Risk factors for nosocomial sepsis in newborn intensive and intermediate care units.

UNLABELLED: A multicentre prospective study was performed to estimate the incidence of hospital infections and to identify the most relevant risk factors for sepsis in a large and unselected population of high-risk newborns. The study involved 49 neonatal intensive care units and 17 neonatal intermediate care units in Italy. Newborns were followed up from admittance to the units until discharge. Data on demographics and clinical characteristics, exposure to the principal invasive procedures, and onset of infectious complications were prospectively collected. Only infections developing after 48 h from admittance to the unit were recorded. A multiple logistic regression was performed to identify which factors were independently associated with sepsis. Among the 8263 newborns included in the analysis, the incidence of infected newborns was 14.4 per 100 newborns and 0.9/100 days of stay. The incidence of infections was 19.1/100 newborns and 1.2/100 days of stay. Sepsis represented 15.4% of all infections (incidence 2.9/100 newborns and 0.2/100 days of stay). The following factors were independently associated with sepsis: umbilical catheterization, both through the vein and the artery for more than 5 days; mechanical ventilation for more than 5 days; necrotizing enterocolitis; birth weight equal to or less than 2500 g; nasogastric tube; total parenteral nutrition; and transfer from other hospitals. Umbilical catheters accounted for the highest proportion of sepsis (62%), followed by arterial catheters (31%), nasopharyngeal cannulae (26%), tracheal cannulae (20%), and nasal cannulae (20%). The population attributable risk for the other procedures was less than 10%. CONCLUSION: This study demonstrates that in a large and unselected newborn population, several host factors and invasive procedures are independently associated with an increased risk of sepsis. After adjustment for clinical severity, intravascular catheterization and assisted ventilation were found to be responsible for a considerable proportion of observed sepsis. They should therefore be considered as priorities for interventions, aimed both at reducing unnecessary use and promoting more strict compliance with aseptic practices.

Prevention of perinatally transmitted hepatitis B virus infection by hepatitis B immunoglobulin immunoprophylaxis: an account of 201 newborn babies of hepatitis Bs antigen carrier mothers.

Of 5,327 pregnant women who were screened between July 1981 and July 1983, 5.2% were found to be hepatitis Bs antigen (HBsAg) carriers. This high percentage of carriers accentuates the importance of vertical transmission of hepatitis B virus in our area. In view of this we sought to verify the effectiveness of hyperimmune immunoglobulins in the prevention of infection. We studied 201 babies born to HBsAg-positive mothers. These babies had regular checkups until 12 months of age. One hundred forty-nine received prophylactic hyperimmune globulin (two to seven doses according to risk ranking), while 52 did not. A higher percentage of infection was found in the babies who had no prophylaxis (25%) than in the babies who had prophylaxis (7.4%). Furthermore, hepatitis appeared earlier (from the 2nd to the 6th month) in the babies who had no prophylaxis than in the babies who had prophylaxis (from the 9th to the 12th month). No infection was observed during prophylaxis or up to 6 months.

[Bifidobacteria colonization in diversely-fed newborn infants]. / Colonizzazione con bifidobatteri in neonati diversamente alimentati.

The aim of this work is to analyse the capacity of several formulas of stimulating the growth of bifidobacteria (Bif.), as these formulas may induced an approach to the intestinal microbiological peculiarities of breast-fed infants. This capacity has been compared with the fecal pH (fig. 2) in the various groups of artificially-fed infants and with the buffering capacity (fig. 1 a. 3) of the different milks. Six group of infants fed the following milks feed were examined: one breast-fed and five artificially-fed (table 1). Fecal specimens were examined at the 4th, 11th and 18th day of life. It is pointed out that different formulas have different capacity of stimulating the growth of Bif., both in the percentage of colonized subjects and in the developed amount of Bif. (tab. 2). It is exhibited a mutual relation between this capacity of a food and the fecal pH (fig. 3) in newborn infants fed on this food. On the contrary it is not easy to find a clear relation between the capacity of growth of Bif. and the buffering properties of a milk: two of the tested milks have nearly the same buffering capacity but allow completely different colonisation (fig. 1 a. 3). It is suggested that if this mutual relation was real, we must think of "how" this buffer capacity is realized and not of its absolute value. Although several Authors proved that there is a "in vitro" antagonism between Bif. and E. coli, it is not confirmed this statement "in vivo" (fig. 2 a. 3).(ABSTRACT TRUNCATED AT 250 WORDS)

[Protocol of treatment of acute diarrhea in infancy]. / Protocollo della terapia delle diarree acute nella prima infanzia.

We suggest some guidelines for symptomatic treatment of acute diarrhea in infants under two, as it has been tested both in several hospital departments. Considering some well-known employed clinical and metabolic evaluations, cases (uncommon) needing sudden parenteral treatment are distinguished from those less serious ones (more common) when previous feeding is quickly re-established using oral rehydratation.

[Nutrition of the very low birth weight newborn infant (less than 1500 g). Experience with a formula for the premature infant]. / La nutrizione del bambino di peso neonatale molto basso (less than 1500 g). Esperienza con una formula per prematuri.

After a short review on the topic of nutrition of very low-birth-weight infants, particularly the very small preterms, results are reported on a trial with an adapted milk for prematures. Subjects involved had a gestational age of 28-34 weeks and weighed less than 1500 g thus representing a sample of very low birth weight babies. By using levels of MCT in the milk, a protein quota of 3, 15 g/Kg/day with 40/60 casein whey-protein ratio, an electrolyte content slightly higher than in most adapted formulas (for fullterm babies) and low osmolarity, good results were obtained for body weight growth, length, head circumference and subcutaneous fat. Growth indices were similar to those typical of the terminal months of intrauterine development as well as a satisfactory overall portrayal of biochemical indices of the nutritional status of VLBW babies.

HBIG immunoprophylaxis of babies born to HBsAg carrier mothers.

Screening of 12 965 pregnant women revealed a prevalence of HBsAg carriers of 3.5%. Of these 4.8% were positive for HBeAg, 92.1% for anti-HBe and 3.1% were HBeAg/anti-HBe negative. Babies born to HBeAg positive mothers were found to be at extremely high risk of acquiring HBV infection and of developing a chronic carrier state, while those born to anti-HBe positive mothers were at lower yet consistent risk of infection and none of them became chronic carriers. Starting from October 1980 babies born to HBsAg carrier mothers were submitted to HBIG treatment. Babies born to anti-HBe mothers received two 0.2 ml/kg doses i.m. at birth and at one month of age, while babies born to HBeAg positive mothers were injected again at 3 and 6 months. After a prolonged follow-up it emerged that: 1) HBIG treatment was of some efficacy in preventing HBsAg chronic carrier state following perinatal transmission of HBV; 2) HBIG treatment rather than preventing HBV infection delayed its onset; 3) interruption of transmission of HBV may also be useful in preventing delta infection since this can occur only in circumstances that permit transmission of HBV infection.

[Serum immunoglobulin behaviour in the immature infant from birth to 2 years]. / Il comportamento delle immunoglobuline seriche nell'immaturo dalla nascita ai due anni.

A brief account of immunity (fundamental stages of the process, part played by the dependent and independent thymus system, importance of the lymphocyte, theories concerning the interpretation of the antibody response) and of the immunoglobulins (the G-A-M-D-E classification and the features and functions of each class), together with a note relating to mother-foetus transmission of immunity) and the autochthonous origin of Ig, are followed by the presentation of data obtained in 28 female and 27 male immature infants (divided into 3 groups on a body weight basis) studied from birth to 2 yr. The results were as follows: IgG behaviour as in the mature child, but low with respect to the adult in proportion to the degree of immaturity. Transient increase (between 10th and 30th day) followed by regular catabolism (min. 4th-6th month). Slow recovery to 50 % and little over 60 % adult values at 1 and 2 yr; IgA - absent at birth, appearing at about 20th day. Rapid increase to 3 months, slight fall to 5th month, with slow recovery to slightly less than 3rd month values (= 31-45% adult) at 1 yr and slightly over the same at 2 yr: this pattern differs from the literature data; IgM--always present at birth, rapid increase in proportion to immaturity during first few days. Decrease from 20th day to 3rd-6th month (only twice reported in the literature) followed by slow recovery to 60% adult values at 1 yr. The overall picture is of precocious antibody (IgM) response broken by a transient fall between the 3rd and 5th due to catabolism of maternal IgG coupled with inadequate autochthonous production of IgG and temporary decrease in autochthonous IgA and IgM values. These findings suggest, inter alia, that the vaccination calendar be shifted to the 6th month to ensure adequate response.