Early Onset Neonatal Sepsis Due to Salmonella enterica Serovar 4,5,12:i:-: A Case Report with Literature Review.

The authors report a case of a 36-week male infant born via spontaneous vaginal delivery who developed Salmonella sepsis at HRH Princess Maha Chakri Sirindhorn Medical Center Srinakharinwirot University, Nakhon Nayok, Thailand. He was born to a mother without identifiable risk factors. On day 3, he developed fever tachycardia, lethargy, poor feeding and diarrhea prompting a sepsis evaluation. Blood and stool cultures were positive for S. enterica serovar 4,5,12:i:-. Therefore, Salmonella infection should be considered in the differential diagnosis of early onset neonatal sepsis (EOS) particularly in endemic areas.

An optimal cut-off point of serum C-reactive protein in prediction of neonatal sepsis.

OBJECTIVE: To determine an optimal cut-off point of serum C-reactive protein (CRP) levels for prediction of neonatal sepsis. MATERIAL AND METHOD: A prospective cohort study of neonates aged from birth to 30 days old presenting with signs and symptoms of neonatal sepsis in neonatal intensive care unit (NICU) from January 2010 through December 2011 was performed. Neonates were assigned to either sepsis or normal group depending on blood culture status. Serial CRP (12-24 hours apart) and complete blood count were then analyzed using independent t-test, Wilcoxon rank-sum test and Receiver operating characteristic (ROC) curves. RESULTS: Of 53 neonates recruited into the present study, 26 (49%) were assigned to sepsis group and the remaining 27 (51%) were assigned to normal group. Baseline characteristics for the two groups were similar except for the higher amount of male participants in sepsis group (p-value 0.006). Most patients in sepsis group (7/26) demonstrated coagulase-negative staphylococci (CoNS) sepsis. The values of 1st CRP and 2nd CRP were significantly higher in sepsis group compared to normal group (p-value < 0.001 and 0.003). From ROC curves, at the cut-off points of 1st CRP > or = 1.90 mg/L and 2nd CRP > or = 1.25 mg/L, the sensitivity were as high as 92.6% and 96.3%, respectively, and the specificity were both at 100%. CONCLUSION: Serial CRP is safe as diagnostic tool to consider antimicrobial treatment in neonatal sepsis with sensitivity of 92.6% and 96.3% for the first CRP cut-off point > or = 1.90 mg/L and the second CRP > or = 1.25 mg/L with 100% positive predictive value. Moreover, these safety profiles might help in reducing overuse of antibiotics with negative predictive value 96.3%.

The efficacy of infrared filter window film to prevent hyperthermia in neonatal hyperbilirubinemia with conventional phototherapy: a randomized control trial.

BACKGROUND: Phototherapy is the first-line treatment of neonatal hyperbilirubinemia. Possible side effects caused by phototherapy include hyperthermia and dehydration. Currently, there are many types of infrared blocking film for potential use in reducing infrared radiation exposure and preventing hyperthermia. This study aims to evaluate the efficacy of infrared blocking film in preventing hyperthermia during the first 24 h of phototherapy. METHODS: The randomized controlled trial study was carried out in 44 newborns with hyperbilirubinemia. Infrared filter film with 75% visible light transmission and 90% infrared rejection was used in the study. Body temperature was measured for the assessment of the efficacy of filter film from axillary and rectal routes. RESULTS: There was a significantly lower incidence of hyperthermia from the axillary temperature in the group with infrared blocking film compared to the control group (p = 0.031). The axillary temperature between before and after initiation of phototherapy in filter film group was significantly better (p = 0.008). According to efficacy of treatment, the study demonstrated that infrared filter film did not interfere with the efficacy of phototherapy in reducing bilirubin level. CONCLUSIONS: The infrared filter film was significantly more effective in preventing hyperthermia from phototherapy in the first 24 h without causing any significant difference in reduction of bilirubin level. THAI CLINICAL TRIALS REGISTRY: TCTR20190619001.

Accuracy of transcutaneous bilirubinometry compare to total serum bilirubin measurement.

BACKGROUND: Neonatal hyperbilirubinemia leads to bilirubin neurotoxicity. Noninvasive transcutaneous bilirubin (TcB) levels can be used as a screening tool for total serum bilirubin (TSB) levels. OBJECTIVE: To evaluate the correlation of TcB for TSB levels before, during and after phototherapy and find the most reliable cutoff values of TcB levels with the highest sensitivity and specificity for TSB levels. DESIGN: Diagnostic study. MATERIAL AND METHOD: In this research, forehead TcB measurement was measured by the transcutaneous bilirubinometer (Minolta Airshilds Jaundice Meter, JM 103). The 224 paired TcB-TSB specimens from 74 term and nearterm newborns were study from September 2007 to October 2008. The mean postnatal age at the time of measurement was 57.85 +/- 22.15 hours. The mean gestational age was 38 +/- 1.29 weeks and mean body weight was 2,864.65 +/- 262 g. RESULTS: The TcB and TSB values had linear correlation with significant correlation coefficient (r 0.81, p < 0.001). The correlation equation was TSB = 0.88 + 0.89 x TcB (r2 = 0.65). TcB levels tended be higher than TSB with mean difference of 0.44 mg/dL (95% CI: 0.7433-0.1323 mg/dL) and SD:1.64. TSB confirmation was recommended when TcB cutoff values greater than 9, 12, 13, 15 mg/dL at 24 (TSB:8 mg/dL), 36 (TSB: 10 mg/dL), 48 (TSB: 12 mg/dL) and 72 (TSB: 15 mg/dL) hours' postnatalage, respectively. CONCLUSION: The TcB levels can accurately predict TSB with the different cutoff points at various postnatal ages before phototherapy.