Neonatal listeriosis in the UK 2004-2014.

OBJECTIVE: To define the clinical features and outcomes of neonatal listeriosis, and identify the maternal risk factors to seek scope for improvement. METHODS: Neonatal listeriosis was identified prospectively from a United Kingdom neonatal infection surveillance network (neonIN) between 2004 and 2014. The participating neonatal units completed a study-specific proforma. RESULTS: The incidence of neonatal listeriosis was 3.4 per 100,000 live births. Of the 21 cases identified, 19 were confirmed with a median gestational age of 33 weeks and a median birth weight of 1960 g. The majority had clinical features (95%, 18/19), presented within the first 24 h (95%, 18/19), and received penicillin empirically (94%, 18/19). The neonatal case-fatality rate was 21% (24% if probable cases were included). A proportion of mothers were investigated (60%, 12/18) and diagnosed with listeriosis (58%, 7/12); 32% (6/19) were treated with antibiotics but only 33% (6/12) included penicillin. DISCUSSION: Despite its rarity and the prompt and appropriate use of antibiotics neonatal listeriosis has a high case-fatality rate. There is room for improvement in the adherence to the empiric antibiotic choice for puerperal sepsis, according to the national guidelines as this, would target listeriosis. Strategies should be in place to prevent pregnancy-associated listeriosis in higher risk population.

Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants.

OBJECTIVE: To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO2) in maintaining arterial oxygen saturation (SpO2) within a higher (91%-95%) and a lower (89%-93%) target range in preterm infants. STUDY DESIGN: Eighty preterm infants (gestational age [median]: 26 weeks, age [median] 18 days) on noninvasive (n = 50) and invasive (n = 30) respiratory support with supplemental oxygen, were first randomized to one of the SpO2 target ranges and then treated with automated FiO2 (A-FiO2) and manual FiO2 (M-FiO2) oxygen control for 24 hours each, in random sequence. RESULTS: The percent time within the target range was higher during A-FiO2 compared with M-FiO2 control. This effect was more pronounced in the lower SpO2 target range (62 ± 17% vs 54 ± 16%, P < .001) than in the higher SpO2 target range (62 ± 17% vs 58 ± 15%, P < .001). The percent time spent below the target or in hypoxemia (SpO2 <80%) was consistently reduced during A-FiO2, independent of the target range. The time spent above the target range or at extreme hyperoxemia (SpO2 >98%) was only reduced during A-FiO2 when targeting the lower SpO2 range (89%-93%). These outcomes did not differ between infants on noninvasive and invasive respiratory support. Manual adjustments were significantly reduced during A-FiO2 control. CONCLUSIONS: A-FiO2 control improved SpO2 targeting across different SpO2 ranges and reduced hypoxemia in preterm infants on noninvasive and invasive respiratory support. TRIAL REGISTRATION: ISRCTN 56626482.

Antenatal corticosteroids and neonatal outcomes according to gestational age: a cohort study.

OBJECTIVE: To see whether there was any difference in the effect of antenatal corticosteroids on neonatal outcomes according to different gestational ages at birth. METHODS: This was a prospective cohort study in a geographically defined population (Trent region, UK). All infants admitted for neonatal care, of 23-32 weeks' gestation, born to Trent resident mothers over the 15-year period between 1993 and 2007 were included. Antenatal corticosteroid treatment was given to pregnant women at risk of preterm birth. The primary outcome was survival until discharge from neonatal unit. Secondary outcomes included length of stay on the neonatal unit, duration of artificial respiratory support (mechanical ventilation and continuous positive airway pressure (CPAP)) and chronic lung disease (CLD). RESULTS: The overall mortality among babies born between 24 and 29 weeks with maternal steroids was lower (n=850 out of 4370; 19.4%) as compared to their counterparts whose mothers did not receive steroids (n=323 out of 920; 35.1%) The gestation-specific mortality figures (%) in the steroid treated group between 24 and 29 weeks' gestation were 61.5, 36.9, 28.5, 17.5, 10.2 and 5.1, respectively, and this was significantly lower than the group without steroid treatment. There was a 9.9% reduction in mortality among babies born at 23 weeks' gestation in the steroid treated group (n=81 out of 102; 79.4%) compared to the non-steroid group (n=75 out of 84; 89.3%), but this did not reach statistical significance (p=0.068). There was no significant effect of antenatal steroid treatment on length of stay, duration of respiratory support and CLD among infants who survived until discharge. There was no trend in survival in the two groups over the 15-year study period. CONCLUSIONS: Antenatal corticosteroid treatment is associated with improved survival in babies born between 24 and 29 weeks' gestation. This, however, does not lead to any significant improvements in length of stay, duration of respiratory support and CLD among survivors.

Surfactant respiratory therapy using Surfaxin/sinapultide.

Respiratory distress syndrome (RDS) is a leading cause of mortality and morbidity in preterm infants. Surfactant replacement therapy has been widely used to prevent and treat RDS in these newborns and has now become a standard of care. First-generation synthetic surfactants such as Exosurf did not contain any surfactant protein. This disadvantage was overcome with animal-derived surfactant preparations which contain specific proteins but has the limitation of being derived from animal sources. This has led to development of newer synthetic surfactants such as lucinactant (Surfaxin, Discovery Laboratories, Philadelphia) which contains the protein B mimic synthetic peptide, sinapultide. Recent phase 3 clinical trials with Surfaxin show promising results with similar efficacy as animal derived surfactants and yet avoiding the disadvantage associated with animal products. The purpose of this paper is to summarise results of recent clinical trials of Surfaxin use in newborns with RDS.

Chronic lung disease of prematurity and intrauterine growth retardation: a population-based study.

OBJECTIVE: To determine the risk of chronic lung disease (CLD) in small for gestational age (SGA) preterm infants in comparison to appropriately grown and large for gestational age (LGA) infants. METHODS: Observational study derived from a geographically defined population (Trent Health Region, United Kingdom). All preterm infants of or=90th centile). Both mortality and CLD rates (using both 28 days' and 36 weeks' postmenstrual age [PMA] definitions) were determined for these groups of infants. RESULTS: Four thousand fifty-one preterm infants

Maternal morbidity and pregnancy outcome in a cohort of mothers transferred out of perinatal centres during a national census.

OBJECTIVE: To record the maternal morbidity and pregnancy outcome in this cohort. DESIGN: Retrospective data collection from a prospectively defined cohort. SETTING: The 37 largest perinatal centres in the UK. POPULATION: 258 in utero transfers recorded during a three-month census (1/4/99-30/6/99). METHODS: A questionnaire regarding the outcome of each mother was sent to the perinatal centre and receiving hospital. RESULTS: Data were returned on 242/258 (94%) mothers. Fifty-eight percent were transferred out of their perinatal centre in preterm labour and 38% had coexisting disease necessitating early delivery. The median gestational age at transfer was 32 weeks (range 23-41). Sixty-one percent delivered at the receiving hospital; 12% were transferred on to a third hospital and 29% ultimately returned to deliver at the original perinatal centre. Fifty-two percent of mothers received postnatal care in hospitals other than those defined as a major perinatal centre. One mother delivered during transfer and a further nine within one hour of arrival. One mother received intensive care after delivery and later died, a further 7% required high dependency care postnatally. Data were available on 273/333 (82%) babies. The median gestational age at delivery was 34 weeks (range 24-41). Six infants were stillborn and 187/264 (71%) infants were admitted to a neonatal unit. CONCLUSIONS: This study has documented the maternal morbidity, potential risks and pregnancy outcome of a cohort of mothers transferred out of the largest perinatal centres in the UK because of a shortage of neonatal cots. A national standard for the delivery of high risk perinatal services is needed to uphold good clinical practice guidelines in the care of high risk mothers and their infants.