Clinical value of transfontanellar ultrasonography for neonatal insular development

Abstract

Objectives: The aims of this study were to assess the morphological characteristics and to establish ultrasonographic standards of normal neonatal insula size using transfontanellar ultrasonography, and to evaluate the clinical value of this technique. Materials and Methods: The authors performed transfontanellar ultrasonography in 481 single-birth cases at 28-43 weeks' gestation. Ultrasonographic examinations were performed in the parasagittal plane at the level of the insula through the anterior fontanelle, measuring area, and perimeter of the insula. Regression analyses were used to evaluate the relationship between insula size and gestational age (GA), and 60 cases were randomly selected for assessment of intra-observer and inter-observer reliability of ultrasonographic measurements. The authors obtained standard values of normal insula size and used them to assess and follow-up 40 cases with suspected insular malformations. Additionally, 30 late-onset neonates who were determined as small for gestational age (SGA) and 45 normally growing neonates were examined and tested using the Neonatal Behavioral Assessment Scale (NBAS). Results: The neonatal insula appeared as an inverted triangle, with the insular gyri extending radially in an anterior-inferior to posterior-superior direction. The area and perimeter of the normal neonatal insula significantly increased with GA (p < 0.01 for both), and these measurements were highly reliable. This assessment of cases with suspected insular malformation showed that five out of 40 cases presented abnormalities. Late-onset SGA neonates presented a significantly smaller area and perimeter in the insula compared to controls. In addition, the measured values of the insula significantly correlated with NBAS scores. Conclusion: Evaluation of the neonatal insula using transfontanellar ultrasonography can be performed and is clinically useful.

Prevalence of extended spectrum beta-lactamase (ESBL) Escherichia coli recovered from ICU and non-ICU at dr. Zainoel Abidin General Hospital

“…In the present study, both ESBL and non-ESBL E. coli displayed nearly equivalent prevalence rates among patients receiving treatment in both the Intensive Care Unit (ICU) and non-ICU settings, constituting 67% of the total cases, as indicated in Figure 3. Although the prevalence of extended-spectrum beta-lactamase (ESBL)-producing E. coli is notably higher within Intensive Care Units (ICUs), it is important to acknowledge that non-ICU patients are also exposed to significant risks of colonization or infection, especially individuals residing in long-term care facilities (LTCFs) or those with a history of recurrent hospitalizations [8,22,23]. These non-ICU patients may exhibit similar risk factors as their ICU counterparts, including prolonged hospital stays and extensive antibiotic exposure [8,22,23].…”

“…Although the prevalence of extended-spectrum beta-lactamase (ESBL)-producing E. coli is notably higher within Intensive Care Units (ICUs), it is important to acknowledge that non-ICU patients are also exposed to significant risks of colonization or infection, especially individuals residing in long-term care facilities (LTCFs) or those with a history of recurrent hospitalizations [8,22,23]. These non-ICU patients may exhibit similar risk factors as their ICU counterparts, including prolonged hospital stays and extensive antibiotic exposure [8,22,23]. In LTCFs, the proximity of patients and frequent utilization of antibiotics can contribute to the dissemination and selection of ESBL-producing strains [23,24].…”

“…Within the healthcare environment, ESBL E. coli has been frequently observed in close association with urinary tract infections (UTIs), as substantiated by antecedent research investigations [4][5][6][7][8][9][10]. Moreover, distinct studies have elucidated its connection with bacteriuria [11], while others have discerned its implication in various categories of infectious ailments [12].…”