Scope and feasibility of operating on the neonatal intensive care unit: 312 cases in 10?years

Purpose

To report the scope, feasibility and learning experience of operating on neonates on the neonatal intensive care unit (NICU).

Methods

(1) Review of all NICU operations performed by general neonatal surgeons over 10?years; (2) 6-month prospective comparison of procedures performed in NICU or operating room; (3) structured interviews with five surgeons with 1–13?years experience of operating on NICU.

Results

312 operations were performed in 249 infants. Median birth weight was 1,494?g (range 415–4,365), gestational age 29?weeks (22–42), and age at operation 25?days (0–163). Nearly half (147) were laparotomy for acute abdominal pathology in preterm, very low birth-weight infants There were no surgical adverse events related to location of surgery. Surgeon satisfaction with operating on NICU for this population was high (5/5). Several factors contribute to making this process a success.

Conclusions

This is the largest reported series of general neonatal surgical procedures performed on NICU. Operating on NICU is feasible and safe, and a full range of neonatal operations can be performed. It removes risks associated with neonatal transfer and is likely to reduce physiological instability. We recommend this approach for all ventilated neonates and urge neonatal surgeons to operate at the cotside of unstable infants.     

Non Benign Neonatal Arrhythmias Observed in a Tertiary Neonatal Intensive Care Unit

Objective

To analyze non benign neonatal arrhythmias (NA) observed in a tertiary neonatal intensive care unit (NICU).

Methods

From June 2006 through July 2011, newborns admitted to the NICU for NA or diagnosed as NA after hospitalization were evaluated retrospectively. The newborns with non benign NA were included in the study.

Results

During the study period, the incidence of non-benign NA was 0.7 % (n?=?55/7880). The mean age at diagnosis was 16.7?±?1.8 d ranging from 1 d to 90 d. The most common type was supraventricular arrhythmia (SVT) with an incidence of 0.3 %. Univariate analyses showed that there were significant differences between the survived and died infants according types of congenital heart disease (CHD), electrolyte imbalance, and arrhythmias. The mortality rates were higher among infants with obstructive type left-to right shunt and common mixing type CHD. The most dangerous type of electrolyte imbalance was hyperkalemia.

Conclusions

Many arrhythmias could not be noticed at neonatal period even in NICU, implying that it is increasingly important for the physician to be aware of the etiology, development, and natural history of these arrhythmias.     

Radiation exposure in extremely low birth weight infants during their neonatal intensive care unit stay

Background

Extremely low birth weight (ELBW <1000 g) infants may have increased sensitivity to radiation exposure. Our objective was to estimate the radiation exposure in survivors of ELBW infants during their neonatal intensive care unit (NICU) stay.

Methods

In this retrospective cohort study, medical records of all ELBW infants who had been admitted to our NICU between May 1999 and October 2009 were reviewed. The infants’ total entrance skin exposure [ESE in micro-Gray (μGy)] was estimated.

Results

Among 450 survivors, the mean gestational age (GA) was 26.3±2.1 weeks, and the mean birth weight (BW) was 774.2±144.4 g. Infants received a median of 32 (range: 1–159) X-rays, with an estimated ESE of 1471 μGy (range: 28–9264). Total ESE was inversely proportional to GA (r=?0.34; P<0.01), and BW (r=?0.39; P=0.01) and proportional to the severity of illness [score for neonatal acute physiology-perinatal extension (SNAPPE), r=0.39; P=0.01]. In a linear regression analysis, GA, SNAPPE and necrotizing enterocolitis were associated with radiation exposure (ESE) in ELBW infants (r2=0.133; P<0.001).

Conclusions

During their NICU stay, ELBW infants were subjected to a significant number of diagnostic X-ray procedures. Our data highlight the need to closely monitor the number of X-ray procedures ordered to ELBW infants to avoid unnecessary radiation exposure.     

Pulmonary hypertension in extremely low birth weight infants: characteristics and outcomes

Background

To determine the characteristics and outcomes of pulmonary arterial hypertension (PAH) in extremely low birth weight (ELBW) infants.

Methods

A retrospective case-control study of all ELBW infants admitted to a level III neonatal intensive care unit (NICU) between January 1, 2003 and December 31, 2010.

Results

During the study period, 450 ELBW infants were admitted. 6.4% (29/450) were diagnosed with PAH and were matched to 26 controls. The mean gestational age of infants with PAH and their controls were similar [24.5±1.3 vs. 24.9±1.8 weeks (P=0.26)]; however the cases were smaller at birth than were controls [640.7±119.5 vs. 727.0±184.5 g (P=0.04)]. The diagnosis of PAH was made at a mean postnatal age of 131.8±53.7 days. Infants with PAH had a higher rate of intrauterine exposure to illicit maternal drug use [12/29 (41%) vs. 1/25 (4%); P=0.001], a longer duration of initial mechanical ventilation [74.9±28.3 vs. 59.1±27.8 days; P=0.04)], a higher incidence of severe BPD [23/29 (79%) vs. 13/26 (50%); P=0.02], and a greater NICU mortality rate [12/29 (41%) vs. 4/26 (15%); P=0.04].

Conclusion

PAH in ELBW infants is associated with maternal illicit drug use in pregnancy, longer exposure to mechanical ventilation, severe bronchopulmonary dysplasia and a significant increase in early mortality.     

Are the neonatal outcomes similar in large-for-gestational age infants delivered by women with or without gestational diabetes mellitus?

Background

Infants are considered large for gestational age (LGA) if their birth weight is greater than the 90th percentile for gestational age and they have an increased risk for adverse perinatal outcomes. Maternal diabetes is one of the factors affecting birthweight. However there are limited data on the perinatal outcomes of infants of gestational diabetic mothers. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus.

Methods

This was a retrospective study of LGA infants of ??36 weeks of gestation born at the Gazi University Medical School Hospital during the period of 2006?C2009. Neonatal outcomes included hypoglycemia and polycythemia in the early neonatal period and hospital admissions. The Chi-square and Student??s t test were used for comparing variables.

Results

Seven hundred eligible infant-mother pairs were enrolled in the study. Eighty-seven of them (12.4%) were infants of gestational diabetic mothers and 613 (87.6%) were infants of non-diabetic mothers. The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) (P=0.014). Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) (P=0.010). Although overall hospital admission rates were not different between the two groups, infants of diabetic mothers were more likely to be admitted because of resistant hypoglycemia (P=0.045).

Conclusions

The results of this study suggested that LGA infants of mothers with gestational diabetes mellitus were at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of nondiabetic mothers.     

Extremely premature infants: How does death in the delivery room influence mortality rates in two level 3 centers in France?

Objectives

Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates’ place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU).

Growth and neurodevelopmental outcome of VLBW infants at 1 year corrected age

Objectives

To evaluate growth and neurodevelopmental outcome of very low birth weight infants (VLBW) and compare with term normal birth weight infants (NBW) till 12 months corrected age.

Design

A prospective cohort study

Setting

Tertiary care neonatal unit in northern India

Subjects

37 VLBW infants and 35 NBW infants born between January 2007 and December 2007.

Interventions

Anthropometric measurements were recorded and Z-scores were computed serially at birth, discharge, 40 weeks post menstrual age (PMA), and at 1, 3, 6 and 12 months of corrected age. Developmental quotient (DQ) at 12 months corrected age was assessed.

Results

Z-scores for weight, length and head circumference (HC) at birth were ?1.21(±0.92), ?0.98(±1.32) and ?0.70(±1.14), respectively for VLBW infants and ?0.37(±0.72), ?0.11(±0.96) and 0.05(±0.73) respectively for NBW infants. VLBW infants had a significant drop in all Z-scores by discharge (P<0.001). There was a catch up to birth scores by 12 month age. VLBW infants had significantly lower Z-scores for weight, length and HC at one year corrected age as compared to NBW infants (P =0.01, 0.04 and 0.001, respectively). DQ at 12 months was significantly lower in VLBW infants (91.5+7.8) than NBW infants (97.5±5.3) (P <0.001). DQ of small for gestational age (SGA) and appropriate for gestational age (AGA) VLBW infants was comparable.

Conclusion

VLBW infants falter in their growth during NICU stay with a catch-up later during infancy. In comparison to NBW infants, they continue to lag in their physical growth and neurodevelopment at 1 year of corrected age.     

Effect of Multisensory Stimulation on Neuromotor Development in Preterm Infants

Objective

To investigate the effect of Auditory, Tactile, Visual and Vestibular stimulus (ATVV) on neuromotor development in preterm infants.

Methods

Fifty preterm infants born at 28–36 wk with a birth weight ranging from 1,000–2,000 g were recruited for the study. They were block randomized into a control group (n?=?25) and study group (n?=?25). New Ballard score was used for the baseline measurement of neuromaturity in both groups. In neonatal intensive care unit (NICU), the study group received multisensory stimulation for 12 min per session, 5 sessions per wk along with routine NICU care either from 33 wk corrected gestational age for infants born at 28–32 wk or from 48 h of birth for infants born at 33–36 wk until discharge from the hospital. The control group received the routine NICU care. At term age the preterm infants were assessed using Infant Neurological International Battery (INFANIB) and the groups were compared using independent t test.

Results

The multisensory stimulated infants showed higher neuromotor score (p?=?0.001) compared to the control group. The french angle components of INFANIB including heel to ear (p?=?0.016) and popliteal angle (p?=?0.001) were statistically significant between the groups.

Conclusions

Multisensory stimulation appears to have a beneficial effect on the tonal maturation in preterm infants. However, further studies are warranted to investigate the long-term effects of multisensory stimulation on neurodevelopmental outcome in preterm infants.     

Outcome of very low birth weight infants with abnormal antenatal doppler flow patterns: A prospective cohort study

Background

Fetal growth restriction and abnormal Doppler flow studies are commonly associated. Neonatal outcomes are not well known particularly in developing countries, where the burden of the disease is the highest.

Objective

To determine outcomes of preterm infants with history of absent/reversed end-diastolic umbilical artery Doppler flow (AREDF) vs. infants with forward end-diastolic flow (FEDF).

Design

Cohort study.

Setting

Tertiary care perinatal center in India.

Participants

103 AREDF very low birth weight (<1500 gm) (VLBW) infants and 117 FEDF VLBW infants were prospectively enrolled.

Results

At 40 weeks adjusted post-menstrual age, AREDF vs. FEDF group had a higher risk for death in the NICU (12% vs. 1%), respiratory distress syndrome (33% vs. 19%), and cystic periventricular leukomalacia (12% vs. 1%). At 12–18 months corrected age, AREDF vs. FEDF group had a trend towards increased risk for cerebral palsy (7% vs. 1%, P=0.06). After logistic regression analysis, adjusting for confounders, AREDF was independently associated only with mortality in the NICU.

Conclusion

AREDF is an independent predictor of adverse outcomes in preterm infants in a developing country setting.     

An MRI system for imaging neonates in the NICU: initial feasibility study

Background

Transporting premature infants from a neonatal intensive care unit (NICU) to a radiology department for MRI has medical risks and logistical challenges.

Objective

To develop a small 1.5-T MRI system for neonatal imaging that can be easily installed in the NICU and to evaluate its performance using a sheep model of human prematurity.

Materials and methods

A 1.5-T MRI system designed for orthopedic use was adapted for neonatal imaging. The system was used for MRI examinations of the brain, chest and abdomen in 12 premature lambs during the first hours of life. Spin-echo, fast spin-echo and gradient-echo MR images were evaluated by two pediatric radiologists.

Results

All animals remained physiologically stable throughout the imaging sessions. Animals were imaged at two or three time points. Seven brain MRI examinations were performed in seven different animals, 23 chest examinations in 12 animals and 19 abdominal examinations in 11 animals. At each anatomical location, high-quality images demonstrating good spatial resolution, signal-to-noise ratio and tissue contrast were routinely obtained within 30?min using standard clinical protocols.

Conclusion

Our preliminary experience demonstrates the feasibility and potential of the neonatal MRI system to provide state-of-the-art MRI capabilities within the NICU. Advantages include overall reduced cost and site demands, lower acoustic noise, improved ease of access and reduced medical risk to the neonate.     

Mortality and Morbidity in Extremely Low Birth Weight (ELBW) Infants in a Neonatal Intensive Care Unit

Objective

To determine the morbidity and mortality in ELBW babies till discharge from a Neonatal Intensive Care Unit (NICU).

Methods

This study was a prospective observational study conducted in a 40 bed well equipped level III care NICU between 01.12.2006 and 30.04.2008. All ELBW babies admitted during this period were assessed for morbidities and interventions required during NICU stay and for their outcome like survival or death.

Results

The survival rate of 87 ELBW babies admitted during this period was 56.1 %. Pulmonary hemorrhage was the commonest cause of death (25 %) followed by respiratory distress syndrome (22.5 %), intraventricular hemorrhage (22.5 %) and sepsis (20 %). Significantly higher number of non-survivors were <750 g at birth (p?=?0.0001) and <28 wk gestation (p?=?0.0001). Small for gestational babies had better chances of survival compared to those appropriate for gestational age (p?=?0.005). RDS (67.8 %), probable sepsis (62.1 %) and hyperbilirubinemia (59.8 %) were the most frequent morbidities. Conventional ventilation (72.4 %) and nasal CPAP(48.3 %) were the commonest respiratory interventions. Surfactant replacement therapy was required in 47.1 % babies.

Conclusions

ELBW babies have a major contribution to mortality in a NICU. Babies with birth weight <750 g and gestation <28 wk have poor survival. RDS, pulmonary hemorrhage, IVH and sepsis are the common causes of death while RDS, sepsis and hyperbilirubinemia are the most common morbidities.     

Effect of two different doses of parenteral amino acid supplementation on postnatal growth of very low birth weight neonates — A randomized controlled trial

Objectives

To evaluate the effects of two different doses of parenteral aminoacid supplementation on postnatal growth in Very Low Birth Weight (VLBW) infants receiving partial parenteral nutrition (PPN).

Design

Double blinded randomized controlled trial.

Settings

Level 3 NICU between February 2008 to February 2010.

Participants

150 inborn babies with birthweight between 900–1250 g, irrespective of gestational age, were randomized to either of the two interventions of amino acid supplementation.

Intervention

Two different initial doses of parenteral amino acids (AA) in the PPN solutions- Low AA group: 1 g/kg/d versus High AA group: 3 g/kg/d from day 1 of life with increment by 1 g/kg every day till a maximum of 4 g/kg/d, until babies tolerated 75% enteral feeds.

Main outcome

Average postnatal weight gain (in g/kg/d)) by 28 days of life.

Results

Both groups had similar baseline characteristics. The gain in weight, length and head circumference at 28 days were significantly lower in the High AA group. The average weight gain at 28 days was 8.67g/kg/d in the High AA group and 13.15g/kg/d in the Low AA group (mean difference 123.12, 95% CI 46.67 to 199.37, P<0.001). The incidences of neonatal morbidities associated with prematurity were similar in both groups.

Conclusion

Higher initial parenteral aminoacid supplementation, in settings where partial parenteral nutrition is administered, results in poor growth in VLBW infants due to inadequate non-protein calorie intake.     

Praktizierte Therapie-Begrenzung bei schwerkranken Früh- und Termingeborenen auf einer Neonatologischen Intensivstation

Background

Our aim was to investigate the incidence and reasons for withdrawing treatment in severely ill neonates.

Patients and methods

The case notes on all neonates who died in our neonatal intensive care unit within the 8 year study period (1997–2004) were retrieved and the following data collected: gestational age, birth weight, time between birth and death and autopsy results when available. The ethnic background of the patients was also noted. The reasons for withdrawal of life support were assessed together with underlying diseases and the role of the parents in decision making. Pre-term and full-term babies were analysed separately.

Results

A total of 132 patients were eligible for analysis, of whom 31 were full- or near-term infants (≥34 weeks of gestation) and 101 were pre-term. In 86 cases (65%), life support was withdrawn prematurely and palliative care initiated. There was no difference in this decision between premature and mature infants; however, the reasons for the decision was different. In term infants, the major reason for withdrawing life support was the underlying disease (90%), whereas in preterm infants the main reasons were therapeutic complications and a poor prognosis (70%). In two preterm infants, a gestational age <24 weeks was the reason for withholding treatment. Parental consent in decision making was documented in 91% of preterm infants and in all term infants.

Conclusions

Most of our patients do not expire during resuscitation or intensive care but because physicians and parents jointly decide to withdraw life support. In term infants, this decision is based upon the underlying disease whereas in preterm infants, complications are the decisive factor.     

Predictors of significant jaundice in late preterm infants

Objectives

To study (i) the incidence and course of jaundice, and (ii) the predictors of ??significant jaundice?? in late preterm infants.

Design

Prospective analytical study.

Setting

Urban perinatal center.

Patients

Inborn late preterm infants (post menstrual age of 34 0/7 to 36 6/7 weeks).

Methods

Infants were followed till day 14 of life or till onset of significant jaundice. Relevant maternal, perinatal and neonatal variables were prospectively recorded. Transcutaneous bilirubin (TcB) was measured in each infant twice daily for the first 48 hours of life.

Outcomes

Significant jaundice defined as requirement of phototherapy/exchange transfusion as per hour specific total serum bilirubin (TSB) nomogram of AAP guidelines.

Results

216 infants were enrolled, of which 123 (57%) had significant jaundice. 36% of the jaundiced infants had TSB greater than 15 mg/dL. The mean duration of onset of significant jaundice was 61 ± 32 hours. The mean duration of phototherapy was 49 ± 26 hours. Large for gestation, lower gestational age, birth trauma and previous sibling with jaundice predicted severe jaundice. TcB measured at 24?C48 hrs was a better predictor of ??significant jaundice with onset after 48 hrs?? than clinical risk factors.

Conclusion

There is a high incidence of significant jaundice in late preterm infants. TcB measured at 24?C48 hrs of life better predicts ??significant jaundice after 48 hours of life??, in comparison with clinical risk factors.     

Intracranial haemorrhage: an incidental finding at magnetic resonance imaging in a cohort of late preterm and term infants

Background

Intracranial haemorrhage (ICH) in term newborns has been increasingly recognised but the occurrence in late preterm infants and the clinical presentation are still unclear.

Objective

To investigate the appearance of intracranial haemorrhage at MRI in a cohort of infants born at 34 weeks’ gestation or more and to correlate MRI findings with neonatal symptoms.

Materials and methods

We retrospectively reviewed neonatal brain MRI scans performed during a 3-year period. We included neonates ≥34 weeks’ gestation with intracranial haemorrhage and compared findings with those in babies without intracranial haemorrhage. Babies were classified into three groups according to haemorrhage location: (1) infratentorial, (2) infra- and supratentorial, (3) infra- and supratentorial + parenchymal involvement.

Results

Intracranial haemorrhage was observed in 36/240 babies (15%). All of these 36 had subdural haemorrhage. Sixteen babies were included in group 1; 16 in group 2; 4 in group 3. All infants in groups 1 and 2 were asymptomatic except one who was affected by intraventricular haemorrhage grade 3. Among the infants in group 3, who had intracranial haemorrhage with parenchymal involvement, three of the four (75%) presented with acute neurological symptoms. Uncomplicated spontaneous vaginal delivery was reported in 20/36 neonates (56%), vacuum extraction in 4 (11%) and caesarean section in 12 (33%). Babies with intracranial haemorrhage had significantly higher gestational age (38?±?2 weeks vs. 37?±?2 weeks) and birth weight (3,097?±?485 g vs. 2,803 ± 741 g) compared to babies without intracranial haemorrhage and were more likely to be delivered vaginally than by caesarian section.

Conclusion

Mild intracranial haemorrhage (groups 1 and 2) is relatively common in late preterm and term infants, although it mostly represents an incidental finding in clinically asymptomatic babies; early neurological symptoms appear to be related to parenchymal involvement.     

Nosokomiale Infektionen bei Frühgeborenen

Background

We systematically evaluated the practical implementation of the KRINKO (“Kommission für Krankenhaushygiene und Infektionsprävention,” German Commission for Hospital Hygiene and Prevention of Infections) recommendations for the Prevention of nosocomial infections in very low birth weight (VLBW) infants in all participating centers of the German Neonatal Network (GNN).

Methods

All 47 centers were provided with a questionnaire and all centers returned it within 4 weeks.

Results

All centers implemented the new KRINKO recommendations regarding microbiological screening of VLBW infants in neonatal intensive care units (NICU). Colonization with multiresistent pathogens is still a challenge in NICUs, caring of these infants in isolation rooms is not always possible (lack of facilities and staff). Cohorting of patients and contact isolation measures are the practical consequences of colonization with multiresistant pathogens in most GNN centers.

Conclusion

Nosocomial infection outbreaks will become an emerging challenge in NICUs despite implementation of preventive measures. Therefore, a grounded discussion is needed to evaluate deficits and obstacles for the practical implementation of prevention strategies.     

Prognostic value of gradient echo T2* sequences for brain MR imaging in preterm infants

Background

Gradient echo T2*-W sequences are more sensitive than T2-W spin-echo sequences for detecting hemorrhages in the brain.

Objective

The aim of this study is to correlate presence of hemosiderin deposits in the brain of very preterm infants (gestational age <32 weeks) detected by T2*-W gradient echo MRI to white matter injury and neurodevelopmental outcome at 2 years.

Materials and methods

In 101 preterm infants, presence and location of hemosiderin were assessed on T2*-W gradient echo MRI performed around term-equivalent age (range: 40–60 weeks). White matter injury was defined as the presence of >6 non-hemorrhagic punctate white matter lesions (PWML), cysts and/or ventricular dilatation. Six infants with post-hemorrhagic ventricular dilatation detected by US in the neonatal period were excluded. Infants were seen for follow-up at 2 years. Univariate and regression analysis assessed the relation between presence and location of hemosiderin, white matter injury and neurodevelopmental outcome.

Results

In 38/95 (40%) of the infants, hemosiderin was detected. Twenty percent (19/95) of the infants were lost to follow-up. There was a correlation between hemosiderin in the ventricular wall with >6 PWML (P?<?0.001) and cysts (P?<?0.001) at term-equivalent age, and with a lower psychomotor development index (PDI) (P=0.02) at 2 years. After correcting for known confounders (gestational age, gender, intrauterine growth retardation and white matter injury), the correlation with PDI was no longer significant.

Conclusion

The clinical importance of detecting small hemosiderin deposits is limited as there is no independent association with neurodevelopmental outcome.     

Phenobarbital-enhanced hepatobiliary scintigraphy in the diagnosis of biliary atresia: two decades of experience at a tertiary center

Background

Hepatobiliary scintigraphy is highly sensitive for diagnosing biliary atresia; however, its specificity has varied in the literature from 35% to 97%.

Objective

The purpose of this study was to re-evaluate the accuracy of phenobarbital-enhanced hepatobiliary scintigraphy in differentiating biliary atresia from other causes of neonatal cholestasis.

Materials and methods

We retrospectively reviewed all hepatobiliary scans of infants with cholestasis at our institution from December 1990 to May 2011. Per our routine protocol the scans were obtained after pretreatment with phenobarbital (5 mg/kg/day for 5 days) to achieve a serum level of ≥15 mcg/ml. Normal hepatic uptake with no biliary excretion by 24 h was considered consistent with biliary atresia.

Results

One hundred eighty-six infants with 210 hepatobiliary scans composed the study group. Forty-three (23%) infants had the final diagnosis of biliary atresia. Hepatobiliary scintigraphy was 100% sensitive, 93% specific and 94.6% accurate in diagnosing biliary atresia. Of the 186, 39/111 (35.1%) term and 2/68 (2.9%) preterm infants had biliary atresia; two of seven children with unknown gestational age also had biliary atresia. Other diagnoses included neonatal hepatitis, total parenteral nutrition cholestasis, Alagille syndrome, cystic fibrosis, choledochal cyst, hypothyroidism, alpha-1 antitrypsin deficiency and persistent cholestasis of unknown etiology.

Conclusion

Phenobarbital-enhanced hepatobiliary scintigraphy is highly accurate in differentiating biliary atresia from other causes of neonatal cholestasis. Biliary atresia is rare in premature infants.     

Safety of routine early MRI in preterm infants

Background

Cerebral MRI performed on preterm infants at term-equivalent 30 weeks' gestational age (GA) is increasingly performed as part of standard clinical care.

Objective

We evaluated safety of these early MRI procedures.

Materials and methods

We retrospectively collected data on patient safety of preterm infants who underwent early MRI scans. Data were collected at fixed times before and after the MRI scan. MRI procedures were carried out according to a comprehensive guideline.

Results

A total of 52 infants underwent an MRI scan at 30?weeks’ GA. Although no serious adverse events occurred and vital parameters remained stable during the procedure, minor adverse events were encountered in 26 infants (50%). The MRI was terminated in three infants (5.8%) because of respiratory instability. Increased respiratory support within 24 h after the MRI was necessary for 12 infants (23.1%) and was significantly associated with GA, birth weight and the mode of respiratory support. Hypothermia (core temperature < 36°C) occurred in nine infants (17.3%). Temperature dropped significantly after the MRI scan.

Conclusion

Minor adverse events after MRI procedures at 30?weeks GA were common and should not be underestimated. A dedicated and comprehensive guideline for MRI procedures in preterm infants is essential.     

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a neonatal intensive care unit

Background

A molecular epidemiological survey was conducted on an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBLKp) infection in our neonatal intensive care unit (NICU) from February to June 2008.

Methods

Cultures of clinical samples from neonates in the NICU, the hands of healthcare workers and the environment of the NICU were subjected to ESBLKp isolation. Pulsed-field gel electrophoresis was performed to determine Klebsiella pneumoniae strains (type A-D).

Results

In 1439 neonates, 38 (2.6%) had infections and 65 (4.5%) had colonizations with ESBLKp. Microbiological sampling of the NICU environment yielded 33 (14.9%) ESBLKp isolates from 222 samples. Clone A was found in 88.2% of the infected neonates, 66.7% of the colonized neonates, 69.7% of the environmental samples, and the hands of a healthcare worker.

Conclusions

The detection rate of ESBLKp is high in environmental samples, especially those from frequently touched surfaces. Since ESBLKp was identified on the hands of a healthcare worker in the present study, hand and environmental hygiene is mandatory for infection control in neonatal intensive care units.