Nosocomial Infections in the Neonatal Intensive Care Unit.

Nosocomial infections are relatively common in the NICU. These infections increase morbidity and mortality, particularly in the smallest and most fragile infants. The impact of these infections on long-term outcomes and health-care costs is devastating. Worldwide efforts to decrease the incidence of nosocomial infections have focused on implementing specific prevention protocols such as handwashing, central line teams, care bundles, and antimicrobial stewardship. This review summarizes common nosocomial infections in patients in the NICU.

Neonatal Hypocalcemia: Common, Uncommon, and Rare Etiologies.

Calcium homeostasis in the neonatal period is a reflection of the transition from placental regulation to hormonal maturation in the newborn. Hypocalcemia occurring within the first 72 hours after birth, termed early-onset hypocalcemia (EOH), is more common and often asymptomatic. Hypocalcemia occurring beyond 72 hours of age is termed late-onset hypocalcemia (LOH). LOH is less common than EOH, and affected patients are more likely to be symptomatic. To prevent and treat hypocalcemia in the newborn, neonatal clinicians should be familiar with the common, uncommon, and rare etiologies of EOH and LOH, as summarized in this review.

Acetaminophen Therapy for Persistent Patent Ductus Arteriosus.

Persistence of a left-to-right shunt caused by a patent ductus arteriosus (PDA) leads to significant sequelae in extremely premature infants as a result of pulmonary overcirculation and systemic steal. Although timing and duration of treatment for a persistent clinically significant PDA differ among institutions, standard pharmacologic interventions are the nonsteroidal anti-inflammatory drugs indomethacin and ibuprofen. Acetaminophen has emerged as an alternative to indomethacin and ibuprofen with less significant adverse effects, but there is no consensus regarding its use. This review summarizes the most recent evidence for the use of acetaminophen in PDA treatment.

A randomized trial comparing beractant and poractant treatment in neonatal respiratory distress syndrome.

AIM: To compare the effects of beractant and poractant in neonatal respiratory distress syndrome (RDS). METHODS: Infants with RDS were randomized to receive beractant or poractant. The primary outcome measure was fraction of inspired oxygen (FiO2) requirement in the first 48 h after surfactant therapy. RESULTS: 58 infants completed the study. The mean gestational ages for the poractant and beractant groups were 29.6+/-3.6 and 29.3+/-2.9 wk, with average birthweights of 1394+/-699 and 1408+/-534 g, respectively. In the first 48 h, infants who received poractant had a lower FiO2 requirement compared to those who received beractant (p=0.018). The prevalence of patent ductus arteriosus (PDA) was lower in the group of infants that received poractant (17%) compared to the group that received beractant (45%) (p=0.02). CONCLUSIONS: Infants with RDS treated with poractant had a lower FiO2 requirement during the first 48 h compared to infants who received beractant. Infants who received poractant also had fewer PDAs than infants who received beractant. The difference in FiO2 was not associated with a difference in age of first extubation, total intubation time, or incidence of bronchopulmonary dysplasia between groups.