Intravenous lines-related sepsis in new born babies admitied to nicu in a developing country

Nosocomial sepsis is very common in newborn units in developing countries. Routes of infection are multiple but the personal factor stays important. The hypothesis of the study was that intravenous lines may be important routes of infection and that contamination of cannula hub may precede sepsis episodes. Infants in the neonatal intensive care unit III were enrolled in the study. Culture samples were obtained from the intravenous lines hubs every day until removed. At times of suspected sepsis, all patients had blood obtained for culture from a peripheral vein and from the IV line hubs at the same time. Sepsis was considered IV line related f the microorganism isolated from the peripheral blood culture was identical to the organism recovered from the cannula hub or tip or from purulent material at the site of skin entry of the cannula. 260 lines were placed in 83 patients. 45 episodes of sepsis were diagnosed clinically and by blood culturing. Klebsiella species was the predominant organism. Among the klebsiella cases, the organism was isolated from IV line hub in more than 50% of the cases before the onset of clinical and laboratory sepsis and in 14% of the cases was isolated also from the IV line hub at the time of sepsis. This study supports the hypothesis that cannula hub is a major portal of entry for causing sepsis in newborn units in developing countries

Cerebral blood flow velocities in newborn infants with perinatal ashpyxia

The cerebrovascular hemodynamic alteration in asphyxia and intraventricular hemorrhage in newborn infants were determined by monitoring the pulsatile flow changes in the anterior cerebral arteries using Doppler ultrasound. The pulsatility index measurements, which were calculated from the recorded changes in Doppler frequency shifts, were obtained in four groups of newborn infants, each comprising 20, with the following diagnoses: Group I normal term, Group II asphyxia, Group III IVH, Group IV asymptomatic preterm. There was no significant difference between the PI values of groups I and IV. Compared to normal term infants, those diagnosed as having asphyxia had significantly lower PI measurements and those with IVH had significantly higher PI values. The low PI values in asphyxia and prior to the onset of IVH indicate vasodilatation and decreased resistance to blood flow. In IVH, the high PI values denote the opposite. PI =Pulsatility index; S = Mean systolic amplitude; D = mean diastolic amplitude; CBF= Cerebral blood flow; IVH= Intraventricular hemorrhage; AGA= Appropriate for gestational age

Selective intrapartum prophylaxis for group B streptococcus colonization: management and outcome of newborns

Intrapartum Antibiotic Prophylaxis [IAP] in mothers with group B streptococcus [GBS] colonization presents difficult neonatal management decisions. IAP was instituted in response to an increased incidence of early-onset group B Streptococcus sepsis [EOGBSS]. This study was planned to evaluate the outcome of these newborns. Prenatal GBS cultures were obtained from 250 mothers in their third trimester of pregnancy. Al time of delivery, GBS-positive women who had at least one risk factor were to receive IAP. Only the newborns with positive screening laboratory tests or symptoms of sepsis received further laboratory evaluation and antibiotic treatment. Two hundred mothers gave birth to 203 newborns. Thirty-three mothers [16.5%] were colonized with GBS and 12 [36.4%] had at least one risk factor. IAP was given to 10 mothers [5% of all deliveries]. Thirty-four newborns were born to 33 GBS-positive mothers. Two newborns had EOGBSS. Vertical transmission demonstrated by positive mucocutaneous cultures from newborns, was found to be inversely proportionate to the number of doses of IAP. The incidence was 12.5% in infants of GBS-positive mothers who received no IAP, 9% in those who received one dose and 0.0% in those who received two doses