Sepsis remains a leading cause of mortality in the neonatal population, and currently, there is still no consensus on an accurate biomarker that can aid prompt diagnosis. This review focuses on studies investigating biomarkers for late-onset neonatal sepsis specifically. We discuss the current evidence for traditionally used biomarkers and present recent developments on more novel markers. Suitable articles were selected from PubMed, Embase, Medline, Cochrane Handbook of Systematic Reviews, and ScienceDirect. Inclusion criteria were studies published from 2010 to 2020. Exclusion criteria were animal model-based studies. Keywords in search strategy were late-onset neonatal sepsis + biomarkers + diagnosis. Evidence is growing increasingly weak for commonly studied biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT). Levels of markers such as Serum Amyloid A and Neutrophil CD64 increase more rapidly post-onset of infection compared to CRP. Moreover, this review found that the more novel biomarkers discussed such as presepsin and endocan may show superior and more promising potential as diagnostic markers. However, larger studies over multicenters are deemed essential to ascertain the ideal biomarker.

Background Necrotising enterocolitis (NEC) is the commonest gastrointestinal emergency among premature infants, and accounts for significant morbidity and mortality. Breast milk (BM) is considered as the best nutritional option to prevent NEC. Traditionally cow's milk-based fortifier is added to BM to optimise growth of extremely premature infants, thus potentially increasing the risk of NEC. More recently the value of replacing the traditional cow's milk-based fortifier with human breast milk-based fortifier [resulting in the concept of an exclusive human milk (EHM) based diet] has been demonstrated to reduce NEC, improve feeding tolerance, reduce dependence on parenteral nutrition and enhance growth. We report the nursing/midwifery experience of introducing EHM for the first time in Ireland, through a qualitative study. Aims To explore nurses' and midwives' perspectives on the provision of human breast milk-based fortifier in an Irish neonatal unit for the first time.Methods Seven senior neonatal nurse/midwives, who were involved in hands-on provision of human breast-milk based fortifier in the NICU at University Maternity Hospital Limerick (UMHL), were offered a semi-structured questionnaire. Following audit committee approval, a thematic interpretive qualitative study was conducted. Results Four themes were identified based on 54 feeding episodes noted in 2017 and 2018 from the two extremely low birth weight (ELBW) infants who were offered human breast milk-based fortifier for the first time in Ireland. Key observations, experiences, expectations and barriers highlighted were analysed. Themes noted were, 1. breastfeeding improvement and culture, 2. feeding tolerance, 3. educational needs and support, and 4. confidence and concerns of nurses/midwives. Sub-themes identified were further evaluated. Conclusion Supportive environment and targeted staff education within NICU would assist in maintaining high breastfeeding rates as well as implementation of an exclusive human milk diet for ELBW infants.

Neonatal herpes simplex virus (NHSV) infections are associated with significant morbidity and mortality. Numerous factors influence the transmission of HSV infection to newborns; however, immersion in water during labor has received very little attention as a possible risk factor despite the increasing popularity of water births. We report a case of disseminated NHSV type 1 infection, possibly acquired during a water birth. The purpose of this report is to alert healthcare providers to this potential route of transmission and to highlight the importance of screening guidelines for HSV before a water birth. Furthermore, it is essential to consider NHSV infection in any febrile infant who is not responding to standard empirical antibiotic management, even in the absence of herpetic lesions.

UVC), umbilical arterial catheter (UAC) and Peripherally Inserted Central Catheter (PICC).The infant developed recurrent abdominal distension, associated with bilious aspirates and vomits. On examination, the abdomen appeared tense and shiny, with dilated veins. Necrotising enterocolitis (NEC) was suspected and enteral feeds were held repeatedly. Plain film abdominal x-rays revealed bowel distension. However they did not identify other radiological features of NEC or perforation, such as pneumatosis intestinalis or pneumoperitoneum.Coagulation screens were normal. On Day 36, the infant's clinical condition rapidly deteriorated. She developed a grossly distended abdomen, associated with increased oxygen requirement and desaturations. She required ventilation, inotropic support and transfer to a tertiary centre. She continued to deteriorate and further treatment was considered futile. Following discussion with her parents, palliative care was introduced and she passed away shortly afterwards.Subsequent postmortem examination revealed idiopathic superior mesenteric vein thrombosis. Discussion A differential diagnosis for neonatal abdominal distension and bilious vomiting includes necrotising enterocolitis (NEC), intestinal malrotation and volvulus. 3 Superior mesenteric vein thrombosis causes chronic, recurrent and progressive devitalisation of the small bowel wall. It is associated with pre-terminal neutropaenic sepsis and peritonitis. 4 It may be caused by an unidentified congenital thrombophilia. 5 Conclusion In refractory cases of suspected NEC, venous thromboembolism should be considered. Abdominal x-ray findings are non-specific and are unlikely to contribute to a correct diagnosis. More specific investigations include Doppler ultrasound and CT angiography. 6

NEC is a life-threatening gastrointestinal disease in neonates. It occurs in 7% of very low birth weight infants. Aim:To identify the risk factors for NEC 2002 -2009 in a tertiary neonatal centre. Methods:Retrospective chart review of infants with NEC examining demographics, risk factors, morbidity, mortality and length of stay.Results: 67 patients had NEC (modified Bell stage ≥2), comprising 0.83% of admissions to NICU. 38 (57%) were male, 92.5% were < 1500 g. Median gestational age was 27 weeks (range 23+4/7 to 38+4/7), median birth weight was 840g (range 490-2690g). Median age when NEC developed was 10 days (range 1-60). Perforation occurred in 28/67 (42%) infants, 14/28 (50%) died. Sepsis was proven in 37% of all cases. Four infants had recurrent NEC. Median length of stay was 64 days (range 3 -176).Mortality was 33% (22/67), 68% of deaths occurred in infants < 27 weeks.Risk factors for developing NEC were: assisted ventilation 83.5 %, RDS 82%, PDA 56.7% , sepsis 37.3%, premature rupture of membranes 31.3%, IUGR 30%, red cell transfusion 30%, and IVH grade (3-4) 24%. Feeding was: never fed 30%, EBM 53%, formula 10.4%, mixed 5.9%. Conclusion:The aetiology of NEC is poorly understood but prematurity remains the greatest risk factor. The results of a recent updated meta-analysis of probiotics for preventing NEC "confirms the significant benefits of probiotic supplements in reducing death and disease in preterm neonates" (Deshpande et al, Pediatrics 2010). Hopefully, their use will decrease the incidence of NEC.