Factors influencing nurse compliance in maintaining aseptic technique in the insertion of peripheral intravenous access in neonates

BackgroundAseptic technique is the foundation for preventing bloodstream infections due to peripheral intravenous access insertion. This study aims at identifying the factors influencing nurse compliance in maintaining aseptic technique in the insertion of a peripheral intravenous catheter (PIVC).MethodologyThe research method is cross-sectional with 160 nurses. The related variables measured were repeated insertion, infant care (incubator or radiation warmer), age of nurse, working experience, level of education of nurses, level of knowledge, work schedule, and number of teams on duty. The nurse's knowledge was measured using a modified questionnaire, and the level of compliance was measured by an observation sheet.ResultsHigher age and education level of nurses were significantly associated with an increase in the level of nurse compliance (β = 0.053–1.22; p < 0.001; <0.015). Working experience, the number of insertions, the level of knowledge of nurses about PIVC, and the place of care in the radiant warmer were associated negatively with a decrease in the level of nurse compliance in the use of aseptic PIVC techniques (β = −0.011; - 0.152; p < 0.001).ConclusionAge and educational qualifications should be considered for the potential contributing to nurses' compliance with the aseptic protocol in the neonatal care unit.     

Extensive subpial cortical demyelination is specific to multiple sclerosis

Cortical demyelinated lesions are frequent and widespread in chronic multiple sclerosis (MS) patients, and may contribute to disease progression. Inflammation and related oxidative stress have been proposed as central mediators of cortical damage, yet meningeal and cortical inflammation is not specific to MS, but also occurs in other diseases. The first aim of this study was to test whether cortical demyelination was specific for demyelinating CNS diseases compared to other CNS disorders with prominent meningeal and cortical inflammation. The second aim was to assess whether oxidative tissue damage was associated with the extent of neuroaxonal damage. We studied a large cohort of patients diagnosed with demyelinating CNS diseases and non‐demyelinating diseases of autoimmune, infectious, neoplastic or metabolic origin affecting the meninges and the cortex. Included were patients with MS, acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), viral and bacterial meningoencephalitis, progressive multifocal leukoencephalopathy (PML), subacute sclerosing panencephalitis (SSPE), carcinomatous and lymphomatous meningitis and metabolic disorders such as extrapontine myelinolysis, thus encompassing a wide range of adaptive and innate cytokine signatures. Using myelin protein immunohistochemistry, we found cortical demyelination in MS, ADEM, PML and extrapontine myelinolysis, whereby each condition showed a disease‐specific histopathological pattern. Remarkably, extensive ribbon‐like subpial demyelination was only observed in MS, thus providing an important pathogenetic and diagnostic cue. Cortical oxidative injury was detected in both demyelinating and non‐demyelinating CNS disorders. Our data demonstrate that meningeal and cortical inflammation alone accompanied by oxidative stress are not sufficient to generate the extensive subpial cortical demyelination found in MS, but require other MS‐specific factors.     

Outcomes beyond hospital discharge in infants and children with viral meningitis: A systematic review

Viruses are the commonest cause of childhood meningitis, but outcomes beyond hospital discharge are poorly described. We undertook a systematic literature review of long‐term outcomes following paediatric viral meningitis. A search was carried out using MEDLINE, Embase, and Cochrane Review for studies from 1 January 1990 to 31 December 2018. Studies were included where specific outcome measures were available beyond hospital discharge for children <16 years old with viral meningitis. In total, 3588 papers were identified of which 14 were eligible for inclusion. Four studies reported outcomes in children with nonenterovirus 71 meningitis. A US study of 16 cases demonstrated subtle language difficulties at 3‐year follow‐up in infants in contrast to an Australian study, which revealed no impairment in language. A Fijian study showed that two out of eight cases had sensorineural hearing loss compared with none in a UK cohort of 668 infants. Three studies evaluated outcomes of enterovirus 71 meningitis in China and Taiwan, two showed cases recovered without sequelae, while one demonstrated an increased risk of attention deficit hyperactivity disorder. Two studies including 141 cases of human parechovirus revealed no evidence of neurodevelopmental sequelae. Conversely, an Australian study demonstrated neurodevelopmental sequelae in 11 out of 77 infants with parechovirus meningitis. Most studies identified in this review demonstrated a high proportion of good clinical outcomes following viral meningitis. However, the data are limited, so robustly conducted neurodevelopmental studies are warranted to inform the evidence‐based management of viral meningitis beyond hospital discharge.     

新蝶呤和S100b在诊断儿童中枢神经系统感染中的价值

目的 研究脑脊液中新蝶呤（NPT）、S100b水平在诊断儿童中枢神经系统感染中的价值。方法 采用ELISA法测定中枢神经系统感染患儿脑脊液NPT及S100b浓度,对比感染及非感染患儿之间指标的异同,并采用ROC法评价两种指标的诊断价值。结果 病毒性脑炎患儿脑脊液中NPT及S100b浓度较对照组及化脓性脑膜炎患儿明显升高,差异有统计学意义（PP>0.05）,但化脓性脑膜炎患儿S100b水平明显高于对照组（P结论 NPT及S100b在儿童中枢神经系统感染的诊断中有一定的价值,且在诊断病毒性脑炎中作用明显,尤以S100b指标为佳。     

Bacteroides fragilis concealed in an infant with Escherichia coli meningitis

Anaerobic meningitis in infants is rare, therefore a high index of clinical suspicion is essential as routine methods for processing cerebrospinal fluid (CSF) do not detect anaerobes and specific antimicrobial therapy is required. We present an infant with Escherichia coli meningitis where treatment‐resistance developed in association with culture negative purulent CSF. These features should have alerted us to the presence of anaerobes, prompting a search for the causes of polymicrobial meningitis in infants.     

Streptococcus gallolyticus subsp. pasteurianus meningitis in an infant

Streptococcus gallolyticus subsp. pasteurianus was formerly classified as S. bovis biotype II/2, which is recognized as a rare cause of neonatal sepsis and meningitis. Since the taxonomy classification change, there have not been many reports of meningitis due to S. gallolyticus subsp. pasteurianus. Moreover, the pathogenesis of late onset S. gallolyticus subsp. pasteurianus meningitis in infants is unclear. Here we report a case of meningitis in a 5‐week‐old infant with preceding diarrhea. S. bovis biotype II/2 was isolated from the blood, cerebrospinal fluid and stool, and then was identified as S. gallolyticus subsp. pasteurianus on 16S rRNA gene sequencing. Isolates from all three sample types had identical profiles on pulsed‐field gel electrophoresis. The intestinal tract was thought to be the source of the infection.     

Bacterial meningitis after radiofrequency diathermy for adenoid hypertrophy

A 6‐year‐old otherwise healthy girl who underwent radiofrequency diathermy for adenoid hypertrophy presented with fever on the same day and was diagnosed as having bacterial meningitis 2 days later. Culture of cerebrospinal fluid indicated that the pathogens were penicillin‐sensitive Streptococcus pneumoniae and methicillin‐sensitive Staphylococcus aureus. The serotype of the causative pneumococcus, 11A, was not covered by the 7‐valent pneumococcal conjugate vaccine the patient had been inoculated with. Although not previously reported, radiofrequency diathermy for adenoid hypertrophy can be considered a risk factor for bacteremia and meningitis.