Comparison of proposed National Institute of Child Health and Human Development panel recommendations with newborn sepsis risk calculator in term neonates exposed to maternal chorioamnionitis.

BACKGROUND: Maternal chorioamnionitis (MC) is one of the major risk factors for early-onset neonatal sepsis. Kaiser sepsis risk calculator (SRC) is a validated risk assessment tool for such newborns. The National Institute of Child Health and Human Development (NICHD) workshop on MC has proposed a risk assessment algorithm. The objective of the study was to compare the reduction in antibiotic use in newborns treated with SRC and NICHD algorithm and determine the antibiotic use correlation between them. METHODOLOGY: A retrospective chart review was performed on newborns born at ≥ 37 weeks to mothers with MC during the years 2018-2020. The same cohort of newborns was evaluated using SRC and NICHD algorithm to determine whether treatment with antibiotics could have been avoided in some patients. The data were analyzed using a t-test, Chi-square test, and ANOVA. RESULTS: During the study period, 101 newborns were born to mothers with chorioamnionitis and received antibiotics. When the newborns were assessed using the SRC, only 16/101 (15.84%) would have received treatment. When NICHD algorithm was applied to the same cohort 71/101 (70.30%) newborns would have received treatment. The two approaches agreed in their assessment for treatment or observation only in 44/101 (43.56%) of the cases. The NICHD treatment group had a higher incidence of chorioamnionitis as seen in placental pathology (94.37% vs. 75.00% for Kaiser, p-0.015). The SRC treatment group however had newborns with significantly lower Apgar score at 1 min (8.21 vs 6.63, p-0.006) and 5-minute (8.69 vs 8.00, p-0.019) and had significantly higher supplemental oxygen requirements at admission (62.50% vs. 21.13%, p < 0.001). CONCLUSION: Both SRC and NICHD algorithms expose fewer newborns to antibiotics; however, they differ in the number of newborns that would require antibiotics. Ventilation assistance and lower Apgar scores were associated with higher probability of antibiotic administration.

In Utero Vertical Transmission of Coronavirus Disease 2019 in a Severely Ill 29-week Preterm Infant.

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) or coronavirus disease 2019 (COVID-19) is currently in worldwide pandemic state with very limited data about the mode of transmission to the growing fetus. There are a few published cases of COVID-19 infection in the infants born to COVID-19 positive mothers where most of the reported cases were either mildly symptomatic with positive COVID-19 polymerase chain reaction (PCR) or had negative COVID-19 PCR raising the question of vertical transmission. We present a case of likely intrauterine transmission of COVID-19 infection in a critically ill premature infant born to a COVID-19 infected mother and describing her clinical course thus far. The clinical presentation in the infant is consistent with COVID-19 infection described so far in literature along with positive PCR, and positive COVID-19 serology: immunoglobulin G, immunoglobulin M, and immunoglobulin A.

Intervención fisioterápica preventiva del deterioro de la musculatura respiratoria en ancianas institucionalizadas con limitación funcional / Physiotherapy Intervention for Preventing the Respiratory Muscle Deterioration in Institutionalized Older Women with Functional Impairment

Introducción: En el anciano de edad avanzada (> 80 años) la función respiratoria puede verse afectada cuando a la presencia de comorbilidad y la pérdida de movilidad se suma el descenso de la fuerza de la musculatura respiratoria (MR). La literatura médica ha mostrado que el entrenamiento de la MR puede ser una intervención efectiva para mejorar la funcionalidad y prevenir el deterioro clínico, especialmente en la población con debilidad de la MR. El objetivo del estudio fue evaluar la efectividad del entrenamiento de la MR en la fuerza y resistencia de esta musculatura, en ancianas institucionalizadas con limitación funcional. Método: Se asignaron aleatoriamente 54 residentes con limitación para deambular (media 85 años, DE 6,7) a un grupo control (n = 27) y entrenado (n = 27). Se desarrolló un programa de entrenamiento supervisado, mediante Threshold ®IMT, 5 días por semana durante 6 semanas. Las variables principales fueron: la presión inspiratoria máxima (PImáx), la presión espiratoria máxima (PEmáx) y la ventilación voluntaria máxima (MVV), medidas en las semanas 0, 4, 7 y 10.ResultadosLos análisis estadísticos no revelaron cambio en la PImáx (F3,114 = 1,04, p = 0,368, R2 = 0,027), PEmáx (F3,114 = 1,86, p = 0,14, R2 = 0,047) y MVV (F3,114 = 1,74, p = 0,162, R2 = 0,044) entre ambos grupos tras la intervención. No obstante, la carga de trabajo mejoró significativamente con el entrenamiento (F5,100 = 72,031, p < 0,001, R2 = 0,791). Conclusión: El dispositivo de entrenamiento umbral en un programa interválico de 6 semanas no produce una mejora significativa de los parámetros relacionados con la fuerza y la resistencia de la MR, en la población estudiada(AU)

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness. The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10.ResultsStatistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population(AU)