The ratio of abdominal circumference and body weight--an objective parameter for the daily ward round in a NICU?

OBJECTIVE: Feeding tolerance and the degree of abdominal distension are important factors on the ward round on a NICU. They are basis for systematic changes in enteral feeds and an early indicator of clinical deterioration. Our aim was to examine the ratio of abdominal circumference(AC) to body weight (BW) as an additional variable for abdominal distension and its relationship to feeding, the increase of feeds and CPAP. HYPOTHESIS: The AC/BW ratio of premature infants decreases in serial measurements with increasing body weight during the fi rst 28 days of life. Higher amount of enteral nutrition and CPAP cause an increase. PATIENTS AND METHODS: In 30 premature infants(mean: 27.5 weeks, SD 2.2; 16 male, 2 200 measurements),daily measurement and recording during the fi rst 28 days of life: AC (cm), BW (g),enteral/parenteral amount of fluid intake, type of formula, composition of macronutrients (breastmilk, type of formula), gastric residual volume,CPAP therapy. RESULTS: Increase of AC ratio mean value from 19.9, SD 3.2 (d1) to 25.0, SD 5.2 (d6), followed by continuous decrease to 19.9, SD 4.4 (d28). Weeks of gestation, total amount of enteral feeding had a significant eff ect (p < 0.05). With increasing total amount of enteral feeding, the AC/BW ratio decreased. Changes in enteral feeding volume,CPAP had no significant eff ect. CONCLUSION: Our aim was to provide longitudinal data from VLBW infants and to assess whether AC/BW ratio is affected by feeding, increase in feds and CPAP. In future the ratio may be a more objective parameter to avoid withholding feds or to detect early clinical deterioration.

Healthcare worker-related MRSA cluster in a German neonatology level III ICU: a true European story.

Here we investigated a cluster of eight newly Methicillin-resistant Staphylococcus aureus (MRSA)-colonized neonates at an ICU, and present data on molecular strain characterization as well as the source identification process in which we analyze the impact of MRSA-colonized HCWs. Molecular strain characterization revealed a unique pattern which was identified as spa-type t 127--an extremely rare strain type in Germany. Environmental sampling and screening of parents of colonized neonates proved negative. However, staff screening identified one healthcare worker (HCW; 1/134) belonging to a group of recently employed Romanian HCWs who was colonized with the spa 127 strain. Subsequent screening also detected MRSA in 9/51 Romanian HCWs (18%) and 7/9 (14% of all) isolates showed the same molecular pattern as the index case (spa/PFGE type). All carriers were successfully decolonized, after which no new patient cases occurred. As a result, we have now implemented a universal screening programme of all new employees as part of our infection control management strategy. MRSA-colonized HCWs can act as a source for in hospital transmission. Since HCWs from high endemic countries are particular prone to being colonized, they may pose a risk to patients.

Ballantyne syndrome and congenital anaemia associated with Parvovirus B19 infection: case report and review.

Acute maternal Parvovirus B19 infection affects about 1% of all pregnancies worldwide. Diaplacental transmission of Parvovirus B19 during the second trimester can cause complications like foetal hydrops, premature delivery or foetal loss in about 20-30% of these pregnancies, whereas the majority of maternal infections remain clinically silent. In individual cases, foetoplacental hydrops (of various origins) can trigger a rare form of Preeclampsia in the pregnant woman. The developing maternal oedema in this situation apparently "mirrors" the hydropic state of the foetus. The symptom triad of foetal hydrops, foetoplacental oedema and maternal anasarca defines Ballantyne syndrome. We report a case of Parvovirus-induced Ballantyne syndrome including a 10-year follow-up of mother and child. While the mother recovered rapidly after (preterm) delivery, the infection complicated the first months of life of the neonate. Congenital transfusion-dependent red cell aplasia and cholestatic hepathopathy took a chronic course but resolved under IVIG treatment. Follow-up now finds both the former neonate and the mother entirely recovered. Current knowledge on Ballantyne syndrome as well as perigestational Parvovirus infections including congenital anaemia is briefly reported and pathophysiological hypotheses are discussed.

Intraoperative amiodarone as prophylaxis against atrial fibrillation after coronary operations.

BACKGROUND: New onset of atrial fibrillation is a frequent complication after coronary artery bypass grafting and is a major cause of postoperative morbidity. Preoperative oral treatment with amiodarone hydrochloride has been shown to be efficacious as prophylaxis. The present study investigated whether intraoperative use of intravenous amiodarone has a preventive effect on the incidence of atrial fibrillation after coronary revascularization. METHODS: In a prospective study, 150 consecutive patients (mean age, 63 +/- 8 years; 132 men and 18 women) undergoing coronary artery bypass grafting were randomly assigned to one of three groups. Two groups received different doses of intravenous amiodarone (group I, 300-mg bolus and 20 mg x kg(-1) x day(-1) for 3 days; group II, 150-mg bolus and 10 mg x kg(-1) x day(-1) for 3 days) after aortic cross-clamping and one group, placebo (group III). Continuous electrocardiographic online monitoring was performed for 10 days. Arrhythmias were analyzed with respect to type, frequency, duration, and clinical relevance. RESULTS: New onset of atrial fibrillation occurred in 24% of patients in group I, 28% in group II, and 34% in group III (p = not significant). Atrial fibrillation with a rapid ventricular response (>120 beats per minute) was significantly more frequent in the control group (group I, 14%; group II, 24%; group III, 32%; p < 0.05, group I versus group III) and appeared significantly earlier (group I, day 4.3 +/- 2.5; group II, day 4.8 +/- 2.9; group III, day 2.6 +/- 1.3; p < 0.05, group III versus groups I and II). Temporary atrial pacing because of bradycardia (<60 beats per minute) was necessary significantly more often in group I (group I, 48%; group II, 40%; group III, 28%; p < 0.05, group I versus group III). Early mortality rate (group I, 4%; group II, 2%; group III, 4%), rate of perioperative complications (group I, 14%; group II, 20%; group III, 14%), and duration of hospital stay (group I, 14.0 days; group II, 14.4 days; group III, 14.7 days) were not different between groups. CONCLUSIONS: Intraoperative prophylactic use of amiodarone does not prevent new onset of atrial fibrillation in patients undergoing coronary artery bypass grafting and had no effect on outcome. Therefore, intraoperative prophylactic treatment with amiodarone at the tested doses does not appear to be justified.