Bacterial stability with freezer storage of human milk.

OBJECTIVES: Human milk supports the development of a beneficial newborn intestinal microflora. We have shown previously that human milk had reduced bacteria but unchanged nutrient composition when stored at -20 °C for up to nine months. We suspected declining bacterial colony counts were manifestations of bacterial dormancy and not failure of survival. We investigated differences in selected bacterial colony counts (lactobacillus, bifidobacteria, staphylococcus, streptococcus and enterococcus) in human milk stored for 2 and 12 weeks at -20 °C in either manual or automatic defrost freezers and whether reduced bacterial counts at 12 weeks were the result of dormancy or failure of survival. METHODS: Freshly expressed milk was obtained from mothers in the NICU, divided into aliquots and stored for 2 and 12 weeks at -20 °C in either automatic or manual defrost freezers. Subsequently, duplicate aliquots, one thawed and the other thawed and maintained at room temperature for 4 h, were plated to assess bacterial colony counts. RESULTS: Significant declines in bacterial colony counts were seen from 2 to 12 weeks freezer storage for all bacteria. There were no differences in colony counts between freezer types. Once thawed, no further bacterial growth occurred. CONCLUSIONS: Short-term freezer storage for 12 weeks resulted bacterial killing. Type of freezer used for storage did not have an impact on bacterial survival. It is unknown whether the paucity of important probiotic bacteria in stored human milk has adverse effects on infants.

Point-of-care ultrasound for peripherally inserted central catheter monitoring: a pilot study.

Objective To assess the feasibility and accuracy of point-of-care ultrasound (POCUS) in monitoring peripherally inserted central catheter (PICC) location in neonates by non-radiologist physicians. Methods A prospective cohort study compared PICC localization by ultrasound in neonates with a recent radiograph. The ultrasound exam was performed using a standardized protocol with 13-6 MHz linear and 8-4 MHz phased array transducers by a neonatal-perinatal fellow who was blinded to PICC location on the radiograph. Results Of the 30 neonates included, 96.6% (n = 29) were preterm, with 63.3% (n = 19) weighing <1500 g. Nighty-four percent (n = 94) of ultrasound scans matched the radiograph report. The protocol had a sensitivity of 0.97, specificity of 0.66 and positive predictive value of 0.98. Conclusion Limited ultrasound exams to monitor PICC position in neonates using a standardized protocol by non-radiologist physicians are feasible and accurate in a single ultrasound user. Further study in multiple providers is needed before widespread use.

Safety Culture in Neonatal Intensive Care Units in the Gaza Strip, Palestine: A Need for Policy Change.

INTRODUCTION: Assessment of the prevailing safety culture within the Gazan health care system can be used to identify problem areas. Specifically, the need for improvements, raising awareness about patient safety, the identification and evaluation of existing safety programs and interventions for improving the safety culture. This study aims to assess the safety culture in the neonatal intensive care units (NICUs) in Gaza Strip hospitals and to assess the safety culture in regards to caregivers' characteristics. METHODS: In a cross-sectional study using a census sample, we surveyed all nurses and physicians working in at all the NICUs in the Gaza Strip, Palestine. The Safety Attitudes Questionnaire (SAQ) which includes six scales was used to assess participants' attitudes towards safety culture. RESULTS: The overall score for SAQ was 63.9. Domains' scores ranged between 55.5 (perception of management) and 71.8 (stress recognition). The scores reported by our participants fell below the 75 out of a possible score of 100, which was considered as a cut-off point for a positive score. Moreover, our results revealed substantial variation in safety culture domain scores among participating NICUs. CONCLUSION: These results should be an indicator to our health care policy makers to modify current or adopt new health care policies to improve safety culture. It should also be a call to design customized programs for improving the safety culture in NICUs in the Gaza Strip.

Bacteriophage-based decontamination to control environmental colonization by Staphylococcus capitis in neonatal intensive care units: An in vitro proof-of-concept.

Introduction: In neonatal intensive care units (NICUs), the standard chemical-based disinfection procedures do not allow a complete eradication of pathogens from environmental surfaces. In particular, the clone Staphylococcus capitis NRCS-A, a significant pathogen in neonates, was shown to colonize neonatal incubators. The aim of this study was to evaluate the in vitro effect of a bacteriophage cocktail on NRCS-A eradication. Methods: Three bacteriophages were isolated, genetically characterized and assessed for their host range using a collection of representative clinical strains (n=31) belonging to the clone NRCS-A. The efficacy of a cocktail including these three bacteriophages to eradicate the reference strain S. capitis NRCS-A CR01 was determined in comparison or in combination with the chemical disinfectant Surfanios Premium on either dry inoculum or biofilm-embedded bacteria. The emergence of bacterial resistance against the bacteriophages alone or in cocktail was evaluated by growth kinetics. Results: The three bacteriophages belonged to two families and genera, namely Herelleviridae/Kayvirus for V1SC01 and V1SC04 and Rountreeviridae/Andhravirus for V1SC05. They were active against 17, 25 and 16 of the 31 tested strains respectively. Bacteriophage cocktails decreased the bacterial inoculum of both dry spots and biofilms, with a dose dependent effect. The sequential treatment with bacteriophages then Surfanios Premium did not show enhanced efficacy. No bacterial resistance was observed when using the bacteriophage cocktail. Discussion: This study established a proof-of-concept for the use of bacteriophages to fight against S. capitis NRCS-A. Further investigations are needed using a larger bacterial collection and in real-life conditions before being able to use such technology in NICUs.

Impact of an electronic health record on task time distribution in a neonatal intensive care unit.

BACKGROUND: An Electronic Health Record (EHR) has been introduced to four Irish maternity units, with further implementations planned. Previous studies indicate that healthcare professionals are concerned that EHRs may increase time spent on documentation and medication-related tasks. OBJECTIVE: To determine the impact of an EHR on task time distribution in a Neonatal Intensive Care Unit (NICU). METHODS: A pre-post, time and motion study. An electronic data collection tool was used to collate time spent on direct care, professional communication, reviewing charts, documentation, and medication-related tasks. Interruptions and contact with the patient zone were quantified. Statistical significance was assessed using two-sample proportion tests, two-sample t-tests, and two-sample Wilcoxon rank-sum tests. A Bonferroni correction set significance at p ≤ 0.0025. RESULTS: 63 doctors and nurses participated, with 169.23 h of data collected. There were no significant changes to nurses' task time distribution. The proportion of time spent by doctors on professional communication increased from 15.4% to 26.0% (p < 0.001). Significant increases to median task times were seen for both doctors and nurses. Interruptions to tasks decreased post-implementation (p < 0.001), as did frequency of contact with the patient zone (p < 0.001). CONCLUSION: The EHR did not redistribute time towards documentation and medication-related tasks. A reduction in interruptions to tasks may streamline workflow. Decreased contact with the patient zone may improve patient safety through reduced potential for pathogen transmission.

[Noise Level and Frequency Experienced by Premature Infants Receiving Incubator Care in the Neonatal Intensive Care Unit]. / ì‹ ìƒì•„ì§‘ì¤‘ì¹˜ë£Œì‹¤ 내 ì¸íë² ì´í„° 간호를 받는 미숙아가 경험하는 소음 수준 및 빈도.

PURPOSE: The purpose of this study was to identify the noise level and frequency experienced by premature infants receiving incubator care in the neonatal intensive care unit (NICU). METHODS: The participants were 20 premature infants receiving incubator care in the NICU of a university hospital in Daejeon Metropolitan city. The noise level was measured using a professional sound-level meter (ET-958, FLUS, Shenzhen, China) based on a noise classification table developed by the author. The data were analyzed with descriptive statistics, the t-test, analysis of variance, and Pearson correlation coefficients using SPSS for Windows version 22.0. RESULTS: The average noise level experienced by premature infants receiving incubator care in the NICU was 51.25 dB (range: 45.0~81.7 dB). The frequency of noises was highest for factors related to nursing activities (40.3%), followed by human factors (29.1%), machine alarm sounds (20.1%), incubator operation (6.6%), and internal environmental factors (3.9%). CONCLUSION: According to the above results, the noise level experienced by premature infants receiving incubator care in the NICU exceeded the recommendations of the American Academy of Pediatrics. Therefore, it is necessary to develop an interventional program to reduce noise in the NICU, and to conduct follow-up studies to verify its effectiveness.

The clinical management and outcomes of extremely preterm infants in Japan: past, present, and future.

There is a wide variation in neonatal mortality rates across regions and countries. Japan has one of the lowest neonatal mortality rates in the world; in particular, the mortality rate of extremely preterm infants (i.e., those born before 26 weeks of gestation) is much lower in Japan than in other developed countries. In addition, Japan has low incidences of intraventricular hemorrhage, necrotizing enterocolitis, and late-onset sepsis, a very high incidence of retinopathy of prematurity, and a relatively high incidence of chronic lung disease. In Japan, general perinatal medical centers (PMCs), which are PMCs that offer the highest levels of care, are required to have an obstetric department with maternal-fetal intensive care units as well as a neonatal or pediatric department with neonatal intensive care units (NICU), in order to promote antenatal rather than neonatal maternal transfer of high-risk cases. The limit of viability of extremely preterm infants is 22 weeks of gestation, and approximately half of them are estimated to receive active resuscitation. The clinical management of extremely preterm infants in Japan are characterized by (I) circulatory management that is guided by neonatologist-performed echocardiography, (II) relatively invasive respiratory management, (III) nutritional management, which entails the promotion of breast milk feeding, early enteral feeding, routine glycerin enema, and the administration of probiotics, (IV) neurological management by means of minimal handling, sedation of ventilated infants, and serial brain ultrasounds, and (V) infection control with the assistance of serial C-reactive protein (CRP) monitoring. Thus, this review provides a brief description of the development of neonatology in Japan, introduces the unique features of Japanese clinical management of extremely preterm infants, and overviews their outcomes.

Factors responsible for the prolonged stay of surgical neonates in intensive care units.

OBJECTIVES: The length of hospital stay (HS) for patients is a major concern due to its social, economic and administrative implications; this is particularly important for neonates admitted to intensive care units (ICUs). This study aimed to determine the factors responsible for prolonged HS in surgical neonates. METHODS: This retrospective study was conducted at Sultan Qaboos University Hospital, in Muscat, Oman. The medical records of 95 neonates admitted to the neonatal ICU who underwent general surgical procedures between July 2009 and June 2013 were reviewed. Mann-Whitney U and Pearson's Chi-squared tests were used for non-parametric numerical and categorical variables, respectively. A multiple regression analysis was performed to find a relationship between the variables and to detect the most important factor responsible for prolonged HS. A P value of <0.05 was considered statistically significant. RESULTS: Gestational age, birth weight, number of days on a ventilator and postoperative morbidity were associated with prolonged HS. Furthermore, the age of neonates at first full enteral feed was associated with increased HS using both independent and multiple regression analyses. CONCLUSION: Prolonged HS can occur as a result of many factors. In this study, a number of factors were identified, including low gestational age, low birth weight, increased number of days on a ventilator and postoperative morbidity. Additionally, neonate age at first full enteral feeds also correlated with increased HS. Further research on this topic is suggested to explore this correlation in more detail and to inform future practices.

Emergence of non-albicans Candida species in neonatal candidemia.

BACKGROUND: Candida species are one of the most common causes of blood stream infections among neonates and account for 9-13% of such infections. Although Candida albicans remains the most common fungal isolate from neonatal candidemia, longitudinal studies have detected a shift towards non-albicans Candida (NAC) species. AIM: To examine the prevalence and epidemiology of candidemia among infants admitted to our hospital. MATERIALS AND METHODS: Blood samples were collected from 548 neonates and only those which yielded pure growth of Candida spp. were included in the study. The isolates were identified as per standard mycological techniques and antifungal susceptibility (AFS) was done by disc diffusion method. RESULTS: Of the total 132 neonates included in the study, NAC species were responsible for 80.30% cases with C. parapsilosis (25.0%) and C. tropicalis (21.97%) as the most predominant species; whereas 19.70% of cases were caused by C. albicans. AFS results revealed that 65.91, 73.49, and 96.21% isolates were sensitive to fluconazole (FLK), itraconazole (ITR), and amphotericin B (AMB), respectively. CONCLUSION: Candidemia in neonates is an ominous prognostic sign and is an important entity in our hospital. Strict infection control strategies, appropriate preventive and therapeutic measures such as prophylactic antifungal use and a restrictive policy of antibiotic use should be implemented.