Mycoplasma and Ureaplasma carriage in pregnant women: the prevalence of transmission from mother to newborn.

BACKGROUND: Mycoplasma and Ureaplasma have been extensively studied for their possible impact on pregnancy, and their involvement in newborn diseases. This work examined Mycoplasma and Ureaplasma carriage among gravidas women and newborns in Israel, as well as associations between carriage and demographic characteristics, risk factors, pregnancy outcomes, and newborn morbidity rates. METHODS: A total of 214 gravidas women were examined for vaginal pathogen carriage through standard culture and polymerase chain reaction assay. Pharyngeal swabs were collected from newborns of carrier mothers. Clinical and demographic data were collected and infected newborn mortality was monitored for 6 months. RESULTS: Nineteen mothers were carriers, with highest prevalence among younger women. Pathogen carriage rates were 2.32% for Mycoplasma genitalium (Mg), 4.19% for Ureaplasma parvum (Up) and 2.32% for Ureaplasma urealyticum (Uu). Arab ethnicity was a statistically significant risk factor (p = 0.002). A higher prevalence was seen among women residing in cities as compared to villages. Thirteen (68%) newborns born to carrier mothers were carriers as well, with a higher prevalence among newborns of women delivering for the first time, compared to women that had delivered before. Infection rates among newborns were 20% for Mg (p = 0.238), 100% for Up (p < 0.01), and 28.5% for Uu (p = 0.058), with more male than female newborns being infected. No association was found between maternal carriage and newborn morbidity. CONCLUSIONS: Maternal Mycoplasma or Ureaplasma carriage may be associated with ethnicity and settlement type. Further studies will be needed to identify factors underlying these associations and their implications on delivery.

[AN ELECTRONIC PATIENT RECORD (EPR) - "A STING IN THE TAIL" (E-IATROGENESIS): PRIMUM NON NOCERE].

INTRODUCTION: Use of Electronic Patient records is most efficient but careless use can result in harm to the patient caused by advanced technology - E-Iatrogenesis. Correct use of the electronic systems can reduce the amount of technology-related errors in the Electronic Patient record. Beyond all doubt, handwritten medical records can contribute to human error due to unclear handwriting, unclear phrases, etc. Moreover, physical files can be lost or misplaced thus making it difficult to retrieve patient history.

[MEDICAL CLOWNS: THE TRIPLE VALUE - CLOWN-PARENT-PREMATURE NEONATE].

INTRODUCTION: The infant's brain develops rapidly during the prenatal and early postnatal period. Temporary new neural circuits appear, such as the sub-cortical plate (SCP). SCP links the thalamus and cortex in a time window of sensory circuits' intensive development, creating the basis for the infant's bonding interactions. SCP activity in premature neonates is vulnerable and hypoxic injury may have a long lasting influence on brain development. Preterm birth is an emotional trauma for the parents and may lead to depression, anxiety and stress. This has an impact on the family, effecting parents' function and adaption to their new role, and the development of deep emotional bonds with their infant. Parent-infant negative interaction in NICU or later may lead to non-functional parenthood, hence, early intervention in NICU is important and may improve parental function and bonding with the infant. Humor has positive effects on human physical and mental health. There has been a fast increase in the number of medical clowns in clinical departments, and research shows that the medical clown is effective in enhancing medical efficiency. However, as yet, there is no scientific evidence regarding medical clowns in the NICU. In the NICU, medical clowns create an imaginary triangle by connecting to the parents and their premature neonate, based on a sensory-emotional common denominator and a common language for clinical purposes. The medical clown's clinical model is based on five components related to the parents and the infant. These components serve as a human bridge linking the infant entourage/surrounding. Research based on objective indexes is necessary to evaluate the efficiency of medical clowns for parent-infant bonding and the significance of medical clowns for infant development.

Peripartum maternal transmission of extended-spectrum ß-lactamase organism to newborn infants.

The aim of this study was to determine whether the route of extended-spectrum ß-lactamase (ESBL) transmission to hospitalized newborns was from their mothers during delivery. Neonatal intensive care unit (NICU) hospitalized newborns were sampled for ESBL presence by stool cultures on the first and fourth days of life. Mothers of ESBL-positive newborns were sampled for possible correlation detection. Bacteria isolates were molecularly identified and susceptibility tests for antibiotic agents were performed. Of the 225 newborns, 14 (6.2%) were ESBL positive, 10 (4.4%) were Escherichia coli positive, and 4 (1.7%) were Klebsiella pneumoniae positive. Among the 14 mothers of positive newborns, 13 (92.8%) were found ESBL positive and one mother of a newborn with E. coli carriage was found ESBL negative. Genes encoding for ESBL resistance were identified. Antibiotic sensitivity and resistance were tested. This study demonstrated that ESBL bacteria carrier neonates hospitalized in NICU may be a result of transmission from mother to baby during delivery.

The virtual neonate in The Neonatal Intensive Care Unit: when twin number three adds up to error not imagination.

BACKGROUND: During the administrative admittance of extreme premature twin neonates to the Hospital Information System (HIS), at an Israeli government general hospital, a third virtual baby was mistakenly admitted in addition to the twins. The third virtual baby's records were in department occupancy and transactions were performed in the HIS, such as "admittance" to Neonatal Intensive Care Unit (NICU), being appended to a mother as well as clinical orders. METHODS: Once noticed, the records of the third virtual baby were merged in the system with the second correct twin (Baby II), whose records were also in the department occupancy list. RESULTS: An error occurred in the interface whilst merging the records, and patient demography was not updated for clinical orders for Baby II. As a result, all new clinical orders for Baby II carried the non existing third baby's identity. CONCLUSIONS: We emphasize that it is advisable to register all newborns as early on in life whilst still in the delivery room, with a permanent identification number as opposed to a temporary identification number to avoid any mismatching if patients records are to be merged or updated. Furthermore, steps that could help prevent such an event could be additional administrative staff to register newborns. However, we conclude, that it would be most helpful to introduce a Radio Frequency Identification (RFID) system based on a permanent identity number. If any discrepancies in patient information are detected, an alarm will be triggered during transfer of the baby from the delivery room to the designated Department. A RFID receptor is located at the exit of the delivery room. While most literature available regarding Hospital Information Technology (HIT) and patient safety, mainly discusses mismatching of patients during medication and laboratory testing not much literature regarding the process of registering newborns as a source of patient mismatching has been found. The authors feel that there is a need to further investigate this aspect as it is a source that can affect not only accuracy in the Electronic Patient Record (EPR) but furthermore has the impact to change the course of a life and set tone for that person's future.

Influenza A/H1N1 virus in very low-birth-weight premature infant: case report.

Influenza is an uncommon illness among premature infants in developed modern neonatal intensive care units (NICUs), but if infants do manifest symptoms of this significant illness, they commonly present with an abrupt onset, with temperature instability and upper respiratory tract involvement and, commonly, clinical features similar to bacterial sepsis. Additionally, frequent manifestations include bronchiolitis and pneumonia. Influenza infection in premature infants is likely a result of reduced levels of passively transferred protective maternal antibodies. Timely supportive therapy, antiviral agents, and isolation of affected infants to prevent spread of infection may be sufficient protective measures in the NICU. We report a case of a 50-day-old very low-birth-weight premature infant with novel A/H1N1 influenza virus (swine flu). There were no obvious epidemiological conditions in the NICU among patients and staff. The unique presenting symptom was apnea, which required respiratory support by nasal intermittent positive pressure ventilation. Due to the current pandemic, neonatologists should be aware of possible infection of neonates with novel A/H1N1 influenza virus.