Can we rely on the neutrophil left shift for the diagnosis of neonatal sepsis? Need for re-evaluation

Background

Neonatal sepsis cause significant morbidities and mortality among affected neonates. The gold standard for its diagnosis is the blood culture. However, its usefulness is limited by many factors. A rapid diagnostic test with high sensitivity and specificity is needed for rapid identification of neonatal sepsis without exposing unaffected neonates to antibiotic therapy. The accuracy of immature neutrophil count for the diagnosis of neonatal sepsis is controversial.

Is the water safe for my baby?

Children's behavior and physiology place them at unique risk from waterborne microbial and chemical contaminants. This article reveals children's susceptibility factors and the microbial and chemical contaminants of greatest importance to this age group. It also provides a primer on water treatment and alternatives to tap water. This article concludes with recommendations and resources to aid the practicing pediatrician in addressing patient concerns about drinking water.     

Vitamin K prophylaxis: leaving the old route for the new one?

Oral or parenteral administration of vitamin K is the accepted practice for prevention of early vitamin K deficiency bleeding (VKDB) in the newborn. However, vitamin K prophylaxis in the newborn continues to be a worldwide health concern, particularly in breastfed infants. This paper reviews the current status of the use of vitamin K for the prevention of early and late VKDB.     

Antifungal prophylaxis for the prevention of neonatal candidiasis?

BACKGROUND: Randomized controlled trials suggest that prophylactic administration of antifungal agents reduce the rate of colonization and invasive Candida infection in a subgroup of high-risk very low birth weight (VLBW) neonates. The extent of antifungal prophylaxis use in the United Kingdom and Ireland is unknown. METHODS: A postal questionnaire was administered to neonatologists practicing in the United Kingdom and Ireland caring for VLBW infants. Information was requested on the prophylactic agents used, dosing schedules and duration of therapy. The rationale for reported practices was also ascertained. RESULTS: The response rate was 55% (125/228). Antifungal prophylaxis use was reported by 66 (53%) respondents. First-line agents utilized included oral nystatin (53%) and intravenous fluconazole (41%). The most frequent indications for antifungal prophylaxis included antibiotic administration in 45 (68%) and decreased birth weight in 33 (50%) respondents. The majority of respondents who did not use antifungal prophylaxis felt that the perceived rate of invasive fungal disease within their unit was not high enough to justify its use. CONCLUSIONS: A small majority of clinicians caring for VLBW neonates routinely use antifungal prophylaxis. This reflects the wide variation in the incidence of invasive disease, lack of guidelines supporting a role for prophylaxis and concerns related to emergence of resistant strains.