Urinary neutrophil gelatinase-associated lipocalin (NGAL) and serum cystatin C measurements for early diagnosis of acute kidney injury in children admitted to PICU

Background

Acute kidney injury (AKI) is common in critically ill children with significant mortality and morbidity. Serum creatinine is an insensitive and late biomarker compared to newly proposed AKI biomarkers.

Methods

Prospective study in pediatric intensive care unit (PICU) over three months to compare between serum cystatin-C (s-Cys-C) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) as AKI biomarkers at multiple time points with pediatric risk, injury, failure, loss, end-stage renal disease (pRIFLE) classification in diagnosing AKI.

Results

Forty children were recruited. Of these 40 children, 22 developed AKI according to pRIFLE criteria. There was no significant difference between AKI and non-AKI in age (P = 0.29). Post cardiac surgery, renal insult was the main cause of AKI (27.3%). There was a twofold increased risk of incident AKI in those patients with high baseline uNGAL at PICU admission and almost a fourfold increased risk in patients with high baseline s-Cys-C at PICU admission. uNGAL levels were highly predictive of AKI during the follow-up period [area under the curve (AUC) = 0.76, 95% confidence interval (CI) 0.61–0.92]. The cutoff point with the highest correctly classified proportion was 223 ng/mL (≥ 12 centiles) which correctly predict 80.0% patients with AKI, with a corresponding sensitivity of 72.7% and a specificity of 89.9%. AUC for s-Cys-C was 0.86 (95% CI 0.75–0.97), and the highest correctly classified proportion was 1009 µg/L (≥ 13 centiles); 75% of patients with AKI, with a corresponding sensitivity of 63.6% and a specificity of 88.9%.

Conclusion

uNGAL and s-Cys-C predicts AKI early in critically ill children.

     

Plasma gelsolin level predicts acute kidney injury after cardiopulmonary bypass in infants and young children

Background

Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is a common complication especially in pediatric population. Plasma gelsolin (pGSN) is an anti-inflammatory factor through binding with actin and pro-inflammatory cytokines in circulation. Decrease in pGSN has been reported in some pathologic conditions. The purpose of the study was to determine the alterations of pGSN level in infants and young children after CPB and the role of pGSN as a predictor for the morbidity and severity of post-CPB AKI.

Methods

Sixty-seven infants and young children at age ≤ 3 years old undergoing CPB were prospectively enrolled. PGSN levels were measured during peri-operative period with enzyme-linked immuno-sorbent assay and normalized with plasma total protein concentration. Other clinical characteristics of the patients were also recorded.

Results

In patients developing AKI, the normalized pGSN (pGSN_N) levels significantly decreased at 6 h post-operation and remained low for 24 h post-operation as compared to the patients with non-AKI. PGSN_N at 6 h post-operation combining with CPB time presents an excellent predictive value for AKI.

Conclusions

Decreased pGSN_N identifies post-CPB AKI in the patients ≤ 3 years old, and is associated with adverse clinical outcomes. The findings suggest that circulating GSN in post-CPB patients may have beneficial effects on diminishing inflammatory responses.

     

Trend and causes of neonatal mortality in a level III children’s hospital in Shanghai: a 15-year retrospective study

Background

To determine the trend and causes of neonatal mortality in a large level III neonatal intensive care unit in Shanghai during a 15-year period.

Methods

This is a retrospective, single-centered study. All neonates who died during the period from January 1, 1999 to December 31, 2013 at Children’s Hospital of Fudan University were included. We extracted relevant clinical information from their medical records, analyzed neonatal mortality rate and the characteristics of these patients, and compared neonatal deaths between different periods and populations.

Results

Among a total of 50,957 admissions during the study period, there were 929 neonatal deaths. The neonatal mortality rate was 1.82%. Trends in neonatal mortality rate showed an increase in the period from 1.0% in 2003 to 2.2% in 2013. The main causes of neonatal mortality were complications of preterm birth (33.6%), congenital anomalies (21.3%), infections (12.6%), and birth asphyxia (9.1%). The proportions of complications of preterm birth (P < 0.001) and congenital anomalies (P = 0.018) increased yearly, while the proportions of birth asphyxia (P < 0.001) and infections (P < 0.001) decreased. Proportions of deaths caused by birth asphyxia (P = 0.005) and infections (P < 0.001) were both higher in the migrating population than in the permanent residents.

Conclusions

Neonatal mortality rate increased from 2003 to 2013 in our study. The proportion of preterm infants in neonatal deaths also increased within the same period. Complications of preterm birth were the main cause of neonatal mortality and the percentage increased year by year. Neonates in the migrating population appeared to be at a higher risk of death during the neonatal period compared to those in the permanent residents, and efforts should be made towards improving perinatal care to prevent infections and birth asphyxia in this vulnerable population.

     

Phase Changing Material for Therapeutic Hypothermia in Neonates with Hypoxic Ischemic Encephalopathy — A Multi-centric Study

Objective

To assess the feasibility and safety of cooling asphyxiated neonates using phase changing material based device across different neonatal intensive care units in India.

Design

Multi-centric uncontrolled clinical trial.

Setting

11 level 3 neonatal units in India from November 2014 to December 2015.

Participants

103 newborn infants with perinatal asphyxia, satisfying pre-defined criteria for therapeutic hypothermia.

Intervention

Therapeutic hypothermia was provided using phase changing material based device to a target temperature of 33.5±0.5ºC, with a standard protocol. Core body temperature was monitored continuously using a rectal probe during the cooling and rewarming phase and for 12 hours after the rewarming was complete.

Outcome measures

Feasibility measure - Time taken to reach target temperature, fluctuation of the core body temperature during the cooling phase and proportion of temperature recordings outside the target range. Safety measure - adverse events during cooling

Results

The median (IQR) of time taken to reach target temperature was 90 (45, 120) minutes. The mean (SD) deviation of temperature during cooling phase was 33.5 (0.39) ºC. Temperature readings were outside the target range in 10.8% (5.1% of the readings were <33°C and 5.7% were >34°C). Mean (SD) of rate of rewarming was 0.28 (0.13)°C per hour. The common adverse events were shock/hypotension (18%), coagulopathy (21.4%), sepsis/probable sepsis (20.4%) and thrombocytopenia (10.7%). Cooling was discontinued before 72 hours in 18 (17.5%) babies due to reasons such as hemodynamic instability/refractory shock, persistent pulmonary hypertension or bleeding. 7 (6.8%) babies died during hospitalization.

Conclusion

Using phase changing material based cooling device and a standard protocol, it was feasible and safe to provide therapeutic hypothermia to asphyxiated neonates across different neonatal units in India. Maintenance of target temperature was comparable to standard servo-controlled equipment.

     

Hämorrhagischer Schock im frühen Kindesalter – Besonderheiten der Kreislaufregulation

Background

Acute hemorrhages in neonates and young children can be compensated for a long period of time until a decrease in blood pressure and manifest shock occur.

Objective

To determine the characteristics of the pathophysiology of the circulation in children and to recognize critical signs and symptoms of hemorrhage.

Material and methods

Pathophysiology and discussion of the literature

Results

Shock in neonates and children can be present long before a decrease in blood pressure occurs. It is characterized by tachycardia, tachy(dys)pnea, prolonged capillary refilling time, disorders of consciousness (apathy), disturbance of temperature regulation and reduced urine output. Laboratory markers are metabolic acidosis and elevated lactate and a normocytic anemia earlier than in adults.

Conclusion

In contrast to adults a decrease in blood pressure in neonates and young children is a late sign of shock, whereas normocytic anemia occurs earlier than in adults.

     

Predictors of mortality in pediatric trauma: experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS)

Objectives

Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population.

Methods

1935 consecutive trauma patients aged <18 years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis.

Results

The population was a median age of 11 ± 6 year, 70 % male, and 76 % blunt injury. Median ISS 13 ± 12 and overall mortality 3.5 %. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73–0.95)], HCO3 [OR 0.82 (0.67–0.98)], Glasgow Coma Scale score [OR 0.75 (0.62–0.90)], and ISS [OR 1.10 (1.04–1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982–1.000) vs 0.888 (0.838–0.938)].

Conclusions

ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric trauma patients.

     

Investigation of the feasibility and safety of single-stage anorectoplasty in neonates with anovestibular fistula

Purpose

Anovestibular fistula (AVF) is the most common type of anorectal malformation in females. Delayed anorectoplasty with fistula dilatation is commonly performed during infancy; however, we have been actively performing anorectoplasty in neonates. We report the surgical complications and postoperative defecation function associated with single-stage anorectoplasty performed in neonates.

Methods

Patients who underwent surgery for AVF between 2007 and 2017 at two institutions were retrospectively studied. The operation time, amount of bleeding, time to start oral intake, perioperative complications, and Kelly’s score were compared among patients who underwent surgery as neonates and those who underwent surgery as infants.

Results

Eighteen neonates and 17 infants underwent anterior sagittal anorectoplasty. The median operation time and time to start oral intake were significantly shorter in the neonatal group (72 min; 3 days, respectively) than in the infant group (110 min, p?=?0.0002; 5 days, p?=?0.0024, respectively). Postoperative wound disruption was significantly more frequent in the infant group. Of the ten patients each in the neonatal and infant groups, there was no significant difference in Kelly’s score at age ≥?4 years.

Conclusion

Single-stage anorectoplasty in neonates with AVF can be feasibly performed and does not impair postoperative defecation function.

Levels of evidence

III.

     

Predictors and Outcome of Acute Kidney Injury in Children with Diabetic Ketoacidosis

Objective

To identify predictors and outcome of acute kidney injury (AKI) in children with diabetic ketoacidosis (DKA) admitted to a Pediatric Intensive Care Unit (PICU).

Methods

Retrospective case review of 79 children with DKA admitted between 2011-2014.

Results

28 children developed AKI during the hospital stay; 20 (71.4%) recovered with hydration alone. Serum chloride at 24 hours was independently associated with AKI. Children with AKI had prolonged acidosis, longer PICU stay, and higher mortality.

Conclusions

Majority of children with AKI and DKA recover with hydration. Hyperchloremia at 24 hours had independent association with AKI, although cause-effect relation could not be ascertained.

     

Cardiac Troponin-T as a Marker of Myocardial Dysfunction in Term Neonates with Perinatal Asphyxia

Objectives

To describe the diagnostic test properties of Cardiac Troponin-T (cTnT) in predicting myocardial dysfunction in asphyxiated term neonates by taking echocardiography as the gold standard and to establish the optimum cut-off values of cTnT for myocardial dysfunction, shock, severe hypoxic ischemic encephalopathy (HIE) and mortality by receiver operator characteristic (ROC) curve analysis.

Methods

This was a prospective study based on diagnostic test evaluation. The study included 120 term asphyxiated neonates in a tertiary care neonatal intensive care unit (NICU) in Southern India from June 2011 through June 2015. All the neonates were clinically evaluated. Venous blood was taken at 4 h of life for cTnT estimation. Echocardiography was done within 24 h of birth.

Results

The mean cTnT level of asphyxiated term neonates was 0.207±0.289 ng/ml (mean ± SD). Asphyxiated neonates with myocardial dysfunction had higher cTnT levels (0.277±0.231) as compared to those without myocardial dysfunction (0.061±0.036, p?=?0.0001). Using ROC curve, the cut-off cTnT values for myocardial dysfunction was 0.1145 ng/ml with sensitivity 92.4% and specificity 94.1%. Cardiac Troponin-T levels were significantly higher among asphyxiated neonates with shock (0.378±0.348, p?=?0.0001) and the levels also correlated positively with increasing grades of HIE. The cut-off cTnT value for mortality was 0.2505 ng/ml with sensitivity 83.9% and specificity 96.6%.

Conclusions

In asphyxiated term neonates, early cTnT elevation is a marker for predicting myocardial dysfunction and elevated cTnT levels had high sensitivity and specificity. There was significant relation with increasing cTnT values and increasing grades of HIE.

     

Hyperthyroxinemia at birth: a cause of idiopathic neonatal hyperbilirubinemia?

Background

Some neonates develop idiopathic hyperbilirubinemia (INHB) requiring phototherapy, yet with no identifiable causes. We searched for an association between abnormal thyroid levels after birth and INHB.

Methods

Of 5188 neonates, 1681 (32.4%) were excluded due to one or more risk factors for hyperbilirubinemia. Total thyroxine (TT4) and thyroid stimulating hormone values were sampled routinely at 40–48 hours of age and measured in the National Newborn Screening Program.

Results

Of the 3507 neonates without known causes for hyperbilirubinemia, 61 (1.7%) developed INHB and received phototherapy. Univariate analyses found no significant association between mode of delivery and INHB (vacuum-delivered neonates were a priori excluded). Nonetheless, in cesarean-delivered (CD) neonates, two variables had significant association with INHB: TT4 ≥ 13 µg/dL and birth at 38–38.6 weeks. In vaginally delivered (VD) born neonates, INHB was associated with weight loss > 7.5% up to 48 hours of age. Multivariate logistic regression analysis showed a strong effect of mode of delivery on possible significant association with INHB. In CD neonates, such variables included: TT4 ≥ 13 µg/dL [P = 0.025, odds ratio (OR) 5.49, 95% confidence interval (CI) 1.23–24.4] and birth at 38–38.6 weeks (P = 0.023, OR 3.44, 95% CI 1.19–9.97). In VD neonates, weight loss > 7.5% (P = 0.019, OR 2.1, 95% CI 1.13–3.83) and 1-min Apgar score < 9 (P < 0.001, OR 3.8, 95% CI 1.83–7.9), but not TT4, showed such an association.

Conclusions

INHB was significantly associated with birth on 38–38.6 week and TT4 (≥ 13 µg/dL) in CD neonates, and with a weight loss > 7.5% in VD neonates. We herein highlight some acknowledged risk factors for neonatal hyperbilirubinemia, and thus minimize the rate of INHB.

     

Mortality and morbidity in oesophageal atresia

Background

Several classification systems exist to predict mortality in oesophageal atresia, the most widely quoted of these being over 20 years old. No classification system exists to predict morbidity. We sought to test whether these classification systems remain relevant and to determine whether they can be useful to predict morbidity. In addition, we aimed to identify independent risk factors for predicting mortality and morbidity.

Methods

Neonates presenting with oesophageal atresia over a 20-year period (1990–2010) were retrospectively reviewed. Discriminative statistical analysis compared the performance of current classification systems. Stepwise logistic regression analysis of the influence of perioperative risk factors on mortality and duration of ventilatory support and intensive care unit stay were performed.

Results

All classification systems predicted mortality in this series of 248 neonates. Birth weight, cardiac anomalies and pre-operative pneumonia were independent risk factors for predicting mortality in oesophageal atresia. The Waterston classification is the most useful classification for predicting post-operative morbidity in terms of length of hospital stay and time spent ventilated.

Conclusion

Despite advances in the neonatal care of the very low birth weight infant and those with congenital cardiac disease, these conditions remain relevant in predicting mortality and morbidity in oesophageal atresia.

     

Perinatal features of congenital cystic lung diseases: results of a nationwide multicentric study in Japan

Purpose

The current study aimed to assess the perinatal risk and clinical features of congenital cystic lung diseases (CCLD).

Materials and methods

Of the 874 CCLD patients identified in a nationwide survey, 428 patients born between 1992 and 2012 and treated at 10 high-volume centers, were retrospectively reviewed.

Results

Fetal hydrops was visualized using MRI in 9.2 % of the patients. Prenatal interventions were described for 221 of the 428 patients, including the maternal administration of steroid and pleuro-amniotic shunting. Postnatally, a right-to-left shunt flow through a persistent ductus arteriosus was observed in 7.8 % of the patients. The fetal lung lesion volume ratio (LVR) was significantly higher among these symptomatic patients (2.04 ± 1.71 vs. 0.98 ± 0.50, P < 0.00071), and decreased to a greater degree in non-CCAM patients compared with CCAM patients during the late gestational period (from 1.37 ± 1.28 to 1.14 ± 0.84 in CCAM and from 1.08 ± 0.47 to 0.46 ± 0.64 in non-CCAM).

Conclusions

An estimated 8–9 % of prenatally diagnosed patients carry the highest risk of perinatal respiratory distress. Fetal LVR remaining at a high level during the late gestational period seems to predict a high risk.

     

Insertion of peripherally inserted central catheters in neonates less than 1.5 kg using ultrasound guidance

Background

Neonates commonly require central access, and in those with very low or extremely low birthweight this can be challenging. Described here is a technique that uses ultrasound guidance in the placement of peripherally inserted central catheters (PICC) in neonates and an analysis of outcomes.

Methods

A retrospective chart review was conducted of all patients below 1500 g that underwent placement of a peripherally inserted central catheter under ultrasound guidance between January 1, 2012, and December 31, 2014 at a single center. All patients had multiple previous attempts at PICC placement by experienced NICU vascular access nurses prior to referral. Complications were determined based on clinical and procedural notes.

Results

A total of ten patients were found during the study period. The average estimated gestational age was 29.8 weeks (range 26–38 weeks).The average weight at the time of PICC insertion was 968 g (range 485–1390 g). All attempts at placement were successful. There were no complications directly related to PICC insertion.

Conclusion

Ultrasound guided PICC line placements using ultrasound is an effective technique, which can be applied to very low and extremely low birth weight infants, with excellent success rates and a low risk of complications.

     

Effect of delayed cord clamping on hematocrit,and thermal and hemodynamic stability in preterm neonates: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To evaluate the short term clinical effects of delayed cord clamping in preterm neonates.

Design

Randomized controlled trial.

Setting

A tertiary care neonatal unit from October 2013 to September 2014.

Participants

78 mothers with preterm labor between 27 to 31^6/7 weeks gestation.

Intervention

Early cord clamping (10 s), delayed cord clamping (60 s) or delayed cord clamping (60 s) along with intramuscular ergometrine (500 μg) administered to the mother.

Main outcome measures

Primary: hematocrit at 4 h after birth; Secondary: temperature on admission in neonatal intensive care unit, blood pressure (non-invasive) at 12 h, and urinary output for initial 72 h.

Results

Mean (SD) hematocrit at 4 h of birth was 58.9 (2.4)% in delayed cord clamping group, and 58.7 (2.1)% in delayed cord clamping with ergometrine group as compared to 47.6 (1.3)% in early cord clamping group. Mean (SD) temperature on admission in NICU was 35.8 (0.2)ºC, 35.8 (0.3)ºC, and 35.5 (0.3)ºC, respectively in these three groups. The mean (SD) non-invasive blood pressure at 12 h of birth was 45.8 (7.0) mmHg, 45.8 (9.0) mmHg, and 35.5 (8.6) mmHg, respectively in these three groups. Mean (SD) urinary output on day 1 of life was 1.1 (0.2) mL/kg/h, 1.1 (0.2) mL/kg/hr and 0.9 (0.2) ml/kg/h, respectively.

Conclusion

In preterm neonates delayed cord clamping along with lowering the infant below perineum or incision site and administration of ergometrine to mother has significant benefits in terms of increase in hematocrit, higher temperature on admission, and higher blood pressure and urinary output during perinatal transition.

     

Epidemiology and outcomes of children with renal failure in the pediatric ward of a tertiary hospital in Cameroon

Background

Pediatric nephrology is challenging in developing countries and data on the burden of kidney disease in children is difficult to estimate due to absence of renal registries. We aimed to describe the epidemiology and outcomes of children with renal failure in Cameroon.

Methods

We retrospectively reviewed 103 medical records of children from 0 to 17 years with renal failure admitted in the Pediatric ward of the Douala General Hospital from 2004 to 2013. Renal failure referred to either acute kidney injury (AKI) or Stage 3–5 chronic kidney disease (CKD). AKI was defined and graded using either the modified RIFLE criteria or the Pediatrics RIFLE criteria, while CKD was graded using the KDIGO criteria. Outcomes of interest were need and access to dialysis and in-hospital mortality. For patients with AKI renal recovery was evaluated at 3 months.

Results

Median age was 84 months (1QR:15–144) with 62.1% males. Frequent clinical symptoms were asthenia, anorexia, 68.8% of participants had anuria. AKI accounted for 84.5% (n?=?87) and CKD for 15.5% (n?=?16). Chronic glomerulonephritis (9/16) and urologic malformations (7/16) were the causes of CKD and 81.3% were at stage 5. In the AKI subgroup, 86.2% were in stage F, with acute tubular necrosis (n?=?50) and pre-renal AKI (n?=?31) being the most frequent mechanisms. Sepsis, severe malaria, hypovolemia and herbal concoction were the main etiologies. Eight of 14 (57%) patients with CKD, and 27 of 40 (67.5%) with AKI who required dialysis, accessed it. In-hospital mortality was 50.7% for AKI and 50% for CKD. Of the 25 patients in the AKI group with available data at 3 months, renal recovery was complete in 22, partial in one and 2 were dialysis dependent. Factors associated to mortality were young age (p?=?0.001), presence of a coma (p?=?0.021), use of herbal concoction (p?=?0.024) and acute pulmonary edema (p?=?0.011).

Conclusion

Renal failure is severe and carries a high mortality in hospitalized children in Cameroon. Limited access to dialysis and lack of specialized paediatric nephrology services may explain this dismal picture.

     

Echocardiographic Inferior Vena Cava Measurement As An Alternative to Central Venous Pressure Measurement in Neonates

Objectives

To evaluate the correlation between echocardiographic inferior vena cava (IVC) measurements and central venous pressure (CVP) in neonates. Also, to evaluate the correlation between IVC measurements and gestational age (GA) and body weight (BW).

Methods

This cross sectional analytical study was conducted from June 2014 through June 2016 in a level III NICU. All neonates requiring intensive hemodynamic monitoring and having umbilical venous catheter (UVC) in place for clinical indications were enrolled in the study. IVC measurements were recorded by echocardiography (ECHO) and CVP was measured concomitantly in neonates having appropriate sized UVC in place. IVC measurements were evaluated and compared for any correlation with the CVP, GA and BW.

Results

Fifty neonates with median gestation of 37 wk [Q1 = 29.2, Q3 = 37.8, interquartile range (IQR) = 8.6 wk] and median birth weight of 2420 g (Q1 = 923.5, Q3 = 2850, IQR = 1926.5 g) were included in the study. A strong negative linear correlation was observed between IVC collapsibility index (IVC-CI) and CVP (r = ?0.968, r² = ?0.937, p 0.000). No correlation was observed between IVC-CI and GA or BW. IVC minimum and IVC maximum diameters did not correlate with CVP but correlated well with GA and BW.

Conclusions

Echocardiographic IVC-CI measurement has a good correlation with CVP measurement in neonates. The clinical use will depend on the ability of IVC-CI to predict surrogate markers of tissue perfusion in shock.

     

Are IgM-enriched immunoglobulins an effective adjuvant in septic VLBW infants?

Aim

To investigate the effectiveness of IgM-enriched immunoglobulins (IgM-eIVIG) in reducing short-term mortality of neonates with proven late-onset sepsis.

Methods

All VLBW infants from January 2008 to December 2012 with positive blood culture beyond 72 hours of life were enrolled in a retrospective cohort study. Newborns born after June 2010 were treated with IgM-eIVIG, 250 mg/kg/day iv for three days in addition to standard antibiotic regimen and compared to an historical cohort born before June 2010, receiving antimicrobial regimen alone. Short-term mortality (i.e. death within 7 and 21 days from treatment) was the primary outcome. Secondary outcomes were: total mortality, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, bronchopulmonary dysplasia at discharge.

Results

79 neonates (40 cases) were enrolled. No difference in birth weight, gestational age or SNAP II score (disease severity score) were found. Significantly reduced short-term mortality was found in treated infants (22% vs 46%; p?=?0.005) considering all microbial aetiologies and the subgroup affected by Candida spp. Secondary outcomes were not different between groups.

Conclusion

This hypothesis-generator study shows that IgM-eIVIG is an effective adjuvant therapy in VLBW infants with proven sepsis. Randomized controlled trials are warranted to confirm this pilot observation.

     

Contaminated or dirty wound operations and methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> (MRSA) colonization during hospitalization may be risk factors for surgical site infection in neonatal surgical patients

Purpose

Establishment of evidence-based best practices for preventing surgical site infection (SSI) in neonates is needed. SSI in neonates, especially those with a low birth weight, is potentially life-threatening. We aimed to identify risk factors associated with SSI in neonates.

Methods

A retrospective review was performed using 2007–2016 admission data from our institution. Neonatal patients who were admitted to the neonatal intensive care unit and underwent surgery were evaluated for a relationship between development of SSI and perinatal or perioperative factors and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization.

Results

One hundred and eighty-one patients were enrolled in this study. Overall SSI incidence was 8.8%. Univariate analysis showed that SSI was significantly more frequent in both patients with contaminated or dirty wound operations and patients with MRSA colonization during hospitalization. Both of these factors were identified as independent risk factors for SSI by multivariate analysis [hazard ratio (HR): 6.1, 95% confidence interval (CI) 2.0–19.9; HR: 3.3, 95% CI 1.1–10.4, respectively].

Conclusions

This study identified contaminated or dirty wound operations and MRSA colonization during hospitalization as risk factors for SSI in neonates. MRSA colonization may be a preventable factor, unlike previously reported risk factors.

     

Management of congenital tracheal stenosis in the neonatal period

Purpose

Few reports have focused on the management of congenital tracheal stenosis (CTS) in the neonatal period. The aim of this study was to determine appropriate management strategies for CTS in the neonatal period.

Methods

The medical records of eight neonatal patients with CTS at a single institution between January 2007 and December 2016 were retrospectively reviewed.

Results

Three patients with frequent ventilatory insufficiency despite assisted ventilation underwent surgical intervention (balloon tracheoplasty: n = 1, slide tracheoplasty: n = 2). Ventilatory insufficiency improved after surgery in all three patients. One patient who underwent slide tracheoplasty died due to non-airway-related causes. Observation or conservative management was performed in five patients with minimal respiratory symptoms or stable ventilation under assisted ventilation. All five patients were safely managed non-operatively in the neonatal period.

Conclusion

Depending on the severity of ventilatory insufficiency, there are two management strategies for CTS in the neonatal period. Surgical intervention, such as balloon tracheoplasty or slide tracheoplasty, is indicated for patients with unstable ventilatory status despite assisted ventilation. Observation or conservative management is a more suitable option for neonates with stable ventilation.

     

Transcutaneous bilirubin nomogram for healthy term and late preterm neonates in first 96 hours of life

Objective

To develop nomogram of Transcutaneous Bilirubin among healthy term and late-preterm neonates during first 96 hours of age.

Design

Longitudinal observational study.

Setting

Neonatal unit of a tertiary care Hospital of Central Gujarat, India.

Participants

1075 healthy term and late preterm neonates (≥35weeks).

Intervention

Six-hourly transcutaneous bilirubin was obtained from birth to 96 hour of life using Drager JM 103 Transcutaneous Bilirubinometer.

Main outcome measures

Nomogram of Transcutaneous Bilirubin with percentile values was obtained, rate of rise of bilirubin was calculated and predictive ability of normative data was analyzed for subsequent need of phototherapy.

Results

The age-specific percentile curves and nomogram were developed from the transcutaneous bilirubin readings of 1,010 neonates. Rate of rise in first 12 hour was 0.2 mg/dL and was 0.17 mg/dL in 12 to 24 hour of life which decreased on second day of life. Neonates who required phototherapy had consistently higher readings of transcutaneous bilirubin and also higher rate of rise in first 48 hrs.

Conclusion

Neonates whose transcutaneous bilirubin is above the 50th percentile should be monitored for the development of significant hyperbilirubinemia.