Perinatal transmission of Chlamydia trachomatis and its complication in preterm infants

Introduction: Chlamydia trachomatis is the most common agent of sexually transmitted infections. In pregnant women it can cause premature delivery. In newborns the clinical manifestation are pneumonia and conjunctivitis. Aim: The aim of the study was to estimate the perinatal transmission of Chlamydia trachomatis and the prevalence of neonatal complications. Material and methods: The study included 82 mothers with deliver

Wentylacja mechaniczna z zastosowaniem helioxu w leczeniu wcześniaków z zespołem zaburzeń oddychania

Objective: The aim of the study was to assess the influence of mechanical ventilation with helium-oxygen mixture (heliox) on basic vital signs, oxygenation, acid-base balance and respiratory mechanics in newborns with respiratory distress syndrome (RDS), previously treated with surfactant. Material and methods: The study was carried out in preterm newborns with respiratory failure requiring mechanical ventilation due to RDS, requiring FiO2≥0.4 after a single dose of surfactant. Patients were ventilated using PCSIMV. Parameters of mechanical ventilation, respiratory function, oxygenation, acid-base balance and vital signs were recorded at baseline, one hour during and one hour after heliox ventilation. Results: Ten newborns with RDS were enrolled in the study. Mechanical ventilation with heliox did not affect vital signs and patient general condition remained stable during and after ventilation with heliox. Mechanical ventilation with heliox was associated with a statistically significant increase in tidal volume (mean 5.48 vs 6.55 ml/kg). There were no significant changes in minute ventilation and peak expiratory flow rate. Mechanical ventilation with heliox allowed the use of significantly lower fractions of inspired oxygen (mean 0.55 vs 0.35), with a significant decrease in the oxygenation index (mean 8.77 vs 5.02) and alveolar-arterial oxygen tension difference (mean 63.81vs113.28 mm Hg). After ventilation with this gas mixture was stopped, the patients required higher FiO2, OI and AaDO2 levels increased. Conclusions: Mechanical ventilation with heliox was safe, improved oxygenation and caused an increase in tidal volume in newborns with RDS previously treated with surfactant.Cel pracy: Ocena wpływu wentylacji mechanicznej z zastosowaniem helioxu (mieszaniny tlenu i helu) na postawowe parametry życiowe, utlenowanie, równowagę kwasowo-zasadową oraz wybrane elementy mechaniki oddychania u wcześniaków z ZZO leczonych uprzednio surfaktantem. Materiał i metody: Badanie przeprowadzono u wcześniaków z niewydolnością oddechową w przebiegu zespołu zaburzeń oddychania (ZZO), u których pomimo podania 1 dawki surfaktantu utrzymywało się podwyższone zapotrzebowanie na tlen (stężenie tlenu w mieszaninie oddechowej (FiO2 ) ≥0.4). Pacjenci byli wentylowani mechanicznie z wykorzystaniem trybu PC-SIMV. Parametry wentylacji, funkcji płuc, utlenowania, równowagi kwasowo-zasadowej i podstawowe parametry życiowe były rejestrowane na początku badania, następnie w ciągu godziny wentylacji helioxem oraz 1 godzinę po jej zakończeniu. Wyniki: Do badania włączono 10 noworodków z ZZO. Wentylacja helioxem nie miała wpływu na podstawowe parametry życiowe i stan ogólny pacjentów, który podczas stosowania helioxu oraz po jego zakończeniu pozostawał stabilny. Wentylacja mechaniczna z zastosowaniem helioxu wiązała się ze statystycznie istotnym zwiększeniem objętości oddechowych (5.48 vs 6.55 ml/kg; wartości średnie). Nie wystąpiły istotne zmiany w zakresie wentylacji minutowej i szczytowego przepływu końcowo-wydechowego. Wentylacja helioxem umożliwiła użycie istotnie niższych stężeń tlenu w mieszaninie oddechowej (0.55 vs 0.35), z jednoczesnym obniżeniem wskaźnika utlenowania (8.77 vs 5.02) i pęcherzykowo-tętniczej różnicy prężności tlenu (263.81 vs 113.28 mm Hg). Po zakończeniu wentylacji tą mieszaniną gazów pacjenci wymagali wyższego FiO2, a wartości OI i AaDO2 wzrosły. Wnioski: Wentylacja mechaniczna helioxem była bezpieczna, spowodowała poprawę utlenowania oraz zwiększenie objętości oddechowych u noworodków z ZZO leczonych surfaktantem

Do abnormal results of Doppler examinations in fetuses with growth restriction increase the frequency of postnatal complications of the central nervous system and gastrointestinal tract?

Abstract Objectives: The aim of the work was to assess the correlations between the results of antenatal Doppler examinations in fetuses with growth restriction (IUGR) and the frequency of postnatal complications of central nervous system and gastrointestinal tract. Material and methods: 47 pregnant women and 47 fetuses and newborns from singleton pregnancies with diagnosed intrauterine growth restriction. Two groups of fetuses (newborns) were distinguished based on serial Doppler examinations of fetal umbilical and middle cerebral arteries: 1) newborns with IUGR and abnormal results of antenatal Doppler examinations (group 1); 2) newborns with IUGR and normal results of antenatal Doppler examinations (group 2). The analysis concerned such neonatal complications as intraventricular hemorrhages (IVH) of III and IV degree, leucomalacias and necrotizing eneterocollits (NEC). Results: Among 47 neonates, the abnormal results of Doppler examinations were found in 21 of them, and in the rest of the newborns (26) there were no abnormalities in Doppler antenatal examinations. The frequency of intraventricular hemorrhages of III and IV degree, neonatal leucomalacias and necrotizing eneterocollits did not differ significantly between the groups. The mean time of hospitalization in newborns with abnormal results of antenatal Doppler examinations was significantly longer than in neonates whose antenatal Doppler tests were normal (14 days vs 10 days). The newborns from group 1 required parenteral feeding significantly more often than the newborns from group 2 (28,9% vs 12%). Conclusions: The comparable frequency of central nervous system complications in newborns with abnormal and in neonates with normal results of antenatal Doppler examinations may indicate on effective role of brain sparing effect in fetuses with IUGR as a mechanism which reduces the likelihood of hypoxemic complications in the developing fetal brain. The newborns with IUGR and abnormal results of antenatal Doppler test require both a longer hospitalization and the necessity of parenteral feeding when compared with newborns with IUGR and normal antenatal Doppler test results. Newborns who were diagnosed with absent or reversed end-diastolic flow in umbilical artery are particularly at risk of central nervous system complications

Necrotising enterocolitis in preterm infants : epidemiology and antibiotic consumption in the polish neonatology network neonatal intensive care units in 2009

The aim of this study was to describe the epidemiology of necrotising enterocolitis (NEC), antibiotic consumption and the usefulness of microbiological tests in very low birth weight (VLBW) Polish newborns. METHODS: Prospective surveillance was performed in the year 2009 by local infection control teams. The study covered 910 infants hospitalized in six Polish neonatal intensive care units. Two kinds of indicators were used for the description of antibiotic usage: the duration of treatment (days of treatment, DOTs) and the defined daily dose (DDD). RESULTS: NEC incidence was 8.7% and fatality rate was 19%. Chorioamnionitis, late gestational age and low birth weight were identified as risk factors for NEC. Catheterization, mechanical ventilation and other selected procedures were used considerably longer in newborns with NEC than in the remaining neonates. Total usage of antibiotics reached 2.9 DDDs or 1.437 days; the average use of drugs per case of NEC amounted to 0.47 DDD or 23.2 DOTs. The level of antibiotic usage was analysed with correlation to microbiological tests performed and it was non-significantly greater in the group of children with NEC in whom the tests were performed. CONCLUSIONS: A high risk of developing NEC is closely associated with VLBW and with inflammation of the amnion during labour. We observed no relationship between the consumption of antibiotics in neonates with NEC and positive results of microbiological testing indicating sepsis accompanying NEC or gut colonization with pathogens

Late-onset bloodstream infections of Very-Low-Birth-Weight infants: data from the Polish Neonatology Surveillance Network in 2009–2011

BACKGROUND: Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011. METHODS: The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS. RESULTS: Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%). CONCLUSIONS: Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio