Intrauterine growth retardation is a risk factor for cisapride-induced QT prolongation in preterm infants.

BACKGROUND: Cisapride is a possible cause of potentially life threatening QT prolongation. AIMS: We investigated these cardiac side effects in premature infants, mainly in relation to fetal growth. PATIENTS: Forty six preterms (mean birth weight 1.350 g, mean post conceptional age 31 weeks) were studied. Thirty-one of them were appropriate for gestational age (AGA) and 15 were small for gestational age (SGA). Cisapride was randomly administered at a 0.3 mg/kg or 0.6 mg/kg daily dose. Fifty preterms (15 SGA/35 AGA) not treated with Cisapride were used as control group. METHODS: A pre-treatment ECG was performed and the QT-corrected (Bazzet's formula) intervals were compared with the in-treatment values (normal values < or =440 mseconds). In the control group two different ECG were performed with a timing similar to the treated group (mean interval 5 days). RESULTS AND CONCLUSIONS: No patients showed clinical evidence of drug toxicity. In the small for gestational age group, both baseline QTc (mean 397; range 370-420 ms) and in-treatment QTc (mean 410 range 360-500 ms) were significantly higher than those found in the appropriate for gestational age group (mean 386, range 360-420 ms; mean 396, range 370-420 ms, respectively). This difference was found also in the first ECG of the control group. Moreover the mean QTc lengthening during treatment was significantly higher in small for gestational age group than in the appropriate for gestational age group.Three infants showed a rise in the QTc interval above the value of 440 ms and all were SGA (p = 0.03). No significant correlation was found between birth weight or gestational age and the change in QTc values during Cisapride treatment in the appropriate for gestational age group. Intrauterine growth retardation is a major risk factor for Cisapride-induced QT prolongation in preterm infants

Combined oesophageal impedance-pH monitoring in preterm newborn: comparison of two options for layout analysis.

Gastro-oesophageal reflux (GOR) is common in preterm infants. Combined multichannel intraluminal impedance and pH monitoring (pH-MII) is emerging as an useful tool to study both acid and non-acid GOR in this population. We aimed to highlight main advantages and limits of pH-MII in preterm infants and to test whether the inclusion of GOR episodes detected only by pH monitoring details better the features of GOR. Fifty-two symptomatic preterm infants underwent a 24-hour, continuous and simultaneous measurement of pH-MII. Each layout was analyzed using two different options: option 1 included GOR episodes detected by MII and then classified as acid or non-acid according to the associated pH change; option 2 included GOR episodes detected by MII and also GOR episodes detected only by pH sensor. By adopting option 1, a total number of 2834 GOR episodes was detected by MII: 2162 of them were characterized as non-acid and 672 were characterized as acid. The median (range) number of acid MII-GOR episodes was 10 (1-52); the median (range) number of non-acid MII-GOR episodes was 36.5 (2-119). Median (range) acid MII-GOR-bolus exposure index was 0.28% (0.02-2.73%); median (range) non-acid MII-GOR-bolus exposure index was 1.03% (0.06-38.15%). By adopting option 2, an average of 53.2 acid GOR episodes and an average of 11% oesophageal exposure to acid GOR more than by option 1 was detected. An accurate and detailed description of GOR in preterm infants can be obtained only by including in the analysis all acid GOR episodes detected by pH sensor

Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants.

BACKGROUND: This study examined the effects of a standardized hand hygiene program on the rate of nosocomial infection (NI) in very low birth weight (VLBW) infants (birth weight &lt; 1500 g) admitted to our neonatal intensive care unit (NICU). METHODS: We compared the rate of NI in VLBW infants in 2 separate periods. In the first period, staff were encouraged to perform handwashing using a plain fluid detergent (0.5% triclosan). In the second period, a standardized hand hygiene program was implemented using antimicrobial soap (4% chlorhexidine gluconate) and alcohol-based hand rubs. RESULTS: NI after 72 hours of life was detected in 16 of the 85 VLBW infants in the first period and in 5 of the 80 VLBW infants in the second period. The rate of central venous catheter colonization was significantly lower in the second period (5.8%) than in the first period (16.6%). CONCLUSION: In our NICU, the incidence of NI in VLBW infants was significantly reduced after the introduction of a standardized handwashing protocol. In our experience, a proper hand hygiene program can save approximately 10 NI episodes/year, at a cost of $10,000 per episode. Therefore, improving hand hygiene practice is a cost-effective program in the NICU

Immune Monitoring Using QuantiFERON\uae-CMV Assay in Congenital Cytomegalovirus Infection: Correlation With Clinical Presentation and CMV DNA load.

Background: CMV-specific CD8+ T-cell responses can be detected early in fetal life, but their role in the manifestations of congenital CMV (cCMV) infection remains largely unknown. Methods: CMV-specific CD8+ T-cell responses were assessed in neonates with cCMV using QuantiFERON\uae-CMV assay, within day 14th of life (T0) and during the second month of life (T1). Detection and quantification of CMV DNA in whole blood and urine samples were performed at both time points. QuantiFERON\uae-CMV results were evaluated in relation to timing of maternal infection, clinical manifestations of cCMV and CMV DNA levels. Results: Thirty neonates were enrolled (10/30 [33%] symptomatic; 20/30 [67%] asymptomatic). At T0 16/30 (53%) subjects had a reactive QuantiFERON\uae-CMV result and 16/16 (100%) were asymptomatic, while 14/30 (47%) had a non-reactive or indeterminate QuantiFERON\uae-CMV result and 4/14 (29%) were asymptomatic. At T1, 17/29 (59%) subjects had a reactive QuantiFERON\uae-CMV result and 17/17 (100%) were asymptomatic, while 12/29 (41%) had a non-reactive or indeterminate result and 3/12 (25%) were asymptomatic. At both T0 and T1 reactive QuantiFERON\uae-CMV results correlated with lack of symptoms (P=0.0001). At T1 median CMV DNAemia was lower in subjects with reactive QuantiFERON\uae-CMV results as compared with subjects with non-reactive or indeterminate results (1.82 log IU/mL [1.82-2.89] versus 2.55 log IU/mL [1.82-4.42], P=0.009). No correlation was found between QuantiFERON\uae-CMV results and gestational age at maternal infection nor with urine CMV DNA levels. Conclusions: A detectable CMV-specific CD8+ T-cell response, evaluated using the QuantiFERON\uae-CMV assay, correlates with the lack of CMV-related symptoms and the control of CMV DNAemi

Near-Infrared-Reflectance-Analysis to evaluate human milk’s nitrogen and fat content in Neonatal-Intensive-Care-Unit.

Objective: To validate near-infrared reflectance analysis (NIRA) as a fast, reliable and suitable method for routine evaluation of human milk’s nitrogen and fat content. Setting: One neonatal intensive care unit. Patients: 124 samples of expressed human milk (55 from preterm mothers and 69 from term mothers). Intervention: Measurement of nitrogen and fat content by NIRA and traditional methods (Gerber method for fat and Kjeldahl method for nitrogen). Main outcome measures: Agreement between NIRA and traditional methods. Variability in fat and nitrogen content of human milk. Results: A strong agreement was found between the results of traditional methods and NIRA for both fat and nitrogen content (expressed as g/100 g of milk) in term (mean fat content: NIRA=2.76; Gerber=2.76; mean nitrogen content: NIRA=1.88; Kjeldahl =1.92) and preterm (mean fat content: NIRA=3.56; Gerber=3.52; mean nitrogen content: NIRA=1.91; Kjeldahl =1.89) mothers’ milk. Nitrogen content of the milk samples, measured by NIRA, ranged from 1.18 g/100 g to 2.71 g/100 g of milk in preterm milk and from 1.48 g/100 g to 2.47 g/100 g in term milk; fat content ranged from 1.27 g/100 g to 6.23 g/100 g of milk in preterm milk and from 1.01 g/100 g to 6.01 g/100 g of milk in term milk. Conclusion: NIRA can be used as a quick and reliable tool for routine monitoring of macronutrient content of human milk and for devising individualised human milk fortification regimens in the feeding of very premature infants

Near-Infrared-Reflectance-Analysis to evaluate human milk’s nitrogen and fat content in Neonatal-Intensive-Care-Unit.

Objective: To validate near-infrared reflectance analysis (NIRA) as a fast, reliable and suitable method for routine evaluation of human milk’s nitrogen and fat content. Setting: One neonatal intensive care unit. Patients: 124 samples of expressed human milk (55 from preterm mothers and 69 from term mothers). Intervention: Measurement of nitrogen and fat content by NIRA and traditional methods (Gerber method for fat and Kjeldahl method for nitrogen). Main outcome measures: Agreement between NIRA and traditional methods. Variability in fat and nitrogen content of human milk. Results: A strong agreement was found between the results of traditional methods and NIRA for both fat and nitrogen content (expressed as g/100 g of milk) in term (mean fat content: NIRA=2.76; Gerber=2.76; mean nitrogen content: NIRA=1.88; Kjeldahl =1.92) and preterm (mean fat content: NIRA=3.56; Gerber=3.52; mean nitrogen content: NIRA=1.91; Kjeldahl =1.89) mothers’ milk. Nitrogen content of the milk samples, measured by NIRA, ranged from 1.18 g/100 g to 2.71 g/100 g of milk in preterm milk and from 1.48 g/100 g to 2.47 g/100 g in term milk; fat content ranged from 1.27 g/100 g to 6.23 g/100 g of milk in preterm milk and from 1.01 g/100 g to 6.01 g/100 g of milk in term milk. Conclusion: NIRA can be used as a quick and reliable tool for routine monitoring of macronutrient content of human milk and for devising individualised human milk fortification regimens in the feeding of very premature infants