Agneta Golan

Influence of Antiepileptic Drugs on Amplitude-Integrated Electroencephalography

Amplitude-integrated electroencephalography monitors different aspects of cerebral function in neonatal intensive care units. To examine the influence of various antiepileptic drugs on the background patterns and voltage of amplitude-integrated electroencephalography recordings, we screened 191 tracing segments originating from 77 newborns treated with antiepileptic drugs. The influences of lorazepam, diazepam, and phenobarbital given as bolus doses, and midazolam and lidocaine given in continuous infusion, were examined. Voltages and patterns before and after drug administration were assessed. Time taken to return to previous voltage was assessed in clinically significant cases. Chi-square and Wilcoxon tests were used for statistical analyses. Significant changes were evident after lorazepam, diazepam, phenobarbital, and midazolam administration. Depending on the voltage-assessment method, a clinically significant depression of the lower voltage border occurred in 25-35% of tracings, and of the upper border in 16-32%. In 12% of tracings, change to a worse pattern was noted. The average time for recovery to predrug administration voltage was 2.5 hours (range, 15 minutes to 15 hours). Changes in amplitude-integrated electroencephalography tracings occur after antiepileptic drugs are infused. These changes include deterioration of pattern and depression of voltage that may persist for a considerable period. The potential depressing effects of these drugs should be taken into consideration when assessing amplitude-integrated electroencephalogram tracings.

A prospective study of the patterns and dynamics of colonization with Candida spp. in very low birth weight neonates

Abstract Background: Knowledge of fungal colonization patterns in very low birth weight infants (VLBWI) admitted to the neonatal intensive care unit (NICU) is essential in understanding the process of fungal infections in neonates. We analyzed prospectively, during 2009–2010, the patterns and dynamics of fungal colonization in VLBWI, including timing, colonization sites, and species involved. Methods: Weekly skin, oropharynx, and rectum/stool surveillance fungal cultures were collected from admission until discharge in VLBWI in the NICU. None received antifungal prophylaxis. Results: Overall, 118 VLBWI provided 1723 samples; 34 (29%) had 104 positive samples at least once during the first 10 hospitalization weeks. Thirty-nine (33%) weighed < 1000 g; 68 were delivered by cesarean section. Candida albicans (57/104, 55%) and Candida parapsilosis (26/104, 25%) were the main fungi isolated. Eight (24%) VLBWI were colonized during the first week and 23 (68%) during the second week. No differences in colonization were recorded between cesarean section and vaginally delivered VLBWI. The colonization risk at least once during the first 10 weeks was 23% for skin, 14% for oropharynx, 27% for rectum/stool, and 38% for any anatomic site sampled. Persistent colonization was recorded in 5/34 (15%), while transient colonization was found in 14/34 (41%) VLBWI; 16/34 (47%) were discharged or died colonized with Candida spp. Candidemia was diagnosed in 4 (3%) VLBWI and previous/simultaneous colonization was found in 3/4. Conclusions: The cumulative risk of colonization, at any sampled site and at least once during follow-up, was high. Initial colonization occurred most often during the first 2 weeks of life. Colonization dynamics were characterized by various persistence, disappearance, and recolonization patterns. Candidemia was rare.

Proactive Approach to Containment of Enterovirus Infection in the Nursery

Administration of prophylactic intravenous immunoglobulins to contacts of infants actively shedding enterovirus during a hospital nursery outbreak may attenuate severity of disease in those contacts and aid in containment of the outbreak. Four cases of neonatal enteroviral disease were treated in our hospital nursery in July and August 2011; 3 were presumed or proven vertical transmission cases and 1 was a presumed horizontal transmission. We aimed to prevent development of severe illness in contacts of affected neonates following a ministry of health advisory during the summer of 2011 warning of increased neonatal enteroviral morbidity and mortality in Israel. Strict infection control measures were implemented, including meticulous decontamination of the nursery environment and administration of intravenous immunoglobulin prophylaxis to contacts. No further horizontal transmission occurred after infection control interventions. Immunoglobulin prophylaxis to control enteroviral infection in the nursery should be considered as an auxiliary infection control intervention during a nursery outbreak.

Risk Factors for the Development of Delayed TSH Elevation in Neonatal Intensive Care Unit Newborns.

Context Delayed thyrotropin (TSH) elevation (dTSH) is defined as elevated TSH at the second neonatal screening (after normal TSH levels at the initial screening) in premature, low-birth-weight, and ill newborns, mostly in the neonatal intensive care unit (NICU) setting. The pathogenesis of dTSH is elusive. Objective To identify the risk factors for dTSH development among newborns in the NICU. Design, Setting, and Patients A retrospective medical record review of neonates with dTSH was conducted in eight university-affiliated NICUs. Two controls were selected for each patient, matched for sex and birth weight. The risk factors for dTSH were identified by univariate analysis, followed by multivariate analysis. Main Outcome Measures Maternal variables, types of NICU treatments and procedures, syndromes, and various medical conditions were compared between dTSH patients and their matched controls. Results We enrolled 100 dTSH patients and 200 matched controls and 46 variables were compared between the two groups. Twelve risk factors for dTSH were identified on univariate analysis: cesarean section, mechanical ventilation, patent ductus arteriosus (PDA), pneumothorax, and administration of cefotaxime, vancomycin, fluconazole, dopamine, ibuprofen, furosemide, insulin, and packed red blood cells. On multivariate analysis, four risk factors were identified: PDA and vancomycin, insulin, and furosemide administration. In 26 twin pairs, in which one twin had dTSH, all variables presented similarly in both twins. Conclusions Although some variables had direct effects on pituitary-thyroid axis dysfunction, these variables, altogether, reflect the severity of the clinical conditions in the NICU, which is the common basis for dTSH.

Comparison of Amplitude-Integrated EEG and Conventional EEG in a Cohort of Premature Infants

Objective: To compare amplitude-integrated EEG (aEEG) and conventional EEG (EEG) activity in premature neonates. Methods: Biweekly aEEG and EEG were simultaneously recorded in a cohort of infants born less than 34 weeks gestation. aEEG recordings were visually assessed for lower and upper border amplitude and bandwidth. EEG recordings were compressed for visual evaluation of continuity and assessed using a signal processing software for interburst intervals (IBI) and frequencies’ amplitude. Ten-minute segments of aEEG and EEG indices were compared using regression analysis. Results: A total of 189 recordings from 67 infants were made, from which 1697 aEEG/EEG pairs of 10-minute segments were assessed. Good concordance was found for visual assessment of continuity between the 2 methods. EEG IBI, alpha and theta frequencies’ amplitudes were negatively correlated to the aEEG lower border while conceptional age (CA) was positively correlated to aEEG lower border (P < .001). IBI and all frequencies’ amplitude were positively correlated to the upper aEEG border (P ≤ .001). CA was negatively correlated to aEEG span while IBI, alpha, beta, and theta frequencies’ amplitude were positively correlated to the aEEG span. Conclusions: Important information is retained and integrated in the transformation of premature neonatal EEG to aEEG. Significance: aEEG recordings in high-risk premature neonates reflect reliably EEG background information related to continuity and amplitude.