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.

Effectiveness and Safety of Intravenous Iloprost for Severe Persistent Pulmonary Hypertension of the Newborn.

Objective: The aims of this study were to determine the effectiveness (oxygenation), safety (hemodynamic status) and short term outcomes of intravenous iloprost (IVI) administration as a rescue therapy in severe persistent pulmonary hypertension of the newborn (PPHN). Design: Retrospective medical records review. Setting: Tertiary neonatal intensive care unit at Songklanagarind Hospital, Songkhla Province, Hat Yai, Thailand. Participants: Newborns who received IVI as an adjunctive therapy for treatment of severe PPHN, as defined by an oxygen index (OI) of >20 and without response to conventional therapies. Main Outcome Measures: The change of OI and alveolar-arterial oxygen difference before and after commencement of IVI. Results: 33 neonates with severe PPHN at a median gestation of 39 weeks and a baseline OI of 40 (range, 21-101) received IVI. The median OI and alveolar-arterial oxygen difference had a statistically significant decrease after 2 hours of treatment and continued to decline thereafter (P<0.05). All infants received one or more inotropic medications and volume expanders to provide blood pressure support with no statistically significant difference of blood pressure and heart rate before and after IVI treatment. The mortality rate was 15.2%, all of them had initially severe hypoxemia with a median OI of 53.6. Conclusions: IVI may be effective in improving oxygenation and should be considered as a rescue therapy for infants with severe PPHN, especially in a limited resource environment with no inhaled nitric oxide available. Systemic hypotension may be a cause for concern.

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.

Volume guarantee ventilator of newborn

The pathogenesis of bronchopulmonary dysplasia (BPD) is multifactorial. One cause is ventilatorinduced lung injury (VILI). Experimental studies show that the magnitude of volutrauma is more closely associated with ventilator-induced lung injury rather than end-inspiratory pressure. The volume guarantee (VG) mode, studied most thoroughly, provides automatic weaning of peak pressure in response to improving lung compliance and respiratory effort. A more consistent tidal volume, fewer excessively large breaths, lower peak pressure, less hypocarbia and lower levels of inflammatory cytokines have been documented. These short-term benefits translate into a shorter duration of ventilation.

Volume targeted ventilator of newborn

Advances in neonatal care have led to significant improvements in the survival of preterm infants. However, bronchopulmonary dysplasia (BPD) continues to be a major problem in these infants. BPD is in part thought to be the result of ventilator-induced lung injury. A number of modifications to pressure-limited ventilation have been developed to combine the advantages of pressure-limited ventilation with the benefits of controlling delivered tidal volume. These modalities are designed to deliver a targeted tidal volume by microprocessor-directed adjustments of inspiratory pressure or time. These new choices in ventilator technology can make it difficult to select the most appropriate mode for each infant. Each mode has advantages and disadvantages, with limited data available to judge their effectiveness.