scholarly journals Chorioamnionitis and Neonates; Which Strategy?

2020 ◽  
Vol 23 (7) ◽  
pp. 480-487
Author(s):  
Seyyed-Abolfazl Afjeh ◽  
Mohammad Kazem Sabzehei ◽  
Roxana Mansor Ghanaie ◽  
Mahdiyeh Karimizadeh ◽  
Ahmad Reza Shamshiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Length Of Stay ◽  
Neonatal Intensive Care ◽  
Clinical Findings ◽  
Negative Blood Culture ◽  
Early Onset Sepsis ◽  
New Guidelines ◽  
Culture Positive

Background: Chorioamnionitis (CAM) is one of the major risk factors for neonatal early-onset sepsis (EOS). Different international guidelines have been developed for diagnosis and care of such neonates. This research aimed to evaluate our neonates and compare them with the guidelines. Methods: This prospective cohort study was conducted during five years (March 2012 to March 2017), and comprised of neonates (any gestational age) born to mothers with CAM (any criteria). The neonates’ clinical findings and interventions were collected and analyzed. Results: In total, out of 28,988 live born neonates, CAM was found in mothers of 169 neonates (1.7%). Among the studied neonates, 30.8% were born ≤34 week of gestation, 39% had birth weight <2500 g, and 58.6% were asymptomatic. Out of 99 asymptomatic neonates, 47 were observed near mothers and 52 admitted to the neonatal intensive care unit (NICU). The frequency of abnormal tests was 23.07% in asymptomatic vs. 35.7% in symptomatic neonates; three neonates developed culture positive EOS (2.75%) and 68.05% of the neonates received antibiotics. The length of stay was 2.59 ± 1.13 (median = 2.00, IQR = 1.00) days in asymptomatic vs. 15.15 ± 13.67 (median = 7.00, IQR = 15.25) days in symptomatic neonates (P<0.001). Conclusion: The use of guidelines increased the length of stay, lab tests, and antibiotics in asymptomatic and neonates with negative blood culture. In addition to the mother-neonate separation, these guidelines may increase nosocomial infection, antibiotic resistance, and costs; therefore, new guidelines are needed to be developed.

Early Antibiotic Exposure in Low-Risk Late Preterm and Term Infants

2021 ◽  
Author(s):  
Kelley M. Sonney ◽  
Michael G. Guindon ◽  
James K. Aden ◽  
Caitlin M. Drumm
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Late Preterm ◽  
Antibiotic Exposure ◽  
Term Infants ◽  
Significant Percentage ◽  
Early Onset Sepsis ◽  
Key Points

Objective This study aimed to examine the epidemiology of antibiotic exposure and early onset sepsis (EOS) in late preterm and term infants born via cesarean section with rupture of membranes less than 10 minutes. Study design Retrospective review of 1,187 late preterm and term infants born at Brooke Army Medical Center between January 1, 2012 and August 29, 2019. Subjects were assessed for factors related to antibiotic treatment. Statistical analysis was performed to compare infants treated with antibiotics versus observation. Result An early blood culture was obtained from 234 (19.7%) infants; 170 (14.3%) were treated with antibiotics. Infants treated with antibiotics were significantly younger (p < 0.0001), smaller (p < 0.0001), more often diagnosed with respiratory distress (p < 0.0001), and were more frequently admitted to the neonatal intensive care unit (p < 0.0001). There were no cases of culture proven EOS. Conclusion Although this population lacks risk factors for the development of EOS, a significant percentage was treated with antibiotics. This population may benefit from future antibiotic stewardship efforts. Key Points

An Outbreak of Influenza A in a Neonatal Intensive Care Unit

2000 ◽  
Vol 21 (7) ◽  
pp. 449-454 ◽  
Author(s):  
Robert J. Cunney ◽  
Anne Bialachowski ◽  
Diane Thornley ◽  
Fiona M. Smaill ◽  
Ross A. Pennie
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Influenza A ◽  
Neonatal Intensive Care ◽  
Twin Pregnancy ◽  
Multiple Logistic Regression Analysis

Objectives:Investigation of an outbreak of influenza A in a neonatal intensive care unit (NICU) with examination of risk factors for infection and outcomes.Design:Retrospective cohort study of infants admitted to the unit during the outbreak period. Prospective survey of NICU staff and mothers of infants in the cohort study.Setting:Level III nursery in a university-affiliated tertiary referral center.Results:Nineteen infants in the NICU were infected with influenza A. There were six symptomatic cases and one death who had evidence of virus-associated hemophagocytic syndrome at autopsy. Amantadine prophylaxis was offered to the NICU staff, and amantadine therapy was given to five of the six symptomatic infants. Mechanical ventilation, gestational age, birth weight, Clinical Risk Index for Babies score, and twin pregnancy were associated with acquisition of influenza A on univariate analysis. Mechanical ventilation (odds ratio [OR], 6.2;P=.02) and twin pregnancy (OR, 7.0;P=.04) remained as significant risk factors for infection on multiple logistic regression analysis. Only 15% of respondents to the NICU staff survey were vaccinated against influenza. There was no association between a history of an influenza-like illness during pregnancy and acquisition of influenza A by infants of mothers who responded to the maternal survey (OR, 0.91;P=1.0).Conclusions:Influenza A is an important pathogen in the neonatal population and is readily transmissible in the NICU setting.

scholarly journals Comparision of Clinical and Laboratory Parameters in Culture Proven and Unproven Early Onset Sepsis in NICU

2015 ◽  
Vol 11 (4) ◽  
pp. 310-314 ◽  
Author(s):  
S Shrestha ◽  
S Dhongol Singh ◽  
NC Shrestha ◽  
RPB Shrestha ◽  
SK Madhup
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Laboratory Test ◽  
Neonatal Intensive Care Unit ◽  
Early Onset ◽  
Neonatal Intensive Care ◽  
Study Groups ◽  
Early Onset Sepsis ◽  
Culture Positive

Backgroud Early onset sepsis remains a major cause for neonatal morbidity and mortality.Objectives The aim of this study was to describe and compare the clinical and laboratory characteristics of neonates in neonatal intensive care unit with culture positive and negative early onset sepsis and verify if there were any differences between the groups.Methods A one year comparative prospective study was conducted from January 2011 to January 2012 in neonatal intensive care unit (NICU), Dhulikhel Hospital, Kathmandu University Hospital (KUH).Results Out of 215 cases of suspected neonatal sepsis, 192 (89.30%) cases of early onset sepsis were admitted in neonatal intensive care unit. Out of which 82 cases (42.7%) had blood culture positive and 110( 57.3%) had culture negative but compatible with features of clinical sepsis. There were no cases of culture proven meningitis and urinary tract infections.The clinical characteristic did not show any statistical differences between the study groups except for seizure which was found to be high in culture positive cases (p= 0.041). The hospital stay in neonatal intensive care unit was significantly longer (p=0.02) in culture positive cases. As for the laboratory test there were no differences found between the two study groups except cases of meningitis was more in culture proven early onset sepsis (p=0.00). The overall mortality in early onset sepsis was 36.95%. The higher mortality of 64.7% was seen in culture positive cases but statistically not significant.Conclusion Clinical manifestation and laboratory test were insufficient to distinguish between neonatal infection with blood culture positive and negative sepsis, hence both culture positive and negative cases should be treated promptly and equally.Kathmandu Univ Med J 2013; 11(4): 310-314

scholarly journals Incidence of local complications and risk factors associated with peripheral intravenous catheter in neonates

2016 ◽  
Vol 50 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Mitzy Tannia Reichembach Danski ◽  
Priscila Mingorance ◽  
Derdried Athanasio Johann ◽  
Stela Adami Vayego ◽  
Jolline Lind
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Neonatal Intensive Care ◽  
Intermittent Infusion ◽  
High Rate ◽  
Intravenous Catheter ◽  
Factors Associated ◽  
Peripheral Intravenous Catheter ◽  
Associated Risk Factors

Abstract OBJECTIVE To evaluate the incidence of complications related to the use of peripheral intravenous catheter in neonates and identify the associated risk factors. METHOD Prospective cohort study conducted in a Neonatal Intensive Care Unit. Participants were the hospitalized neonates undergoing peripheral intravenous puncture in the period from February to June 2013. RESULTS The incidence of complications was 63.15%, being infiltration/extravasation (69.89%), phlebitis (17.84%) and obstruction (12.27%). The risk factors were the presence of infection (p = 0.0192) and weight at the puncture day (p = 0.0093), type of intermittent infusion associated with continuous infusion (p <0.0001), endotracheal intubation (p = 0.0008), infusion of basic plan (p = 0.0027), total parenteral nutrition (P = 0.0002), blood transfusion associated with other infusions (p = 0.0003) and other drugs (p = 0.0004). Higher risk of developing complications in the first 48 hours after puncture. CONCLUSION A high rate of complications related to the use of peripheral intravenous catheter, and risk factors associated with infection, weight, drugs and infused solutions, and type of infusion.

scholarly journals 1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S713-S713
Author(s):  
Carlo Fopiano Palacios ◽  
Eric Lemmon ◽  
James Campbell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Linear Regression ◽  
Length Of Stay ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
P Value ◽  
Fisher Exact Test ◽  
The Mean ◽  
Pcr Test

Abstract Background Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU. Methods We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed. Results Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value &lt; 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay. Conclusion Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU. Disclosures All Authors: No reported disclosures

scholarly journals Designing a bed-side system for predicting length of stay in a neonatal intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Harpreet Singh ◽  
Su Jin Cho ◽  
Shubham Gupta ◽  
Ravneet Kaur ◽  
S. Sunidhi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Length Of Stay ◽  
Neonatal Intensive Care ◽  
Financial Burden ◽  
Significant Risk ◽  
Model Performance ◽  
Significant Risk Factor ◽  
Validation Dataset ◽  
Patient Records

AbstractIncreased length of stay (LOS) in intensive care units is directly associated with the financial burden, anxiety, and increased mortality risks. In the current study, we have incorporated the association of day-to-day nutrition and medication data of the patient during its stay in hospital with its predicted LOS. To demonstrate the same, we developed a model to predict the LOS using risk factors (a) perinatal and antenatal details, (b) deviation of nutrition and medication dosage from guidelines, and (c) clinical diagnoses encountered during NICU stay. Data of 836 patient records (12 months) from two NICU sites were used and validated on 211 patient records (4 months). A bedside user interface integrated with EMR has been designed to display the model performance results on the validation dataset. The study shows that each gestation age group of patients has unique and independent risk factors associated with the LOS. The gestation is a significant risk factor for neonates < 34 weeks, nutrition deviation for < 32 weeks, and clinical diagnosis (sepsis) for ≥ 32 weeks. Patients on medications had considerable extra LOS for ≥ 32 weeks’ gestation. The presented LOS model is tailored for each patient, and deviations from the recommended nutrition and medication guidelines were significantly associated with the predicted LOS.

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