Determinación y especiación de selenio de leche humana y en fórmulas comerciales: importancia en la nutrición del lactante / Selenium measurement and speciation in human milk and comercial formulae; importance in the nutrition of the infant

Se determina el contenido de selenio en leche humana y en fórmulas lácteas comerciales utilizando una metodología adecuada (espectrometría de masas con fuente de plasma “ICP-MS” al que se incorpora una celda de colisión para eliminar las interferencias poliatómicas “ICP-(ORC)MS”). Se comprueba que el selenio disminuye con el tiempo transcurrido desde el parto en la leche humana de madres con gestación inferior a 37 semanas y que es insuficiente para cubrir los requerimientos de este oligoelemento. Como la biodisponibilidad del selenio varía en relación a las moléculas a las que su une (especies), se utiliza una técnica híbrida (acoplamiento de una columna de cromatolografía de alta resolución “SEC” al espectrómetro de masas con fuente de plasma y celda de colisión “SEC-ICP-(ORC) MS” para conocer las especies existentes en leche humana y en fórmulas lácteas comerciales. Con esta técnica se comprueba que las distintas especies en la leche humana, no varían de forma significativa ni en relación al tiempo transcurrido desde el parto ni en relación a la duración de la gestación. Sin embargo, se encontraron diferencias significativas entre la especiación de selenio en leche de madres con parto pretérmino (antes de las 37 semanas de gestación) y en fórmulas lácteas comerciales para el recién nacido prematuro. Por último se postula la necesidad de verificar la biodisponiblidad de las diferentes especies de selenio, para así, proponer la más adecuada en la suplementación de fórmulas lácteas comerciales (AU)

The selenium content in human milk and in comercial formulae is measured using an appropriate methodology (mass spectrometry with plasma source, “ICP-MC”) to which a colision cell is added in order to eliminate polyatomic interferences “ICP-(ORC)MS”). It was verified that selenium decrease according to the time from delivery in the human milk of the mother with a pregnancy of less than 37 weeks and Is insufficient to cover the requirements of this oligoelement. As the bioavailability of selenium varies in relationship to the molecules to which it is bond (species),, a hybrid technique (high resolution chromatography column coupling “SEC” to the mass spectrometer with plasma source and collision cell “SEC-ICP-(ORC)MS”) to know the species existing in the human milk and in commercial lactic acid formulae. It ahs been verified with this technique that there is no significant variation regarding the time from delivery or the relationship to the duration of the pregnancy in the different species of human milk. However, significant differences were found between the selenium speciation in the milk of mothers having preterm delivery (before 37 weeks of pregnancy) and in commercial lactic acid formulae for the premature newborn. Finally, the need to verify the bioavailability of the different selenium species has been postulated in order to propose the most adequate in the commercial lactic acid formulae supplementation (AU)

[Spanish multidisciplinary consensus on the prevention of respiratory syncytial virus infection in children]. / Consenso multidisciplinar español sobre la profilaxis de la infección respiratoria pediátrica por virus respiratorio sincitialConsenso.

BACKGROUND: A certain degree of feasibility exists in Spanish clinical practice with respect to interventions performed to prevent paediatric respiratory infection by RSV, including hygienic measures and intramuscular immunoprophylaxis with palivizumab. This task involves different paediatric specialties that may have a different perception of the magnitude of the problem and different professional criteria regarding the most appropriate actions. OBJECTIVES: To develop Spanish multidisciplinary consensus on preventing infection by RSV with the participation of the paediatric scientific societies involved (SNS, SSPC, SSPP and SSHPO). METHODS: Delphi Consensus modified in two rounds was used. The study was conducted in four phases: 1) constitution of a multidisciplinary Scientific Committee at the recommendation of the scientific entities participating in the study, for bibliographic review and submission of the recommendations to discussion; 2) constitution of an Expert Panel with 77 speciality representatives; 3) postal survey organised in two rounds and intermediate processing of opinions and issuing of a report for the panellists, and 4) discussion of the results in a meeting of the Scientific Committee. RESULTS: Consensus was reached on 48 of the 57 preventive recommendations analysed. With respect to the 9 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Only in 3 recommendations was the opinion of the experts associated with the speciality of origin. CONCLUSIONS: A list of anti-RSV prophylactic recommendations was submitted, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a review thereof.

Consenso multidisciplinar español sobre la profilaxis de la infección respiratoria pediátrica por virus respiratorio sincitial. Consenso / Spanish multidisciplinary consensus on the prevention of respiratory syncytial virus infection in children

Antecedentes: Existe cierta variabilidad de práctica clínica en España sobre las intervenciones preventivas para evitar la infección respiratoria infantil por el virus respiratorio sincitial (VRS), entre las que se incluyen medidas higiénicas e inmunoprofilaxis intramuscular con palivizumab. Esta tarea implica varias especialidades pediátricas, que pueden tener distinta percepción de la magnitud del problema y distinto criterio profesional sobre las actuaciones apropiadas. Objetivos: Desarrollar un consenso multidisciplinar español sobre la prevención de la infección por VRS, con participación de las sociedades científicas pediátricas implicadas: Sociedad Española de Neonatología (SEN), Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC), Sociedad Española de Neumología Pediátrica (SENP) y Sociedad Española de Hematología y Oncología Pediátrica (SEHOP). Métodos: Consenso Delphi modificado en dos rondas. El estudio se efectuó en cuatro fases: 1) constitución de un comité científico multidisciplinar, a propuesta de las sociedades científicas participantes, para la revisión bibliográfica y formulación de las recomendaciones a debate; 2) constitución de un panel experto con 77 representantes de las especialidades; 3) encuesta postal en dos rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Se consensúan 48 de las 57 recomendaciones preventivas analizadas. En las nueve cuestiones restantes no se consigue acuerdo, bien por disparidad de opinión profesional, bien por falta de criterio establecido en la mayoría de los expertos. Sólo en tres recomendaciones, la opinión de los expertos se asocia a la especialidad de procedencia. Conclusiones: Se presenta una lista de recomendaciones profilácticas anti-VRS, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que indique su revisión (AU)

Background: A certain degree of feasibility exists in Spanish clinical practice with respect to interventions performed to prevent paediatric respiratory infection by RSV, including hygienic measures and intramuscular immunoprophylaxis with palivizumab. This task involves different paediatric specialties that may have a different perception of the magnitude of the problem and different professional criteria regarding the most appropriate actions. Objectives: To develop Spanish multidisciplinary consensus on preventing infection by RSV with the participation of the paediatric scientific societies involved (SNS, SSPC, SSPP and SSHPO). Methods: Delphi Consensus modified in two rounds was used. The study was conducted in four phases: 1) constitution of a multidisciplinary Scientific Committee at the recommendation of the scientific entities participating in the study, for bibliographic review and submission of the recommendations to discussion; 2) constitution of an Expert Panel with 77 speciality representatives; 3) postal survey organised in two rounds and intermediate processing of opinions and issuing of a report for the panellists, and 4) discussion of the results in a meeting of the Scientific Committee. Results: Consensus was reached on 48 of the 57 preventive recommendations analysed. With respect to the 9 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Only in 3 recommendations was the opinion of the experts associated with the speciality of origin. Conclusions: A list of anti-RSV prophylactic recommendations was submitted, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a review there of (AU)

[Procalcitonin for the diagnosis of neonatal sepsis of vertical transmission]. / Procalcitonina para el diagnóstico de sepsis neonatal de transmisión vertical.

OBJECTIVE: To evaluate procalcitonin (PCT) as a diagnostic marker of neonatal sepsis of vertical transmission and to compare the results of PCT with those of the most widely used laboratory tests for sepsis. PATIENTS AND METHODS: A prospective study was conducted in 136 blood samples from 69 newborn infants admitted to a neonatal department. PCT, C-reactive protein (CRP), leukocyte count, and the immature-to-total neutrophil ratio (I/T ratio) were measured. The PCT reference range of controls from 0 to 72 hours of life was constructed, and the diagnostic efficiency of the tests was calculated, with their 95 % confidence intervals (95 % CI). RESULTS: This study included 35 controls, 24 neonates with noninfectious disorders, and 10 neonates with sepsis (5 with culture-proven sepsis). PCT, CRP, and the I/T ratio discriminated septic from nonseptic patients. Their areas under the ROC curve were 0.696 (p = 0.009), 0.735 (p = 0.002), and 0.703 (p = 0.006), respectively, with no statistically significant differences. The accuracy of PCT, CRP, and leukocyte count improved after 24 hours of life with areas under the ROC curve of 0.813 (p = 0.007), 0.826 (p = 0.005), and 0.841 (p = 0.003), respectively. Overall, PCT detected vertically transmitted sepsis with a sensitivity of 68.4 % (95 % CI: 46.0 %-84.6 %), specificity of 82.4 % (95 % CI: 72.2 %-89.4 %), positive likelihood ratio of 3.89 (95 % CI: 2.18 %-6.96 %), and negative likelihood ratio of 0.38 (95 % CI: 0.19 %-0.76 %), similar to those of CRP. CONCLUSIONS: PCT may be a useful marker for the diagnosis of vertically transmitted sepsis. Studies with larger sample sizes are required to establish the accuracy of PCT.

[Procalcitonin for the diagnosis of nosocomial neonatal sepsis]. / Procalcitonina para el diagnóstico de sepsis neonatal de origen nosocomial.

BACKGROUND: Nosocomial sepsis is a major problem in neonatal units. Because the clinical signs are nonspecific, highly reliable diagnostic markers are required to guide diagnosis. The aim of this study was to evaluate the utility of procalcitonin (PCT) as a diagnostic marker for nosocomial neonatal sepsis, and to compare the results of PCT with those of the most widely used laboratory tests for sepsis. PATIENTS AND METHODS: Twenty neonates with nosocomial sepsis and 20 controls aged 4-30 days were included in a prospective study performed in a neonatal intensive care unit. PCT, C-reactive protein (CRP), leukocyte count, and the immature-to-total neutrophil ratio (I/T ratio) were measured at onset of signs of infection. The sensitivity, specificity, and likelihood ratio for a positive (LR+) and a negative (LR-) result were calculated. RESULTS: PCT, CRP, and the I/T ratio discriminated septic from nonseptic patients. Their areas under the ROC curve were 0.849, 0.880, and 0.884, respectively, with no statistically significant differences. Optimal cut-off values were: PCT > or = 0.65 ng/ml (sensitivity 85 %, specificity 80 %, LR 1 4.25, LR- 0.19), PCR > or = 5 .g/ml (sensitivity 80 %, specificity 95 %, LR 1 16, LR- 0.21), and I/T > or = 0.03 (sensitivity 90 %, specificity 75 %, LR 1 3.6, LR- 0.13). CONCLUSIONS: PCT may be a useful marker for the diagnosis of nosocomial neonatal sepsis. Studies with larger samples are required to compare the accuracy of PCT with that of other markers of sepsis.

Procalcitonina para el diagnóstico de sepsis neonatal de transmisión vertical / Procalcitonin for the diagnosis of neonatal sepsis of vertical transmission

Objetivo: Evaluar la utilidad de la procalcitonina (PCT) para el diagnóstico de sepsis neonatal de transmisión vertical y comparar sus resultados con los marcadores de sepsis más utilizados. Pacientes y métodos: Estudio prospectivo sobre 136 muestras de 69 recién nacidos ingresados en un servicio de neonatología. Se midieron la PCT, proteína C reactiva (PCR), recuento leucocitario e índice de neutrófilos inmaduros/totales (índice I/T). Se construyó el rango de normalidad de la PCT entre 0 y 72 h de vida y se calculó la eficacia diagnóstica de los marcadores de infección estudiados con sus intervalos de confianza del 95 % (IC 95 %). Resultados: Se incluyeron 35 controles, 24 neonatos con procesos no infecciosos y 10 diagnosticados de sepsis (cinco con confirmación bacteriológica). PCT, PCR e índice I/T mostraron capacidad diagnóstica, con áreas bajo la curva COR de 0,696 (p 5 0,009), 0,735 (p 5 0,002) y 0,703 (p 5 0,006), respectivamente, sin diferencias estadísticamente significativas. El rendimiento mejoró a partir de las 24 h de vida para PCT, PCR y recuento leucocitario, con áreas bajo la curva COR de 0,813 (p 5 0,007), 0,826 (p 5 0,005) y 0,841 (p 5 0,003), respectivamente. Globalmente la PCT detectó sepsis de transmisión vertical con sensibilidad del 68,4 % (IC 95 %: 46,0-84,6), especificidad 82,4 % (IC 95 %: 72,2-89,4), cociente de probabilidades del positivo 3,89 (IC 95 %: 2,18-6,96) y cociente de probabilidades del negativo 0,38 (IC 95 %: 0,19-0,76), similares a la PCR. Conclusiones: La PCT puede ser una herramienta útil para el diagnóstico de sepsis de transmisión vertical. Es necesario disponer de estudios con mayor número de pacientes

Objective: To evaluate procalcitonin (PCT) as a diagnostic marker of neonatal sepsis of vertical transmission and to compare the results of PCT with those of the most widely used laboratory tests for sepsis. Patients and Methods: A prospective study was conducted in 136 blood samples from 69 newborn infants admitted to a neonatal department. PCT, C-reactive protein (CRP), leukocyte count, and the immature-to-total neutrophil ratio (I/T ratio) were measured. The PCT reference range of controls from 0 to 72 hours of life was constructed, and the diagnostic efficiency of the tests was calculated, with their 95 % confidence intervals (95 % CI). Results: This study included 35 controls, 24 neonates with noninfectious disorders, and 10 neonates with sepsis (5 with culture-proven sepsis). PCT, CRP, and the I/T ratio discriminated septic from nonseptic patients. Their areas under the ROC curve were 0.696 (p 5 0.009), 0.735 (p 5 0.002), and 0.703 (p 5 0.006), respectively, with no statistically significant differences. The accuracy of PCT, CRP, and leukocyte count improved after 24 hours of life with areas under the ROC curve of 0.813 (p 5 0.007), 0.826 (p 5 0.005), and 0.841 (p 5 0.003), respectively. Overall, PCT detected vertically transmitted sepsis with a sensitivity of 68.4 % (95 % CI: 46.0 %-84.6 %), specificity of 82.4 % (95 % CI: 72.2 %-89.4 %), positive likelihood ratio of 3.89 (95 % CI: 2.18 %-6.96 %), and negative likelihood ratio of 0.38 (95 % CI: 0.19 %-0.76 %), similar to those of CRP. Conclusions: PCT may be a useful marker for the diagnosis of vertically transmitted sepsis. Studies with larger sample sizes are required to establish the accuracy of PCT

Procalcitonina para el diagnóstico de sepsis neonatal de origen nosocomial / Procalcitonin for the diagnosis of nosocomial neonatal sepsis

Antecedentes: La sepsis nosocomial supone una de las mayores preocupaciones en las unidades de neonatología y, dada la falta de especificidad de sus síntomas, se hacen necesarias pruebas complementarias muy fiables para orientar el diagnóstico. El objetivo de este estudio es evaluar la utilidad de la procalcitonina (PCT) para el diagnóstico de sepsis neonatal de origen nosocomial y comparar sus resultados con los marcadores de sepsis más utilizados. Pacientes y métodos: Estudio prospectivo realizado en una unidad de cuidados intensivos neonatales. Se incluyeron 20 casos de sepsis nosocomial y 20 controles de entre 4 y 30 días de vida. Se midieron la PCT, proteína C reactiva (PCR), recuento leucocitario e índice de neutrófilos inmaduros/totales (índice I/T) en el momento de la sospecha de sepsis. Se calculó la sensibilidad, especificidad, valores predictivos y cocientes de probabilidades del positivo (CPP) y del negativo (CPN) de los marcadores de infección estudiados. Resultados: PCT, PCR e índice I/T mostraron capacidad diagnóstica, con áreas bajo la curva COR de 0,849, 0,880 y 0,884, respectivamente, sin diferencias estadísticamente significativas. Los puntos de corte óptimos fueron: PCT >= 0,65 ng/ml (sensibilidad 85%; especificidad 80%; CPP 4,25; CPN 0,19), PCR >= 5 mg/ml (sensibilidad 80%; especificidad 95%; CPP 16; CPN 0,21) e índice I/T >= 0,03 (sensibilidad 90%; especificidad 75%; CPP 3,6; CPN 0,13). Conclusiones: La PCT puede ser una herramienta útil para el diagnóstico de sepsis nosocomial en neonatos, aunque es necesario disponer de estudios con mayor número de pacientes para poder comparar su rendimiento con el de otros marcadores de sepsis neonatal

Background: Nosocomial sepsis is a major problem in neonatal units. Because the clinical signs are nonspecific, highly reliable diagnostic markers are required to guide diagnosis. The aim of this study was to evaluate the utility of procalcitonin (PCT) as a diagnostic marker for nosocomial neonatal sepsis, and to compare the results of PCT with those of the most widely used laboratory tests for sepsis. Patients and Methods: Twenty neonates with nosocomial sepsis and 20 controls aged 4-30 days were included in a prospective study performed in a neonatal intensive care unit. PCT, C-reactive protein (CRP), leukocyte count, and the immature-to-total neutrophil ratio (I/T ratio) were measured at onset of signs of infection. The sensitivity, specificity, and likelihood ratio for a positive (LR1) and a negative (LR­) result were calculated. Results: PCT, CRP, and the I/T ratio discriminated septic from nonseptic patients. Their areas under the ROC curve were 0.849, 0.880, and 0.884, respectively, with no statistically significant differences. Optimal cut-off values were: PCT >= 0.65 ng/ml (sensitivity 85 %, specificity 80 %, LR 1 4.25, LR­ 0.19), PCR >= 5 mg/ml (sensitivity 80 %, specificity 95 %, LR 1 16, LR­ 0.21), and I/T >= 0.03 (sensitivity 90 %, specificity 75 %, LR 1 3.6, LR­ 0.13). Conclusions: PCT may be a useful marker for the diagnosis of nosocomial neonatal sepsis. Studies with larger samples are required to compare the accuracy of PCT with that of other markers of sepsis

Sepsis nosocomial por Hafnia alvei en una unidad de cuidados intensivos neonatales / Nosocomial Hafnia alvei sepsis in a neonatal intensive care unit

Hafnia alvei es un miembro de la familia Enterobacteriaceae raramente relacionado con procesos infecciosos en pediatría y, de manera excepcional, en el período neonatal. Produce infecciones fundamentalmente como germen oportunista. Los cuadros de bacteriemia se relacionan en su gran mayoría con enfermedades abdominales o inmunodepresión. Presentamos cuatro pacientes con sepsis neonatal nosocomial en pacientes prematuros, sin patología o cirugía abdominal previa, con hemocultivos positivos a H. alvei, tratados en nuestro centro en un corto espacio de tiempo (AU)

[Nosocomial Hafnia alvei sepsis in a neonatal intensive care unit]. / Sepsis nosocomial por Hafnia alvei en una unidad de cuidados intensivos neonatales.

Hafnia alvei is a member of the Enterobacteriaceae family, which is rarely associated with infection in pediatric patients and exceptionally in the neonatal period. Infections caused by this organism are usually opportunistic. H. alvei bacteremias are mostly associated with abdominal disease or immunosuppression. We report four cases of nosocomial sepsis in preterm infants with positive blood cultures to H. alvei that were treated in our institution within a short period of time.

Síndrome de megavejiga-microcolon-hipoperistaltismo intestinal / Megabladder-microcolon-intestinal hypoperistaltism syndrome

El síndrome de megavejiga-microcolon-hipoperistaltismo intestinal es una causa rara, grave y congénita de obstrucción intestinal funcional neonatal que además puede llevar asociadas otras alteraciones. Actualmente sigue siendo difícil el diagnóstico prenatal de certeza y debe hacerse diagnóstico diferencial con problemas obstructivos. Al nacimiento se presenta con clínica de obstrucción intestinal y retención urinaria, precisando de pruebas complementarias para la confirmación diagnóstica. En el manejo de estos pacientes es fundamental el soporte nutricional que en muchas ocasiones se basa en nutrición parenteral durante largos periodos de tiempo. A pesar de la mejoría en la asistencia a estos pacientes, este síndrome sigue presentando una elevada morbilidad y mortalidad siendo el trasplante intestinal una alternativa terapéutica. Se presenta a continuación el caso de un paciente que actualmente tiene 6 meses y recibe nutrición enteral a débito continuo suplementada con nutrición parenteral domiciliaria con buena ganancia ponderal y aceptable calidad de vida (AU)

Deleción terminal del 11q (síndrome de Jacobsen) asociada a atresia duodenal con páncreas anular / Deletion 11q23-qter (jacobsen syndrome) associated with duodenal atresia and annular pancreas

El síndrome de Jacobsen es una cromosomopatía infrecuente, causada por una deleción terminal del brazo largo del cromosoma 11. Los principales rasgos clínicos son el retraso psicomotor y del crecimiento, trigonocefalia y dismorfia facial característica, pero existen muchas alteraciones asociadas. Presentamos el caso de un neonato pretérmino con sospecha ecográfica prenatal de atresia duodenal. Al nacimiento presentaba rasgos craneofaciales típicos del síndrome de Jacobsen, equimosis y petequias generalizadas y pies zambos. En el hemograma se objetivó pancitopenia. La ecografía abdominal mostró agenesia renal izquierda y confirmó la atresia duodenal. La tomografía computarizada (TC) cerebral y el electroencefalograma (EEG) fueron normales, así como el estudio cardiológico. En la intervención quirúrgica de la atresia duodenal se observó la presencia de un páncreas anular. El cariotipo fue 46, XY, del (11)(q23.2 qter), con lo cual se confirmó el diagnóstico de síndrome de Jacobsen. Los distintos rasgos clínicos asociados al síndrome de Jacobsen se relacionan con el fragmento cromosómico delecionado. Nuestro paciente presenta atresia duodenal con páncreas anular, manifestación no descrita previamente en la bibliografía (AU)

[Deletion 11q23 --> qter (Jacobsen Syndrome) associated with duodenal atresia and annular pancreas]. / Deleción terminal del 11q (síndrome de Jacobsen) asociada a atresia duodenal con páncreas anular.

Jacobsen syndrome is a rare chromosomal disorder due to terminal 11q deletion. Prominent features are growth and psychomotor retardation, trigonocephaly and a characteristic facial dysmorphism, but many different abnormalities have been reported. We present the case of a preterm male. Prenatal ultrasonography was suspicious for duodenal atresia. At birth, the boy presented the craniofacial features typical of Jacobsen syndrome, together with diffusely spread petechiae and talipes equinovarus. Hemogram revealed pancytopenia. Ultrasound examination showed left renal agenesis and confirmed the duodenal atresia. Cerebral computed tomography scan, electroencephalogram and cardiac studies showed no abnormalities. Annular pancreas was found during surgery to correct the duodenal atresia. The karyotype was 46,XY,del(11)(q23.2 --> qter), which confirmed Jacobsen syndrome.A wide spectrum of clinical features is described in Jacobsen syndrome, with phenotype-karyotype correlation. This is the first report of duodenal atresia and annular pancreas.

Reflexiones en torno a la infección en el recién nacido / Reflecions on infection in the newborn

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Neonatal sepsis of nosocomial origin: an epidemiological study from the "Grupo de Hospitales Castrillo".

A prospective multicenter study was designed to assess the frequency, etiology, and mortality of nosocomial neonatal sepsis diagnosed between 1996 and 1997 in the neonatology services of 27 acute-care hospitals in Spain ("Grupo de Hospitales Castrillo"). Nosocomial sepsis is defined in the literature using chronological criteria (> 3-7 days of life at the onset of symptoms); accordingly, there is the possibility of including late-onset maternally acquired sepsis or of excluding early-onset nosocomial sepsis (< 3-7 days of life). For these reasons, in this study, cases of nosocomial sepsis that developed at < or = 3-7 days after birth (early onset) were also recorded and maternally acquired sepsis diagnosed beyond 3-7 days of life were excluded. Using these criteria in a total of 30,993 admissions to the neonatal units of the participating hospitals, the nosocomial sepsis rate was 2.1% with an incidence density of 0.89 per 1000 patient days. Sepsis rate was significantly more frequent among very low birth weight (VLBW) infants (15.6%) than among those weighing > or = 1500 g (1.16%) (P < 0.001). Fifty-eight percent of all isolates were Gram-positive organisms, mainly Staphylococcus epidermidis (42%). Gram-negative organisms were isolated in 29.5% of cases (Escherichia coli and Klebsiella spp. were the most commonly isolated pathogens) and fungal infections in 12%, with absolute predominance of Candida spp. The overall mortality rate was 11.8% and the following subgroups had significantly higher (P < 0.001) mortality rates: sepsis caused by Gram-negative organisms (19% vs. 5.1% in Gram-positive pathogens) and sepsis caused by Pseudomonas aeruginosa (33.3% vs. 9.4% for the total number of sepsis caused by the remaining causative pathogens). Sepsis caused by S. epidermidis showed a significantly lower mortality rate (5.5%) compared with overall sepsis for the remaining etiologies (14.2%) (P < 0.001). In VLBW infants, the mortality rate was significantly higher than in infants weighing > 1500 g (17.3% vs. 6.5%, P < 0.001).