Respiratory tract culture: could it be an additional diagnostic modality of neonatal sepsis?

Study objective is to evaluate the role of respiratory tract colonization pattern-in predicting pathogens isolated during episodes of neonatal sepsis. A prospective study including 50 septic newborns [21 full term and 29 preterm] was carried in the neonatal intensive care units [NICUs] of Cairo University [Kasr el Aini and Abou el Riche Children Hospital] during the period between March 2007 and December 2007. In addition to routine laboratory work up for sepsis, culture was performed on respiratory specimens obtained using either blind [non bronchoscopic] bronchoalveolar lavage [BAL] or tracheal aspirate [TA]. Comparing blood and respiratory cultures regarding the presence of bacterial growth, there was a statistically significant relation between them; as we retrieved the same organism in almost 30% of cases. In conclusion, Culture of tracheal secretions could be of use as an indicator of changes taking place in the NICU environment. However, it is recommended only if clinical signs point out pneumonia, associated with variation in amount and character of secretions, even if the chest x-ray shows no abnormality. Cultures of tracheal aspirates could not substitute the blood culture in diagnosis of neonatal sepsis

Hypocalcemia in the critically ill child

This study was carried out on 39 critically ill infants and children at the New Children's Hospital of Cairo Univeristy to detect the frequency of hypocalcemia and derangements in calcium homeostasis among the critically ill children. The children were grouped into four groups; cardiac, respiratory, neurological and renal, with 10 normal infants and children as a control group. Determination of total serum calcium, serum ionized calcium, arterial blood pH and serum albumin were done. Results showed that total serum calcium was in all groups, serum ionized calcium was significantly lower in all groups except the neurological one, albumin was low in the renal group only, arterial pH was different from the control group in all other groups except the cardiac one. It was also observed that decreased serum albumin leads to decreased total calcium, increased pH leads to decrease ionized calcium and vice versa. Correlation between total and ionized calcium showed a +ve significant correlation in all groups except the renal group. Therefore, it is indicated that hypocalcemia is a common, unrecognized problem in the critically ill pediatric patient. The total serum calcium concentration is a poor predictor for those patients while serum ionized calcium value is a better predictor for the more clinically relevant cases. For that reason, it is recommended to measure serum ionized calcium in critically ill children and consequently calcium administration, specially in those suffering from multisystem derangements, even if the total serum calcium is within normal value