Newborns with staphylococcus aureus and coagulase-negative sepsis treated with vancomycin after an increase in serum levels around the valley

Introduction: Vancomycin is a glycopeptide antibiotic considered the gold standard in the treatment of staphylococcal infections that are oxacillin-resistant. Objective: To analyse the concentration of serum level in the voucher (one hour before the next administration of the drug dose) of vancomycin in newborns with Staphylococcus aureus infection or oxacillin-resistant coagulase-negative. Methods: This is an experimental study with data collection between the years 2001 and 2016. We selected 30 patients who had staphylococcus aureus and coagulase-negative sepsis and used vancomycin as a treatment. We collected and recorded their serum levels. Results: Of the 30 patients included in the present study, 80% were preterm. Among all the newborns, mean serum concentrations in the vancomycin valley were 40% adequate, 13.34% lower than expected, and 46.67% higher than the reference values. In seven patients (23.34%), the first serum level in the Vancomycin valley collected was adequate, but in nine (30%) and 14 (46.67%) patients, the serum concentration in the valley was respectively below and above the correct values. After dose shifting of those who did not achieve adequate levels, only three of the 14 patients in whom the first dose was not adequate had a mean serum total level within the expected range; the remaining 11 stayed at high levels, which raised great concern due to the fact that if the infection is not being treated, the elevated serum level leads to nephrotoxic and ototoxic problems. The monitoring of serum levels in the vancomycin valley is of great importance as it minimises nephrotoxic effects, thus increasing the efficacy of the drug. The dosage adjustment of vancomycin in severely ill patients admitted to an intensive care unit is important and requires more studies related to this area, as the work of a multidisciplinary body makes the treatment better and more specific. Conclusion: The concentrations of serum levels in the Vancomycin valley (10–15 μg/mL) in patients hospitalised in a neonatal intensive care unit of a reference hospital in Latin America were thought to be bactericidal; however, this is not the values observed in our study

Sepse e meningite neonatal por Neisseria meningitidis: relato de caso

OBJECTIVE: To report a full-term newborn infant that developed a sepsis associated to meningitis caused by Neisseria meningitidis serogroup C on the 14th day of life. CASE DESCRIPTION: The patient was a term female infant, born to a mother with Systemic Lupus Erythematosus, with birth weight of 2,610g, Apgar Score 1, 4 and 8, who needed mechanical ventilation for 24 hours. On the 7th day of life, the neonate was discharged from the hospital with good overall condition. On the 15th day of life, the newborn infant presented fever and respiratory failure. The cerebrospinal fluid showed 1042 cells/mm&sup3;, with neutrophilic predominance, protein of 435 mg/dL, and glucose < 10 mg/dL. The blood and the cerebrospinal fluid cultures were positive for Neisseria meningitidis serogroup C. The neonate was hospitalized, needing mechanical ventilation and vasoactive drugs, and received 21 days of crystalline penicillin. After hospital discharge, there were no signs of neurological sequels and the infant was able to be breastfed. The case report presents a unique situation: an uncommon etiology of neonatal meningitis and favorable evolution, despite neurological sequels reported in the literature. This report emphasizes the need to prevent the premature exposure of newborn infants to pathological agents, especially if they presented birth injuries and/or are preterm, due to their lack of immunological capacity.OBJETIVO: Relatar o caso de um recém-nascido de termo que apresentou no 14º dia de vida sepse associada à meningite, cujo agente etiológico foi a Neisseria meningitidis sorotipo C. DESCRIÇÃO DO CASO: recém-nascido de termo, cuja mãe é portadora de lupus eritematoso sistêmico, feminino, peso de nascimento de 2610g, Escala de Apgar 1, 4 e 8, sendo intubado e ventilado por 24 horas. Recebeu alta no 7º dia de vida em boas condições. No 15º dia de vida apresentou febre e desconforto respiratório. O líquido cefalorraquidiano mostrou 1042 células/mm&sup3;, com predomínio de neutrófilos, proteinorraquia de 435 mg/dL e glicorraquia < 10 mg/dL; a bacterioscopia revelou a presença de diplococos. Foi internado na Terapia Intensiva Neonatal, necessitou de ventilação mecânica e de drogas vasoativas. A hemocultura e a cultura do líquido cefalorraquidiano foram positivas para Neisseria meningitidis C. O recém-nascido foi tratado por 21 dias com penicilina cristalina. Recebeu alta hospitalar em boas condições, em aleitamento materno exclusivo e sem seqüelas neurológicas. O caso descrito apresenta como peculiaridades: etiologia incomum de meningite neonatal e evolução favorável, apesar dos relatos em literatura mostrarem seqüelas neurológicas. Destaca-se ainda, a necessidade de enfatizar a não exposição precoce do recém-nascido, especialmente se tiver tido agravos ao nascimento ou for prematuro, devido à sua inexperiência imunológica

Post-natal prognostic factors in CDH: experience of 11 years in a referral center in Brazil

Objective: To describe post-natal risk factors associated with death in Newborns (NB) with Congenital Diaphragmatic Hernia (CDH) in a Brazilian reference center. Methods: In this retrospective cohort study, post-natal clinical factors of all NB diagnosed with CDH were reviewed in an 11-year period (2007‒2018). The primary outcome was death. Secondary outcomes included clinical features, prognostic indexes, type of mechanical ventilation, complications during hospitalization and surgical repair. Results: After applying the exclusion criteria, the authors analyzed 137 charts. Overall mortality was 59% (81/137), and the highest rates were observed for low-birth-weight NB (87%), syndromic phenotype (92%), and those with major malformations (100%). Prognostic indexes such as Apgar, SNAPPE-II and 24hOI (best oxygenation index in 24 hours) were all associated with poor evolution. In a multivariate analysis, only birth weight and 24hOI were statistically significant risk factors for mortality, with a reduction in mortality risk of 17.1% (OR&nbsp;=&nbsp;0.829, 95% IC 0.72‒0.955, p&nbsp;=&nbsp;0.009) for each additional 100g at birth and an increase by 26.5% (OR&nbsp;=&nbsp;1.265, 95% IC 1.113‒1.436, p&nbsp;=&nbsp;0.0003) for each unitary increase at the 24hOI. Conclusion: Prognostic indexes are an important tool for predicting outcomes and improving resource allocation. Post-natal risk factors may be more suitable for settings where antenatal diagnosis is not universal. Classical risk factors, such as prematurity, low birth weight, higher need for supportive care, and poorer prognostic indexes were associated with mortality in our CDH population

Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america

Introduction: Congenital malformations are major diseases observed at birth. They are the second most common cause of death in the neonatal population, the fi rst one being prematurity. Objective: To characterise the clinical outcome of newborns with gastroschisis (GS) in a neonatal intensive care unit. Methods: A retrospective observational clinical study in 50 infants with GS using the association of intestinal abnormalities, impossibility of primary closure of the abdominal defect and reoperation necessity as classifi cation criteria for the disease. The signifi cance level was p &lt; 0.05. Results: The hospitalisation to primary surgery occurred with a median age of 2 hours. Fourteen percent of children were subjected to a primary silo interposition and 24% had associated intestinal malformation. Nineteen newborns (NB) required more than one surgery. The median length of stay was 33 days, higher in patients with complex GS (56 days). All NB recovered from urine output 48 hours after surgery and 40% had hyponatraemia and oligoanuria in this period. There was no difference between the natraemia and fasting time (p = 0.79). Weight gain was similar in both groups with total parenteral nutrition and became signifi cantly higher in patients with simple GS after enteral feeding (p = 0.0046). These NB evolved 2.4 times less cholestasis. Late-onset sepsis occurred in 58% of patients and was related to the infection of the central venous catheter in 37.9% of cases. Mortality was higher in infants infected with complex GS and the overall mortality rate was 14%. Conclusion: Clinical characterisation of newborns with gastroschisis depends on the complexity and the knowledge and conduct of morbidities to reduce mortality

Evaluación del desarrollo motor y del efecto de la intervención de la fisioterapia en recién nacidos quirúrgicos en una Unidad de Cuidados Intensivos Neonatal

The objective of this study was verify the applicability of the Test of &nbsp;Infant Motor Performance (TIMP) in surgical newborns as a tool for evaluating motor performance and to evaluate the benefit of the physical therapy intervention. Surgical newborns, divided between group without physiotherapy (n=38) and group with motor physical therapy (n=38), were evaluated by TIMP and reevaluated 2 weeks later. The physiotherapy group performed standardized exercises for motor sensory stimulation once a day, while the no physiotherapy group received the usual care from the Neonatal Intensive Care Unit. The predominant surgical diagnosis in both groups was gastroschisis, followed by congenital diaphragmatic hernia. In the initial evaluation there was no difference in motor performance between the groups, classified as "below average" for age, with score -z = -1.28 (p=0.992). In the reassessment, the physiotherapy group presented better scores (p&lt;0.001) and a higher difference in -z-score (p&lt;0.001), higher percentage of newborns classified as "within the mean" (44% in the physiotherapy group and 2.6% in the no physiotherapy group), as well as a higher percentage of weight gain (p=0.038). In the revaluation there was a worsening of motor performance in 10.5% of the no physiotherapy group (p&lt;0.001). Improvement in motor performance was observed in 81.6% of the physiotherapy group and in only 13.2% of the no physiotherapy group (p&lt;0.001). Conclusion: TIMP was applied to newborns safely and effectively and needs to be performed by professionals experienced in the approach of this population. Motor intervention was beneficial, with significant improvement in motor performance, and if started early, it may be able to adapt the motor development of these newborns, even before hospital discharge. &nbsp;| El objetivo de este estudio fue verificar la aplicabilidad delTest of Infant Motor Performance (TIMP) en recién nacidos quirúrgicos(RN) como una herramienta de evaluación del desempeño motor,y analizar el beneficio de la fisioterapia. Los RN quirúrgicos, divididosen los grupos sin fisioterapia motora (n=38) y con fisioterapia(n=38), fueron evaluados por el TIMP y reevaluados dos semanasdespués. El grupo con fisioterapia realizó ejercicios de estimulaciónsensoriomotora una vez al día, mientras que el grupo sin fisioterapiarecibió la atención habitual de la Unidad de Cuidados IntensivosNeonatal (UCIN). El diagnóstico quirúrgico predominante en ambosgrupos fue el de la gastrosquisis, seguido de hernia diafragmáticacongénita. En la evaluación, no hubo diferencia en el desempeñomotor entre los grupos, clasificados como “por debajo del promedio”para la edad, con puntaje -z=−1,28 (p=0,992). En la reevaluación,el grupo con fisioterapia tuvo mejor puntuación (p&lt;0,001) y mayordiferencia de puntaje (p&lt;0,001), con mayor porcentaje de RNclasificados como “dentro de la media” en comparación con el gruposin fisioterapia (44% y 2,6%, respectivamente); además de un mayorporcentaje de ganancia de peso (p=0,038). En la reevaluación huboun empeoramiento del desempeño motor en el 10,5% del grupo sinfisioterapia (p&lt;0,001), mientras que se observó una mejora en eldesempeño motor en el 81,6% del grupo con fisioterapia y solo en el13,2% del grupo sin fisioterapia (p&lt;0,001). Se concluyó que el TIMPse aplicó con seguridad y eficacia y que este debe ser realizado porprofesionales con experiencia con esta población. La fisioterapiamotora mejoró significativamente el rendimiento motor y, si se iniciaprecozmente, puede ser capaz de adaptar el desarrollo motor deestos RN, incluso antes del alta hospitalariaO objetivo do estudo foi verificar a aplicabilidade do Test of Infant Motor Performance (TIMP) em recém-nascidos cirúrgicos como ferramenta para avaliação do desempenho motor e avaliar o benefício da fisioterapia. Recém-nascidos cirúrgicos, divididos em grupo sem fisioterapia motora (n=38) e com fisioterapia motora (n=38), foram avaliados pelo TIMP e reavaliados 2 semanas após. O grupo com fisioterapia realizou exercícios para estimulação sensório motora 1 vez ao dia, enquanto o grupo sem fisioterapia recebeu os cuidados habituais da Unidade de Terapia Intensiva Neonatal. O diagnóstico cirúrgico predominante nos dois grupos foi gastrosquise, seguido de hérnia diafragmática congênita. Na avaliação não houve diferença no desempenho motor entre os grupos, classificados como “abaixo da média” para idade, com escore -z = -1,28 (p=0,992). Na reavaliação o grupo com fisioterapia apresentou melhor pontuação (p&lt;0,001) e maior diferença de escore -z (p&lt;0,001), maior porcentagem de recém-nascidos classificados como “dentro da média” (44% no grupo com fisioterapia e 2,6% no grupo sem fisioterapia), assim como maior porcentagem de ganho de peso (p=0,038). Na reavaliação houve piora do desempenho motor em 10,5% do grupo sem fisioterapia (p&lt;0,001). A melhora do desempenho motor foi observada em 81,6% do grupo com fisioterapia e em apenas 13,2% do grupo sem fisioterapia (p&lt;0,001). O TIMP foi aplicado de forma segura e eficaz e necessita ser realizado por profissionais experientes na abordagem dessa população. A fisioterapia motora melhorou significativamente o desempenho motor, e se iniciado precocemente, pode ser capaz de adequar o desenvolvimento motor desses recém-nascidos, antes mesmo da alta hospitalar

Nonthyroidal illnesses syndrome in full-term newborns with sepsis

ABSTRACT Objective: To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. Materials and methods: We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. Results: 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. Conclusions: This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-3

Monocyte-to-HDL ratio and non-HDL cholesterol were predictors of septic shock in newborns

Background: The association between lipoprotein levels and late-onset neonatal sepsis has shown controversial results. The aims are to assess lipid profile, cytokines, and Monocyte-to-HDL (M/H) ratio as diagnostic and prognostic markers for late-onset neonatal sepsis. Methods: This prospective study included&nbsp;49&nbsp;septic neonates and 17&nbsp;controls. Cholesterol (CT), Triglyceride (TG), Very-Low-Density (VLDLc), Low-Density (LDLc), and High-Density Lipoproteins (HDLc) were measured at admission (D0) and on days&nbsp;3,&nbsp;7 and&nbsp;10 to evaluate septic shock outcomes. Cytokines and monocytes were evaluated by flow cytometry. Results: Septic newborns showed higher IL-6 and IL-8 at D0 and CT levels on D7 and on D10, which also presented higher TG, VLDLc and non-HDL cholesterol concentrations than controls. The septic shock group (n = 22) revealed a higher number of male subjects, CRP, IL-6, IL-8 and IL-10 levels, while lower TG, HDLc, monocyte numbers and M/H ratio at admission compared to the non-shock group (n = 27). M/H ratio and non-HDL cholesterol on D0 were risk factors for septic shock (OR = 0.70, 0.49‒0.99; OR = 0.96, 0.92‒0.99, respectively). Decreasing levels from D0 to D3 of CT (OR = 0.96, 0.93‒0.99), VLDLc (OR = 0.91, 0.85‒0.98), and non-HDL cholesterol (OR = 0.92, 0.87‒0.98) were also predictors of septic shock. Conclusions: Lower M/H ratios and non-HDL cholesterol at admission and decreasing levels of cholesterol, VLDLc and non-HDL cholesterol during a hospital stay are associated with the development of septic shock in newborns with late-onset neonatal sepsis