Late Onset Sepsis in Very Low Birth Weight Infants in the South American NEOCOSUR Network.

BACKGROUND: The main aim is to determine the incidence and associated factors of late onset sepsis (LOS) in very low birth weight infants (500-1500 g), from the NEOCOSUR Network during years 2001-2013. Secondary objectives are to describe the microbiology of the first and second episode of LOS and to study the association between catheter dwell time and LOS. METHODS: Demographic information and outcome data are prospectively and routinely collected across the network using predefined diagnostic criteria and online data entry. LOS was confirmed by isolation of the organism in blood or through cerebrospinal fluid in cultures. The participating countries were Argentina, Brazil, Chile, Paraguay, Peru and Uruguay. RESULTS: Overall incidence was 22.2% (3066/13,821). Infants who developed LOS were smaller by weight and gestational age; also, they feature less prenatal care and prenatal steroids, and longer hospital stays. A greater number of infants in the LOS group had 1 minute Apgar Scores ≤3. Multivariate logistic regression analysis showed a positive association between LOS and necrotizing enterocolitis, mechanical ventilation requirements, patent ductus arteriosus, oxygen dependency at 36 weeks and death. The majority of first LOS episode was caused by coagulase-negative staphylococci (44.3%). An increased risk of LOS was observed in relation to catheter dwell time (6% per day of stay of central lines). CONCLUSIONS: The incidence of LOS was associated with mechanical ventilation, patent ductus arteriosus, necrotizing enterocolitis and death. LOS was an important cause of morbidity and mortality in very low birth weight infants in our network, and coagulase-negative staphylococci was the most frequent causative microorganism.

Timing of umbilical cord clamping of term infants. / Tiempo de clampeo del cordón umbilical en recién nacidos de término.

For at least over 200 years, multiple controversies have arisen around the timing of umbilical cord clamping. In the past decades, early cord clamping (within the first 15 seconds) had markedly prevailed. Only in the 21st century, randomized controlled trials have demonstrated the benefits of delayed cord clamping (at 2-3 minutes). Delayed cord clamping has been practiced in obstetrics based on the recommendations made by scientific societies and in systematic reviews, which have provided solid evidence to support this practice in term infants. This review describes the most relevant factors supporting the use of delayed cord clamping in term infants. It points out the essential role played by physiological mechanisms which, undoubtedly, allow us to understand the benefits of delayed cord clamping and advise us to wait for what nature has established. Other relevant aspects supporting delayed cord clamping are also described here.

El tiempo de clampeo del cordón umbilical ocasionó múltiples controversias, al menos, desde hace más de 200 años. En las últimas décadas, predominó marcadamente la práctica del clampeo temprano (primeros 15 segundos). Recién en este siglo, investigaciones aleatorizadas controladas mostraron los beneficios del clampeo demorado del cordón (de 2 a 3 minutos). Esta práctica fue instalada en la asistencia obstétrica por las recomendaciones de sociedades científicas y de las revisiones sistemáticas, que señalaron las sólidas evidencias que apoyaban esta conducta en neonatos de término. En esta revisión, se describen los factores más relevantes que sustentan la aplicación del clampeo demorado del cordón en recién nacidos de término. Se destaca el esencial rol que juegan los mecanismos fisiológicos, que, sin duda, nos llevan a comprender los beneficios de esta práctica y nos enseñan a respetar lo que la naturaleza ha determinado. Asimismo, se abordan otros importantes aspectos que también apoyan el empleo del clampeo demorado.