Double-catheter technique for the proper insertion of umbilical venous catheters in newborns

To document the usefulness and safety of inserting a second umbilical venous catheter in ill neonates, while a previously misplaced first catheter was still in its place. Subjects and Methods:The case series involved 25 newborn babies who were admitted to the Neonatal Intensive Care Unit, Maternity Hospital, Kuwait, over a 3-year period from 1999 to 2002. The umbilical venous catheter of the babies was misplaced and diverted to the liver, necessitating insertion of a second catheter while the previous one was still in place. The characteristics of the babies and possible catheter-related complications were recorded. Results:Of the 25 babies, 19 had the second catheter properly placed in the right atrium, while in the remaining 6 neonates, the catheter was still misplaced. Misplacement occurred mostly in full-term babies or the catheter was inserted at a later stage. No life-threatening complication was observed during the procedure. Conclusion:Insertion of a second umbilical venous catheter with the misplaced first catheter in situ is a useful and safe procedure

Wheezing in infancy; is it asthma? Guidelines for general practitioners

Pediatricians and general practitioners frequently deal with infants who are wheezing. The main challenge is the treatment of the acute attacks, management of recurrent attacks, and above all, how to counsel the parents regarding the prognosis of the illness. The majority of wheezing attacks in infants are initiated by respiratory syncytial virus [RSV] infection, although factors like maternal smoking and others may predispose to the illness.1-3 Up to half of those infants may continue wheezing till six years of age and a smaller percentage continues to wheeze in their late childhood.1,2 This paper gives some guidelines to the pediatrician and general practitioners for dealing with wheezing in infancy

Pattern of candidiasis in the newborn: a Study from Kuwait

To determine the rate and pattern of Candida infection in a large neonatal unit in Kuwait. A prospective study of all newborn infants who were admitted to the neonatal intensive care unit [NICU] at Maternity Hospital in Kuwait during the year of 1997 and who were suspected of having Candida infection were collected and analyzed. Method of selection of neonates, laboratory parameters and possible risk factors of the infection were identified and defined. Results:Candida infection was recognized in 22 [8.4%] cases out of 263 total infants admitted to the NICU. All the proven cases originated from 168 infants of birth weight less than 2,000 g with an incidence of 13%. In addition, Candida infection was suspected and treated without positive culture in 15 infants [5.7%]. Cases with proven Candida sepsis had longer mean duration of endotracheal intubation [p < 0.03] and total parenteral nutrition [p < 0.03] and more episodes of concomitant bacterial infection [p < 0.01] compared to infants with suspected candidiasis. For an early diagnosis of candidiasis, a high index of suspicion in septic low-birth weight infants is always warranted since the clinical and laboratory diagnostic parameters are difficult to differentiate between suspected and proven cases

Neoatal candidiasis

Invasive candidiasis has become a significant problem of preterm, low birth weight infants. Candida albicans is the most frequent cause, but other species of Candida, such as C. parapsilosis, C. tropicalis and C. glabrata are being increasingly reported. Early acquisition of the Candida sp. occurs from the mother's genital tract during delivery, while colonization thereafter is acquired mostly through caretakers. The major risk factors are low birth weight, prolonged use of central venous catheter or other lines, hyperalimentation therapy, prolonged use of broad spectrum antibiotics, and an extended period of endotracheal intubation. Colonization of skin or gut with Candida species may precede bloodstream infection, and this could be facilitated by slight trauma to fragile integument. The clinical features of neonatal candidiasis are non-specific and include deteriorating respiratory function, abdominal distention, and temperature instability. An apparently septic preterm neonate who deteriorates, despite adequate antibiotic treatment, should be considered to have systemic candidiasis, particularly if other risk factors are present. In the disseminated disease, meningitis, skin lesions, endophthalmitis or involvement of renal/genitourinary tract are not uncommon. Affected neonates may exhibit neutropenia or neutrophilia, thrombocytopenia, glucose intolerance and oliguria. At present, no single laboratory test can reliably diagnose systemic candidiasis. Blood cultures, preferably by lysis centrifugation method, microscopic examination of buffy coat smears, culture and microscopic examinations of urine samples collected by suprapubic aspiration, serial measurements of C-reactive protein, and the determination of Candida antigen levels may provide useful diagnostic information. Fundoscopic examination of the retina for fluffy white lesions, and ultrasound scans for cardiac, hepato-splenic and renal involvement, should be routinely performed. Once candidiasis is diagnosed, treatment should be started promptly. The removal of central lines and stoppage of broad-spectrum antibiotics are initial important steps and should be considered. Amphotericin B remains the drug of choice. Nephrotoxicity is minimal if the dose is kept under 1 mg/kg in preterm infants. Although amphotericin B can be used alone, combination with flucytosine [100 mg/kg] may be needed to treat neonates with severe central nervous system involvement. The duration of antifungal therapy depends upon the severity of infection and response to therapy, and therefore must be individualized. In absence of any consensus on the duration of therapy, it should be continued for 7-14 days after the first negative blood culture and/or when the signs or symptoms of the disease have completely disappeared. Fluconazole has been used successfully in some studies with minimal side-effects. A dose of 6 mg/kg every three days in the first week of life, followed by 6 mg/kg every two days in subsequent weeks, has been suggested. Likewise, liposomal amphotericin B has been successfully used in a few studies with a dose of 3 mg/kg in most of the cases. Despite sporadic reports of the therapeutic efficacy and safety of both these drugs, additional evaluation is needed to develop a consensus administration protocol. Until such information is available, fluconazole and liposomal amphotericin B may be used selectively in neonates who are either unable to tolerate conventional amphotericin B or who have failed the treatment by it

Rate of and risk factors associated with retinopathy of prematurity: a prospective study from Kuwait

To determine the rate of retinopathy of prematurity [ROP] among a population of preterm infants in Kuwait, and to review the risk factors associated with the disease. Methodology: A prospective cohort study of all preterm infants of less than 2,000 g birth weight and/or 36 weeks gestational age who were screened for ROP during 1995 at the neonatal unit of the Maternity Hospital in Kuwait. The rate of and some of the possible risk factors associated with the disease were determined. A total of 130 babies were screened of which 59 [45.4%] developed some stage of ROP. The frequency of blindness was 3 [2.3%]. Low birth weight, oxygen therapy, patent ductus arteriosus, intraventricular hemorrhage and blood transfusion were the risk factors found to be associated with the disease. However, with logistic regression analysis, only low birth weight and oxygen were independently associated with ROP. The rate of ROP in our unit is not different from that of the other centers, and low birth weight and oxygen therapy are the main risk factors associated with the disease