No abstract

ABSTRACT. Objectives. Improvements in neonatal care have resulted in increasing survival of extremely premature infants whose hospital course often runs into weeks or months. Some interventions during the acute care of these neonates, such as umbilical catheterization and use of steroids, not infrequently result in elevation of blood pressure (BP). It is, therefore, essential that these infants be monitored accurately for possible hypertension during their convalescence. Unfortunately, normative data on BP in this population are scant and comparison of data from various studies is hampered by methodologic differences in design. Studies in adults address the necessity for a restful state, adopting a comfortable position, and attempts to reduce the startle response to initial cuff inflation. Studies in the newborn using the oscillometric technique have not addressed these concerns. A standard BP measurement protocol was studied to determine the effect of ensuring a restful state, startle response to cuff inflation, and infant position on BP in clinically stable low birth weight infants after the first week of life.Study Design. The Dianamap oscillometer was used to measure BP in infants with a birth weight <2500 g between 7 and 42 days postnatal age. Each infant was studied only once when they were clinically stable. BP was measured in two positions, prone and supine, in random order. Infants were studied at least 1 1 ⁄2 hours after their last feeding or medical intervention. An appropriate sized cuff was applied to the right upper arm and the infant was positioned according to randomization. The infant was then left undisturbed for at least 15 minutes or until the infant was sleeping or in a quiet awake state. Three successive BP recordings were taken at 2-minute intervals. The infant's position was then reversed and another 15 minutes of quiet time was allowed. Thereafter, a second set of three successive BP recordings were obtained. The most recent routine nursing BP measurement was also recorded. Data were analyzed using analysis of variance and are presented as means and standard errors of the mean.Results. Sixty-four infants were studied. Birth weights ranged from 901 to 2423 g and gestational ages from 26 to 37 weeks. Overall, mean BP was significantly lower in the prone than supine positions (45.7 ؎ 0.7 vs 47.8 ؎ 0.8 mm Hg, P < .002). In either position, the first measurement was significantly higher than the third (average difference was 3 mm Hg, P < .003). In general, the relationships among position and order of measurement were similar for systolic and diastolic BP. Mean BPs obtained by routine nurse measurements were significantly higher than those in either position using our standard protocol (54.4 vs 47.0 or 49.1 mm Hg, P < .003). Moreover, the routine nurse measurements varied more widely than did those obtained using the standard protocol. The standard deviation for the routine mean BP measurements by nurses was 11.4 compared with 6.8 and 8.2 for the first measurements in the prone and supine pos...

A total of 166 episodes of fever in 162 children with sickle cell anaemia (SCA) aged between 6 months and 16 years who presented with rectal temperatures > or = 38.3 degrees C were studied for bacteraemia. Non-sicklers of similar ages and with similar temperatures were also studied as controls. Bacteraemia occurred in 32.5% (54) of children with SCA and in 26% (39) of controls. Gram-negative bacteria were the predominant organisms (70.4%) in SCA. The commonest organisms isolated were Salmonella (25.9%), Klebsiella (25.9%) and Staphylococcus aureus (22.2%). Gram-positive bacteria were the predominant organisms (51.3%) in controls, with Staphylococcus aureus accounting for 41% of all organisms isolated. In both groups, the incidence of bacteraemia decreased in children after the age of 10 years. Use of antibiotics prior to presentation in hospital was commoner among children with SCA (47.6%) than controls (14.7%). Antimicrobial agents were detected in the urine of 12 children with SCA and four controls whose parents denied prior antibiotic usage. The predominant organisms isolated were sensitive to gentamicin and 3rd-generation cephalosporins.

Central line associated blood stream infections (CLABIs) are associated with an increase in length of stay, morbidity, hospital costs, and mortality. In 2009, CLABIs were on the increase at Covenant Healthcare's 55 bed Level III neonatal intensive care unit (NICU). Prior to this practice initiative, there were no standardized central line management practices in the NICU. We retrospectively reviewed the incidence CLABIs for the six months prior to the initiation of the standardization of central line management and then 3 months following the implementation of the new practice policy. Specific outcomes measured were the number of CLABIs, length of stay related to CLABIs, and adherence to the policies and procedures. The project was implemented in four phases: 1) hand hygiene, 2) "scrub the hub", 3) central line tubing changes, 4) central line insertion, removal, and dressing changes. Although there were no statistically significant changes in the outcome measures, there were clinically significant differences between length of stay and risk for central line infection, incidence of CLABIs, and an increase in adherence to the central line practice change policies. The study showed for every week that is added to the patient stay, the patient was 7 times more likely to have a CLABIs. The rate of central line infection was decreased from 15.6 percent per 1000 line days to zero in 2010.