Assessment of Gestational Age using New Ballard Examination in High-Risk Infants

Abstract Background The monoclonal antibody, palivizumab is licensed for use in high-risk infants to prevent severe illness caused by respiratory syncytial virus (RSV). The level of its use and compliance with current jurisdictional guidelines which were amended in 2010, is unknown. We determined the level of palivizumab use in a cohort of high-risk infants in Western Australia. Methods Using probabilistically linked administrative data, we conducted a birth cohort study within tertiary neonatal intensive care units (NICUs) born between 2002 and 2013. We described palivizumab use by patient characteristics, eligibility criteria according to guidelines over the period of study and identified predictors of its use. Results Of 24,329 infants admitted to tertiary NICUs, 271 (1.1%) were dispensed 744 palivizumab doses with 62.5% being dispensed to infants born 2010–2013. The median number of doses received was 2. A total of 2679 infants met at least one of three criteria for palivizumab (criteria 1: gestational age at birth < 28 weeks and chronic lung disease; criteria 2: gestational age < 28 weeks and Aboriginal; criteria 3: congenital heart disease not otherwise in criteria 1 or 2). The extent of palivizumab use differed across the 3 groups. Of 803 infants meeting criteria 1, 21.8% received at least 1 dose of palivizumab; 52.8% from 2010 onwards. From 174 infants meeting criteria 2, 14.4% received at least 1 dose; 43.1% from 2010 onwards and from 1804 births meeting criteria 3, only 3.7% received at least 1 dose; 5.4% from year of birth 2010 onwards). In adjusted analyses, being born after 2010, being extreme preterm, chronic lung disease, congenital lung disease and being born in autumn or winter were independent predictors of palivizumab use. Conclusion In this high-risk setting and notwithstanding the limitations of our data sources, the level of compliance of palivizumab use against current guidelines was low. Most doses were dispensed to infants meeting at least one high-risk criterion. Evidence of incomplete dosing is an important finding in light of recent developments of single dose monoclonal antibodies offering longer protection.

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Respiratory Syncytial Virus Infection in High-risk Infants – an Update on Palivizumab Prophylaxis

The Open Microbiology Journal ◽

10.2174/1874285801408010071 ◽

2014 ◽

Vol 8 (1) ◽

pp. 71-77 ◽

Cited By ~ 23

Author(s):

Bernhard Resch

Keyword(s):

Respiratory Syncytial Virus ◽

High Risk ◽

Rare Diseases ◽

Gestational Age ◽

Meta Analysis ◽

Infants And Children ◽

High Morbidity ◽

Syncytial Virus ◽

Economic Analyses ◽

High Risk Infants

Morbidity due to respiratory syncytial virus (RSV) disease is still high in infants and children worldwide during the first two to five years of life. Certain categories of high-risk infants with increased morbidity and mortality attributed to RSV disease have been identified and are included in national recommendations for prophylaxis with the monoclonal RSV antibody palivizumab. Most guidelines recommend palivizumab for preterm infants born less than or equal to 32 weeks gestational age with or without bronchopulmonary dysplasia, those born between 33 and 35 weeks gestational age with additional risk factors, and infants and children with hemodynamically significant congenital heart disease. Over the last years several rare diseases have been identified demonstrating high morbidity associated with RSV disease, thus, extension of guidelines for the prophylaxis with palivizumab for these patients with rare diseases including children with malignancy, congenital and acquired immune deficiency, Down syndrome, neuromuscular impairment, cystic fibrosis, congenital diaphragmatic hernia and other severe respiratory disease is increasingly discussed. Efficacy of palivizumab prophylaxis is documented by meta-analysis, and different economic analyses demonstrate cost-effectiveness of palivizumab for the most common indications during the first RSV season.

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Impact of the Withdrawal of Palivizumab Immunoprophylaxis on the Incidence of Respiratory Syncytial Virus (RSV) Hospitalizations Among Infants Born at 33 to 35 Weeks’ Gestational Age in the Province of Quebec, Canada: The RSV-Quebec Study

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa046 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jesse Papenburg ◽

Isabelle Defoy ◽

Edith Massé ◽

Georges Caouette ◽

Marc H Lebel

Keyword(s):

Respiratory Syncytial Virus ◽

High Risk ◽

Gestational Age ◽

Retrospective Cohort ◽

Lower Respiratory Tract ◽

Primary Outcome ◽

Birth Month ◽

Syncytial Virus ◽

High Risk Infants ◽

The Impact

Abstract Background Infants born at 33–35 completed weeks’ gestational age (wGA) aged <6 months at the start of or born during respiratory syncytial virus (RSV) season and classified as moderate/high risk of severe RSV disease were included in a palivizumab RSV prophylaxis program in the province of Quebec, Canada, until 2014–2015. We assessed the impact of withdrawal of this indication on lower respiratory tract infection (LRTI)/RSV hospitalizations (H) in this population. Methods We conducted a 4-year, retrospective, cohort study in 25 Quebec hospitals (2 seasons with and 2 without palivizumab prophylaxis for moderate- to high-risk infants). Our primary outcome was LRTI/RSV-H incidence. We compared LRTI/RSV-H incidence before (2013–2015; seasons 1 + 2 [S1/2]) and after (2015–2017; S3/4) the change in indication. Results We identified 6457 33–35 wGA births. LRTI/RSV-H occurred in 105/3353 infants (3.13%) in S1/2 and 130/3104 (4.19%) in S3/4. Among LRTI/RSV-H, 86.4% were laboratory-confirmed RSV-H. Adjusting for sex, wGA, and birth month, S3/4 was significantly associated with increased LRTI/RSV-H incidence (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.04–1.76) but not with laboratory-confirmed RSV-H (aOR, 1.19; 95% CI, 0.90–1.58). Mean duration of LRTI/RSV-H was 5.6 days; 22.6% required intensive care unit admission. Comparing S3/4 with S1/2, infant percentage with LRTI/RSV-H classified as moderate/high risk increased from 27.8% to 41.9% (P = .11). Conclusions In a province-wide study, we observed a significant increase in LRTI/RSV-H incidence among infants born at 33–35 wGA in the 2 years after withdrawal of RSV prophylaxis.

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Retrospective Assessment of Selenium Status in High Risk Infants

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_150 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1078-1078

Author(s):

Laura Sherlock ◽

Kimberly Vollrath ◽

Emma Ross ◽

Susan Marshall ◽

Nicole Larez ◽

...

Keyword(s):

Birth Weight ◽

High Risk ◽

Gestational Age ◽

Late Onset ◽

Neurodevelopmental Outcomes ◽

Perinatal Medicine ◽

Average Birth Weight ◽

Se Deficiency ◽

High Risk Infants ◽

Se Status

Abstract Objectives Selenium (Se) is an essential trace mineral important in neonatal development that contributes to oxidative stress and the inflammatory response. Se deficiency in preterm infants is associated with late onset sepsis, bronchopulmonary dysplasia, poor neurodevelopmental outcomes, and retinopathy of prematurity. Current Se dosing in many US Neonatal Intensive Care Units is based on the amount of Se in term breastmilk. However, it is unclear if this is sufficient and higher levels may be needed to prevent or treat Se deficiency. Our goal was to evaluate if the current practice supplementing total parenteral nutrition (TPN) with sodium selenite 2 mcg/kg/d is sufficient at preventing Se deficiency in high risk infants. Methods This is a retrospective chart review of Se status at a level IV Children's Hospital NICU from January 1, 2017 to August 30, 2019. Infants were included if born from 22–42 weeks gestation and received TPN for >4 weeks. They were excluded if there was concern for active sepsis or bacterial illness at time of Se draw. Normal Se status was defined as 45–90 ng/mL for infants 0–2 months. Birth weight, IUGR status, gestational age, and % enteral feeds were evaluated. Se deficient infants received higher Se dosing at 5–7 mcg/kg/d. Repeat levels were evaluated after 4 weeks. Results are reported as mean ± SD. Results Se status was assessed for 39 infants. Average gestational age was 29.8 ± 5.36 weeks. Average birth weight was 1499 ± 837 g. At the time of first Se assessment, 78% of infants were Se deficient, with a mean Se level of 40.95 ± 12 ng/mL. Repeat Se levels on higher dosing was assessed in 23 infants. After >4 weeks of higher Se dosing, 35% of infants remained Se deficient, with a mean Se level of 54.04 ± 14 ng/mL. By t-test, statistically fewer infants were Se deficient on higher Se dosing (P < 0.0003). Conclusions Infants on prolonged TPN >4 weeks are at high risk for Se deficiency. Se dosing at 2 mcg/kg/day is insufficient in preventing deficiency for a majority of these babies. Higher Se dosing improved the percentage of Se sufficient infants, but a third remained deficient. Future studies are needed to prospectively determine if higher Se in TPN prevents Se deficiency. Funding Sources University of Colorado, Section of Neonatal-Perinatal Medicine.

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1424. Short-Course Antibiotic Therapy for Urinary Tract Infection (UTI) in the NICU: It’s Safe and Effective!

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1616 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S795-S795

Author(s):

Jacqueline Magers ◽

Pavel Prusakov ◽

Sunday Speaks ◽

Pablo J Sanchez

Keyword(s):

High Risk ◽

Antibiotic Therapy ◽

Gestational Age ◽

Antimicrobial Therapy ◽

Audit And Feedback ◽

Antibiotic Exposure ◽

Stewardship Program ◽

Short Course ◽

Management Protocol ◽

High Risk Infants

Abstract Background Antibiotic overuse in the neonatal intensive care unit (NICU) has been associated with adverse patient outcomes such as necrotizing enterocolitis (NEC), late-onset sepsis, invasive candidiasis, bronchopulmonary dysplasia, neurodevelopmental impairment, and death. On 11/2020 at Nationwide Children’s Hospital, Columbus, OH, the Neonatal Antimicrobial Stewardship Program Committee recommended 5 days of antibiotic therapy with a subsequent antibiotic “timeout” for uncomplicated UTI without bacteremia as part of ongoing efforts to reduce antibiotic exposure among high risk infants in 7 Level 2/3/4 NICUs. Methods Retrospective review of all infants who received antimicrobial therapy for UTI after implementation of a UTI Diagnosis and Management Protocol. Twice weekly NEO-ASP meetings provided prospective audit and feedback to neonatologists on appropriate antibiotic therapy and duration. Pertinent clinical, laboratory, and outcome data were obtained from the infants’ electronic health record. Safety measure evaluated include recurrence of infection with the same previously identified pathogen in the fourteen days after discontinuation of antibiotic therapy and mortality. Results Since implementation of the UTI protocol, 28 infants (median gestational age, 28 wk [IQR, 26-30 wk; median birth weight, 1203 g [IQR, 731-1801 g]) received antimicrobial therapy for treatment of a UTI at a median age of 50 days (IQR, 28-69 days). The most frequent pathogens were E. coli (n=8), K. pneumoniae (n=5), and Enterobacter spp. (n=4). Median duration of antibiotic therapy was 6 calendar days (IQR, 5-6 days). Only 1 (4%) infant had antibiotic therapy restarted within 14 days of discontinuation of initial therapy; infant had fever but blood, urine, and CSF cultures were sterile and antibiotic therapy was discontinued after 48 hours. One (4%) infant (23 wk gestational age) died at 6 weeks of age from NEC totalis not related to the previous UTI. 22 (81%) infants have been discharged home while 6 remain in the NICU. Conclusion Our preliminary data suggests that short course antibiotic therapy (with a timeout) < ![if !supportAnnotations] >[SP1]< ![endif] > for uncomplicated UTIs in the NICU is an effective and safe therapy that ultimately may lead to less antibiotic exposure among high risk infants. Disclosures All Authors: No reported disclosures

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