1,721,016 research outputs found
Outbreaks in the Neonatal Intensive Care Unit: Description and Management
Full text linkHealthcare settings, especially intensive care units, can provide an ideal environment for the transmission of pathogens and the onset of outbreaks. Many factors can contribute to the onset of an epidemic in a neonatal intensive care unit (NICU), including neonates’ vulnerability to healthcare-associated infections, especially for those born preterm; facility design; frequent invasive procedures; and frequent contact with healthcare personnel. Outbreaks in NICUs are one of the most relevant problems because they are often caused by multidrug-resistant organisms associated with increased mortality and morbidity. The prompt identification of an outbreak, the subsequent investigation to identify the source of infection, the risk factors, the reinforcement of routine infection control measures, and the implementation of additional control measures are essential elements to contain an epidemic
Pharmacokinetic and Pharmacodynamic Considerations of Antibiotic Use in Neonates
Full text linkThe selection of an appropriate dose of a given antibiotic for a neonate not only requires knowledge of the drug’s basic pharmacokinetic (PK) and pharmacodynamic (PD) properties but also the profound effects that organ development might have on the volume of distribution and clearance, both of which may affect the PK/PD of a drug. Interest has grown in alternative antibiotic dosing strategies that are better aligned with the antibiotic’s PK and PD properties. These strategies should be used in conjunction with minimum inhibitory concentration measurements and therapeutic drug monitoring to measure their potential success. They can also guide the clinician in tailoring the delivery of antibiotics to suit an individual patient’s needs. Model-informed precision dosing, such as Bayesian forecasting dosing software (which incorporates PK/PD population models), may be utilized to optimize antibiotic exposure in neonatal populations. Consequently, optimizing the antibiotic dose and exposure in each newborn requires expertise in different fields. It drives the collaboration of physicians together with lab technicians and quantitative clinical pharmacologists
Antimicrobial therapy in neonatal intensive care unit
Full text linkSevere infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units (NICUs) and in industrialized countries about 1% of neonates are exposed to antibiotic therapy. Sepsis has often nonspecific signs and symptoms and empiric antimicrobial therapy is promptly initiated in high risk of sepsis or symptomatic infants. However continued use of empiric broad-spectrum antibiotic treatment in the setting of negative cultures especially in preterm infants may not be harmless. The benefits of antibiotic therapy when indicated are clearly enormous, but the continued use of antibiotics without any microbiological justification is dangerous and only leads to adverse events. The purpose of this review is to highlight the inappropriate use of antibiotics in the NICUs, to exam the impact of antibiotic treatment in preterm infants with negative cultures and to summarize existing knowledge regarding the appropriate choice of antimicrobial agents and optimal duration of therapy in neonates with suspected or culture-proven sepsis in order to prevent serious consequences
The impact of placental massive perivillous fibrin deposition on neonatal outcome in pregnancies complicated by fetal growth restriction
No full textIntroduction: Massive perivillous fibrin deposition (MPDD) is an uncommon placental lesion which has been associated with an increased risk of adverse pregnancy outcome in retrospective series. The purpose of the study was to evaluate the frequency and consequences of MPFD in pregnancies complicated by fetal growth restriction (FGR). Materials and methods: A cohort study of 355 pregnancies complicated by FGR diagnosed according to standard ultrasonographic criteria, enrolled, followed and delivered at a single obstetric unit. Pathological placental lesions were classified according to the Amsterdam Placental Workshop Consensus. Penalized logistic regression models were used to evaluate the association of MPFD with maternal risk factors, other pathological lesions and neonatal outcome. Results: The rates of moderate (25–50% of villi) and severe (>50% of villi) MPFD were 8.7% (31/355) and 3.1% (11/355), respectively. Compared to other FGR cases, MPFD pregnancies were characterized by higher placental volume (450 ± 144.5 SD as compared to 412.2 ± 151 cm3,p grade II) (OR = 5.66,95% CI = 1.69–18.97), sepsis (OR = 5.9, 95% CI = 1.27–27.12), proven necrotizing enterocolitis (OR = 9.84,95% CI = 2.49–38.8) and overall severe adverse neonatal outcome (OR = 5.71,95% CI = 2.05–15.87). Conclusions: Moderate-to-severe MPFD was relatively common among FGR pregnancies and was associated with morphometric modifications of placenta and with an increased risk of severe adverse neonatal outcome
Group B streptococcus: early- and late-onset infections
No full textGroup B streptococcus has emerged as a prominent neonatal pathogen in developed countries since the late 1960s. The incidence of disease remained fairly constant until the 1990 s, when prevention efforts increased. American consensus guidelines were endorsed in the mid 1990 s; since then a decrease in disease incidence has been reported in the United States. This review summarizes the main issues regarding the prevention of neonatal infection and presents aspects of group B streptococcal disease with the first population data recently obtained in a northern region of Italy
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Efficacia della terapia con propranololo negli emangiomi infantili: studio di un caso difficile
Full text linkGli emangiomi infantili rappresentano il tumore più frequente dell’infanzia, con un’incidenza del 4-5% dei bambini di età inferiore a un anno e del 10% dei bambini di razza caucasica. La maggior parte di essi compare nelle prime quattro settimane di vita, in una minoranza dei casi le lesioni sono presenti già alla nascita. La patologia risulta più frequente nelle femmine rispetto ai maschi, con un rapporto di 3:1. Le lesioni sono caratterizzate da una rapida crescita neonatale, seguita da una fase di lenta regressione, con scomparsa delle lesioni entro i primi anni di vita. Nonostante si tratti di tumori benigni dell’endotelio capillare con tendenza all’involuzione spontanea la loro gestione deve essere attentamente valutata. Nella maggior parte dei casi può essere indicato un approccio wait and, see, ma nei casi di emangiomi problematici a rischio di complicanze deve essere preso in considerazione un approccio terapeutico. Per oltre quarant’anni i corticosteroidi sono stati utilizzati come terapia di prima linea, seguiti da vincristina e interferone alfa. Tutti questi farmaci tuttavia erano gravati da numerosi effetti collaterali. Dopo la scoperta dell’utilità del propranololo nel trattamento degli emangiomi infantili numerosi studi hanno confermato la sua efficacia nell’indurre la regressione di lesioni emangiomatose in assenza di effetti collaterali importanti. Presentiamo il caso di una paziente affetta da un emangioma infantile problematico e trattata con propranololo, che ha mostrato una regressione stabile della lesione dopo 12 mesi complessivi di trattamento
Rapid detection of bacteria in bloodstream infections using a molecular method: a pilot study with a neonatal diagnostic kit
No full textNeonatal sepsis is a life-threatening condition and its early diagnosis is crucial for infant survival. Identifying responsible pathogens is a key step. Blood culture (BC) is the gold standard, but more rapid and specific diagnostic methods are needed. We evaluated the reliability and utility of 3 h turnaround time diagnostic molecular kit, “EuSepScreen lattanti “CE IVD marked, (EuSepScreen lattanti, Eurospital Spa Trieste, Italy) specifically targeted to detect 4 pathogens in neonatal sepsis: Klebsiella pneumoniae (KP), Escherichia coli (EC), Streptococcus agalactiae (GBS), and Lysteria monocytogenes. We evaluated 69 neonates, 40 full term and 29 preterm infants, with suspected bloodstream infection, who, overall the routine clinical procedures, were tested using the molecular kit. Kit results were compared to BC outcomes. Nineteen cases for early onset sepsis (EOS) were evaluated, 2 of them resulted positive to a molecular kit and to BC (both for GBS and EC). In the 50 cases of suspected late onset sepsis (LOS), 7 infants reported positive and coincident results to both the methods, in 3 further cases the molecular kit identified pathogens (EC) in neonates with negative BC result; in 10 cases BC revealed etiological pathogens exceeding the molecular kit possibility of identification. In case of EOS, results of the molecular kit were coincident to these of BC, but available in 3 h turnaround time, which is an advantage, so the kit may actually be an “add-on tool” for EOS, with reference to EC and GBS, but a larger study with a greater number of EOS cases are needed to validate its usefulness in the NICU. Regarding LOS the restricted panel of identifiable microorganisms failed to provide timely information for sepsis diagnosis, highlighting the need of enlarged number microorganisms for the diagnosis of LOS. Trial registration number: NCT03884894
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