Serial perirectal swabs are used to identify colonization of multidrug-resistant bacteria and prevent spread. The purpose of this study was to determine colonization with carbapenem-resistant Enterobacterales (CRE) and vancomycin-resistant Enterococci (VRE). An additional purpose was to establish whether sepsis and epidemic associated with these factors were present in the neonatal intensive care unit (NICU), to which infants with hospital stays exceeding 48 h in an external healthcare center NICU were admitted. Perirectal swab samples were collected in the first 24 h by a trained infection nurse using sterile cotton swabs moistened with 0.9% NaCl from patients admitted to our unit after hospitalization exceeding 48 h in an external center. The primary outcome was positivity in perirectal swab cultures, and the secondary outcomes were whether this caused invasive infection and significant NICU outbreaks. A total of 125 newborns meeting the study criteria referred from external healthcare centers between January 2018 and January 2022 were enrolled. Analysis revealed that CRE constituted 27.2% of perirectal swab positivity and VRE 4.8%, and that one in every 4.4 infants included in the study exhibited perirectal swab positivity. The detection of colonization by these microorganisms, and including them within the scope of surveillance, is an important factor in the prevention of NICU epidemics.
Lumbar puncture (LP) is widely employed to evaluate infectious, neurological and metabolic diseases in the newborn. Neonatal LP is a difficult procedure with 45–54% success rates. Although there are studies examining traumatic LP failure, studies on the effects of needle sizes are limited. This study was intended to investigate the effect of needle sizes on LP traumatization. Term and premature babies who underwent LP in the neonatal intensive care unit between 30 November 2017 and 30 July 2019 were included in the study by retrospective file scanning. LP was performed by a pediatric or neonatal specialist using a 22 Gauge pen (G) or 25 G pen spinal needle in all cases, with all patients being placed in the lateral decubitus position. The primary outcome was to evaluate the effect of needle sizes used in LP on traumatization. The secondary outcome was to evaluate traumatization rates and complications. A statistically significant difference was determined in the rate of traumatized LP and desaturation development between needle sizes and CSF microscopic findings (p = 0.031, p = 0.005, and p = 0.006, respectively). The study data show that 25 G pen-tip spinal needles cause less traumatic LP in neonates than 22 G pen-tip spinal needles.
Burkholderia cepacia complex (BCC) is a rare cause of sepsis in neonates, but infections are usually severe. It can be encountered unexpectedly when adequate health care is not provided. In this study, 49 neonatal cases with blood culture-proven BCC bacteremia within the first 72 h following admission to the neonatal intensive care unit between June 2017 and December 2018 were retrospectively analyzed in detail. All but one of the cases were born in Jarabulus, Al Bab, or Aleppo in Syria and were referred to Turkey due to urgent medical treatment needs. The rate of BCC bacteremia among the neonates transferred from across the border was 16.1% (48/297). The most common coexisting problems in the cases were multiple congenital malformations (12.2%), gastrointestinal system atresia (8.2%), and congenital heart diseases (4.1%). The median age at the time of their admission in Turkey was three days, and the median length of stay in another center before the referral was 11.5 h. The case fatality rate was 14.3%. In this study, a high rate of BCC infection and associated mortality was seen in neonates referred from cross-border regions. For centers accepting cases from conflict-affected regions, it is crucial to be careful regarding early detection of bacteremia, planning appropriate treatments, and preventing cross-contamination risks within the unit.
Amaç: Yenidoğan yoğun bakım ünitesinde çalışan hemşire ve doktorların damar yoluna bağlı ekstravazasyon bilgi birikimi ve yönetiminin incelenmesi hedeflenmiştir. Bu çalışma ekstravazasyon bilgisini ve yönetimini değerlendiren ilk anket çalışmasıdır. Yöntem: Kesitsel anket çalışması olarak tasarlanan bu araştırmaya yenidoğan yoğun bakım ünitesinde görev alan 300 sağlık çalışanı dahil edilmiştir. Yenidoğan sağlık çalışanlarına pandemi sürecinin gerekliliği nedeni ile mobil telefonlara, mail adreslerine “Google Forms” aracılığıyla hazırlanan 28 soruluk anketin yer aldığı formun sayfa uzantısı gönderilerek doldurulması sağlanmıştır. Bulgular: Çalışmaya katılan sağlık çalışanları, ekstravazasyon gelişimi ve sağlık bakımı ile ilgili en önemli risk faktörünün yüksek riskli ilaçlar verilirken yetersiz takip yapılması (%51.7, p=0.028) idi. Bebek ile ilgili risk faktörünü ise prematürite (%33.3) ve hipotansiyon/hipoperfüzyon (%34.7) olarak belirledi (p<0.001). Ekstravazasyon tedavisinde ilk yaklaşım infüzyonun durdurulması ve damar yolunun çekilmesi oldu (p<0.001). Sağlık çalışanlarının meslek hayatları boyunca %91.6 oranında ekstravasyon, %58 oranında ise uzuv kaybı veya plastik cerrahi tedavisi gerektirecek kadar ciddi komplikasyonlar ile karşılaştıkları görüldü. Sonuç: Yenidoğan yoğun bakım ünitesinde çalışan tüm sağlık çalışanlarına hizmet içi eğitime devam edilerek bilgilerin güncelliği sağlanmalı, farklı yaklaşımların önüne geçmek için ekstravazasyon tedavi protokolleri geliştirilmelidir.
Yenidoğan bebeklerin bakımının iyileşmesiyle hasta yenidoğanların yaşam oranları son yıllarda önemli ölçüde artmıştır. Hastalıkların patofizyolojisinin ve genetik temelinin daha iyi anlaşılmasının yanı sıra yeni tanı ve tedavi modalitelerinin geliştirilmesi ile kemik ve mineral bozuklukları alanında hızlı ilerlemeler olmaya devam etmektedir. Tedaviye başlamanın zaman açısından kritik ve hayat kurtarıcı olduğu bazı durumlarda, hızlı teşhis hayati önem taşır. Bu yazıda, yenidoğanın metabolik kemik hastalıklarına yönelik yaklaşımların olgular eşliğinde sunulması amaçlandı. Ancak, prematüre bebeklerde görülen metabolik kemik hastalığı (prematüre osteopenisi) tamamen ayrı bir konu olduğu için bu derlemede bahsedilmemiştir.
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