Epidemiology and Outcomes of Neonatal Sepsis: Experience from a Tertiary Australian NICU.

INTRODUCTION: Neonatal sepsis is associated with significant mortality and morbidity. Low-middle-income countries are disproportionately affected, but late-onset sepsis (LOS) still occurs in up to 20% of infants <28 weeks in high-income countries. Understanding site-specific data is vital to guide management. METHODS: A retrospective cohort study was conducted at King Edward Memorial Hospital (KEMH), Perth. Infants admitted between January 2012 and June 2022 were included. Data were extracted from routine electronic databases. Incidence and aetiology of sepsis were determined and the association of sepsis with neonatal outcomes analysed. RESULTS: During the study period, 23,395 newborns were admitted with a median gestation of 37 weeks and birth weight of 2,800 g. There were 370 sepsis episodes in 350 infants; 102 were early-onset sepsis (EOS) (1.6 per 1,000 live births), predominantly Streptococcus agalactiae (35, 34.3%) and Escherichia coli (27, 26.5%); 268 were LOS (0.9 per 1,000 inpatient days), predominantly coagulase-negative staphylococci (CONS) (156, 57.6%) and E. coli (30, 11.1%). The incidence of LOS declined from 2012 to 2022 (p = 0.002). Infants with EOS had increased brain injury (25.7% vs. 4.1%; p = 0.002) and mortality (18.8% vs. 1.6%; p < 0.001). Those with LOS had increased hospital stay (median 95 vs. 15 days; p < 0.001), mortality (15.3% vs. 1.6%; p = 0.018), necrotising enterocolitis (NEC) (7.4% vs. 0.5%; p < 0.001), and chronic lung disease (CLD) (58.1% vs. 5.9%; p = 0.005). Infants <28 weeks with sepsis were at increased risk of neurodevelopmental impairment compared to those without infection (43.2% vs. 30.9%, p = 0.027). CONCLUSIONS: While we observed a reduction in LOS incidence, sepsis remains associated with higher mortality, and in survivors with longer hospital stay and increased risk of brain injury, NEC, CLD, and neurodevelopmental impairment.

Neonatal Staphylococcus Aureus Sepsis: a 20-year Western Australian experience.

OBJECTIVES: The purpose of this study was to characterise neonatal Staphylococcus aureus (SA) sepsis in Western Australia (WA) between 2001 and 2020 at the sole tertiary neonatal intensive care unit (NICU), examine risk factors for sepsis in the cohort, and compare short- and long-term outcomes to control infants without any sepsis. METHODS: Retrospective cohort study at the Neonatal Directorate at King Edward Memorial Hospital (KEMH) and Perth Children's Hospital, using electronic databases and patient medical records. RESULTS: The overall incidence of SA sepsis was 0.10 per 1000 live births (62/614207). From 2001 to 2010 the incidence was 0.13/1000 live births, reducing to 0.07/1000 live births from 2011 to 2020. SA was most frequently isolated from endotracheal aspirates, and infants with SA sepsis had longer median duration of ventilatory support than those without any sepsis (31 days vs 18 days respectively, p < 0.001). In our cohort, SA sepsis was associated with worse neurodevelopmental outcomes compared to infants without any sepsis. CONCLUSIONS: The incidence of neonatal SA sepsis has reduced over the last 20 years, suggesting potential effectiveness of the preventative interventions implemented. Endotracheal tube (ETT) colonisation and prolonged ventilation may be under-recognised as potential sources of SA infection. Our study suggests SA sepsis may negatively impact neurodevelopmental outcomes.

Effect of cumulative dexamethasone dose in preterm infants on neurodevelopmental and growth outcomes: a Western Australia experience.

OBJECTIVE: Comparing the long-term neurodevelopmental and growth outcomes of lower and higher cumulative dexamethasone exposure in preterm infants ventilated for a minimum cumulative duration of 7 days. DESIGN: A retrospective cohort medical chart review of infants born in Western Australia <29 weeks' gestation between January 2007 and May 2016 who were mechanically ventilated >7 days. INTERVENTION: No dexamethasone (controls) or a total cumulative dexamethasone dose of <2 mg/kg (lower) and ≥2 mg/kg (higher). MAIN OUTCOME MEASURES: Long-term disability at 2 and 5 years and growth measurement outcomes at 2 years of age. RESULTS: Dexamethasone was given to 104 infants (66 with cumulative dose <2 mg/kg; 38 with cumulative dose ≥2 mg/kg), and 324 infants were controls. There was no difference in odds of long-term disability in infants with any dexamethasone exposure compared with controls (aOR: 0.90, 95% CI 0.34 to 2.02, p=0.784). No difference in long-term disability was found between the lower and higher groups (p=0.494). The prevalence of cerebral palsy (Gross Motor Functional Classification System level ≥2) between the control, lower and high-dose groups did not differ significantly (5.8% vs 4.0% vs 0%). The higher dose group had lower mean weight z-score (mean effect: -0.83, 95% CI: -1.54 to -0.01, p=0.023), height z-score (mean effect: -0.63, 95% CI: -12.5 to -0.01, p=0.048) and head circumference z-score (mean effect: -0.65, 95% CI: -1.25 to -0.05, p=0.035) compared with controls. CONCLUSIONS: In our cohort, dexamethasone use was not associated with increased odds of long-term disability. Dexamethasone use was associated with lower growth measurements compared with controls.

Reproductive Strategies in Mediterranean Legumes: Trade-Offs between Phenology, Seed Size and Vigor within and between Wild and Domesticated Lupinus Species Collected along Aridity Gradients.

To investigate wild and domesticated Mediterranean annual reproductive strategies, common garden comparisons of Old World lupins collected along aridity gradients were initiated. These are excellent candidates for ecophysiology, being widely distributed across contrasting environments, having distinct domestication histories, from ancient Lupinus albus to recently domesticated Lupinus angustifolius and Lupinus luteus, facilitating the study of both natural and human selection. Strong trade-offs between seed size, early vigor and phenology were observed: vigor increasing, and flowering becoming earlier with increasing seed size. Despite large specific differences in all these traits, natural and human selection have operated in very similar ways in all 3 species. In wild material, as collection environments became drier and hotter, phenology became earlier, while seed size, early vigor and reproductive investment increased. Wild and domesticated germplasm separated along similar lines. Within similar habitats, domesticated material was consistently earlier, with larger seeds, greater early vigor and higher reproductive investment than wild, suggesting selection for both early establishment and timely maturity/drought escape in both domesticated and wild low rainfall ecotypes. Species differences reflected their distribution. Small and soft-seeded, low vigor L. luteus had a late, rainfall-responsive phenology specifically adapted to long season environments, and a narrow coastal distribution. L. angustifolius was much more conservative; more hard-seeded, flowering and maturing much earlier, with a wide Mediterranean distribution. L. albus flowered earlier but matured much later, with longer reproductive phases supporting much larger seed sizes and early vigor than either L. luteus or L. angustifolius. This ruderal/competitive combination appears to give L. albus a broad adaptive capacity, reflected in its relatively wider Mediterranean/North African distribution.

Individual, Social, and Environmental Correlates of Healthy and Unhealthy Eating.

BACKGROUND: Few studies use comprehensive ecological approaches considering multilevel factors to understand correlates of healthy (and unhealthy) dietary intake. The aim of this study was to examine the association between individual, social, and environmental factors on composite measures of healthy and unhealthy dietary intake in adults. METHOD: Participants (n = 565) of the Australian RESIDential Environments (RESIDE) project self-reported dietary intake, home food availability, and behavioral and perceived social and physical environmental influences on food choices. A geographic information system measured proximity of supermarkets from each participant's home. "Healthy" and "unhealthy" eating scores were computed based on adherence to dietary guidelines. Univariate and multivariate models were constructed using linear regression. RESULTS: After full adjustment, "healthy" eating (mean = 6.25, standard deviation [SD] = 1.95) was significantly associated with having confidence to prepare healthy meals (ß = 0.34; 95% confidence interval [CI] = [0.13, 0.55]); having more healthy (ß = 0.13; 95% CI = [0.09-0.16]) and fewer unhealthy (ß = -0.04; 95% CI = [-0.06, -0.02]) foods available at home; and having a supermarket within 800 meters of home (ß = 1.39; 95% CI = [0.37, 2.404]). "Unhealthy" eating (mean = 3.53, SD = 2.06) was associated with being male (ß = 0.39; 95% CI = [0.02, 0.75]), frequently eating takeaway (ß = 0.33; 95% CI = [0.21, 0.46]) and cafe or restaurant meals (ß = 0.20; 95% CI = [0.06, 0.33]) and having fewer healthy (ß = -0.07; 95% CI = [-0.10, -0.03]) and more unhealthy (ß = 0.09; 95% CI = [0.07, 0.10]) foods available within the home. CONCLUSION: Initiatives to improve adherence to dietary guidelines and reduce the consumption of unhealthy foods needs to be multifaceted; addressing individual factors and access to healthy food choices in both the home and neighborhood food environment. Ensuring proximity to local supermarkets, particularly in new suburban developments, appears to be an important strategy for facilitating healthy eating.