Evrim Kıray Baş

Neonatal Infection with Neisseria meningitidis: Analysis of a 97-Year Period Plus Case Study

ABSTRACT Neisseria meningitidis is one of the major causes of meningitis in children and adolescents, but it is rarely found during the neonatal period. Here, we describe a neonate with meningococcal sepsis who was admitted to the hospital on postnatal day 10, and we discuss the clinical features of neonatal infection with N. meningitidis in relation to the literature (analysis of a 97-year period).

Use of Colistin in a Neonatal Intensive Care Unit: A Cohort Study of 65 Patients

Background The emergence of infections related to multidrug-resistant Gram-negative bacilli (MDR-GNB) reintroduced the use of colistin, an antibiotic that was previously abandoned due to adverse effects. However, because of its limited use in neonatal intensive care units, there is very little data about the effectiveness and safety of colistin in children and newborns. In this study, which will be the largest case study in the literature, we aimed to evaluate the effectiveness and safety of colistin in full-term and preterm newborns. Material/Methods The study included patients admitted into 2 level 3 neonatal intensive care units between January 2013 and June 2015. The medical records of patients diagnosed with sepsis, meningitis, pneumonia, and urinary tract infection based on the diagnostic culture results and treated with colistin were analyzed retrospectively. The patients whose infections were not verified were excluded from the study. Results The study included 65 patients (18 term, 47 preterm). The most frequently isolated pathogens were Klebsiella pneumoniae and Acinetobacter baumannii followed by Pseudomonas aeruginosa and Enterobacter cloacae. Mean colistin treatment time was 15±3.5 days. All patients treated with colistin were being treated with at least 1 other antibiotic. While a complete clinical response was achieved in 51 (72.3%) patients, 14 (21.5%) patients died during treatment. Four (7.7%) patients died during as a result of another infection. Three patients developed renal toxicity, another 3 patients had seizures, and apnea was observed in 3 patients. Conclusions Colistin was found to be effective and safe for treatment of MDR-GNB infections in preterms and infants with very low birth weight. Given the severity of the infection, the adverse effects of colistin were at acceptable levels.

Hospital acquired bloodstream infections in neonatal intensive care unit

Bulgular: Bir y›ll›k süre içerisinde 807 hasta 72 saatten daha uzun süre yatt›. Kan kültüründe üreme say›s› 97 idi. Üreme olanlar›n %65,6’s› erken do¤mufl, %34,4’ü zaman›nda do¤mufl bebeklerdi. En s›k elde edilen mikrorganizmalar koagülaz negatif stafilokok ve Klebsiella pneumonia türüydü. Kan ak›m enfeksiyon h›z› 5,9:1000 gün, katetere ba¤l› kan ak›m› enfeksiyon h›z› 9,6:1000 gün, ventilatörle iliflkili pnömoni h›z› 13,8:1000 gün olarak bulundu. Gram pozitif mikroorganizmalarda glikopeptit direnci görülmedi. Hastane enfeksiyonu için hastane yat›fl süresi, mekanik ventilasyon ve kateter varl›¤›n›n anlaml› risk etmenleri oldu¤u saptand›. Kan kültüründe üreme olanlarda ölüm oran› %12,5 idi.

Etiology and Causative Pathogens of Febrile Neonates

Background: Evaluation and treatment of febrile neonates varied widely among the different centers. The prevalence of serious bacterial infection (SBI) is high in neonates; thus, most experts would support the approach of a full sepsis evaluation and hospitalization. We aimed to evaluate the clinical and laboratory characteristics of febrile neonate less than 28 days of age and describe the incidence of SBI in febrile neonates. Methods: This prospective observational cohort study was include neonates with a rectal temperature of ≥ 38°C who admitted to NICU between 2011 and 2015. Demographic information, physical examination findings, laboratory test results, and final diagnosis were recorded and compared to identifA±edas serious bacterial infection (SBI) or no-SBI. For determination of SBI; CRP and WBC cut-off values were calculated by receiver operating characteristic curve analysis. Results: 328 infants were included the study. The overall rate of SBI was 38.4%. The common final diagnosis were found unknown reason (43.6%), urinary tract infection (15.5%), dehydration (14%), and bacteremia (5.8%). The most common bacterial growth in culture Escherichia coli in 19 cases and Methicillin-Resistant Coagulase-Negative Staphylococci in 16 cases detected. A significant cut-off value could not be determined for CRP (AUC: 0.664) 95% CI: 0.604-0.723 and WBC (AUC: 0.535) 95% CI: 0.472-0.597. Conclusion: Gram positive pathogens were more common in febrile neonates than older febrile infants. A reliable cutoff value for CRP and WBC for detection SBI in neonatal period could not be determined.

A comparison of the effects of invasive mechanic ventilation/surfactant therapy and non-invasive nasal-continuous positive airway pressure in preterm newborns

Abstract Aims: This study compared the early-term outcomes of mechanical ventilation (MV)/surfactant treatment with nasal-continuous positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS). Materials and methods: Data from newborns born between ≥24 and ≤32 weeks of gestation, hospitalized at our newborn intensive care unit, and diagnosed with RDS between January 2009 and February 2012 were analyzed. Results: Of 193 newborns with RDS who were enrolled in the study, 113 were treated with nCPAP and 80 with MV at a level of 57.5% of nCPAP. Within the study group, 46.3% of the infants were female. The mean gestation of the continuous positive airway pressure (CPAP) group was 29.07 ± 1.99 weeks; that of the MV group was 28.61 ± 2.01 weeks. The birth weight was 1321.1 ± 325.4 g and 1240.3 ± 366.1 g; however, the difference between the two groups was not significant. MV was not required in 54.9% of the patients with nCPAP treatment. Bronchopulmonary dysplasia (BPD) developed in 20 (18.7%) patients in the nCPAP group and 18 (24.4%) patients in the MV group; the difference was not significant (p = .351). Between 2009 and 2012, nCPAP was used at a rate of 33.9, 70.8, 68.4, and 69%. The risk factors for developing BPD were low gestation week, duration of intubation, and proven sepsis (p = .0001, p = .004, and p = .011, respectively). Conclusions: Early nCPAP treatment in preterm infants (≤32 weeks of gestation) decreases both the need for MV and the use of surfactant, but without a significant effect on BPD development. (No. 2016/324)

Management of febrile neonate

The recommended management of febrile neonates, in first 28 days of life is controversial. Given that the overall prevalence of serious bacterial infection is higher in the neonate, most experts would advocate for a full sepsis evaluation, and hospitalization for giving antibiotics. In recent years, opinions have been raised regarding the follow-up without hospitalization and antibiotics or follow-up even without hospitalization in febrile newborn infants. In our review the evidence for diagnostic accuracy of screening methods for identification of serious bacterial infection in febrile neonates will be evaluated.

Evaluation of health care professionals’ knowledge and attitudes regarding maternal vitamin D supplementation

Date of acceptance / Kabul tarihi: October 21, 2016 / 21 Ekim 2016 ABSTRACT: Evaluation of health care professionals’ knowledge and attitudes regarding maternal vitamin D supplementation Objective: To determine the knowledge and attitudes of healthcare professionals regarding vitamin D supplementations in pregnant and breastfeeding mothers. Material and Method: Our study was conducted between April and May 2015 with the participation of 752 healthcare professionals (pediatrician, pediatric resident, specialist family physician, family physician resident, general family practitioner and nurse). The study questionnaire was created by researchers in accordance with experiences and literature information. Ethics committee approval was obtained. In questionnaire along with the demographic characteristics of the participants, the knowledge and practices on vitamin D supplementation for pregnant women and nursing mothers were asked. The data were analyzed by percentage and chi-square tests. Results: A total of 574 physicians (76.4%) and 178 nurses (23.6%) participated in our study. Of these, 418 (55.6%) participiants suggested vitamin D supplementation to pregnants. The ratio of family physician specialists’ recommendations of vitamin D supplementation (66.7%) was higher than the other groups (p<0.001). The highest dose of vitamin D supplementation suggested to pregnants was 800-1000 IU/day with a rate of 23.4%. A total of 451 of participiants (60.0%) recommend vitamin D supplementation to breastfeeding mothers. Pediatric residents and specialists’ recommendations of vitamin D supplementation rate (70.0% and 63.6%, respectively) were higher than the other groups (p<0.001). Highest rate of vitamin D supplementation recommended to breastfeeding mothers was 800-1000 IU/day with a rate of 27.0%. The rate of recommendation according to the Ministry of Health’s recoomendations to pregnant women with 1200 IU/day of vitamin D was 6.0% and breastfeeding mothers with 1200 IU/day of vitamin D was 4.5%. Conclusion: We found that the rate of recommendation and doses of vitamin D supplementation to breastfeeding mothers and infants by healthcare professionals were low in our study. It has been determined that training programs for healthcare professionals should be organized in order to prevent vitamin D deficiency.

Factors Affecting the Target Oxygen Saturation in the First Minutes of Life in Preterm Infants.

Background The aim of this study was to describe the effect of factors on time to reach a pulse oxygen saturation (SpO2) level of 90% in preterm infants in the delivery room. Methods Preterm (<35 gestational age) infants who did not require supplemental oxygen were included in the study. Continuous recordings were taken by pulse oximetry during the first 15 min of life. Results Of 151 preterm infants, 79 (52.3%) were female and 126 (83.5%) were delivered by cesarean section. Target saturation level (≥90%) was achieved faster in preductal measurements. Mean times taken to have a preductal and postductal SpO2 level of 90% were significantly lower in preterm babies born by vaginal delivery, with umbilical arterial pH ≥ 7.20 and whose mothers were non-smokers during pregnancy. Conclusions Differences in achievement of target saturation level were influenced by multiple factors (birth way, probe location, maternal smoking and umbilical blood gas pH) in the delivery room during resuscitation of preterm babies.

Early Neonatal Outcomes of Very Low Birth Weight Infants of Preeclamptic Mothers

Objective: Our aim is to investigate the effect of preeclampsia on very low birth weight infants’ morbidity and mortality rates in early neonatal periods. Methods: Infants admitted to the Sisli Etfal Children Hospital Neonatal Intensive Care Unit between the years of 2007-2011 and birth weights under 1500 gr were examined retrospectively. Babies whose mothers with and without preeclampsia were compared in terms of demographic characteristics and neonatal morbidity and mortality results. The Chi-square test was used for qualitative data and an independent simple t-test was used for quantitative data. Results: The study included a total of 246 very low birth weight infants. 53 of them had preeclamptic mothers (Goup 1). The other groups consisted of 193 babies (Group 2). When the preeclamptic group was compared with the other group, mean gestational age, average birth weight and male gender ratios were similar (29.1±2.32 vs 28.8±3.12, 1086±254 g vs 1127±290 g, 49.1% vs 46.1%, respectively, for each p> 0.05). The rate of SGA infants in the preeclampsia group was elevated nonsignificantly (14% to 17%, p>0.05). There was no significant difference between groups according to antenatal factors that may affect prognosis (mean maternal age, regular pregnancy follow-up, application rates of antenatal steroids, placental abnormalities and oligohydramnios). Cesarean delivery in the preeclampsia group was significantly higher than in the other group (92.5% to 69.4%, p=0.0001). There were no significant differences between the groups in terms of respiratory distress syndrome (67.3% vs 72.6), stage 2-3 necrotizing enterocolitis (5.7% vs 3.6%), patent ductus arteriosus (9.1% vs 17.6%), grade 3-4 intraventricular hemorrhage (5.7% vs 6.7%) and retinopathy of prematurity (26.4% vs 21.2). Mortality (18.9% vs 26.9%, p:0.23), and red blood cell transfusion rates (42.6% vs 57.6%, p:0.065) were lower in infants of preeclamptic mothers although there was no statistically significant difference. Conclusion: Short-term morbidity and mortality rates were not changed in very low birth weight infants of mothers having preeclampsia. The gestational week of pregnancy and birth weight have been more influential in the prognosis of these babies. There is much debate regarding respiratory and other morbidities in preeclamptic premature babies in the literature. In future studies, evaluating the grade of preeclampcy will unravel these controversies. (JAREM 2012; 2: 64-7)