Cerebrospinal Fluid Polymerase Chain Reaction in the Diagnosis of Neonatal Bacterial Meningitis: A Single-Center Experience From Vietnam.

OBJECTIVE: To compare the performance of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) with bacterial culture for the diagnosis of neonatal bacterial meningitis (NBM). METHOD: The CSF analysis of neonate with confirmed bacterial meningitis was performed with PCR and bacterial culture, and results were compared. RESULT: Among 24 neonates, the pathogens Identified included E. coli K1, GBS, Streptococcus pneumoniae and Listeria. PCR identified 20 (83.3%) pathogens, and culture 4 (16.7%) pathogens. Prior antibiotics were administered to 20 (83.3%) neonates in whom PCR identified 17 (85%) and culture 3 (15%) pathogens. CONCLUSION: CSF PCR had a higher yield of pathogens than CSF culture in confirmed neonatal bacterial meningitis with a high rate of prior antibiotic therapy.

Very preterm infants admitted to a tertiary neonatal unit in central Vietnam showed poor postnatal growth.

AIM: We aimed to evaluate the postnatal growth of very preterm infants. METHODS: This was a cross-sectional observational study of neonates born before 32 weeks of gestation and admitted to the neonatal unit at Da Nang Hospital for Women and Children, Vietnam, between 1 February 2020 and 30 September 2020. Morbidities, therapies, nutrition modalities and growth status were recorded from admission to discharge. RESULTS: The 78 infants (51% female) were born at a median of 29 weeks and mean birth weight of 1247 grams. The mean weight gain velocity from regaining their birth weight until discharge was 12.7 ± 4.9 g/kg/d. At discharge, the Z-scores for weight, length, both weight and length and weight for length were lower than at birth in 94%, 67%, 64% and 95% of infants and the Delta Z-scores were less than -1 in 73%, 44%, 39% and 82%. Late-onset sepsis (LOS) and bronchopulmonary dysplasia (BPD) were significantly associated with growth failure, with adjusted odds ratios of 3.6 and 20.1, respectively. CONCLUSION: The high rate of poor growth among the very preterm infants in our study indicates the need to reduce LOS and BPD and ensure the availability of human milk fortifier, vitamin and mineral supplements.

Preterm nutrition and neurodevelopmental outcomes.

Survival of preterm infants has been steadily improving in recent years because of many recent advances in perinatal and neonatal medicine. Despite these advances, the growth of survivors does not reach the ideal target level of the normal fetus of the same gestational age. Postnatal weight gain is often not achieved because extrauterine growth has higher energy requirements than intrauterine growth, due to the intensive care environment, illness and inadequate nutrition. Although many other factors influence infant brain development, including family socioeconomic and educational background, the role of nutrition is considerable and fortunately, amenable to intervention. In the preterm neonate, the brain is the most metabolically demanding organ, consuming the largest proportions of energy and nutrient intake for its function and programmed growth and maturation. Weight gain, linear and head circumference growth are all markers of nutritional status and are independently associated with long-term neurodevelopment. Brain development is not only the result of nutrients intake, but in addition, of the interaction with growth factors which depend on adequate nutrient supply and overall health status. This explains why conditions such as sepsis, necrotizing enterocolitis and chronic lung disease alter the distribution and accretion of nutrients thereby suppressing growth factor synthesis. In this review, we will focus on the direct role of nutrition on neurodevelopment, emphasizing why it should be started without delay. The nutritional requirements of the preterm infant will be discussed, followed by the effects of general nutritional interventions and specific nutrients, as well as the role of nutritional supplements on neurodevelopment. The primordial role of human breast milk, breast milk fortifiers and human milk oligosaccharides will be discussed in detail. We will also examine the role of nutrition in preventing neonatal complications which can affect neurodevelopment in their own right.

Problematic within-family alliances in conjoint family therapy: a close look at five cases.

We intensively analyzed five sessions in which the within-family alliance was manifestly problematic and family members reported discrepant perceptions of the family's sense of purpose about working together in therapy. Triangulation of observer ratings with (a) session content, (b) participants' post-session perceptions, (c) therapists' alliance-related interventions, and (d) clients' pretreatment target complaints and problem descriptions suggested three essential, interrelated aspects of the within-family alliance: family members (a) agreeing on the problem(s) and goals for treatment, (b) feeling connected in coping with their concerns ("a felt unity"), and (c) seeing conjoint therapy as valuable. Within-family disagreements on any of these aspects seemed to account for the observed in-session struggles. The analysis also suggested several missed opportunities for strengthening the within-family alliance.

Ethnic differences in umbilical cord blood vitamin D and parathyroid hormone--South Asians compared to Whites born in the UK.

Serum calcium, 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) were measured in umbilical cord blood samples taken from 54 White and 22 South Asian babies born in the UK during the summer months. South Asians had lower serum calcium (p < 0.0027) and 25OHD (p < 0.0002) than Whites. Serum PTH was low in all subjects, but South Asians had relatively higher concentrations of serum PTH (p < 0.001) than Whites. The lower vitamin D and calcium in South Asian newborns is not associated with secondary hyperparathyroidism as previously reported but may still explain their increased prevalence of neonatal hypocalcaemia and rickets.

Small for gestational age neonates--are we missing some by only using standard population growth standards and does it matter?

OBJECTIVES: Birth weight below the 10th percentile on growth charts based on population norms or small for gestational age (SGA) is associated with adverse perinatal outcome. We compare the association among neonatal mortality, morbidity and SGA as determined by currently used percentiles based on population standards (method A) and customised birth weight percentiles (method B). METHODS: Study of outcomes of SGA neonates from a cohort of 6125 consecutive pregnancies, analysed in function of the method (A or B) used to diagnose SGA. RESULTS: There were 831 SGA infants, 84% were born at term and the majority were of European origin (61.4%). By method A, there was a sixfold decrease in the prevalence of SGA babies (2.3%) compared with method B (13.5%). After correcting for prematurity, SGA infants diagnosed by method B alone (not identified by standard population method) still constituted a high proportion of infants with hypothermia and hypoglycaemia (p < 0.05). CONCLUSION: Customised charts identified six times more SGA infants than standard charts. These infants, considered appropriately grown by standard charts, are at a significantly higher risk of morbidity.

The application of a core curriculum and options to an undergraduate paediatric course: a personal view.

The time allocated to the undergraduate paediatrics curriculum has been reduced in recent years. It is therefore increasingly important to organize a structured curriculum that provides students with the necessary competences to care for sick children in the early years after graduation. In this paper, the educational strategy of a core curriculum and options is discussed and its application to an undergraduate paediatrics course is described. A core curriculum with options can be readily adapted to undergraduate paediatrics but it requires careful planning to provide the student with the necessary competences and a rewarding and enjoyable educational experience.