Epidemiology of neonatal sepsis in two neonatal intensive care units in Krakow, Poland in 2016-2017 years.

BACKGROUND: Sepsis in low-birth-weight neonates remains one of the most significant causes of neonatal morbidity and mortality. Approximately 3 million newborns suffer from sepsis globally every year. The aim of this study was to compare demographic and clinical features, as well as etiology and antibiotic susceptibility, of the main pathogens related to neonatal sepsis in two neonatal intensive units during a two-year period. METHODS: We observed early-onset (EO-BSI) and late-onset bloodstream infections (LO-BSI) cases in two high-reference neonatal intensive care units (NICU) over a 24-month period (2016-2017). Samples of patients' blood were tested for the presence of the microorganisms. All bacterial isolates were tested for susceptibility to antibiotics. RESULTS: The majority of sepsis cases weighed above 1000 g and were born by cesarean section. About 10% of the EO-BSI group died. There were differences in the EO-BSI /LO-BSI ratio in the compared wards due to differences among the admitted children. The most common pathogens isolated from blood were coagulase-negative staphylococci (CoNS) were represented by two dominating species: S. epidermidis and S. haemolyticus, followed by Klebsiella spp. strains and E.coli, which were mostly found in EO-BSI cases. No single S. agalactiae (GBS) strain was isolated. The majority of CoNS strains were resistant to methicillin, half were resistant to aminoglycosides, and one-third were resistant to macrolides and lincosamides. Half of the Gram-negative rods were resistant to beta-lactams. CONCLUSIONS: The epidemiology of sepsis in two observed NICUs is comparable to data obtained from other studies with a predominance of methicillin-resistant CoNS in LO-BSI and beta-lactam resistant E. coli in EO-BSI. It is of importance that the campaign for controlling GBS carriage in pregnant women in Poland resulted in the disappearance of GBS as a cause of sepsis. Unfortunately, there are no such measures to control E.coli related sepsis.

A new score for postnatal clinical assessment of fetal maturity in newborn infants.

OBJECTIVES: To investigate the clinical repeatability of Klimek's method of fetal maturity assessment in newborns. METHODS: A cohort of 800 consecutive singletons was assessed immediately after birth by a pediatrician, who was unaware of the infants' gestational age. The assessment, according to Klimek's method, consisted of six criteria to evaluate posture and skin appearance, and each variable was scored from 0 to 2 points. After dividing the material into two identical groups, the results were compared with those obtained by means of Ballard's method. RESULTS: Statistical analysis did not show statistically significant differences between the compared averages in both groups. A significant correlation between the clinically compared methods of fetal maturity grading was found (r> or =0.69, t> or =19, and P<0.001). CONCLUSIONS: Klimek's method of fetal maturity assessment offers a possibility of objective evaluation of maturity immediately after birth. The clinical methods used to date do not have such advantages. Moreover, they require the evaluation of 12-34 parameters, their point range is more complex and their results are given on the scale of 10-50 points. In each of the applied divisions of observed newborns, there was found a high, statistically significant correlation between the indexes evaluating maturity by means of both comparable methods (i.e. Ballard and Klimek scores), which do not take into account weight and fetal age, but refer directly to fetal maturity. The new scale, which has been proposed, is simple and produces comparable results encompassing full maturity in the range of only 6-12 points.

[Clinical method of newborn's maturity evaluation according to R. Klimek's index]. / Kliniczny sposób oceny dojrzalosci noworodka wedlug wskaznika R. Klimka.

The object of the study was to evaluate R. Klimek's new simple clinical method of computing newborn's maturity index (K) without having to use the computer-aided method or understand the basics of the quantum mechanics or theory of relativity, which gave rise to the modern definition of maturity. The study was based on the material of 1000 successive newborns delivered in the Clinic of Gynecology and Obstetrics of the Jagiellonian University. Their maturity was determined routinely in BK scale, and confirmed by means of computer-aided method of birth term prognosis. Posture, angle of the elbow, pulling an elbow to the middle line of the body, breast appearance, presence of lanugo and plantar creases were evaluated by means of K index with points from 0 to 2. Newborns' maturity index K was 9.2 +/- 1.9 points (range 2-12). 2.6% newborns were immature and one third of them (0.8%) were born with the gestational age < 37 weeks, 28 of which (77%) had correct K index > or = 6 points. There is a high, statistically significant correlation between maturity assessed in Ballard-Klimek scale and K index (r = 0.61, t = 24.78).

[Evaluation of newborn maturation and gestational age using the Ballard-Klimka scale]. / Ocena dojrzalosci noworodka i wieku ciazowego wg skali Ballard-Klimka.

Results of prospective studies of 1404 consecutive vaginal and cesarean deliveries of newborns weighted > or = 2500 g were analyzed in relation to their maturity. It was stated that Ballard Maturation Score is a valid accurate assessment tool for precise interpretation of the degree of fetal maturity, but not of the calendar length of gestation, especially beyond 36 weeks. Therefore it was reasonable to propose a constant distribution of scores: 39 +/- 3 points within the period from 37% to 43% weeks while at the 28th week: 10 +/- 2 points (Ballard-Klimek scale of pregnancy dating) instead of therefore used J. L. Ballard rule that only newborns at 44 weeks can have scores of 50 and infants with shorter gestational age have lower values, e.g. 33 at the 37th week.

[Neonatal evaluation of obstetrical criteria of prematurity]. / Neonatologiczna ocena polozniczych kryteriów wczesniactwa.

Paediatric maturity was assessed in newborns whose birth weight was above or equal to 2500 g, of 1742 women of single pregnancy who delivered vaginally, and in 81 newborns with birth weight below 2500 g, by means of Ballard method. The range of maturity was 39 +/- 3 points of Ballard/Klimek score. There were only 14 newborns with birth weight below 2500 g born before 37 gestational weeks, which is only 30.4% of all newborns with a score below 33 points. The neonatological assessment of physical and neuro-muscular maturity of the newborns, allows to determine the degree of maturity and simultaneously the obstetrical criteria (newborn weight below 2500 g and 37 weeks of pregnancy), indicate only a lower limit of possible maturity.