Comprehensive Morphological Assessment of Cord Blood: Normal Values and the Prevalence of Morphologically Aberrant Leukocytes.

INTRODUCTION: Cord blood (CB) is becoming a valuable source for stem cells utilized in a variety of cell therapy applications, as well as for newborn diagnostics. Some parameters of the CB cellular components can be provided by automated analyzers, while others, such as immature or aberrant cells, require blood film morphological assessment. The objectives of the study were to establish normal CB morphology and to determine the prevalence of morphologically aberrant leukocytes in CB. METHODS: We performed a comprehensive morphological analysis of 100 CB samples taken from healthy term and appropriate-for-gestational-age neonates born to healthy mothers, preterm neonates, neonates of diabetic mothers, and small-for-gestational-age neonates. Blood counts were assessed, and manual morphological analyses were performed by laboratory specialists. RESULTS: The manual differential count of normal CB samples established the following values: 47.8 ± 10.7% neutrophils, 31.2 ± 9.8% lymphocytes, 10.0 ± 4.0% monocytes, and 3.0 ± 2.5% eosinophils, with no significant sex-related differences. Blasts were observed in 44/100 samples with an average of 0.5 ± 0.7% per sample, and only a minor left shift was observed. There were significant populations of large granular lymphocytes (19.1 ± 10.6% of the total lymphocytes) and morphologically aberrant lymphocytes (12.4 ± 5.4% of the total lymphocytes) in the samples, irrespective of neonatal status. The differentials of preterm CB samples differ significantly from normal term CB samples, including the reverse of neutrophils/lymphocytes ratio, and the lack of basophils. CONCLUSIONS: Normal values and unique morphological features in the CB of neonates are described. The abundant morphologically aberrant lymphocytes in CB may represent an immature state of the immune system at birth.

[THE EFFECT OF MUSIC IN PRETERM ON RESTING ENERGY EXPENDITURE - A PROSPECTOVE RANDOMIZED CLINICAL TRIAL].

BACKGROUND: We have recently showed that Wolfgang Amadeus Mozart's music significantly lowers resting energy expenditure (REE) in preterm infants. Whether or not this effect is specific to Mozart is unknown. OBJECTIVES: To study whether familiar ("ethnic") music has the same effect on REE in preterm infants as music by Mozart. METHODS: A prospective, randomized clinical trial with cross-over was conducted in 9 healthy, appropriate weights for gestational age, gavage fed, preterm infants. Infants were randomized to be exposed to a 30-minute period of Mozart music or "ethnic" music or no music over 3 consecutive days. Metabolic measurements were performed by indirect calorimetry. RESULTS: A total of 27 REE measurements were performed. On average REE was lower in preterm infants who were exposed to "ethnic" music compared to preterm infants who were exposed to music by Mozart (p=0.388). REE was lower in preterm infants who didn't listen to music at all compared to Mozart (p=0.014) or to "ethnic" (p=0.134). CONCLUSIONS: Exposure to music by Mozart significantly elevated REE in healthy preterm infants compared to preterm infants who didn't listen to music at all. Nevertheless a trend of lower REE was demonstrated when preterm infants listened to "ethnic" music compared to Mozart. DISCUSSION: We were unable to demonstrate a significant decrease in REE by exposure of preterm infants to Mozart- or "familiar" music. At this time point we cannot recommend music therapy for preterm infants in order to lower the REE. We speculate that a larger study sample might show a definite effect.

Cardiac screening in pediatric patients with neurofibromatosis type 1: similarities with Noonan syndrome?

Both Neurofibromatosis type 1 (NF1) and Noonan syndrome (NS) are RASopathies. Characteristic cardiac phenotypes of NS, including specific electrocardiographic changes, pulmonary valve stenosis and hypertrophic cardiomyopathy have not been completely studied in NF1. PURPOSE: The aims of this study were to assess: (1) similarities in the prevalence and types of ECG and conventional echocardiographic findings described in NS in asymptomatic patients with NF1, and (2) the presence of discrete myocardial dysfunction in NF1 patients using myocardial strain imaging. METHODS: Fifty-eight patients with NF1 (ages 0-18 years), and thirty-one age-matched healthy controls underwent cardiac assessment including blood pressure measurements, a 12-lead ECG, and detailed echocardiography. Quantification of cardiac chamber size, mass and function were measured using conventional echocardiography. Myocardial strain parameters were assessed using 2-Dimensional (2D) Speckle tracking echocardiography. RESULTS: Asymptomatic patients with NF1 had normal electrocardiograms, none with the typical ECG patterns described in NS. However, patients with NF1 showed significantly decreased calculated Z scores of the left ventricular internal diameter in diastole and systole, reduced left ventricular mass index and a higher incidence of cardiac abnormal findings, mainly of the mitral valve, in contrast to the frequently described types of cardiac abnormalities in NS. Peak and end systolic global circumferential strain were the only significantly reduced speckle tracking derived myocardial strain parameter. CONCLUSIONS: Children with NF1 demonstrated more dissimilarities than similarities in the prevalence and types of ECG and conventional echocardiographic findings described in NS. The role of the abnormal myocardial strain parameter needs to be explored.

A silent outbreak of vancomycin-resistant Enterococcus faecium in a neonatal intensive care unit.

OBJECTIVE: To describe the containment of a widespread silent outbreak of vancomycin-resistant Enterococcus faecium (VRE-fm) in the Tel-Aviv Medical Center (TASMC) neonatal intensive care unit (NICU). METHODS: Setting - an NICU, participants - 49 cases of VRE-fm-colonized neonatal inpatients. RESULTS: A newborn was transferred from the TASMC NICU to another hospital and screened positive for VRE-fm upon arrival. All TASMC NICU patients were then immediately screened for VRE and 21/38 newborns were identified as VRE carriers. Interventional measures were strictly enforced. By the end of the outbreak, 49 cases of VRE carriage had been identified. There were no VRE clinical infections. The source of the outbreak was not identified. CONCLUSION: Our study highlights the importance of screening implementation in a NICU setting since this outbreak could have been prevented by active screening of all out-born transfer patients and by having adopted mandatory screening into the NICU's routine procedures. Screening for multi-drug resistant organisms upon admission of all transferred patients to the NICU has been implemented.

Hand hygiene compliance rates after an educational intervention in a neonatal intensive care unit.

An observational study was performed at a level III neonatal intensive care unit to assess the impact of a hand hygiene promotion educational program on rates of compliance with hand hygiene on entrance into the unit. There was an initial improvement in the rate of compliance at 1 month after the intervention (from 89% [168 of 189 opportunities] to 100% [212 of 212 opportunities]; P<.001], but the rate decreased to the baseline rate at 3 months (89% [85 of 96 opportunities]).

Conjunctival colonization of infants hospitalized in a neonatal intensive care unit: a longitudinal analysis.

OBJECTIVES: To determine the frequency of conjunctival colonization, identify the colonizing flora, and correlate culture results with physical findings in infants in a NICU. DESIGN: Surveillance study. SETTING: Level III NICU of a large university teaching hospital. PATIENTS: All infants admitted for longer than 24 hours during a 26-week period. METHODS: Weekly bacterial conjunctival cultures were performed for all infants. The conjunctival appearance at the time of culture was recorded. The frequency, identity, and correlation of culture results with physical findings were determined. RESULTS: One thousand ninety-one cultures were performed for 319 infants: 133 (42%) had no positive cultures and 186 (58%) had at least one positive culture. Culture analysis revealed that 411 (38%) were positive and yielded 494 isolates comprising more than 18 bacterial species. Bacteria most commonly isolated included coagulase-negative Staphylococcus (CoNS) (75%), viridans group streptococci (8.7%), Staphylococcus aureus (3.8%), Enterococcus species (2.6%), and Serratia marcescens (2.4%). The frequency of non-CoNS isolates increased significantly during the first 6 weeks of patient hospital stay (6% [1 to 3 weeks] to 12% [4 to 6 weeks]; P = .01), with an increasing trend to 15 weeks (18%). Correlation of bacteriologic results with physical findings demonstrated that infants with non-CoNS isolates exhibited conjunctival edema, erythema, or exudates more frequently than did infants with CoNS alone (30% vs 13%; P = .0001). CONCLUSIONS: Conjunctival colonization was common among infants in a NICU. Prolonged hospitalization predisposes to colonization with potentially pathogenic organisms. Physical findings were more likely in patients with non-CoNS conjunctival isolates.

Seventy-five years of neonatal sepsis at Yale: 1928-2003.

OBJECTIVE: Yale-New Haven Hospital (Y-NHH) has maintained the longest running, single-center longitudinal database of neonatal sepsis, started in 1928. The objective of this study was to update this database with review of neonatal sepsis cases at Y-NHH to identify longitudinal trends in demographics, pathogens, and outcome. METHODS: Records of infants with positive blood cultures obtained while they were inpatients in the NICU at Y-NHH from 1989 to 2003 were reviewed retrospectively. Records of infants who were < or =30 days of age, had positive blood cultures, and were hospitalized at Y-NHH outside the NICU from the same period were also reviewed, and all findings were compared with 60 years of preexisting data. RESULTS: A total of 862 organisms were identified in 755 episodes of sepsis from 647 infants. The percentage of cases of early-onset sepsis decreased and late-onset sepsis increased compared with the previous 10-year study period. A marked increase in cases as a result of commensal species was observed, particularly in preterm infants who had indwelling central vascular catheters, were receiving parenteral nutrition, and required prolonged mechanical ventilation. The overall percentage of sepsis caused by group B streptococcus and Escherichia coli decreased. No episodes of sepsis from Streptococcus pneumoniae or S pyogenes, common in the early years of the survey, were observed. The sepsis-related mortality rate steadily decreased, from 87% in 1928 to 3% in 2003. CONCLUSIONS: The demographics, pathogens, and outcome associated with neonatal sepsis continue to change. The increase in late-onset sepsis in preterm infants who required prolonged intensive care indicates that strategies to prevent infection are urgently needed for this population of infants.