Concordancia interobservador del electroencefalograma integrado por amplitud en el neonato con asfixia perinatal

Introduction: Amplitude integrated electroencephalography (aEEG) is a widely tool used for neuromonitoring in the critical neonate. In the patient with perinatal asphyxia, its interpretation is key to identifying candidates for therapeutic hypothermia, detecting subclinical seizures and providing pronostic information. Our aim was to analyze the concordance in the interpretation of aEEG among neonatologists with different level of experience. Material and methods: Unicenter retrospective study of newborns ≥35 weeks with perinatal asphyxia included consecutively over a two-year period and monitored with aEEG for at least 6 h. The bedside neonatologist interpreted aEEG regarding background pattern, sleep-wake cycling, and seizures. The aEEG tracings were blindly reviewed by two neonatologists with different experience. The aEEG tracings were divided into periods of 0–3 h and 3-6 h of life, and the concordance (Cohen Kappa coefficient, k), between the two examiners and that of their consensus with the bedside neonatologist, was analyzed. Results: Seventy-five newborns were included, 5 of them were not aEEG-monitored. 132 tracings were analyzed with a very good concordance between the two examiners in the three characteristics of the aEEG. The k for the bedside neonatologist was very good for background pattern (k = 0.93), moderate (k = 0.52) for sleep-wake cycling, and weak (k = 0.32) for seizures. Conclusions: This study supports that background pattern is easily interpreted compared to sleep-wake cycling or crisis, improving when targeted training on aEEG is receivedLa electroencefalografía integrada por amplitud (aEEG) es una herramienta utilizada en la neuromonitorización del neonato crítico. En el paciente con asfixia perinatal, su interpretación es clave para identificar a los candidatos a hipotermia terapéutica, detectar crisis subclínicas y aportar información pronóstica. Nuestro objetivo fue analizar la concordancia en la interpretación del aEEG entre neonatólogos con distinto nivel de experiencia. Material y métodos: Estudio retrospectivo unicéntrico de los recién nacidos ≥ 35 semanas con asfixia perinatal incluidos consecutivamente durante un periodo de dos años y monitorizados con aEEG durante al menos 6 horas. El médico de guardia interpretó el aEEG respecto al trazado de base, los ciclos vigilia-sueño y las crisis. Los aEEG fueron revisados de forma ciega por dos neonatólogas con distinta experiencia. Se analizó la concordancia (coeficiente Kappa de Cohen, k) de los aEEG divididos en periodos de 0-3 horas y 3-6 horas de vida, entre ambas y la de su consenso con el médico de guardia. Resultados: Se incluyeron 75 neonatos, 5 de ellos no se monitorizaron. Se analizaron 132 tra- zados con una concordancia muy buena entre las dos examinadoras en las tres características del aEEG. El k respecto al médico de guardia fue muy bueno para el trazado de base (k= 0,93), moderado (k= 0,52) para los ciclos vigilia-sueño y débil (k= 0,32) para las crisis. Conclusiones: Este estudio apoya una mayor facilidad para interpretar adecuadamente el trazado de base frente a los ciclos vigilia-sueño o las crisis, mejorando cuando se recibe una formación dirigida en el aEEGEste estudio ha sido parcialmente financiado por la Gerencia Regional de Salud de Castilla y León (N.◦ de expediente GRS 827/A/13

Ceftazidime–Avibactam Use in a Case Series of Difficult-to-Treat or Recurrent Infections in Pediatric Patients with Complex Chronic Conditions: Effectiveness and Absence of Resistance Development

The prevalence of multidrug-resistant Gram-negative infections, particularly carbapenem-resistant strains, has become a significant global health concern. Ceftazidime–avibactam (CZA) has emerged as a promising treatment option. However, data on its efficacy and safety in children are scarce, necessitating further investigation. We conducted a descriptive case series at a tertiary hospital in Spain from February 2019 to January 2022. Pediatric patients (n = 8) and biliary atresia (n = 4). The predominant type of infection for which they received CZA was intra-abdominal infection caused or suspected to be caused by OXA-48-producing Klebsiella pneumoniae. CZA was generally well tolerated. Within the first month of starting CZA therapy, two patients died, with one case directly linked to the infection’s fatal outcome. Some patients needed repeated courses of therapy due to recurrent infections, yet no resistance development was noted. In summary, the use of CZA showed effectiveness and safety, while the lack of resistance development highlights CZA’s potential as a primary treatment option against OXA-48-producing infections

Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain—What Have We Learned?

Antibiotic misuse in pediatric intensive care units (PICUs) can lead to increased antimicrobial resistance, antibiotic-triggered side effects, hospital costs, and mortality. We performed a multicenter, prospective study, analyzing critically ill pediatric patients (≥1 month to ≤18 years) admitted to 26 Spanish PICUs over a 3-month period each year (1 April–30 June) from 2014–2019. To make comparisons and evaluate the influence of AMS programs on antibiotic use in PICUs, the analysis was divided into two periods: 2014–2016 and 2017–2019 (once 84% of the units had incorporated an AMS program). A total of 11,260 pediatric patients were included. Total antibiotic prescriptions numbered 15,448 and, overall, 8354 patients (74.2%) received at least one antibiotic. Comparing the two periods, an increase was detected in the number of days without antibiotics in patients who received them divided by the number of days in PICUs, for community-acquired infections (p p p p = 0.045). Despite the high rate of antibiotic use in PICUs, our results showed a significant increase in appropriate antibiotic use and adjustment following the implementation of AMS programs

Device Exposure and Patient Risk Factors’ Impact on the Healthcare-Associated Infection Rates in PICUs

Healthcare-associated infections related to device use (DA-HAIs) are a serious public health problem since they increase mortality, length of hospital stay and healthcare costs. We performed a multicenter, prospective study analyzing critically ill pediatric patients admitted to 26 Spanish pediatric intensive care units (PICUs) over a 3-month period each year from 2014 to 2019. To make comparisons and evaluate the influence of HAI Zero Bundles (care bundles that intend to reduce the DA-HAI rates to zero) on PICU HAI rates, the analysis was divided into two periods: 2014–2016 and 2017–2019 (once most of the units had incorporated all the Zero Bundles). A total of 11,260 pediatric patients were included. There were 390 episodes of HAIs in 317 patients and the overall rate of HAIs was 6.3 per 1000 patient days. The DA-HAI distribution was: 2.46/1000 CVC days for central-line-associated bloodstream infections (CLABSIs), 5.75/1000 MV days for ventilator-associated pneumonia (VAP) and 3.6/1000 UC days for catheter-associated urinary tract infections (CAUTIs). Comparing the two periods, the HAI rate decreased (p = 0.061) as well as HAI episodes (p = 0.011). The results demonstrate that exposure to devices constitutes an extrinsic risk factor for acquiring HAIs. The multivariate analysis highlights previous bacterial colonization by multidrug-resistant (MDR) bacteria as the most important extrinsic risk factor for HAIs (OR 20.4; 95%CI 14.3–29.1). In conclusion, HAI Zero Bundles have been shown to decrease HAI rates, and the focus should be on the prompt removal of devices, especially in children with important intrinsic risk factors