Neonatal Analysis Research Articles

Precision and accuracy of transcutaneous CO2 monitoring in infants born at 32-36 weeks of pregnancy on respiratory support

Background Respiratory disorders in premature neonates often require respiratory support. Continous transcutaneous monitoring is an available non-invasive option to monitor CO2 pressure, substituting the need for blood gas analysis as the gold standard evaluation in practice. Most studies have been conducted on very and extremely preterm neonates, but rarely in late and moderately preterm neonates. Objective To determine the precision and accuracy of transcutaneous CO2 pressure measuring devices compared to arterial blood gas analysis in neonates of 32-36 weeks gestational age who received respiratory support. Methods This diagnostic, cross-sectional study was conducted on 35 late and moderately preterm neonates of 32–36 weeks gestation who received cardiopulmonary resuscitation (CPR) in the Neonatology Unit at Rumah Sakit Cipto Mangunkusumo, Jakarta. Subjects were monitored with a transcutaneous CO2 monitor and blood gas analysis (BGA). CO2 pressure measurements were made three times from the two devices. Data were analyzed using Spearman’s correlation and Bland-Altman tests to determine the precision and accuracy of transcutaneous monitoring by comparing its mean difference (MD) to BGA as the gold standard measurement. Results Spearman’s analysis revealed a significant positive correlation between BGA and transcutaneous CO2 monitoring (P<0.001). However, the Bland - Altman test revealed a level of agreement between measuring devices was -14.46 to 6.9, with mean difference of -3.78; indicating poor precision of the transcutaneous evaluation regardless its high accuracy compared to its gold standard. Conclusion The transcutaneous CO2 monitoring device has low precision, but a strong positive correlation to BGA; underlining its high accuracy in practice. Transcutaneous CO2 monitoring cannot replace BGA, the gold standard examination.

Incision to Delivery Times in Preterm Cesarean Deliveries and Outcomes: An analysis in Neonates

Incision to Delivery Times in Preterm Cesarean Deliveries and Outcomes: An analysis in Neonates

A novel method for electroencephalography background analysis in neonates with hypoxic-ischemic encephalopathy

To explore a new method for electroencephalography (EEG) background analysis in neonates with hypoxic-ischemic encephalopathy (HIE) and its relationship with clinical grading and head magnetic resonance imaging (MRI) grading. A retrospective analysis was performed for the video electroencephalography (vEEG) and amplitude-integrated electroencephalography (aEEG) monitoring data within 24 hours after birth of neonates diagnosed with HIE from January 2016 to August 2022. All items of EEG background analysis were enrolled into an assessment system and were scored according to severity to obtain the total EEG score. The correlations of total EEG score with total MRI score and total Sarnat score (TSS, used to evaluate clinical gradings) were analyzed by Spearman correlation analysis. The total EEG score was compared among the neonates with different clinical gradings and among the neonates with different head MRI gradings. The receiver operating characteristic (ROC) curve and the area under thecurve (AUC) were used to evaluate the value of total EEG score in diagnosing moderate/severe head MRI abnormalities and clinical moderate/severe HIE, which was then compared with the aEEG grading method. A total of 50 neonates with HIE were included. The total EEG score was positively correlated with the total head MRI score and TSS (rs=0.840 and 0.611 respectively, P<0.001). There were significant differences in the total EEG score between different clinical grading groups and different head MRI grading groups (P<0.05). The total EEG score and the aEEG grading method had an AUC of 0.936 and 0.617 respectively in judging moderate/severe head MRI abnormalities (P<0.01) and an AUC of 0.887 and 0.796 respectively in judging clinical moderate/severe HIE (P>0.05). The total EEG scores of ≤6 points, 7-13 points, and ≥14 points were defined as mild, moderate, and severe EEG abnormalities respectively, which had the best consistency with clinical grading and head MRI grading (P<0.05). The new EEG background scoring method can quantitatively reflect the severity of brain injury and can be used for the judgment of brain function in neonates with HIE.

P333 Candidemia due to Candida pelliculosa in neonates admitted in SNCUs of district hospitals of Chhattisgarh: first state-wide study from secondary-level health care facilities in Central India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesTo study the Candida pelliculosa isolates, from the blood culture of neonates admitted to district hospital SNCUs in the state of Chhattisgarh, their antifungal susceptibility pattern, risk factors, and clinical co-relation. Although Candida species remain the leading cause of invasive fungal infections (IFI), there are certain rare species like C. pelliculosa, that can cause fungemia. Various studies reveal that infants, children, and immunocompromised individuals are more susceptible to bloodstream infections of C. pelliculosa. Few cases of fungemia caused by this rare species of Candida have been reported worldwide. We have found a few cases of C. pelliculosa bloodstream infection in neonates admitted to special newborn care units (SNCUs).MethodsThis is an observational study on the Candida isolates from blood cultures of neonates admitted in SNCUs of the state of Chhattisgarh, over a period of 4 years from March 2018 till March 2022. Blood culture isolates of Candida were identified and their AFST was performed on an automated Bacterial ID-AST system by BioMerieux (VITEK -2) and also manually using standard laboratory protocols. Demographic and clinical data of the patients having Candida pelliculosa candidemia were taken from laboratory records.ResultsPaired blood culture samples of total 4997 SNCU neonates were received in the laboratory. Out of these 25% were found positive for bacteria and or Candida spp. Among these positive blood cultures, Candida spp. was isolated in 18.76% patients. Amongst the isolates of Candida, C. pelliculosa was found to be the predominant Candida spp., isolated in 60 neonates, thus comprising of 25.64% of all Candida spp. Further analysis of neonates having C. pelliculosa infection revealed that 40% (24/60) neonates were either low birth weight, very low birth weight (VLBW), or extremely low birth weight (ELBW) babies, 25% cases had respiratory distress, 21.6% neonates were premature and 10% cases had hypoglycemia, as risk factors.Antifungal susceptibility pattern showed 99% isolates of C. pelliculosa as susceptible to amphotericin B, 100% being susceptible to voriconzole, and 95% and 100% isolates were susceptible to fluconazole and flucytosine respectively. More resistance was observed for Echinocandins. Caspofungin was found to be least susceptible in 88.9% of isolates. Various indications for blood culture were also analyzed. Only one neonate, out of 60, succumbed to C. pelliculosa infection.Conclusion Candida pelliculosa is found to be an emerging pathogen responsible for candidemia among neonates in SNCUs, which has shown relatively poor in-vitro susceptibility to Echinocandins. It is of extreme clinical importance that neonates of secondary-level health care facilities should also have access to quality laboratory support in the form of culture and sensitivity, so that pathogen profile and antibiogram data are available from such high-risk units as well, which would prove useful in timely institution of targeted therapy, thereby reducing neonatal mortality.

Amino Acids from Urine as Possible Biomarkers for Early Detection of Vancomycin Nephrotoxicity

Abstract: Drug-induced nephrotoxicity is an important therapeutic concern, as many endogenous compounds are filtered through the kidneys for excretion into urine. Vancomycin is a drug of last resort used to treat multiple drug-resistant infections, and is primarily used in paediatrics to treat infections caused by gram-positive organisms resistant to beta-lactam antibiotics. Vancomycin is primarily (80–90%) excreted through the kidney. To identify biochemical markers useful for the early diagnosis of nephrotoxicity, amino acid profiling was performed in young Wistar rats treated with vancomycin. A liquid chromatography mass spectrometry-based method was developed for targeted amino acid analysis from urine samples collected after dosing with vancomycin (300 mg/kg). Alterations in amino acids levels were observed in urine immediately after the first dosing, and increased in prominence during the course of treatment. Nephrotoxicity was confirmed using established methods such as histopathological evaluation and clinical chemistry analysis. Of note, a significant change in amino acid levels in urine was observed well before any noticeable increase in traditional markers. This suggests that quantification of amino acids from urine could be a good alternative to blood-based analysis in neonates and children as a strategy for the detection of kidney injury at an earlier stage than any existing methods. Keywords: Amino acid profiling, LC-MS, Method validation, Nephrotoxicity, Targeted analysis, Vancomycin.

Correlation Between the Urine Analysis in Neonates with Renal Anomaly

Background: According to the literature, urine analysis to diagnose urinary tract infection (UTI) in neonates is not the basis. It even is not recommended as a part of the evaluation, but some abnormalities in a simple urine test in neonates with UTI may be associated with urinary tract anomaly. Therefore, a simple urine test in neonates with UTI can be helpful for early diagnosis and timely treatment of urinary tract anomalies. Methods: This study was performed as a cross-sectional study. First, 100 neonates hospitalized for various reasons and diagnosed with urinary tract infections were chosen. Before treatment, urine samples were taken from all neonates by catheterization or suprapubic sterility for culture and urine bag for urinalysis. Finally, neonates with positive culture were treated with antibiotics and evaluated; kidney and urinary tract ultrasound and voiding cystourethrography (VCUG) is used to diagnose renal anomalies. The obtained information from urine analysis of neonates without urinary tract anomalies was compared with urinary tract anomalies neonates by SPSS 21 software. To compare the qualitative data, the chi-square and Fisher’s exact tests were used, whereas to compare the quantitative data, we used Wilcoxon test. P &lt; 0.05 was considered statistically significant. Results: Out of 100 patients who were evaluated, only 30 patients had renal anomalies. No statistically significant correlation was found between gender, cause of hospitalization, positive culture, and type of organism with the renal anomaly. However, pyuria (P-value 0.003), bacteriuria (P-value 0.016), fever (P-value 0.002), nitrite positive (P-value 0.001), and leukocyte esterase (P-value 0.001) showed a statistically significant correlation with the renal anomaly. Conclusions: Certain indicators such as pyuria, bacteriuria, nitrite, and leukocyte esterase can be seen in a simple urine analysis as criteria for suspicious urinary tract anomalies in neonates with UTIs.

Efficacy and safety of aprotinin in paediatric cardiac surgery: A systematic review and meta-analysis.

The relicensing of aprotinin in Europe and Canada has stimulated discussions on its usefulness in paediatric cardiac surgery. To systematically evaluate the available evidence on the efficacy and safety of aprotinin in paediatric cardiac surgery. Systematic review of all randomised and observational studies comparing aprotinin with tranexamic acid, epsilon aminocaproic acid, placebo or no drug in paediatric cardiac surgery. Meta-analyses were performed on efficacy and safety outcomes. PubMed, Cochrane Central Register of Controlled Trials, Web of Science and Embase were searched from January 2000 to March 2021. Studies that enrolled children under 18 years undergoing cardiac surgery with cardiopulmonary bypass. Thirty-two studies enrolling a total of 63 894 paediatric cardiac procedures were included. Aprotinin significantly reduced total blood loss [mean difference -4.70 ml kg-1, 95% confidence interval (CI), -7.88 to -1.53; P = 0.004], postoperative transfusion requirements and the incidence of surgical re-exploration for bleeding [odds ratio (OR) 0.74, 95% CI, 0.56 to 0.97; P = 0.03]. Aprotinin had no effects on 30-day mortality (OR 1.02, 95% CI, 0.93 to 1.11; P = 0.73) and on other safety outcomes, except for the incidence of renal replacement therapy (RRT), which was significantly increased in patients given aprotinin (OR 1.29, 95% CI, 1.08 to 1.54; P = 0.006). Findings from observational and randomised controlled trials did not largely differ. A sub-group analysis in neonates showed that aprotinin significantly reduced packed red blood cell transfusions and the incidence of postoperative surgical re-exploration for bleeding and/or tamponade. When compared with lysine analogues, aprotinin was more effective at reducing bleeding and transfusion without increasing the risk of side effects. This meta-analysis suggests that aprotinin is effective and well tolerated in paediatric cardiac surgery. Given the large heterogeneity of the results and the risk of selection bias in observational studies, large randomised controlled trials are warranted.

Speckle-Tracking Global Longitudinal and Regional Strain Analysis in Neonates with Coarctation of Aorta: A Case-Control Study.

Our objectives are to compare speckle-tracking peak global longitudinal (pGLS) and regional strain values in neonates with coarctation of aorta (CoA) and control groups. Echocardiographic parameters measured by speckle-tracking were studied in a retrospective single-center study. A comparison of pGLS and segmental deformation between neonates with CoA and control group was performed using a three-way mixed ANOVA model. There was a significant difference in the means of segmental strain values between CoA and control group at the apical (p = 0.018) and basal segments (p = 0.031) of the interventricular septum and at the apical segment (p = 0.026) of the left ventricle (LV). After correcting for multiple comparisons, the results had a tendency toward statistical significance (adjusted-p < 0.10). There was significant difference in the mean values of pGLS [F(1, 39) = 7.61, p = 0.009, adjusted p = 0.018] between the studied groups. The results of ROC analysis showed that a cut-off value of −16.60% for pGLS provided an estimated sensitivity of 92.31% (95% CI: [63.97, 99.81]) and 71.43% specificity (95% CI: [51.33, 86.78]) for the diagnosis of CoA in neonates (AUC = 0.794, 95% CI: [0.66, 0.93]). pGLS can be regarded as a feasible and reproducible parameter reflecting LV dysfunction in newborns with CoA when compared to newborns with a false-positive diagnosis.

Administration of breast milk cell fractions to neonates with birthweight equal to or less than 1800\u2009g: a randomized controlled trial

BackgroundMost premature and very low birthweight infants cannot tolerate breast milk feeding in the first few days of life and are deprived of its benefits. This study evaluates the clinical outcomes of administering breast milk cell fractions to neonates with a birthweight of ≤1800 g.MethodsWe conducted a randomized controlled trial on 156 infants in the neonatal intensive care unit of Mahdieh Maternity Hospital in Tehran, Iran, from May 2019 to April 2020. All neonates with a birthweight ≤1800 g were enrolled and divided into intervention and control groups using stratified block randomization. Neonates in the intervention group received the extracted breast milk cell fractions (BMCFs) of their own mother’s milk after being centrifuged in the first 6 to 12 h after birth. The control group received routine care, and breastfeeding was started as soon as tolerated in both groups. Study outcomes were necrotizing enterocolitis (NEC), death, and in-hospital complications.ResultsWe divided participants into two groups: 75 neonates in the intervention group and 81 neonates in the control group. The mean birthweight of neonates was 1390.1 ± 314.4 g, and 19 (12.2%) neonates deceased during their in-hospital stay. The incidence of NEC was similar in both groups. After adjustment for possible confounders in the multivariable model, receiving BMCFs were independently associated with lower in-hospital mortality (5 [26.3%] vs. 70 (51.1%]; odds ratio (OR): 0.24; 95% confidence interval [CI] 0.07, 0.86). Also, in a subgroup analysis of neonates with birthweight less than 1500 g, in-hospital mortality was significantly lower in the intervention group (4 [9.5%] vs. 13 [30.2%]; OR: 0.24; 95% CI 0.07, 0.82). There were no differences in major complications such as bronchopulmonary dysplasia and retinopathy of prematurity between the two groups. No adverse effects occurred.ConclusionsOur research demonstrated a significantly lower mortality rate in neonates (with a birthweight of ≤1800 g) who received breast milk cell fractions on the first day of life. Since this is a novel method with minimal intervention, we are looking forward to developing and evaluating this method in larger studies.Trial registrationIIranian Registry of Clinical Trials. Registered 25 May 2019, IRCT20190228042868N1.

Assessing Agreement of Transcutaneous Carbon Dioxide Monitoring and Blood Gas Analysis in a Neonatal Population

Objective: To assess agreement between transcutaneous carbon dioxide (TcCO2) monitoring and blood gas analysis in neonates. Study Design: This was a prospective observational study performed in a tertiary neonatal intensive care unit. 19 infants with a mean postmenstrual age of 35+3 weeks were included. Agreement was assessed by Bland-Altman analysis and concordance correlation coefficient. End-user feedback was collected from staff and infants were assessed for evidence of skin damage. Results: Overall bias from 698 paired samples was -0.30 (SD 1.21, p&lt;0.0001) with good concordance (CCC 0.80). 69% (95% CI 65%-72%, p=0.0003) of samples fell within the predefined clinically acceptable difference of 1kPa. Agreement was more favorable for non-invasively ventilated infants (bias -0.11, CCC 0.91). Staff feedback was positive, and no infants suffered skin damage. Conclusion: TcCO2 monitoring is a reliable assessment tool for both invasively and non-invasively ventilated neonates. It can be used as an adjunct to blood gas analysis, reducing the frequency of invasive blood tests.

Clinical significance of electroencephalography power spectrum density and functional connection analysis in neonates with hypoxic-ischemic encephalopathy.

To investigate the effects of electroencephalography (EEG) power and functional connectivity analysis on cerebral cortex function in neonates with hypoxic-ischemic encephalopathy (HIE), and to identify the neurobiological indicators of neural development in HIE. We recruited 20 mild HIE neonates, 15 moderate HIE neonates, and 30 controls. EEG was performed about 72hr after birth. The power spectral density (PSD) and imaginary part of coherency (ICOH) were analyzed. Gesell developmental schedule (GDS) was used to evaluate the neural development in the mild and moderate HIE groups at 1year of age, and the correlation between the quantitative EEG results and the state of neural development was analyzed. Compared with the controls, FP1, FP2, C3, C4, Fz, Cz, Pz , F3, and P4 of moderate HIE neonates showed that the PSD of theta, alpha and beta bands decreased significantly. In terms of the mean whole-brain PSD, themoderate HIEgroupshowed a significant decrease in all frequency bands. ICOH of the moderate HIE group showed that functional connectivity was significantly less than that in the controls mainly in the delta band, and the functional connectivity of the delta, theta, alpha1, and alpha2 bands was markedly reduced compared with the mild HIE. GDS test at 1year old showed that two infants in the moderate HIE group had suspected neurological delay in gross motor and language. The developmental quotient(DQ) of gross motor, language, and personal-social ability in the moderate HIE group were significantly lower than in the mild HIE group. And there was a significant positive correlation between PSD in each EEG frequency band and GDS score in the moderate HIE group. PSD and ICOH can be used to evaluate brain function. PSD can detect the delayed neurological development in infants with moderate HIE, and can be a neurobiomarker of brain development in HIE.

An analysis of neonates with surgical diagnoses admitted to the neonatal intensive care unit at Charlotte Maxeke Johannesburg Academic Hospital, South Africa.

The burden of neonatal surgical conditions is not well documented in low- to middle-income countries (LMICs). These conditions are thought to be relatively common, with a considerable proportion of neonates admitted to the neonatal intensive care unit (NICU) requiring surgical intervention. To review neonates with surgical conditions admitted to the NICU in our hospital setting. This was a retrospective, descriptive study of neonates with surgical conditions admitted to the NICU at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, between 1 January 2013 and 31 December 2015. The characteristics and survival of these neonates were described using univariate analysis. The NICU at CMJAH is combined with a paediatric intensive care unit, to a total of 15 beds, and serves as a referral unit. Of 923 neonates admitted to the NICU, 319 (34.6%) had primarily surgical conditions. Of these 319 neonates, 205 survived (64.3%). There were 125/319 neonates (39.2%) with necrotising enterocolitis (NEC), 55 of whom survived (55/125; 44.0%), making the presence of NEC significantly associated with poor outcome (p&lt;0.001). Other significant predictors of poor outcome were the patient being outborn (p=0.029); the presence of late-onset sepsis (p&lt;0.001), with Gram-negative organisms (p=0.005); and lesser gestational age (p=0.001) and lower birth weight (p&lt;0.001). Major birth defects were present in 166/319 neonates (52.0%). The abdomen was the most prevalent site of surgery, with 216/258 procedures (83.7%) being abdominal, resulting in a mortality rate of 76/216 (35.2%). Neonates with major surgical conditions accounted for one-third of NICU admissions in the present study. The study highlights the considerable burden placed on paediatric surgical services at a large referral hospital in SA. Paediatric surgical services, with early referral and improvement of neonatal transport systems, must be a priority in planned healthcare interventions to reduce neonatal mortality in LMICs.

Acoustic analysis of neonatal breath sounds using digital stethoscope technology.

There is no published literature regarding the use of the digital stethoscope (DS) and computerized breath sound analysis in neonates, despite neonates experiencing a high burden of respiratory disease. We aimed to determine if the DS could be used to study breath sounds of term and preterm neonates without respiratory disease, and detect a difference in acoustic characteristics between them. A commercially available DS was used to record breath sounds of term and preterm neonates not receiving respiratory support between 24 and 48 hours after birth. Recordings were extracted, filtered, and computer analysis performed to obtain power spectra and mel frequency cepstral coefficient (MFCC) profiles. Recordings from 26 term and 26 preterm infants were obtained. The preterm cohort had an average gestational age (median and interquartile range) of 32 (31-33) weeks and term 39 (38-39) weeks. Birth weight (mean and SD) was 1767 (411) g for the preterm and 3456 (442) g for the term cohort. Power spectra demonstrated the greatest power in the low-frequency range of 100 to 250 Hz for both groups. There were significant differences (P < .05) in the average power at low (100-250 Hz), medium (250-500 Hz), high (500-1000 Hz), and very high (1000-2000 Hz) frequency bands. MFCC profiles also demonstrated significant differences between groups (P < .05). It is feasible to use DS technology to analyze breath sounds in neonates. DS was able to determine significant differences between the acoustic characteristics of term and preterm infants breathing in room air. Further investigation of DS technology for neonatal breath sounds is warranted.

Electrocardiographic Assessment and Genetic Analysis in Neonates: a Current Topic of Discussion.

Background: Sudden death of a newborn is a rare entity, which may be caused by genetic cardiac arrhythmias. Among these diseases, Long QT syndrome is the most prevalent arrhythmia in neonates, but other diseases such as Brugada syndrome, Short QT syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia also cause sudden death in infants. All these entities are charac-terized by well-known alterations in the electrocardiogram and the first symptom of the disease may be an unexpected death. Despite the low prevalence of these diseases, the performance of an electro-cardiogram in the first hours or days after birth could help identify these electrical disruptions and adopt preventive measures. In recent years, there has been an important impulse by some experts in the scientific community towards the initiation of a newborn electrocardiogram-screening program, for the detection of these electrocardiographic abnormalities. In addition, the use of genetic analysis in neonates could identify the cause of these heart alterations. Identification of relatives carrying the ge-netic alteration associated with the disease allows adoption of measures to prevent lethal episodes.Conclusion: Recent technological advances enable a comprehensive genetic screening of a large number of genes in a cost-effective way. However, the interpretation of genetic data and its translation into clinical practice are the main challenges for cardiologists and geneticists. However, there is im-portant controversy as to the clinical value, and cost-effectiveness of the use of electrocardiogram as well as of genetic testing to detect these cases. Our review focuses on these current matters of argue.

Comparison of oxygen saturation measured by pulse oximetry and arterial blood gas analysis in neonates

Background Arterial blood gas is usually beneficial to discern thenature of gas exchange disturbances, the effectiveness of com-pensation, and is required for adequate management. AlthoughPaO 2 is the standard measurement of blood oxygenation, oxygensaturation measured by pulse oximetry (SapO 2 ) is now a custom-ary noninvasive assessment of blood oxygenation in newborn in-fants.Objective To compare oxygen saturation measured by pulse oxi-metry (SapO 2 ) and arterial blood gas (SaO 2 ), its correlation withother variables, and to predict arterial partial pressure of oxygen(PaO 2 ) based on SapO 2 values.Methods A cross sectional study was conducted on all neonatesadmitted to Pediatric Intensive Care Unit (PICU) during February2001 to May 2002. Neonates were excluded if they had impairedperipheral perfusion and/or congenital heart defects. Paired t-testwas used to compare SapO 2 with SaO 2 . Correlation between twoquantitative data was performed using Pearson’s correlation. Re-gression analysis was used to predict PaO 2 based on SapO 2 val-ues.Results Thirty neonates were included in this study. The differ-ence between SaO 2 and SapO 2 was significant . There were sig-nificant positive correlations between heart rate /pulse rate andTCO 2 , HCO 3 ; respiratory rate and TCO 2 , HCO 3 , base excess (BE);core temperature and HCO 3 , BE; surface temperature and pH,TCO 2, HCO 3, BE; SapO 2 and pH, PaO 2 ; and significant negativecorrelation between SapO 2 and PaCO 2 ; the correlations were weak.The linear regression equation to predict PaO 2 based on SapO 2values was PaO 2 = -79.828 + 1.912 SapO 2 .Conclusion Pulse oximetry could not be used in place of arterialblood gas analysis available for clinical purpose

Neonates and Infants Discharged Home Dependent on Medical Technology

Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization. To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital. This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed. Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization. Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital. Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.

Treatment Options for Persistent Coagulase Negative Staphylococcal Bacteremia in Neonates.

Coagulase-negative staphylococci (CoNS) are the leading cause of late-onset sepsis in neonatal intensive-care units (NICUs). Despite adequate therapeutic levels and in vivo susceptibility, vancomycin is not always adequate in clearing CoNS bacteremias and other theurapeutic regimens are warranted especially when dealing with persistent CoNS bacteremias. Retrospective analysis of neonates with persistent CoNS bacteremias in a tertiary NICU in two study periods (January 2006 to December 2007 and January 2011 to December 2012). Demographics, clinical characteristics and antibiotics used were recorded. We also performed a literature review on the treatment options for persistent CoNS bacteremia. Out of the 1485 admissions during the 4 years, 121 (8,1%) neonates developed CoNS bacteremia and 42 of them (34.7%) were persistent. The most common CoNS species was S.epidermidis (91%). Apart from the shorter mean duration of bacteremia (p = 0.003), during the second part of the study, no other differences were observed between the two study periods. Ten (23.8%) neonates were treated with vancomycin monotherapy. In 23 (54.7%) neonates, rifampicin was added to vancomycin. Linezolid was given to seven neonates (16.6%), whereas daptomycin was given to two neonates (4.7%). No differences were found when we compared the characteristics of neonates treated with different antibiotics. All neonates tolerated treatment well. Our literature review revealed 16 relevant studies, the majority of which are small case series. The addition of rifampicin, linezolid and daptomycin in neonates with persistent CoNS bacteremia can provide useful therapeutic alternatives. Further studies are required to bring more insight into the field.

Abstract 216: Leveraging the First Statewide Congenital Cardiac Consortium to Reduce Variation in Modifiable Preoperative Management Among Neonates Undergoing Arterial Switch Operation

Objective: Seven public and private California cardiac centers have joined to form the first statewide consortium created to improve the quality and value of congenital cardiac care. The overall goals of the consortium are: 1) to understand variation in modifiable perioperative processes of care among participating hospitals, and 2) to determine whether standardization of those process measures will reduce adverse events and cost. In this pilot study, preoperative management of neonates undergoing arterial switch operation (ASO) within one center was analyzed for variation and these process measures were then associated with increased inpatient costs and length of stay. Methods: Through retrospective analysis of neonates undergoing ASO for Transposition of the Great Arteries with Intact Ventricular Septum (TGA/IVS) (n=34) at one center between 2004-2014, variation within the following preoperative process measures was described: feeding protocols, ventilation management, use of balloon atrial septostomy (BAS) and prostaglandin, and timing of surgery. Independent review by echocardiologists (SS, SP, AMG) confirmed preoperative and discharge diagnoses. Risk factors for increased total hospital length of stay (TLOS), postoperative length of stay (PLOS) and inpatient hospital costs were analyzed by univariable linear regression. Results: The population (N=34) was predominantly male (80%, 27/34) with low overall prenatal diagnosis rate (27%, 9/34). Birth weight was 3295±521 grams and gestational age (GA) was 39.1±1.4 weeks. Variation was found in duration of preoperative hospital stay (7.1±3.7 days), proportion of preoperative stay spent in the Cardiac ICU (0.58±0.35), use of BAS (53%, 18/34), preoperative enteral feeding (50%, 17/34) and preoperative extubation (24%, 8/34). Increased birth weight was negatively associated with costs (p=0.01), TLOS (p=0.14) and PLOS (p=0.02). Delayed timing of surgery was positively associated with TLOS (p=0.0004) and total costs (p=0.01) but not PLOS (p=0.93). Preoperative Cardiac ICU management trended towards negative association with total costs (p=0.20) but not TLOS (p=0.35) or PLOS (p=0.99) when compared with preoperative Neonatal ICU management. Lower GA, preoperative BAS, preoperative enteral feeding and preoperative extubation were not significantly associated with increased costs, TLOS, and PLOS. Conclusions: Variations in preoperative management of neonates undergoing ASO for TGA/IVS are significantly associated with total healthcare costs and hospital LOS. Concatenated data from the remaining consortium members will be critical to validate these findings and to power morbidity and mortality analysis. Integrated findings will allow the consortium to develop and implement consensus based recommendations regarding standardization of those process measures that will reduce major complications and cost.

Use of Levetiracetam in Neonates in Clinical Practice: A Retrospective Study at a German University Hospital.

We performed a retrospective chart analysis in neonates routinely treated with levetiracetam (LEV) in a university setting. Patients and Methods We assessed clinical characteristics of the included neonates. Documented LEV doses and the duration of treatment were evaluated. To assess LEV effectiveness, we compared the need of any additional anticonvulsant as co- and rescue therapies before and following the initiation of LEV treatment. To assess LEV tolerance, we sought to identify documented adverse drug reactions resulting in a termination of LEV treatment. We analyzed a total of 72 neonates receiving LEV with a median gestational age at initiation of LEV treatment of 30 (4/7) gestational weeks (min., 24(5/7)/max., 43(0/7) weeks). LEV was applied in target doses of 41.7 mg/kg/d (min., 14.4/max., 106.2 mg/kg/d). Patients received LEV treatment at hospital for a median of 28 days (min., 1/max., 195 days). Additional anticonvulsant therapy decreased a week after LEV treatment was initiated (p = 0.008). We did not find any cases of terminated LEV treatment resulting from adverse drug reactions. Long term use of high LEV doses is rather frequent in immature neonates. Our data indicate good effectiveness and a low risk of adverse drug reactions.

PP04.15 – 2395: Cortical laminar necrosis after neonatal and childhood arterial ischemic stroke. A relevant finding?

Objective Variations in imaging patterns after stroke may help to establish the stroke mechanism. To analyze the frequency and characteristics of cortical laminar necrosis (CLN) on MRI due to arterial ischemic stroke in neonates and children. Methods Retrospective analysis of neonates and children with arterial ischemic stroke admitted to our institution between 2003 and 2014. Inclusion criteria for eligibility for further analysis were acute arterial ischemic stroke (DWI and ADC positive) on MRI and cortical laminar necrosis as defined by hyperintense cortical lesions on T1-weighted MR imaging. Results 23 childhood arterial ischemic stroke cases (CAIS) and 9 neonatal stroke cases with CLN were identified. Of those 56 (CAIS) and 19 (neonatal) MRI scans were available for analysis. Blood sensitive sequences, available in 15 (CAIS) cases and 9 (neonatal), were negative in all. Serial imaging was perfomed in 13 (CAIS) and 6 (neonatal) patients. In 9/10 CAIS compared to 1/6 neonatal patients who had an MRI performed during the first week after stroke CLN was negative. Persistence of CLN after stroke up to >12 months post stroke was observed. All vascular territories were involved. MCA strokes represented the majority of cases and a predominance of the parietooccipital area within the MCA distribution was found. Stroke etiology could be established in 80% of cases: congenital heart defect (n=9), GBS meningitis (n=2), Moyamoya (n=2), CNS vasculitis (n=2), Takayasu, AML, traumatic brain injury. Conclusion CLN is not an uncommon finding after neonatal and CAIS. Our findings suggests that bleeding does not contribute to CLN. Congenital heart defect is the most commonly found stroke etiology. We hypothesize that CLN may be related to areas of hypoperfusion with some pathophysiological overlap with watershed infarcts. Future pathology studies will clarify further the exact nature of the underlying histopathology.