Chlorhexidine bathing in a tertiary care neonatal intensive care unit: A pilot study.

BackgroundConcerns regarding potential risk of dermal irritation have led to the exclusion of NICU patients from the recommendation regarding the use of 2% chlorhexidine gluconate (CHG) wash for daily skin cleansing to reduce bloodstream infections. Our aim was to assess the safety of 2% CHG bathing in NICU patients.MethodsThe regulator required a stepwise study enrollment to three successive groups: term infants, followed by near-term and pre-term infants. For comparison, we used a cohort of matched controls. A propensity score-adjusted regression model was used to compare the groups.InterventionInfants were bathed thrice-weekly with 2% CHG-impregnated washcloths. Participant's skin was examined daily.ResultsOver a total of 661 days of treatment: 384,129, and 148 days for the term, near-term and pre-term groups, respectively, no skin reactions were observed. The intervention group was generally sicker, however, bloodstream infections were similar between the groups.ConclusionFor infants >30 weeks and >3 days old, 2% CHG bathing was safe. Large multicenter studies are urgently needed to establish the effectiveness of this practice in the NICU

Chlorhexidine bathing in a tertiary care neonatal intensive care unit: A pilot study

Background Concerns regarding potential risk of dermal irritation have led to the exclusion of NICU patients from the recommendation regarding the use of 2% chlorhexidine gluconate (CHG) wash for daily skin cleansing to reduce bloodstream infections. Our aim was to assess the safety of 2% CHG bathing in NICU patients. Methods The regulator required a stepwise study enrollment to three successive groups: term infants, followed by near-term and pre-term infants. For comparison, we used a cohort of matched controls. A propensity score-adjusted regression model was used to compare the groups. Intervention Infants were bathed thrice-weekly with 2% CHG-impregnated washcloths. Participant’s skin was examined daily. Results Over a total of 661 days of treatment: 384,129, and 148 days for the term, near-term and pre-term groups, respectively, no skin reactions were observed. The intervention group was generally sicker, however, bloodstream infections were similar between the groups. Conclusion For infants >30 weeks and >3 days old, 2% CHG bathing was safe. Large multicenter studies are urgently needed to establish the effectiveness of this practice in the NICU

Mode of delivery and offspring adiposity in late adolescence: The modifying role of maternal pre-pregnancy body size.

ObjectiveTo study the association between mode of delivery and offspring BMI in late adolescence in a large cohort that predated the obesity epidemic, and assess the role of maternal pre-pregnancy BMI (ppBMI) in this association.Study designWe conducted a historical prospective study in the setting of the Jerusalem Perinatal Study (JPS), a population-based cohort that includes all 17,003 births to residents of West Jerusalem, between 1974 and 1976. Offspring's BMI at age 17 was obtained upon army recruitment and was available for 11,001 of cohort participants. The associations were examined using logistic regressions, adjusting for socio-demographic characteristics and for proxies for indication for C-Section birth. Analyses were then stratified by quartiles of ppBMI.ResultsC-Section was associated with offspring overweight/obesity, with adjusted OR of 1.44 (95%CI:1.14-1.82). Significant interaction of ppBMI with mode of delivery was observed, such that the associations of C-Section with overweight/obesity were limited to the upper quartile of ppBMI (adjusted OR = 1.70, 95%CI:1.18-2.43). Restricting the analyses to singleton first births and excluding pregnancies complicated with toxemia and gestational diabetes yielded similar findings.ConclusionsC-Section was positively associated with being overweight/obese at age 17. Importantly, ppBMI modified this association, with a significant association between C-Section and overweight/obesity evident only among offspring born to mothers in the highest ppBMI quartile. In light of the growing rates of obesity in women of reproductive age, these results should be considered in patient-doctor shared decisions related to selection of mode of delivery, in the absence of a clear medical indication

Catheter-Related Fungemia Due to Candida thermophila

We report a case of bloodstream infection caused by Candida thermophila, a yeast not previously associated with human disease. The infection occurred in a 13-year-old boy with medulloblastoma who presented with 1 day of fever. Multiple blood cultures were positive for yeast. Removal of the catheter resulted in prompt resolution of the fever and sterilization of the blood cultures. The species was identified by sequencing domains 1 and 2 of the large subunit rRNA gene. Antifungal susceptibility testing was also performed

Low Interferon Relative-Response to Cytomegalovirus Is Associated with Low Likelihood of Intrauterine Transmission of the Virus.

BACKGROUND:Congenital Cytomegalovirus (CMV) is a very common intrauterine infection which can cause severe mental and hearing impairments. Notably, only 40% of primarily infected women transmit CMV to the fetus. CMV-specific T-cell response has a role in CMV disease but individual immune heterogeneity precludes reliable correlation between measurable T-cells response and intrauterine transmission. STUDY AIM:To establish a correlation between maternal T-cells response and fetal CMV transmission using an individual normalized immune response. METHODS:We analyzed IFN-γ secretion upon whole blood stimulation from primary CMV-infected pregnant women, with either CMV-peptides or PHA-mitogen. RESULTS:We established a new normalization method of individual IFN-γ response to CMV by defining the ratio between specific-CMV response and non-specific mitogen response (defined as IFN-γ relative response, RR), aiming to overcome high person-to-person immune variability. We found a unique subpopulation of women with low IFN-γ RR strongly correlated with absence of transmission. IFN-γ RR lower than 1.8% (threshold determined by ROC analysis) reduces the pre-test probability of transmission from 40% to 8%, revealing an unexpected link between low IFN-γ RR and non-transmission. CONCLUSION:In pregnant women with primary CMV infection, low IFN-γ RR is associated with low risk of transmission

Association of toll-like receptors polymorphism and intrauterine transmission of cytomegalovirus

<div><p>Background</p><p>Congenital Cytomegalovirus (CMV) is a very common intrauterine infection which can cause severe developmental disabilities. Transmission of the virus to the fetus occurs in only 40% of primarily infected women. The probability of intrauterine transmission is higher when infection occurs during the second trimester of pregnancy than in the first trimester. The Toll-like receptors (TLRs) protein family plays a key role in both innate immune response to CMV infections and in normal pregnancy. Specific single nucleotide polymorphisms (SNPs) in TLRs can affect CMV infections and maternal–fetal interface expression. Therefore, TLR SNPs could be involved in intrauterine transmission determination.</p><p>Study aim</p><p>To establish a correlation between TLR2 (rs4696480, rs3804100, rs1898830), TLR3 (rs3775291) and TLR7(rs179008) SNPs with CMV intrauterine transmission during the first and second trimester.</p><p>Methods</p><p>SNPs of 83 pregnant women with primary CMV were analyzed by Real-Time PCR and PCR-RFLP assay and compared to intrauterine transmission state.</p><p>Results</p><p>Women bearing the GG genotype in the rs1898830 TLR2 SNP who were infected with CMV during the second trimester did not transmit the virus to the fetus. Likewise, in the co-dominant or recessive models of this SNP, a significant association was found between the genotypes and CMV intrauterine transmission. In all cohort women or in women infected during the first trimester, no such associations were found between the tested SNPs and intrauterine transmission of the virus.</p><p>Conclusion</p><p>Women bearing the GG genotype in the rs1898830 SNP, who are infected with CMV during the second trimester of pregnancy, have a low likelihood of transmitting the virus to the fetus.</p></div

Clinical characteristics of CMV-infected pregnant women.

<p>Clinical characteristics of CMV-infected pregnant women.</p

The distribution of genotype frequencies of TLR2 (rs4696480, rs3804100, rs1898830), TLR3(rs3775291) and TLR7(rs179008) SNPs in pregnant women who were infected with primary CMV in the first trimester, and intrauterine transmission.

<p>The distribution of genotype frequencies of TLR2 (rs4696480, rs3804100, rs1898830), TLR3(rs3775291) and TLR7(rs179008) SNPs in pregnant women who were infected with primary CMV in the first trimester, and intrauterine transmission.</p