Neonatal Blood Cultures Research Articles

Combined education and skin antisepsis intervention for persistently high blood-culture contamination rates in neonatal intensive care

Contaminated blood cultures represent challenges regarding diagnosis, duration of hospitalization, antimicrobial use, pharmacy and laboratory costs. Facing problematic neonatal blood culture contamination (3.8%), we instigated a successful intervention combining skin antisepsis using sterile applicators with 2% chlorhexidine gluconate in 70% isopropanol prior to phlebotomy (replacing 70% isopropanol) and staff education. In the six months prior to intervention, 364 neonatal peripheral blood samples were collected. Fourteen (3.8%) were contaminated. In the post-intervention six months, 314 samples were collected. Three (0.96%) were contaminated, representing significant improvement (Fisher's exact test: P=0.0259). No dermatological sequelae were observed. The improvement has been sustained.

Clinical and Bacteriological Profile of Neonatal Sepsis in King Khaleed Civilian Hospital, Tabuk, Kingdom of Saudi Arabia

Neonatal sepsis is defined as a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 28 days of life. Of newborns with early-onset sepsis, 85% present within 24 hours, 5% present at 24-48 hours, and a smaller percentage present within 48-72 hours. The present study included 38 septic neonates. They were divided into two groups: Group with early onset neonatal sepsis (29) and another group with late onset neonatal sepsis (9). The study group with early-onset sepsis showed 18 (62.1%) males, 11 (37.9%) females, mean gestational age (weeks) 34.28±4.7, mean body weight (gm) 2.1±0.8, mean Apgar score at 1 min. 6.7±1.8. 21 (72.4%) delivered by CS, 8 (27.6%) delivered by NVD. E. coli was the commonest organism identified in blood culture of septic neonates. Maternal anemia, PROM, and fever were significant risk factors for neonatal sepsis. Prematurity and low birth weights were among the most common neonatal risk factors. Respiratory manifestations were the commonest manifestations of neonatal sepsis in both groups. Treating maternal anemia during pregnancy will help to reduce the incidence of neonatal sepsis <i>E. coli</i> is still an important cause of early-onset neonatal sepsis. Blood cultures need to be done strictly before the start of the first dose of antibiotic.

Presepsin: A New Marker of Neonatal Sepsis-Experience of a Tertiary Level NICU in Delhi

Neonatal sepsis is a significant problem in any level of NICU with non-specific clinical features. Sepsis screen and blood culture are considered classical tools for diagnosis of neonatal sepsis. However sepsis screen components are non-specific for neonatal sepsis and blood culture positivity rate is low. Empirical use of routine and broad spectrum antibiotic for one or two positive markers of sepsis and probability of sepsis in any clinically sick baby is a common practice especially in developing countries. We studied level of presepsin as a new marker of neonatal sepsis in our unit and results are very promising. When faced with clinical and biochemical dilemma of neonatal sepsis, use of prespsin level as a marker of sepsis can decrease overuse of expensive and irrational antibiotics and also decrease financial burden of family.

Bacteriological profile and antibiotic sensitivity patterns of blood cultures

Background: Neonatal septicemia is a significant cause of morbidity and mortality worldwide especially so in developing countries. To reduce the mortality caused by neonatal septicemia, it became vital to diagnose it as soon as possible and treat with administration of appropriate antibiotics. The objective of the study was bacteriological spectrum in blood culture of neonates admitted in a hospital, and antibiotic susceptibility pattern of blood culture positive isolates. Methods: A total of 593 blood culture sample were received from NICU admissions for a period of 15 months were included for this study. Under aseptic precautions, 1 ml of blood was collected from a peripheral vein and inoculated into a bottle of Brain Heart Infusion broth and was incubated for 7 days. Repeated sub-culturing was done as per standard procedures. Inoculation on blood agar and Mac-Conkey’s agar plates were made. Any growth was subjected for identification by appropriate biochemical tests. Antibiotic susceptibility testing was done by disc diffusion method. Results: Of the 593 cases studied 12.14 % were blood culture positive. Among the blood culture positive neonates 67% were male neonates. Late onset septicemia (87.5%) was more common than early onset septicemia (12.5%). Gram negative organisms 46 (63.88%) were predominant than gram positive organisms 18 (25%). Klebsiella pneumonia 18 (25%), Citrobacter 10 (13.88%), and Pseudomonas auroginosa was found in 7 (9.72%). The other organisms isolated were Escherichia coli 06 (8.33%), Enterobacter 04 (5.55%), Gram positive organisms were obtained in 18 (25.00%) out of 72 cases. MSSA 06 (8.33%), Enterococci 06 (8.33%) was the commonest organisms isolated. Most of the isolates were more susceptible imipenem, meropenem, and ciprofloxacin to amikacin antibiotics. Conclusions: Blood culture remains the gold standard for the diagnosis of neonatal septicemia. Periodic surveillance of organisms and their antibiotic sensitivity patterns are essential to understand and to prevent emergence of resistant organisms. Effective/Correct selection of antibiotic is essential to decrease mortality and morbidity in the vulnerable group of neonatal population.

Non-haemolytic and non-pigmented group b streptococcus, an infrequent cause of early onset neonatal sepsis.

The haemolysin of Group B streptococci (GBS), a leading cause of neonatal infections, is a key virulence factor that has been implicated in the development of invasive infection. The frequency of non-haemolytic (NH) GBS isolates is around 5% among GBS carriers. To determine if similar rates are observed among invasive strains, we evaluated the incidence of NH strains among 199 GBS strains isolated from neonatal blood cultures (first week of life). Overall, we found two (1%) NH strains. This finding suggests that the frequency of NH GBS strains causing early onset invasive neonatal infection is lower than the reported frequency of NH GBS among colonizing strains.

Utility of cord blood culture in early onset neonatal sepsis.

Neonatal sepsis is a major cause of neonatal mortality. The clinical outcome mainly depends on the early diagnosis and peripheral venous blood culture (PVBC) is the most widely practiced diagnostic method. This study aimed to evaluate the utility of umbilical cord blood culture (UCBC) in neonates at high risk of early onset neonatal sepsis (EONS) in comparison to peripheral venous blood culture. A total of 40 neonates with two or more risk factors for EONS were included in the study. Umbilical cord blood was collected aseptically during delivery for blood culture and C-reactive protein (CRP). Peripheral venous blood was collected within 24 hours of birth for sepsis screen and PVBC. Although 11 babies were sepsis screen positive, cord blood CRP was negative in all cases. In comparison to PVBC, UCBC had 100 per cent sensitivity and 94.9 per cent specificity. The results of UCBC were consistent with PVBC. One neonate who was both UCBC and PVBC positive also had isolation of the same pathogen in both the cultures and 33 per cent PPV for UCBC. UCBC is a simple convenient method, which ensures culture of adequate volume of blood from newborns allowing effective early isolation of bacterial pathogens, especially in EONS.

Outbreak of Extended Spectrum Beta Lactamase Producing Klebsiella Species Causing Neonatal Sepsis at Patan Hospital in Nepal

Introductions: Klebsiella sepsis is the most important nosocomial infection in neonates. The objectives of this study were to review an outbreak in a neonatal unit caused by Klebsiella species, to identify the source of the infections, and to identify infection control measures for eradication and prevention of these infections. Methods: The case notes and investigation reports of all sepsis cases admitted in neonatal units of Patan hospital from July to December 2011 caused by Klebsiella species were retrospectively reviewed. The demographic profile, risk factors along with clinical features and management of sepsis were reviewed. Results: Twenty three out of 37 neonatal blood cultures grew Klebsiella species. Thirty one were K. pneumoniae and six K. oxytoca. Seventeen of the 31 (55%) K. pneumoniae isolates were multidrug resistant and extended spectrum beta lactamase producers. Eighteen of 23 (78%) neonates with Klebsiella sepsis died. After extensive cleaning methods and identifying an intermittently leaking roof in one of the nurseries below a vescicovaginal fistula room of gynecological ward above, the infection outbreak was finally controlled. Conclusions: Infections with extended spectrum beta lactamase producing Klebsiella spp. are a threat in neonatal units because of limited treatment options for these multidrug resistant organisms. Identification of the source and control of the outbreak can be a challenge. Plain Language Summary: The study was done to review an outbreak caused by Klebsiella species, to identify the source of the infections along with infection control measures for eradication and prevention of these infections in neonate unit. Identification of the source and eradication of the outbreak of Klebsiella species can be a challenge. Hand washing remains one of the most important methods to prevent cross infections and nosocomial infections. DOI: http://dx.doi.org/10.3126/jpahs.v1i1.13011 Journal of Patan Academy of Health Sciences. 2014 Jun;1(1):20-25

Microbiological study of neonatal septicemia with special reference to metallo-beta-lactamase producing pseudomonas aeruginosa

Introduction: Metallo-beta-lactamase (MβL) producing Pseudomonas aeruginosa has emerged as a potential threat in cases of neonatal septicemia and poses great therapeutic challenge for physicians treating such infections. The emergence, selective multiplication & dissemination of antibacterial resistance are a serious global problem. Methods: This study was conducted with the objective to know the microbiological profile of neonatal septicemia cases and to examine the incidence of MβL producing strains among multidrug resistant (MDR) Pseudomonas aeruginosa from the suspected cases of neonatal sepsis between January 2012 – December 2014. A total of 994 cases admitted with the suspicion of neonatal sepsis were investigated. 295 (29.7%) isolates were obtained from the blood cultures of neonates. The isolates were identified and tested for the susceptibility to various antimicrobial agents. Results: Pseudomonas aeruginosa with 116 (48.3%) isolation among 240 Gram negative isolates was the predominant pathogen in our study. All the 74 (63.8%) multidrug resistant P. aeruginosa isolates were screened initially for Imipenem resistance, which were further tested for the presence of MβL by Imipenem-ethylene diamine tetraacetic acid (EDTA) disc method. MβL production was seen in 20 (71.4%) of the 28 Imipenem-resistant Pseudomonas aeruginosa isolates. Conclusion: It creates a great therapeutic problem as it may spread rapidly to various other species of Gram-negative bacilli. Therefore, to prevent the further spread of MβL producers, it is essential to rapidly detect MβL-positive isolates.

Role of risk-based approach in the prevention of vertical transmission of neonatal sepsis

Vertical transmission of infections remains a common cause of neonatal morbidity and mortality worldwide. We studied the risk-based approach in preventing the vertical transmission of neonatal sepsis. A prospective case control study of 154 pregnant women with risk factors for vertical transmission of infections (subjects) and 154 pregnant women without the risk factors (control) at University of Ilorin Teaching Hospital, Ilorin from 1st July to 31st December, 2010. After counseling and consent taking, all participants had active management of labour and all subjects had parenteral intrapartum antibiotic prophylaxis with Ampicillin. There was postnatal evaluation of all babies for signs of neonatal sepsis followed by blood culture and treatment of culture positive babies. The outcome measures were signs and symptoms of neonatal sepsis, neonatal positive blood culture and maternal postpartum morbidity. Neonatal sepsis occurred in 16 babies (subjects=11, control=5); three babies had Early Onset Group B Streptococcal Disease (EOGBSD) (subjects=2, control=1; P=0.501) while 13 had non Group B Streptococcal (GBS) infections (subjects=9, control=4; P=0.113); onset of signs and symptoms was < 24hrs in all cases, incidence of EOGBSD were 12.9/1000 (subjects) and 6.5/1000 (controls). Subjects whose babies had sepsis had multiple risk factors; one dose of antibiotics and antibiotics to delivery interval < 2hours. There was no sepsis in babies of mothers who had adequate antibiotic prophylaxis. There was no maternal or neonatal death but 17.5% of subjects had maternal postpartum morbidities. The risk-based approach is a practicable alternative in preventing vertical transmission of neonatal sepsis if antibiotic prophylaxis is adequate before delivery.

Study of the Prevalence of Neonatal Septicaemia with Antibiotic Susceptibility in a Large Tertiary Care Hospital

Introduction: Invasion of the blood stream by microorganisms constitutes one of the most serious situations in infectious disease and as a result, timely detection and identification of blood borne pathogens is one of the most important functions of the microbiology laboratory. Positive blood cultures may help provide clinical diagnosis, as well as a specific etiological diagnosis. Neonatal septicemia constitutes an important cause of morbidity and mortality amongst neonates in India. However, with presently available antimicrobial agents, neonatal septicemia may be treated successfully. Early diagnosis and proper management of neonatal septicemia can bring down the morbidity and mortality substantially. Hence, the present study was undertaken to study the bacteriological profile of neonatal septicemia cases and their antimicrobial sensitivity pattern for planning strategy in the management of these cases. Materials and Methods: This retrospective study was carried out in the CNBC and MYH, department of microbiology and paediatrics, M.G.M. medical college and M.Y. hospital, Indore, from January to December in 1000 blood cultures. Identification of organism was done as per standard methods like gram’s staining, cultural characteristics, motility and biochemical reactions. Results: In our study done on 1000 neonatal blood cultures, we found 42.2 % cultures were positive, in which 51.3 % were males and 48.7 % were female neonates. We found 52.8 % were Early onset septicaemia (EOS) (2 days). Among 1000 neonates 543 were institutional delivered (inborn) and 457 were out born referred from other hospitals; 64.7 % were term, 35.3 % were preterm, 80.1 % were normal deliveries and 19.9 % were LSCS. Key words: Septicaemia, Blood culture, CoNS, MRSA, EOS, LOS

Clinical manifestation and laboratory findings in positive blood culture in neonatal septicemia

Background/objective: Neonatal septicemia is one of the major causes of mortality in newborns. The aim of this study is to evaluate the clinical manifestations and laboratory findings in positive blood culture in neonatal septicemia. Methods: In this retrospective study, we allocated 100 records positive blood culture of neonates suffering from septicemia. A questionnaire was completed for each patient consisting the age at admission, gender, weight at birth, admission time, type of delivery, pre- or post-term delivery and the clinical symptoms. Types of organism causing sepsis, and their resistance to antibiotics were evaluated and method for empirical treatment was recommended. Results: Respiratory distress, cyanosis and lethargy were more common in the patients. The antibiogram showed Ampicillin resistance in 86% and Gentamycin resistance in 66% of studied records. Also, 36% cases of positive blood culture with gram-negative and 64% with gram-positive bacteria were observed. The most common bacteria in blood cultures were negative-coagulase Staphylococcus (%35), Staphylococcus Aureus (%24), Klebsiella (%18), respectively. Other bacteria were Enterobacter, Escherichia coli and Enterococcus (%5), Acinetobacter (%3), Pseudomonas aeruginosa and Negative-Gram Bacilli (%2) and Ceratia (%1). The most common effective antibiotics against bacterial growth in Antibiograms were Vancomycin, Cephalosporin, Amikacin, Co-trimoxazole and Gentamycin. Conclusion: Since the most common bacteria in neonatal septicemia cases were negative-coagulase Staphylococcus, Staphylococcus Aureus, Klebsiella, the pediatricians must select the regiments that cover gram-negative bacteria for empirical antibiotic treatments.

Clinical value of repeat blood cultures in neonatal patients receiving antibiotic treatment.

Retrospective database study to determine the clinical usefulness of repeat blood cultures in antibiotic-treated neonates. Data regarding blood culture indication and findings for patients admitted to a neonatal intensive care unit (NICU) over a 2-year period were obtained from the hospital database. Repeat blood culture was defined as culture performed <7 days from initial testing in a patient receiving antibiotic treatment. Repeat cultures made up 21.3% of all blood cultures originating in the NICU (500/2352 cultures; 338 initial positive cultures; 210 patients). The most common indications for repeat culture were follow-up of clinically well babies with previous positive culture findings and the development of new symptoms. The majority of culture findings were negative (60.2%), with 7.2% indicating the presence of a new pathogen. Cultures repeated on day 5 were significantly more likely to reveal a new pathogen than those repeated on days 1-4. Repeat blood cultures in neonatal patients who have developed new symptoms >4 days after initial testing may be beneficial. The use of repeat blood culture is not recommended for any other indication.

PO-0533 Neonatal Blood Culture: Survey Of Blood Culture Bottle Use In Uk Neonatal Units

Introduction Neonatal sepsis carries a high morbidity and mortality. Blood culture is the current ‘gold standard’ investigation. The results obtained is of vital diagnostic, therapeutic, surveillance and prognostic importance. Traditionally in the past, paired samples were used, however with the decrease in anaerobic infections, from the 1980s and current Health Protection Agency (UK) figures on bacteria causing neonatal sepsis, this practice is changing with calls to abandon anaerobic blood cultures. Objectives Survey of all Neonatal units in UK to determine- Whether single (aerobic) or paired (aerobic and anaerobic) bottles are used. If single, whether there are special occasions when anaerobic cultures are included. Any variations in practice according to the level of care and in the different nations of the UK. Methods Read Literature on neonatal blood culture bottle use to inform questionnaire design. Telephone survey Feb–March 2014. Interviewee: medical staff or nurse-in-charge only. Results All 204 neonatal units were surveyed. Number using single = 197/204 (96.1%); paired =8/204(3.9%). 11/197 using single, occationally use paired. Paired: England 3/170 (1.8%); Scotland 2/15 (13.4%); Wales 0/12 and NI 3/7 (42%) (Figure 1). Level of care: NICU 2/55(3.6%), LNU 5/90(5.6%) and SCBU 1/59(1.7%) (Figure 2). Conclusions There is general uniformity in the type of bottle used- single aerobic bottles. As the ‘gold standard’ investigation for neonatal sepsis, it needs to follow evidence-based traditions to improve yield. There is a need to be aware of when an anaerobic bottle should be included rather than a ‘box-standard’ approach.

PC.41 Is species identification informative in ascertaining true Coagulase Negative Staphylococci (CoNS) bacteraemia in a tertiary neonatal intensive care population?

BackgroundCoagulase negative Staphylococci (CoNS) are the commonest organisms recovered from neonates with late onset sepsis in the neonatal intensive care unit. CoNS are normal skin commensals and vary in species,...

Time to Positivity of Blood Cultures in Neonates

Blood culture reports in neonatal sepsis aid physician in either optimizing therapy or discontinuing antibiotics. We determined the time taken for neonatal blood cultures to become positive using the aerobic BacT/Alert system. Of 944 blood cultures from 816 neonates, 139 (14.7%) were positive. Growth of all definitive bacteria, 95% of possible bacteria and 84% of fungi were detected within 48 hours of incubation.

Comparison of Susceptibility of Various Candida Species Isolated From Neonatal Septicaemia to Voriconazole and Fluconazole

Background: Candida species are known to be the most common fungal pathogens isolated from blood cultures of neonates. Recent reports from our country indicates trend towards an increasing prevalence of non-albicans candidemia. Candida species possess a number of virulence factors which enable them to cause hematogenously disseminated infections in susceptible hosts with increased morbidity and mortality. Objectives:To know the prevalence of candidemia in neonates and their antifungal susceptibility pattern. Materials and Methods: Blood samples from suspected cases of neonatal septicemia were subjected to culture, incubated for 7 days and subcultures performed. Culture yielding pure growth of Candida were included for the study and identified by standard methodology. Antifungal susceptibility was performed towards fluconazole and voriconazole by disc diffusion method on Muller-Hinton agar with 2% glucose and methylene blue. Result: Among 1583 blood cultures 80(5%) candida isolates were obtained. The various species isolated were C.pseudotropicalis 34(42.5%), C.tropicalis 22(27.5%), C.albicans 12 (15%) C.guillermondii 6(7.5%), C.parapsilosis 4(5%) and C.krusei 2(2.5%). Fluconazole susceptibility was observed in 56(70%) sensitive, 18 (22.5%) Susceptible-Dose Dependent (SDD) and 6(7.5%) resistant and all were sensitive to voriconazole. Conclusion: In this study non albicans candida was the common isolate & they showed decreased resistance to Fluconazole. In neonatal septicemia speciation & antifungal susceptibility may help in management.

Coagulase-negative staphylococci strains resistant to oxacillin isolated from neonatal blood cultures

Coagulase-negative staphylococci (CoNS) are the microorganisms most frequently isolated from clinical samples and are commonly found in neonatal blood cultures. Oxacillin is an alternative treatment of choice for CoNS infections; however, resistance to oxacillin can have a substantial impact on healthcare by adversely affecting morbidity and mortality. The objective of this study was to detect and characterise oxacillin-resistant CoNS strains in blood cultures of newborns hospitalised at the neonatal ward of the University Hospital of the Faculty of Medicine of Botucatu. One hundred CoNS strains were isolated and the mecA gene was detected in 69 of the CoNS strains, including 73.2% of Staphylococcus epidermidis strains, 85.7% of Staphylococcus haemolyticus strains, 28.6% of Staphylococcus hominis strains and 50% of Staphylococcus lugdunensis strains. Among these oxacillin-resistant CoNS strains, staphylococcal cassette chromosome mec (SCCmec) type I was identified in 24.6%, type II in 4.3%, type III in 56.5% and type IV in 14.5% of the strains. The data revealed an increase in the percentage of CoNS strains isolated from blood cultures from 1991-2009. Furthermore, a predominant SCCmec profile of the oxacillin-resistant CoNS strains isolated from neonatal intensive care units was identified with a prevalence of SCCmec types found in hospital-acquired strains.

In vitro synergy of oxacillin and gentamicin against coagulase‐negative staphylococci from blood cultures of neonates with late‐onset sepsis

Coagulase-negative staphylococci (CoNS) are the leading cause of late-onset sepsis (LOS) in neonates. Increasing resistance of CoNS to beta-lactams and aminoglycosides has led to widespread use of vancomycin, which in turn may lead to resistance to vancomycin. Thus, combination therapy of LOS has been advocated. We aimed to determine the interaction of oxacillin and gentamicin against CoNS. In 2005, 34 isolates of oxacillin- and gentamicin-resistant CoNS were obtained from blood samples of neonates with LOS. Combination effect was tested using the checkerboard method, E-test with the other antibiotic incorporated in the medium (E-test-1) and two E-test strips placed in a cross-formation (E-test-2). Of 34 isolates 61.8%, 53% and 73.5% revealed synergy or an additive effect when tested by the checkerboard method, E-test-1 and E-test-2, respectively. Results of all three tests were concordant for six (17.6%) isolates, four showing synergy, and two indifference. Our in vitro results support that combination therapy with penicillinase-resistant penicillin and aminoglycoside can be an alternative to vancomycin.

175: The effect of subclinical hypothyroidism on IQ in seven to eight year old children

IQ in seven to eight year old children Niamh Murphy, Mairead Diviney, Jennifer Donnelly, Sharon Cooley, Colin Kirkham, Adrienne Foran, Fionnuala Breathnach, Fergal Malone, Michael Geary Rotunda Hospital, Department of Obstetrics and Gynaecology, Dublin, Ireland, Rotunda Hospital, Department of Neonatology and Paediatrics, Dublin, Ireland, Rotunda Hospital, Department of Statistics, Dublin, Ireland, National University of Ireland, Maynooth, Department of Psychology, Co. Kildare, Ireland OBJECTIVE: In our practice, pregnant women are not routinely screened or treated for subclinical hypothyroidism (SCH), although overt hypothyroidism is treated. Our objective was to compare the IQ of children whose mothers had been diagnosed with SCH antenatally (in a prior observational trial) with closely matched controls. STUDY DESIGN: In a previous study from our group, 1000 healthy nulliparous patients were screened anonymously for SCH. Those with overt hypothyroidism were informed and treated, whereas those with SCH were contacted postnatally for paediatric follow-up. SCH (defined as reduced free T4 with normal TSH, or normal free T4 with raised TSH) was found in 4.6% (n 46) of the study population. These cases were matched for gestational age, gender and mode of delivery with 47 controls. All children underwent a formal neurodevelopmental assessment at age 7 to 8 years by a single psychologist blinded to the original maternal thyroid status. WISC-IV assessment scores were used to compare the groups. RESULTS: From the cohort of cases, 23 mothers agreed to assessment of their children as well as 47 controls. The children in the control group had higher mean scores than those in the case group across the categories of Verbal Comprehension Intelligence, Perceptual Reasoning Intelligence, Working Memory Intelligence, Processing Speed Intelligence and Full Scale IQ. Mann Whitney U testing confirmed a statistically significant difference in IQ between the cases (composite score 103.87) and the controls (composite score 109.11) This had a 95% confidence interval (.144, 10.330). CONCLUSION: Our results highlight significant differences in IQ of children of mothers who had unrecognised SCH during pregnancy. While our study size and design prevents us from making statements on causation, our data suggests significant potential public health implications in terms of routine thyroid function screening in pregnancy. The results of prospective intervention trials to address a causative association will be vital to address this issue. 176 Perinatal risk factors for severe hypoxic-ischemic encephalopathy in neonates treated with whole body hypothermia Christopher Wayock, Benjamin Greenberg, Jacky Jennings, Frances Northington, Ernest Graham Johns Hopkins University School of Medicine, Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Baltimore, MD, Johns Hopkins University School of Medicine, Division of Neonatology, Department of Pediatrics, Baltimore, MD, Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD OBJECTIVE: Whole body hypothermia has been shown to reduce the risk of death or neurologic injury in neonates with hypoxic-ischemic encephalopathy (HIE). However, newer regimens and other therapies may also benefit the most severely injured neonates. Our objective is to identify perinatal risk factors that identify the most severely injured neonates. STUDY DESIGN: A case-control study was conducted from 1/2007 to 5/2012 among 104 neonates 35 weeks with suspected HIE treated with whole body hypothermia of which 99 underwent an MRI at 7-10 days of life. Of the 5 neonates that did not have an MRI 3 died. 39% were born within our system, and 61% were transferred. Cases were defined as those neonates who died or had an abnormal brain MRI at 7-10 days. Controls were surviving neonates with a normal MRI. Logistic regression models were used to determine the predictive value of factors hypothesized to impact neurologic injury. RESULTS: Cases and controls did not differ on gestational age, birthweight, mode of delivery, sentinel events, initial neonatal blood gas, positive neonatal blood cultures, histologic chorioamnionitis, funisitis or diagnosis of nonreassuring fetal heart rate prior to delivery. Cases were significantly more likely to have an abruption, a cord blood gas showing metabolic acidosis, elevated initial neonatal WBC count and seizures. In multivariable logistic regression, decreased cord pH (p 0.001) and increased initial neonatal WBC count (p 0.026) predicted an increased risk of neurologic injury. Cord pH and initial neonatal WBC count can predict an abnormal brain MRI with a sensitivity of 59.4%, specificity of 77.6%, positive predictive value of 66.7% and negative predictive value of 71.7%. CONCLUSION: Worsening metabolic acidosis in cord blood at birth and elevated initial neonatal WBC correlate with neurologic injury among neonates with HIE treated with whole body hypothermia. These cases may be candidates for new hypothermia regimens as well as other therapies.

Differences between Two Clinical Staphylococcus capitis Subspecies as Revealed by Biofilm, Antibiotic Resistance, and Pulsed-Field Gel Electrophoresis Profiling

Coagulase-negative staphylococci have been identified as major causes of late-onset neonatal bacteremia in neonatal intensive care units. Sixty isolates of Staphylococcus capitis obtained from blood cultures of neonates between 2000 and 2005 were examined in this study. Biochemical analysis confirmed that 52 of these isolates belonged to the subsp. urealyticus, and the remaining 8 belonged to the subsp. capitis. Isolates of the predominant subsp. urealyticus clones were characterized by their resistance to penicillin, erythromycin, and oxacillin and their biofilm formation ability, whereas subsp. capitis isolates were generally antibiotic susceptible and biofilm negative. Pulsed-field gel electrophoresis (PFGE) after SacII digestion separated the 60 isolates into five major clusters. Sequence analysis showed that, in S. capitis, the ica operon plus the negative regulator icaR was 4,160 bp in length. PCRs demonstrated the presence of the ica operon in all isolates. Further analysis of five isolates (two biofilm-positive subsp. urealyticus, one biofilm-negative subsp. urealyticus, and two biofilm-negative subsp. capitis) revealed that the ica operons were identical in all of the biofilm-positive subsp. urealyticus strains; however, the biofilm-negative isolates showed variations. The distinctive phenotypic and genotypic characteristics revealed by this study may affect the epidemiology of the two subspecies of S. capitis in the clinical setting. These results may provide a better understanding of the contribution of these two species to bloodstream infections in neonates.