Objective There has been national strive to decrease the time needed to identify microorganisms in blood culture samples to reduce antibiotic use. This study evaluated rapid molecular polymerase chain reaction (PCR) use in identifying microorganisms in negative culture bottles from neonates with suspected bacterial blood stream infection at 20 to 24 hours of incubation. Study Design All blood specimens from neonates with suspected blood stream infection were included. Specimens were incubated using a standard blood culturing instrument that would flag positive if bacterial growth was detected. If the specimen was flagged positive at <20 hours, it was tested by PCR and plated for identification as per standard protocol. In our design, if specimen was not flagged at 20 hours of incubation, the bottle was sterilely accessed and a sample was obtained for PCR testing. The bottle would be returned for incubation for 120 hours or until flagged positive. Results A total of 192 blood specimens were included. Four specimens flagged positive at <20 hours and were all found to be positive by PCR. All other samples did not flag positive by 20 hours of incubation and were tested by PCR between 20 and 24 hours. One sample tested positive via PCR at 21.6 hours then flagged positive on the culturing instrument at 23.5 hours. All other specimens were negative by PCR and remained culture negative at 120 hours. The positive and negative predictive value of PCR verified by blood culture were both equal to 1.0. Conclusion Using rapid molecular PCR on blood culture specimens at 20 to 24 hours of incubation provides 100% true negative results possibly allowing providers to discontinue antibiotics at 24 hours. Key Points
Objective Neuromuscular re-education (NMRE) therapy including bracing, containment, facilitation techniques, joint compression, weight (WT) bearing, and myofascial release has been shown to improve neurodevelopmental maturation in premature infants. This study aimed to examine the association of NMRE with growth parameters including WT and length (L) at 36 weeks postmenstrual age (PMA) and at discharge. Study Design We analyzed data of infants <34 weeks gestational age (GA) or <1,800 g birth weight (BW) to examine the association of NMRE with growth parameters using correlation coefficient analysis. The effect of potential confounders was examined using multilinear regression models. Results Study includes 253 premature infants. Average GA was 300/7 weeks (±23/7) and BW was 1,315 g (±416), 49.8% were females and 65% were African Americans. NMRE has inverse correlation with WT at birth and at 36 weeks PMA, −0.66 (<0.001) and −0.21 (<0.001), respectively, but not at the time of discharge. NMRE has direct correlation with change in WT from birth to 36 weeks PMA and time of discharge, 0.50 (<0.001) and 0.62 (<0.001), respectively, and from the time of starting therapy to 36 weeks PMA or discharge, 0.25 (<0.001) and 0.51 (<0.001), respectively. There was no negative correlation between NMRE with daily WT gain from birth to 36 weeks PMA or to discharge, −0.05 (0.43) and −0.07 (0.23), respectively, or from the time of starting therapy to 36 weeks PMA, −0.09 (0.14). There was an inverse correlation between NMRE with average WT gain per day from the time of starting therapy to discharge, −0.26 (<0.001), Similar findings were found examining the correlation between NMRE and changes in L. Multilinear regression analysis examining the relationship while controlling for GA, BW, sex, and race; socioeconomic variables; and concurrent massage therapy and sensory integration revealed similar results. Conclusion NMRE, aimed to enhance neurodevelopmental outcomes of premature infants, may not have a negative impact on their physical growth. Key Points
We aimed to assess the association of umbilical catheters placement with pericardial effusion (PCE) in newborn infants after controlling for confounding variables. We analyzed three subpopulations: infants with birth weight (BW) > 2500g, infants with BW < 1500g, and infants with congenital heart diseases (CHD). We utilized the US-National Inpatient Sample dataset (1997–2012). First analysis included a 22,822,931 infants with BW > 2500g with no hydrops fetalis. Of them, 2583 neonates (0.01%) had PCE. PCE was found in 0.33% of infants with UAC only, 0.22% of infants with UVC only and 0.37% of infants with both catheters (aOR = 2.7, CI:2.4–3.2, p < 0.001), aOR = 2.8, CI: 2.3–3.5, p < 0.001), and aOR = 2.8, CI: 2.4–3.2, p < 0.001), respectively. The second analysis included a 200,288 infants with CHD and BW > 2500g. Of them, 1130 (0.56%) had PCE. PCE was found in 1.46% of infants with UAC, 0.78% of infants with UVC and 0.98% of infants with both catheters (aOR = 2.1, CI:1.8–2.6, p < 0.001), aOR = 1.4, CI:1.1–1.9, p = 0.036) and a OR = 1.6, CI:1.3–1.9, p < 0.001), respectively. While, a total of 1,187,727 infants with BW < 1500g were included in the third analysis. Of them, 1667 (0.14%) had PCE. PCE was found in 0.15% of infants with UAC, 0.19% of infants with UVC and 0.26% of infants with both catheters. (aOR = 1.1, CI: 0.9–1.3, p < 0.90), aOR = 1.4, CI: 1.2–1.7, p < 0.001) and aOR = 1.6, CI:1.4–1.8, p < 0.001), respectively. Conclusion: Central umbilical catheters are associated with increased risk for pericardial effusion and they may be independently associated with the occurrence of pericardial effusion in infants with congenital heart disease.
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