Neonatal Intensive Care Patients Research Articles

External Evaluation of Population Pharmacokinetic Models of Piperacillin in Preterm and Term Patients from Neonatal Intensive Care.

Piperacillin/tazobactam is extensively used off-label to treat late-onset neonatal sepsis, but safety and pharmacokinetic data in this population are limited. Additionally, the organic immaturity of the newborns contributes to a high piperacillin pharmacokinetic variability. This affects the clinical efficacy of the antibiotic treatment and increases the probability of developing drug resistance. This study aimed to evaluate the predictive performance of reported piperacillin population pharmacokinetic models for their application in a model-informed precision dosing strategy in preterm and term Mexican neonatal intensive care patients. Published population pharmacokinetic models for piperacillin which included neonates in their study population were identified. From the reference models, structured models, population pharmacokinetic parameters, and interindividual and residual variability data were extracted to be replicated in pharmacokinetic software (NONMEM® version 7.4). For the clinical study, a sampling schedule was designed, and 2-3 blood samples of 250 µL were taken from neonates who met the inclusion criteria. Piperacillin plasma concentrations were determined by liquid chromatography/tandem mass spectrometry. The clinical treatment data were collected, and piperacillin plasma concentrations were estimated using reference pharmacokinetic models for an a priori or Bayesian approach. Statistical methods were used in terms of bias and precision to evaluate the differences between observed and estimated neonatal piperacillin plasma concentrations with the different approaches and to identify the pharmacokinetic model that best fits the neonatal data. A total of 70 plasma samples were collected from 25 neonatal patients, of which 15 were preterm neonates. The overall median value (range) postnatal age, gestational age, body weight, and serum creatinine at the sampling collecting day were 12 (3-26) days, 34.2 (26-41.1) weeks, 1.78 (0.08-3.90) Kg, 0.47 (0.20-0.90) mg/dL, respectively. Three population pharmacokinetic models for piperacillin in infants up to 2months were identified, and their predictive performance in neonatal data was evaluated. No pharmacokinetic model was suitable for our population using an a priori approach. The model published by Cohen-Wolkowiez et al. in 2014 with a Bayesian approach showed the best performance of the pharmacokinetic models evaluated in our neonatal data. The procedure requires two blood samples (predose and postdose), and, when applied, it predicted 66.6% of the observations with a relative median absolute predicted error of less than 30%. The population pharmacokinetic model developed by Cohen-Wolkowiez et al. in 2014 demonstrated superior performance in predicting the plasma concentration of piperacillin in preterm and term Mexican neonatal intensive care patients. The Bayesian approach, including two different piperacillin plasma concentrations, was clinically acceptable regarding bias and precision. Its application for model-informed precision dosing can be an option to optimize the piperacillin dosage in our population.

Which left atrial volume measurement should we use in the neonatal intensive care?

BackgroundIncreased left atrial volume (LAV) is a marker of cardiovascular risk. Echocardiography standards to assess LAV in adults and children are the biplane area-length method (AL) and method of disks (MOD). LAV in neonatology is usually derived as M-mode ratio between the LA and the Aorta (LAAo). The aim of this study is to determine feasibility and reliability of these methods in neonatal clinical practice. MethodsClinically indicated echocardiograms in neonatal intensive care patients were retrospectively analyzed. Feasibility was determined with an image quality score describing insonation angle, foreshortening and wall clarity. Reliability was determined with Bland-Altman and correlation coefficient analysis of intra- and inter-observer measurements. Results104 infants ranging from 23 to 39 weeks gestation were included. The feasibility of LAAo, AL and MOD was comparable (median image score 4 out of 6 points). Linear regression between AL and MOD was excellent (R2 0.99). LAAo best-fit with MOD was reached with curve-linear regression (R2 0.28) whereby a LAAo of 1.60 correlated with 1.24 ml/kg, but with a wide 95 % CI. The correlation coefficient within and between observers for LAAo, biplane AL, biplane MOD and monoplane MOD was 0.93 (0.87–0.96), 0.98 (0.96–0.99), 0.98 (0.96–0.99), 0.99 (0.97–0.99) and 0.58 (0.11–0.81), 0.75 (0.44–0.89), 0.92 (0.88–0.98), 0.96 (0.88–0.98) respectively. ConclusionAll methods were equally feasible and reliable when repeated by the same observer, but LAAo reliability was poor when repeated by a different observer. Biplane MOD was the most reliable and thus recommended in neonatal practice. Monoplane MOD performed well and could be considered as alternative but might be less accurate.

Sounds in intensive care units: Perspectives of patients and parents. A qualitative study

Sounds in intensive care units: Perspectives of patients and parents. A qualitative study Abstract: Background: Sound levels in intensive care units exceed internationally recommended limits. This can have negative effects on patients, relatives, and staff. There is a lack of evidence on noise-reducing measures. Aim: The aim of the study was the implementation and evaluation of ward-specific noise management in intensive care units. In the present article, the question of the noise and stress experience of intensive care patients and parents of neonatal intensive care patients was explored. Methods: 33 semi-structured interviews with intensive care patients and parents of neonatal intensive care patients in three intensive care units were conducted and analysed. Results: Sounds in intensive care units can be stressful (especially alarms) but also be interpreted as meaningful. This is not only related to the context of the ICU, but also to individual experiences and the social aspects of the sounds. In order to avoid or reduce stress, participants apply individual noise (stress) management. In contrast, ward-related noise management had no specific effect on the participants. Conclusions: The findings offer indications for suitable measures to reduce the noise exposure of intensive care patients and parents of neonatal intensive care patients. Research about measures such as concepts for supporting the attribution and differentiation of sounds could follow.

Initial feasibility and challenges of hyperpolarized 129 Xe MRI in neonates with bronchopulmonary dysplasia.

The underlying functional and microstructural lung disease in neonates who are born preterm (bronchopulmonary dysplasia, BPD) remains poorly characterized. Moreover, there is a lack of suitable techniques to reliably assess lung function in this population. Here, we report our preliminary experience with hyperpolarized 129 Xe MRI in neonates with BPD. Neonatal intensive care patients with established BPD were recruited (N = 9) and imaged at a corrected gestational age of median:40.7 (range:37.1, 44.4) wk using a 1.5T neonatal scanner. 2D 129 Xe ventilation and diffusion-weighted images and dissolved phase spectroscopy were acquired, alongside 1 H 3D radial UTE. 129 Xe images were acquired during a series of short apneic breath-holds (˜3 s). 1 H UTE images were acquired during tidal breathing. Ventilation defects were manually identified and qualitatively compared to lung structures on UTE. ADCs were calculated on a voxel-wise basis. The signal ratio of the 129 Xe red blood cell (RBC) and tissue membrane (M) resonances from spectroscopy was determined. Spiral-based 129 Xe ventilation imaging showed good image quality and sufficient sensitivity to detect mild ventilation abnormalities in patients with BPD. 129 Xe ADC values were elevated above that expected given healthy data in older children and adults (median:0.046 [range:0.041, 0.064] cm2 s-1 ); the highest value obtained from an extremely pre-term patient. 129 Xe spectroscopy revealed a low RBC/M ratio (0.14 [0.06, 0.21]). We have demonstrated initial feasibility of 129 Xe lung MRI in neonates. With further data, the technique may help guide management of infant lung diseases in the neonatal period and beyond.

Patterns of Pediatric Palliative and End-of-Life Care in Neonatal Intensive Care Patients in the Southern U.S.

Despite high rates of mortality among infants in the Southern U.S., little is known about the timing of pediatric palliative care (PPC), the intensity of end-of-life care, and whether there are differences among sociodemographic characteristics. To describe PPC patterns and treatment intensity during the last 48 hours of life among neonatal intensive care unit (NICU) patients in the Southern U.S. who received specialized PPC. Medical record abstraction of infant decedents who received PPC consultation in two NICUs (in Alabama and Mississippi) from 2009 to 2017 (n = 195) including clinical characteristics, palliative and end-of-life care characteristics, patterns of PPC, and intensive medical treatments in the last 48 hours of life. The sample was racially (48.2% Black) and geographically (35.4% rural) diverse. Most infants died after withdrawal of life-sustaining interventions (58%) and had do not attempt resuscitation orders documented (75.9%); very few infants enrolled in hospice (6.2%). Initial PPC consult occurred a median of 13 days after admission and a median of 17 days before death. Infants with a primary diagnosis of genetic or congenital anomaly received earlier PPC consultation (P = 0.02) compared to other diagnoses. In the last 48 hours of life, NICU patients received intensive interventions including mechanical ventilation (81.5%), CPR (27.7%) and surgeries or invasive procedures (25.1%). Black infants were more likely to receive CPR compared to White infants (P = 0.04). Overall, PPC consultation occurred late in NICU hospitalizations, infants received high-intensity medical interventions in the last 48 hours of life, and there are disparities in intensity of treatment interventions at end of life. Further research is needed to explore if these patterns of care reflect parent preferences and goal concordance.

Coding Hotline

This month’s Coding Hotline addresses coding for neonatal intensive care services and patients in observation status.

The Potential Impact of Preemptive Pharmacogenetic Genotyping in the Neonatal Intensive Care Unit

To evaluate the use of drugs with pharmacogenomic (PGx) guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC) in early childhood. A retrospective observational study of neonatal intensive care (NICU) patients admitted between 2005 - 2018 with at least one subsequent hospitalization at or after 5 years of age was performed to determine PGx-drug exposure. Data regarding hospitalizations, drug exposures, gestational age, birth weight, and congenital anomalies and/or a primary genetic diagnosis were collected. Incidence of PGx-drug and drug class exposures was determined and patient specific factors predictive of exposure were investigated. During the study, 19,195 patients received NICU care and 4,196 (22%) met study inclusion; 67% received 1-2, 28% 3-4, and 5% 5 or more PGx-drugs in early childhood. Preterm gestation, low birth weight (<2,500 grams), and the presence of any congenital anomalies and/or a primary genetic diagnosis were statistically significant predictors of CPIC drug exposures (p<0.01, p<0.01, p<0.01, respectively). Preemptive PGx testing in NICU patients could have a significant impact on medical management, during the NICU stay and throughout early childhood.

Good handling practice of parenterally administered medicines in neonatal intensive care units - position paper of an interdisciplinary working group.

This position paper, developed by an interdisciplinary expert group of neonatologists, paediatric infectious disease physicians, clinical pharmacists and specialists for the prevention and control of nosocomial infections, describes the "Good handling practice of medicines parenterally administered to patients on NICUs". It takes equal account of patient safety and the specialties of neonatal intensive care regarding feasibility and proportionality. The overall concept is perceived as a "learning system", in which open communication within the health-care team relating to medication errors and critical incidents enables continuous development and improvement to ensure patient safety. In our opinion, pharmacists, who are responsible for the supply of ready-to-administer parenteral medicinal products for neonatal intensive care patients, as well as the hygiene staff responsible on site are integral parts of the interdisciplinary treatment team. Risks of the current clinical practice of parenteral treatment of NICU patients are discussed in detail and recommendations for safety-relevant procedures are given.

Effective Use of Extended Dwell Peripheral Intravenous Catheters in Neonatal Intensive Care Patients.

Implementing innovative approaches to vascular access can be challenging in the newborn intensive care unit (NICU). The purpose of this project was to describe the implementation of extended dwell peripheral intravenous (EPIV) catheters, a vascular access device not widely used in the NICU. The implementation involved (1) designing clinical criteria for EPIV catheter use, (2) education of vascular access NICU nurses, and (3) comparing clinical outcomes between vascular access devices (ie, PIV and EPIV catheters). We developed evidence-based clinical criteria guiding the use of vascular access devices. We then developed an educational plan for NICU nurses focused on vascular access. Finally, we collected and compared demographic characteristics and clinical data on catheter type and placement attempts, dwell time, and clinical complications associated with each catheter. EPIV catheters were implemented according to evidence-based criteria by a vascular access NICU nursing team. Fifteen percent of PIV catheter placements required 3 or more attempts compared with just 1% of EPIV catheter placement attempts. EPIV catheters had a longer median dwell time (3.5 vs 1 day) and fewer complications than PIV catheters (P < .001). Implementation of an evidence-based approach to vascular access by a team of NICU nurses may improve clinical outcomes. EPIV catheters may be an appropriate alternative device to PIV catheters due to fewer placement attempts, longer dwell times, and overall fewer complications during use. Future vascular access research in the NICU may include a greater focus on innovative placement strategies, optimal maintenance and infection control, and prevention of complications.

Ultrasound control of the feeding tube position in newborns: a prospective study

INTRODUCTION. In the last decade, there has been a rethinking of the value of nutritional support for neonatal intensive care patients. According to the American and European guidelines for nutritional therapy, enteral feeding is the preferred method of nutrition for patients with a functioning gastrointestinal tract. Preterm infants in critical ill have a low tolerance to during gastric feeding. Research shows that the use of transpiloric feeding is comparable in effectiveness to operative fundoplication. X-ray control method is used to confirm the correct position of the transpyloric tube. OBJECTIVES. The goal of this study was to evaluate the effectiveness and safety of ultrasound control of the transpyloric tube position in comparison with X-ray examination. MATERIALS AND METHODS. All patients included in the study had a low tolerance to enteral feeding through a gastric tube. The use of ultrasound during this manipulation provided an alternative method for monitoring the position of the tube without the X-ray control. Before the tube insertion procedure, the pyloric canal and postpyloric area were visualized in 100 % of patients. RESULTS. After the manipulation, according to sonography data, in 94.1 % of patients, the transpyloric tube was located outside the pyloric part of the stomach (in the duodenum). In more than half of the cases, there was a complete coincidence of the conclusions of radiography and ultrasound examination. At 41.2 % of cases, the radiologist could not determine the exact location of the distal end of the tube between the duodenum and jejunum. CONCLUSIONS. Usage transpyloric tube of ill infants may lead to improved treatment outcomes. The obtained data indicate that ultrasound imaging of the tube is statistically more reliable than X-ray control. The use of ultrasound to visualize the process of installing tube may exclude the additional use of radiography.

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital.

To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children's hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission (P = .020) and prolonged length of stay (P = .004) were associated with decreased likelihood of completing recommended follow-up. Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

Re-evaluating Safe Osmolarity for Peripheral Parenteral Nutrition in Neonatal Intensive Care Patients.

To reach nutrition goals for neonatal patients, institutions often exceed the American Society for Parenteral and Enteral Nutrition recommended maximum of 900 mOsm/L for peripheral parenteral nutrition (PPN). Evidence is limited regarding the safety of PPN osmolarities above this maximum, specifically in neonatal patients. The purpose of this study was to determine if PPN with osmolarities ≥ 1000 mOsm/L is associated with an increased rate of line-related complications. This retrospective study included infants admitted to the Penn State Health Children's Hospital NICU from January 1, 2013, through July 31, 2018, who were receiving PPN, to assess if solutions with osmolarities ≥ 1000 mOsm/L versus < 1000 mOsm/L are associated with increased rates of line-related complications. A total of 200 patients were included in the study, and 618 individual PPN days were analyzed. Baseline patient characteristics were similar between groups. The PPN osmolarities ranged from 610 to 1267 mOsm/L. Overall, the incidence of line-related complications for PPN < 1000 (n = 342 PPN days) and ≥ 1000 mOsm/L (n = 276 PPN days) was 28.9% and 29.0%, respectively (OR 1.00 [95% CI 0.72-1.40, p = 0.99]). Irrespective of PPN osmolarity, infants weighing > 1.5 kg had significantly greater odds of experiencing line complications compared with patients < 1 kg, but showed no difference compared with patients weighing 1 to 1.5 kg. There were no significant differences in the incidence of line-related complications in NICU patients receiving PPN with osmolarities 1000 to 1250 versus < 1000 mOsm/L.

Evaluating predictive equations for deriving PaO 2 from SpO 2 in neonatal intensive care patients Joseph McDonell 1 , Trassanee Chatmethakul 3 , Phillip Levy 4 , Patrick J. McNamara 3 , Michael Tomasson 2 , Craig Wheeler 4 , Melissa L. Bates 1,2,3 Departments of

The oxygen-hemoglobin dissociation curve can be used to calculate the arterial partial pressure of oxygen (PaO2) from the peripheral saturation (SpO2)in adults. Our objective was to evaluate whether this calculation could be performed in neonates. We obtained blood gas measurements from 104 de-identified infants at the University of Iowa Hospitals and Clinics (UIHC) neonatal intensive care unit. We plotted PaO2 against SaO2, measured by co-oximetry, and compared the resultant curve to published curves for adults and neonates. The UIHC curve was leftward shifted compared to published curves for neonates and adults. We tested the additional hypothesis that this because of the large proportion of premature infants (72.3%) in our cohort, but gestational age was not a predictor of the shift. Next, we quantified the degree to which pH, PaCO2, and gestational age contributed to sources of error in using this curve to estimate PaO2 from SpO2. We found that deviations in pH and PaCO2 from the physiological ideal contribute up to 3 mmHg and 4 mmHg of error, respectively, to the calculation of PaO2 using our cohort's curve. We demonstrate that data from previously published cohorts may not be universally useful for the calculation of PaO2. In future studies, we will validate the UIHC curve in additional patients with well characterized clinical phenotypes. Additional simulations are needed that quantify the additive contribution of pH, PaCO2, and gestational age to the error in calculated PaO2 in neonates.

Use of the respiratory physiotherapy technique selective insuflation to revert the Atelectasia in a newborn

INTRODUCTION: Pulmonary atelectasis is common among neonatal intensive care patients, mainly due to the anatomy of the newborn and the clinical and pathological conditions that are being exposed. OBJECTIVE: Describing the effectiveness of the selective insufflation technique to reverse atelectasis in a single visit. CASE REPORT: Premature, who present pulmonary atelectasis in the upper right lobe,with a gestational age of 35 weeks, on the seventh day of invasive mechanical ventilation received daily respiratory therapy. CONCLUSION: The total reversal of atelectasis in one single visit was confirmed by means of a chest X-ray immediately before and after the maneuver. The patient was followed up until hospital discharge, with no subsequent atelectasis event, even after extubation.

Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients.

To describe the epidemiology and management of appendicular fractures occurring in the neonatal ICU in a large series of patients treated a single, quaternary care neonatal intensive care unit. Patients <1years old with appendicular fractures treated from 2012 to 2016 at a quaternary-level NICU were identified. Bivariate testing compared fractures, work-up and management based on designated mechanism (presumed birth-related vs unknown). In patients with unknown mechanism, factors with potential fracture association were analysed in a descriptive fashion. Eighty-five fractures (54 patients) were included. Mechanistic cohorts differed by birthweight (P<.001) and gestational age at birth (P<.001). Presumed birth-related fractures were more commonly upper extremity (P<.001), solitary (P=.001) and radiographically diagnosed in the acute state (<.001). The biochemical profile of the cohorts differed significantly. The prevalence of factors with potential fracture association was high in patients with unknown mechanism. Only one patient required surgery, while all others resolved with minimal orthopaedic intervention. Findings indicate these injuries rarely require operative intervention and that two distinct injury profiles appear to exist based on fracture mechanism. Steroid use, ventilation use, diuretic use, nutritional supplementation and recent bedside procedures were common among patients without known fracture mechanism. Level III-Retrospective Cohort Study.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Clinical Recommendations for Managing the Impact of Insulin Adsorptive Loss in Hospital and Diabetes Care.

Adsorption of insulin to infusion sets impacts patient therapeutic outcomes and, unaccounted for, may exacerbate persistent hyperglycemia or result in therapy-induced hypoglycemia. This article aims to provide recommendations for clinicians involved in intensive care and/or outpatient pump therapy contexts. A dynamic adsorption model is used to evaluate time-varying insulin concentration in the infusion set outflow. Hourly and daily percentage insulin loss to adsorption is examined for neonatal, pediatric, and adult intensive care patients, as well as outpatient children and adults weighing 30, 50, and 80 kg. A short review of preconditioning methods is included. Insulin adsorption in outpatient pump therapy is most pronounced in the first hour, where as much as 80% of the intended insulin dose may be lost to adsorption. Subsequently, insulin adsorptive loss is typically negligible. Overall, extra care should be taken in the first 1-6 h of a new infusion set, particularly in children or teenagers. Typically, insulin adsorption in the adult intensive care unit is negligible unless infused at low flow rates (<2 mL/h). Insulin adsorption is significant in pediatric and neonatal intensive care, resulting in delivery concentrations as low as 5%-50% of that intended. Thus, it is recommended that preconditioning of insulin delivery lines be carried out prior to infusion initiation in this context. However, no preconditioning method completely removes adsorption, and care should still be taken in the first 1-6 h of insulin dosing. Recommendations made in this article are dependent on the insulin concentration and flow rate used in each clinical context.

Outcomes of Neonates With Complex Medical Needs.

Children with complex medical needs (CMN) are high healthcare resource utilizers, have varying underlying diagnoses, and experience repeated hospitalizations. Outcomes on neonatal intensive care (NICU) patients with CMN are unknown. The primary aim is to describe the clinical profile, resource use, prevalence, and both in-hospital and postdischarge outcomes of neonates with CMN. The secondary aim is to assess the feasibility of sustaining the use of the neonatal complex care team (NCCT). A retrospective cohort study was conducted after implementing a new model of care for neonates with CMN in the NICU. All neonates born between January 2013 and December 2016 and who met the criteria for CMN and were cared for by the NCCT were included. One hundred forty-seven neonates with a mean (standard deviation) gestational age of 34 (5) weeks were included. The major underlying diagnoses were genetic/chromosomal abnormalities (48%), extreme prematurity (26%), neurological abnormality (12%), and congenital anomalies (11%). Interventions received included mechanical ventilation (69%), parenteral nutrition (68%), and technology dependency at discharge (91%). Mortality was 3% before discharge and 17% after discharge. Postdischarge hospital attendances included emergency department visits (44%) and inpatient admissions (58%), which involved pediatric intensive care unit admissions (26%). Neonates with CMN have multiple comorbidities, high resource needs, significant postdischarge mortality, and rehospitalization rates. These cohorts of NICU patients can be identified early during their NICU course and serve as targets for implementing innovative care models to meet their unique needs. Future studies should explore the feasibility of implementing innovative care models and their potential impact on patient outcomes and cost-effectiveness.

Multiple antibiotic resistance as a risk factor for mortality and prolonged hospital stay: A cohort study among neonatal intensive care patients with hospital-acquired infections caused by gram-negative bacteria in Vietnam.

BackgroundAntibiotic resistance (ABR) is an increasing burden for global health. The prevalence of ABR in Southeast Asia is among the highest worldwide, especially in relation to hospital-acquired infections (HAI) in intensive care units (ICU). However, little is known about morbidity and mortality attributable to ABR in neonates.AimThis study aimed to assess mortality and the length of hospitalization attributable to ABR in gram-negative bacteria (GNB) causing HAI in a Vietnamese neonatal ICU (NICU).MethodsWe conducted a prospective cohort study (n = 296) in a NICU in Hanoi, Vietnam, from March 2016 to October 2017. Patients isolated with HAI caused by GNB were included. The exposure was resistance to multiple antibiotic classes, the two outcomes were mortality and length of hospital stay (LOS). Data were analysed using two regression models, controlling for confounders and effect modifiers such as co-morbidities, time at risk, severity of illness, sex, age, and birthweight.ResultsThe overall case fatality rate was 44.3% and the 30 days mortality rate after infection was 31.8%. For every additional resistance to an antibiotic class, the odds of a fatal outcome increased by 27% and LOS increased by 2.1 days. These results were statistically significant (p < 0.05).ConclusionABR was identified as a significant risk factor for adverse outcomes in neonates with HAI. These findings are generally in line with previous research in children and adults. However, heterogeneous study designs, the neglect of important confounders and varying definitions of ABR impair the validity, reliability, and comparability of results.

Distribution and susceptibility to various antifungal agents among blood stream Candida isolates from Neonatal intensive care unit

Background: During the past several decades, there has been a steady increase in the frequency of isolation of Candida spp. from blood stream infections from NICU worldwide. Furthermore, monitoring programs have detected an increase in the prevalence of infections caused by non albicans Candida (NAC). NAC are reported to be intrinsically resistant and less susceptible to empirically used azoles like Fluconazole. Thus speciation and antifungal susceptibility testing become imperative for these isolates. Objective: To study the trend in species distribution and antifungal susceptibility pattern among blood stream Candida strains isolated from neonatal intensive care patients was the aim of the study. Method: Susceptibility testing of clinically significant Candida isolates to various antifungal was performed by E-test in accordance with manufacturer instructions. The results obtained were analyzed and compared. Results: The most frequently isolated species was Candida tropicalis (52.83%) followed by Candida parapsilosis (16.98%), Candida albicans (9.4%), Candida glabrata (9.4%), Candida krusei (7.5%) and Candida guilliermondii (3.77%). Overall sensitivity of 85%, 81%, 26%, and 98% respectively to Amphotericin B, Fluconazole, Itraconazole and Voriconazole was found. Conclusion: The study shows the clinical significance and mycological shift of Candida species in blood culture of the neonatal population with a predominance of NAC species. Voriconazole showed an excellent activity and can be used in empirical treatment for candidemia rather than Fluconazole.