Bacterial Pathogens and Evaluation of a Cut-Off for Defining Early and Late Neonatal Infection.

Bacterial infections are an important cause of mortality and morbidity in newborns. The main risk factors include low birth weight and prematurity. The study identified the most common bacterial pathogens causing neonatal infections including their resistance to antibiotics in the Neonatal Department of the University Hospital Olomouc. Additionally, the cut-off for distinguishing early- from late-onset neonatal infections was assessed. The results of this study show that a cut-off value of 72 h after birth is more suitable. Only in case of early-onset infections arising within 72 h of birth, initial antibiotic therapy based on gentamicin with ampicillin or amoxicillin/clavulanic acid may be recommended. It has been established that with the 72-h cut-off, late-onset infections caused by bacteria more resistant to antibiotics may be detected more frequently, a finding that is absolutely crucial for antibiotic treatment strategy.

Lactate as an early predictor of psychomotor development in neonates with asphyxia receiving therapeutic hypothermia.

AIMS: This prospective study aimed to evaluate the relationship between persistently elevated lactate values in the arterial blood of newborns with grade II and III hypoxic ischemic encephalopathy (treated with therapeutic hypothermia) and psychomotor development at 24 months. METHODS: 51 neonates of gestational age from 36 to 41 weeks receiving therapeutic hypothermia for moderate to severe hypoxic ischaemic encephalopathy had arterial blood lactate levels regularly analysed. At 24 months the infants' psychomotor development was evaluated and they were divided into two groups - those where the outcome was favourable (i.e. normal psychomotor development) and adverse (severe motor or sensory impairment or death). The lactate dynamics over time were retrospectively evaluated from the data collected, with the normal upper limit set at 4 mmol/L. RESULTS: Of the 51 affected neonates, 7 died over the course of the study. 34 of the remaining 44 infants demonstrated normal psychomotor findings at 2 years old, with adverse findings in 10 cases. Although both groups experienced significant reductions in lactate over time, there were statistically significant differences between them regarding currently measured lactate levels. CONCLUSION: Absolute lactate values and their development over time can be a used as an auxiliary factor in making early estimates of the long-term outcome for newborns with neonatal asphyxia being treated with therapeutic hypothermia.

Kinematic analysis of preterm newborns' spontaneous movements for postural activity assessment.

AIMS: The objectives of this pilot study were to assess the potential use of 3D videography for analyzing the motion of the body center of mass (COM) in newborns and to determine differences in spontaneous movements between preterm and full-term infants. METHODS: The group comprised 10 preterm newborns (gestational age at birth between 26 and 37 weeks; birth weight 800 to 2960 g; gestational age at the time of examination 34 to 39 weeks) and 10 full-term infants (gestational week 38 to 41; birth weight 2810 to 4360 g). To determine the range of motion of the COM, 3D videography was used (2 cameras, 25 Hz). When recording their movements, the infants were in the supine position, calm and awake. The recordings were processed using the APAS software. Selected points on the body were marked to obtain data for calculating the basic parameters of COM trajectories. RESULTS: The range of motion of the COM in both craniocaudal and anteroposterior directions was significantly greater in premature infants (P < 0.05 and P < 0.01, respectively) than in full-term babies. The variability of motion of the COM was significantly greater in the craniocaudal (P < 0.01) and anteroposterior (P < 0.05) directions in preterm babies. This was also valid for the velocity of motion of the COM in the craniocaudal direction (P < 0.05). CONCLUSIONS: 3D videography can be used for experimental assessment of motor behavior in preterm infants. Basic kinematic characteristics of the motion of the COM (range, variability, velocity) are greater in preterm infants.

Skin conductance as a marker of pain in infants of different gestational age.

AIMS: To assess the use of skin conductance as an objective measure of pain in infants of different gestational age. A second aim was to investigate the relationship between skin conductivity and selected physiological and behavioural variables (oxygen saturation, heart rate and behavioural state). METHODS: Infants were divided according to gestational age into the following 3 groups; group A: 25+0-31+6 weeks (13 infants), group B: 32+0-35+6 weeks (25 infants), group C: 36+0-41+6 weeks (19 infants). The pain stimulus was blood sampling. RESULTS: The most sensitive parameter for describing changes in skin conductance related to pain was peak per second. No other parameter correlated with the physiological variables chosen. The results showed that the inability to determine basal skin conductance is a crucial disadvantage to practical application. The lack of correlation between conductance parameters and gestational age is surprising. CONCLUSION: We conclude that the Peak per Second is the best parameter for evaluating skin conductance in infants and it is not influenced by gestational age. Peaks per Second correlate only with Prechtl's Scale of behavioural state and not with the physiological parameters chosen.

Tc-99m exametazime (HMPAO)-labeled leukocyte scintigraphy in premature infants: detection and localization of necrotic enterocolitis and osteomyelitis.

Two cases of successful detection of inflammatory foci using Tc-99m exametazime (HMPAO)-labeled leukocyte scintigraphy in premature infants were reported. Necrotizing enterocolitis was detected in a child with a body weight of 1.6 kg. Scintigraphy confirmed a neonatal osteomyelitis in the distal part of the leg of another patient weighing 2.2 kg. These 2 cases indicate that it is feasible to perform Tc-99m HMPAO-labeled leukocyte scintigraphy even if the blood sample volume is lower than the minimal volumes required by the guidelines for pediatric patients.

Analysis of ESBL- and AmpC-positive Enterobacteriaceae at the Department of Neonatology, University Hospital Olomouc.

Bacterial infections are an important issue in current clinical medicine. The severity of infectious diseases has increased dramatically in recent years, which is also due to increasing numbers of resistant bacteria, including strains producing broad-spectrum beta-lactamases. The study aimed at determining the prevalence of ESBL- and AmpC-positive Enterobacteriaceae at the Department of Neonatology, University Hospital Olomouc. Enterobacteriaceae were isolated from clinical samples from infants hospitalized at the Department of Neonatology, University Hospital Olomouc over a period of 2 years. ESBL- and AmpC-positive isolates were subjected to basic genetic analysis. In the study period, a total of 1,526 isolates of the Enterobacteriaceae family were identified, including 55 (3.6%) cases of the ESBL phenotype and 17 (1.1%) AmpC-positive isolates. Genetic analysis of ESBL-positive isolates revealed a majority of CTX-M enzymes. Among AmpC beta-lactamases, the EBC, CIT, DHA, and MOX types were detected. An Escherichia coli strain was isolated with mutations in the promoter region of the ampC chromosomal gene that are associated with overproduction of the relevant enzyme.

[Molecular biology characteristics of ESBL-positive strains of Klebsiella pneumoniae collected in the Neonatal Unit of the Teaching Hospital in Olomouc]. / Molekulárne-biologická analýza ESBL-pozitivních kmenu Klebsiella pneumoniae na novorozeneckém oddelení Fakultní nemocnice Olomouc.

BACKGROUND: One of the problems of contemporary medicine is an increasing number of bacterial strains with hazardous phenotypes of resistance. This is also true for neonatal units where nosocomial infections caused by multiresistant bacteria pose a serious threat to newborns. The feared bacterial pathogens include Klebsiella pneumoniae strains producing AmpA Extended-Spectrum Beta-Lactamases. The study focused on the molecular biology characteristics of ESBL-positive strains of K. pneumoniae collected in the Neonatal Unit of the Teaching Hospital in Olomouc (THO). MATERIALS AND METHODS: Clinical material from newborns hospitalized in the THO Neonatal Unit between January and June 2004 was used to isolate and determine K. pneumoniae strains by standard identification procedures. Their susceptibility to antibiotics was tested using a dilution micromethod. A Double-Disk Synergy Test was used for phenotype determination of ESBL production. The bla gene coding ESBL production was demonstrated by PCR. Molecular biology characteristics of ESBL-positive strains utilized the genomic DNA isolation, XbaI restrictase digestion and PFGE differentiation. The acquired restriction maps of individual isolates were compared using the GelCompare software and their relationship was determined. The selection pressure of antimicrobial agents was assessed according to the absolute number of defined daily doses of individual antibiotics. RESULTS: During the monitored period, 112 K. pneumoniae strains were isolated in total. In 22 of them (19.6%), the TEM-type ESBL production was determined. ESBL-positive strains were only observed in upper respiratory tract and rectal swabs collected from newborns with no signs of infection. The molecular biology analysis showed that 21 ESBL-positive strains had an identical restriction profile, i.e. they were very likely to be identical. The selection pressure of third- and fourth-generation cephalosporins was very low over the observed period and their consumption accounted for 1.9 % of all administered antimicrobial agents. CONCLUSION: The results presented above suggest that ESBL-positive strains of K. pneumoniae occurred in the THO Neonatal Unit due to clonal and horizontal spread from an unidentified source.