Prevalence of multidrug resistant extended-spectrum beta-lactamase producing gram-negative bacteria in neonatal sepsis

Neonatal sepsis with extended-spectrum beta-lactamase [ESBL] producing microorganisms is recognized increasingly in recent years. ESBL can be produced by various bacterial strains. This study was conducted to determine the prevalence of ESBL producing pathogens in neonatal sepsis and its impact on clinical outcome. A study was carried out from Jan 2012 to Jan 2013 in a referral university hospital. All neonates who had diagnosed as sepsis were enrolled in this study. Blood cultures were processed using the automated BACTEC 9120 system. Antibiotic resistance and beta-lactamase production of bacterial isolates was tested. All patients were followed till discharge. One hundred three neonates with gestation age 36.7 +/- 3.2 weeks were enrolled in this study and 56 cases [54%] were boys. The most common isolated gram negative pathogens were Klebsiella pneumoniae, Acinetobacter species, and Pseudomonas aeruginosa. The rate for beta-lactamase production were 97.7% in Klebsiella pneumoniae, 81.3% in Acinetobacter, 85.7% in E. coli, 53.3% in Pseudomonas aeruginosa and 100% in Serratia. Thirty eight [35.9%] neonates were dead, that 34 of them were beta-lactamase producers. The mean duration of hospitalization were longer in patients infected with beta-lactamase producers [30.2 +/- 20.5 vs. 22.8 +/- 16.6 days P=0.05] and ESBL producing strains [29.13 +/- 20.39 vs. 19 +/- 9.84 P=0.05]. ESBL production rate were determined 95.5% and 86.7% in Klebsiella pneumoniae by combined disk test [CDT] and double disk synergy test [DDST] method, respectively. These methods were positive for ESBL production in 78.6% and 64.3% of E. coli isolates, respectively. In our study, the high rate of beta-lactamase and ESBL production were determined for common isolated organisms in neonatal sepsis. Infection with ESBL producing pathogens was associated with longer hospital stay. CDT method was detected more ESBL producing pathogens than DDST method in our study. It is recommended future studies to determine the risk factors predisposing newborn infants with these pathogens

Vascular endothelial growth factor and insulin-like growth factor-1 in preterm infants with retinopathy of prematurity

<p><b>INTRODUCTION</b>Retinopathy of prematurity (ROP) can lead to severe visual impairment. This study was conducted to determine the levels of biochemical mediators (i. e. vascular endothelial growth f actor [ VEGF] and insulin- like growth factor-1 [IGF-1]) in the blood of premature infants with proliferative ROP.</p><p><b>METHODS</b>Blood samples from 71 preterm infants born at or before 32 weeks of gestation were obtained 6-8 weeks after birth. These infants were classified into two groups according to their eye examination results. The control group consisted of 41 infants who had no evidence of ROP, and the study group consisted of 30 infants with proliferative ROP at stage III or higher. Blood VEGF and IGF-1 levels were measured using enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>The mean gestational ages of the infants at birth were 28.4 ± 1.6 and 28.8 ± 1.6 weeks in the study and control groups, respectively (p = 0.259). The mean postmenstrual age of the infants at the time of blood sampling was 34.9 ± 1.2 weeks in the study group and 34.6 ± 1.3 weeks in the control group (p = 0.339). The mean blood IGF-1 (18.48 ± 11.79 µg/L and 16.75 ± 13.74 µg/L in the study and control groups, respectively; p = 0.580) and VEGF (267.35 ± 103.43 pg/mL and 237.52 ± 130.92 pg/mL in the study and control groups, respectively; p = 0.305) levels of the infants were not significantly different between the two groups.</p><p><b>CONCLUSION</b>At 6-8 weeks after birth, blood IGF-1 and VEGF levels were not found to be significantly different between premature infants with proliferative ROP and those without.</p>

Comparing the efficacy of face mask CPAP with nasopharyngeal CPAP for neonatal transport after delivery

Preterm infants have respiratory failure and complications because surfactant in alveolus is low. CPAP [Continuous positive airway pressure] is a method for respiratory support in pre-term neonates and is provided by different equipment and methods. This study aims to compare two different routes of CPAP delivery in preterm newborn infants and to determine the need for surfactant replacement therapy in two groups. This is a randomized controlled clinical trial. Eighty four preterm infants delivered in Al-Zahra Hospital with gestational age 28-32 weeks were enrolled in this study from January 2012 to September 2012. They were randomly allocated in two groups. After initial stabilization in delivery room, forty two infants transferred to neonatal intensive care unit [NICU] with face mask CPAP and 42 infant with nasopharyngeal CPAP and continued nasal CPAP in the NICU in both groups. All infants were followed for developing respiratory distress and need for surfactant replacement therapy and oxygen dependency till discharge. The neonates that treated with two methods of CPAP delivery were similar with respect to gestation age, birth weight and other demographic characteristics. Twenty three neonates [65.5%] in face mask group and 15 neonates [39.5%] in nasopharyngeal CPAP group need surfactant replacement therapy [p=0.08]. Mask CPAP or nasopharyngeal CPAP can used in preterm infants after delivery for neonatal transfer to NICU. This study showed no method of CPAP delivery is preferable to other in decreasing the need for surfactant therapy

Plasma leptin concentrations in preterm infants with retinopathy of prematurity [ROP]

Retinopathy of prematurity [ROP] is a postnatal disorder of retinal vessels that develops in the incompletely vascularized retina of preterm infants. This disorder regresses in most patients but can lead to severe visual impairment. There is evidence that leptin stimulates angiogenesis. This study was conducted to determine blood levels of leptin in premature infants with proliferative ROP. Blood samples were obtained 6-8 weeks after birth from 71 preterm infants born at or before 32 weeks of gestation. These infants consisted of two groups according their eye examination results. The control group consisted of 41 neonates without evidence of ROP and the case group included 30 patients with proliferative ROP at stage III or more. Plasma leptin concentrations were measured using enzyme-linked immunosorbent assay [ELISA]. The mean gestation age of studied patients at birth were 28.4 +/- 1.6 wk and 28.8 +/- 1.6 in case and control group respectively [P= .25]. The mean post menstrual age of studied patients at blood sampling was 34.9 +/- 1.2 wk in the case group and 34.6 +/- 1.3 wk in the control group [p=0.33]. Mean blood levels of leptin were not significantly different among patients of the two groups [0.64 +/- 0.41 ng/ml in case group and 0.79 +/- 0.83 ng/ml in control group respectively, p=0.39]. Our data demonstrated that plasma leptin concentrations were not significantly different in premature infants with proliferative ROP at 6-8 weeks after birth from premature infants without ROP at this age

Preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy

To evaluate the effect of preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy. In a randomized clinical trial, 62 patients selected for unilateral mastectomy were recruited in Tabriz Imam Reza educational Hospital during 18-month period. They were randomly divided into two equal groups; receiving either preincisional ipsilateral stellate ganglion block using bupivacaine [study group] or without these blocks [control group]. Postoperative pain was evaluated based on visual analogue scale [VAS]. The total dose of analgesics were also compared between the two groups. Thirty one female patients with a mean age of 48.7 +/- 7.4 [36-60] years and 31 other female patients with a mean age of 50.7 +/- 6.9 [36-60] years were enrolled in the study and control groups, respectively [p=0.292]. The number of patients with decrease in postoperative pain was significantly higher in the case study group comparing with that of the control group [p < 0.001]. Decrease in total dose of postoperative analgesics was also significantly lower in the case study group compared with control group [P < 0.001]. Forty eight hours after operation, there were 15 pain-free patients in the study group with no pain-free patients in the control group. This difference was statistically significant [P < 0.001]. Based on our findings, the preincisional ipsilateral stellate ganglion block is an effective method in controlling the postoperative pain after unilateral mastectomy. This approach had also got a considerable analgesic-sparing effect

prospective study of the safety of tracheal extubation using endotracheal ventilation catheter in patients undergoing maxillofacial surgery

To assess the use of endotracheal ventilation catheter for extubation of patients who underwent maxillofacial surgery. Sixty patients who underwent maxillofacial surgery were enrolled in this study from September 2004 to October 2006 in Imam Khomeini Hospital, Tabriz, Iran. They were randomized to 2, 30-person groups. In the intervention group, endotracheal ventilation catheter was inserted before extubation. Patients of the control group were extubated routinely. Upper airway obstruction [stridor] was seen in 3 patients of each group, which improved with supplemental oxygen in the intervention group. The rate of cyanosis, release of intramaxillary fixation, and reintubation in the intervention group was significantly less than the control group [p=0.021]. Endotracheal ventilation catheter is a safe and easy to use device for extubation, and patients can tolerate it well. Therefore, we recommend the use of this type of exchange catheter for the extubation of patients undergoing maxillofacial surgery

Evaluation of tracheal intubating condition in adults after coinduction with propofol plus lidocaine and different doses of remifentanil

To evaluate tracheal intubation condition in adults after anesthetic coinduction with lidocaine and propofol and various doses of remifentanil. In three groups, induction was compared with lidocaine [1.5 mg/kg], propofol [2 mg/kg], and three varing doses of remifentanil [0.5-1-2 micro g/kg]. Tracheal intubation was graded according to the ease of laryngoscopy, the position of vocal cords, coughing, jaw relaxation and the movement of limbs. Hemodynamic variables were compared during preoxygination and 45 seconds after induction. There were 90 ASA I or ASA II patients with 30 in each group. Tracheal intubating condition was regarded as acceptable in 33%, 53% and 90% of patients in groups 1, 2 and 3 respectively. All three groups had a decrease in heart rate and mean arterial pressure after induction but this changes wasn't clinically significant. Tracheal intubating condition was best after induction with lidocaine 1.5mg/kg, propofol 2mg/kg and remifentanil 2microg/kg