Piet Vanhaesebrouck

Tracheal colonization with Sphingomonas paucimobilis in mechanically ventilated neonates due to contaminated ventilator temperature probes

Sphingomonas paucimobilis was isolated from tracheal secretions of a total of 85 mechanically ventilated babies in a neonatal intensive-care unit (NICU) during a two-year-period. None of the neonates developed pneumonia or sepsis. After each increase in the fluctuating number of S. paucimobilis isolates, extra attention was paid to hand hygiene and to the maintenance of the ventilation equipment. This resulted in a reduction of the frequency of isolation each time. Cultures of all liquids in use and of the ventilation equipment were negative on several occasions. Fifteen months after the start of the outbreak, the NICU was moved to another building, and some older ventilation equipment was abandoned. After a period of six weeks without problems, S. paucimobilis was isolated in association with at least four ventilators. A new investigation showed that the ventilator temperature probes were the source of contamination. Once effective sterilization procedures for the temperature probes were introduced no new cases appeared, until a spare ventilator with an unautoclaved temperature probe was accidentally used and this caused contamination of one child. After correction, no further cases have occurred to date. The clonal relatedness of the outbreak isolates from patients and from ventilator temperature probes was documented by fingerprinting with the arbitrarily primed polymerase chain reaction.

Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011) : trends in incidence, pathogens, and mortality

OBJECTIVEnTo analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992-2011).nnnDESIGNnHistorical cohort study.nnnSETTINGnThirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital.nnnPATIENTSnNeonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD).nnnMETHODSnA hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition-days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis.nnnRESULTSnIn total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2-3.9). A significant increasing time trend in incidence density was observed for the period 1995-2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001).nnnCONCLUSIONSnAn increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.

Extremely Preterm Born Children at Very High Risk for Developing Autism Spectrum Disorder

This study aimed to provide a more comprehensive picture of the prevalence of autism spectrum disorder (ASD) in a geographic cohort of extremely preterm born adolescents by using established diagnostic instruments in addition to screening instruments. 53 participants passed a screening procedure with two screening instruments and a diagnostic evaluation with a semi-structured assessment and a parent interview. 28xa0% of the adolescents had a community based clinical diagnosis of ASD. When research diagnoses were also taken into account, this rate increased to 40xa0%. Intellectual disability, language impairment and behavioural difficulties are characteristic for these children with ASD. This study is to our knowledge the first to use ASD-specific diagnostic instruments to confirm ASD diagnoses in extremely preterm born children in early adolescence. The study expands findings of previous research and raises the need for follow-up into late childhood and early adolescence.

Extremely high mutation load of the mitochondrial 8993 T>G mutation in a newborn: implications for prognosis and family planning decisions

The propositus presented with hypotonia, respiratory failure, and seizures in the newborn period and was found to have severe hyperlactacidemia and a hypertrophic heart. He carried a de novo pathogenic mutation (m.8993xa0T>G) in the gene encoding subunit 6 of the mitochondrial ATP synthase (MTATP6). Although the lactate concentration in serum normalized and the proband recovered after a short period at the neonatal intensive care unit, his ultimate motor and cognitive development was poor. Brain MRI at the age of 6xa0months showed bilaterally signal abnormalities in the caudate nucleus, putamen, thalamus, and mesencephalon. He died at the age of 9xa0months. The difficulty in genetic counseling in families with a maternal mitochondrial mutation disorder is emphasized. Conclusion: Here, we report on a neonate with the m.8993xa0T>G mutation and emphasize implications of mtDNA disorders on family planning decisions.

Enzymatic differentiation of Candida parapsilosis from other Candida spp. in a membrane filtration test

A previously reported enzyme assay on a membrane filter using 4-methylumbelliferyl (4-MU)-N-acetyl-beta-D-galactosaminide, -phosphate and -pyrophosphate as substrates for the differentiation of four Candida spp. has been extended to Candida parapsilosis. The substrate 4-MU-beta-D-glucoside was hydrolyzed by 28 test strains of this species but to a variable extent by seven other yeasts also. For a full enzymatic differentiation of C. parapsilosis from other medical yeasts, a battery of six reactions was required. Of 71 C. parapsilosis positive clinical samples, 4.2% gave a false negative result due to overgrowth by Candida albicans. The present assay is more rapid than a described spectrofluorometric determination of beta-D-glucosidase in a broth, i.e., 9-11 h versus up to >48 h.

Desmopressin Lyophilisate for the Treatment of Central Diabetes Insipidus: First Experience in Very Young Infants

Introduction: In neonates and small infants, early diagnosis of central diabetes insipidus (CDI) and treatment with desmopressin in low doses (avoiding severe hypo- or hypernatremia) are important to prevent associated high morbidity and mortality in this particular age group. Case Presentation: We described pharmacokinetic and pharmacodynamic results of the use of recently launched oral desmopressin lyophilisate (Minirin Melt®) in two infants with CDI, diagnosed at the age of 12 and 62 days, respectively. We observed that a starting dose of 60 μg of Minirin Melt® in the first case resulted in a pharmacokinetic profile largely exceeding the reference frame observed in children with nocturnal enuresis, while a dose of 15 μg in the second case resulted in acceptable concentrations. After initial dose adjustments, administration of sublingual lyophilisate resulted in rather stable serum sodium concentrations. Conclusions: Using Minirin Melt® in infants with CDI appears to be effective, easy to use and well tolerated.

Functional Polymorphism in Gamma-Glutamylcarboxylase is a Risk Factor for Severe Neonatal Hemorrhage

A neonate who received vitamin K (VK) supplementation then developed severe late-onset bleeding with abnormal prothrombin time and activated partial thromboplastine time. The bleeding was corrected after intravenous VK. Molecular analysis of the gamma-glutamylcarboxylase gene revealed a heterozygous single nucleotide polymorphism, which decreases carboxylase activity and induces VK-dependent coagulation deficiency.

Prenatale diagnostiek van congenitale afwijkingen: multidisciplinaire aanpak

Prenatale diagnostiek (PND) is een razendsnel evoluerend subspecialisme binnen de verloskunde. Dit heeft geleid tot een aantal evoluties: ouders verwachten een garantie op een „gezond” kind. In een klimaat van verregaande autonomie eist men vaak een soort van „alleenbeslissingsrecht” over het verdere verloop van de zwangerschap. PND komt steeds vaker aan bod in juridische procedures. De toenemende mogelijkheden in het genetische onderzoek kunnen leiden tot vaststellingen die niet het oorspronkelijke doel waren van het onderzoek of waarvan de klinische gevolgen onduidelijk of (vooralsnog) onbehandelbaar zijn. Daarnaast betreft het een zeer gevoelig en emotioneel beladen domein in de geneeskunde. Al deze evoluties hebben ertoe geleid dat een raadpleging in een prenataal diagnostisch centrum op een professionele manier aangepakt moet worden door een prenataal diagnosticus met kennis ter zake, alsook gebaseerd moet zijn op een aantal hoekstenen: multidisciplinariteit (met een continue beschikbaarheid van specialismen zoals medische genetica en neonatologie, alsook de ad-hocbeschikbaarheid van pediatrische orgaanspecialisten), wetenschappelijke expertise (aangepast aan de meest recente evidentie), patientcommunicatieve vaardigheden (met aandacht voor de patient met inbegrip van de psychologische en de sociale aspecten), een continue paramedische ondersteuning door vroedvrouwen en sociaal assistenten met een specifieke opleiding en tot slot een collegiale samenwerking met de verwijzer.