Endotracheal aspirate cultures in predicting sepsis in ventilated neonates.

Nosocomial infections are the most common complications encountered in the neonatal intensive care unit (NICU). They are associated with high mortality and prolonged duration of hospitalization in the survivors, contributing to an increased cost of health care. In this article, we review the literature on the value of routine endotracheal aspirate cultures for the prediction of neonatal sepsis and provide guidelines to prevent nosocomial infections. Upon reviewing the literature it appears that the practice of routine cultures of endotracheal aspirate and cultures obtained from multiple body sites is an expensive proposition with low yield. The sensitivity of this test is at best 50% and all studies report a very low positive predictive value. The specificity of this test is 80%, hence its role is mainly limited to identifying infants who are at low risk for sepsis. As we do not have any reliable test for early diagnosis of neonatal sepsis and also to identify infants at high risk for sepsis, our main emphasis should be towards preventing nosocomial infections. Guidelines for reducing nosocomial infections are described.

Body electrolytes in bronchopulmonary dysplasia and the effects of diuretic therapy.

Body electrolytes and their regulatory hormones were studied in preterm infants who suffered from bronchopulmonary dysplasia under two groups: those who were not treated with diuretics (Group II), and those who were treated with diuretics (Group III). The values were compared with a group of matched healthy controls (Group I). Lower serum Na levels, a need of higher Na intake, and higher urinary Na concentrations and urinary specific gravity were found in Group II infants. FeNa was normal and the urinary flow rate was lower than the controls. These data suggest an inability of these infants to dilute urine. Group III infants who were treated with diuretics showed higher serum Na levels and lower urinary specific gravity than Group II infants. These values, as well as water and Na intake/output ratios, were all similar to the control values. Serum aldosterone level was highest in Group II but did not reach significance. Intracellular K concentration was not different between the groups indicating an optimum total body K balance. A significant negative correlation between serum Na and aldosterone levels was found in Group II infants, which was not noted in the controls. Significant correlations were also found between FeNa and plasma aldosterone level in the BPD groups, unlike the controls. The control group of infants showed significant positive correlation between Na balance and serum Na levels. Our results suggest that inability to dilute urine appropriately might be the reason for the BPD patients to retain body water. Water restriction and diuretic therapy therefore are reasonable therapeutic approaches in such cases.

Fecal sodium and potassium losses in low birth weight infants.

We measured 24-hour fecal losses of sodium (Na) and potassium (K) in immediate post natal period of preterm neonates to determine the role of this route in the electrolyte imbalances seen in such infants. The values from preterm infants were compared to a group of age matched term infants. Eleven studies were done on unfed extremely low birth weight infants (group I, birth weight < 1200 gms), seven on fed preterm infants (group II, birth weight 1201-2500 gms) and nine on fed term infants (group III, birth weight 2501-4000 gms). Measured and derived variables compared between the groups were 24 hour fecal volume, total fecal electrolyte contents, Na or K lost per kg of body weight and per gm. of stool and Na or K losses as percent of intake. Although 24 hour fecal volume was lowest in group I, none of the variables related to Na differed between groups I and II whereas all of them were significantly lower in group I when compared with group III. Groups II and III differed only in terms of Na loss/gm stool which was lower in the previous group. Conversely K loss/gm of stool was significantly higher in group I when compared with both groups II and III and the only variable that differed between groups II and III was a higher fecal K content as fraction of intake. Fecal K/Na ratio was highest in group I, and decreased progressively with advancing gestational age, whereas creatinine clearance was lowest in group I and increased along with gestational age.(ABSTRACT TRUNCATED AT 250 WORDS)