Risks and burdens of third-generation cephalosporin resistant Enterobacteriaceae in neonatal sepsis

@#Third-generation cephalosporin resistant Enterobacteriaceae (TCRE) is a global concern especially in neonatal sepsis. We performed a secondary data analysis in a Thai neonatal intensive care unit to identify the risk factors for acquisition of TCRE sepsis and mortality of Enterobacteriaceae sepsis between 1991 and 2017. Multivariate logistic and Cox proportional regression were used for analysis. Numbers of neonates with TCRE and nonTCRE sepsis were 100 and 41 patients, respectively. Medians (interquartile ranges) of gestational age, birthweight, onset of sepsis and total hospital stay of neonates with Enterobacteriaceae sepsis were 32 (28, 38) weeks, 1670 (1025, 2750) grams, 11 (6, 25) days and 41 (22, 74) days, respectively. Univariate and multivariate analysis, neonates with TCRE sepsis were more likely to have birth asphyxia (adjusted odds ratio [aOR] = 2.6; 95% confidence interval [CI] 1.1-6.0; p = 0.02) and history of aminoglycoside exposure (aOR = 2.9; 95% CI 1.36.7; p = 0.01). In-hospital case fatality rate from Enterobacteriaceae sepsis was 26% (36/141). In Cox regression, neonates with TCRE sepsis was not an independent risk of non-survivors, but septic shock (adjusted hazard ratio = 9.9; 95% CI 5.0-19.7, p < 0.001) increased 30-day mortality in the final model. Asphyxia and previous aminoglycoside consumption were risks of acquisition for neonatal TCRE sepsis while the burden was not a significant difference. Infection prevention and control must be strictly implemented in high multidrug-resistant area.

Fat Loss in Thawed Breast Milk: Comparison Between Refrigerator and Warm Water.

Objective: To compare the fat loss between refrigerator and warm water thawed breast milk. Design: Experimental. Setting: Tertiary-care pediatric university hospital. Participants: Ninety samples of expressed breast milk were collected from mothers with singleton babies of a gestational age 32-42 weeks. Main Outcome Measures: Fat content in fresh breast milk (FM); thawed breast milk by refrigeration (RM); and thawed breast milk by warm water (WM). R E S E A R C H P A P E R INDIAN PEDIATRICS 877 VOLUME 49__NOVEMBER 16, 2012 Results: The mean (SD) total fat content in FM, RM and WM were 2.98 (0.97), 2.76 (0.99) and 2.66 (0.88) g/100 mL, respectively. The mean difference (SD) of the total fat in FM declined significantly after the frozen milk was thawed by refrigeration or warm water at -0.22 (0.50) g/100 mL (P=0.0001) and -0.32 (0.45) g/100 mL (P<0.0001), respectively. The mean (SD) total fat loss of frozen breast milk thawed by refrigeration was less than thawing in warm water at 0.094 (0.38) g/100 mL (P=0.02). Conclusion: The fat loss of thawed breast milk by refrigeration was significantly less than placing it in warm water.

Early neonatal mortality at Songklanagarind Hospital from 1987 to 1997.

During the 11 year period (1987-1997), there were 23,584 livebirths at Songklanagarind Hospital. The average incidence of low birth weight was 8.17 per cent, it has increased slightly during the last 6 year period (8.53 per cent) compared to the first 5 year period (7.59 per cent). There has been little decrease in the early neonatal mortality rate (ENMR) during the last 6 years (3.94 per 1000 livebirths) compared to the first 5 years (4.71 per 1000 livebirths). ENMR was markedly reduced when we compared ENMR of the first year (6.73 per 1000 livebirths in 1987) to the last year (1.52 per 1000 livebirths in 1997). During the last 6 year period, early neonatal mortality (ENM) of neonates less than 1000 g and 1000-1499 g has greatly reduced from 57.14 per cent to 16.67 per cent and from 50 per cent to 6.25 per cent respectively. The major cause of ENM was congenital anomalies in the first 5 year and the last 6 year period and all birth weight groups except the group less than 1000 g of which the leading cause of death was respiratory distress syndrome.

Pseudohypoaldosteronism: mineralocorticoid unresponsiveness syndrome.

We described a 10 day old boy who presented with hyponatremia, hyperkalemia, and metabolic acidosis. Therapeutic treatment with exogenous glucocorticoid and mineralocorticoid for 8 months failed to correct the electrolyte abnormalities. The elevated serum cortisol up to 44.34 micrograms/dl along with the absence of skin hyperpigmentation excluded defects in the glucocorticoid pathway. Pseudohypoaldosteronism was diagnosed on the basis of hyponatremia, severe urinary salt loss despite the markedly elevated serum aldosterone up to 6,500 pg/ml (normal range 50-800 pg/ml). The patient responded very well to oral salt supplementation and cation exchange resin therapy shown by normal physical growth and normal levels of serum electrolytes.

Growth patterns of low-birth-weight infants: 2-year longitudinal study.

A 2 year longitudinal study of the growth of 147 low birthweight (LBW) < 2,500 g infants who had no known factors disturbing growth was conducted. The infants were divided into 6 groups according to birthweight and maturity: group 1--appropriate for gestational age (AGA) with birthweight < 1,500 g (n = 18); group 2--AGA 1,500-1,999 g (n = 41); group 3--AGA 2,000-2,499 g (n = 26); group 4--small for gestational age (SGA) < 1,500 g (n = 5); group 5--SGA 1,500-1,999 g (n = 20); group 6--SGA 2,000-2,499 g (n = 37). The control group consisted of 149 normal birthweight (> 2,500 g) infants. Weight, height, and head circumference were measured at birth, 2, 4, 6, 9, 12, 18, and 24 months postnatally and recorded in standard deviation score (SDS). All groups showed catch-up growth in the first 6 months. At 2 years old, all infants were above -2 SDS. However, the SGA infants with birthweight < 1,500 g were significantly lighter (-0.9 SDS, p = 0.003), shorter (-0.6 SDS, p = 0.001) and had smaller head size (-0.65 SDS, p = 0.027) whereas, the other groups were not different compared to the control group. We also compared those LBW infants who, at 2 years of age, weighed below -1 SDS to those who weighed above -1 SDS and found no significant difference in familial income, parental education, nursing care or parental height. We concluded that with adequate nutritional intake and nursing care, LBW infants have the potential for good catch-up growth. For the SGA infants with birthweight < 1,500 g, although they showed good catch-up growth, they still remained smaller than their peers at 2 years of age.