Surveillance swabbing for MRSA on neonatal intensive care units – is weekly nasal swabbing the best option?

Most paediatric meticillin resistant Staphylococcus aureus (MRSA) infections occur in neonatal units, but evidence for ongoing MRSA surveillance is lacking and practice varies. The aim of this study was to determine the optimal strategy for neonatal MRSA screening according to swab site, gestational age and birth weight. MRSA detection on simultaneous weekly nasal and groin surveillance swabs and suspected infected sites was determined for all admissions to a tertiary neonatal unit over eight years. Twenty one thousand, seven hundred and thirty six surveillance specimens were examined (3,784 admissions). Infants colonised with MRSA were smaller and of lower gestational age compared with uncolonised infants ( p&lt;0.0001). Infants initially positive on groin swabs alone (13/68; 19%) were of significantly greater gestational age and weight at birth compared with infants initially positive on nose swabs/both nose and groin swabs (55/68; 80%). Infants initially identified on groin swabs were all subsequently detected on nasal swabs or discharged within two weeks of age. 18/86 (21%) of MRSA cases were initially detected on swabbing suspected infected sites. Surveillance swabbing identified 43% of infants before MRSA bacteraemia. Eighty five per cent of colonised infants would be detected by weekly nasal swabs and by swabbing suspected infected sites. Groin swabs detect a small number of bigger mature babies who are discharged before two weeks of age. </jats:p

Intensive care admissions for children with imported malaria in the United kingdom.

This study describes 977 children with imported malaria in England and Wales between 2004 and 2008, focusing on 29 (3.0%) patients admitted to intensive care, of whom 10 had cerebral malaria, 4 required inotropes, and 1 had concurrent septicemia. The remaining 14 were admitted for monitoring only. None died, but 1 child developed cerebellar infarction

Prospective, national clinical and epidemiologic study on imported childhood malaria in the United Kingdom and the Republic of Ireland.

BACKGROUND: Current knowledge of clinical features of imported childhood malaria is largely limited to small, retrospective, and/or single-center case series. This prospective, population-based study describes the epidemiology and clinical features of imported childhood malaria in children <16 years in the United Kingdom and Republic of Ireland. METHODS: Active prospective national surveillance with clinical data collection was performed between January 1, 2006 and January 31, 2007 through the British Pediatric Surveillance Unit and capture-recapture analysis using cases reported independently to respective national surveillance centers. RESULTS: There were 290 cases, including 186 reported through the British Pediatric Surveillance Unit with clinical details. Capture-recapture analysis estimated the burden of imported childhood malaria to be 2.8/100,000 per year for the United Kingdom and 4.6/100,000 per year for Ireland. Black-African children born in the United Kingdom and Ireland and traveling to West Africa during school holidays without antimalarial prophylaxis accounted for the majority of cases. Thirty of 117 children (26%) who had traveled to a malaria-endemic country had previously been diagnosed with malaria, reflecting missed opportunities to educate families on malaria prevention. A third of children (46/148) with Plasmodium falciparum malaria fulfilled World Health Organization criteria for severe or potentially complicated malaria, although only 11/46 (24%) required intensive care. The choice of antimalarials varied considerably among hospitals and within the same hospital. However, recrudescence occurred in only 1 child and none died. CONCLUSIONS: Interventions to prevent imported childhood malaria should focus on Black-African families traveling to West Africa, while pediatricians should be offered clearer guidance on the treatment of childhood malaria

Increase in the use of inhaled nitric oxide in neonatal intensive care units in England: a retrospective population study

Objective To describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.Design Retrospective analysis using data extracted from the National Neonatal Research Database.Setting All National Health Service neonatal units in England.Patients Infants of all gestational ages born 2010–2015 admitted to a neonatal unit and received intensive care.Main outcome measures Proportion of infants who received iNO; age at initiation and duration of iNO use.Results 4.9% (6346/129 883) of infants received iNO; 31% (1959/6346) were born &lt;29 weeks, 18% (1152/6346) 29–33 weeks and 51% (3235/6346)&gt;34 weeks of gestation. Between epoch 1 (2010–2011) and epoch 3 (2014–2015), there was (1) an increase in the proportion of infants receiving iNO: &lt;29 weeks (4.9% vs 15.9%); 29–33 weeks (1.1% vs 4.8%); &gt;34 weeks (4.5% vs 5.0%), (2) increase in postnatal age at iNO initiation: &lt;29 weeks 10 days vs 18 days; 29–33 weeks 2 days vs 10 days, (iii) reduction in iNO duration: &lt;29 weeks (3 days vs 2 days); 29–33 weeks (2 days vs 1 day).Conclusions Between 2010 and 2015, there was an increase in the use of iNO among infants admitted to English neonatal units. This was most notable among the most premature infants with an almost fourfold increase. Given the cost of iNO therapy, limited evidence of efficacy in preterm infants and potential for harm, we suggest that exposure to iNO should be limited, ideally to infants included in research studies (either observational or randomised placebo-controlled trial) or within a protocolised pathway. Development of consensus guidelines may also help standardise practice