygen saturation, 23.2% heart rate and 29.3% respiratory rate. The inputs used in the first bath: heated tap water (56.1%), with bacteriological control (52.4%), liquid soap (89.0%), with neutral pH (76.8%). Conclusion: Failure to observe clinical signs and inadequate supplies for bathing the very low birth weight premature newborn can put patient safety at risk; emerging adaptations to strengthen clinical nursing practice.Descriptors: Infant, Very Low Weight; Neonatal Intensive Care Units; Neonatal Nursing; Baths. Objetivo: Identificar los criterios clínicos y los insumos utilizados para la administración del primer baño en recién nacidos prematuros de muy bajo peso al nacer en unidades de cuidados intensivos neonatales. Métodos: Estudio descriptivo, con enfoque cuantitativo, basado en el Método Canguro/Ministerio de Salud, realizado en cinco unidades de cuidados intensivos neonatales; población compuesta por 82 profesionales del equipo de enfermería. Resultados: Los criterios clínicos no mencionados en la evaluación fueron 19.5% para la saturación de oxígeno, 23.2% de frecuencia cardíaca y 29.3% de frecuencia respiratoria. Los insumos utilizados en el primer baño: agua caliente del grifo (56.1%), con control bacteriológico (52.4%), jabón líquido (89.0%), con pH neutro (76.8%). Conclusión: El incumplimiento de los signos clínicos y los suministros inadecuados para bañar al recién nacido prematuro de muy bajo peso pueden poner en riesgo la seguridad del paciente; adaptaciones emergentes para fortalecer la práctica clínica de enfermería.Descriptores: Infantil, Muy Bajo Peso; Unidades de Cuidados Intensivos Neonatales; Enfermería Neonatal; Baños.

scholarly journals Case report of COVID-19 positive new born with necrotizing enterocolitis (NEC)

2021 ◽  
Vol 8 (8) ◽  
pp. 1442
Author(s):  
Rajshree Rajurkar ◽  
Chanda Dangi ◽  
Gunjan Kela
Keyword(s):  
Case Report ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Case Reports ◽  
High Incidence ◽  
Preterm Babies ◽  
Bowel Rest ◽  
Severity Of The Disease ◽  
Immune Defences

COVID-19 caused by SARS-Cov-2 virus has spread rapidly across the world. Children are just as like as adult to become infected with virus but have lesser symptoms and less severity of the disease. Necrotizing enterocolitis is one of the common gastrointestinal emergencies in neonatal intensive care unit. More than 85% of cases of NEC occur among preterm and very low birth weight. Preterm babies are vulnerable to develop NEC because of high incidence of perinatal distress factor, stasis of gut due to autonomic immaturity, poor barrier function of gut or immune defences, lack of feeding with human milk and higher incidence of nosocomial infections. During the current COVID-19 pandemic, no similar finding has been reported in the neonatal population to date. In this review we summarize the case report of two newborns admitted in our NICU who were COVID 19 positive presented to us with symptoms suggestive of necrotizing enterocolitis (NEC) and their outcome based on presence of comorbidity. Our case reports two case of two COVID-19 positive newborns admitted in our NICU with history, examination and investigations suggestive of necrotizing enterocolitis. Early initiation of antibiotics covering bowel flora, bowel rest and resuscitation, similar to our tried and true medical management of NEC, should be considered for initial management to avoid surgical intervention

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