Safety of neonatal skin cleansing in rural Nepal

OBJECTIVE: A high proportion of deaths during the neonatal period are attributed to infections. Neonatal skin plays an important role in protecting the newborn from invasive pathogens. In preparation for a study of newborn skin cleansing with chlorhexidine in Nepal, we evaluated the feasibility, acceptability, and safety of the newborn cleansing procedure. STUDY DESIGN/SETTING: Observational pilot study of full-body cleansing of newborns in rural Nepal. METHODS: Thirty two newborn infants were wiped with commercially available non-antiseptic baby wipes. Pre and post-procedure axillary temperatures were recorded to estimate the impact of cleansing on body temperature. Skin aggravation, residual moisture, removal of vernix, and maternal satisfaction were assessed qualitatively. RESULTS: Body temperature of newborns decreased an average of 0.40 C (95% CI: 0.31 to 0.49 C, p < 0.0001) during the procedure. There was no evidence of skin aggravation, injury or removal of vernix, and mothers expressed satisfaction with the procedure. The procedure was simple and project workers were easily trained. CONCLUSION: Care must be taken to promptly wrap infants after skin cleansing procedures as slight temperature decrease was noted after the procedure. These pilot data indicate, however, that gentle cleansing of newborn skin poses minimal risk to infants. This procedure is safe and appropriate precautions can be taken to deliver safe skin antisepsis with chlorhexidine to infants in the community.     

Skin cleansing in neonates and infants-basics of cleansers

OBJECTIVE: Using a proper cleanser for bathing neonatal and infant skin is of prime importance considering the anatomical differences with regard to adult skin. Choosing the right cleanser requires knowledge of the composition of a cleanser as well as the properties of the individual ingredients. METHODS: The article discusses the guidelines for cleansing the skin of neonates and infants. The characteristics of an ideal cleanser for pediatric skin have also been enumerated. RESULTS: In India, majority of cleansers recommended for babies do not mention their active ingredients. Their claims of "mildness" have not been substantiated with clinical studies. Cetaphil, a non-soap, lipid-free liquid cleanser, has been clinically proven to be non-irritating by the Chamber Scarification Test. Moreover, Cetaphil also has a pH of less than 7, which does not alter the physiological pH of skin. CONCLUSION: Hence, Cetaphil should definitely be considered while choosing a cleanser for neonates and infants.     

Skin cleansing in neonates and infants-basics of cleansers

Objective: Using a proper cleanser for bathing neonatal and infant skin is of prime importance considering the anatomical differences with regard to adult skin. Choosing the right cleanser requires knowledge of the composition of a cleanser as well as the properties of the individual ingredients.Methods: The article discusses the guidelines for cleansing the skin of neonates and infants. The characteristics of an ideal cleanser for pediatric skin have also been enumerated.Results: In India, majority of cleansers recommended for babies do not mention their active ingredients. Their claims of “mildness” have not been substantiated with clinical studies. Cetaphil, a non-soap, lipid-free liquid cleanser, has been clinically proven to be non-irritating by the Chamber Scarification Test. Moreover, Cetaphil also has a pH of less than 7, which does not alter the physiological pH of skin.Conclusion: Hence, Cetaphil should definitely be considered while choosing a cleanser for neonates and infants. An erratum to this article is available at .     

A randomized controlled trial of the impact of chlorhexidine skin cleansing on bacterial colonization of hospital-born infants in Nepal

BACKGROUND: Chlorhexidine skin cleansing might substantially reduce neonatal infection and mortality in developing countries. Few data exist on the impact of chlorhexidine cleansing on skin colonization of infants during the first day of life or on the absorption potential of chlorhexidine during newborn skin cleansing. METHODS: Hospital-born newborns in Kathmandu, Nepal were randomly allocated to full-body skin cleansing with 0.25%, 0.50%, or 1.00% chlorhexidine solution. Skin swabs were collected from the axilla, inguinal, and peri-umbilical areas before cleansing (baseline), and at 2 and 24 hours after treatment. Skin flora was quantified and organisms identified. In a subsample, heel prick blood was collected 24 hours after the cleansing and percutaneous absorption of chlorhexidine was assessed. RESULTS: Among 286 enrolled newborns, no adverse effects on skin were reported and body temperature was minimally reduced (mean reduction, 0.33 degrees C). In all groups, positive skin culture rates were significantly reduced at 2 hours but generally not at 24 hours; greater reductions were observed with higher concentrations of chlorhexidine. Effect at 24 hours was highest in the 1.00% group (37% lower positive skin culture rate). For 15 of 75 infants with heel pricks, chlorhexidine was detected at trace concentrations (<8 ng/mL, n = 14; 25.8 ng/mL, n = 1). CONCLUSIONS: Chlorhexidine skin cleansing seemed safe and reduced skin flora in newborns in a dose-dependent manner 2 hours after treatment. Greater residual effect at the highest concentration (1%) might provide broader benefit and may simplify combined maternal and neonatal regimens by matching the concentration used for vaginal cleansing during labor.     

光疗对于黄疸新生儿肠道菌群及耐药基因的影响分析

目的 分析接受光疗的黄疸新生儿肠道菌群及其耐药基因的变化,探讨其临床意义。方法 通过宏基因组测序的方法,分析黄疸新生儿接受光疗后肠道菌群及其携带耐药基因的变化。结果 光疗24 h及48 h后肠道菌群丰度的α和β多样性差异无统计学意义(P>0.05)。菌种水平上,个别菌种相对丰度增多,包括梭状芽孢杆菌、粪肠球菌、嗜热链球菌(P<0.01)。新生儿肠道菌群携带大量耐药基因,共242种,主要是四环素类、β-内酰胺类、大环内酯类、磺胺类、氨基糖苷类耐药基因,同时还发现了较多大肠杆菌耐药基因。随着光疗时间延长,β-内酰胺类耐药基因(CTX-M-14)、氨基糖苷类耐药基因(aadA2)、四环素类耐药基因[tet(59)]、外排泵基因(efmA)、喹诺酮类耐药基因(QnrS2)、碳青霉烯酶基因(OXA-347)和磺胺类耐药基因(dfrA1)丰度发生显著增加;金黄色葡萄球菌调节耐药基因(mgrA)丰度在光疗后降低(P<0.05)。光疗48 h后,肠道菌群菌种水平的丰度与耐药基因呈显著正相关的有：梭状芽孢杆菌与氨基糖苷类耐药基因[APH(3’)-Ia],单形拟杆菌与β-内酰胺类耐药基因...     

出生早期新生儿肠道双歧杆菌动态检测

目的 了解出生1周新生儿肠道双歧杆菌的动态变化.方法 采用16srRNA/DNA荧光定量PCR技术,分别对40例足月儿和40例早产儿生后第1(>12 h)、4、7天粪便标本中的双歧杆菌进行定量分析.结果 生后第1、4、7天足月儿粪便标本中双歧杆菌数量(拷贝数/g湿便)的对数值分别为6.52±0.52、8.30±0.48、8.89±0.48,差异有统计学意义(F=210.87,P<0.01);早产儿分别为6.28±0.44、6.97±0.48、7.34±0.49,差异有统计学意义(F=29.31,P<0.01);相同日龄两组间比较,第4、7天差异有统计学意义(t=11.56、13.98,P均<0.01).结论 新生儿肠道双歧杆菌的建立呈动态变化,早产儿落后于足月儿.     

Faecal flora in neonates with oesophageal atresia.

The bacteriological findings of a study of intestinal colonisation in 24 neonates with oesophageal atresia are reported. Only five of the patients received antibiotics. When compared with published findings in healthy neonates, the rate of intestinal colonisation in our series was prolonged, with Staphylococcus albus predominating in the first week. Anaerobic colonisation was delayed and bacteroides spp were present in only five patients by the third week. Bifidobacteria were almost completely absent. The onset of intestinal colonisation seemed to be related temporally to enteral feeding. The use of antibiotics in five patients resulted in colonisation by candida in four and clinical thrush in three.     

Ciprofloxacin treatment in preterm neonates in Bangladesh: lack of effects on growth and development

BACKGROUND: Quinolone-induced arthropathic toxicity in weight-bearing joints observed in juvenile animals during preclinical testing has largely restricted the routine use of ciprofloxacin in the pediatric age group. As histopathologic, radiologic and magnetic resonance imaging monitoring evidence has gathered supporting the safety of fluoroquinolones in children, many pediatricians have started to prescribe quinolones to some patients on a compassionate basis. OBJECTIVE: The objective of this study was to ascertain the safety of ciprofloxacin in preterm neonates <33 weeks gestational age treated at Dhaka Shishu (Children) Hospital in Bangladesh. METHODS: Long-term follow up was done to monitor the growth and development of preterm infants who were administered intravenous ciprofloxacin in the neonatal period. Ciprofloxacin was used only as a life-saving therapy in cases of sepsis produced by bacterial agents resistant to other antibiotics. Another group of preterm neonates with septicemia who were not exposed to ciprofloxacin, but effectively treated with other antibiotics and followed up, were matched with cases for gender, gestational age and birth weight and included as a comparison group. Forty-eight patients in the ciprofloxacin group and 66 patients in the comparison group were followed up for a mean of 24.7 +/- 18.5 months and 21.6 +/- 18.8 months, respectively. RESULTS: No osteoarticular problems or joint deformities were observed in the ciprofloxacin group during treatment or follow up. No differences in growth and development between the groups were found. CONCLUSIONS: Ciprofloxacin is a safe therapeutic option for newborns with sepsis produced by multiply resistant organisms.     

母乳喂养新生儿早期重度高胆红素血症肠道菌群特征研究

目的探讨母乳喂养新生儿早期重度高胆红素血症的肠道菌群特征。方法以2018年1月至6月因早发型母乳性高胆红素血症入院的母乳喂养新生儿为研究对象,并以母乳喂养健康新生儿为对照组。收集粪便样本,采用16S rDNA测序方法分析比较肠道菌群。结果 6例高胆红素血症及6例健康新生儿的肠道菌群,在多样性水平上的差异无统计学意义(P0.05);在属水平上,高胆红素血症组的大肠杆菌属丰度较对照组高,差异有统计学意义(P0.05),LEfSe分析显示葡萄球菌科、葡萄球菌属、克雷伯菌属、芽孢杆菌目丰度在对照组较高。结论早期重度高胆红素血症母乳喂养新生儿与母乳喂养健康新生儿的肠道菌群在属水平上有一定差异,但在多样性上未见明显差异。     

Pharyngeal and tracheal flora in intubated neonates: interrelations and role of streptococci

Fourteen neonates intubated within 48 hours of birth were studied for a mean period of two weeks. None were candidates for antimicrobial therapy. Microorganism loads were evaluated twice a week, quantitatively in the pharynx and semiquantitatively in the trachea. Most microorganisms recovered were Gram-positive cocci. All species acquired reached 10(7) CFU/g by the time of the second sampling. All species recovered from the pharynx were recovered from the trachea within 0.25 weeks. The presence of alpha-hemolytic streptococci did not modify the other populations. A colonization pattern similar to that seen in the digestive tract but with specific features due to countercurrent colonization is suggested.     

Bacterial enteropathogens of neonates admitted to an urban diarrhoeal hospital in Bangladesh

Data on the aetiology of diarrhoea in neonates are scarce, especially from developing countries including Bangladesh. A retrospective review of the electronic database of the Microbiology Laboratory of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), was carried out to examine enteropathogens associated with diarrhoea in neonates. Stool specimens of the neonates on admission to the Dhaka Hospital of ICDDR,B were collected and sent to the laboratory for direct plating onto taurocholate tellurite gelatin agar, Salmonella-Shigella agar and MacConkey's agar. Stool specimens of 2511 neonates of either sex were examined. Bacterial pathogens were recovered from the stools of 699 (27.8%) of these neonates--a single bacterial pathogen from 670 neonates and more than one pathogen from 29 neonates. Vibrio cholerae, Shigella, Salmonella, Aeromonas spp. and Plesiomonas shigelloides were isolated from 294, 108, 52, 222 and 19, respectively, of the neonates. The year-wise isolation of these pathogens varied between 4.9-23.4%, 2.7-5.4%, 0-4.7%, 0-19.4% and 0-1.6%, respectively, of the neonates. The results of the study indicate that infection by V. cholerae, Shigella spp., Salmonella spp., Aeromonas and P. shigelloides is common in neonatal diarrhoea in Bangladesh.     

Reactive hyperemia of skin microcirculation in septic neonates

Reactive hyperemia after 1 min of arterial occlusion was studied in back, thigh and heel skin of 40 preterm and full-term neonates using laser Doppler flowmetry. Twelve infants had clinical signs of septicemia, but normal laboratory tests at the time of fluxmetry. However, CRP, leukocyte count and the ratio of immature to total neutrophils increased during the following days and septicemia was confirmed by positive blood cultures (septic group). Seven neonates with clinical signs of septicemia had developed neither positive blood cultures nor laboratory signs (non-septic group). Fifteen were healthy neonates. In the septic neonates, time to reach maximal hyperemia, maximum post-occlusive hyperemia and recovery time of skin perfusion were increased significantly in back and thigh skin and the heal skin temperature was decreased when compared to healthy neonates. Healthy and non-septic neonates showed no significant difference in any of the parameters. We conclude that altered reactive hyperemia in the skin may be an earlier sign of neonatal septicemia than laboratory tests.     

Safety and immunogenicity of tetravalent rhesus-based rotavirus vaccine in Bangladesh.

BACKGROUND: Rotavirus is the most common cause of severe gastroenteritis among children worldwide. OBJECTIVES: To compare the safety, immunogenicity and shedding patterns of rhesus rotavirus (RRV)-tetravalent vaccine vs. placebo among infants in rural Bangladesh. METHODS: A double blinded, placebo-controlled trial was conducted in which infants (n = 120) were randomly assigned to receive three doses of either vaccine or placebo administered at approximately 6, 10 and 14 weeks of age together with routine immunizations. Data on possible adverse effects of vaccinations were collected daily for 7 days after each dose. Stool samples were collected after each dose, and serum samples were obtained before the first and after the third vaccination. RESULTS: Fever (> or = 38 degrees C), as measured by study assistants, was noted more frequently among vaccinees (15%) than among placebo recipients (2%) during the 7 days after vaccination but was not reported more frequently by parents of vaccinees vs. placebo recipients. Overall 87% of vaccinees had an antibody response (measured by IgA or anti-RRV-neutralizing antibodies) after vaccination compared with 32% of placebo recipients. Rates of seroconversion were higher among subjects with lower levels of prevaccination antibodies and those who shed rotavirus after vaccination. Vaccine strain viruses were detected in stools from placebo vaccine recipients who had evidence of IgA seroconversion. CONCLUSIONS: In this population RRV-tetravalent vaccine was comparably immunogenic and safe as in trials conducted in developed countries, where this vaccine has been proved effective in preventing severe rotavirus diarrhea. These data support continued evaluation of rotavirus vaccines in developing countries.     

Lumbosacral skin markers and identification of occult spinal dysraphism in neonates

ABSTRACT. Some skin lesions over the spine are known to be associated with occult spinal dysraphism, but the significance of common skin lesions, such as sacral pits and dimples, is uncertain. In this prospective study, 95 neonates (1.9% of 4989 live births) were referred with possible markers of occult spinal dysraphism. Seven of 94 babies examined had abnormalities demonstrated by spinal ultrasound, compared with 5 of 105 controls. In 2 of 94 and 3 of 105 of these, the conus medullaris was located at L3 but no other abnormalities were found. Of the 75 babies with a sacral dimple or pit alone, none had an abnormality, suggesting that these skin lesions do not indicate a high risk of occult spinal dysraphism.