Neonatal Intensive Care Unit Ward Research Articles

THE STUDY OF MULTIDRUG-RESISTANCE IN NEONATAL INTENSIVE CARE UNIT AT THE CENTRAL JAVA HOSPITAL

Objective: Multidrug-resistance (MDR) is defined as an acquired non-susceptibility to at least one agent in three or more antimicrobial categories. MDR can be caused by several factors, including the misuse of antibiotics. Resistance to antibiotics still poses a global challenge, especially in Indonesia. This study aimed to identify patterns of MDR in Neonatal Intensive Care Unit (NICU) at the Central Java Hospital, during the period of January 2014 to December 2015.Methods: The study was conducted using a descriptive retrospective design. The research population comprised of 225 patients. Patient inclusion criteria were neonatal patients treated in NICU ward with infection diagnosis. All patients had culture and sensitivity examinations on their bloods. The culture and sensitivity examinations were performed by microbiology clinicians.Results: The most common infection type was sepsis (60%). The most common bacteria found in the blood specimen of patients in the NICU ward was Gram-negative bacteria with a 72% rate, the other was Gram-positive bacteria. Bacteria which infected patients include; Klebsiellapneumoniaessppneumoniae, Pseudomonas aeruginosa, Bulkholderiacepacia, Acinetobacterbaumannii, Enterobactercloacae ssp cloacae, Serratiamarcescens, Staphylococcus haemolyticusand Staphylococcus epidermidis. The research result showed that 97.8% MDR cases were reported in the NICU ward. Antibiotics which were still potent for all bacteria found in NICU patients were tigecycline, meropenem and ciprofloxacin (for Gram-negative bacteria) and tigecycline, linezolid, nitrofurantoin, moxifloksacin and vancomycin (for Gram-positive bacteria).Conclusion: A high percentage of MDR occurred in NICU patients. Sepsis is the most common diagnosis in NICU patients. The usage of third generation antibiotics should be limited and regulated systematically.

Profile of newborns discharged from the intensive neonatal care unit submitted to the kangaroo ward

Background: Describe the profile of newborns discharged from the neonatal intensive care unit (NICU) sent to a kangaroo ward and their neonatal variables.Methods: Retrospective and documentary study with a quantitative approach, performed at the General Hospital César Cals, whose sample consisted of 30 charts. The following variables were analyzed: weight, gestational age, Apgar score, gender, race, adequacy of the pregnancy and assistance provided in the NICU and kangaroo ward. The variables were analyzed using Microsoft Excel® 2010 program to obtain percentages.Results: There was a prevalence of extremely premature infants with high underweight and small size for the gestational age, male gender and browns, with Apgar score at 1st and 5th minutes more than 7, born by cesarean section, who used mechanical ventilation and surfactant, with prevalence of respiratory distress syndrome, with admission weight in Kangaroo ward less than 1.250g, making use of exclusive breast milk, who were attended by physiotherapy and with weight less than 1.600g at discharge, of the variables studied.Conclusions: Kangaroo care is an excellent cost-effective model for the newborn coming from the neonatal intensive care unit.

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

Background. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in a hospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied. Objectives. To determine the incidence of medication errors in neonatal and paediatric inpatients, investigate the origin of medication errors that occurred and describe and categorise the types of medication errors made in both the neonatal intensive care unit (NICU) and paediatric wards. Methods. The study followed a prospective, quantitative design with a descriptive approach. A prospective record review of inpatients’ medication charts was undertaken to determine what was prescribed by the physician, dispensed by the pharmacy and administered by the nurses. The researcher also directly observed the preparation and administration techniques as performed by the nurses. A medication error checklist was used to collect the data. Results. A total of 663 medication errors were detected in 227 patients over the study period of 16 weeks, of which 177 (78%) patients had one or more error(s). There were 338 (51%) administration errors and 309 (47%) prescribing errors. Incorrect dosing was the most frequent type of error (34%), followed by omission of medication (18.5%) and medication given at the incorrect time (12%). The causes of these medication errors were mostly due to miscalculation (26%), failure to monitor (15%) and procedures not followed (15%). Anti-infectives (43%) and analgesics (25%) had the most errors. In 118 (67%) patients the errors resulted in no harm to the patient, whereas in 59 (33%) patients the medication error resulted in some level of harm. Conclusion. The incidence of medication errors in the NICU and paediatric wards at the teaching hospital was higher than values reported elsewhere globally. Most errors occur during prescribing and administration of medication. Dosing errors are a common problem in paediatrics. Therefore, a formalised system to record these errors should be introduced alongside regular discussions on preventive measures among the multidisciplinary team.

Pseudomeningitis due to Pseudomonas aeruginosa in a paedriatic ward of a tertiary care centre: a glimpse on infection control measures

Paediatric bacterial meningitis is a life threatening illness. We report a pseudo-outbreak of Pseudomonas aeruginosa meningitis in neonates from the neonatal intensive care unit (NICU) and paediatric ward of our 567 bed tertiary care hospital. The infection control team (ICT) investigated the cause of a sudden significant increase of Pseudomonas meningitis in neonates. A retrospective analysis of all the isolates from CSF and environmental sampling from NICU and paediatric ward was done. Direct culture of autoclaved rubber caps of glass vials as well as cetrimide and chlorhexidine solution yielded growth of P. aeruginosa, with an antibiogram similar to CSF isolates. Pseudo-infection not only burdens the work of health care providers but also has financial implications; hence every measure should be taken to prevent it.

Parents’ experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify, appraise and synthesize the best available studies exploring parents’ experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit. The review questions are: 1. How do parents describe their preparedness for bringing their infant(s) home? 2. How do the parents experience the event of discharge? 3. What issues do the parents describe as influencing their transition experiences when the infant is discharged from a NICU to home? INCLUSION CRITERIA Types of participants This review will consider studies that include mothers, fathers, step-parents or foster parents of infants who are hospitalized in a neonatal intensive care unit regardless of civil status, ethnicity or country of origin. Types of intervention(s)/phenomena of interest This review will include studies that investigate how parents experience the discharge of their infant from the Neonatal Intensive Care Unit. The included studies should describe parents’ experiences of being prepared for the discharge and the event of the discharge. Transition in this study is defined as: “a passage from one fairly stable state to another fairly stable state and it is a process triggered by a change”. The focus of this review is infants’ discharge from the Neonatal Intensive Care Unit. Context The context of this review is a Neonatal Intensive Care Unit defined as an intensive care unit of ill or premature and/or newborn infants. This review includes studies from all four classified levels for Neonatal Intensive Care Unit care TRUNCATED AT 250 WORDS

Hearing screening and diagnosis in a large sample of infants in Central China

To investigate the referral rate, prevalence and aetiology of neonatal hearing loss. A total of 11,894 infants were screened by two-stage transient evoked otoacoustic emission testing. Those who failed were diagnosed by distortion product otoacoustic emission, 1000 Hz probe tone tympanometry and auditory brainstem response. The results of these tests were analysed by statistical software SPSS16.0. The initial referral rate was 17.36%. The rescreening referral rate was 21.29%. The referral rate of initial screening in maternity wards (15.37%) was lower than in neonatal intensive care unit wards (22%) (chi-square [χ(2)], P < 0.05). There were 68 cases (106 ears) diagnosed with hearing loss (incidence 0.571%). Of these, 31 cases were conductive, 16 cases were sensorineural, and 21 cases were mixed hearing loss. The prevalence of hearing loss was 12.92% (38/294) in the bilateral referred group and 5.00% (30/600) in the unilateral referred group. The moderate/severe hearing loss was 33.33% (10/30) and 86.84% (66/76), respectively (χ(2), P < 0.05). The causes of hearing loss included jaundice (24.56%, 14/57), infection (24.56%, 14/57), asphyxia (19.30%, 11/57), low birth weight (17.54%, 10/57) and other factors (14.04%, 8/57). Bilateral referrals were more likely to suffer greater degrees of hearing loss than unilateral referrals. Jaundice, infection, asphyxia and low birth weight were the major aetiologies of neonatal hearing loss.

Antibiotic sensitivity pattern of common bacterial pathogens in NICU and neonatal ward in Hamedan province of Iran

Bacterial pathogens and drug resistance are different in hospitals of each country. In this study we determined bacterial path- ogens and drug sensitivity in the neonatal ward and neonatal intensive care unit (NICU) in Ekbatan hospital in Hamedan. This cross-sectional descriptive study was done on 1150 hospitalized neonates in neonatal and NICU wards of Ekbatan hospital of the Hamadan university of medical sciences from September 2004 to September 2006. Blood, cerebrospinal fluid (CSF), urine, stool, eye excretion, synovial fluid, umbilical secretion and ascitic fluid were evaluated. Positive cultures were evaluated for antibiotic resistance with disk diffusion test methed. All of the data in questionnaires was analyzed with SPSS 13. Cultures including blood, urine, CSF , stool, eye excretion, synovial fluid, umbilical secretion and ascitic fluid was done in 417 neonates (833 cultures). These cultures were including: urine, 323 cases (38.8%) blood 293 cases (35.2%), CSF 180 cases (21.6%) , stool 17 cases (2%), eye secretion 16 cases (1.9%) and other secretions (synovial, umbilical, etc) 4 cases (0.5%). The cultures were positive in 105 cases (25.2%). 60 male neonates (57.1%) and 45 female neonates (42.9%) were culture positive. The most common microorganisms were E coli 66.7% (70 cases), Klebsiella 10.5% (11 cases). Drug resistance was high in these microorganisms. The most common microorganisms were Ecoli and klebsiella. Drug resistance was high in the isolated microorganisms.

Use of pulsed-field gel electrophoresis typing to study an outbreak of infection due to Serratia marcescens in a neonatal intensive care unit.

Serratia marcescens is a well-known cause of nosocomial infections and outbreaks, particularly in critically ill neonates and immunocompromised patients. Numerous methods have been proposed for typing. We used pulsed-field gel electrophoresis (PFGE) typing to analyze an outbreak in a neonatal intensive care unit (NICU). We included 23 patient isolates from an outbreak (March to July 1995), and 10 patient isolates from different wards during the same time period. PFGE of whole-cell DNA digested by SpeI was used as a marker of strain identity. The most common presentation of the infection was sepsis in 18 of 23 (78%) neonates. Only four different biotypes were identified; biotype A8d accounted for 84% of the strains. PFGE typing revealed two clones responsible for two different clonal strain dissemination outbreaks from March to July, with 24 patient isolates being pattern A and 4 patient isolates being pattern E. PFGE typing suggests cross transmission between patients in the NICU and other wards. The isolates from 5 other patients showed distinct PFGE patterns. Extensive investigation and cultures failed to identify any environmental or staff reservoir of S. marcescens. This is one of the first reports applying PFGE to the study of S. marcescens, and this method was a useful marker of strain identity. PFGE typing distinguished strains which appeared to be the same by biotyping.