371 Molecular and Bioinformatic Detection of Bacterial Infection in Preterm Delivery

Abstract

Background: Adequate nutrient intake is essential to prevent postnatal growth retardation in preterm infants. In January 2002 a neonatal nutrition support team (NNST) was introduced in our Neonatal Intensive Care in order to increase the awareness of the importance of optimum nutrition as part of the overall patient treatment. The NNST focused on optimization of energy and protein intake and postnatal growth. We hypothesize that the establishment of a NNST improves nutrient intake and postnatal weight gain in preterm infants.Aim: To evaluate: 1. the computerized energy and protein prescription; 2. the effect on postnatal growth in preterm infants, before (Ͻ2002) and after (Ͼ2002) the establishment of a NNST.Study Design: Nutrient prescription and body weight were recorded using a computerized prescription system (PDMS) for all newborn infants admitted between July 1999 and December 2004. PDMS provides a quick and complete overview of the amount of fluid, nutrients and medication prescribed, and records these data in a database. Data from preterm infants Ͻ32 weeks gestational age, admitted within 72 hours after birth and staying Ͼ3 days, were included in the analysis (nϭ871).Results: Gestational age and birth weight were comparable: Ͻ2002: 29.3 Ϯ 1.7 weeks and 1206 Ϯ 326 g; Ͼ2002: 29.4 Ϯ 1.7 weeks and 1226 Ϯ 352 g. Energy and protein prescriptions increased significantly over the years, as did percent weight gain from birth weight in the first 4 postnatal weeks (PϽ0.001). Weight gain expressed as days to regain birth weight was better in the group Ͼ2002: 11.3 Ϯ 4.5 vs. 12.9 Ϯ 4.9 days in the group Ͻ2002 (pϽ0.001).Conclusions: The establishment of a NNST in our Neonatal Intensive Care resulted in increased energy and protein prescription, and improved postnatal weight gain in preterm infants. MOLECULAR AND BIOINFORMATIC DETECTION OF BACTERIAL IN-FECTION IN PRETERM DELIVERYA large number of bacterial species have been identified in fetal membranes after preterm labour associated with intrauterine infection by microbiological culture. In this study we have investigated a molecular and bioinformatic approach to organism identification which surmounts the need for specific and diverse microbiological culture conditions required by conventional methods.Methods: Samples of fetal membranes were taken from 37 preterm infants, and 6 normal term controls delivered by Caesarean section, in which bacteria had been detected by in situ hybridisation of 16S ribosomal RNA using a generic probe. Degenerate primers were designed to amplify bacterial 16S ribosomal DNA by polymerase chain reaction and used to amplify bacterial DNA from human fetal membranes. Amplicons were cloned, sequenced and bacteria identified bioinformatically by comparison of sequences with known bacterial DNA genomes. In situ hybridisation using an organism specific probe was then used to confirm the presence of the commonest identified organism in tissue samples.Results: Bacterial DNA amplified from 15/43 samples, all from preterm deliveries, and the bioinfor...