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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Late onset perinatal sepsis in the neonatology intensive care unit – risk factors


The lowest-birth-weight premature is very susceptible for nosocomial infections. These infants require the most invasive therapeutic interventions and the longest exposure to environment conductive for microbial colonization. Incidence of nosocomial infection and risk factors in premature has been compared over two years, 2010 and 2015. We examined the effects of common procedures on the incidence of nosocomial sepsis. Birth weight, distribution of pathogens and the therapeutically procedures had been analysed. We tried to find strategies to minimise the risks for acquiring sepsis. Hospital documentation from neonatal intensive care unit (NICU) has been analysed retrospectively during two different years in the University Hospital Osijek. Incidence of nosocomial sepsis among hospitalised premature has been 8.9% in 2010, and 4.8% in 2015. The highest rate of affected infants weighed below 1,500 g in both periods. Statistically significance in these two periods has been found in the percentage of pre-term infants with umbilical vein catheter (UVC), and in the number of pre-term on invasive mechanical ventilation. The most common pathogen in 2010 was methicillin-resistant Staphylococcus epidermidis (MRSE), and in 2015 coagulase negative Staphylococci (CONS). The percentage of Candida parapsylosis was higher in 2015. Lowering the incidence of late-onset sepsis has been accomplished by using peripherally inserted central catheters (PICCs) and non-invasive mechanical ventilation. Invasive procedures must be avoided as much as possible.

Key words: low-birth-weight pre-term infants, nosocomial infections, risk factors, umbilical venous catheters, NICU, PICC, mechanical ventilation, high-flow nasal cannula

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Risk factors for developing epilepsy after neonatal seizures


Neonatal seizures are the most frequent neurological disorder in the neonatal period. The incidence is reported to be higher than at any other period in life. Because of the unique nature of neonatal brain anatomy, connections and the paradoxical nature of neurotransmitters, seizures in this age group vary in semiology from those in older children. They may cause irreversible changes to the synapses in the immature brain and progress to epilepsy.

The aim of the study was to analyse laboratory, clinical, neurophysiological and neuroimaging risk factors for epilepsy in a group of children who experienced seizures in the neonatal period.

A retrospective study of 176 newborns admitted to the Department of Neonatology, University Children’s Hospital Ljubljana, due to seizures, was performed. Metabolic disorders and hypoxic-ischaemic encephalopathy were the most frequent aetiological factors associated with seizures. Epilepsy rate in the group was 18%. Pathological cardiotocography, reanimation after delivery, myoclonic type of seizures, more than one type of seizures, severely abnormal electroencephalography, abnormal neurological examination and neuroimaging, treatment with more than one antiepileptic drug and duration of treatment more than one month constituted statistically significant independent predictive factors for epilepsy (p< 0.05).

The results of our study further elucidate risk factors for epilepsy after neonatal seizures.

Key words: newborns, seizures, epilepsy, risk factors

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Outbreak of nosocomial bacteremias, caused by Enterobacter gergoviae and Enterobacter aerogenes, in the neonatal intensive care unit, case – control study


In this case-control study we describe epidemiological characteristics and evaluate risk factors for bacteremias caused by a rare human pathogen Enterobacter gergoviae, and Enterobacter aerogenes, among neonates in the intensive care unit, under conditions of nosocomial outbreak.
Crude rate of bacteremias was 16 per 1000 admissions. Bacteremias most commonly occurred between 7th to 30th day of hospitalization and were 1.9 times more frequent in males than females. The following risk factors were significantly associated with the development of bacteremias: a) colonization or infection of neonates prior to the onset of bacteremia with Enterobacter spp. (OR=3.4, 95%CI=1.2-9.9) or non-Enterobacter spp. (OR=7.9, 95%CI=1,2-52.5); b) use of antimicrobial drugs most notably ceftazidime (OR = 7.8, 95% CI = 1.6.-38.6), or amikacin (OR = 7.5, 95% CI = 2.8-19.9); and c) invasive interventions: mechanical ventilation (OR = 4.7, 95% CI = 1.6-13.5), umbilical catheterization (OR = 3.1, 95% CI = 1.1-13.3), or nasogastric tube insertion (OR = 3.8, 95% CI = 1.8-8). These results show that some previously described risk factors for developing Enterobacter bacteremia were equally applicable in the case of Enterobacter gergoviae infections.
In addition, the report represents an important contribution to establishing E. gergoviae as a relevant human pathogen with epidemiological potential, as it is the first case-control report in the region and one of a few in the world, analyzing outbreaks of bacteremias in the neonatal intensice care unit (ICU) caused by E. gergoviae.

Key words: neonatal intensive care unit, bacteremia, Enterobacter gergoviae, Enterobacter aerogenes, risk factors

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Anthracycline-related cardiotoxicity: risk factors and therapeutic options in childhood cancers


Anthracyclines play an important role in chemotherapeutic regimens for a wide spectrum of childhood tumors, but they can cause cytotoxic damage to cardiac cells, especially in combination with radiotherapy. Furthermore, cardiotoxicity increases with the cumulative dose and may lead to congestive heart failure and cardiomyopathy. Other factors, including age, pre-existing cardiac disease, length of follow-up, gender, route of administration, concomitant exposure to some chemotherapeutic drugs, trisomy 21 and black race, play a role in increasing the risk of cardiac dysfunction. The prevention of anthracycline-induced cardiotoxicity is mandatory as children are expected to survive for decades after being cured of their cancer. The purpose of this work is to point out the major risk factors of cardiotoxicity in children and to summarize some strategies to limit or prevent this complication and to treat the development of acute heart failure.

Keywords: anthracycline, cardiotoxicity, childhood cancer, risk factors, prevention, acute heart failure

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