To estimate the effect of maternal age on survival free of major morbidity among preterm newborns younger than 33 weeks of gestation at birth.
Data from a retrospective cohort of preterm newborns younger than 33 weeks of gestation admitted to Canadian neonatal intensive care units between 2003 and 2008 were analyzed. The primary outcome was survival without major morbidity (defined as bronchopulmonary dysplasia, intraventricular hemorrhage grade 3 or 4, periventricular leukomalacia, retinopathy of prematurity stage 3, 4 or 5, or necrotizing enterocolitis stage 2 or 3). Trends in outcomes in relation to maternal age groups were examined using a multivariable analysis that controlled for confounders.
Baseline comparison for the 12,326 eligible newborns revealed no differences in sex, small-for-gestational-age status, and chorioamnionitis among different maternal age groups. Higher rates of cesarean delivery, use of prenatal steroids, maternal hypertension, and diabetes were noted as maternal age increased (P
We have studied all newborns admitted to our neonatal intensive care unit during 1993 and treated with intravenous antibiotics. Patient-files were examined for all available data at admission, focusing on factors predisposing for infection, symptoms, additional diagnoses, laboratory tests, bacteriology and antibacterial treatment. Antibiotics were given to 126 (28%) patients, of whom 90 were suspected of having an infection on admission. 57 of these were discharged with an infection-related diagnosis. 33 patients received prophylactic antibiotics, of whom three later developed infection. Retrospectively, 53 patients had proven or very probable infection. Fourteen patients tested blood culture positive. In our material the incidence of septicaemia was 0.45% of all newborn. Both the frequency of treatment and the incidence of septicaemia are consistent with the findings in earlier reports. We find that our material contains an unacceptably high frequency of false negative blood cultures. Recently published data show that the incidence of positive blood cultures is proportional to the amount of blood extracted.
Neonatal intensive care units (NICUs) and intensive care units (ICUs) provide care for newborns in need of specialized medical attention. Across Canada, rates of NICU/ICU admission vary. Due to the high cost of monitoring and interventions these admissions cost more than general newborn stays - whether the newborn is in a specialized NICU or in an ICU in those facilities without specialized units for newborns. This study explores the variation in NICU/ICU admissions and the characteristics of mothers and newborns associated with an increased likelihood of NICU/ICU admission. We focus further on the association between NICU/ICU admission and Caesarean section (C-section). After excluding multiple births, preterm births, small for gestational age births and those delivered by women with select complications, we find an increased risk for NICU/ICU admission for babies born by C-section as their only indication. NICU/ICU admission following C-section alone may not represent the most desirable pathway of care for these newborns.
This retrospective case-control study was performed to determine risk factors for bacteremia due to persistent coagulase-negative staphylococci in our neonatal intensive-care unit. Enteral nutrition and the presence of a nasogastric tube were identified as possible risk factors for coagulase-negative staphylococcal bacteremia involving one of the persistent strains.
Describe the epidemiology of central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) participating in a standardized and mandatory CLABSI surveillance program.
Retrospective cohort. Setting. We included patients admitted (April 2007-March 2011) to 7 level II/III NICUs who developed a CLABSI (as defined by the National Healthcare Safety Network).
CLABSIs/1,000 central line-days and device utilization ratio were calculated; ?(2) test, Student t test, Kruskal-Wallis, and Poisson regression were used.
Overall, 191 patients had 202 CLABSI episodes for a pooled mean rate of 4.0 CLABSIs/1,000 central line-days and a device utilization ratio of 0.20. Annual pooled mean CLABSI rates increased from 3.6 in 2007-2008 to 5.1 CLABSIs/1,000 central line-days in 2010-2011 (P - .01). The all-cause 30-day case fatality proportion was 8.9% (n = 17) and occurred a median of 8 days after CLABSI. Coagulase-negative Staphylococcus was identified in 112 (50.5%) cases. Staphylococcus aureus was identified in 22 cases, and 3 (13.6%) were resistant to methicillin. An underlying intra-abdominal pathology was found in 20% (40/202) of CLABSI cases, 50% of which were reported in the last year of study. When adjusted for mean birth weight, annual CLABSI incidence rates were independently associated with the proportion of intra-abdominal pathology (P = .007) and the proportion of pulmonary pathology (P = .016) reported.
The increase in CLABSI rates in Quebec NICUs seems to be associated with an increased proportion of cases with underlying intra-abdominal and pulmonary pathologies, which needs further investigation.
We describe trends in the rates of admission of preterm twin and triplet infants to neonatal intensive care units (NICUs) across Canada and compare their neonatal outcomes over a 6-year period. Temporal trends of admission rates for 5193 twins and triplets
Episodes of septicaemia due to coagulase-negative staphylococci (CNS) were more frequent in a level III than in a level II neonatal unit in Stockholm, Sweden. Colonization with CNS during the first 2 weeks of life was investigated in 10 infants from each unit. As the use of antibiotics differed between the two units, the aim was to correlate colonization and antimicrobial resistance patterns to antibiotic usage. Antimicrobial susceptibility of CNS to isoxazolylpenicillins, co-trimoxazole, erythromycin, clindamycin, chloramphenicol and gentamicin was determined. Selected isolates were typed with restriction endonuclease analysis of plasmid DNA and of genomic DNA. Infants were frequently colonized with multiple strains and species of CNS, and transmission of strains from patient to patient occurred within the unit. Qualitative and quantitative differences in antibiotic use were not correlated with colonization. The prevalence of resistant isolates, mostly of Staphylococcus haemolyticus, was higher in the level II unit with lower use of antibiotics. Staphylococcus epidermidis, which is generally more virulent, prevailed in the level III unit, where there were more severely ill children and invasive procedures were more frequently performed.
To compare the outcomes of multiple-birth and singleton very preterm infants who were admitted to neonatal intensive care units (NICUs).
Three-level hierarchical generalized linear and hierarchical linear model analyses were used to compare the risk-adjusted outcomes of 3,242 infants born at or before 32 weeks of gestational age who were admitted to 24 Canadian NICUs in 2005.
With the exception of respiratory distress syndrome (RDS), multiple-birth infants were not at a higher risk than singleton birth infants for death, patent ductus arteriosus, necrotizing enterocolitis, chronic lung disease, severe intraventricular hemorrhage, severe (stages 3 or higher) retinopathy of prematurity, or nosocomial infection, after adjusting for perinatal risks and neonatal illness severity. In addition, multiple-birth infants did not have a more prolonged duration of neonatal intensive care unit stay, duration of length of continuous positive airway pressure use, duration of ventilation, or duration of oxygen use than did singletons. Multiple-birth infants had a higher incidence of RDS (adjusted odds ratio 1.3, 95% confidence interval 1.0-1.6) and a lower incidence of severe retinopathy of prematurity (adjusted odds ratio 0.5, 95% confidence interval 0.3-0.9) than did singletons.
Multiple-birth and singleton very preterm infants had similar outcomes, except for a higher incidence of RDS among multiple-birth infants.
To assess daily practices in paediatric and neonatal ventilatory care in Finland.
All neonatal and paediatric intensive care units in Finland were sent a questionnaire on ventilatory strategies and were offered a 3-month prospective survey.
A total of 96% of units returned the questionnaire, and clinicians agreed on most of the principles of lung-protective ventilation. Seventeen hospitals (94%) joined the prospective survey. On average, 2.3 new ventilation episodes were started daily, and totally 211 episodes were monitored. Pulmonary problems (64%) were the main cause of treatment in neonates and postoperative care (68%) in older children. Synchronized intermittent mandatory ventilation with pressure support was the primary mode in 42% of episodes. Hypocapnia was observed repeatedly in all units. In adult intensive care units, children often received high oxygen fraction, leading to hyperoxia, and they were frequently sedated with propofol, which is not licensed for that purpose. A large proportion of children had only light sedation or no sedation at all. Despite the different strategies and practices, most episodes resulted in a favourable outcome.
Most of the principles of lung-protective ventilation have been well accepted by clinicians. More attention should be paid to achieving normocapnia and normoxia and to the correct use of sedatives, especially in units that only occasionally provide paediatric ventilation.