Cerebral Oximetry Monitoring in Extremely Preterm Infants.

BACKGROUND: The use of cerebral oximetry monitoring in the care of extremely preterm infants is increasing. However, evidence that its use improves clinical outcomes is lacking. METHODS: In this randomized, phase 3 trial conducted at 70 sites in 17 countries, we assigned extremely preterm infants (gestational age, <28 weeks), within 6 hours after birth, to receive treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or to receive usual care. The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks' postmenstrual age. Serious adverse events that were assessed were death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis. RESULTS: A total of 1601 infants underwent randomization and 1579 (98.6%) were evaluated for the primary outcome. At 36 weeks' postmenstrual age, death or severe brain injury had occurred in 272 of 772 infants (35.2%) in the cerebral oximetry group, as compared with 274 of 807 infants (34.0%) in the usual-care group (relative risk with cerebral oximetry, 1.03; 95% confidence interval, 0.90 to 1.18; P = 0.64). The incidence of serious adverse events did not differ between the two groups. CONCLUSIONS: In extremely preterm infants, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth was not associated with a lower incidence of death or severe brain injury at 36 weeks' postmenstrual age than usual care. (Funded by the Elsass Foundation and others; SafeBoosC-III ClinicalTrials.gov number, NCT03770741.).

The role of recombinant human CC10 in the prevention of chronic pulmonary insufficiency of prematurity.

BACKGROUND: Preterm neonates can develop chronic pulmonary insufficiency of prematurity (CPIP) later in infancy. Recombinant human CC10 protein (rhCC10) is an anti-inflammatory agent that could potentially prevent CPIP. METHODS: The safety and efficacy of a single intratracheal dose of rhCC10 in reducing CPIP at 12 months corrected gestational age (CGA) was evaluated in a Phase II double-blind, randomized, placebo-controlled, multisite clinical trial. Eighty-eight neonates were randomized: 22 to placebo and 22 to 1.5 mg/kg rhCC10 in the first cohort and 21 to placebo and 23 to 5 mg/kg rhCC10 in the second cohort. Neonates were followed to 12 months CGA. RESULTS: With CPIP defined as signs/symptoms, medical visits, hospital readmissions, and use of medications for respiratory complications at 12 months CGA, no significant differences were observed between rhCC10 or placebo groups. Only 5% of neonates had no evidence of CPIP at 12 months CGA. CONCLUSIONS: A single dose of rhCC10 was not effective in reducing CPIP at 12 CGA. Since most neonates had evidence of CPIP using these exploratory endpoints, it is essential to develop more robust outcome measures for clinical trials of respiratory medications in high-risk premature neonates.

Compliance with the RSV immunoprophylaxis dosing schedule in the Polish registry for palivizumab (2008-2014).

OBJECTIVE: Background: Respiratory syncytial virus infection causes respiratory diseases in about 90% of the children under 2 years of age. Currently the only way to prevent infection is through immunoprophylaxis based on palivizumab. Aim: The aim of the study was to assess compliance with the recommended prophylaxis regimen in children qualified for the Polish National Programme for Respiratory Syncytial Virus Immunoprophylaxis over six consecutive virus seasons (2008-2014). PATIENTS AND METHODS: Material and methods: A retrospective analysis of data obtained from a multicentre, non-interventional observational study was performed. The prevention programme included 3,780 children aged 4 weeks to 2 years. The analysis included: the course of the neonatal period, clinical features at the time of inclusion in the programme, the immunisation course, and adherence to the palivizumab dosing schedule. RESULTS: Results: During the programme, the children received an average of 3.8 (range 1-5) injections. The highest mean number of injections was recorded in the 2013/14 season (4.3±1), and the lowest in the 2009/10 season (2.7±0.8). Overall, 3,084 children (81.7%) received all of the expected doses, while 2,352 (62.2%) children received injections within the appropriate interdose interval. The probability of non-compliance was higher for males. None of the other demographic, social, or clinical factors seemed to impact compliance. CONCLUSION: Conclusions: Compliance with the monthly dosing schedule of palivizumab is key to achieving the proper immunoprophylaxis efficacy. Education regarding the consequences of non-compliance with the regime and increased doctor-parent communication is recommended in future.

Factors related to compliance with palivizumab prophylaxis for respiratory syncytial virus (RSV) infection - data from Poland.

AIM: To evaluate compliance and health outcomes in children receiving palivizumab prophylaxis and to identify factors that could impact parental compliance with the recommended regimen of palivizumab immunoprophylaxis. MATERIAL AND METHODS: A retrospective, multicentre, non-interventional study of children enrolled in the Polish National Programme for Respiratory Syncytial Virus (RSV) Immunoprophylaxis who received ≥1 dose of palivizumab during two consecutive RSV seasons (I: 2008-2009, II: 2009-2010). For each child qualified to receive palivizumab, the following data were collected: sociodemographic factors, clinical characteristics at enrolment, and in the course of palivizumab prophylaxis. RESULTS: One thousand twenty-one infants were enrolled into the Registry at 29 sites across Poland and received a total of 3,241 palivizumab injections (average: 3.2 doses per child). The incidence of adverse reactions was 3.33%; nervousness was the most frequently reported event (1.23%). Overall, 771 (75.5%) children received all of their expected injections, whereas 635 (62.2%) children received their injections within the appropriate interdose interval. Compliance was lower in male infants. None of the other demographic, social, or clinical factors seemed to impact compliance. Non-compliant children had a higher rate of hospitalisation due to respiratory illness (22% vs 9.9%, p<0.0001, and 18.4% vs 9.5%, p<0.0001, for compliance defined by the number of expected injections received and by the interdose interval, respectively). CONCLUSIONS: Palivizumab prophylaxis was conducted in accordance with recommendations and was well tolerated in at-risk infants. Non-compliance was higher among male infants and was related with a higher rate of hospitalisation due to respiratory illness.

[Lactoferrin - a glycoprotein of great therapeutic potentials]. / Laktoferyna-glikoproteina o duzym potencjale terapeutycznym.

Lactoferrin is an iron-binding glycoprotein, which is present in most biological fluids with particularly high levels in colostrum and in mammalian milk. Bovine lactoferrin is more than 70% homologous with human lactoferrin. Most of the clinical trials have used bovine lactoferrin for supplementation. This review summarizes the recent advances in explaining the mechanisms, which are responsible for the multifunctional roles of lactoferrin, and presents its potential prophylactic and therapeutic applications. On the ground of the results of preliminary clinical observations, authors suggest beneficial effect of lactoferrin supplementation on the prevalence of necrotizing enterocolitis in infants with birth weight below 1250 grams.

Epidemiology, antibiotic consumption and molecular characterisation of Staphylococcus aureus infections--data from the Polish Neonatology Surveillance Network, 2009-2012.

BACKGROUND: Our aim was to determine and characterize S. aureus (SA) isolated from infections in newborns for antibiotic resistance, virulence factors, genotypes, epidemiology and antibiotic consumption. METHODS: Prospective surveillance of infections was conducted. Data about antibiotic treatment were analyzed. Antimicrobial susceptibility was assessed. PCR amplification was used to detect resistance and virulence genes. Typing methods such as PFGE, spa-typing and SCCmec were used. RESULTS: SA was found to be associated with 6.5% of infections. Methicillin-Resistant Staphylococcus aureus accounted for 32.8% of SA-infections. An incidence of MRSA-infections was 1.1/1000 newborns. MRSA-infections were diagnosed significantly earlier than MSSA-infections in these newborns (14th day vs. 23rd day (p=0.0194)). MRSA-infections increased the risk of newborn's death. Antibiotic consumption in both group was similar, but a high level of glycopeptides-usage for MSSA infections was observed. In the MRSA group, more strains were resistant to erythromycin, clindamycin, gentamicin and amikacin than in the MSSA group. Hla gene was present in 93.9% of strains, and seg and sei in 65.3% of strains, respectively. One dominant clone was found among the 14 MRSA isolates. Fifteen strains belonging to SCCmec type IV were spa-t015 and one strain belonging to SCCmec type V was spa-t011. CONCLUSIONS: Results obtained in the study point at specific epidemiological situation in Polish NICU (more detailed studies are recommended). High usage of glycopeptides in the MSSA infections treatment indicates the necessity of antimicrobial stewardship improvement and introducing molecular screening for early identification of infections.

Mode of delivery and other risk factors for Escherichia coli infections in very low birth weight infants.

BACKGROUND: Infections in newborns remain one of the most significant problems in modern medicine. Escherichia coli is an important cause of neonatal bloodstream and respiratory tract infections and is associated with high mortality. The aim of our study was to investigate the epidemiology of E. coli infection in Polish neonatal intensive care units (NICUs) and resistance to antibiotics, with particular reference to the safety of very low birth weight infants. METHODS: Continuous prospective infection surveillance was conducted in 2009-2012 in five NICUs, including 1,768 newborns whose birth weight was <1.5 kg. Escherichia coli isolates from different diagnostic specimens including blood, tracheal/bronchial secretions and others were collected. All isolates were tested using disk diffusion antimicrobial susceptibility methods. Pulsed-field gel electrophoresis was used to determine the possible horizontal transfer of E. coli among patients. RESULTS: The incidence of E. coli infections was 5.4% and 2.0/1,000 patient-days. The occurrence of E. coli infections depended significantly on the NICU and varied between 3.9% and 17.9%. Multivariate analysis that took into account the combined effect of demographic data (gender, gestational age and birth weight) and place of birth showed that only the place of hospitalisation had a significant effect on the E. coli infection risk. The highest levels of resistance among all E. coli isolates were observed against ampicillin (88.8%) and amoxicillin/clavulanic acid (62.2%). Among E. coli isolates, 17.7% were classified as multidrug resistant. Escherichia coli isolates showed different pulsotypes and dominant epidemic clones were not detected. CONCLUSIONS: Our data indicate that antibiotic prophylaxis in the presence of symptoms such as chorioamnionitis and premature rupture of membranes did not help reduce the risk of E. coli infection. Multivariate analysis demonstrated only one significant risk factor for E. coli infection among infants with a birth weight <1.5 kg, that is, the impact of the NICU, it means that both neonatal care and care during pregnancy and labour were found to be significant.

Nasal CPAP (Infant Flow) applied at birth in extremely low birth weight newborns.

OBJECTIVE: Evaluation of nasal CPAP (Infant Flow) as a ventilatory support, applied at birth in spontaneously breathing, extremely low birth weight newborns (ELBW). MATERIAL AND METHODS: Retrospective analysis of the clinical course of respiratory distress syndrome (RDS) in 97 ELBW, who needed ventilatory support. In all patients the noninvasive ventilatory support was introduced within the first minute of life. RESULTS: Among all analyzed newborns, 37.1% of patients were not intubated during hospitalization. Moreover, another 10.3% patients were intubated only due to surfactant administration according to the INSURE method and after 2-3 minutes of invasive ventilation they were switched to n-CPAP. Nearly half (47.4%) of all evaluated ELBW newborns who needed ventilatory support avoided mechanical ventilation. We found the frequency of bronchopulmonary dysplasia in 97 analyzed patients markedly lower when compared to data presented in literature (19% vs 34%; p=0.026). CONCLUSION: We suggest that starting ventilatory support with the n-CPAP from the first minute of life is a safe and effective strategy in extremely low birth weight infants. It also reduces the costs of treatment, associated with surfactant administration.

Vaccination of preterm infants by polyvalent vaccines: immunogenicity and safety- review of literature.

The immunization of infants against infectious diseases still raises many controversies, not only with parents, but also among physicians. This refers particularly to preterm infants. Due to the increasing popularity of polyvalent vaccines, a number of studies has recently been conducted to verify their immunogenicity and safety in preterm infants. The aim of the present paper was to review the current literature dealing with the problem in question. The following recommendations regarding the use of polyvalent vaccines in preterm infants and neonates with low birth weight can be formulated on the basis of current evidence (1). Due to sufficient immunogenicity, polyvalent vaccines can be administered to preterm infants in accordance with their calendar age (2). Booster vaccination of preterm infants after completing 12 months of age is vital for achieving complete and persistent immunity against all vaccine antigens (3). In order to reduce the risk of adverse events after the administration of a polyvalent vaccine, it is essential to carefully consider the cardiorespiratory status of preterm infants during preimmunization examination, as well as their history of any cardiorespiratory dysfunctions. In such cases administering the first dose of the vaccine in a hospital setting is strongly advised.

May the supplementation of lipid emulsion containing DHA in VLBW infants influence their psychological development evaluated at three years of age? Preliminary study.

OBJECTIVES: The aim of the study was to evaluate the possible influence of a lipid emulsion containing DHA (docosahexaenoic polyunsaturated fatty acid), parenterally administered from the first day of life, on the psychological development of 3-year-old children born with very low birth weight (VLBW). It was suspected that an increased amount of DHA in parenteral nutrition may be a variable that modifies the relation between other medical or social factors and their influence on the child's development. MATERIAL AND METHODS: Two groups of three-year-old children with calendar age ranging from 29 to 51 months (mean value--38 months) were tested. The children in the study group (n=23) were parenterally nourished during the first weeks of life with a lipid emulsion containing DHA. The patients in the control group (n=13) were fed with a lipid emulsion without DHA. RESULTS: Using the General Linear Model (GLM) with the analysis of interaction effects, it was found that the supplementation of the lipid emulsion containing DHA in parenteral nutrition from the first day of life beneficially influenced the relation between immaturity associated with the children's health status at birth and emotional development evaluated at three years of age. It also modified the relation between emotional and linguistic development. CONCLUSIONS: When administered after birth in prematurely born children, the lipid emulsion containing DHA may influence their development at the age of three years. It may either compensate the negative effects that immaturity associated with the health status at birth has on emotional development, or stimulate the language development in children whose emotional development is normal.

The Assessment of Iodine Concentrations in Colostrum and Breast Milk Using ICP-MS: The Impact of Delivery Type, Thyroid Function and Gestational Diabetes-A Pilot Study.

Considering the spectrum of benefits of breast milk feeding, determining the essential components of an infant's only food-mother's milk-seems justified, especially in the case of those whose deficiency (e.g., iodine) may result in developmental disorders. The main aim of this study was the determination of the total iodine content of breast milk (including colostrum and mature milk). A secondary objective was to assess the influence of factors such as the type of delivery, hypothyroidism, gestational diabetes or the stage of lactation on this parameter. The study materials were colostrum and milk after 1 (n = 14), 2 and 3 months (n = 8) of lactation with a range of iodine concentrations (µg/L): 195-1648 and 170-842, 174-650 and 273-751, respectively. Iodine was determined using the inductively coupled plasma mass spectrometry (ICP-MS). Multivariate statistical analysis revealed, e.g., that delivery by caesarean section or dose of L-thyroxine taken by women to normalise thyroid hormones, had a significant effect on iodine concentrations in breast milk. Further research aimed at assessing the quality of breast milk should also include determining the factors influencing it.

Respiratory Syncytial Virus Infections in Polish Pediatric Patients from an Expert Perspective.

Respiratory syncytial virus (RSV) is the most common pathogen causing respiratory tract infections in infants, affecting over 90% of children within the first two years of life. It may cause lower respiratory tract infections, which constitute a significant healthcare burden both in the primary and secondary care settings. Meanwhile, the data regarding RSV disease in Poland is scarce, and published data significantly differs from the numbers reported for other countries with longstanding surveillance and reporting systems. A literature review and an expert panel were conducted to (1) understand the healthcare burden of RSV infections in Poland; (2) collect data on infection seasonality, patient pathway, and management patterns; and (3) evaluate RSV infection surveillance in Poland. According to the literature, RSV is the major agent responsible for non-influenza respiratory diseases in Poland. The reported rates of hospitalization for RSV infections are 267.5/100,000 for children under 5 years of age and 1132.1/100,000 for those under 1 year of age. Comparisons with data from other countries suggest that these values may be underestimated, possibly due to insufficient access to microbiological testing and a low awareness of RSV. Infections occur mainly between December and April, however, this pattern has changed following the implementation of preventive measures for coronavirus disease 2019 in the past few years. According to available reports, bronchodilators, antibiotics, corticosteroids, and X-ray imaging have been frequently used. The surveillance system in Poland has limitations, but these may be overcome due to recent changes in healthcare law as well as the availability and reimbursement of diagnostic tests.

Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland.

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists' voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20-30 ng/mL (50-75 nmol/L)], and optimal concentration [30-50 ng/mL (75-125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland.

Protocol for a multicenter, double-blind, randomized, placebo-controlled phase III trial of the inhaled ß2-adrenergic receptor agonist salbutamol for transient tachypnea of the newborn (the REFSAL trial).

Background: Transient tachypnea of the newborn (TTN), which results from inadequate absorption of fetal lung fluid, is the most common cause of neonatal respiratory distress. Stimulation of ß-adrenergic receptors enhances alveolar fluid absorption. Therefore, the ß2-adrenergic receptor agonist salbutamol has been proposed as a treatment for TTN. This study aims to evaluate the efficacy and safety of salbutamol as supportive pharmacotherapy together with non-invasive nasal continuous positive airway pressure (NIV/nCPAP) for the prevention of persistent pulmonary hypertension of the newborn (PPHN) in infants with TTN. Methods and analysis: This multicenter, double-blind, phase III trial will include infants with a gestational age between 32 and 42 weeks who are affected by respiratory disorders and treated in eight neonatal intensive care units in Poland. A total of 608 infants within 24 h after birth will be enrolled and randomly assigned (1:1) to receive nebulized salbutamol with NIV or placebo (nebulized 0.9% NaCl) with NIV. The primary outcome is the percentage of infants with TTN who develop PPHN. The secondary outcomes are the severity of respiratory distress (assessed with the modified TTN Silverman score), frequency of need for intubation, duration of NIV and hospitalization, acid-base balance (blood pH, partial pressure of O2 and CO2, and base excess), and blood serum ionogram for Na+, K+, and Ca2+. Discussion: The Respiratory Failure with Salbutamol (REFSAL) study will be the first clinical trial to evaluate the efficacy and safety of salbutamol in the prevention of persistent pulmonary hypertension in newborns with tachypnea, and will improve short term outcomes. If successful, the study will demonstrate the feasibility of early intervention with NIV/nCPAP together with nebulized salbutamol in the management of TTN. Ethics and dissemination: The study protocol was approved by the Bioethics Committee of the Medical University of Warsaw, Warsaw, Poland on November 16, 2020 (decision number KB/190/2020). All procedures will follow the principles of the Declaration of Helsinki. The results of the study will be submitted for knowledge translation in peer-reviewed journals and presented at national and international pediatric society conferences. Clinical Trial Registration: It is registered at ClinicalTrials.gov NCT05527704, EudraCT 2020-003913-36; Protocol version 5.0 from 04/01/2022.

Epidemiology and Pathogenesis of Staphylococcus Bloodstream Infections in Humans: a Review.

Staphylococci are among the most frequent human microbiota components associated with the high level of bloodstream infection (BSI) episodes. In predisposed patients, there is a high risk of transformation of BSI episodes to sepsis. Both bacterial and host factors are crucial for the outcomes of BSI and sepsis. The highest rates of BSI episodes were reported in Africa, where these infections were up to twice as high as the European rates. However, there remains a great need to analyze African data for comprehensive quantification of staphylococcal BSI prevalence. The lowest rates of BSI exist in Australia. Asian, European, and North American data showed similar frequency values. Worldwide analysis indicated that both Staphylococcus aureus and coagulase-negative staphylococci (CoNS) are the most frequent BSI agents. In the second group, the most prevalent species was Staphylococcus epidermidis, although CoNS were not identified at the species level in many studies. The lack of a significant worldwide decrease in BSI episodes indicates a great need to implement standardized diagnostic methods and research etiological factors using advanced genetic methods.

COVID-19 impact on perinatal care: risk factors, clinical manifestation and prophylaxis. Polish experts' opinion for December 2020.

Rapid spread of severe acute respiratory syndrome coranovirus-2 virus (SARS-CoV-2) caused the pandemic of Coronavirus Disease 19 (COVID-19). Clinical course of the disease presents symptoms mainly from the respiratory system such as: cough, dyspnea and fever, and among some patients, can deteriorate even further to acute respiratory distress syndrome (ARDS), eventually leading to death. This outbreak, as well as previous ones (SARS, MERS) pose a significant challenge for health care managers, epidemiologists and physicians. Below we are presenting the clinical profile of the COVID-19 among special group of patients; pregnant women and newborns, who require special clinical management during hospitalization. In the summary of this manuscript, we present practical guidelines for managing pregnant women infected with SARS-CoV-2, labor and care of the newborn of a positive mother, as well as practical guidelines for COVID-19 vaccinations. It is important to stress, that this manuscript is based on information available as of December 2020.

Effect of a Short-Time Probiotic Supplementation on the Abundance of the Main Constituents of the Gut Microbiota of Term Newborns Delivered by Cesarean Section-A Randomized, Prospective, Controlled Clinical Trial.

The gut microbiota plays a pivotal role in the maintenance of human health. Numerous factors, including the mode of delivery, impact early gut colonization in newborns. Recent research focuses on the use of probiotics in the prevention of gut dysbiosis in newborns delivered by cesarean section (CS). The objective of this study was to determine whether a probiotic supplement given to newborns delivered by CS during their stay in the maternity ward alters the pattern of early gut colonization by lactic acid bacteria versus potential pathogens. A prospective, randomized trial was conducted. In total, 150 newborns, born at 38-40 weeks gestational age and delivered by CS, were included in the study. They were randomized into the intervention group, supplemented orally with a probiotic containing Bifidobacterium breve PB04 and Lactobacillus rhamnosus KL53A, and the control group. Stool samples were obtained on days 5 and 6 of life and after one month of life and were analyzed for the presence and abundance of the main groups of bacteria. An application of two probiotic bacteria during the first days of life after CS resulted in quick and abundant colonization by days 5 and 6, with high populations of L. rhamnosus and B. breve. The applied bacterial strains were present in the majority of neonates one month after. The supplementation of term neonates delivered by cesarean section immediately after birth with a mixture of L. rhamnosus and B. breve enriched the gut microbiota composition with lactic acid bacteria.

Coagulase-Negative Staphylococci Contained in Gut Microbiota as a Primary Source of Sepsis in Low- and Very Low Birth Weight Neonates.

BACKGROUND: There are only a few reports in the literature about translocation of coagulase-negative staphylococci (CoNS) as a primary cause of sepsis in neonates, although CoNS are among a short list of "translocating" bacteria when present in abundance. METHODS: 468 blood samples, 119 stool samples, and 8 catheter tips, from 311 neonates, were tested for presence of microorganisms. CoNS strains isolated from the blood and stool or from blood and catheter tip of the same newborn at approximately the same time were paired and typed with PFGE (Pulse-Field Gel Electrophoresis) method. The strains were then tested for the presence of adherence genes and biofilm formation. RESULTS: The strains with identical PFGE profiles in comparison to those with non-identical profiles differed in terms of the pattern of the virulence genes and showed a lack of the genes related to adherence, but more often presence of IS256, which is related to virulence. They also were phenotypically unable to adhere to intestinal Caco2 cells. CONCLUSIONS: A considerable proportion of CoNS strains isolated from bloodstream of VLBW/LWB neonates was identical to the strains isolated from faeces of the same neonates at the same time. These observations may offer indirect evidence indicating that at least some CoNS can translocate from the gastrointestinal tract of the premature neonates into the bloodstream and thus cause generalized infection.