Factors influencing antibiotic duration in culture-negative neonatal early-onset sepsis.

STUDY OBJECTIVE: Little guidance exists on the treatment duration of culture-negative early-onset sepsis (CN-EOS) in neonates, which may lead to prolonged antimicrobial therapy and adverse outcomes. Our objective was to identify risk factors associated with prolonged antibiotic therapy in CN-EOS in neonates. DESIGN: This was a retrospective, matched cohort study of neonates treated with empiric antibiotic therapy for EOS. Infants were sampled with matching of gestational age (GA) into short (≤3 days) and prolonged (>3 days) antibiotic course. Primary outcomes were to identify predictive factors that may be associated with prolonged therapy and compare rates of late-onset sepsis (LOS) and mortality. Secondary outcomes included necrotizing enterocolitis, feeding intolerance, and early development assessment. Predictors associated with prolonged antibiotic therapy were identified using multivariable-adjusted logistic regression. MEASUREMENTS AND MAIN RESULTS: Three hundred infants were included with 150 infants in each group. Mean GA and birthweights were 34.2 ± 4.7 weeks and 2293 ± 991 g, respectively. Male gender, 5-min Apgar <7, immature-to-total neutrophil ratio ≥0.2, C-reactive protein (CRP) ≥10 mg/L, need for vasopressors, and mechanical ventilation were identified as significant predictors for prolonged antibiotics in all infants. Independent of GA, elevated CRP (OR 40.84, 95% CI 15.28-109.15, p < 0.001), need for vasopressors (OR 13.48, 95% CI 3.86-47.15, p < 0.001), and mechanical ventilation (OR 12.98, 95% CI 4.91-34.35, p < 0.001) remained significant predictors of prolonged antibiotic use. Infants in the prolonged courses experienced significant delays in achieving independent oral feeding compared with infants receiving short-course antibiotics (median 17.5 vs. 8 days, p = 0.002, respectively). There were no significant differences in LOS, mortality, or other neonatal comorbidities. CONCLUSIONS: Elevated CRP levels, need for vasopressors, and mechanical ventilation were associated with prolonged antibiotic use in neonates presumptively treated for CN-EOS. Further research is warranted in identifying selective biomarkers for EOS and evaluating whether early antibiotic discontinuation for CN-EOS, despite abnormal laboratory tests/illness severity, is safe and justified.

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome.

The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

Activities of daily living (ADL) and instrumental activities of daily living (IADL) items were stable over time in a longitudinal study on aging.

OBJECTIVE: The purpose of this analysis was to examine the stability over time of the activities of daily living (ADL) and instrumental activities of daily living (IADL) items in the Aging in Manitoba (AIM) Longitudinal Study and to evaluate the existence of differential item functioning across settings (home, nursing home). STUDY DESIGN AND SETTING: The study used data from 607 participants of the AIM Longitudinal Study who were more than 85 years of age in 1996 and who had complete data from 1983, 1990, and 1996 for all ADL and IADL items. Rasch analysis was used to examine how the rating scale of the ADL and IADL items was used by participants, and to determine if the ordering of items remained stable across three time periods (1983, 1990, 1996) and the two different settings (home, nursing home). RESULTS: The rating scale worked best when dichotomized into "received no assistance" and "receives assistance." Except for four items (making tea, making meals, doing nursing care, and going outside in any weather), the items were stable across administration periods, and across settings. CONCLUSION: The AIM can be used to evaluate changes in disability over time and may have the potential to identify those at risk for transitions in care.

Longitudinal performance of infants with cerebral palsy on the Test of Infant Motor Performance and on the Alberta Infant Motor Scale.

Understanding the natural history of development in children with cerebral palsy (CP) is important for studying the consequences of early intervention. The purpose of this paper is to present results on the Test of Infant Motor Performance (TIMP) from 0-4 months of age and on the Alberta Infant Motor Scale (AIMS) from 3 to 12 months of age in a group of infants later diagnosed as having CP. Ages at which infants with CP were first recognized as having delayed motor performance on each instrument and the stability of performance over time are presented. Clinical implications for using both instruments are discussed.

Influência de fatores de risco biológico nos escores de um teste para detecçäo de paralisia cerebral em crianças pré-termo / Influence of biologic risk factors in the scores of a test for identification of cerebral palsy in preterm newborns

Nesse estudo examinamos o impacto de fatores de risco biológico nos escores do MAI (Movement Assessment of the Infant), que é um teste específico para detecçäo precoce de paralisia cerebral (PC). A amostragem incluiu 170 recém-nascidos pré-termo (idade gestacional < 37 semanas) que frequentavam um programa de acompanhamento do desenvolvimento de crianças de risco. O MAI foi aplicado aos 4 meses de idade, sendo examinada a relaçäo entre o mundo de pontos de risco obtidos no exame e sete variáveis biológicas (sexo, idade gestacional, escores de Apgar, peso ao nascimento, intercorrências neonatais, idade e doenças da mäe). Resultados de regressäo múltipla (stepwise) indicaram que o conjunto de variáveis biológicas contribuiu para explicar uma porçäo modesta (23 porcento), mas significativa, da variaçäo dos escores do MAI. Das sete variáveis examinadas, apenas a idade gestacional, o sexo (masculino) e o número de intercorrências neurológicas contribuiram de maneira significativa para explicar a variância nos escores do MAI. Os resultados indicam o potencial do MAI como instrumento para detecçäo precoce de PC, sendo importante continuar examinando a validade do teste para crianças brasileiras