Developing the Mansoura Early Feeding Skills Assessment Scale for Preterm Infants / 대한소아소화기영양학회지

Purpose@#This study aimed to develop a new bedside scoring system scale that assesses preterm infants’ oral feeding skills (OFS) in the neonatal intensive care unit (NICU). @*Methods@#A literature review and critical appraisal of available oral feeding assessment tools/ scores were performed. Subsequently, we developed the “Mansoura Early Feeding Skills Assessment” (MEFSA) scale, an 85-item observational measure of oral feeding skills with three main sections. Forty-one preterm infants who did not receive oral feeding but were clinically stable enough to initiate oral feeding were included in the study. Next, we applied and interpreted the MEFSA to describe and score their feeding skills. @*Results@#Applying the MEFSA resulted in a smooth feeding transition, early start of oral feeding, full oral feeding, and discharge with a shorter period of tube feeding in preterm infants. @*Conclusion@#The MEFSA is a successful bedside scoring system that assesses the OFS of preterm infants in the NICU.

Risk Factors of catheter related blood stream infection in neonatal intensive care unit: experience from a developing country

Objective: The aim of this study was to detect the rate of catheter-related bloodstream infection [CRBSI] in NICU of Mansoura University Children's Hospital and to focus on possible predictors of infection. Study

Design: A cross sectional comparative study to detect rate of CRBSI among neonates with central vascular catheters during the period between January 2009 and April 2012. Then, a nested case control study done among CRBSI cases and central vascular catheters none infected as a control group to detect predictors associated with their occurrence

Patients and Methods: Blood samples were collected from III neonates clinically suspected ofsepticemia and had inserted venous line. Central, peripheral blood and catheter tip cultures were done for each case

Results: CRBSI was confirmed in 69 cases as central blood culture count was > 3 folds of peripheral blood culture count. Catheter tip culture showed > 103 CFV/ ml per catheter of the same organisms. Low birth weight, age below 7 days, prematurity, mechanical ventilation, TPN administration and prolonged hospital stay were predictors of CRBSI. Logistic regression of the studied predictors showed that birth weight, TPN administration and length of central venous catheter stay were significant predictors of CRBSI

Conclusion: CRBSI is a common problem in NICU. Predictors of CRBSI included low birth weight, prematurity and mechanical ventilation. Potential use of TPN, prolonged catheter stay and low birth weight are independent predictors for CRBSI

Detection of SHV-1 and SHV-2 in extended spectrum beta-lactamase producing klebsiella pneumoniae isolated from neonatal intensive care unit in Mansoura university children's hospital

Extended spectrum beta- Lactamase producing klebsiella [ESbetaL-KP] is an important cause of nosocomial infections in neonatal intensive care units [NICUs]. We conducted a prospective cohort study in the NICU, Mansoura University Children's Hospital, over a period of twelve months starting from June 2005 to May 2006, to assess the incidence of ESbetaL-KP, identify the frequency of SHV-1 and SHV-2 gene acquisition among ESbetaL-KP isolates, and the risk factors associated with ESbetaL-KP infection. Antimicrobial susceptibility was determined by, phenotypic confirmation of ESbetaL production was done by the double-disk synergy test [DDST] and Etest. Genetic detection of SHV-1 and SHV-2 genes in ESbetaL-KP isolates was done by polymerase chain reaction [PCR] and restriction fragment length polymorphisms [RFLP]. Risk factors associated with ESbetaL-KP infection were analyzed by both univariate and multiple logistic regression methods. Three hundred and ninety-eight neonates were enrolled in the study cohort. The overall nosocomial infection incidence rate was 36.6%. Klebsiella species was the commonest organism [27 among 138 bacterial isolates [19.6%]]. Eighteen klebsiella isolates [66.7%] exhibited phenotypic ESbetaL- resistance patterns. PCR amplicons from the 18 ESbetaL-KP isolates were subjected to RFLP analysis which revealed the presence of SHV-2 in all 18 isolates [100%], SHV-1 gene in 8 strains [44.4%]. Independent risk factors for ESbetaL-KP infection were: mechanical ventilation [odds ratio [OR]: 4.18, 95% confidence intervals [CI]: 1.57 -11.00]; birth weight < 1500 g [OR: 3.19, CI: 1.22 - 8.30]; duration of hospitalization > 15 days [OR: 4.09, CI: 1.17-14.40]; total parenteral nutrition [TPN] [OR: 4.93, CI: 1.12 - 21.70]; and prior use of oxyimino-antibiotics [OR: 4.87, CI: 1.10 -21.50]. Neonates infected with ESbetaL-KP higher mortality [27.8%] compared to other neonates [11%] [P=0.04]

Conclusion: This study confirms the high incidence of ESbetaL-KP in our NICU and further demonstrates the role of genes coding for SHV-1 and SHV-2 enzymes in clinical and environmental isolates. Independent risk factors for acquisition of ESbetaL-KP were mechanical ventilation; birth weight 15 days; and prior exposure to oxyimino antibiotics. Neonates infected with ESbetaL-KP experienced increased mortality compared to other neonates

Valvular versus myocardial dysfunction in children with rheumatic fever

To study the myocardial factor in patients. with the initial attack of acute rheumatic fever [ARF]. Twenty-eight patients with initial attack of 8 without carditis [group 1] and 20 with carditis [group 2] were studied in the acute inflammatory stage of the disease and after subsidence of rheumatic activity. Control group included 8 healthy children. Levels of cardiac troponin-I [cTnI], creatine kinase-MB [CK-MB] as well as M-mode, Two-dimensional echocardiography and color Doppler examinations were performed in all patients and controls. Serum cTnI and CK-MB levels were not significantly different groups 1 and 2 compared with controls [P>0.05] and in group 1 com ed with group 2 [p>0.05]. Moreover, no change in cTnI, CK-MB or M-mode echocardiographic findings was found after subsidence of rheumatic activity [p>0, 05]. No correlation was found between serum cTnI, CK-and the severity of carditis as determined by chamber enlargement severity of valvular regurgitation by echocardiography [P>0.05]. Left ventricular fractional shortening, as an indicator of left ventricular systolic function was normal in patients enrolled in the study and did not differ between patient groups. No laboratory evidence of myocardial cell injury was demonstrated in patients with ARF. Moreover, echocardiographic evidence-of decreased systolic function of the left ventricle was lacking even presence of severe valvular regurgitation. This supports the current that acute valvular regurgitation, rather than myocardial involvement, is the major hemodynamic abnormality in these patients

Plasma endothelin-1 and nitric oxide in children with insulin-dependent diabetes mellitus

Dysfunction of vascular endothelium is considered an early step in the development of diabetic complications. To assess plasma endothelin-1 [ET-1] and nitric oxide [NO] levels in children with insulin-dependent diabetes mellitus [IDDM] and their relation to the degree of metabolic control and disease duration. Plasma ET-1 and NO levels were assessed-by enzyme immunoassay-in 34 children with IDDM and compared to 17 healthy controls of matched age and sex. Diabetic patients had higher plasma ET-1 levels compared to controls [median [IQR]=5.9 [4.9-39.2] Vs 4.9 [4.4-6.1] pg/mI, P=0.02]. ET-1 levels were higher in patients with poor and moderate metabolic control when compared to those with ideal control [p=0.004 and 0.001; respectively]. ET-1 levels were positively correlated with NO levels [r=0.48, p=0.004]; HblAc level [r=0.57, P=0,001]; and disease duration [r=0.39, p=0.02]. Although, plasma NO levels in diabetic patients were not significantly different from controls [median [IQR]=24.6 [21.9-30.2] Vs 22.0 [21.0-26.5] umol/L, P 0.09]; NO levels were significantly higher in patients with poor metabolic control when compared to those with ideal control [p<0.001]. In children with IDDM, poor metabolic control and increased disease duration are associated with increased ET-1 production, which may be related to future diabetic complications. The elevated plasma NO levels in poorly controlled patients might mean a compensatory protective response towards increased ET-1 production

Bone mineral density and serum calcium hotheostasis in Egyptian children and adolescents with insulin-dependent diabetes mellitus

Although osteopenia is often reported as a complication of insulin-dependent-diabetes mellitus [IDDM], studies of bone mineral density [BMD] and serum calcium homeostasis in IDDM have yielded conflicting results. To determine BMD and serum calcium homeostasis in children and adolescents with IDDM and evaluate its relationship to metabolic control and disease duration. BMD was measured by dual-energy X-ray absorptiometry [DXA] in the lumbar spine [L2-L4] in 38 patients with IDDM [14 males, 24 females; aged 4-15 years; duration of diabetes 1.5-10 years] and their values were compared to those of 352 healthy Egyptian children and adolescents-[195 boys and 157 girls, aged 1-15 years]. In addition, glycosylated hemoglobin [HbA1c], serum calcium, phosphorus, 25 [OH] D3, and intact parathyroid hormone [iPTH] were measured in the diabetic patients and in 12 healthy controls of matched age and sex. As compared to normal BMD of Egyptian children and adolescents, nine patients [23.7%] had severe osteopenia [Z-score-2 SD or more negative] and 5 patients [13.1%] had mild osteopenia [Z-score:-1 to<-2 SD]; 24 [63.2%] patients had normal BMD. A negative correlation was found between BMD Z-score and disease duration [r-0.44, p=0,01], No relationship was found between BMD Z-score and metabolic control [HbA1c] or calcium homeostatic parameters. Diabetic patients had significantly lower iPTH compared to controls. On the other hand, serum calcium, phosphorus, and 25 [OH] D3 were not significantly different in IDDM patients compared to controls. IDDM in Egyptian children and adolescents was associated with osteopenia, which is significantly related to disease duration but not the degree of metabolic control. Calcium homeostasis was within normal in IDDM. iPTH was significantly lower in diabetic patients compared to controls. Periodic assessment of BMD in diabetic children and adolescents is mandatory