Prevention of anemia and iron deficiency in very low-birth-weight infants

Abstract

outbreaks had at least one stool found negative for HRV by EM or ELISA prior to developing infection. In at least two instances HRV was introduced into the nursery by an infected infant. Three other patients who may have introduced HRV were admitted with no diarrhea and nonspecific or subtle signs which led to a work-up to exclude the possibility of sepsis. They were not isolated initially. Such infants may represent particularly deceptive sources of HRV introduction into a nursery. Introduction of HRV by medical staff and nursery personnel also seems possible in view of previous reports of nosocomial spread? In keeping with the British experience, 3 our nursery infections appeared near the peak of the epidemic of HRV in the community. However, ours disappeared as the community outbreak waned, whereas theirs continued (though at decreased levels) until the increase which accompanied the next community epidemic. We detected no HRV infection in neonates requiring the highest level of intensive care, who were housed in two rooms with six bassinettes nearby (nonoutbreak rooms, Table I). The policy for admission to these rooms was the same as that applied to other rooms in the nursery. However, in these rooms, visitors were restricted and there was essentially one-on-one nursing care, with the same staff regularly assigned to a particular baby. Particularly in special care nurseries, in which both transfer from other hospitals and prolonged stay are common, when HRV is prevalent in the community, we recommend the use of rapid methods of diagnosis, especially direct electron microscopy or ELISA, if possible, for screening nursery admissions from the community and for those who develop diarrhea. Once a nursery outbreak is demonstrated, we recommend screening of all nursery patients, cohorting of contacts, whether or not patients are shedding HRV in their stools, and restriction of staff movement (i.e., specific assignment to suspect nursery room). These measures should aid in preventing further spread of the virus. Whether a benign HRV infection in the neonatal period results in immunization should be studied by prospective follow-up of such infected patients.