Influenza A Outbreak in a Neonatal Intensive Care Unit During the 2011-2012 Influenza Season in Korea

PURPOSE: An outbreak of influenza virus is uncommon in neonatal intensive care unit (NICU). The clinical presentation of influenza virus infection in neonates is diverse. This study was aimed to report an outbreak of influenza A in a NICU and to investigate the clinical characteristics of influenza virus infection in neonates especially preterm infants during the 2011-2012 influenza season in Korea. METHODS: We reviewed the medical records of 29 patients who were evaluated by respiratory virus multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) at NICU of Kosin University Gospel Hospital during the 2011-2012 seasonal influenza outbreak in Korea. RESULTS: Eleven patients (37.9%) were influenza A virus RT-PCR positive during the survey periods. They were all preterm infants and three of them had no symptoms. Eight patients had symptoms and it was fever (18%, 2/11), respiratory difficulty (72.7%, 8/11) without symptoms of upper respiratory infection, and gastrointestinal symptoms (27.3%, 3/11). The median duration of symptom was 5 days. There were differences of duration of admission at the test of respiratory RT-PCR, Clinical Risk Index for Babies (CRIB) score, use of mechanical ventilation, and use of dexamethasone before infection between influenza A virus RT-PCR positive and negative group. All 11 patients with influenza A were discharged without any complications. CONCLUSIONS: The symptoms of influenza A virus infection in the preterm infants is nonspecific. Influenza A virus should be considered as a possible cause of infection in NICU during the influenza season in the community.

Preterm Ovarian Hyperstimulation Syndrome

Preterm ovarian hyperstimulation syndrome (POHS) is characterized by swelling of the vulva and hypogastrium, elevated estradiol and gonadotropin levels, and multiple ovarian follicular cysts in premature baby girls. We report a case of POHS with a review of the literature. The patient presented with swelling of the clitoral hood, and the labia majora and minora. We confirmed multiple ovarian cysts, as well as elevated estradiol and lutenizing hormone levels by performing pelvic ultrasound and laboratory tests. The symptoms resolved gradually and spontaneously.

Clinical Characteristics Associated with Blood Culture Contamination in Neonates

PURPOSE: This study was aimed to investigate the contamination rates of blood culture in a neonatal intensive care unit (NICU) and to examine the clinical characteristics related to the contamination. METHODS: Eight hundred thirty cases of blood culture performed from March 2013 to February 2014 were analyzed. We evaluated the contamination rates of blood culture by blood sampling sites and compared the clinical characteristics such as real name system and body weights of the contaminated cases and those of non-contaminated ones. The clinical characteristics were retrospectively reviewed by medical records. RESULTS: The overall contamination rate was 3.6% (30/830). The contamination rates by blood sampling sites were as follows: peripheral vein 15.6% (10/64), peripheral artery 2.6% (20/759), and umbilical arterial catheter 0% (0/7). There was no difference in the contamination rates between cases with and without real name system (P =0.484). However, there were significant differences in the contamination rates by the physicians who performed the culture (P =0.038) and body weight ( or =1,000 g) at the time of blood culture (P<0.001). CONCLUSIONS: These results suggest that neonates with a body weight less than 1,000 g have more risks of the contamination of blood culture. Furthermore, there is a necessity to provide blood culture performers with active feedbacks and individualized education plans that can help diminish blood culture contamination rates. Prospective studies in a systematic manner that can be applied in actual clinical settings are needed in order to figure out factors that can diminish the contamination rates of blood culture in NICU.