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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: neonate (Page 1 of 2)

Invasive Candida infections in the nursery: state of the art

Abstract

Neonatal sepsis caused by fungi (mainly Candida spp.) causes a huge burden of morbidity and mortality, poor late outcomes, as well as increased hospital costs.

Invasive Candida Infections (ICI) include bloodstream, urine, cerebrospinal, peritoneal infections, infections starting from burns and wounds, or from any other usually sterile site.

Premature neonates are particularly prone to this kind of disease, due to their decreased innate and adaptive immunities, translating into a specific, decreased resistance to candidiasis.

This specific, increased risk for ICI is greatest when gestational age and birth weight are lowest. As the burden of ICI has been increasing over the last years, research efforts have been focused towards identifying key risk factors, effective preventative strategies, and efficacious and well-tolerated antifungal drugs for the neonatal population.

This article summarizes the most remarkable issues in these areas, and features an overview of the current diagnostic, preventative and treatment strategies.

Key words: Candida, neonate, infection, preterm, micafungin, fluconazole

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Leukocytes influence peripheral tissue oxygenation and perfusion in neonates

Abstract

Background. Leukocyte counts may influence peripheral (micro) circulation due to changes in rheology. The aim of this study was to investigate a possible association between leukocyte counts and peripheral tissue oxygenation/perfusion measured with near infrared spectroscopy (NIRS) in term and preterm neonates.

Methods. In this observational study we included term and preterm neonates within the first 2 months of life, in whom peripheral tissue NIRS measurements were performed and blood samples (leukocytes and C reactive protein (CRP)) taken to investigate clinical signs of infection. Tissue-oxygenation index (TOI), fractional oxygen extraction (FTEO), oxygen delivery (DO2), oxygen consumption (VO2) and vascular resistance (VR) were measured by NIRS and venous occlusion method. TOI, FTOE, DO2, VO2 and VR were correlated to leukocyte counts on the same day and maximal CRP levels within 24 hours (CRP max).

Results. In 180 infants, with a mean gestational age of 35.5±3.3 weeks, leukocyte counts were 16546± 8830/µl (median 14830; range 1790 to 67840) and CRP max was 8.0± 19.0 mg/l (median 0.0; range 0.0 to 110.0mg/l).

TOI was 71.1±5.5%, FTOE 28.5±6.1%, DO2 46.7±19.7, VO2 12.5±4.4 and VR 11.7±6.4.

Leukocyte counts correlated negatively (r= -0.21; p= 0.005) with TOI and positively (r=0.17; p=0.029) with VR. Correlations with CRP max did not reach significance.

Conclusion. We demonstrated that peripheral tissue oxygen consumption decreases and vascular resistance increases with increasing leukocyte counts.

Key words: near-infrared spectroscopy, neonate, microcirculation, leukocytes.

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Thromboelastometry in neonates and infants undergoing cardiac surgery

Abstract

Introduction. Rotational thromboelastometry (ROTEM) in monitoring coagulation in children undergoing cardiac surgery has been studied with promising results. Since the data about ROTEM in infants and neonates undergoing cardiac surgery are scarce, the aim of our study was to asses ROTEM abnormalities in this patient group.

Methods. Infants and neonates undergoing cardiac surgery on cardiopulmonary bypass were included in this prospective, observational study conducted in a level III multidisciplinary neonatal and pediatric intensive care unit (ICU) between May 2011 and January 2012. ROTEM analysis, together with determination of platelet count, international normalized ratio of prothrombin time (INR), activated partial thromboplastin time (PTT), and fibrinogen concentration, was done in all neonates and infants before surgery (t1), after admission to ICU (t2) and 24 hours after surgery (t3).

Results. Twenty infants and neonates were operated on during the time of the study. ROTEM abnormalities seen after surgery (t2) were: thrombocytopenia 14, hypofibrinogenemia 1, mixed hypofibrinogenemia and coagulation factor deficiency 1, and mixed thrombocytopenia with mild hyperfibrinolysis 1. Three patients were found to have normal ROTEM results. The median values of all except one of the ROTEM tests, as well as platelet count, INR, PTT, and fibrinogen concentration, showed significant prolongation or deterioration after admission to ICU and these deteriorations persisted in several parameters for 24 hours.

Conclusions. In our neonates and infants, cardiac surgery on cardiopulmonary bypass predominantly affects platelets, although most of the ROTEM parameters deteriorated after admission to ICU.

Key words: thromboelastometry, cardiac surgery, neonate, infant, thrombocytopenia, hypofibrinogenemia.

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The risk of central line-associated bloodstream infections with different types of central vascular catheters in a multidisciplinary neonatal and pediatric intensive care unit

Abstract

Objective. Central line-associated bloodstream infections (CLABSIs) are a significant cause of morbidity in critically ill neonates and children. The objective of this study was to compare CLABSI rate associated with different types of central vascular catheters (CVCs) in a multidisciplinary neonatal and pediatric intensive care unit (ICU).
Methods. A prospective cohort study was conducted in a multidisciplinary neonatal and pediatric ICU. All patients, admitted between January 1st 2011 and February 29th 2012, requiring a CVC were included and monitored for CLABSI (defined by CDC/NHSN criteria). CLABSI rates were calculated for each type of CVC as CLABSI episodes/1000 catheter-days. CLABSI rates were compared between patients with single and multiple CVCs.
Results. Of the 557 patients admitted, 362 (65%) required insertion of a CVC (4259 patient-days, 3225 catheter-days, CVC utilization ratio 0.76). There were 14 episodes of CLABSI. CLABSI rate was lowest for umbilical catheters (0/1000 catheter-days), followed by short-term noncuffed and nontunneled CVCs (3.1/1000 catheter-days) and peripherally inserted CVCs (8.8/1000 catheter-days). Higher rates were observed with long-term cuffed and tunneled CVCs (15.9/1000 catheter days) and noncuffed, nontunneled CVCs for temporary renal replacement therapy (RRT) (20.0/1000 catheter days). CLABSI rate expressed per 1000 catheter-days was 3.0 and 19.7 for patients with single or multiple CVCs at the same time, respectively.
Conclusion. The use of noncuffed, nontunneled CVCs for temporary RRT and the presence of multiple CVCs at the same time are associated with a significant increase in the rate and risk of developing CLABSI in a multidisciplinary neonatal and pediatric ICU population.

Key words: central line-associated bloodstream infections, nosocomial infections, central vascular catheter, bloodstream infections, pediatric intensive care unit, neonate, child

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Temperature to heart rate relationship in the neonate

Key words: neonate, fever, hypothermia, heart rate, neonatal sepsis

In neonatal intensive care, measurement of heart rate is part of every clinical examination and it is used for monitoring hemodynamic status. However, it is influenced by some exogenous and endogenous factors, such as medication, pain, and stress. (1) Similarly, an increased heart rate is a normal physiological response to fever. Heart rate is known to increase by 10 beats per minute (bpm) per degree centigrade increase in body temperature in children. (2) In order to allow physicians to identify patients who have a higher heart rate than would be expected for a given level of temperature, Thompson et al. (3) created temperature specific heart rate centile charts adaptable to children from three months to ten years. Very few data exist on the relationship of temperature and heart rate in younger infants. The only study on this topic so far was performed in an emergency department that included infants up to the age of 12 months, where they found no linear correlation between fever and heart rate in the group of infants younger than two months. (4) To our knowledge no studies have ever addressed this issue in newborns.

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