Bacteriological Profiles in Early-Onset-Sepsis (EOS) and Late-Onset-Sepsis (LOS) in Neonates.

Aim This audit is performed to see the bacteriology profiles in early-onset sepsis (EOS) and late-onset sepsis (LOS) to compare the microorganisms identified and the antibiotic sensitivity results against hospitals' guidelines for empiric treatment of early and late-onset sepsis. Methods We retrospectively collected the neonate's microbiological data from the laboratory which included the date blood culture (BC) samples were collected, patients' day of life when the samples were collected to determine whether it was EOS or LOS, time to positivity of BC, and antibiotic susceptibility results. Results In EOS, most infection was caused by Gram-positive organisms which were 12 out of 14 isolates (85.7%) with GBS as the most common pathogen identified. In LOS, the number of infections caused by Gram-negative organisms, which were 14 of 25 isolates (56%) was higher than those caused by Gram-positive organisms, which were 11 out of 25 isolates (44%). E. coli was identified as the leading pathogen causing BSI. All organisms were sensitive to the antibiotics used according to the protocol. Conclusion Escherichia coli was the most common organism and was sensitive to the first-line antibiotics used. Group B Streptococcus is still the main pathogen in EOS. The rate of antibiotic resistance is low. The audit showed the importance of analysing the bacteriological and antibiotic susceptibility pattern to ensure optimal treatments are administered to infants.

Altered inflammasome activation in neonatal encephalopathy persists in childhood.

Neonatal encephalopathy (NE) is characterized by altered neurological function in term infants and inflammation plays an important pathophysiological role. Inflammatory cytokines interleukin (IL)-1ß, IL-1ra and IL-18 are activated by the nucleotide-binding and oligomerization domain (NOD)-, leucine-rich repeat domain (LRR)- and NOD-like receptor protein 3 (NLRP3) inflammasome; furthermore, we aimed to examine the role of the inflammasome multiprotein complex involved in proinflammatory responses from the newborn period to childhood in NE. Cytokine concentrations were measured by multiplex enzyme-linked immunosorbent assay (ELISA) in neonates and children with NE in the absence or presence of lipopolysaccharide (LPS) endotoxin. We then investigated expression of the NLRP3 inflammasome genes, NLRP3, IL-1ß and ASC by polymerase chain reaction (PCR). Serum samples from 40 NE patients at days 1 and 3 of the first week of life and in 37 patients at age 4-7 years were analysed. An increase in serum IL-1ra and IL-18 in neonates with NE on days 1 and 3 was observed compared to neonatal controls. IL-1ra in NE was decreased to normal levels at school age, whereas serum IL-18 in NE was even higher at school age compared to school age controls and NE in the first week of life. Percentage of LPS response was higher in newborns compared to school-age NE. NLRP3 and IL-1ß gene expression were up-regulated in the presence of LPS in NE neonates and NLRP3 gene expression remained up-regulated at school age in NE patients compared to controls. Increased inflammasome activation in the first day of life in NE persists in childhood, and may increase the window for therapeutic intervention.

Neurodevelopmental outcome of preterm babies of 1999-2009.

The Bayley scale of infant development is employed as the performance indicator at 2 years corrected gestational age for high risk paediatric groups. We compare neurodevelopmental outcomes in two cohorts of VLBW infants born in 1999 to a cohort born a decade later, while also examining the challenges of direct comparison of modified scales: BSID-II (2nd edition of the scales) with Bayley-III, BSID-II was used in the 1999 group and Bayley-III for the 2009 cohort. We demonstrated that over a ten year period there was an improvement in neurodevelopmental scores achieved in VLBW babies. Overall there was almost an 8 point increase in the cognitive scores from the 2009 cohort compared with the 1999 cohort in this time period. The mean motor score increased by 6 points when comparing 1999 and 2009. However we highlight the difficulties in comparing developmental scales, and consider whether Bayley-III overestimates developmental ability?

[Aetiology and prognosis of prenatally diagnosed megacystis regarding gestational age at discovery. A six-year retrospective study]. / Étiologies et pronostic des mégavessies de diagnostic prénatal selon l'âge de découverte. Étude rétrospective sur six années.

OBJECTIVES: The purpose of this study is to describe the diagnosis, the care and the prognosis of the fetuses with an antenataly diagnosed megacystis. PATIENTS AND METHODS: Six year retrospective study about 46 cases of megacystis (26 diagnosed during 1st trimester; 14 during 2nd trimester; 9 during 3rd trimester) referred in the prenatal fetal medicine unit of the Femme-Mère-Enfant hospital in Lyon (France). RESULTS: The main aetiology is urethral occlusion, particularly for megacystis discovered during the 1st and the 2nd trimesters. Twenty-two terminations of pregnancy were performed (47.8%) and 6 pregnancies arrested spontaneously (13%). Eighteen children were born alive, but 2 died in neonatal period. Finally, 16 children survived (34.8%). Chromosomal abnormalities are frequent (22%). DISCUSSION AND CONCLUSION: Antenatal discovery of a megacystis is a complex situation, and often of poor fetal prognosis. It requires a multidisciplinary approach to allow the concerned couple to be determined on the best care of this pregnancy.

Consensus statements on the borderlands of neonatal viability: from uncertainty to grey areas.

The gestational age and birth weight cut off for intact survival in extremely preterm infants is unclear. There is uncertainty among obstetricians and neonatologists about when it is inadvisable to institute intensive care. The suggested definition in relation to viability is when mortality does not exceed 50% but the corresponding figure for disability is undetermined. On foot of these concerns many groups have produced consensus statements on viability over the past 15 years. In this paper we examine the findings in 7 consensus statements on viability- British Association of Perinatal Medicine, American Academy of Pediatrics, The Fetus and Newborn Committee Canada, The Dutch Group, The Australian Group, Nuffield Institute of Bioethics, Neonatal Section of the Irish Faculty of Paediatrics. A number of points of agreement emerge. All would provide intensive care at 26 weeks and most would not at 23 weeks. The grey area is 24 and 25 weeks gestation. This group of infants constitute 2 per 1000 births. The difficulty is that there are a number of confounding variables. Girls have approximately 1 week advantage over boys, every day increases survival by 3%, the benefits of a full course of antenatal steroids, the problem of multiple birth, the baby's condition at delivery. Also concerns have been expressed about basing policy on short-term follow-up only. Extreme prematurity is both uncommon and complex and should be managed in high volume tertiary centres that are familiar with the necessary facets for decision making.