[Risk factors and protective factors in a population a risk for newborn necrotizing enterocolitis]. / Fattori di rischio e fattori protettivi in una popolazione esposta a enterocolite necrotizzante neonatale.

NEC represents the most common gastrointestinal disorder in newborn. Its range varies from 1% to 7.7% and is frequently associated with factors such as intestinal ischaemia, prematurity, gastrointestinal infection and early and rapid enteral feeding. Between 15/1/1990 and 15/6/1995, 129 critically ill newborns were admitted in NICU of Policlinico S. Orsola-Bologna. We examined only 93 patients, hospitalized for over 48 hours, presenting one or more risk factors for the development of NEC, such as birthweight < 2000 gm, respiratory distress, gastrointestinal bacterial colonization, sepsis, PDA and use of umbilical catheters. The aim of the study was to evaluate NEC incidence in newborns exposed to this complication and the analysis of risk factors associated with the elements of prevention and protection. No cases of NEC were observed despite the high incidence of risk factors. The newborns studied were divided in six different groups with increasing risk factors. Among the prevention elements of NEC, every patient was treated by nutrition, at first exclusively by TPN followed by careful enteral feeding (< 20 ml/kg/die) and the improvement of mesenteric blood flow by dopamine (2-3 mcg/kg/min); other preventive treatments were given according to clinical condition: dobutamine (5-10 mcg/kg/min in 51 ps.) to improve the cardiovascular function, gastrointestinal decontamination (8 ps.), antibiotic therapy (81 ps.), in cases of diagnosed infection and intravenous immunoglobulin (25 ps.) after discovering low ematic values. Analyzing the treatments and their day numbers in the 6 groups of patients no statistically significant differences were evident. On the contrary, dividing the patients into 3 groups according to GA (< 30 w, 30-35 w, > 35 w) an extension in treatment time is more evident in the group of GA < 30 weeks. Our therapeutic behaviour, based on respect of gastrointestinal blood flow, careful and gradual enteral feeding and prevention, constant monitoring and infection treatment, has been useful to stop the NEC incidence.

[Infusion constituents in pediatric anesthesia]. / Apporti infusionali in anestesia pediatrica.

A suitable perioperative fluid therapy during paediatric anaesthesia presupposes a valuation of renal function and the preoperative fluid and electrolyte imbalance, a precise knowledge of fluid requirements and the physiological stress responses to surgery in different paediatric groups. Fluid administration must be suited to the pathology of the patients and surgical approach. It must replace the deficits from the preoperative status (including fasting), provide maintenance fluid and correct intraoperative translocated fluids and blood loss. Fluid management requires reduced hypotonic solution in order to prevent hyponatremia and avoid excessive amount of glucose which can be harmful. In order to prevent the dangers from blood transfusions you need to estimate the intraoperative loss and follow the "acceptable hematocrit" values. Rational intraoperative fluid management reduces perioperative morbidity and mortality.

[Methicillin-resistant staphylococci in pediatric resuscitation]. / Stafilococchi meticillino-resistenti in rianimazione pediatrica.

OBJECTIVE: To evaluate the incidence of colonization and infection by methicillin-resistant in PICU. DESIGN: Prospective cohort study during 2 years for the surveillance of nosocomial infections. SETTING: Four beds Pediatric Intensive Care Unit. PATIENTS: We studied two-hundred patients with duration of hospitalization longer than 24 hours out of the 255 patients who were hospitalized during the same period. METHODS: The patients were divided in two groups according to the presence or the absence of MRS. The difference of the two populations were compared using the t-test and the CATANOVA: Wilcoxon's test was used to analyze the relation between the two values. The results were significant when p = 0.05 and Ct = 3.81. RESULTS: Fourty patients (20%) were colonized or infected by MRS with two seasonal peaks which were not correlated with the amount of index work. Nine patients were already colonized at entrance in PICU (4.5%) and the rate of infected patients versus infections was 1.5% (3 patients with 3 clinical manifestations). The presence of MRS in the different sections of the hospital could be shown. The rate of PICU-acquired colonization was 12.5% (25), the rate of PICU-acquired infected patients was only 2% (4), the infections rate was 3.5% (7 events). The average time which occurred the colonization by MRS to happen was 10,1 days from the day of hospitalization on, which is longer than that of the other germs (p = 0.001). Clinically the infection by MRS was localized as follows: 3 septicemiae, 2 pneumoniae and 2 muco-cutaneous infections. Most the patients with carriage of the MRS were prematures or newborns who had a long stay in PICU, who underwent invasive diagnostic and therapeutic treatment and who had a previously long stay in other department of the hospital. The stay in the PICU lasted longer in those patients who had a MRS carriage. They furthermore had a lower mortality rate (12.5%) than the other patients (Cc = 0.976); the 4 infected patients survived. CONCLUSIONS: The clinical impact of MRS in terms of morbidity and mortality in this PICU is modest. The prevention and limitation of the spread of MRS could be obtained by simple but essential measures of control.

Intensive care units as a source of methicillin-resistant Staphylococcus aureus.

Over a 12 month period, 209 isolates of methicillin resistant Staphylococcus aureus (MRSA) were obtained in 39 patients admitted to an ICU. In 23 patients MRSA was the major pathogen, producing either pneumonia, bacteremia or wound infection. In eight patients death was directly related to the MRSA infection. This study suggests an increasing occurrence of MRSA infections in ICU and the need to adopt control measures.