Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit.

BACKGROUND: Several neonatal intensive care units (NICU) have reported exposure to sputum smear positive tuberculosis (TB). NICE guidelines give support regarding investigation and treatment intervention, but not for contact definitions. Data regarding the reliability of any interferon gamma release assay (IGRA) in infants as a screening test for TB infection is scarce. We report an investigation and management strategy and evaluated the viability of IGRA (T-Spot) in infants and its concordance to the tuberculin skin test (TST). METHODS: We performed an outbreak investigation of incident TB infection in a NICU after prolonged exposure to sputum smear positive miliary TB by an infant's mother. We defined individual contact definitions and interventions and assessed secondary attack rates. In addition, we evaluated the technical performance of T-Spot in infants and compared the results with the TST at baseline investigation. RESULTS: Overall, 72 of 90 (80%) exposed infants were investigated at baseline, in 51 (56.7%) of 54 (60%) infants, follow-up TST at the age of 6 months was performed. No infant in our cohort showed a positive TST or T-Spot at baseline. All blood samples from infants except one responded to phytohemagglutinin (PHA), which was used as a positive control of the T-Spot, demonstrating that cells are viable and react upon stimulation. 149 of 160 (93.1%) exposed health care workers (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection. 5 of 92 (5.5%) exposed primary contacts were tested positive, all coming from countries with high TB incidences. In total, 1 of 342 exposed contacts was newly diagnosed with latent TB infection. The secondary attack rate in this study including pediatric and adult contacts was 0.29%. CONCLUSION: This investigation highlighted the low transmission rate of sputum smear positive miliary TB in a particularly highly susceptible population as infants. Our expert definitions and interventions proved to be helpful in terms of the feasibility of a thorough outbreak investigation. Furthermore, we demonstrated concordance of T-Spot and TST. Based on our findings, we assume that T-Spot could be considered a reliable investigation tool to rule out TB infection in infants.

Reference Values for Umbilical Artery Lactate by Mode of Delivery and Gestational Age: A Retrospective Observational Study.

INTRODUCTION: Umbilical artery cord blood provides information about the intrauterine metabolism during labor. Umbilical artery lactate is a useful parameter in predicting neonatal morbidity, but data on normal values are limited. We aimed to provide reference ranges of umbilical artery lactate values across the combination of gestational age and mode of delivery. METHODS: A single-center retrospective observational study of liveborn infants born between 23 and 42 completed weeks gestation was conducted. Lactate, base deficit (BD), and pH from arterial cord blood were assessed between June 2018 and November 2020 and compared across gestational ages and modes of delivery. RESULTS: Overall, there were 3,353 infants with evaluable data. Lactate values at the 50th, 90th, and 97th percentile were 3.4, 7.0, and 9.0 mmol/L. Lactate was inversely correlated with pH (r = -0.77, p < 0.001) and positively correlated with BD (r = 0.63, p < 0.001). Lactate values changed significantly across gestational age (Kruskal-Wallis test, p < 0.001) which was attributable to an increase in lactate at 39-41 weeks gestational age. Also, lactate values were different across modes of delivery (Kruskal-Wallis test, p < 0.001) with lowest values in elective CS and highest values in vaginal instrumental deliveries. Comprehensive reference ranges across modes of delivery and gestational ages could be established. DISCUSSION: Mode of delivery and gestational age contribute to lactate levels with highest values occurring in vaginal instrumental deliveries and between 39 and 41 weeks gestational age. Based on these observations, we provide detailed reference ranges for clinical use.

Determinants for voluntary participation in staff screening during an methicillin-resistant Staphylococcus aureus (MRSA) outbreak on a neonatal ward.

We investigated healthcare worker (HCW) behavior with regard to a voluntary methicillin-resistant Staphylococcus aureus (MRSA) staff screening during a MRSA outbreak in a neonatal ward. Avoiding MRSA transmission from HCWs to patients was the most important reason for participation. Inconvenient screening time was the most frequently cited reason for nonparticipation.

Very preterm infants show earlier emergence of 24-hour sleep-wake rhythms compared to term infants.

BACKGROUND: Previous studies show contradictory results about the emergence of 24-h rhythms and the influence of external time cues on sleep-wake behavior in preterm compared to term infants. AIMS: To examine whether very preterm infants (<32 weeks of gestational age) differ in their emergence of the 24-h sleep-wake rhythm at 5, 11 and 25 weeks corrected age compared to term infants and whether cycled light conditions during neonatal intermediate care affects postnatal 24-h sleep-wake rhythms in preterm infants. STUDY DESIGN: Prospective cohort study with nested interventional trial. SUBJECTS: 34 preterm and 14 control term infants were studied. During neonatal hospitalization, preterm infants were randomly assigned to cycled light [7 am-7 pm lights on, 7 pm-7 am lights off, n=17] or dim light condition [lights off whenever the child is asleep, n=17]. OUTCOME MEASURES: Sleep and activity behavior recorded by parental diary and actigraphy at 5, 11 and 25 weeks corrected age. RESULTS: Sleep at nighttime and the longest consolidated sleep period between 12 pm-6 am was longer (mixed model analysis, factor group: p=0.02, resp. p=0.01) and activity at nighttime was lower (p=0.005) at all ages in preterm compared to term infants. Cycled light exposed preterm infants showed the longest nighttime sleep duration. Dim light exposed preterm infants were the least active. CONCLUSIONS: Preterm infants show an earlier emergence of the 24-h sleep-wake rhythm compared to term infants. Thus, the length of exposure to external time cues such as light may be important for the maturation of infant sleep-wake rhythms. Trial registry number: This trial has been registered at www.clinicaltrials.gov (identifier NCT01513226).

Cycled light exposure reduces fussing and crying in very preterm infants.

OBJECTIVE: To examine whether cycled lighting (CL) conditions during neonatal care in very preterm infants (<32 weeks' gestational age [GA]) decrease crying and fussing behavior, improve the consolidation of sleep, and influence activity behavior at 5 and 11 weeks' postterm corrected age (CA) compared with preterm infants cared for in dim lighting (DL) conditions. METHODS: Thirty-seven preterm infants were randomly assigned to CL (7 am-7 pm lights on, 7 pm-7 am lights off [n = 17; mean GA: 30.6 ± 0.95 weeks; 9 girls]) or DL (lights off whenever the child is asleep [n = 20; GA: 29.5 ± 2.1 weeks; 8 girls]) conditions. Sleeping, crying, and activity behavior was recorded by using parental diaries and actigraphy at 5 and 11 weeks' CA. RESULTS: A significant reduction of fussing (59.4 minutes/24 hours [± 25.8 minutes]) and crying (31.2 minutes/24 hours [± 14.4 minutes]) behavior and a trend to higher motor activity during daytime was found in CL-exposed infants at 5 and 11 weeks' CA compared with infants cared for in DL conditions. No significant difference between groups was observed for sleep behavior at 5 and 11 weeks' CA. Infants in CL conditions showed a trend to improved daily weight gain (average: 3.6 g/d) during neonatal care compared with DL conditions. CONCLUSIONS: CL conditions in neonatal care have beneficial effects on infant's fussing and crying behavior and growth in the first weeks of life. This study supports the introduction of CL care in clinical neonatal practice.