Infants In Neonatal Intensive Care Unit Research Articles

An investigation of the risk factors for infection with methicillin-resistant Staphylococcus aureus among patients in a neonatal intensive care unit

The aims of this study were to investigate the risk factors of methicillin-resistant Staphylococcus aureus (MRSA) infection among infants to establish effective infection control measures for neonatal intensive care unit (NICU). Data were prospectively collected from 961 infants hospitalized in a teaching hospital in Japan, from July 2002 through December 2005. Among all infants, 28 (2.9%) developed MRSA infections. Multivariate logistic regression analyses demonstrated the risk factors for developing MRSA infections to include a low birth weight (odds ratio [OR], 0.91; 95% confidence interval [CI]: 0.93-0.99), the presence of eye mucous (OR, 6.78; 95% CI: 2.87-16.01), the practice of kangaroo mother care (OR, 3.82; 95% CI: 1.11-13.13), and the MRSA colonization rate (OR, 11.12; 95% CI: 1.32-93.89). The risk factors for developing a MRSA infection among infants in NICU were a low birth weight, the presence of eye mucous, the practice of kangaroo mother care, and a high MRSA colonization rate. Therefore, extra attention should be given to infants in high-risk groups demonstrating a low birth weight and the presence of eye mucous and who have undergone kangaroo mother care. As a result, the cohort isolation of infants with MRSA may therefore be an effective strategy to prevent MRSA infections.

Admission of all gestations to a regional neonatal unit versus controls: Neonatal morbidity

To describe the neonatal course and morbidity of all infants admitted to the regional neonatal intensive care unit (NICU) at Christchurch Women's Hospital (CWH) and to compare these with term control infants who were not admitted, in one calendar year. Infants in both NICU and control cohorts were enrolled in a 2-year follow-up study. All infants born over a 12-month period from February 2001 and admitted to the NICU, whose parents were domiciled in a defined geographical region, were eligible for study, together with every eighth healthy infant born at term and not admitted (to a total of 300). Comprehensive perinatal and neonatal data were collected for all enrolled infants. A total of 387 NICU infants (86% eligible) were enrolled in the study together with 306 controls. Forty-one percent of NICU admissions were term and 40% were 33-36 weeks gestation. Term NICU infants were more likely to be born following induction of labour or by Caesarean section (34%, of which 50% were pre-labour) than control infants (18%, of which 32% were pre-labour). Infants of <28, 28-32, 33-36 and > or =37 weeks accounted for 74, 16, 7 and 3% of assisted ventilation days and 18, 31, 31 and 20% of total baby days, respectively. The need for assisted ventilation and length of NICU stay was inversely proportional to gestation. However, preterm infants of 28 weeks gestation and greater, as well as term infants, account for a high proportion of the NICU workload.

Admissions of all gestations to a regional neonatal unit versus controls: 2‐year outcome

To assess neurodevelopmental outcome at 2 years for neonatal intensive care unit (NICU) admissions compared with controls, and to trial a parent-reporting scheme. All infants admitted to the NICU at Christchurch Women's Hospital over a 12-month period and whose parents were domiciled in a defined geographical region were eligible for study, together with every eighth term infant not admitted (to a total of 300). Parents completed a two-page questionnaire on their child's 2nd birthday. All infants <28 weeks gestation and a random 300 NICU admissions and 108 controls underwent a paediatric examination and Bayley II assessment at 2 years of age. A total of 387 NICU infants (86% eligible) and 306 controls were enrolled. At 2 years of age, 276 NICU infants (89% survivors) and 94 controls (87%) had some follow up. For infants of <33 weeks, 33-36 weeks, > or =37 weeks gestation and controls, the percentage >1 SD below the mean on the Bayley Mental Development Index scales were 33.3, 36.5, 44.6 and 24.1, respectively (P= 0.03); on the Psychomotor Developmental Index scales were 30.0, 29.1, 41.1 and 19.5 (P= 0.02) and the percentage with any cerebral palsy were 11.1, 2.8, 5.2 and 1.2. At 2 years of age, NICU graduates have more developmental problems than controls across a range of measures. In many cases, term NICU graduates have the least favourable outcome. There was only moderate agreement between parents' reporting of moderate or severe developmental disability by means of a questionnaire, compared with professionals (kappa statistic 0.38), with parents tending to underestimate problems.

Acute Posttraumatic Stress Symptoms Among Urban Mothers With Newborns in the Neonatal Intensive Care Unit: A Preliminary Study

Traumatic stress symptoms from multiple causes are endemic among impoverished women who are also at high risk for delivering infants requiring neonatal intensive care unit (NICU) care, but whether this event itself constitutes a distinct traumatic stress trigger is unknown. Previous research does suggest having an infant in the NICU generates traumatic stress among white middle-class mothers, stress that can impact their infant's behavior and development. This study evaluated the prevalence of acute posttraumatic stress symptoms among low-income mothers of infants admitted to the NICU compared with similar mothers with infants in the well baby nursery (WBN). A total of 59 NICU and 60 WBN mothers were recruited from the Boston Medical Center. Within the first week after birth, all participants were assessed for postpartum acute posttraumatic stress and depression symptoms and asked about lifetime traumatic events before the birth of their baby. The acute posttraumatic stress symptoms were analyzed as a continuous variable and whether they reached the categorical severity criteria for acute stress disorder. NICU mothers show increased symptoms of acute posttraumatic stress and depression. Twenty-three percent of NICU and 3% of WBN reached severity criteria for acute stress disorder. When controlling for relevant covariates, having a newborn in the NICU had a significant association with the number of mothers' acute posttraumatic stress symptoms not fully explained by their symptoms of depression or prior lifetime history of traumatic events. Addressing acute posttraumatic stress symptoms may enhance interventions to help urban families of NICU infants.

Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine

We performed a prospective case-control study of bloodstream infections in order to determine the infection rate of Acinetobacter baumannii and to determine the risk factors associated with infection and mortality. Between February 2004 and January 2005, 579 consecutive blood specimens were collected from the two neonatal intensive care units (NICUs) of Al-Nasser and Al-Shifa hospitals in Gaza City. Forty (6.9%) isolates of A. baumannii were obtained from neonates aged under 28 days. Of the patients, 62.5% were male and 37.5% were female. Compared to matched, uninfected controls, statistically significant risk factors were weight<1500 g (odds ratio (OR) 3.89, p<0.001), age <7 days (OR 2.33, p=0.027), median hospitalization of =20 days (OR 3.1, p=0.003), mechanical ventilation (OR 3.5, p=0.001), use of a central venous catheter (CVC; OR 10.5, p<0.001), and prior antibiotic use (OR 4.85, p=0.003). The overall mortality was also significantly different (overall mortality 37.5% in cases vs. 12% in uninfected controls; OR 4.4, p=0.001). Compared to infected controls, statistically significant risk factors were mechanical ventilation (OR 2.68, p=0.008), use of a CVC (OR 6.68, p<0.001), and prior antibiotic use (OR 5.68, p=0.001). The multidrug-resistant type was significantly associated with death in the neonates (p=0.023). The isolates of A. baumannii were resistant to commonly used antibiotics, while susceptible to meropenem (92.5%), imipenem (90%), ciprofloxacin (75%), gentamicin (57.5%), and ceftriaxone (50%). The infection rate with multidrug-resistant A. baumannii is considerable and alarming in NICU infants, and is associated with significant mortality.

Screening to detect permanent childhood hearing impairment in neonates transferred from the newborn nursery

The focus of this report is hearing screening of newborns transferred from the regular nursery to a specialized area. The purpose of the study undertaken was: (1) to determine whether screening coverage in this population was achieved; (2) to establish whether the linkage between neonatal screening and the diagnostic follow-up was carried out correctly; (3) to better determine the incidence of permanent childhood hearing impairment (PCHI) in this at-risk population. Six population centres averaging 12,000 births annually participated (Bordeaux, Lille, Paris, Marseille, Toulouse and Lyon). Automated auditory brainstem response (AABR) (Natus ALGO 3i) screening was performed in two stages: i.e. infants with initial "positive" results were screened a second time using the same technique. Of the 117,103 babies born during the study period, 4972 neonates were "transferred" and comprised the population for this report (4.2% of the total births). Screening results for 4972 "transferred" neonates were compared with those of non-transferred neonates (N=112,131). Screening coverage of eligible infants was significantly lower (75.4%) in "transferred" neonates (3750 infants screened) compared to 97.5% coverage of non-transferred neonates (109,349 infants screened). The rate of positive results after the first stage AABR was higher in the "transferred" population (11.1%) than in the non-transferred population (6.5%). Of the 415 "transferred" newborns with initial positive screens, 91.3% were rechecked as stipulated in the project protocol. The second pre-discharge AABR ascertained that in half of the cases auditory function had normalized in the day. Of the 183 "transferred" infants whose result remained suspect at the conclusion of both stages of the neonatal screen (4.9% of the tested population), only 70.5% returned to the audiology centre for diagnostic follow-up. The incidence of bilateral PCHI was markedly higher (4/1000) in "transferred" infants than in the non-transferred population (1.08/1000). The difficulty of obtaining universal screening coverage in "transferred" infants was, unfortunately, verified in this prospective, multicentre study. Further, the diversity of our "transferred" population was not much greater than that revealed by careful analysis of published hearing screening studies in neonatal intensive care unit (NICU) infants. The influence of risk factors and their more or less complex combinations is apparent.

Predictors of depressive symptom trajectories in mothers of preterm or low birth weight infants.

Predictors of maternal depression trajectories were examined longitudinally in families with an infant born preterm or at a low birth weight. A total of 181 mother-infant dyads enrolled in the study before the infant's neonatal intensive care unit (NICU) discharge. Maternal depressive symptoms were assessed at 5 timepoints, and contextual variables and infant risks were assessed at NICU discharge. Hierarchical linear models revealed that mothers who experienced more risk factors reported more depressive symptoms just before their infant's NICU discharge and showed less decline in depressive symptoms in the months immediately following the child's birth. Although cumulative risks predicted depression trajectories, this effect appeared driven by maternal and family sociodemographic risks rather than infant risks. Addition of family support as a covariate in the multilevel models with a subsample of families revealed that social support and depression covaried across time. However, most of the findings regarding the association between risk and depression remained consistent, whereas the effects of maternal race and multiple birth were slightly attenuated.

Clinical Significance of the Nutritional Support Team for Preterm Infants in a Neonatal Intensive Care Unit

목 적: 영양지원팀(nutritional support team, NST)은 영양부족이 위험성이 있는 환자에게 영양을 효율적으로 제공하기 위해 운영된다. 미숙아는 소화, 흡수의 미숙, 비축된 영양의 부족, 요구량의 증가, 다양한 질환에의 이환으로 인하여 영양 불균형의 위험성이 높으며 경구영양이 완전히 진행되기까지는 총정맥영양(total parenteral nutrition, TPN)에 의존하므로 적극적인 영양지원을 필요로 한다. 이에 본 연구에서는 NST 활동이 신생아중환자실에 입원하여 TPN을 투여 받는 미숙아들의 임상경과에 미치는 영향을 검토함으로써 NST의 임상적 의의를 평가하고자 하였다. 방 법: 2003년 7월에서 2006년 7월까지 분당서울대 병원 신생아중환자실에 입원하여 TPN을 시행 받은 미숙아 48명을 대상으로 하여 후향적으로 의무기록을 검토하였다. 대상 환아들을 NST 활동 여부에 따라 각각 NST 설립 이전 시기인 2003년 7월에서 2005년 2월까지 입원한 미숙아군과 NST 활동 시기인 2005년 3월에서 2006년 7월 사이에 입원한 미숙아군으로 나누어 각 군에서의 임상 지표들을 비교분석하여 NST 활동이 미치는 영향을 평가하였다. 통계학적 분석을 위해 Mann-Whitney 검정과 Fisher's exact test를 적용하였고, pvalue 0.05 미만을 통계적으로 유의하다고 판정하였다. 결 과: 대상 환아 48명(남아 27명, 여아 21명)의 재태기간은 평균 $28^{+1}$ 주(범위: 25주~ $32^{+6}$ 주), 출생체중은 평균 1,008.5 ${\pm}$ 242.5 g (범위: 520~1,490 g), 재원기간은 평균 74 ${\pm}$ 40일(범위: 26~274일)이었다. 영양사, 약사 또는 NST가 환아의 TPN에 개입하기까지의 기간이 NST 활동 전에는 14.8 ${\pm}$ 21.0일 소요되었으나 NST 활동 이후 0.5 ${\pm}$ 2.0일로 유의하게 감소하였다(p=0.000). TPN 투여기간은 NST 활동 전의 41.5 ${\pm}$ 26.2일에서 NST 활동 후에는 20.5 ${\pm}$ 16.6일로 유의하게 감소하였다(p=0.001). TPN을 통해 투여된 칼로리는 NST 활동 전후로 각각 88.1 ${\pm}$ 19.0 kcal/kg/day와 98.8 ${\pm}$ 8.2 kcal/kg/day로서 유의하게 상승하였고(p=0.016), 단백 투여량은 각각 2.74 ${\pm}$ 0.50 g/kg/day와 3.36 g/kg ${\pm}$ 0.34 g/kg/day (p=0.000), 지방 투여량은 각각 2.53 ${\pm}$ 0.86 g/kg/day와 3.40 g/kg ${\pm}$ 0.52 g/kg/day로서 두 군 간에 유의한 차이를 보였다(p=0.000). 환아들의 금식기간이 NST 활동 전후 각각 10.5 ${\pm}$ 11.3일과 5.9 ${\pm}$ 7.3일로서 NST 활동 시작 후 유의하게 감소하였으며(p=0.017), 환자들이 완전 경장영양으로 진행하기까지 소요된 기간도 각각 44.7 ${\pm}$ 26.1일과 24.0 ${\pm}$ 17.6일로 NST 활동 후 의미 있게 감소하였다 (p=0.001). 항생제 투여기간도 NST 활동 전의 34.8 ${\pm}$ 30.8일에서 NST 활동과 더불어 15.6 ${\pm}$ 15.2일로 유의하게 감소하였다(p=0.007). 결 론: 신생아중환자실에 입원한 미숙아에게 있어 NST 활동에 의한 적극적인 영양지원은 적절한 영양을 공급하여 영양상태를 개선하는 측면과 더불어 임상적 측면에서도 장점이 있으므로 미숙아의 영양지원에 있어 NST 활동이 갖는 의의가 크다고 하겠다. 【Purpose: Preterm infants are very susceptible to malnutrition because of a lack of storage of nutrients, immature digestion and metabolism, and accompanying diseases associated with prematurity. The purpose of this study was to evaluate the effects of nutritional support by the pediatric nutritional support team (pNST) on the clinical course of preterm infants in the neonatal intensive care unit (NICU). Methods: Between July 2003 and July 2006, 48 preterm infants who were admitted to the NICU at Seoul National University Bundang Hospital were included. The subjects were divided into the following two subgroups according to the presence of NST activity; pre-NST group (n=23) and NST group (n=25). Hospital records were reviewed retrospectively. Results: Forty-eight preterm babies were included (M：F=27：21; gestational age, 25~33 weeks). A dietician, pharmacists, or the pNST participated in the prescription of total parenteral nutrition (TPN) more rapidly in the NST group (p=0.000). The fasting periods and TPN administration periods were significantly decreased in the NST group compared to the pre-NST group (p=0.017 & p=0.001, respectively). The doses of calories, protein, and lipids administered via TPN were significantly increased in the NST group compared to the pre-NST group (p=0.016, p=0.000, and p=0.000, respectively). The total period on antibiotic therapy was significantly decreased in the NST group compared to the pre-NST group (p=0.007). Conclusion: Because nutritional support by the pNST is of benefit to the clinical course of preterm infants in the NICU, the pNST should recommend to improve the nutritional status and clinical outcome of preterm infants.】

Health care–associated outbreak of Salmonella Tennessee in a neonatal intensive care unit

In December 2006, we investigated an outbreak of Salmonella serotype Tennessee in a neonatal intensive care unit (NICU) that coincided with a nationwide Salmonella Tennessee outbreak associated with contaminated peanut butter. Salmonellosis was defined as isolation of Salmonella Tennessee from any clinical specimen or more than 1 episode of bloody stool within a 24-hour period. We conducted a cohort study among 13 NICU infants, reviewed medical records, cultured stool from infants and staff, collected environmental samples, and examined infection control practices. Ten of the 13 infants had salmonellosis (77%). No medical or dietary risk factors were identified. The proportion of days in which the NICU census exceeded its 11-bed design capacity was higher in December compared with the previous 11 months (41.9% vs 0.3%; P < .001). Hand sinks did not meet operational standards. Salmonella Tennessee was isolated from 9 of the 13 infants, 2 of 40 staff members, and 6 of 42 environmental samples; all isolates matched the pulsed-field gel electrophoresis pattern of the nationwide Salmonella Tennessee outbreak. Although the source of Salmonella Tennessee was not identified, the high census and limited access to sinks likely facilitated transmission to the NICU infants. Infection control interventions, including halting new NICU admissions, interrupted further transmission.

Optimizing Otoacoustic Emission Protocols for a UNHS Program

Objective: To identify the optimal test protocol to screen for hearing problems in newborns, an evaluation of three distortion product otoacoustic emission (DPOAE) protocols was conducted in neonates, from a well-baby nursery (WBN) and from a neonatal intensive care unit (NICU) and compared to the performance in newborns of a more standard protocol based on transient-evoked OAEs (TEOAEs). Methods: The DPOAE protocols used asymmetrical stimulus intensities (L₁ > L₂) with a frequency ratio of 1.22, in the following format: (P1), L₁ = 60, L₂ = 50 dB SPL; (P2), L₁ = 65, L₂ = 55 dB SPL, and (P3), L₁ = 75, L₂ = 65 dB SPL. Linear TEOAE responses, evoked by click stimuli of 75 dB peSPL, were used as controls of normal cochlear function. Five frequencies at 1.5, 2.0, 3.0, 4.0 and 5.0 kHz were tested with a common commercially available macro-based software subroutine (Otodynamics Corp, ILO-92). The project evaluated the responses from 1200 WBN infants (average age 48 h) and 350 low-birth-weight NICU infants, all randomly selected. Results: Statistical analyses comparing the signal-to-noise ratios (S/N), at the predefined f₂ frequencies, indicated that the P1 and P2 DPOAE protocols generated similar responses. Significant S/N differences were observed in the P3 to P2 dataset comparisons. DPOAE scoring criteria were estimated from the P3 dataset using a one-sided, distribution-free confidence intervals. The scoring criteria for a ‘pass’ were estimated as a minimum S/N of 6.0, 7.0 and 6.0 dB at 2.0, 3.0 and 4.0 kHz, respectively. In terms of feasibility, the P3 protocol generated responses in 98% of the WBN and 94.8% of the NICU infants. Conclusions: All three DPOAE protocols demonstrated shorter time-recording requirements than the standard TEOAE test. The false-positive and false-negative rates for the NICU infants were estimated as 0.0028 and 0.003%, respectively.

Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months

Background Parental distress following the birth of a premature infant diminishes the parent's ability to be sensitive to the infant's cues, and this may affect infant developmental outcomes. Aims The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the interactive behavior of mothers with their very low birthweight (VLBW) children in toddlerhood. Subjects A sample of 56 mothers and their VLBW infants were recruited in the NICU. Study design During the infant's NICU stay, mothers completed a self-report measure of trait anxiety. These mothers and their infants were followed when the infants were 24 months corrected age, when mothers and their children were videotaped during free play at home. These videotapes were then coded using the Emotional Availability Scales. Results Maternal anxiety was not found to be related to severity of neonatal illness. Maternal anxiety in the NICU was associated with less sensitivity and less structure in interaction with their toddlers at 24 months corrected age, even controlling for maternal education and child birthweight. Children of mothers with higher anxiety scores in the NICU were less likely to involve their mothers in their play at 24 months corrected age. Conclusions Maternal anxiety in the NICU predicted adverse interactive behaviors when the children were 24 months corrected age. Early identification of anxious mothers in the NICU is needed in order to initiate preventive intervention to support the mother–infant relationship.

Epidemiology of Gram-Negative Conjunctivitis in Neonatal Intensive Care Unit Patients

To describe the epidemiologic features, risk factors, and antibiotic susceptibilities for gram-negative conjunctivitis among neonatal intensive care unit (NICU) patients. Retrospective, observational study. In a University Tertiary Care Hospital with a level III-IV NICU, 65 NICU infants (< eight weeks of age) with positive culture results for conjunctivitis between January 1, 2001 and June 1, 2007, were included. Patient demographics, clinical examination results, device usage, and antibiotic susceptibility data were compared between infants with gram-negative conjunctivitis and infants without gram-negative conjunctivitis. One or more episodes of gram-negative conjunctivitis occurred in 38% (n = 25/65) of NICU infants. Predominant pathogens included Klebsiella species (23%), Escherichia coli (17%), Serratia marcescens (17%), Pseudomonas aeruginosa (3%), and Enterobacter species (2%). Birth weight and gestational age were significantly less in infants with gram-negative conjunctivitis than in infants without gram-negative conjunctivitis (P = .008 and P = .008, respectively). With multivariate analysis, birth weight less than 1500 g (odds ratio [OR], 4.35; 95% confidence interval [CI], 1.42 to 13.36), and gestational age of 29 weeks or fewer (OR, 5.60; 95% CI, 1.88 to 16.66) were identified as risk factors for the development of gram-negative conjunctivitis. Antibiotic resistance of gram-negative organisms to ampicillin, cefazolin, gentamicin, and levofloxacin were 96%, 52%, 13%, and 7% respectively. Of the Klebsiella isolates, two (25%) of eight were resistant to gentamicin. Low birth weight and low gestational age in NICU infants with clinical signs of conjunctivitis should raise the suspicion for a gram-negative cause. Given the observed resistance patterns of Klebsiella isolates, gentamicin resistance should be considered when designing empiric treatment.

Molecular and Descriptive Epidemiology of Multidrug-Resistant Enterobacteriaceae in Hospitalized Infants

To investigate the epidemiology of multidrug-resistant Enterobacteriaceae (MDRE) in hospitalized infants. From 2000 through 2005, active surveillance cultures for MDRE were performed for patients admitted to a 40-bed neonatal intensive care unit (NICU) that provides care for critically ill infants 6 months of age or younger. MDRE epidemiology and the genetic relatedness of MDRE strains determined by repetitive-sequence polymerase chain reaction were analyzed. Active surveillance cultures revealed that 759 (23%) of 3,370 NICU infants (or approximately 1 in 5) developed MDRE colonization or infection and that 613 (72%) of the 853 isolates with epidemiologic data available were healthcare acquired. MDRE colonization occurred more frequently (in 653 infants [86%]) than did MDRE infection (in 106 [14%]). Of the 653 infants with MDRE colonization, 119 (18%) eventually became infected, with 29 (4%) acquiring sterile site infections. The most commonly isolated organisms were the Enterobacter species, accounting for 612 (71%) of the 862 isolates. Molecular epidemiologic analysis revealed that genetic-relatedness clustering (related clusters defined as having a genetic similarity coefficient greater than 95%) varied depending on microbial species. Clustering was detected for 36 (78%) of the 46 Enterobacter aerogenes isolates, 22 (45%) of the 49 Enterobacter cloacae isolates, and 13 (59%) of the 22 Klebsiella pneumoniae isolates. Hospitalized infants are at significant risk of acquiring MDRE, specifically Enterobacter species, at the study institution. Active surveillance cultures identified colonized patients who likely contributed to the institutional reservoir of MDRE. Molecular epidemiologic studies suggest that both patient-to-patient transmission and de novo acquisition of resistance play a role in the acquisition of these organisms, and that the clinical significance of such acquisition varies by species. The high percentage of E. aerogenes isolates that demonstrated genetic clustering suggests that monitoring the prevalence of this organism could serve as a useful measure of compliance with infection control procedures.

Neonatal Candida Spp. Infections: An Update

Candida-related morbidity and mortality have increased in neonatal intensive care units (NICUs) in the last 20 years. Invasive fungal infections (IFIs) in preterm infants are associated with high severity, high attributable mortality, substantial morbidity and poor outcomes owing to the frequent association with late neurodevelopmental impairment and retinopathy of prematurity in the survivors. Preterm very-low birth weight infants in NICUs have a specific, increased risk for IFIs, mainly because up to 60% of them may become colonized during their first month of life. Prevention of Candida colonization and infection is the key in these settings of unique patients, and solid data have recently been added to the very first promising results obtained in the early 2000’s with administation of fluconazole. In a multicenter randomized trial, this azole caused a striking reduction in the incidences of Candida spp. colonization (from 33 to 9%) and infection (from 13.2 to 3.2%), with no occurrence of significant side-effects and no signs of selective resistance during the 15-month study period. New guidelines incorporating the recent multicenter results are urgently needed.

Influenza vaccination rates of expectant parents with neonatal intensive care admission

Objectives. To ascertain the rate of influenza immunization in pregnant couples whose infants required neonatal intensive care unit (NICU) admission, and to clarify predictors for trivalent inactivated influenza vaccine (TIV) use in this targeted parent population.Study design. During the 2005–07 influenza seasons, parents of NICU patients at two level III centers were surveyed about TIV after their infant's NICU admission. Data on immunization history, location of immunization, and other risk factors for influenza were assessed. Infant data including birth weight, gestational age, and multiple births were also obtained.Results. Seven hundred and eighty-six parents had infants in the NICU. Five hundred and forty-seven (69.5%) were surveyed. The overall parental rate of vaccination was 23.2% (127/547). The parental vaccination rate did not differ between years (23.2% vs. 23.2%). Mothers were less likely to have received TIV prior to delivery than fathers (17.0% vs. 28.4%; p < 0.02). Of the population, 19.3% received immunization from their OB/GYN. A concordance rate of 8.9% was noted between married couples receiving TIV. More parents received TIV in January and February of the influenza seasons than November and December (p < 0.05, Student's t-test). Influenza immunization rate in NICU parents was unrelated to infant's gestational age, parental age, total number of risk factors for TIV, hospital length of stay, multiple gestation, or need for high risk obstetrical care.Conclusions. TIV rates among high-risk pregnant parents whose infants are admitted to NICU are lower than expected compared with the general population. Patient refusal of influenza vaccine is not a major obstacle toward acceptance.

Extremely low birth weight infants are at high risk for auditory neuropathy

Auditory neuropathy (AN) is a condition in which transmission of sound to the brain is abnormal. This is reflected as an electrophysiologic profile of normal otoacoustic emissions (OAE), with abnormal auditory brainstem evoked responses (ABR). Functionally speech perception is impaired and management strategies remain controversial. AN can be missed if high-risk newborns are screened for hearing loss with only OAE testing. The rate of sensorineural hearing loss (SNHL) in high-risk nursery infants is 10 times greater compared with normal term newborns. Therefore, we hypothesize that infants from the neonatal intensive care unit (NICU) are at significantly higher risk for AN than normal term infants. The objective of this study is to establish a prevalence rate and characterize risk factors for NICU graduates who demonstrate the AN electrophysiologic profile. This retrospective study examined infants admitted to the NICU at Kapi'olani Medical Center for Women and Children in Honolulu, HI from 1999 through 2003. Infants were screened with automated ABR. Diagnostic testing and OAE were performed before discharge if the ABR was abnormal. Hospital courses of 24 AN, 71 SNHL and 95 gestational age (GA)-matched control infants with normal hearing were reviewed. With a SNHL prevalence of 16.7/1000, the rate for AN was 5.6/1000 NICU infants. Compared to infants with SNHL, infants with AN were significantly younger (GA 28.3+/-4.8 AN vs 32.9+/-5.2 weeks SNHL, P<0.0001) and smaller (BW 1318+/-894 AN vs 1968+/-1006 g SNHL). Nearly two-thirds of the AN infants were ELBW and had significantly longer hospital stays compared to SNHL infants of the same birth weight group. Exposure to furosemide, aminoglycosides, vancomycin or dexamethasone was associated with increased AN but not SNHL. Peak bilirubin level correlated with SNHL but not AN. Low birth weight NICU infants are at significant risk for AN. ELBW infants are at significantly higher risk for both AN and SNHL. Infants admitted to the NICU should be routinely screened by automated ABR and if abnormal, further evaluation should be started before hospital discharge. Early identification of AN will result in better understanding of this disorder and lead to the development of appropriate intervention strategies.

Prevalence and independent risk factors for hearing loss in NICU infants

To determine the prevalence and independent relationship between hearing loss and risk factors in a representative neonatal intensive care unit (NICU) population. Automated auditory brainstem response (AABR) hearing screening has been introduced since 1998 in the Dutch NICUs. After a second AABR failure, diagnostic ABR was used to establish diagnosis of hearing loss. Newborns who died before the age of 3 months were excluded. In the present study only the NICU infants who were born with a gestational age <30 weeks and/or a birth weight <1000 g between October 1, 1998 and January 1, 2002 were included. Risk factors included in the study were familial hearing loss, in utero infections, craniofacial anomalies, birth weight <1500 g, hyperbilirubinemia, ototoxic medications, cerebral complications, severe birth asphyxia, assisted ventilation > or =5 days and syndromes. A nationwide cohort of 2186 newborns were included. Mean gestational age was 28.5 weeks (SD 1.6) and mean birth weight was 1039 g (SD 256). Prevalence of uni- or bilateral hearing loss was 3.2% (71/2186; 95% CI 2.6-4.1). Multivariate analysis revealed that the only independent risk factors for hearing loss were severe birth asphyxia (OR 1.7; 95% CI 1.0-2.7) and assisted ventilation > or =5 days (OR 3.6; 95% CI 2.1-6.0). The prevalence of hearing loss in a representative NICU population was 3.2%. Independent risk factors for hearing loss were severe birth asphyxia and assisted ventilation > or =5 days.

Pregnancy Intention and Birth Outcomes: Does the Relationship Differ by Age or Race?

We hypothesized that intended pregnancy is associated with decreased risk of poor birth outcomes, irrespective of age or race. We conducted a cross-sectional study of 47,956 live singleton births using 1993-2001 data from the Centers for Disease Control and Prevention's (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS). We used logistic regression to estimate the odds of giving birth to a very low birth weight/very preterm infant (VLBW/VPT) or an infant admitted to the neonatal intensive care unit (NICU) by pregnancy intention. Intended pregnancy was associated with a slightly higher risk than unintended pregnancy of a VLBW/VPT birth in young white women (< or = 22 years) and black women of all ages. Intended pregnancy was associated with a slightly higher risk of infant NICU admission in white women under age 28 but with a lower or equivalent risk of infant NICU admission for black women of all ages than unintended pregnancy. From ages 22 to 37, black women had a significantly higher risk of VLBW/VPT birth with intended pregnancies than white women, but from ages 18 to 32, white women were at significantly more risk than black women of requiring infant NICU admission with intended pregnancies. Contrary to our hypothesis, an intended pregnancy at a young age was associated with a higher risk of poor birth outcomes.

Hair Cortisol as a Potential Biologic Marker of Chronic Stress in Hospitalized Neonates

Background: As preterm and term infants in the neonatal intensive care unit (NICU) undergo multiple stressful/painful procedures, research is required that addresses chronic stress. Objectives: To determine whether (a) hair cortisol levels differed between term and preterm infants exposed to stress in the NICU and (b) an association exists between hair cortisol levels and severity of illness or indicators of acute stress. Methods: Hair cortisol levels were determined using the ELISA method (solid-phase enzyme-linked immunoassay, Alpco Diagnostics, Windham, N.H., USA) in 60 infants >25 weeks gestational age at birth. Results: No significant differences were found between the hair cortisol levels of term infants compared to preterm infants in the NICU. When compared to a group of healthy term infants, hospitalized infants had significantly higher hair cortisol levels (t (76) = 2.755, p = 0.004). A subgroup analysis of the term NICU infants showed a statistically significant association between total number of ventilator days and hair cortisol levels. For every extra day on the ventilator, hair cortisol levels increased on average by 0.2 nmol/g (p = 0.03). 21% of the variance in hair cortisol levels was explained by the total number of days on the ventilator. Conclusions: Hair cortisol is influenced by days of ventilation in NICU term infants. This is a potentially valid outcome for chronic neonatal stress in these infants and warrants further investigation.

Significance of coagulase-negative staphylococci isolated from a single blood culture from neonates in intensive care

Coagulase-negative staphylococci (CoNS) are the most common pathogens of late-onset bacteraemia in neonatal intensive care units (NICUs). Discriminating true infection from contamination is difficult. To evaluate the significance of a single blood culture yielding CoNS from only one blood culture obtained from NICU infants between July 1999 and November 2000, paired blood cultures were obtained simultaneously from two peripheral sites from infants hospitalised in two NICUs with clinically suspected late-onset sepsis, and a single blood culture was obtained peripherally from infants hospitalised in a third NICU. Demographic data, predisposing factors, clinical manifestations, laboratory data, management and outcome of infants with either paired or single blood cultures yielding CoNS were analysed and compared. Both blood cultures yielded CoNS during 26 episodes in 24 infants. A single blood culture which grew CoNS from one blood culture was identified during 24 episodes in 23 infants. Except for prior use of an umbilical venous catheter, there was no significant difference between the infants with CoNS isolated from a paired or a single blood culture in terms of demographic characteristics, predisposing factors, clinical manifestations, laboratory findings, management and outcome. There was no difference in the clinical features of CoNS infection between single and paired CoNS-positive blood cultures.