Neonatal intravascular catheter colonisation and association with infection in LUHS hospital Kauno Klinikos

Study aim. To characterise intravascular catheter infection cases during the period of 2013 and 2015-2016 at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos (HLUHS KK) Department of Neonatology. Study tasks: to characterise the types of catheter-related infection and their prevalence; to determine the diagnostic value of catheter cultures; to find out the most prevalent colonising microorganisms. Participants. This is a prospective observation study which included intravascular catheters inserted at the Neonatal Intensive Care Unit of HLUHS KK during the study period. Methods. We performed segmental semi-quantitative microbiological cultures of the removed catheters and compared the results with neonatal infection-related data obtained from medical charts by performing statistical tests. Results. The study included 54 catheters which stayed in situ for 532 catheter days. 33% (18) of catheters were removed due to suspected sepsis. The prevalence of definite catheter-related sepsis (CRS) was 7,4% of all cases or 7,5 cases per 1000 catheter-days. The composite prevalence of definite and possible CRS was 14,8%, while one case (1,9%) was assigned to non-catheter sepsis group. In this study the distal segments were colonised more often than proximal, while the catheter culture was positive more often in the “colonised catheter“ group. The positive predictive value for definite CRS was 20% and 23% for proximal and distal segments, respectively. The catheters were most often colonised by coagulase-negative staphylococci, Staphylococcus aureus and S. epidermidis. Conclusions. The calculated prevalence of definite CRS was average and matched to that published while catheter colonisation and suspected neonatal infdection were higher in our study. The diagnostic value of semi-quantitative catheter culture was low due to high colonisation rate. The most abundant microorganisms recovered were skin staphylococci; however, atypical species prevailed, too. Recommendations. We recommend individual decisions on performing neonatal intravascular catheter cultures in clinical practice as well as using alternative culture methods (e.g. catheter flush)

Associations between red blood cell transfusions and necrotizing enterocolitis in very low birth weight infants: ten-year data of a tertiary neonatal unit

Background and Objective: Necrotizing enterocolitis (NEC) remains an important cause of mortality in preterm neonates. There are many risk factors for NEC; however, probably the most controversial one is red blood cell transfusions (RBCT). The data concerning the link between NEC and RBCT has been conflicting. Therefore, we aimed to analyze the association between NEC and RBCT in Neonatal Intensive Care Unit (NICU) at the Hospital of Lithuanian University of Health Sciences. Materials and Methods: We used the Very Low Birth Weight (VLBW) Infants database to match all infants with 2a Bell’s stage NEC admitted between 1 January 2005 and 31 December 2014 (n = 54) with a control group (n = 54) of similar gestational age and birth weight and without NEC. We analyzed the charts of these infants and performed statistical analysis on 20 clinical variables including RBCT. Results: The main clinical and demographic characteristics did not differ between the two groups. All variables associated with RBCT (receipt of any RBCT, the number of transfusions and the volume transfused in total) were significantly higher in the NEC group both before the onset of NEC and throughout the hospitalization. RBCT increased the odds of NEC even after adjustment for confounding factors. In addition, we found that congenital infection was more abundant in the NEC group and increased the odds of NEC 2.7 times (95% confidence interval CI (1.1, 6.3), p = 0.024). Conclusions: A higher number and the total volume of RBCT are associated with an increased risk of NEC in VLBW infants. The presence of congenital infection might identify the infants at risk