Epidemiology of neonatal sepsis in two neonatal intensive care units in Krakow, Poland in 2016-2017 years.

BACKGROUND: Sepsis in low-birth-weight neonates remains one of the most significant causes of neonatal morbidity and mortality. Approximately 3 million newborns suffer from sepsis globally every year. The aim of this study was to compare demographic and clinical features, as well as etiology and antibiotic susceptibility, of the main pathogens related to neonatal sepsis in two neonatal intensive units during a two-year period. METHODS: We observed early-onset (EO-BSI) and late-onset bloodstream infections (LO-BSI) cases in two high-reference neonatal intensive care units (NICU) over a 24-month period (2016-2017). Samples of patients' blood were tested for the presence of the microorganisms. All bacterial isolates were tested for susceptibility to antibiotics. RESULTS: The majority of sepsis cases weighed above 1000 g and were born by cesarean section. About 10% of the EO-BSI group died. There were differences in the EO-BSI /LO-BSI ratio in the compared wards due to differences among the admitted children. The most common pathogens isolated from blood were coagulase-negative staphylococci (CoNS) were represented by two dominating species: S. epidermidis and S. haemolyticus, followed by Klebsiella spp. strains and E.coli, which were mostly found in EO-BSI cases. No single S. agalactiae (GBS) strain was isolated. The majority of CoNS strains were resistant to methicillin, half were resistant to aminoglycosides, and one-third were resistant to macrolides and lincosamides. Half of the Gram-negative rods were resistant to beta-lactams. CONCLUSIONS: The epidemiology of sepsis in two observed NICUs is comparable to data obtained from other studies with a predominance of methicillin-resistant CoNS in LO-BSI and beta-lactam resistant E. coli in EO-BSI. It is of importance that the campaign for controlling GBS carriage in pregnant women in Poland resulted in the disappearance of GBS as a cause of sepsis. Unfortunately, there are no such measures to control E.coli related sepsis.

Is there a benefit of antenatal corticosteroid when given < 48 h before delivery?

OBJECTIVE: We assessed the association between a short antenatal corticosteroid administration-to-birth interval and neonatal outcome. STUDY DESIGN: A retrospective study was conducted between 2010 and 2020. Eligible cases were singleton preterm live-born neonates born between 24-0/7 and 33-6/7 weeks of gestation and were initiated an ACS course of betamethasone. We divided the first 48 h following the first ACS administration to four time intervals and compared each time interval to those born more than 48 h following ACS administration. The primary outcome was a composite of adverse neonatal outcome, including neonatal mortality or any major neonatal morbidity. RESULTS: A total of 200 women gave birth less than 48 h from receiving the first betamethasone injection, and 172 women gave birth within 2-7 days (48-168 h) from ACS administration. Composite adverse neonatal outcome was higher for neonates born less than 12 h from initial ACS administration compared to neonates born 2-7 days from the first betamethasone injection (55.45% vs. 29.07%, OR 3.45 95% CI [2.02-5.89], p value < 0.0001). However, there was no difference in composite adverse neonatal outcomes between neonates born 12-48 h following ACS administration and those born after 2-7 days. That was also true after adjusting for confounders. CONCLUSIONS: 12-24 h following ACS administration may be sufficient in reducing the same risk of neonatal morbidities as > 48 h following ACS administration. It may raise the question regarding the utility of the second dose of ACS.

Impact of the shift to neonatal noninvasive ventilation in Poland: a population study.

OBJECTIVE: This study was undertaken to document the real impact of a directed shift in the standard of neonatal practice to a pervasive use of noninvasive respiratory support. DESIGN: Before-after observational study. SETTING: All 18 neonatal ICUs in the capital region of Poland. PATIENTS: Every infant admitted to a neonatal ICU who received respiratory pressure support over a 7-year period of interest (12-month transition to the new noninvasive standard and 36 months before and after). INTERVENTION: Education as to the benefits of noninvasive respiratory support and widespread availability of Infant Flow noninvasive ventilation systems. MEASUREMENTS AND MAIN RESULTS: Five thousand five hundred fifty-one infants required respiratory support in this period. Of these, 14% were less than 28 weeks estimated gestational age, 33% between 28 and 32 weeks, 31% between 33 and 36 weeks, and 22% more than 36 weeks. The use of noninvasive support, as the first form of respiratory support, increased by 19% (p < 0.001). The use of noninvasive support, for weaning following extubation, increased by 32% (p = 0.06). The increased use in weaning was the most pronounced in infants younger than or equal to 32 weeks estimated gestational age (p < 0.001). There were two prospective primary endpoints, mortality and bad outcome among survivors younger than or equal to 32 weeks estimated gestational age. Mortality decreased from 11% to 7%, and the difference remained statistically significant after controlling for baseline factors (p < 0.001). The reduced mortality was more apparent in infants younger than or equal to 32 weeks estimated gestational age. In infants younger than or equal to 32 weeks estimated gestational age, bad outcome in survivors (grade III bronchopulmonary dyplasia and retinopathy of prematurity requiring laser treatment) did not increase (p = 0.669) after controlling for significant baseline variables. CONCLUSIONS: We believe that the adoption of an approach emphasizing noninvasive ventilation in Poland resulted in decreased mortality without an increase in significant pulmonary or retinal morbidity.

Influence of ozone and acid mist on the contents of gibberellic acid (GA(3)) in spruce needles (Picea abies) (L.) Karst.

The phytohormone GA(3) in needles from 4-year-old Norway spruce trees was analyzed after treatment with ozone and acid mist in environmental chambers under controlled conditions. GA(3) was extracted with methanol from the lyophilized material. Subsequent purification steps included the use of polyvinylpyrollidone (PVP), cartridge reversed-phase purification, ethylacetate extraction and HPLC. The GA(3) was determined in the methylated form by means of a highly specific and sensitive enzyme immunoassay. Higher GA(3) contents were detected in young needles (year 1987) as compared to older ones (year 1986). However, no statistically significant differences were found in the GA(3) levels between the controls and the needles of trees which were treated with increased levels of ozone and acidic mist.

Pentoxyfylline in and prevention and treatment of chronic lung disease.

The anti-inflammatory effects of pentoxfylline are associated with a number of clinical benefits. These include reduction in mortality in patients who have undergone bone marrow transplants or suffer peritonitis. In infants with sepsis, a reduction in mortality has also been associated with pentoxyfylline administration. The anti-inflammatory effects of pentoxyfylline, as well as its bronchodilator, diuretic and respiratory muscle stimulant effects suggest it may have a useful role in BPD. Interim analysis of a prophylactic trial suggests pentoxyfylline may reduce treatment requirements after the neonatal period and that, in established BPD, pentoxyfylline and dexamethasone may be of similar efficacy.

[Clinical method of newborn's maturity evaluation according to R. Klimek's index]. / Kliniczny sposób oceny dojrzalosci noworodka wedlug wskaznika R. Klimka.

The object of the study was to evaluate R. Klimek's new simple clinical method of computing newborn's maturity index (K) without having to use the computer-aided method or understand the basics of the quantum mechanics or theory of relativity, which gave rise to the modern definition of maturity. The study was based on the material of 1000 successive newborns delivered in the Clinic of Gynecology and Obstetrics of the Jagiellonian University. Their maturity was determined routinely in BK scale, and confirmed by means of computer-aided method of birth term prognosis. Posture, angle of the elbow, pulling an elbow to the middle line of the body, breast appearance, presence of lanugo and plantar creases were evaluated by means of K index with points from 0 to 2. Newborns' maturity index K was 9.2 +/- 1.9 points (range 2-12). 2.6% newborns were immature and one third of them (0.8%) were born with the gestational age < 37 weeks, 28 of which (77%) had correct K index > or = 6 points. There is a high, statistically significant correlation between maturity assessed in Ballard-Klimek scale and K index (r = 0.61, t = 24.78).

[Evaluation of newborn maturation and gestational age using the Ballard-Klimka scale]. / Ocena dojrzalosci noworodka i wieku ciazowego wg skali Ballard-Klimka.

Results of prospective studies of 1404 consecutive vaginal and cesarean deliveries of newborns weighted > or = 2500 g were analyzed in relation to their maturity. It was stated that Ballard Maturation Score is a valid accurate assessment tool for precise interpretation of the degree of fetal maturity, but not of the calendar length of gestation, especially beyond 36 weeks. Therefore it was reasonable to propose a constant distribution of scores: 39 +/- 3 points within the period from 37% to 43% weeks while at the 28th week: 10 +/- 2 points (Ballard-Klimek scale of pregnancy dating) instead of therefore used J. L. Ballard rule that only newborns at 44 weeks can have scores of 50 and infants with shorter gestational age have lower values, e.g. 33 at the 37th week.

[Neonatal evaluation of obstetrical criteria of prematurity]. / Neonatologiczna ocena polozniczych kryteriów wczesniactwa.

Paediatric maturity was assessed in newborns whose birth weight was above or equal to 2500 g, of 1742 women of single pregnancy who delivered vaginally, and in 81 newborns with birth weight below 2500 g, by means of Ballard method. The range of maturity was 39 +/- 3 points of Ballard/Klimek score. There were only 14 newborns with birth weight below 2500 g born before 37 gestational weeks, which is only 30.4% of all newborns with a score below 33 points. The neonatological assessment of physical and neuro-muscular maturity of the newborns, allows to determine the degree of maturity and simultaneously the obstetrical criteria (newborn weight below 2500 g and 37 weeks of pregnancy), indicate only a lower limit of possible maturity.

[Evaluation of treatment results for anemia of prematurity treated with various doses of human recombinant erythropoietin]. / Ocena wyników leczenia niedokrwistosci wczesniaków z zastosowaniem róznych dawek rekombinowanej ludzkiej erytropoetyny.

We evaluated the results of administering recombinant human erythropoietin (rHuEPO) and iron in 19 randomly selected premature infants, who had no infections, did receive oxygen support or aminophylline. rHuEPO was administered intravenously from days to 37 (biweekly) in a dose of 100 U/kg (group I) or 400 U/kg (group II). Also, infants in both groups were supplemented with 10 mg/kg/week of iron intravenously. Seven of 19 infants did not receive either rHuEPO or iron (group III). Infants of all groups had similar birth weights, gestational age and hematocrit, RBC count as well as total and fetal hemoglobin concentrations in blood obtained within the first hour of life. However, infants treated with 400 U/kg of rHuEPO required a significantly (p < 0.04) lower volume of packed erythrocytes in comparison to untreated infants, both between days 7 and 37 of life (18.6 ml vs 46.8 ml; p < 0.04) and between day 7 of life and the day of discharge (35.8 ml vs 94.2 ml; p < 0.04). No difference in neutrophil count, fetal hemoglobin concentration and no toxicity were observed in infants treated with rHuEPO in comparison to untreated prematures.

Factors affecting outcomes in very low birth weight infants treated electively with nasal continuous positive airway pressure.

OBJECTIVE: Although interest in nasal continuous positive airway pressure (nCPAP) to avoid intubation is increasing, there is limited data regarding patient selection and outcome. We sought to determine the baseline parameters associated with failure. STUDY DESIGN: In all, 938 cases of elective nCPAP use were extracted from our registry. Two primary end points, Treatment Failure (need for intubation) and Bad Outcome (death, need for respiratory support at 40 weeks post conceptual age, grade 4 intraventricular hemorrhage or periventricular leucomalacia), and 12 potentially predictive baseline parameters were prospectively defined and evaluated using logistic regression. RESULT: Intubation occurred in 31%, and Bad Outcome occurred in 11%. Besides estimated gestational age (EGA), only a few variables were significant predictors in the multivariate models: Intubation (PaO(2)/FiO(2)<150 or pH< 7.25) and Bad Outcome (FiO(2), low weight for EGA). The relative risk doubled between infants of 34 and 26 weeks EGA and increased by about 50% for those meeting the other criteria. CONCLUSION: We hope these findings will help those using elective nCPAP to refine their practice and those considering its use in establishing reasonable guidelines, as well as be useful for designing clinical research.

Pentoxifylline reduces plasma tumour necrosis factor-alpha concentration in premature infants with sepsis.

UNLABELLED: Increased plasma tumour necrosis factor alpha (TNF) concentration correlates with mortality in sepsis. We suggested that pentoxifylline (PTXF), which is known to inhibit TNF production, may improve survival and attenuate clinical symptoms of sepsis in neonates. Plasma TNF levels were evaluated in 29 newborn infants with sepsis. Patients were randomly assigned into two groups, receiving PTXF in a dose of 5 mg/kg per hour for 6 h or placebo (saline), on 3 successive days. Both groups were subjected to the same conventional therapy. TNF was evaluated before and after PTXF or placebo administration on the 1st and 3rd days of therapy. There was a statistically significant decrease in plasma TNF level in the PTXF group when the values before the first and after the last PTXF infusion were compared [mean: 671.5 pg/ml; SD: 438; med: 729.6 vs mean: 41.0 pg/ml; SD: 64.1; med: 11.5; P < 0.000004]. In the placebo group, decrease was not significant [mean: 633.0 pg/ml SD: 488.6; med: 618.9 vs 246.9 pg/ml; SD: 243.9; med: 191.0]. A significantly higher plasma TNF level, evaluated after the last PTXF infusion, was found in the placebo group [246.9 pg/ml vs 41.0 pg/ml; P < 0.001]. Only one of four infants with signs of shock in the placebo group survived, whereas all of five newborns with symptoms of shock in the PTXF group survived [P < 0.04]. An increased incidence of metabolic acidosis [P < 0.05], necrotizing enterocolitis [P < 0.04] and renal insufficiency [P < 0.05] was observed in infants in the placebo group. CONCLUSION: PTXF inhibits production of TNF and may have therapeutic value in the treatment of premature infants with sepsis complicated by shock.

Effect of pentoxifylline on nitric oxide released by murine macrophages.

The growing knowledge on the pathological role of tumor necrosis factor alpha (TNF-alpha) and nitric oxide in septic shock stimulated efforts to control their generation pharmacologically in clinical situations. Pentoxifylline (PTXF) is well known as an inhibitor of TNF synthesis, whereas information about its role in suppression of NO generation is much less available. In our study, we have shown that PTXF suppresses the synthesis of both mediators, TNF and NO, released by macrophages activated with different stimuli. However, in contrast to N-monomethyl-L-arginine (an inhibitor of NO synthase), PTXF influenced NO generation only during the induction phase. In conclusion, we suggest that a possible new therapeutic approach in septic shock may result from the inhibition of these two major mediators by simultaneous application of PTXF and a specific inhibitor of NO generation. Further experimental investigations and clinical trials are necessary to evaluate the safety and effectiveness of application of these inhibitors.