Своєрідність київського маґдебурзького права: нотатки на марґінесі нової книги про Київ кінця XV – першої половини XVII століть

Рецензія на монографію: Білоус Н. Київ наприкінці XV – у першій половині XVII століття. Міська влада і самоврядування. – К.: Вид. дім “Києво-Могилянська академія”, 2008. – 360 с

Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants

Objectives: Indwelling central venous catheters are the most important risk factors for the development of sepsis attributable to coagulase-negative staphylococci among preterm infants admitted to neonatal intensive care units. In addition, removal of a central venous catheter also may cause coagulase-negative staphylococci sepsis, which may be prevented by the short-term administration of an anti-staphylococcal agent during the procedure of removal. The administration of a specific anti-staphylococcal agent (cefazolin) was evaluated for the prevention of central venous catheter removal-associated coagulase-negative staphylococci sepsis. Design: A prospective, open, randomized, controlled intervention study. Setting: Twenty-eight-bed neonatal intensive care unit at a tertiary care children's hospital. Patients: Eighty-eight preterm infants (gestational age Intervention: From April 2007 to January 2010, infants were randomized to receive two doses of cefazolin during removal of the percutaneously inserted central venous catheter (intervention group, n = 44) or no antimicrobial agent (control group, n = 44). Percutaneously inserted central venous catheter removal-associated sepsis was defined as sepsis occurring Measurements and Main Results: Clinical characteristics and central venous catheter duration did not show differences between both groups. Five infants (11%) of the control group developed coagulase-negative staphylococci sepsis <48 hrs after removal of the percutaneously inserted central venous catheter compared to none (0%) in the intervention group (p = .021). Conclusions: Two doses of the anti-staphylococcal agent cefazolin during the procedure of removal of a percutaneously inserted central venous catheter were effective in the prevention of coagulase-negative staphylococci sepsis. It is recommended to include this regimen in the guidelines on management of central venous catheters in very-low-birth-weight infants. (Pediatr Crit Care Med 2011; 12:445-448

Long-Term Trends in the Epidemiology of Neonatal Sepsis and Antibiotic Susceptibility of Causative Agents

Background: In an era with increased maternal antibiotic use, patterns in early- and late-onset sepsis and antibiotic susceptibility may have changed. Objectives: To identify longitudinal trends in causative microorganisms for neonatal sepsis and analyze antibiotic susceptibility of all blood isolates of infants with sepsis. Methods: Early- and late-onset sepsis cases from 29 years (1978-2006) were studied retrospectively, in five clusters of 5 years (period I-V) and one cluster of 4 years (period VI), including antibiotic susceptibility profiles of blood isolates during the years 1999-2006. Results: The incidence of early- onset sepsis decreased (

Human parechovirus causes encephalitis with white matter injury in Neonates

Objective: To assess the role of human parechoviruses (HPeVs) as a cause of neonatal cerebral infection and to report neuroimaging findings of newborn infants with encephalitis caused by HPeVs. Methods: Clinical presentation, cranial ultrasonography, magnetic resonance imaging (MRI) findings, and neurodevelopmental outcome of 10 infants admitted to a neonatal intensive care unit and diagnosed with encephalitis caused by HPeVs are reported. Results: Nine of 10 infants, with a gestational age of 29 to 41 weeks, presented at 36 to 41 weeks postmenstrual age with clinical seizures. Seven had a fever and six had a rash. Clinical presentation was similar to that of infants with enterovirus infection. Cranial ultrasonography showed increased echogeniciry in the periventricular white matter in all infants. Neonatal MRI confirmed white matter changes in nine infants, which changed to gliosis on later MRI. Outcome was variable with cerebral palsy in one, a suspect outcome at 18 months in one, learning disabilities at 7 years of age in one, epilepsy in one, and normal neurodevelopmental outcome in five children. Follow-up of one infant was only 9 months. Interpretation: HPeVs should be added to the list of neurotropic viruses that may cause severe central nervous system infection in the neonatal period. White matter injury can be visualized with cranial ultrasonography, but more detailed information is obtained with MRI and especially diffusion-weighted imaging. Because clinical presentation of HPeV encephalitis is similar to that of enterovirus, real-time polymerase chain reaction for both viruses should be performed in atypical presentation of neonatal seizures

Genotype distribution, viral load and clinical characteristics of infants with postnatal or congenital cytomegalovirus infection.

BACKGROUND:Congenital cytomegalovirus infection is a leading cause of long-term sequelae. Cytomegalovirus is also frequently transmitted to preterm infants postnatally, but these infections are mostly asymptomatic. A correlation between cytomegalovirus genotypes and clinical manifestations has been reported previously in infants with congenital infection, but not in preterm infants with postnatal infection. OBJECTIVES:The main objective of this study was to investigate cytomegalovirus genotype distribution in postnatal and congenital cytomegalovirus infection and its association with disease severity. METHODS:Infants admitted to the neonatal intensive care unit of the University Medical Center Utrecht, The Netherlands between 2003-2010 and diagnosed with postnatal or congenital cytomegalovirus infection were included. Classification of cytomegalovirus isolates in genotypes was performed upon amplification and sequencing of the cytomegalovirus UL55 (gB) and UL144 genes. Clinical data, cerebral abnormalities, neurodevelopmental outcome and viral load were studied in relation to genotype distribution. RESULTS:Genotyping results were obtained from 58 preterm infants with postnatal cytomegalovirus infection and 13 infants with congenital cytomegalovirus infection. Postnatal disease was mild in all preterm infants and all had favourable outcome. Infants with congenital infection were significantly more severely affected than infants with postnatal infection. Seventy-seven percent of these infants were symptomatic at birth, 2/13 died and 3/13 developed long-term sequelae (median follow-up 6 (range 2-8) years). The distribution of cytomegalovirus genotypes was comparable for postnatal and congenital infection. UL55 genotype 1 and UL144 genotype 3 were predominant genotypes in both groups. CONCLUSIONS:Distribution of UL55 and UL144 genotypes was similar in asymptomatic postnatal and severe congenital CMV infection suggesting that other factors rather than cytomegalovirus UL55 and UL144 genotype are responsible for the development of severe disease

Sequences of oligonucleotide primers used for CMV PCR and sequencing (12,27).

<p>Sequences of oligonucleotide primers used for CMV PCR and sequencing (12,27).</p

Demographic and clinical characteristics of 58 postnatally and 13 congenitally infected infants.

<p>a. Symptoms of postnatal CMV infection included pneumonia (n = 3), and sepsis-like illness with thrombocytopenia (n = 2).</p><p>Symptoms of congenital CMV infection included intra-uterine growth retardation (n = 5), microcephaly (n = 2), hepatosplenomegaly (n = 4), petechiae (n = 3), jaundice (n = 1), seizures (n = 1), thrombocytopenia (n = 6), anaemia (n = 2), and neutropenia (n = 1).</p><p>b. MRI was performed in 30 postnatally infected infants and 7 congenitally infected infants. Severe MRI abnormalities included polymicrogyria (n = 1), occipital cysts (n = 1), ventricular dilatation (n = 1) and abnormal white matter signal intensity (n = 4).</p><p>Demographic and clinical characteristics of 58 postnatally and 13 congenitally infected infants.</p

UL55 and UL144 genotype distribution of postnatal and congenital CMV infection.

<p>a. In two postnatally infected infants only UL144 or UL55 could be genotyped.</p><p>UL55 and UL144 genotype distribution of postnatal and congenital CMV infection.</p

Log₁₀ CMV urine load in postnatally and congenitally infected infants.

<p>Bar in boxplot represent median viral load after log₁₀ transformation. Upper and lower limit of boxplot represent 75^th and 25^th percentile, respectively. Whiskers represent 5–95% coincidence interval. Dots represent outliers.</p