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The use of postnatal dexamethasone in premature newborns can be associated with a deleterious neurodevelopmental outcome. The effect of hydrocortisone on developmental outcome in these patients is less clear. We therefore sought to examine the effect of hydrocortisone on early developmental outcome in premature newborns. We retrospectively examined the effect of hydrocortisone on developmental outcome during the first 2 years of life in premature infants <29 weeks' gestation at birth. Even though hydrocortisone was used in infants with a greater risk for poor outcome, its use, unless prolonged >7 days, was generally not associated with a worse developmental outcome or higher rate of referral for early intervention. A short course of hydrocortisone in sick premature newborns does not appear to have a deleterious effect on developmental outcome.

Extremely low birth weight premature infants are at risk for poor neurodevelopmental outcome. Postnatal dexamethasone has often been used in premature infants to prevent or treat bronchopulmonary dysplasia, and this drug is thought by some to affect neurodevelopmental outcome. We retrospectively examined the effect of this steroid on early neurodevelopment. Dexamethasone exposure was associated with an adverse outcome and was a stronger predictor of outcome than other accepted risk factors. If used, dexamethasone should be used in these high-risk infants for as short a period as possible.

BackgroundMeningoencephalitis has a high mortality rate, therefore rapid identification of the underlying etiology is essential to optimize clinical and stewardship outcomes. The standard for diagnosis of meningoencephalitis included cerebrospinal fluid (CSF) culture and viral polymerase chain reaction (PCR) until approval of the BioFire® Meningitis/Encephalitis (ME) panel, a multiplex PCR panel for the rapid detection of 14 central nervous system pathogens. The objective of this study was to determine the impact on clinical outcomes of the newly adopted ME panel in a central laboratory as compared with previously utilized CSF studies within a large, multicenter health systemMethodsThis is a multicenter, retrospective cohort study of adult and pediatric patients who received at least one dose of intravenous (IV) acyclovir for presumed meningoencephalitis, with study patients divided into pre-ME and post-ME panel cohorts. The primary endpoint is duration of IV acyclovir. Secondary endpoints include duration of antibacterials, in-hospital mortality, intensive care unit length of stay (LOS), hospital LOS, rates of acute kidney injury and test-turnaround time (TAT). Subgroup analyses were performed analyzing the impact of number of daily couriers and distance from the central laboratory on TAT.ResultsA total of 208 patients were included: 87 pediatric and 121 adult. The duration of IV acyclovir decreased after implementation of the ME panel (41.6 vs. 30.8 hours; P < 0.01). The TAT was reduced with the implementation of the ME panel (37.3 vs. 6.2 hours; P < 0.01). There were no significant differences in the remaining secondary outcomes. Subgroup analyses of the post-ME cohort showed that the number of daily couriers to the central laboratory and the distance from the central laboratory significantly impacted TAT (P < 0.01) but not duration of IV acyclovir.ConclusionThe ME panel significantly reduced the duration of IV acyclovir and TAT, which could have cost and safety implications when applied to a larger patient population. Multicenter healthcare systems implementing the ME panel may consider on-site ME platforms at multiple sites due to the significant effect of a central laboratory on TAT. Disclosures All authors: No reported disclosures.

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