A Neuropathologic Analysis of Neonatal Deaths Occurring in a Single Neonatal Unit Over a 20-Year Period

This study presents an overview of 2515 consecutive autopsies performed on newborn infants who died during the first 28 days of life at The Hospital for Sick Children, Toronto, during the period 1970-89. The infants were grouped into two categories according to their gestational age, then subdivided into groups of early (0-6 days) and late (7-28 days) neonatal death. Trends in the occurrence of neuropathologic observation were documented. For each 5-year period and each gestational group, the following diagnoses were recorded: hypoxic-ischemic neuronal changes, periventricular leukomalacia, infarction, kernicterus, meningitis, and hemorrhage (subependymal, parenchymal, choroidal). Over these 20 years, our results show that death in preterm infants decreased because of a drop in the incidence of subependymal hemorrhage/intraventricular hemorrhage, kernicterus, and meningitis but increased in term infants as a result of a higher frequency of hypoxic-ischemic neuronal necrosis and choroid plexus hemorrhage.     

Flavobacterium meningosepticum Infections in a Neonatal Intensive Care Unit

ABSTRACT. An outbreak of nosocomial infections by Flavobacterium meningosepticum in a neonatal intensive care unit is described. During a period of eleven weeks two patients presented with septicaemia and meningitis. In addition, nine patients were found to be colonized and three of these neonates developed septicaemia. The infected patients were treated with clindamycin and piperacillin. All the patients survived, but the neonates with meningitis developed hydrocephalus. An extensive bacteriological screening of the staff was negative, but in the ward environment, F. meningosepticum was found around sinks, on rubber stoppers for milk bottles and on "cleaned" teats. Several infection control measures were instituted. Established routines were revised, with particular emphasis on the handling of objects containing or in regular contact with water.     

轮换抗生素控制细菌耐药在新生儿重症监护病房中的应用

目的 探讨定期轮换使用抗生素对降低新生儿重症监护病房(NICU)细菌耐药率的作用.方法 回顾性分析2007年6月-2010年6月东莞市妇幼保健院NICU收治的502例应用头孢他啶、哌拉西林他唑巴坦或头孢噻肟的患儿,观察肺炎克雷伯菌亚种感染的108例在相继5个研究阶段轮换使用头孢他啶和哌拉西林他唑巴坦时细菌耐药性的变化.基础阶段为12个月,无序地应用头孢他啶、哌拉西林他唑巴坦及头孢噻肟;后4个阶段每一阶段为6个月,交替使用头孢他啶与哌拉西林他唑巴坦,基本不用头孢噻肟.结果 随着停用头孢他啶时间的延长,肺炎克雷伯菌亚种对头孢他啶的耐药率从基础阶段的59.3%下降至第3阶段的40 4%,到第4阶段又上升至45.9%,各阶段其耐药率比较差异有统计学意义(χ2=3.992,P<0.05).哌拉西林他唑巴坦耐药率从基础阶段的6.7%下降至第4阶段的2.6%,而第5阶段则为4.5%,各阶段其耐药率比较差异有统计学意义(χ2=4.683,P<0.05).头孢噻肟的耐药率也逐渐下降,从基础阶段的59.8%下降至第2阶段的47.8%,第3阶段继续有所下降为45.4%,第4阶段为40 4%,第5阶段为33.6%,各阶段其耐药率比较差异有统计学意义(χ2=3.896,P<0.05),但停药2 a耐药率仍偏高,未能消除.结论抗生素轮换在相对封闭的环境,可达到降低细菌耐药率的成效.但细菌耐药性的消除需2 a以上或更长时间.     

重症监护条件下新生儿缺氧缺血性脑病疗效评价

目的观察重症监护条件下新生儿缺氧缺血性脑病（HIE）的治疗效果，探索更有效的治疗方法。方法2006年5-12月50例HIE患儿（NICU组）纳入新生儿重症监护病房（NICU）管理治疗，严密监测生命体征、经皮血氧饱和度、血生化等，以血糖和新生儿行为神经评分（NBNA）为指标评价3项支持和3项对症治疗的效果，并与2005年同期42例（对照组）对照。结果二组入院时血糖及3d内NBNA比较均无差异（Pa〉0．05）。治疗后NICU组血糖及NBNA改善情况明显优于对照组（Pa〈0．05）；NICU组总有效率为96％，对照组为76％，二组比较差异极为显著（x^2=9．83P〈0．01）。结论NICU治疗环境对改善HIE疗效和预后有积极意义。     

Parent Support of Feeding in the Neonatal Intensive Care Unit

To examine the perceptions of parent education and support of feeding in the neonatal intensive care unit (NICU), a survey was conducted with occupational therapists (OTs) and parents of infants in the NICU. Data were collected from 32 OTs and 11 parents. The results showed that OTs used a variety of teaching methods to convey information about feeding to parents, that parents felt “very confident” and OTs felt “confident” in the parents' understanding of the material, and that different types of equipment and follow-up services were offered to parents following their child's discharge from the NICU.     

新生儿重症监护室存活儿生命质量的随访

目的探讨新生儿重症监护室救治存活的危重新生儿2-3岁时的生命质量。方法对积极抢救存活的60例危重新生儿随机分为干预组及非干预组各30例,并与同期出生的正常新生儿进行对比分析。干预组予干预训练,并由专人对小儿进行定期的体格检查、智力及精神运动发育指数测定,2-3岁时对小儿进行心理卫生、行为、气质及家庭情况调查。结果干预组智力及精神运动发育指数明显高于非干预组(P<0.05,<0.001),而与正常对照组比较无明显差异(P>0.05);非干预组心理卫生及行为问题较干预组均明显增多(P均<0.05)。结论经积极抢救存活的危重新生儿给予早期干预,可明显提高其生命质量。     

新生儿重症监护室细菌定植和医院感染的监测

目的 观察NICU细菌定植及医院感染情况,以降低NICU医院感染发病率.方法 2009年1-12月在本院NICU住院的465例新生儿入院时行痰培养,进行定植菌检测.机械通气患儿更换或拔除气管插管时,常规留气管插管头行细菌培养.所有培养阳性结果行药敏试验.住院时间>48 h的426例新生儿纳入医院感染调查,疑似医院感染时,根据临床表现行相关病原学检查.计算医院感染发病率、日医院感染发病率、呼吸机相关性肺炎(VAP)发病率.结果 465例新生儿行痰培养,72.7%(338/465例)有细菌定植,其中38.8%为正常菌群,61.2%为致病菌.定植的致病菌主要为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌.医院感染发病率为12.4%(53/426例),日医院感染发病率为12.1‰,呼吸机使用率为2.5%,VAP发病率为65.6‰.不同出生体质量组新生儿医院感染发病率差异有统计学意义(χ2=12.35,P＜0.05),出生体质量≤1 500 g的新生儿医院感染发病率最高.有致病菌定植的新生儿医院感染发病率高于无致病菌定植的新生儿,差异有统计学意义(χ2=19.88,P＜0.05).结论 细菌(尤其是致病菌)定植在NICU很常见,革兰阴性细菌是常见定植致病菌,致病菌定植与医院感染密切相关.对NICU住院患儿进行定植菌检测,有助于减少医院感染的发生.     

Prevalence of the Neonatal Autopsy: A Report of the Study Group for Complications of Perinatal Care

Neonatal autopsy findings are valuable additions to the information base for current cases and future perinatal care, so the reported decline in the autopsy rate is disturbing. In order to estimate the prevalence of the neonatal autopsy among a large population of deaths, we surveyed participating institutions of the Study Group for Complications of Perinatal Care. Investigators from 37 neonatal intensive care units, located in 9 children's hospitals, 4 hospitals for women and infants, and 24 full-service pediatric and adult care hospitals, reported their neonatal death and autopsy rates for 1989. The overall neonatal autopsy rate was 51% among 1645 neonatal deaths. The rate was variable, ranging from 22 to 100%. We found the neonatal autopsy rate to be lower than previously reported and not apparently influenced by the type of center or by the type of medical staff at the centers. In order to assess and potentially reverse the current low rate, the influence of neonatal demographic and clinical factors, as well as physician-related factors, must be studied.     

Change in Pathogens Causing Late-onset Sepsis in Neonatal Intensive Care Unit in Izmir,Turkey

Objective

Neonatal sepsis is a common cause of morbidity and mortality among newborns in the developing world. We have investigated the causative agents and their antimicrobial susceptibility of late-onset sepsis (>72 h post-delivery), and determined the possible association between various risk factors and the mortality due to neonatal sepsis in 2008. To view the changes in years, we compared them with the data which we gained in 2004.

Methods

Medical records of all neonates with late-onset sepsis were reviewed for demographic characteristics (birth weight, gestational age, gender, type of delivery, and mortality rate), positive cultures and risk factors of mortality.

Findings

One hundred and forty-seven and 227 neonates had been diagnosed as late-onset sepsis in 2004 and 2008, respectively. Coagulase-negative staphylococcus was the most frequent microorganisms. Gram-negative bacilli, particularly Pseudomonas aeruginosa showed a significant increase in years. The mortality rate was 11.5% and 19% in 2004 and 2008, respectively. Birth weight, gestational age, and infection with Klebsiella spp. isolates were found to have significant association with sepsis mortality in our neonatal intensive care unit (NICU).

Conclusion

The present study emphasizes the importance of periodic surveys of sepsis encountered in particular neonatal setting to recognize the trend. Increased Gram-negative bacilli rate was possibly related to the widespread use of antibiotics in our NICU.     

Early Neonatal Deaths in Geographically Defined Populations with Different Organization of Medical Care

ABSTRACT. A comparison of early neonatal deaths was performed in fourteen Swedish referral districts over six years (1973–1978). Two populations of newborn infants were compared: those born of mothers resident in referral districts of general hospitals with specialized obstetric service but without own neonatal wards; and those born of mothers living in districts of central hospitals with specialized obstetric and neonatal care in the same hospital. The early neonatal death rates of these two populations did not differ significantly. However, a tendency was observed indicating a lower mortality in the former group, necessitating further analysis.     

High-dose Intravenous Gammaglobulin for Neonatal Alloimmune Thrombocytopenia in Twins

ABSIRACT. Pietz J., Kiefel V., Sontheimer D., Kobialka B., Linderkamp O and Mueller-Eckhardt C. (Division of Neonatology, Children's Hospital, University of Heidelberg, and Institute of Clinical Immunology and Transfusion Medicine, University of Giessen, FRG). High-dose intravenous gammaglobulin for neonatal alloimmune thrombocytopenia in twins. Acta Paediatr Scand 80: 129, 1991.
We report the successful treatment of neonatal alloimmune thrombocytopenia with repeated infusions of high-dose immunoglobulin G (400 mg/kg/d for 5 days) in twins. Platelet counts increased within 3 days from less than 20×10⁹/1 to more than 70 × 10⁹/1. The first twin survived without neurological or other sequelae. The second twin had probably developed intracranial hemorrhage (ICH) in utero. This infant developed long-term neurological sequelae with blindness, cerebral palsy and infantile spasms. Implications of the therapeutic approach and prevention of severe complications in pregnancies with known risk for neonatal alloimmune thrombocytopenia are discussed.