Children with human immunodeficiency virus infection admitted to a paediatric intensive care unit in South Africa

BACKGROUND: Early data regarding the outcome of human immunodeficiency virus (HIV)-infected children in paediatric intensive care units (PICU) suggested mortality as high as 100%. Recent studies report mortality of 38%. Survival depends on the indication for admission. OBJECTIVES: To describe the prevalence, duration of stay, and outcome of HIV-infected patients in a single PICU over a 1-year period. Additional objectives included describing the indications for admission as well as the clinical and laboratory characteristics of HIV-infected infants and children requiring PICU admission. METHOD: Retrospective chart review of all children with serological proof of HIV admitted to PICU at Tygerberg Children's Hospital from 1 January to 31 December 2003. RESULTS: Of the 465 patients admitted, 47 (10%) were HIV-infected. For HIV-infected children the median age on admission was 4 months. The median duration of stay was 6 days, significantly longer than for the non-HIV group (p = 0.0001). Fifty-seven percent had advanced clinical and immunological disease. Seventeen died in PICU and four shortly afterwards, poor PICU outcome was significantly associated with HIV status (p = 0.001). Lower total lymphocyte count (p = 0.004) and higher gamma globulin level (p = 0.04) were paradoxically the only findings significantly associated with survival. Acute respiratory failure (ARF) accounted for 76% of admissions, including Pneumocystis jiroveci in 38%. Fifty-one percent had evidence of cytomegalovirus infection. CONCLUSIONS: HIV-infected children requiring PICU can survive despite the lack of availability of antiretroviral therapy.     

新生儿重症监护室院内感染的影响因素

新生儿重症监护室(neonatal intensive care unit,NICU)院内感染是引起新生儿死亡的重要原因之一.文章对近年NICU院内感染的一些研究进展进行总结,对院内感染的定义、病原和发病率及主要危险因素作一简介并讨论其主要预防措施.     

Spectral analysis of noise in the neonatal intensive care unit

Objective  To perform spectral analysis of noise generated by equipments and activities in a level III neonatal intensive care unit (NICU) and measure the real time sequential hourly noise levels over a 15 day period. Methods  Noise generated in the NICU by individual equipments and activities were recorded with a digital spectral sound analyzer to perform spectral analysis over 0.5–8 KHz. Sequential hourly noise level measurements in all the rooms of the NICU were done for 15 days using a digital sound pressure level meter. Independent sample t test and one way ANOVA were used to examine the statistical significance of the results. The study has a 90% power to detect at least 4 dB differences from the recommended maximum of 50 dB with 95 % confidence. Results  The mean noise levels in the ventilator room and stable room were 19.99 dB (A) sound pressure level (SPL) and 11.81 dB (A) SPL higher than the maximum recommended of 50 dB (A) respectively (p < 0.001). The equipments generated 19.11 dB SPL higher than the recommended norms in 1–8 KHz spectrum. The activities generated 21.49 dB SPL higher than the recommended norms in 1–8 KHz spectrum (p< 0.001). The ventilator and nebulisers produced excess noise of 8.5 dB SPL at the 0.5 KHz spectrum. Conclusion  Noise level in the NICU is unacceptably high. Spectral analysis of equipment and activity noise have shown noise predominantly in the 1–8 KHz spectrum. These levels warrant immediate implementation of noise reduction protocols as a standard of care in the NICU.     

Bacterial changes in neonatal intensive care unit

Organisms routinely cultured from throat swabs and infectious agents of sepsis and/or meningitis were reviewed. During the last 12 years, Klebsiella pneumoniae and Escherichia coli have been replaced by Staphylococcus aureus and Pseudomonas aeruginosa as the predominant isolates from throat swabs after admission. These change in the etiologic pattern of infectious agents of sepsis and/or meningitis, i.e., K. pneumoniae, E. coli, S. aureus, P. aeruginosa and staphylococcus epidermidis, were in agreement with the organisms isolated from the throat swabs after admission. The S. aureus isolated from throat swabs after admission showed a decrease in the bacterial activity of cloxacillin, cephazolin and cefotaxime since 1978.     

Two outbreaks of Burkholderia cepacia nosocomial infection in a neonatal intensive care unit

Background:   An outbreak of Burkholderia cepacia septicaemia occurred in our neonatal unit over a 9-week period in 2001, affecting 23 babies and two died. A second outbreak lasting 8 days occurred a year later, affecting five babies.
Setting:   Neonatal Intensive Care Unit, Kuala Terengganu Hospital.
Aim:   To review the patient characteristics and the risk factors for septicaemia in the first outbreak.
Methods:   Retrospective review of records and in the first outbreak a case–control analysis with 23 matched controls for risk factors for septicaemia.
Results:   In the first outbreak, median birthweight was 1670 g (range 860–3760) and median gestational age was 32 weeks (range 27–41). There were 32 episodes of septicaemia, and five and two patients had two and three episodes, respectively. The mortality rate was 6.3% per septicaemic episode. Multiple logistic regression showed the presence of a prior long line was associated with first septicaemic episode (OR 7.07, 95% CI 1.37–36.47 with P  = 0.019) but not prior assisted ventilation. The organism was isolated from the water of an oxygen humidifier in the delivery room, three ventilator water traps and one humidifier water trap in the neonatal unit. In the second outbreak, six episodes of septicaemia occurred in five neonates with median birthweight 2060 g and median gestational age 32.5 weeks. The organism was isolated from two ventilator water traps.
Conclusion:   These two outbreaks of Burkholderia cepacia subsided with general infection control measures. The sources of these two outbreaks were not identified.     

Acute peritoneal dialysis in neonatal intensive care unit: An 8-year experience of a referral hospital

Background

The aim of present study was to evaluate the indications, complications and outcomes of acute peritoneal dialysis (APD) in neonates at a referral university hospital during the previous 8 years.

Ampicillin‐ and ampicillin/sulbactam‐resistant Escherichia coli infection in a neonatal intensive care unit in Japan

The incidence of ampicillin (ABPC)‐resistant Escherichia coli (E. coli) infection in very low‐birthweight infants has been increasing. The rate of ABPC/sulbactam (ABPC/SBT)‐resistant E. coli in this population, however, is currently unknown. We encountered two cases of severe infection due to resistant E. coli and retrospectively studied the prevalence of ABPC‐ and ABPC/SBT‐resistant E. coli in regular surveillance cultures obtained from all neonatal intensive care unit (NICU) patients between 2000 and 2013. The overall prevalence of ABPC‐resistant E. coli was 39% (47/120), accounting for 63% of cases (32/51) between 2007 and 2013, compared with 22% (15/69) between 2000 and 2006. The prevalence of ABPC/SBT resistance was 17% (20/120), which was similar in both periods (16%, 8/51 vs 17%, 12/69). According to these results, not only ABPC, but also ABPC/SBT‐resistant E. coli must be considered in the NICU.     

Another outcome of neonatal intensive care: First year mortality and hospital morbidity

Objectives: To determine first year mortality and hospital morbidity after neonatal intensive care.
Methodology: Cohort study of 6077 surviving infants inborn in one regional hospital in 1988. Nine hundred and eighty-eight received neonatal intensive care and 103 were very low birthweight (VLBW).
Results For infants who required care in the neonatal intensive care unit (NICU), the relative risk of dying before their first birthday was 3.6 (95% confidence intervals [Cl] 1.5-8.8). This increased risk was associated with low birthweight (LBW) rather than requirement for NICU care. Of all inborn survivors, 10.4% were readmitted to hospital in the first year and 2.4% more than once. The readmission rate was 20% for NICU survivors and 30% for VLBW infants. The risk of hospitalization was independently associated both with NICU admission (odds ratio 2.3, Cl 1.9-2.9) and with VLBW (OR 1.8, Cl 1.1-3.0). The NICU survivors also had multiple admissions and prolonged hospital stays.
Conclusions Both low birthweight and neonatal illness requiring intensive care are important indicators of continuing medical vulnerability over the first year of life.     

重症监护病房新生儿深部真菌感染临床特点分析

目的 提高新生儿深部真菌感染的临床诊断及经验性治疗水平.方法 选取2008年1月 - 2010年12月期间NICU住院确诊深部真菌感染的21例新生儿为研究对象,分析患儿的临床表现、实验室结果、基础疾病、真菌类别,以及抗真菌治疗效果.结果 患儿基础疾病以肺部疾病最多见,占47.6%;外科手术治疗5例,占23.8%,其中腹部手术者4例.临床表现以喂养不耐受、呼吸暂停、发热和反应差最多见,有19例(90.5%)出现血小板减低,19例(90.5%)超敏CRP增高,白细胞正常13例(61.9%).其中确诊真菌败血症18例(85.7%),真菌脑炎1例(4.8%),尿路感染2例(9.5%).病原菌均为假丝酵母菌.用氟康唑及两性霉素B脂质体治疗,总治愈率71.4%,好转19.1%,死亡9.5%.结论 喂养不耐受、发热、呼吸暂停和反应差是深部真菌感染患儿最多见的临床表现;患儿多数表现有血小板减低及超敏CRP增高,白细胞正常不能排除该病;近平滑假丝酵母菌感染最多见,白假丝酵母菌次之.