Drug Utilization Evaluation of Vancomycin in Pediatric Department

Background: Increasing reports of Vancomycin resistance have raised concerns about effectiveness of this drug. One of the most important factors of resistance emergence is no adherence of physician to principles of antibiotic therapy. This study is a drug utilization evaluation (DUE) of Vancomycin in pediatric ward to assess appropriateness of drug regimens and to find possible problems in clinical practices that may necessitate reconciliation to improve Vancomycin use.Materials and Methods: This prospective study was done for 1year from October 2014 to September 2015 at Khalij Fars General Hospital in Bandar Abbas. Data including patients’ demographics, paraclinic, diagnosis, vancomycin dose, and treatment duration were collected. The concordance of practice with standard guidelines (CDC, ASHP, and IDSA) and principles of antibiotic therapy was assessed. Results were analyzed by SPSS 20.Results: 102 medical records were reviewed in this study. Pneumonia (60=59%) and sepsis (22=21.5%) were the most common diagnosis. Sampling was done in 6% of patients with 2% antibiogram. Vancomycin was administered appropriately in 56.9% percent of patients with no sex difference (PV= 0.55) but age with significant difference (PV= 0.017). Over use was in a great proportion of patients (36cases=35%) as unnecessary, improper combination and broad spectrum regimen.Conclusion: Vancomycin was overused irrationally in a great proportion of patients. There was no serum level monitoring. Microbial resistance, serum trough level monitoring programs and continuous medical education for physicians can be effective in rational use of antibiotic

Validation of the Postnatal Growth and Retinopathy of Prematurity (G-ROP) screening criteria

Background: Retinopathy of prematurity (ROP) is a leading cause of irreversible blindness in infants. The Postnatal Growth and ROP (G-ROP) study proposed new screening criteria for ROP. This study aimed to validate the G-ROP screening criteria in a group of Iranian premature infants who were treated in the neonatal intensive care unit (NICU) for at least 40 days. Methods: In this retrospective study, we extracted the data pertaining to infants admitted to the NICU from January 2020 to December 2021. We screened all the included infants for ROP based on the Iranian national screening criteria. We applied the G-ROP criteria to our study population, and if no criterion was met, the infant was exempted from ROP screening. We determined the sensitivity and specificity of the G-ROP guidelines for ROP detection, along with its capacity for predicting the requirement for ROP treatment. Moreover, we compared the G-ROP guidelines with the Iranian and North American guidelines for ROP screening. Results: A total of 166 premature infants with complete datasets were included: 130 had ROP, of whom 61 were treated. There were 109 female infants (65.7%). The mean (standard deviation [SD]) birth weight and gestational age were 1080 (256) g and 28.28 (1.97) weeks, respectively. Applying the G-ROP criteria, 127 of 130 infants with ROP were identified (sensitivity, 97.69%; 95% confidence interval [CI], 95.11% – 100%), and of 36 infants without ROP, three were correctly excluded (specificity, 8.33%; 95% CI, 0% – 17.36%). The G-ROP criteria did not fail to identify infants who required treatment for ROP (sensitivity, 100%; 95% CI, 98.29 – 100) and had a specificity of 8.69% (95% CI, 2.04% – 15.34%). Although the Iranian and North American criteria had 100% sensitivity for infants with any stage of ROP, they could not detect infants without ROP (0% specificity). Conclusions: The G-ROP screening criteria had a sensitivity of 100% in identifying infants requiring treatment for ROP in our high-risk group; however, specificity was not sufficiently high. Further studies with larger numbers of referred infants could confirm a decrease in the burden of retinal examinations using these criteria

Risk factors associated with serious bacterial infections among newborns with high body temperature : High body temperature in newborns

Introduction: Study aimed to identify factors associated with high body temperature in newborns while focusing on serious bacterial infections (SBIs). Methods: A convenience sample of 54 newborns admitted to our hospital in Iran (March-July 2015) with rectal temperature >38°C (100.4°F) were examined for clinical signs, blood cultures, complete blood counts, platelets, ESR, CRP, renal function, chest/abdominal x-rays, spinal tap, and history of maternal infections. Results: Newborns had either fever due to infections, or hyperthermia due to dehydration and/or extreme warm environment. Bacterial infections (37%) included: sepsis (15%) (coagulase-positive or coagulase-negative staphylococci, Enterobacter, Klebsiella, Escherichia coli), meningitis (13%), and 3.5% UTI, 3.5% pneumonia, 2% cellulitis, and 2% omphalitis. Degrees of dehydration experienced by 55.6% included 37% of cases associated with hyperthermia caused by warm clothing/environment, while in 18.6% dehydration was secondary to fever. Viral infections (11%) included upper respiratory infections, gastroenteritis, while in remaining 13% cause of high body temperature was unknown.   The group with SBIs had higher chance of having history of PROM (premature rupture of membrane) (p=0.023), positive CRP (p=0.041), and abnormal platelets count (p=0.021) comparing all others.   Conclusions: High body temperature in newborns needs careful evaluation to identify fever due to SBIs. In case of sepsis, antibiotics should cover prevalent bacteria including staphylococci and Enterobacter. Dehydration was prevalent among newborns with high body temperature due to hyperthermia or secondary to infections. To avoid hyperthermia, parents should know how to clothe their newborns appropriate for environmental temperature. Newborns’ SBIs associated with positive CRP, abnormal platelet count, and maternal PROM. &nbsp

Evaluation of Risk Factors for Retinopathy of Prematurity in Preterm Neonates

Background: The most common cause of preventable blindness in children is retinopathy of prematurity (ROP). The most important risk factors for this disease are preterm delivery and low birth weight (LBW). This research was performed to evaluate the prevalence ofand risk factors for ROP in preterm neonates. Methods: Our research was a cross-sectional descriptive and retrospective study conducted on preterm neonates in the Neonatal Intensive Care Unit (NICU) of Mahdieh Hospital in Tehran, Iran, in 2015. All neonates with a gestational age of < 32 weeks and birth weight of < 1,500 g were enrolled. Demographic data and risk factors for ROP were evaluated. Statistical analysis was conducted by SPSS (version 20) with a 95% confidence interval and. P-value less than 0.05 was considered statistically significant. Results: Our study was conducted on 154 patients. Mean gestational age and birth weight of the newborns were 28.69±1.82 weeks (range: 23-32 weeks) and 1114.94±240.982 g (range: 550-1500 g). The ROP was detected in 76 (49.4%) patients, 55.26%, 34.2%, and 10.53% of whom had stages I, II, and III of ROP. Stages IV and V were not seen in our patients. The incidence of ROP was significantly affected by low gestational age and birth weight, delivery room resuscitation, prolonged oxygen therapy and mechanical ventilation, and repeated packed cell transfusion. Conclusion: Despite the improvement in the care of preterm infants in the NICUs, the prevalence rate of ROP was high. Therefore, it is critical to adopt better care for disease prevention, timely screening, and appropriate treatment programs for the neonates who are at the risk of this disease

Bilirubin Induced Encephalopathy, a Review Article

Hyperbilirubinemia is one of the most common neonatal disorders. Delayed diagnosis and treatment of the pathologic and progressive indirect hyperbilirubinemia lead to neurological deficits, defined as bilirubin induced encephalopathy . The incidence of this disorder in underdeveloped countries is much more than developed areas. All neonates with  the risk factors for increase the blood level of indirect bilirubin are at risk for bilirubin encephalopathy ,especially preterm neonates which are prone to low bilirubin kernicterus .Bilirubin toxicity can be transient and acute(with early ,intermediate and advanced phases)or be permanent, chronic(kernicterus)and lifelong ( with tetrad of symptoms including visual (upward gaze palsy), auditory (sensory neural hearing loss), dental dysplasia abnormalities, and extrapyramidal disturbances (choreoathetosis cerebral palsy).Beside the abnormal neurologic manifestations of the jaundiced neonates ,brain MRI is the best imaging modality for the confirmation of the diagnosis. Although early treatment of extreme hyperbilirubinemia by phototherapy and exchange transfusion can prevent the BIE, unfortunately the chronic bilirubin encephalopathy does not have definitive treatmen

Abdominal Neuroblastoma and Early Onset Acinetobacter Septicemia in a Newborn

Background: Neonatal sepsis is a leading cause of mortality and morbidity in the first month of life. The underlying risk factors for early-onset infection (in the first 3 days of life) are prematurity, low birth weight, maternal history of infection, difficult delivery, male gender, twin pregnancy, and congenital malformations. Acinetobacter is a nosocomial infection and rarely caused the early-onset-sepsis and meningitis. The most common neonatal tumor is neuroblastoma; however, it is not defined as a risk factor for early-onset sepsis.  Case  report: A 13-day-old newborn female was referred to our hospital due to ventriculitis, persistent meningitis, and an abdominal mass. She was a term neonate delivered by cesarean section from a mother with a nearly normal pregnancy with no complications, such as chorioamnionitis, prolonged rupture of membrane, urinary tract infection, preeclampsia, and diabetes.  A fetal abdominal mass was detected on the left kidney in prenatal sonography. The patient was admitted to the Neonatal Intensive Care Unit in the first minutes of life because of respiratory distress and cyanosis. Subsequently, mechanical ventilation, endotracheal surfactant instillation, and antibiotic therapy were prescribed. Due to the deterioration of the general condition, fever, seizure, and hematuria on the third day, sepsis workup and changing the antibiotics were performed. Blood culture and cerebrospinal fluid (CSF) were positive for Acinetobacter baumannii. Persistent positive CSF culture led to the diagnosis of ventriculitis which was confirmed by brain computed tomography scan (CTS) and ventricular tap. The condition of the patient got better after intraventricular amikacin injection in addition to intravenous colistin and piperacillin.  Postnatal sonography and CTS confirmed the abdominal neuroblastoma. Chemotherapy was initiated after the complete treatment of sepsis, meningitis, and ventriculitis. This case report presents a term and female neonate with early-onset neonatal sepsis and  meningitis, caused by an unusual microorganism, and a prenatal history of abdominal neuroblastoma. Conclusion: By this case report, the clinicians are suggested to consider the Acinetobacter baumannii as the cause of fulminant sepsis and meningitis in a term neonate with no underlying risk factors for infection.   Keyword