Point-of-Care Verification of Blood Culture Volume in Neonates: A Feasibility Trial.

BACKGROUND: Blood cultures remain the gold standard for the diagnosis of sepsis. However, volumes of blood submitted for cultures often do not match the recommended values. We propose a simple intervention aimed to verify the volume of blood sampled using a scale. This study was undertaken in preparation for a future, multicenter, pre- and post-intervention trial. Our primary objective was to test the feasibility (uptake and retention) of this future intervention. MATERIALS AND METHODS: This study was conducted at a neonatal department in Warsaw, Poland, over a period of eight months (May to December 2020). Before starting the study, we undertook an educational intervention focused on obtaining adequate blood volumes for culture. The culture bottles that were weighed in advance were distributed in all blood collection areas. Blood volume was verified by weighing the bottle immediately after blood inoculation. The calculated value was communicated to the collecting clinician and recorded. The primary outcome measure was the percentage of blood culture submissions for which the blood volume inoculated into the bottles was determined by weighing. RESULTS: During the study period, 244 blood samples were collected for culture, out of which 205 samples were weighed (84.0%, CI95 [78.8% to 88.4%]). This high proportion remained stable throughout the study period. We have not observed any adverse events related to the study. CONCLUSIONS: The point-of-care verification of blood culture volume using a scale was feasible to implement. Since we have met our pre-established criterion for success, a future, definitive trial is likely to proceed.

Rationale for the Use of Cord Blood in Hypoxic-Ischaemic Encephalopathy.

Hypoxic-ischaemic encephalopathy (HIE) is a severe complication of asphyxia at birth. Therapeutic hypothermia, the standard method for HIE prevention, is effective in only 50% of the cases. As the understanding of the immunological basis of these changes increases, experiments have begun with the use of cord blood (CB) because of its neuroprotective properties. Mechanisms for the neuroprotective effects of CB stem cells include antiapoptotic and anti-inflammatory actions, stimulation of angiogenesis, production of trophic factors, and mitochondrial donation. In several animal models of HIE, CB decreased oxidative stress, cell death markers, CD4+ T cell infiltration, and microglial activation; restored normal brain metabolic activity; promoted neurogenesis; improved myelination; and increased the proportion of mature oligodendrocytes, neuron numbers in the motor cortex and somatosensory cortex, and brain weight. These observations translate into motor strength, limb function, gait, and cognitive function and behaviour. In humans, the efficacy and safety of CB administration were reported in a few early clinical studies which confirmed the feasibility and safety of this intervention for up to 10 years. The results of these studies showed an improvement in the developmental outcomes over hypothermia. Two phase-2 clinical studies are ongoing under the United States regulations, namely one controlled study and one blinded study.

Echocardiographic assessment of tricuspid regurgitation and pericardial effusion after cardiac device implantation.

BACKGROUND: The frequency of cardiac implantable electronic device (CIED) implantations is constantly increasing. Pericardial effusion (PE) and tricuspid regurgitation (TR) may occur after CIED implantation. The aim of the present study is to evaluate the prevalence and risk factors for new occurrences or progression of TR and PE early after CIED implantation. METHODS: This is an on-going, single-center, observational study of patients after their first CIED implantation, with an echocardiographic evaluation within 60 days before and 7 days after the procedure. Data are presented for first 110 consecutive patients who underwent CIED implantation from August 2015 to July 2016. RESULTS: Median age was 75 years, and 44% were women. In total, 87 (79%) pacemakers, 21 (19%) implantable cardioverter-defibrillators and 2 cardiac resynchronization therapy devices were implanted. After CIED implantation, there was TR progression in 17 (16%) patients: 5 patients developed moderate TR, none developed severe TR. An increase in TR was more often observed after implantations performed by operators in training than by certified operators (35% vs. 12%, p = 0.02). New PE after the procedure was observed in 8 (7%) patients and was trivial ( < 5 mm) in all cases. Patients with new PE after implantation had lower baseline hemoglobin levels and tended to be women. CONCLUSIONS: New PE and an increase in TR severity are rare complications early after CIED implantation. Operator experience might be related to TR progression. Increasing the number of patients in the current on-going study will allow a more reliable assessment of the prevalence and risk factors of these complications.