Comparison between two different modes of non-invasive ventilatory support in preterm newborn infants with respiratory distress syndrome mild to moderate: preliminary data

Despite of improved survival of premature infants, the incidence of long term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as a better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. HFNC may be effective in the treatment of some neonatal respiratory conditions while being more user-friendly for care-givers than conventional NCPAP. Limited evidence is available to support the specific role, efficacy and safety of HFNC in newborns and to demonstrate efficacy compared with NCPAP; some studies suggest a potential role for HFNC in respiratory care of the neonate as a distinct non invasive ventilatory support. We present the preliminary data of a randomized clinical trial; the aim of this study was to assess efficacy and safety of HFNC compared to NCPAP in preterm newborns with mild to moderate respiratory distress syndrome (RDS)

Detection of Parechovirus (P) and Enterovirus (E) Among Infants Evaluated for Late-Onset Sepsis in the Neonatal Intensive Care Unit (NICU): The VIRIoN-P-E Study

Background: Limited data exist on the role of human parechoviruses (HPeV) and enteroviruses (EV) as causes of late-onset sepsis (LOS) in the NICU. Objective: To determine the frequency of detection of parechoviruses and enteroviruses among infants >72 hr of age who were evaluated for LOS in 2 academic NICUs (Parkland Memorial Hospital [PMH], Dallas -shared bays; Women & Infants Hospital [W&I], RI -single patient rooms) Design/Methods: Prospective cohort study of inborn infants hospitalized in the NICU at PMH and WIH from 1/2012 to 1/2013 and were enrolled in the Viral Respiratory Infections in the Neonatal Intensive Care Unit (VIRIoN-I; J Pediatr 2014:165:690). Eligible subjects were infants of all gestational ages (GA) and birth weights (BW) who were >72 hrs of age, remained in the NICU since birth, and underwent evaluation with initiation of antibiotic therapy for suspected LOS. Nasopharyngeal specimens were obtained within 72 hrs of the sepsis evaluation using flexible flocked nylon swabs that were placed in universal transport medium and frozen at -80\ub0C until tested for parechovirus and enterovirus RNA by polymerase chain reaction (PCR) assay (Virology Laboratory, Nationwide Children\u2019s Hospital, Columbus, OH). Demographic, clinical, laboratory, and radiographic data were obtained. Results: Of the 100 infants enrolled in the VIRIoN-I study, nasopharyngeal specimens were available from 65 (59, PMH; 6, WIH) for parechovirus and enterovirus PCR testing. These 65 infants (38, male; 27, female; 49, Hispanic; 6, white; 9, Black; 1, unknown) had a mean \ub1SD gestational age of 30 \ub1 5 wks and birth weight of 1619 \ub1 929 g, and received empirical antibiotics for possible LOS. Infants had a total of 94 sepsis evaluations (65, 1 evaluation; 16, 2; 8, 3; 4, 4) at a mean age of 20 days. Reasons for the sepsis evaluations included fever (9), hypothermia (65), apnea (50),feeding intolerance (51), seizure (1), irritabilitiy (5), emesis (20), diarrhea (1), bloody stool (5), rhinorrhea/congestion/cough (6), and lethargy (9). Four infants died. None of the infants had parechovirus or enterovirus detected in nasopharygeal specimens either at the first or subsequent sepsis evaluations. Conclusion(s): The burden of disease due to parechovirus and enteroviruses among inborn infants who remain in the NICU since birth appears to be low in those evaluated for LOS. Larger, prospective studies are needed to fully determine their contribution to \u201cculture-negative\u201d sepsis in the NICU. Publication Number: 3860.53

Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six "COVID-19 maternity centres" were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards

Seroprevalencia de leptospirosis en canes castrados por el Departamento de Zoonosis de la Municipalidad de Maipú, Mendoza

Leptospirosis es una zoonosis cosmopolita causada por la bacteria Leptospira (250 serovares). Produce infecciones asintomáticas hasta cuadros muy graves y mortales. Afecta distintas especies animales: perros, roedores, vacas, caballos y humanos. Se adquiere por contacto directo con fluídos y tejidos infectados o en forma indirecta por agua contaminada con orina infectada . Los animales son huéspedes primarios y reservorios de un serovar determinado. Identificar los reservorios animales de Leptospiras patógenas y su prevalencia es fundamental para la prevención de esta zoonosis. Los perros son un factor de riesgo en la transmisión de leptospirosis urbana debido a la estrecha relación en la dupla perro-hombre

Practice-based film education for children: teaching and learning for creativity, citizenship and participation

Practice-oriented film education aimed at children has been hailed for various reasons: at a personal level, as a means of providing tools for self-expression, for developing creativity and communication skills. And at a social level, it is argued that children must now become competent producers, in addition to critical consumers, of audiovisual content so they can take part in the global public sphere that is arguably emerging. This chapter discusses how the challenges posed by introducing children to filmmaking (i.e. digital video) are being met at three civil associations in Mexico: La Matatena AC, which seeks to enrich the children’s lives by means of the aesthetic experience filmmaking can bring them. Comunicaciòn Comunitaria, concerned with the impact filmmaking can have on the community, preserving cultural memory and enabling participation. And Juguemos a Grabar, with a focus on urban regeneration through the cultural industries

Interstitial lung disease in a newborn affected by mevalonic aciduria

Introduction: Mevalonic aciduria (MA) is the most severe phenotype of mevalonate-kinase deficiency (MKD), with a onset in early infancy and poor prognosis. MA diagnosis may be challenging in the neonatal period given its rarity and its unspecific symptoms that frequently recall those of other neonatal diseases. To our knowledge, interstial lung involvement has never been described as onset feature in a newborn with MKD. Objectives: We report the case of a newborn affected by MKD characterized by interstitial lung disease. Methods: The patient underwent laboratory and radiology evaluation as clinically indicated. Direct Sanger sequencing was used to screen the 10 exons of the MVK gene. Results: A female neonate born at term from consanguineous parents was referred to our hospital at 16 days of life (DOL) for mild hypotonia and persistent raised inflammatory markers despite antibiotic therapy. Infectious work-up was negative for both viral and bacterial infections. Chest x-ray revealed bilateral perihilar peribronchial thickening. Electroencephalography (EEG) reported moderate diffuse anomalies of background activity without major abnormalities. On DOL 20 the first episode of fever was recorded. Due to worsening tachypnea and persistent abnormal chest x-ray, a pulmonary CT scan was performed and showed diffuse ground-glass bilateral infiltrates consistent with alveolar-interstitial lung disease. On DOL 22 a palpable maculo-papular skin rash appeared on feet and hands, vanishing spontaneously 24 hours later. Bone marrow examination and levels of perforins, neuron-specific enolase and urinary catabolites of catecholamines were normal. A total body MRI was normal except for a mild cerebellar hypoplasia and the known interstitial lung disease. The patient kept presenting hypotonia, relapsing episodes of fever and skin rashes, developed anemia requiring blood transfusions and failure to thrive became evident. Type-I IFN signature was negative. A genetic test was requested, as well as quantification of urinary levels of mevalonic acid, which were markedly above the normal range. Direct Sanger sequencing allowed to detect a homozygous c.709A>T missense mutation in the exon 8 of the MVK gene, coding for a protein substitution p.T237S already classified as pathogenic in the INFEVERS database (http://fmf.igh.cnrs.fr/ISSAID/infevers/) and therefore consistent with the diagnosis of MKD. Both parents and her sister were found to be heterozygous carriers of the same mutation. On DOL 38 treatment with anakinra was started, with prompt regression of fever and skin rash, decrease in inflammatory markers, increase in reticulocytes count and weight gain. Hypotonia improved but persisted. The patient was discharged from hospital on DOL 56 in good clinical conditions, with acute phase reactants within the normal range and mild hypotonia. She is now 4 months old, still on anakinra treatment without adverse events. Conclusion: Autoinflammatory diseases in the neonatal period are a diagnostic challenge. Clinical suspicion is crucial in order to perform specific laboratory and genetic testing and start appropriate treatment. Interstitial lung involvement may be present in MKD and, together with increased inflammatory markers, could be the first manifestation of the disease

Determining the reference range of blood presepsin in term and preterm neonates

Introduction Sepsis is still a major cause of morbidity and mortality in neonates, especially in preterm infants. Mortality can reach 60-70% in very low birth weight infants (birthweight 0.20). This reduced model explains 3.8% of the total sum of squares. After adjustment for all the factors in the model, presepsin levels appear to be significantly lower in twins (496 pg/ml \uf0b1 65.5 vs 655 pg/ml \uf0b1 11.8) and in neonates with Apgar at 1 min 658 (644 pg/ml \uf0b1 11.8 vs 774 pg/ml \uf0b1 56.2). So none of the above factors seems worth to be taken into account in determining the reference limits for presepsin blood levels in healthy term neonates. Preterm neonates. The largest differences in presepsin level are observed between small for gestational age (SGA) (903 pg/ml \uf0b1 57.1) and adequate for gestational age (AGA) neonates (703 pg/ml \uf0b1 26.7), between neonates with and without mechanical ventilation at blood sampling (1090 pg/ml \uf0b1 86.9 vs 711 pg/ml \uf0b1 24.7) and at delivery (855 pg/ml \uf0b1 87.3 vs 729 pg/ml \uf0b1 25.8), between neonates with and without venous catether (801 pg/ml \uf0b1 47.5 vs 716 pg/ml \uf0b1 28.9), between neonates who underwent blood sampling after the 4th day or before (797 pg/ml \uf0b1 46.2 vs 716 pg/ml \uf0b1 29.2), between males and females (778 pg/ml \uf0b1 35.1 vs 701 pg/ml \uf0b1 34.7). All these factors, when simultaneously introduced into a multivariable linear model, explain only 18.8% of the total sum of squares. A second multivariable linear model was fitted after removing the factors that showed the lowest effect on presepsin level (those associated with a p-value >0.50). This reduced model explains 13.4% of the total sum of squares. A third and more parsimonious multivariable linear model was fitted after removing the factors that showed the lowest effect on presepsin level (those associated with a p-value >0.20). This reduced model explains 12.3% of the total sum of squares. After adjustment for all the factors in the model, presepsin levels result to be significantly lower in AGA neonates (706 pg/ml \uf0b1 25.7 vs 890 pg/ml \uf0b1 55.0) and between neonates with and without mechanical ventilation at blood sampling (1074 pg/ml \uf0b1 85.3 vs 712 pg/ml \uf0b1 24.2). Even in this case, none of the above factors is expected to substantially affect the reference limits for presepsin blood levels in preterm neonates. Conclusion Presepsin blood levels seem to be quite independent of most of maternal and neonatal conditions examined in this study both in preterm and term neonates. The factors exerting significant effects (multiple birth and Apgar at 1 min, in term neonates, weight by gestational age and mechanical ventilation in preterm neonates) are expected to affect presepsin reference limits only to minor extent. References [1] Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. Yaegashi Y., Shirakawa K., Sato N., Suzuki Y., Kojika M., Imai S., Takahashi G., Miyata M., Furusako S., Endo S. J Infect Chemother. 2005;11:234-8. [2] CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infection in the acute care setting. Horan T.C., Andrus M., Dudeck M.A. Am J Infect Control. 2008;36:309-32

Does chorioamnionitis worsen the outcome of preterm infants? A controversial issue

The term chorioamnionitis is used to describe an intrauterine status of infection/inflammation of either mixed fetal-maternal (choriodecidual space) or fetal origin (chorioamniotic membranes, amniotic fluid, umbilical cord). Histological, microbiological, biochemical and clinical criteria are used to define chorioamnionitis. Histopathological examination of the placenta is the gold standard for evaluating antenatal inflammatory processes that might influence fetal development. Chorioamnionitis is the leading cause of very preterm delivery and its incidence increases with decreasing gestational age. Therefore, it contributes to the high morbidity and mortality of infants born prematurely. In the last decades, several studies have been performed to assess a gestation-independent effect of chorioamnionitis on neonatal and long-term outcome with variable results. The discrepancy observed across studies may be attributable to differences in inclusion and exclusion criteria, disease definitions, methods, and whether potential confounding factors such as gestational age were considered. As underlined by several Authors, the increasingly widespread use of antenatal steroids may have contributed to improve neonatal outcome and can therefore partially explain the different results between studies. In the current review we aim to give an overview and synthesis of a vast amount of existing literature on the association between antenatal infection/inflammation and neonatal and long-term outcome

Exchange transfusion in the treatment of neonatal septic shock : a ten-year experience in a neonatal intensive care unit

Septic shock, occurring in about 1% of neonates hospitalized in neonatal intensive care unit (NICU), is a major cause of death in the neonatal period. In the 1980s and 90s, exchange transfusion (ET) was reported by some authors to be effective in the treatment of neonatal sepsis and septic shock. The main aim of this retrospective study was to compare the mortality rate of neonates with septic shock treated only with standard care therapy (ScT group) with the mortality rate of those treated with ScT and ET (ET group). All neonates with septic shock admitted to our NICU from 2005 to 2015 were included in the study. Overall, 101/9030 (1.1%) neonates had septic shock. Fifty neonates out of 101 (49.5%) received one or more ETs. The mortality rate was 36% in the ET group and 51% in the ScT group (p = 0.16). At multivariate logistic regression analysis, controlling for potentially confounding factors significantly associated with death (gestational age, serum lactate, inotropic drugs, oligoanuria), ET showed a marked protective effect (Odds Ratio 0.21, 95% Confidence Interval: 0.06\u20130.71; p = 0.01). The lack of observed adverse events should encourage the use of this procedure in the treatment of neonates with septic shock