Perinatal Outcomes of Late Preterm Rupture of Membranes with or without Latency Antibiotics.

OBJECTIVE: This study aimed to examine whether the addition of latency antibiotics in late preterm rupture of membranes (ROM) decreases neonatal infection and increases latency. STUDY DESIGN: This retrospective two-center study was conducted at Holy Family Hospital (HFH) in Nazareth and Emek Medical Center (EMC) in Afula, on data collected between January 2017 and April 2023. HFH is the smaller institution. EMC and HFH implement similar policies regarding ROM at 340/7 to 366/7 weeks' gestation; the only difference is that a 10-day course of latency antibiotics is implemented at EMC. All women with ROM between 340/7 and 366/7 weeks' gestation who were admitted to one of the centers during the study period, and had a live fetus without major malformations, were included. The primary outcome was neonatal sepsis rate. Secondary outcomes included a composite of neonatal sepsis, mechanical ventilation ≥24 hours, and perinatal death. Additionally, gestational age at delivery and delivery mode were examined. RESULTS: Overall, 721 neonates were delivered during the study period: 534 at EMC (where latency antibiotics were administered) and 187 at HFH. The gestational age at ROM was similar (35.8 and 35.9 weeks, respectively, p = 0.14). Neonatal sepsis occurred in six (1.1%) neonates at EMC and one (0.5%) neonate at HFH (adjusted p = 0.71; OR: 1.69; 95% Confidence Interval [CI]: 0.11-27.14). The composite secondary outcome occurred in nine (1.7%) and three (1.6%) neonates at EMC and HFH, respectively (adjusted p = 0.71; OR: 0.73; 95% CI: 0.14-3.83). The gestational age at delivery was 36.1 and 36.2 weeks at EMC and HFH, respectively (mean difference: 5 h; adjusted p = 0.02). The cesarean delivery rate was 24.7% and 19.3% at EMC and HFH, respectively (adjusted p = 0.96). CONCLUSION: Latency antibiotics administered to women admitted with ROM between 340/7 and 366/7 weeks' gestation did not decrease the rate of neonatal sepsis. KEY POINTS: · Latency antibiotics in late preterm ROM does not decrease neonatal sepsis.. · Latency antibiotics in late preterm ROM does not prolong gestational age at delivery.. · Latency antibiotics in late preterm ROM does not affect the mode of delivery..

Reducing Neonatal Hypothermia in Premature Infants in an Israeli Neonatal Intensive Care Unit.

BACKGROUND: Neonatal hypothermia (< 36°C) has been associated with both neonatal morbidity and mortality. OBJECTIVES: To develop a multifactorial approach to reduce the incidence of neonatal hypothermia at admission to the neonatal intensive care unit. METHODS: The approach involved a detailed quality improvement (QI) plan, which included the use of occlusive wrapping and exothermic mattresses as well as higher delivery and operating room environmental temperatures. The improvement plan was implemented over a 10-month period. Retrospective comparison to the same 10-month period during the previous year assessed the effectiveness of the approach in reducing the incidence of admission hypothermia. RESULTS: The QI project included 189 patients. These patients were compared to 180 patients during the control period. The characteristics of the patient groups were similar and included preterm infants, who were subsequently analyzed as a subgroup. We found a significant reduction in the incidence of hypothermia, which was most profound for the subgroup of premature infants born at < 32 weeks gestation. Neonatal hyperthermia was identified as an unintended consequence of the project, and subsequently improved after initiating simple preventive measures. CONCLUSIONS: Occlusive wrapping, exothermic mattresses, and higher delivery and operating room environmental temperature may be successful in reducing admission neonatal hypothermia.

[THE PREVALENCE OF SUBCLINICAL MYOCARDITIS AMONG YOUNG CHILDREN WITH ACUTE VIRAL INFECTION].

BACKGROUND: Viruses are the most prevalent ausative agents of myocarditis in young children. Studies have shown acute myocarditis in post mortem examinations during viral disease outbreaks. The aims of this study are to assess the prevalence of and risk factors for subclinical acute myocarditis in young children hospitalized with an acute viral disease. OBJECTIVES: Evaluation of the prevalence of asymptomatic myocarditis or decrease in heart functions during viral infection. METHODS: A prospective study was conducted between 1st January and 30th September, 2009. The study included 45 children 3-60 months old hospitalized with febrile illness with no clinical or microbiological evidence of acute bacterial infection. Serum levels of troponin were obtained, and ECG and echocardiography were performed in all the children. Parameters that determined myocarditis included: (1) ECG ST-T changes suggestive of myocarditis; (2) Increased serum troponin level; (3) Echocardiography findings including: shortening fraction less than 28%, left ventricle end diastolic diameter > than 2 standard deviations for age, abnormal mitral valve incompetence, or abnormal diastolic function. Clinical and epidemiological data were analyzed in order to determine parameters related to findings suggestive of silent acute myocarditis. RESULTS: In 16 (35%) children at least one parameter, and in 7 (16%) at least 2 parameters of acute myocarditis were found. Impaired diastolic function was found in 11 cases (69%), ECG changes in 5 children (35%, left ventricle dilatation in 4 (25%), and decreased shortening fraction in 3 cases (18%]. Other symptoms and signs of myocarditis were not found in any of the 16 children, and no clinical or epidemiological parameter was significantly associated with silent myocarditis. CONCLUSIONS: In a third of the patients, some evidence of myocardial dysfunction was documented. In seven of them (16% of all cases), there were two different categories of myocardial dysfunction. Those cases are suspected to be silent acute myocarditis. No clinical and epidemiological parameters associated with the disease were found. The clinical importance of this phenomenon should be determined by a long-term follow-up study. SUMMARY: In this preliminary study, we found a high prevalence of cardiac involvement in hospitalised children with viral infections. It seems that this cardiac involvement is due to acute sub-clinical myocarditis. The importance of these findings should be evaluated.

Investigating human microskin grafting technique in a new experimental model.

BACKGROUND: Microskin graft technique is a possible solution for treating major burns. The goal of this study was to investigate microskin graft techniques using a new model of grafting human skin onto athymic nude mice. MATERIALS AND METHODS: Twenty female nude mice were randomly divided into a research group and a control group (14 mice in the research group, six in the control group). On the 11th day after the procedure, the following parameters were investigated: percentage of epithelial coverage, degree of contracture, thickness of the epidermis, thickness of the dermis, number of blood vessels, number of melanocytes. RESULTS: The healing rate (epithelial coverage) of the wounds was an average of 100% (+/-0%) in the control group and 97% (+/-5%) in the research group (P>0.05). The average degree of wound contraction in the control group was 30% compared to 63% in the research group (P<0.01). The average thickness of the epidermis formed at the grafted site was 8.17 (+/-1.94)microm in the control group compared to 4.45 (+/-4.17)microm in the research group, at the wound margins (P>0.05). CONCLUSION: We found that the microskin graft, created by grinding a sheet of human skin, remained vital, and tissue of human origin was present at the grafted site. Our study shows that this novel method is feasible and has the advantage of enabling investigation of human skin on an animal model. Significant contracture appears to be a drawback of this technique, and we feel that the method should be improved before its clinical application on patients.

Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis.

AIM: We evaluated the use of computerized quantification of wheezing and crackles compared to a clinical score in assessing the effect of inhaled albuterol or inhaled epinephrine in infants with RSV bronchiolitis. METHODS: Computerized lung sounds analysis with quantification of wheezing and crackles and a clinical score were used during a double blind, randomized, controlled nebulized treatment pilot study. Infants were randomized to receive a single dose of 1 mgr nebulized l-epinephrine or 2.5 mgr nebulized albuterol. Computerized quantification of wheezing and crackles (PulmoTrack) and a clinical score were performed prior to, 10 minutes post and 30 minutes post treatment. Results were analyzed with Student's t-test for independent samples, Mann-Whitney U test and Wilcoxon test. RESULTS: 15 children received albuterol, 12 received epinephrine. The groups were identical at baseline. Satisfactory lung sounds recording and analysis was achieved in all subjects. There was no significant change in objective quantification of wheezes and crackles or in the total clinical scores either within the groups or between the groups. There was also no difference in oxygen saturation and respiratory distress. CONCLUSION: Computerized lung sound analysis is feasible in young infants with RSV bronchiolitis and provides a non-invasive, quantitative measure of wheezing and crackles in these infants.