Painless blood testing to prevent neonatal sepsis.

The current US guidelines advise that all women colonized with Group B streptococcus (GBS) at 35-37 weeks, as well as those laboring before this time and all women with GBS urinary tract infections, should be offered intrapartum antibiotic prophylaxis, usually in the form of high-dose intravenous penicillin or ampicillin, unless delivered by planned cesarean section before the onset of labor in a woman with intact membranes. In term and preterm babies who are born to treated women, in addition to babies who act ill, the recommendation is to treat the baby with antibiotics. In certain circumstances, such as when the mother receives an intrapartum antibiotic < 4 hours prior to delivery, the baby receives antibiotics even if the baby appears well. This paper proposes a new process for testing for GBS that involves using the umbilical cord. If this process were used, babies would not need to have blood drawn and would experience less pain.

Of lobsters, electronic medical records, and neonatal total parenteral nutrition.

At the Mayo Health System in LaCrosse, Wisconsin, there are >1000 infant total parenteral nutrition (TPN) orders placed per year. It is the most complicated order that the pharmacy fills, so a recent peer-review article in Pediatrics moved a group of us to action at our center to buy or develop a TPN calculator. We did this because no stand-alone commercial calculators were available to us, and expensive electronic medical records typically do not include TPN calculators for neonatal patients. The new software includes decision support, and the orders are consistently legible. The physician performs fewer calculations, and there are no mathematical errors. This article examines the broader significance of providers having to write their own TPN software.

Vitamin K prophylaxis for premature infants: 1 mg versus 0.5 mg.

We studied babies (22 to 32 weeks gestational age) of mothers wishing to breast-feed. Group 1 received 1 mg of vitamin K and Group 2 received 0.5 mg of vitamin K. The Day 2 plasma levels of vitamin K were 1900 to 2600 times higher on average, and the Day 10 vitamin K levels 550 to 600 times higher on average, relative to normal adult plasma values, whether an initial prophylaxis dose of 0.5 mg or 1 mg was used. We conclude that 0.5 mg as the initial dose of vitamin K intramuscularly or intravenously would likely be more than adequate to prevent hemorrhagic disease of the newborn, and that 0.3 mg/per kg may be used for babies with birth weights below 1000 g. To decrease vitamin K intakes in this population, new preparations of total parenteral nutrition multivitamins are needed.