Sergio G. Golombek

“Proactive” Management of Percutaneously Inserted Central Catheters Results in Decreased Incidence of Infection in the ELBW Population

OBJECTIVE: Extremely low birth weight (ELBW) infants often acquire catheter-related infections (CRIs) when a percutaneously inserted central catheter (PICC) is used for parenteral nutrition or drug administration. Our objective was to compare the incidence of CRIs after we established a “PICC Maintenance Team” for the proactive management — compared to expectant management — of these lines.STUDY DESIGN: We did a prospective collection and analysis of catheter-related sepsis data over a 15-month period from February 1, 1998 through May 1, 1999. Eligible patients included all neonates weighing <1000 g at birth.RESULTS: There was a significantly decreased incidence of CRIs, to a rate of 7.1%, or 5.1/1000 catheter days (p<0.05).CONCLUSION: “Proactive” management of PICC, significantly reduced the incidence of CRIs. The reduction in infection rate is estimated to save 180 hospitalized patient days/100 very low birth weight neonates, with a concomitant savings in morbidity and medical expense.

Plasma Biomarkers of Oxidative Stress: Relationship to Lung Disease and Inhaled Nitric Oxide Therapy in Premature Infants

OBJECTIVES. Inhaled nitric oxide treatment for ventilated premature infants improves survival without bronchopulmonary dysplasia. However, there has been no information regarding possible effects of this therapy on oxidative stress. We hypothesized that inhaled nitric oxide therapy would not influence concentrations of plasma biomarkers of oxidative stress. PATIENTS AND METHODS. As part of the Nitric Oxide Chronic Lung Disease Trial, we collected blood samples at specified intervals from a subpopulation of 100 infants of <1250 g birth weight who received inhaled nitric oxide (20 ppm, weaned to 2 ppm) or placebo gas for 24 days. Plasma was assayed for total protein and for 3-nitrotyrosine and carbonylation by using immunoassays. RESULTS. The demographic characteristics and primary outcome for the infants were representative of the entire group of infants who were in the Nitric Oxide Chronic Lung Disease Trial. For all infants at baseline, before receiving study gas, the concentration of total protein was inversely correlated with the respiratory severity score, and plasma carbonyl was positively correlated with severity score, supporting an association between oxidative stress and severity of lung disease. Infants who survived without bronchopulmonary dysplasia had 30% lower protein carbonylation concentrations at study entry than those who had an adverse outcome. At each of 3 time points (1–10 days) during exposure to study gas, there were no significant differences between control and treated infants for concentrations of plasma protein, 3-nitrotyrosine, and carbonylation. CONCLUSIONS. Inhaled nitric oxide treatment for premature infants who are at risk for bronchopulmonary dysplasia does not alter plasma biomarkers of oxidative stress, which supports the safety of this therapy.

Necrotizing enterocolitis following the use of intravenous immunoglobulin for haemolytic disease of the newborn

Aim:  To describe a series of patients who received intravenous immunoglobulin (IVIg) for the treatment of neonatal hyperbilirubinaemia and developed necrotizing enterocolitis (NEC) shortly thereafter.

Surfactant Function and Composition in Premature Infants Treated With Inhaled Nitric Oxide

OBJECTIVES. We hypothesized that inhaled nitric oxide treatment of premature infants at risk for bronchopulmonary dysplasia would not adversely affect endogenous surfactant function or composition. METHODS. As part of the Nitric Oxide Chronic Lung Disease Trial of inhaled nitric oxide, we examined surfactant in a subpopulation of enrolled infants. Tracheal aspirate fluid was collected at specified intervals from 99 infants with birth weights <1250 g who received inhaled nitric oxide (20 ppm, weaned to 2 ppm) or placebo gas for 24 days. Large-aggregate surfactant was analyzed for surface activity with a pulsating bubble surfactometer and for surfactant protein contents with an immunoassay. RESULTS. At baseline, before administration of study gas, surfactant function and composition were comparable in the 2 groups, and there was a positive correlation between minimum surface tension and severity of lung disease for all infants. Over the first 4 days of treatment, minimum surface tension increased in placebo-treated infants and decreased in inhaled nitric oxide–treated infants. There were no significant differences between groups in recovery of large-aggregate surfactant or contents of surfactant protein A, surfactant protein B, surfactant protein C, or total protein, normalized to phospholipid. CONCLUSIONS. We conclude that inhaled nitric oxide treatment for premature infants at risk of bronchopulmonary dysplasia does not alter surfactant recovery or protein composition and may improve surfactant function transiently.

Nonthyroidal Illness Syndrome and Euthyroid Sick Syndrome in Intensive Care Patients

This article reviews the pathophysiology of non-thyroidal illness syndrome (NTIS) and euthyroid sick syndrome (ESS), a multifactorial phenomenon characterized by suppression of thyroid hormone levels that has been described in several disease states, probably due to different causes in different patients. It also describes the laboratory values of thyroid function tests (TFTs), relevant animal studies, the association of NTIS and ESS with cardiovascular problems and sepsis, and the rationale for treatment.

Compliance with prophylaxis for respiratory syncytial virus infection in a home setting

Background. Respiratory syncytial virus (RSV) is the most common respiratory pathogen in infancy and childhood. Objective. To compare the compliance and biologic efficacy of a home health care agency dosing-compliance program to treatment provided in a physician’s office setting during a single RSV season (November to May). Methods. AAP guidelines were used to identify neonates who were eligible for RSV prophylaxis before discharge from a neonatal intensive care unit setting. Parents were asked to choose to receive the recommended treatment for their child either in their pediatrician’s office setting or through a sequence of periodic nursing visits to their home. All home health care records were reviewed for demographics, number of doses received and hospitalization rate. Pediatricians office records were surveyed by telephone interview of their office staff and parents. Compliance data were calculated based on actual monthly injections given during the RSV season. Results. We followed prospectively 1446 infants who received palivizumab during a single RSV season (November 1, 2000 through April 30, 2001). Of these infants 67% (969 of 1446) received their monthly injections in the home setting where 98% of the doses were given on schedule. In contrast 477 infants (33%) received their injections in a pediatrician’s office (parent’s choice) with a compliance of only 89% for completion of all recommended doses (P < 0.001 vs. home setting). There were 9 RSV hospitalizations (0.93%) in the home setting group and 8 RSV hospitalizations (3.57%) in the office setting (P < 0.001). More parents indicated that the in-home prophylaxis program was more convenient than was true for those receiving treatment in the physician’s office setting (P < 0.01). Conclusions. Better compliance with home injections was associated with a decrease in the hospitalization rate for RSV with a higher degree of parental satisfaction.

Cord blood interleukin-6 as a predictor of early-onset neonatal sepsis.

Aim:  To compare diagnostic accuracy in cord blood of interleukin‐6 (IL‐6) with C‐reactive protein (CRP) as predictors of early‐onset neonatal sepsis (EOS) in newborns with prenatal risk factors for infection.

Treatment of transient hypothyroxinemia of prematurity: a survey of neonatal practice.

We mailed a survey on treatment practices for transient hypothyroxinemia of prematurity (THOP) to 100 randomly selected neonatologists. In the year before the survey, 13 of 62 respondents (21.0%) had treated an average of 4.5 THOP patients with thyroid hormone, and 3 had treated 10 or more patients. Randomized trials assessing the value of thyroid supplementation in THOP are urgently needed.

Randomized Trial of Alcohol Versus Triple Dye for Umbilical Cord Care

Over a 4-month period, all infants admitted to the well-baby nursery were enrolled in a prospective study designed to compare cord separation times between infants treated with triple dye once, followed by daily alcohol application, to infants treated with daily alcohol application alone. Follow-up phone calls were done 7 days after discharge, with weekly calls until cord separation occurred. The objective was to determine whether the umbilical cord care regimen of triple dye followed by alcohol has an advantage over the alternative regimen of alcohol alone, with regard to cord separation, parenting, or healthcare caretaker preferences. In total, 634 infants were enrolled, with 599 infants (94%) completing the study. Infants in the alcohol alone group had a shorter cord separation time by 3 days (10 versus 13 days) (p < 0.0001). There was no reported increase in infection, and monetary savings were noted. We conclude that alcohol applied once a day appears to be a safe and effective means of promoting cord detachment.

The history of congenital diaphragmatic hernia from 1850s to the present.

Congenital diaphragmatic hernia (CDH) is believed to result from incomplete fusion of the pleuroperitoneal membrane, and passage of the abdominal contents into the chest. A historical review of the literature on this subject shows a wide divergence of opinion on the etiology of the various types of CDH, and on the recommended treatment. A variety of theories regarding its causes and the optimal way of approaching it have been published from the mid 19th century through the 20th century, and are reviewed in this article.