[Nosocomial infections in a neonatal unit epidemiology and risk factors]

Nosocomial infections [NI] are a major problem for neonates especially premature and low birth weight infants The objective of this study was to identify the risk factors and the bacterial epidemiology for nosocomial infection. This was a retrospective study of confirmed nosocomial infections, recorded from January 2003 to December 2005 at the neonatal unit of Charles Nicolle Hospital-Tunis. During the study period, 37 NI were recorded. The diagnosis was performed at a mean age of 7 days. Intra-uterine growth retardation was recorded in 54%of all cases, 70%of all infected infants were prematures and 75%were low birth weight. An antibiotic treatment before NI was recorded in 70%. Peripheral intravenous line placement, administration of intravenous medications, fluids and umbilical vein catheterization were significantly higher at the infected group [p<10[-3]] The pathogens most frequently isolated were klebsiella pneumoniae [73%] coagulase-negative staphylococci [13%]. The mortality rate was 27%[10/37], Nosocomial infections affect specially premature and low birth weight infants and are associated with a high mortality. klebsiella pneumoniae was the most frequently isolated pathogen

[Postnatal corticosteroid and chronic lung disease]

Cortieosteroids can be used postnatally to prevent or treat chronic lung disease. Controversy exists, however, about its effects on long term survival infants. Systematic reviews of randomised controlled trials of postnatal corticosteroids in the Chochrane Library were examined to determine the cost-benefit ratios of treatment. Beneficial effects include earlier extubation, reduced chonic lung disease and avoidance of late steroids. However, there are significant adverse short-term effects such as hyperglycaemia, hypertension, hypertrophic cardiomyopathy, gastrointestinal bleeding and growth failure. More important are long-term adverse effects of cerebral palsy, developmental delay. These adverse effects are more pronounced with early [<96 h] treatment but probably also occur when steroids are given later in the postnatal peroid. Postnatal steroids should be avoided if at all possible. More trials should be undertaken with a long term follow-up