Late-onset Septicemia Research Articles

Prevalence of Multidrug-Resistant Pathogens Causing Neonatal Early and Late Onset Sepsis, a Retrospective Study from the Tertiary Referral Children's Hospital.

Sepsis is the most severe infectious disease with the highest mortality rate, particularly among neonates admitted to the neonatal intensive care unit (NICU). This study retrospectively analyzed the epidemiology, antibiotic resistance profiles, and prevalence of multidrug-resistant (MDR) bacteria isolated from blood or cerebrospinal fluid (CSF) cultures in order to evaluate the appropriateness of initial empirical therapy for neonatal sepsis. A retrospective study was conducted in the NICU from January 1, 2015, to December 31, 2022. Microbiological data from patients admitted to the NICU were anonymously extracted from the Laboratory of Microbiology database. Neonatal sepsis was classified into two types: early-onset sepsis (EOS), which occurs within the first 72 hours of life, and late-onset sepsis (LOS) for those begins later. A total of 679 bacterial strains, 543 from blood and 136 from CSF, were detected in 631 neonates. Among these, 378 isolates (55.67%) were Gram-positive bacteria, and 301 isolates (44.33%) were Gram-negative bacteria. The most frequently isolated pathogens were Coagulase-negative staphylococci (CoNS) (36.52%), followed by Klebsiella pneumoniae (20.47%) and Escherichia coli (13.84%). In EOS, 121 strains were found, CoNS represented the majority (33.88%), followed by Klebsiella pneumoniae (23.97%) and Escherichia coli (8.26%). Early-onset septicemia exhibited 67 (55.37%) MDR bacteria. In LOS, 558 strains were isolated, CoNS represented the majority of pathogens (37.10%), followed by Klebsiella pneumoniae (19.71%) and Escherichia coli (15.05%). Late-onset septicemia showed 332 (59.50%) MDR bacteria. High rates of MDR were found in CoNS (76.21%), carbapenem-resistant Klebsiella pneumoniae (66.91%), and MRSA (33.33%). The study revealed an alarming prevalence of MDR strains isolated from neonatal sepsis, emphasizing the necessity of finding effective prevention and treatment measures. Colistin can be used for MDR Gram-negative bacteria, while vancomycin and teicoplanin can be considered treatment therapies for staphylococcal infections.

Evidence of Multi-clrug resistant group G streptococci (GGS) in thePediatrics Ward at Tikrit Teaching Hospital

During period of Ten months, 200 cases of clinically suspected neonatal septicemia in Kirkuk city were included in this study. The aim of the study was to identify the causative agents of neonatal septicemia and their susceptibility to antibiotics. Blood culture was positive in 79 (39.5%) neonates, 50(63.3%) of them were males and 29(36.7%)were females. Out of 79 positive cases, 53(67.1%) had early-onset septicemia and 26(32.9%) had late-onset septicemia. Gram-negative bacteria were encountered ‘in more than 90 % of these neonates. While gram-positive bacteria represented by Staphylococcus aureus were isolated from 5(6.3%) of neonates only. According to antibiotic susceptibility test it was found that the most effective drug was cefotaxime followed by ciprofloxacin and gentamicin. While most of the isolates were resistant to commonly used antibiotics like Amoxicillin, Ampicillin, Tetracyclin, and erythromycin.

Prevalence and Antibiogram Profile of Neonatal Septicemia inKirkuk Pediatric Hospital

During period of Ten months, 200 cases of clinically suspected neonatal septicemia in Kirkuk city were included in this study. The aim of the study was to identify the causative agents of neonatal septicemia and their susceptibility to antibiotics. Blood culture was positive in 79 (39.5%) neonates, 50(63.3%) of them were males and 29(36.7%)were females. Out of 79 positive cases, 53(67.1%) had early-onset septicemia and 26(32.9%) had late-onset septicemia. Gram-negative bacteria were encountered ‘in more than 90 % of these neonates. While gram-positive bacteria represented by Staphylococcus aureus were isolated from 5(6.3%) of neonates only. According to antibiotic susceptibility test it was found that the most effective drug was cefotaxime followed by ciprofloxacin and gentamicin. While most of the isolates were resistant to commonly used antibiotics like Amoxicillin, Ampicillin, Tetracyclin, and erythromycin.

Estimated daily intake of phthalates, parabens, and bisphenol A in hospitalised very low birth weight infants

Very low birth weight infants (VLBW, birth weight (BW) < 1500 g) are exposed to phthalates, parabens and bisphenol A (BPA) early in life. We estimated daily intake (EDI) of these excipients in 40 VLBW infants the first and fifth week of life while hospitalised. Based on urinary samples collected in 2010, EDI was calculated and compared to the tolerable daily intake (TDI) with hazard quotients (HQs) evaluated. A HQ > 1 indicates that EDI exceeded TDI with increased risk of adverse health effects. EDI was higher in VLBW infants compared to term-born infants and older children. VLBW infants born at earlier gestational age (GA), or with lower BW, had higher EDI than infants born at later GA or with higher BW. First week median EDI for BPA was higher than TDI in 100% of infants, in 75% for di(2-ethylhexyl) phthalate (DEHP), 90% for the sum of butyl benzyl phthalate (BBzP), di-n-butyl phthalate (DnBP), DEHP and di-iso-nonyl phthalate (DiNP) = ∑BBzP+DnBP+DEHP+DiNP, and in 50% of infants for propylparaben (PrPa), indicating increased risk of adverse effects. Fifth week EDI remained higher than TDI in all infants for BPA, in 75% for DEHP and ∑BBzP+DnBP+DEHP+DiNP, and 25% of infants for PrPa, indicating prolonged risk. Maximum EDI for di-iso-butyl phthalate was higher than TDI suggesting risk of adverse effects at maximum exposure. VLBW infants born earlier than 28 weeks GA had higher EDI, above TDI, for PrPa compared to infants born later than 28 weeks GA. Infants with late-onset septicaemia (LOS) had higher EDI for DEHP, ∑BBzP+DnBP+DEHP+DiNP and BPA, above TDI, compared to infants without LOS. More 75% of the infants' EDI for DEHP and ∑BBzP+DnBP+DEHP+DiNP, 25% for PrPa, and 100% of infants' EDI for BPA, were above TDI resulting in HQs > 1, indicating increased risk of adverse health effects.

English

BACKGROUND This study was an attempt to find the association of physical parameters, risk factors, common signs &amp; symptoms of septicaemia, analyse the distribution of microorganisms isolated from clinically suspected cases of septicaemia, and collect their antibiogram. We also wanted to evaluate the haematological findings in conventional culture, correlate them to the sensitivity and specificity, and quantitatively identify the relevance of these haematological tests through their positive and negative predictive values. METHODS A total of 350 blood samples were received from patients with clinically suspected cases of blood stream infections (BSI) at the Department of Microbiology for routine culture &amp; sensitivity and were processed using standard microbiological techniques to determine the percentage distribution of bacterial pathogens causing BSI and their antibiotic susceptibility patterns. Mueller-Hinton agar (MHA) with 4 % NaCl was used to detect methicillin resistance. RESULTS Of the 350 septicaemic cases, 58.8 % were from neonatal ICU and 41.2 % were from paediatric wards. Maximum culture positivity (45.3 %) was seen in &lt; 28 days age group. Bacterial growth was seen in 62.0 % preterm babies. Probability of sepsis was more with leukopenia (85.4 %) as compared to leucocytosis (68.9 %); positive C-reactive protein (CRP) findings (63.8 %) were more likely to be associated with sepsis as compared to negative CRP findings (2.1 %). Leukopenia (97.5 %) and leucocytosis (96.3 %) had the highest specificity values. CONCLUSIONS Low birth weight (LBW) neonates, preterm birth and Caesarean section deliveries are risk factors that predispose neonates to septicaemia. Meropenem can be used in septaemia, but it should be reserved for critical cases, particularly those with multidrug resistant (MDR) bacteria, rather than on routine basis to prevent inadvertent promotion of bacterial resistance. This study showed that leukopenia and CRP are good indicators of sepsis, when used in combination. KEYWORDS Blood Stream Infection, Early Onset Septicemia, Late Onset Septicemia

English

BACKGROUND Neonatal septicaemia is a bacterial infection with positive blood culture in first four weeks of life. The early sepsis screen is vital as it detects earlier and benefits the clinician to treat the infection reducing neonatal mortality and morbidity. We wanted to evaluate various haematological screening parameters and C-reactive protein (CRP) in blood culture positive neonates in sepsis. METHODS This prospective study was conducted for a period of one year. Blood samples from hundred clinically suspected neonatal septicaemia cases were subjected to aerobic culture and sepsis screen tests like C-reactive protein, erythrocyte sedimentation ratio (ESR), total WBC count, absolute neutrophil count, immature / total neutrophil count (I / T) ratio and platelet count. The culture results were correlated with the sepsis screen tests. RESULTS Of the hundred cases studied, 18 % were blood culture positive and 66 % were males. Early onset septicaemia was more common, seen in 64 % of cases than late onset septicaemia (26 %) cases. Staphylococcus aureus was the commonest organism isolated in 38.46 % of cases followed by Klebsiella pneumoniae &amp; E. Coli. Among the haematological parameters, the positivity was best with Creactive protein (94.44 %) followed by immature &amp; mature neutrophil ratio (I / M) (94.44 %), I / T ratio (88.88 %) and the least with absolute neutrophil count (66.0 %). Any two or more parameters were positive in 94.44 % of the subjects. CONCLUSIONS Sepsis screen has good sensitivity, specificity and is a valuable aid for early diagnosis of neonatal septicaemia. Sepsis screen is simple, cost effective, less time consuming and easy to perform. As an individual test C-reactive protein has shown highest sensitivity, specificity and is a sensitive and responsive indicator of neonatal sepsis. KEYWORDS Blood Culture, Neonatal Septicaemia, Sepsis Screen

High urinary concentrations of parabens and bisphenol A in very low birth weight infants

Very low birth weight infants (VLBW; birth weight < 1500 g) are treated with pharmaceuticals and medical equipment containing parabens and bisphenol A (BPA). Parabens are used in pharmaceuticals, whereas BPA in medical equipment where concentrations are rarely reported in hospitalised VLBW infants. We measured urinary concentrations of parabens and BPA and hypothesised high and increasing concentrations in infants born at lower gestational ages (GAs), and among infants with bronchopulmonary dysplasia (BPD) and late-onset septicaemia (LOS) due to higher exposure from pharmaceuticals and medical equipment. Urinary samples were collected during the first (n = 38) and fifth (n = 36) week of life. Methylparaben, ethylparaben, propylparaben, butylparaben, and BPA concentrations were measured using ultra high-performance liquid chromatography coupled to tandem mass spectrometry. VLBW infants had very high urinary concentrations of parabens and BPA compared to term infants and older children. The Σ paraben concentration was higher than detected in previous studies on premature infants. Lower GA at birth was associated with higher concentrations of parabens and BPA. Infants born before 28 weeks GA had higher first week concentrations of propylparaben (38.6 vs. 9.05 ng/mL, p = 0.007), butylparaben (0.28 vs. 0.09 ng/mL, p = 0.05) and fifth week concentrations of BPA (15.1 vs. 6.02 ng/mL, p = 0.02) than infants born after 28 weeks GA. Infants with LOS and BPD had higher fifth week concentrations of BPA than infants without LOS and BPD (LOS: 14.2 vs. 6.77 ng/mL, p = 0.07; BPD: 18.6 vs. 7.62 ng/mL, p = 0.05).

A study on platelet count and their indices as a marker of neonatal sepsis

Objectives . Effect of sepsis on platelet counts and their indices. . Monitoring of platelet count and their indices in neonatal sepsis in relation to specific organisms. . To identify organism involved in proven neonatal sepsis affecting platelet indices. Design: Prospective hospital based study. Setting: The study subjects are all neonates admitted in Shadan Institute of Medical Sciences and has proven sepsis. Method: The study was carried out over a period of one and half year from December 2019 to July 2020 at Shadan Institute of Medical Sciences. 100 cases were considered for this study after proper screening for CBC, platelet count and their indices like mean platelet volume, platelet distribution width and CRP and blood culture in neonates admitted in our NICU with proven sepsis. Results: A total of 100 neonates with blood culture positive for bacterial cases were considered for the study. Early onset septicaemia (59%) was more common than late onset septicaemia (41%). Out of 100 cases 57% cases had growth of gram negative organisms, 40% had growth of gram positive organisms and 3% had growth of fungal. Tachypnea (27%), Lethargy (20%) and refusal of feeds (8%) were the commonest clinical presentation followed by, Fever (6%), convulsions (5%) and jaundice (5%). 60% neonates has thrombocytopenia of varying severity. Staphylococcus aureus was the most common organism associated with thrombocytopenia (43.3%%). MPV was high in 85% of cases and PDW was high in 96% of cases. Conclusion: The present study highlights the association of thrombocytopenia, mean platelet volume and platelet distribution width with causative organism in proven neonatal sepsis. Staphylococcus aureus was the most common organism causing thrombocytopenia in our NICU.

Bacterial Etiology of Neonatal Sepsis, Antibiotic Susceptibility Profile, and Associated Factors at Burdwan Medical College, Burdwan, West Bengal, India

AbstractObjective Neonatal sepsis remains to be a major cause of neonatal mortality and morbidity in developing countries like India. This study was aimed to identify the bacterial isolates and study antimicrobial profile among admitted babies with neonatal sepsis.Methods A cross-sectional retrospective study was conducted in the sick neonatal wards and neonatal intensive care unit of Burdwan Medical College from March 2017 to February 2018. A total of 299 neonates suspected of neonatal sepsis was evaluated. Diagnosis of neonatal sepsis was made through positive blood culture. Positive samples were subcultured on specific media like blood, chocolate agar, nutrient, Muller–Hinton agar, and MacConkey plates, and the organisms were identified by gram staining and biochemical reactions. Antibiotic susceptibility was tested by Kirby–Bauer disc diffusion method.Results Overall, 118 blood cultures out of 299 patients (39.46%) were bacteria-positive. Of these, 31.3% cases had early-onset septicemia (EOS), while 68.6% had late-onset septicemia (LOS). The prevalence of sepsis was higher in males (55.9%), preterm babies (58.47%), and low birth weight neonates (37.29%). The highest bacterial strains isolated were Klebsiella spp. (33.8%) followed by Staphylococcus aureus (25.8%), Escherichia coli (22.8%), coagulase-negative Staphylococcus (12.5%), Pseudomonas spp. (2.5%), Enterococcus spp. (1.6%), Acinetobacter spp. (0.8%), and Burkholderia spp. (0.8%). Resistance is high among the gram-negative bacteria, like Enterobacter and Pseudomonas, for piperacillin–tazobactam and cephalosporins but they are mostly sensitive to meropenem, colistin, and levofloxacin. Gram-positive bacteria, like S. aureus, are mostly resistant to amoxicillin–clavulanic acid but highly sensitive to linezolid, vancomycin, azithromycin, and teicoplanin.Conclusion K. spp. and S. aureus are the most common isolates in our study. The level of resistance among the organisms toward conventional antibiotics like amoxicillin, cephalosporins, and piperacillin–tazobactum is alarmingly high. This warrants formulation of a hospital-specific guideline for antibiotic use and periodic review of the same.

Effect of neonatal sepsis on platelet counts and their indices

Background: Neonatal septicemia is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. Objective of the study was to know the effect of sepsis on platelet counts and their indices.Methods: The study was carried out over a period of one and half year from December 2015 to July 2017 at Sangmeshwar and Basaveshwar hospital attached to M. R. medical college, Kalaburagi. 100 cases were considered for this study after proper screening for complete blood count (CBC), platelet count and their indices like mean platelet volume, platelet distribution width and C-reactive protein (CRP) and blood culture in neonates admitted in our neonatal intensive care unit (NICU) with proven sepsis.Results: A total of 100 neonates with blood culture positive for bacterial cases were considered for the study. Early onset septicaemia (59%) was more common than late onset septicaemia (41%). Out of 100 cases 57% cases had growth of gram negative organisms, 40% had growth of gram positive organisms and 3% had growth of fungal. Tachypnea (27%), lethargy (20%) and refusal of feeds (8%) were the commonest clinical presentation followed by, fever (6%), convulsions (5%) and jaundice (5%). 60% neonates had thrombocytopenia of varying severity. Staphylococcus aureus was the most common organism associated with thrombocytopenia (43.3%). Mean platelet volume (MPV) was high in 85% of cases and platelet distribution width (PDW) was high in 96% of cases.Conclusions: The present study highlights the association of thrombocytopenia, mean platelet volume and platelet distribution width with causative organism in proven neonatal sepsis. Staphylococcus aureus was the most common organism causing thrombocytopenia in our NICU.

Predicting “Sepsis Ruled In” in Very Low Birth Weight NICU patients: A 3-NICU collaboration

Background: Signs of late-onset septicemia (LOS) and necrotizing enterocolitis (NEC) overlap with normal variations in preterm neonatal physiology, and about 10-20 sepsis evaluations are performed and antibiotics given for each case of proven LOS or NEC. Early diagnosis is important for improving outcomes, but unnecessary antibiotics increase multiple morbidities. Objective: To develop a model for accurate prediction of LOS or NEC using clinical variables and signs at the time of LOS/NEC evaluation. Methods: Records of consecutive very low birth weight (VLBW) infant admissions at 3 NICUs were reviewed, excluding those that died within 3 days of birth or were admitted after 28d. For infants with F0B31 blood culture for suspected LOS/NEC, the first positive workup was evaluated and if all workups were negative, the first negative was evaluated. A positive LOS/NEC evaluation was defined as a positive blood culture or radiographic diagnosis of NEC and F0B3 5d of antibiotics given, and sepsis ruled out (SRO) was …

Organism involved and clinical presentation in proven neonatal sepsis affecting platelet indices

Background: Sepsis is a common complication in the neonatal intensive care unit and is a major cause of neonatal mortality. Objective: To identify organism involved in proven neonatal sepsis affecting platelet indices. Setting: The study was carried out over a period of one and half year from December 2015 to July 2017 at Sangmeshwar and Basaveshwar Hospital attached to M.R. Medical College, KALABURAGI. 100 cases were considered for this study after proper screening for CBC, platelet count and their indices like mean platelet volume, platelet distribution width and CRP and blood culture in neonates admitted in our NICU with proven sepsis.Result: A total of 100 neonates with blood culture positive for bacterial cases were considered for the study. Early onset septicaemia (59%) was more common than late onset septicaemia (41%). Out of 100 cases 57% cases had growth of gram negative organisms, 40% had growth of gram positive organisms and 3% had growth of fungal. Tachypnea (27%), Lethargy (20%) and refusal of feeds (8%) were the commonest clinical presentation followed by, Fever (6%), convulsions (5%) and jaundice (5%). 60% neonates had thrombocytopenia of varying severity. Staphylococcus aureus was the most common organism associated with thrombocytopenia (43.3%). Conclusion: It was concluded that neonatal sepsis was common in males. Gram positive organisms were the predominant causative agents of septicaemia 40% as compared to gram negative organisms 57% and fungal sepsis 3%. Staphylococcus aureus was the commonest organism responsible for thrombocytopenia.

A study of pattern of neonatal infections, socio-demographic correlates; clinical manifestations and bacteriological profile of neonatal infections

Background: In the newborns one of the leading causes of deaths and disease is septicemia. Classical clinical features are absent which poses a challenge for early diagnosis. Hence to prevent the deaths and diseases it is essential to go for early diagnosis and early treatment. Objective of this study pattern of neonatal infections, socio-demographic correlates; clinical manifestations and bacteriological profile of neonatal infections.Methods: A hospital based follow up study was carried out among total of 140 study subjects with age less than 28 days of life were studied over a period of one year. All these subjects were suspected to have neonatal septicaemia. Detailed history, thorough clinical examination was carried out. Samples were sent for culture and sensitivity. Subjects were followed till the outcome.Results: Among 2.02% was the incidence of the neonatal septicemia. Females were less affected than the males. Late onset septicemia was less common. Chest retraction was the most common clinical manifestation. Culture positivity rate was 44.29%. Gram-negative organisms were detected in 20 cases (64.5%). Case fatality rate was 17.14%. 41 babies (58.6%) affected by septicemia belonged to low socio economic status. 63 babies (90%) were diagnosed to have septicemia, 3 babies (4.28%) were affected by Meningitis, 2 babies were affected by pneumonia. 49 babies (50%) Belonged to Hindu both in case and control group,12 babies (42.9%) belonged to Buddhist in case group, 16 babies in control group.Conclusions: Males were more susceptible compared to the female babies as well those with higher birth weight. Late onset septicemia was less common.

Neonatal sepsis due to coagulase negative Staphylococci: a study from Kashmir valley, India

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. Early diagnosis and treatment with appropriate antibiotics are important to improve the prognosis of neonatal sepsis. Coagulase-negative Staphylococci (CoNS) have emerged as prominent pathogens in the neonatal intensive care unit. These infections are rarely fatal, but they cause significant morbidity, especially among very low birth weight infants. This study was done to know the prevalence of Coagulase-negative Staphylococci in neonatal sepsis and to determine their antibiotic susceptibility pattern.Methods: A prospective study was conducted on blood samples of suspected neonatal septicaemia between August 2017 and May 2018 received at Department of Microbiology, Government Medical College, Srinagar. Blood culture was done by automated blood culture system, (BacT/Alert) and identification and antibiotic susceptibility was done by VITEK2 method.Results: Out of 356 neonates screened, there were 185 (53.4%) positive blood cultures. Among the culture positive cases, 107 (57.83%) were male and 78 (42.16%) were female. Early Onset Septicaemia cases (130 [70.27%]) were found to be three times higher than late onset Septicaemia (55 [29.72%]). Coagulase-negative Staphylococci (CoNs) (30.27%) were the most common organisms isolated followed by Acinetobacter sp (15.1%), Klebsiella sp (5.4%) S. aureus (4.8%) and E. coli (4.8%). All the isolates of CoNS were sensitive to linezolid and vancomycin and tigecycline. Methicillin resistance was seen in 84% isolates.Conclusions: Present study highlights the emergence of Coagulase-negative Staphylococci (CoNS) as predominant cause of neonatal septicaemia. Most of the isolates were resistant to methicillin which is alarming and a cause for concern.

Changing Trend of Neonatal Septicemia and Antibiotic Susceptibility Pattern of Isolates in Nepal.

Background Neonatal septicemia is one of the most common leading reasons for neonatal morbidity and mortality in developing countries. Frequent monitoring on pathogens with recent updates and their antimicrobial sensitivity pattern is mandatory for the better treatment. The aim of the study was to determine the bacteriological profile of neonatal septicemia and their antibiotic susceptibility pattern. Methods This was a cross-sectional study conducted in Outpatient Department (OPD), Neonatal Intensive Care Unit (NICU), and Pediatrics Ward of Chitwan Medical College Teaching Hospital (CMCTH), Bharatpur, Nepal. Blood cultures were performed on all suspected neonates attending to the hospital with a clinical analysis of neonatal septicemia. Isolated organism was identified by the standard microbiological protocol and antibiotic sensitivity testing was done by Kirby-Bauer disk diffusion method. Results Out of 516 specimens, bacterial growth was obtained in 56 specimens (10.8%). Prevalence of early onset sepsis was higher 35 (62.5%) in neonates compared to late onset sepsis 21 (37.5%). Majority of neonatal septicemia were caused by gram-negative isolates 39 (69.6%). Acinetobacter species 18 (32.1%) was most commonly isolated organism followed by Staphylococcus aureus 11 (19.6%). The predominant isolate in early onset septicemia was Acinetobacter species 18 (32.1%) and Staphylococcus aureus 9 (16%) and in late onset septicemia was Staphylococcus aureus 11 (19.6%) and Acinetobacter species 5 (8.9%). Staphylococcus aureus and coagulase-negative Staphylococci displayed highest susceptibility towards vancomycin, amikacin, teicoplanin, and meropenem. Gram-negative isolates showed susceptibility towards amikacin, piperacillin/tazobactam, meropenem, ofloxacin, and gentamicin. Conclusions Acinetobacter species and Staphylococcus aureus remain the most predominant organisms responsible for neonatal septicemia in a tertiary care setting and demonstrate a high resistance to the commonly used antibiotics. Above all, since the rate of Acinetobacter species causing sepsis is distressing, inspiring interest to control the excess burden of Acinetobacter species infection is mandatory.

Development and external evaluation of a population pharmacokinetic model for continuous and intermittent administration of vancomycin in neonates and infants using prospectively collected data.

Vancomycin is commonly used for nosocomial bacterial pathogens causing late-onset septicaemia in preterm infants. We prospectively collected pharmacokinetic data aiming to describe pharmacokinetics and determine covariates contributing to the variability in neonatal vancomycin pharmacokinetics. Further, we aimed to use the model to compare the ratio of AUC24 at steady-state to the MIC (AUC24,ss/MIC) of several intermittent and continuous dosing regimens. Newborns receiving vancomycin for suspected or confirmed late-onset sepsis were included. Peak and trough concentrations for intermittent vancomycin dosing and steady-state concentrations for continuous vancomycin dosing were measured. NONMEM 7.3 was used for population pharmacokinetic analysis. Monte Carlo simulations were performed to compare dosing schemes. Data from 54 infants were used for model development and from 34 infants for the model evaluation {corrected gestational age [median (range)] = 29 (23.7-41.9) weeks and 28 (23.4-41.7) weeks, respectively}. The final model was a one-compartment model. Weight and postmenstrual age were included a priori, and then no additional covariate significantly improved the model fit. Final model parameter estimates [mean (SEM)]: CL = 5.7 (0.3) L/h/70 kg and V = 39.3 (3.7) L/70 kg. Visual predictive check of the evaluation dataset confirmed the model can predict external data. Simulations using MIC of 1 mg/L showed that for neonates with gestational age ≤25 weeks and postnatal age ≤2 weeks AUC24,ss/MIC was lower with the intermittent regimen (median 482 versus 663). A population pharmacokinetic model for continuous and intermittent vancomycin administration in infants was developed. Continuous administration might be favourable for treating infections caused by resistant microorganisms in very young and immature infants.

Highlights in this issue

Measles is one of the most contagious infectious diseases. Before the introduction of an efficient vaccine, it is estimated that there were 30 million cases and two million deaths each year, mostly among children in low-income countries. During the 1980s, measles was almost eliminated in many European countries. An editorial by Leif Dotevall 1 discusses the paradoxical and painful resurgence of measles in Europe in the last few years and highlights the need to regain confidence in immunisation. In a double-blind randomised study, Wejryd et al. gave 134 extremely low-birthweight infant oil drops containing the probiotic Lactobacillus reuteri DSM 17938 or a placebo. They did this once a day until the infants reached 36 weeks of gestation 2. The authors found that the probiotic did not reduce the time it took the infants to reach full enteral feeds. However, the infants who received the probiotic supplements had a better head growth rate during the first month of life. Claris 3 comments on the findings. This issue includes three reviews on paediatric hypertension. Wühl 4 shows that hypertension in childhood obesity was associated with significantly increased cardiovascular morbidity and mortality and states that early diagnosis and treatment for blood pressure control and weight reduction are essential. Meanwhile, Krmar 5 reviewed the prevalence of white-coat hypertension from a paediatric perspective and reports that this condition was best diagnosed in children by using ambulatory blood pressure monitoring over a 24-hour period. Carlström 6 studied hydronephrosis, and the risk of later hypertension, and points out that today's nonoperative management of hydronephrosis should be reconsidered to reduce the risk of developing elevated blood pressure or hypertension later in life. In 2014, an outbreak of group B streptococcus caused severe late-onset septicaemia in five very preterm infants and colonisation in 10 more infants in a neonatal intensive care unit (NICU) in Sweden. Åberg et al. 7 analysed the course of the outbreak, to find tools that stopped it from happening again. Meanwhile, Rønning et al. 8 adopted a similar approach to investigate an outbreak caused by antibiotic-susceptible Klebsiella oxytoca in a Norwegian NICU. The authors concluded that appropriate microbiological molecular screening methods and strict infection control measures are important, in order to control an outbreak. Readers may also be interested in the paper by Özenci and Schubert 9, which evaluated the implementation of an earlier, and more targeted, treatment of neonatal sepsis. The number of child deaths fell in Sweden from 2000 to 2014, but as many as 25% were from badly defined external causes or unknown causes, according to a study by Otterman et al. 10. A sizeable number of deaths were registered without death certificates, especially for infants. The authors conclude that systematic death reviews could yield information that could prevent future deaths. Palusci 11 comments on the findings. Readers may also be interested in the paper by Lykke et al. 12 on child mortality rates in Denmark, which we published in 2018, and the accompanying editorial by Kreicbergs 13, who discussed why and where children die. Figures 1–5. Istockphoto.com.

Harbouring group B streptococci in a neonatal intensive care unit led to an outbreak among preterm infants.

We report a nosocomial outbreak with group B streptococci (GBS) in a level two neonatal intensive care unit (NICU) at Sachs' Children and Youth Hospital, Stockholm, Sweden, in 2014. There were five very preterm infants with severe late-onset septicaemia, and 10 further infants were colonised. Pulsed-field gel electrophoresis and multilocus sequence typing genetic characterisation showed that one GBS strain was the cause: serotype Ia, sequence type 23, clonal complex 23. The NICU environment cultures revealed GBS reservoirs on surfaces near sick and colonised patients. We identified workflows and guidelines that could increase the risks of nosocomial infections. Conclusion: This nosocomial GBS outbreak among preterm infants demonstrates that GBS can be harboured in the NICU environment.

Early Pulse Oximetry Data Improves Prediction of Death and Adverse Outcomes in a Two-Center Cohort of Very Low Birth Weight Infants.

We previously showed, in a single-center study, that early heart rate (HR) characteristics predicted later adverse outcomes in very low birth weight (VLBW) infants. We sought to improve predictive models by adding oxygenation data and testing in a second neonatal intensive care unit (NICU). HR and oxygen saturation (SpO2) from the first 12 hours and first 7 days after birth were analyzed for 778 VLBW infants at two NICUs. Using multivariate logistic regression, clinical predictive scores were developed for death, severe intraventricular hemorrhage (sIVH), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity (tROP), late-onset septicemia (LOS), and necrotizing enterocolitis (NEC). Ten HR-SpO2 measures were analyzed, with first 12 hours data used for predicting death or sIVH and first 7 days for the other outcomes. HR-SpO2 models were combined with clinical models to develop a pulse oximetry predictive score (POPS). Net reclassification improvement (NRI) compared performance of POPS with the clinical predictive score. Models using clinical or pulse oximetry variables alone performed well for each outcome. POPS performed better than clinical variables for predicting death, sIVH, and BPD (NRI > 0.5, p < 0.01), but not tROP, LOS, or NEC. Analysis of early HR-SpO2 characteristics adds to clinical risk factors to predict later adverse outcomes in VLBW infants.

MENINGITIS

Objectives: To determine the frequency of meningitis in neonates having late onsetsepticemia. Study Design: Descriptive, cross-sectional study. Place and Duration of Study:Department of Pediatrics, D.H.Q, Faisalabad from August, 2015 to January, 2016. Methodology:105 neonates aged between 3-28 days having late onset septicemia were included in the studythrough non-probability consecutive sampling. Neonates having spina bifida, anencephalyand very sick neonates, after initial stabilization were excluded. For assessment of meningitis1ml blood sample and CSF sample were sent to the hospital pathology laboratory. Meningitiswas labeled if the patient had all of the following criteria: CSF glucose less than the plasmaglucose by ≥50%, CSF white cell count &gt;10/cumm and CSF protein &gt;80 mg/dl. Results: Outof 105 patients, mean age was 13.53±6.99 days. 59 (56.2%) patients were male and 46 (43.8%)patients were females. The prevalence of meningitis was found to be 20 (19%). 11 (18.6%) malepatients had meningitis while 9 (19.6%) female patients had meningitis with p-value = 0.905.Meningitis is more common in patients having age between 4-15 days 17 (26.6%) than the 3(7.3%) patients having age between 16-27 days with p-value = 0.014. Conclusion: Meningitisis a common disorder in neonates having late onset septicemia. By knowing the magnitude ofthis complication preventive measure can be adopted to minimize the burden of this disease.