Iatrogenic Anetoderma of Prematurity: A Case Report and Review of the Literature

Anetoderma is a skin disorder characterized by focal loss of elastic tissue in the mid dermis, resulting in localized areas of macular depressions or pouchlike herniations of skin. An iatrogenic form of anetoderma has been rarely described in extremely premature infants and has been related to the placement of monitoring devices on the patient skin. Because of the increasing survival of extremely premature infants, it is easy to foresee that the prevalence of anetoderma of prematurity will increase in the next future. Although it is a benign lesion, it persists over time and can lead to significant aesthetic damage with need for surgical correction. Sometimes the diagnosis can be difficult, especially when the atrophic lesions become evident after discharge. Here, we report on a premature infant born at 24 weeks of gestation, who developed multiple anetodermic patches of skin on the trunk at the sites where electrocardiographic electrodes were previously applied. The knowledge of the disease can encourage a more careful management of the skin of extremely premature babies and aid the physicians to diagnose the disease when anetoderma patches are first encountered later in childhood

Pp65 antigenemia, plasma real-time PCR and DBS test in symptomatic and asymptomatic cytomegalovirus congenitally infected newborns

<p>Abstract</p> <p>Background</p> <p>Many congenitally cytomegalovirus-infected (cCMV) neonates are at risk for severe consequences, even if they are asymptomatic at birth. The assessment of the viral load in neonatal blood could help in identifying the babies at risk of sequelae.</p> <p>Methods</p> <p>In the present study, we elaborated the results obtained on blood samples collected in the first two weeks of life from 22 symptomatic and 48 asymptomatic newborns with cCMV diagnosed through urine testing. We evaluated the performances of two quantitative methods (pp65 antigenemia test and plasma Real-time PCR) and the semi-quantitative results of dried blood sample (DBS) test in the aim of identifying a valid method for measuring viral load.</p> <p>Results</p> <p>Plasma qPCR and DBS tests were positive in 100% of cases, antigenemia in 81%. Only the latter test gave quantitatively different results in symptomatic versus asymptomatic children. qPCR values of 10³copies/ml were found in 52% of newborn. "Strong" DBS test positivity cases had higher median values of both pp65 positive PBL and DNA copies/ml than cases with a "weak" positivity.</p> <p>Conclusions</p> <p>As expected antigenemia test was less sensitive than molecular tests and DBS test performed better on samples with higher rates of pp65 positive PBL and higher numbers of DNA copies/ml. The prognostic significance of the results of these tests will be evaluated on completion of the ongoing collection of follow-up data of these children.</p

Exposure to Gastric Acid Inhibitors Increases the Risk of Infection in Preterm Very Low Birth Weight Infants but Concomitant Administration of Lactoferrin Counteracts This Effect

Objective: To investigate whether exposure to inhibitors of gastric acidity, such as H2 blockers or proton pump inhibitors, can independently increase the risk of infections in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit. Study design: This is a secondary analysis of prospectively collected data from a multicenter, randomized controlled trial of bovine lactoferrin (BLF) supplementation (with or without the probiotic Lactobacillus rhamnosus GG) vs placebo in prevention of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in preterm infants. Inhibitors of gastric acidity were used at the recommended dosages/schedules based on the clinical judgment of attending physicians. The distribution of days of inhibitors of gastric acidity exposure between infants with and without LOS/NEC was assessed. The mutually adjusted effects of birth weight, gestational age, duration of inhibitors of gastric acidity treatment, and exposure to BLF were controlled through multivariable logistic regression. Interaction between inhibitors of gastric acidity and BLF was tested; the effects of any day of inhibitors of gastric acidity exposure were then computed for BLF-treated vs -untreated infants. Results: Two hundred thirty-five of 743 infants underwent treatment with inhibitors of gastric acidity, and 86 LOS episodes occurred. After multivariate analysis, exposure to inhibitors of gastric acidity remained significantly and independently associated with LOS (OR, 1.03; 95% CI, 1.008-1.067; P = .01); each day of inhibitors of gastric acidity exposure conferred an additional 3.7% odds of developing LOS. Risk was significant for Gram-negative (P < .001) and fungal (P = .001) pathogens, but not for Gram-positive pathogens (P = .97). On the test for interaction, 1 additional day of exposure to inhibitors of gastric acidity conferred an additional 7.7% risk for LOS (P = .003) in BLF-untreated infants, compared with 1.2% (P = .58) in BLF-treated infants. Conclusion: Exposure to inhibitors of gastric acidity is significantly associated with the occurrence of LOS in preterm VLBW infants. Concomitant administration of BLF counteracts this selective disadvantage. Trial registration: isrctn.org: ISRCTN53107700

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: 0.06–0.71; p = 0.01). The lack of observed adverse events should encourage the use of this procedure in the treatment of neonates with septic shock

Rotarix® and RotaTeq® administration to preterm infants in the neonatal intensive care unit: Review of available evidence

Rotavirus (RV) is the leading cause of severe acute gastroenteritis (GE) in infants worldwide. Several vaccines against RV were developed to reduce disease burden, hospitalization rates and health utilization costs. RV GE is a serious disease in preterm (PT) infants, and the administration of RV vaccine to these at-risk subjects at the proper time could have great clinical relevance. However, most data on the efficacy and safety of RV vaccinations were collected in healthy full-term infants, and few studies investigated PT infants. The lack of studies in PT infants may explain why neonatologists in several neonatal intensive care units (NICUs) do not follow the official recommendations, which indicate that RV vaccine may be administered in hospitals. Increasing neonatologists' knowledge on the efficacy and safety of RV vaccines and defining PT candidates for vaccination and the necessary precautions are extremely important to avoid potential vaccine virus transmission and improve RV vaccination coverage in PT infants. Further studies should analyse the impact of vaccination of PT infants of different gestational ages and various clinical histories in stable conditions in the NICU with a careful monitoring of adverse events to the vaccine and RV GE occurrence. Only data that confirm the efficacy and safety of RV vaccines in large numbers of PT infants with different characteristics will convince neonatologists to use RV vaccines in PT infants hospitalized in NICUs

La gestione neonatologica dell&apos;infezione congenita da citomegalovirus

Il citomegalovirus (CMV) \ue8 la causa pi\uf9 frequente di infezione virale congenita, interessando lo 0,2-2% dei nati vivi, e pertanto rappresenta un problema rilevante di salute pubblica. I neonati con infezione congenita, sia sintomatici sia asintomatici alla nascita, possono presentare sequele, in particolare ipoacusia neurosensoriale e danno neurologico. Il virus pu\uf2 essere trasmesso al feto sia in seguito ad una infezione materna primaria sia in seguito ad una infezione ricorrente. Nonostante il rischio di trasmissione sia significativamente pi\uf9 elevato in caso di infezione materna primaria che non in caso di infezione ricorrente, non \ue8 ad oggi raccomandato lo screening per CMV in gravidanza in quanto non c\u2019\ue8 sufficiente evidenza in favore di terapie prenatali. Quando l\u2019infezione congenita viene diagnosticata alla nascita, il ganciclovir per via endovenosa o il valganciclovir per os rappresentano i farmaci di scelta per il trattamento dei neonati sintomatici. In base alle evidenze scientifiche attuali, la terapia antivirale dovrebbe essere proseguita per sei mesi nei neonati con infezione di entit\ue0 media/grave. In ogni caso, tutti i neonati con infezione congenita, sia sintomatici sia asintomatici alla nascita, dovrebbero essere seguiti con un programma di follow-up mirato fino all\u2019et\ue0 di sei anni al fine di diagnosticare tempestivamente le sequele tardive e mettere in atto gli interventi riabilitativi necessari. L\u2019esecuzione di uno screening universale alla nascita per l\u2019infezione congenita da CMV sarebbe auspicabile in quanto consentirebbe di identificare anche i neonati con infezione congenita asintomatica alla nascita nati da donne con infezione non primaria in gravidanza. La ricerca del DNA di CMV tramite PCR nella saliva sembra essere il test che presenta le migliori caratteristiche per uno screening. Sicuramente sono necessari studi su larga scala per valutare il rapporto rischio/beneficio di uno screening universale che potrebbe essere determinante nel ridurre il \u201ccarico\u201d derivante dall\u2019infezione congenita da CMV.Cytomegalovirus (CMV) is the leading cause of congenital infection in humans, affecting 0.2-2% of all live births, and thus constitutes a major public health problem. Congenitally infected infants, both symptomatic and asymptomatic at birth, may develop sequelae, especially sensorineural hearing loss and brain damage. The virus can be transmitted to the fetus following either a primary or a non-primary maternal infection during pregnancy. Even though the transmission rate is much higher in primary infected mothers than in mothers with preconceptional immunity, routine CMV screening of pregnant women is not recommended today because no consensus exists on prenatal treatment options. Intravenous ganciclovir or oral valganciclovir are used to treat neonates with symptoms at birth. Valganciclovir treatment for six months is recommended for congenitally infected neonates with moderately to severely symptomatic disease. All infants with congenital CMV infection, both symptomatic and asymptomatic at birth, need a followup evaluation to detect sequelae as early as possible, so that infants can receive intervention promptly. For several years, a universal newborn screening for congenital CMV infection has been suggested by many Authors, inasmuch it would allow us to detect sequelae promptly even in neonates asymptomatic at birth born to women with non-primary infection in pregnancy. A real-time PCR assay of saliva specimens seems to offer the best characteristics for use in screening. Large-scale studies to evaluate the cost/benefit ratio of a universal newborn screening for congenital CMV infection are needed to further reduce the burden of congenital CMV infection

Blood withdrawal and infusion via umbilical catheters: Effect on cerebral perfusion and influence of ibuprofen

Withdrawal and infusion of blood via umbilical catheters can affect cerebral blood flow in preterm infants. We compared the effects on cerebral perfusion of 3 ml/kg blood withdrawal and infusion via umbilical arterial (UAC) and venous (UVC) catheters in 16 infants 6432 weeks gestation, age <24 h, on mechanical ventilation. Near infrared spectroscopy was used to monitor changes in cerebral oxy- and deoxyhemoglobin, total cerebral hemoglobin (an index of cerebral blood volume; CBV) and HbD (an index of cerebral intravascular oxygenation). In 10 infants the study was repeated 1 h after intravenous administration of 10 mg/kg ibuprofen as prophylaxis against PDA. Withdrawal and infusion via the UVC caused significant MABP and concordant HbD and CBV changes. Smaller modifications were seen following blood withdrawal and infusion via the UAC. Ibuprofen attenuated cerebral hemodynamic changes associated with withdrawal, but not infusion, from UAC and UVC. Copyright \ua9 2003 S. Karger AG, Basel

Presepsin (Soluble CD14 Subtype): Reference Ranges of a New Sepsis Marker in Term and Preterm Neonates.

OBJECTIVE:Presepsin (soluble CD14 subtype) has been shown to be beneficial as a sepsis marker in adults. Nevertheless, very few data are available in neonates. The aim of the present study was to determine reference ranges of presepsin in term and preterm neonates. METHODS:Healthy term neonates and preterm neonates without clinical signs of infection admitted to the Neonatal Unit were consecutively enrolled. Presepsin concentrations in whole blood were measured using a point-of-care assay system located in the Unit. Demographic data, antenatal and perinatal variables commonly affecting C-reactive protein and procalcitonin values were considered. RESULTS:Of the 684 neonates enrolled in the study, 484 (70.8%) were born at term and 200 (29.2%) were preterm (24-36 weeks' gestation). In term infants, presepsin median value was 603.5 pg/mL (interquartile range: 466.5-791 pg/mL; 5th and 95th centiles: 315 and 1178 pg/mL respectively). In preterm infants, presepsin median value was slightly higher, equal to 620 pg/mL (interquartile range: 503-864 pg/mL; 5th and 95th centiles: 352 and 1370 pg/mL respectively). The reference ranges of presepsin we determined were much higher than those seen in healthy adults. No correlation between presepsin levels and postnatal age was observed, as well as no significant difference was demonstrated in preterm neonates at different gestational ages. None of the variables analyzed affected presepsin levels at a clinical significant extent. CONCLUSION:For the first time, this study provides reference ranges of presepsin in term and preterm neonates. Having reliable reference values is crucial for obtaining an adequate diagnostic accuracy. Based on our results, most variables commonly affecting C-reactive protein and procalcitonin values do not affect presepsin levels, which suggests that presepsin could be an effective sepsis marker. Further investigations in large groups of neonates with sepsis are needed to determine the diagnostic and prognostic value of this biomarker