新生儿院内感染发生情况的调查及危险因素分析

目的调查新生儿院内感染发生情况并分析其危险因素。方法收集我院新生儿病房2014年3月-2015年2月收治的1044例新生儿作为研究对象展开回顾性分析,明确院内感染患儿的病原菌分布情况及感染部位,对比感染患儿与未感染患儿的相关资料,明确新生儿院内感染的危险因素。结果40例感染患儿中,病原菌分布:革兰阴性菌22例(55.0%)、革兰阳性菌15例(37.5%)、真菌3例(7.5%)。革兰阴性杆菌对阿米卡星及头孢他啶的耐药率均较高,革兰阳性球菌则对阿莫西林与氨苄西林的耐药率高。29例(72.5%)感染部位为呼吸道,其次为血液6例(15.0%)、消化道3例(7.5%)、皮肤2例(5.0%)。胎龄32周、体质量2.5 kg、Apgar评分5分、合并基础疾病、合并新生儿缺氧缺血脑病(HIE)、使用呼吸机、侵入性操作、使用抗菌药物、住院时间超过1周等均为新生儿住院期间的院内感染危险因素,其中使用呼吸机、侵入性操作、使用抗菌药物、体质量2.5 kg为独立危险因素。结论医护人员需加强无菌观念,避免预防性应用抗生素,尽量减少侵入性操作及呼吸机使用,以降低新生儿院内感染率。     

The gut mucosal immune system in the neonatal period

Invasive sepsis in the newborn period is a major cause of childhood morbidity and mortality worldwide. The infant immune system undoubtedly differs intrinsically from the mature adult immune system. Current understanding is that the newborn infant immune system displays a range of competencies and is developing rather than deficient. The infant gut mucosal immune system is complex and displays a plethora of phenotypic and functional irregularities that may be clinically important. Various factors affect and modulate the infant gut mucosal immune system: components of the intestinal barrier, the infant gut microbiome, nutrition and the maternal–infant hybrid immune system. Elucidation of the phenotypic distribution of immune cells, their functional significance and the mucosa‐specific pathways used by these cells is essential to the future of research in the field of infant immunology.     

Ultrasound measurement of the corpus callosum and neural development of premature infants

Length and thickness of 152 corpus callosa were measured in neonates within 24 hours of birth.Using ultrasonic diagnostic equipment with a neonatal brain-specific probe,corpus callosum length and thickness of the genu,body,and splenium were measured on the standard mid-sagittal plane,and the anteroposterior diameter of the genu was measured in the coronal plane.Results showed that corpus callosum length as well as thickness of the genu and splenium increased with gestational age and birth weight,while other measures did not.These three factors on the standard mid-sagittal plane are therefore likely to be suitable for real-time evaluation of corpus callosum development in premature infants using cranial ultrasound.Further analysis revealed that thickness of the body and splenium and the anteroposterior diameter of the genu were greater in male infants than in female infants,suggesting that there are sex differences in corpus callosum size during the neonatal period.A second set of measurements were taken from 40 premature infants whose gestational age was 34 weeks or less.Corpus callosum measurements were corrected to a gestational age of 40 weeks,and infants were grouped for analysis depending on the outcome of a neonatal behavioral neurological assessment.Compared with infants with a normal neurological assessment,corpus callosum length and genu and splenium thicknesses were less in those with abnormalities,indicating that corpus callosum growth in premature infants is associated with neurobehavioral development during the early extrauterine stage.     

Liofilchem? O.A. Listeria agar and direct CAMP test provided sooner Listeria monocytogenes identification from neonatal bacteremia

Listeria monocytogenes infection in pregnant women and newborns is a cause for serious concern, and invasive disease outcome strongly depends on prompt antibiotic therapy. To provide sooner identification from neonatal bacteremia we performed a CAMP test directly on positive blood aliquots and inoculated the Liofilchem^® O.A. Listeria chromogenic agar as well, thus providing a 24-h turn-around time for response.     

The effect of transport on the physiologic stability of neonates with ductal-dependent single-ventricle lesions

Objective: To compare the status of infants with hypoplastic left heart syndrome (HLHS) or pulmonary atresia-hypoplastic right heart (PA-HRH) before and following transport using the validated Transport Risk Index of Physiologic Stability (TRIPS) score.

Methods: In this retrospective review of infants with HLHS or PA-HRH transported to a Children’s Hospital by a pediatric transport team, an increase in TRIPS score (temperature, blood pressure, respiratory status, and response to stimuli) following transport was defined as deterioration. Statistical analyses included t-test (paired and independent), χ², and McNemar’s tests for comparisons between groups with and without deterioration and before and after transport.

Results: Our cohort [n?=?64; 39 (61%) HLHS and 25 (39%) PA-HRH] was predominantly female (61%), black (56%), and diagnosed antenatally (78%). Median transport time was 20 (10–30) min and age was?<12?h in 48 (75%) infants. TRIPS scores worsened after transport in 24 (37.5%) infants, due to temperature (n?=?10) or respiratory (n?=?7) dysregulation. Infants who deteriorated during transport had HLH more often (83 versus 48%) and lower pH [7.27 (0.12) versus 7.33 (0.07)]. HLH was significantly predictive of deterioration during transport [OR 5.60 (95% C.I. 1.18–26.62)].

Conclusions: The physiologic deterioration in a third of infants with single ventricle following short transports is intriguing and may have implications on their optimal place of birth.     

Fatal neonatal nephrocutaneous syndrome in 18 Roma children with EGFR deficiency

Epidermal growth factor receptor (EGFR) is a transmembrane glycoprotein with tyrosine-kinase signaling activity, involved in many cellular functions including cell growth and differentiation. Germ line loss-of-function mutations in EGFR lead to a severe neonatal skin disorder (Online Mendelian Inheritance in Man #131550). We report 18 premature Roma children from 16 families with birthweights ranging 440–1470 g and multisystem diseases due to the homozygous mutation c.1283G˃A (p.Gly428Asp) in EGFR. They presented with thin, translucent, fragile skin (14/15), skin desquamation (10/17), ichthyosis (9/17), recurrent skin infections and sepsis (9/12), nephromegaly (10/16) and congenital heart defects (7/17). Their prognosis was poor, and all died before the age of 6 months except one 13-year-old boy with a severe skin disorder, dentinogenesis imperfecta, Fanconi-like syndrome and secondary hyperaldosteronism. Management of ion and water imbalances and extremely demanding skin care may improve the unfavorable outcome of such patients.