morphine and Sepsis

Meconium stained amniotic fluid (MSAF) is common and associated with meconium aspiration syndrome (MAS). Other consequences of meconium passage before birth are less well understood.. We reviewed the literature for original papers reporting on outcomes associated with MSAF.. Among preterm infants MSAF is more prevalent than previously believed and is associated with higher neonatal morbidity. Intrauterine exposure to meconium is associated with inflammation of tissues of the lung, chorionic plate and umbilical vessels and through various mechanisms may contribute to neonatal morbidity, independent of MAS. No compelling evidence supported an association between MSAF and increased neurological impairment, including early seizure activity.

Topics: Acidosis; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Female; Fetus; Humans; Infant, Newborn; Infant, Premature; Meconium; Meconium Aspiration Syndrome; Otitis Media; Pregnancy; Seizures; Sepsis

Chorioamnionitis is more likely to occur when meconium-stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving as a growth factor, inhibiting bacteriostatic properties of amniotic fluid. Many adverse neonatal outcomes related to MSAF result from meconium aspiration syndrome (MAS). MSAF is associated with both maternal and newborn infections. Antibiotics may be an effective option to reduce such morbidity.. The objective of this review is to assess the efficacy and side effects of prophylactic antibiotics for MSAF during labour in preventing maternal and neonatal infections.. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014). . Randomised controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment during labour for women with MSAF.. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.. We included two studies with 362 pregnant women. Both studies compared ampicillin-sulbactam (N = 183) versus normal saline (N = 179) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, there was a significant decrease in the risk of chorioamnionitis (RR 0.36, 95% CI 0.21 to 0.62). No serious adverse effects were reported. Drug resistance, duration of mechanical ventilation and duration of admission to NICU/hospital were not reported. Most of the domains for risk of bias were at low risk of bias for one study and at unclear risk of bias for the other study. The quality of the evidence using GRADE was low for neonatal sepsis, postpartum endometritis, and neonatal mortality and morbidity prior to discharge (Neonatal intensive care admissions) and of moderate quality for chorioamnionitis.. Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess the effect of prophylactic antibiotics in the incidence of maternal and neonatal complications.

Topics: Amniotic Fluid; Ampicillin; Anti-Bacterial Agents; Chorioamnionitis; Endometritis; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Labor, Obstetric; Meconium; Pregnancy; Randomized Controlled Trials as Topic; Sepsis; Sulbactam

Chorioamnionitis is more likely to occur when meconium-stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving as a growth factor, inhibiting bacteriostatic properties of amniotic fluid. Many adverse neonatal outcomes related to MSAF result from Meconium Aspiration Syndrome (MAS). MSAF is associated with both maternal and newborn infections. Antibiotics may be an effective option to reduce such morbidity.. The objective of this review is to assess the efficacy and side effects of prophylactic antibiotics for MSAF during labour in preventing maternal and neonatal infections.. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2010). . Randomized controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment during labour for women with MSAF.. Two review authors independently assessed the results of the only available trial and extracted data on maternal and neonatal outcomes.. We included one study with 120 pregnant women. It compared ampicillin-salbactam (N = 60) versus normal saline (N = 60) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, significant decrease in the risk of chorioamnionitis (RR 0.29, 95% CI 0.10 to 0.82). No serious adverse effects were reported.. Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess the effect of prophylactic antibiotics in the incidence of maternal and neonatal complications.

Topics: Amniotic Fluid; Ampicillin; Anti-Bacterial Agents; Chorioamnionitis; Endometritis; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Labor, Obstetric; Meconium; Pregnancy; Randomized Controlled Trials as Topic; Sepsis; Sulbactam

The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in term neonates born through meconium-stained amniotic fluid (MSAF). Two hundred and fifty eligible neonates were randomized to study group (Antibiotic group-receiving first-line antibiotics for 3 days) and control group (No Antibiotic group). Both groups were evaluated clinically and by laboratory parameters (sepsis screen and blood cultures) for development of sepsis. All neonates were monitored for respiratory, neurological, and other systemic complications and received supportive treatment according to standard management protocol of the unit. One hundred and twenty one neonates were randomized to 'Antibiotic' group and 129 to 'No Antibiotic' group. The overall incidence of suspect sepsis was 9.6 % in the study population with no significant difference between 'No Antibiotic' and 'Antibiotic' groups (10.8 vs. 8.2 %, p = 0.48, odds ratio (OR) 0.74, 95 % confidence interval (CI) 0.32-1.73). Incidence of culture-proven sepsis was also not significantly different between the two groups (5.42 vs. 4.13 %, p = 0.63, OR 0.75, 95 % CI 0.23-2.43). The incidence of mortality, meconium aspiration syndrome, and other complications was comparable amongst the two groups.. Routine antibiotic prophylaxis in neonates born through MSAF did not reduce the incidence of sepsis in this study population. (Clinicaltrials.gov no. - NCT01290003).

Topics: Amikacin; Amniotic Fluid; Anti-Bacterial Agents; Antibiotic Prophylaxis; Double-Blind Method; Female; Humans; Infant, Newborn; Infusions, Intravenous; Male; Meconium; Meconium Aspiration Syndrome; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pregnancy; Prospective Studies; Sepsis

Feed intolerance delays achievement of enteral feeding in preterm infants. Parenteral nutrition is associated with cholestasis and increased risk of sepsis. Glycerin suppositories have been used to promote gastrointestinal motility and feed tolerance.. To investigate whether daily glycerin suppositories (a) reduce the time to full enteral feeding in infants born at <32 weeks' gestation, and (b) influence feed tolerance, incidence of sepsis or necrotizing enterocolitis, duration of oxygen requirement, growth or age at discharge.. Design - prospective open randomized controlled trial; study population - preterm infants stratified into 2 subgroups, 24-27(+6) weeks (24-27 weeks + 6 days) and 28-31(+6) weeks; intervention - daily glycerin suppository for 10 days from 24 h of age, 250 mg (24-27(+6) weeks subgroup) or 500 mg (two 250-mg suppositories; 28-31(+6) weeks subgroup); controls - no intervention. The same feeding protocol and departmental guidelines for other aspects of neonatal intensive care were used in all subjects. Analysis was by intention to treat.. 54 babies were recruited (31 males), 29 randomized to receive suppositories; 48 achieved full enteral feeds. The median (range) time to full feeds was 1.6 days shorter in intervention group babies than controls, but not statistically significant: 7.4 (4.6-30.9) days versus 9.0 (4.4-13.3) days (p = 0.780; 95% confidence interval: -1.917, 2.166). No significant differences were observed in secondary outcomes. Intervention group babies passed their first stool earlier than controls (median: day 2 vs. day 4; p = 0.016).. Regular glycerin suppositories did not reduce the time to full enteral feeds in infants born at <32 weeks' gestation in our setting.

Topics: Dose-Response Relationship, Drug; Enteral Nutrition; Enterocolitis, Necrotizing; Feeding Behavior; Female; Gastrointestinal Motility; Glycerol; Humans; Incidence; Infant, Newborn; Infant, Premature; Male; Meconium; Sepsis; Suppositories; Time Factors; Treatment Outcome

Early-onset neonatal sepsis (EONS) remains one of the leading causes of morbidity and mortality related to premature birth, and its diagnosis remains difficult. Our goal was to evaluate the intestinal microbiota of the first meconium of preterm newborns and ascertain whether it is associated with clinical EONS.. In a controlled, prospective cohort study, samples of the first meconium of premature infants with a gestational age (GA) ≤32 weeks was obtained at Hospital de Clínicas de Porto Alegre and DNA was isolated from the samples. 16S rDNA based microbiota composition of preterm infants with a clinical diagnosis of EONS was compared to that of a control group.. 40 (48%) premature infants with clinical diagnosis of EONS and 44 (52%) without EONS were included in the analysis. The most abundant phylum detected in both groups,. These findings suggest that the first-meconium microbiota is different in preterm neonates with and without clinical EONS.

Topics: Female; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Meconium; Microbiota; Neonatal Sepsis; Pregnancy; Premature Birth; Prospective Studies; Sepsis

Intrapartum antibiotic prophylaxis reduces the risk of infection to a mother and neonate, but antibiotic-mediated maternal and neonatal microbiota dysbiosis increases other health risks to newborn infants. We studied the impact of perinatal antibiotic prophylaxis on the microbiota in mothers and newborns with full-term or preterm delivery. Ninety-eight pregnant women and their neonates were divided into the following four groups: full term without antibiotic exposure (FT), full term with antibiotic exposure (FTA), preterm without antibiotic exposure (PT), and preterm with antibiotic exposure (PTA). Bacterial composition was analyzed by sequencing the 16S rRNA gene from maternal vaginal swabs (V) and neonatal meconium (F). The results showed that in maternal vaginal and neonatal meconium microbiota, FT and PT groups had a higher load of

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Dysbiosis; Female; Gastrointestinal Microbiome; Gestational Age; Humans; Infant Health; Infant, Newborn; Maternal Exposure; Maternal-Fetal Exchange; Meconium; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; RNA, Ribosomal, 16S; Sepsis; Streptococcal Infections; Vagina; Young Adult

Nosocomial sepsis is the main problem that preterms have to face during their stay at neonatal intensive care units (NICU).. Twenty-six preterm infants born with a gestational age ≤ 32 weeks and/or weigh ≤1500 g were included in the study. Samples of meconium and feces (. A total of 179 . The local ethic committee approved this trial with the reference 09/157.

Topics: Anti-Bacterial Agents; Cluster Analysis; Cross Infection; DNA, Bacterial; Enteral Nutrition; Evolution, Molecular; Feces; Female; Genotyping Techniques; Humans; Infant; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Male; Meconium; Microbial Sensitivity Tests; Phylogeny; Sepsis; Serratia Infections; Serratia marcescens

Topics: Adult; Amniotic Fluid; Apgar Score; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Israel; Jaundice, Neonatal; Meconium; Meconium Aspiration Syndrome; Patient Admission; Phototherapy; Respiration Disorders; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Sepsis; Tachypnea; Term Birth; Young Adult

To validate established neonatal neutrophil reference ranges (RRs) and determine the utility of serial measurements of neutrophil values in the first 24 hours to predict the absence of neonatal early-onset sepsis (EOS).. Retrospective study of 2073 admissions to the neonatal intensive care unit (2009-2011). Neonates were classified as blood culture-positive, proven EOS (n = 9), blood culture-negative but clinically suspect EOS (n = 292), and not infected (n = 1292). Neutrophil values from 745 not-infected neonates without perinatal complications were selected to validate RR distributions. Positive and negative predictive values were calculated; area under receiver operating characteristic curves (AUCs) were constructed to predict the presence or absence of EOS. Neutrophil value scores were established to determine whether serial neutrophil values predict the absence of EOS.. Seventy-seven percent of admissions to the neonatal intensive care unit were evaluated for EOS: 9 (0.56%) had proven EOS with positive blood culture ≤ 37 hours; 18% had clinically suspect EOS. Neutropenia occurred in preterm neonates, and nonspecific neutrophilia was common in uninfected neonates. The distribution of neutrophil values differed significantly between study groups. The specificity for absolute total immature neutrophils and immature to total neutrophil proportions was 91% and 94%, respectively, with negative predictive value of 99% for proven and 78% for proven plus suspect EOS. Absolute total immature neutrophils and immature to total neutrophil proportions had the best predictability for EOS >6 hours postnatal with an AUC ∼ 0.8. Neutrophil value scores predicted the absence of EOS with AUC of 0.9 and 0.81 for proven and proven plus suspect EOS, respectively.. Age-dependent neutrophil RRs remain valid. Serial neutrophil values at 0, 12, and 24 hours plus blood culture and clinical evaluation can be used to discontinue antimicrobial therapy at 36-48 hours.

Topics: Apgar Score; Asphyxia Neonatorum; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Meconium; Neutrophils; Predictive Value of Tests; Pregnancy; Reference Values; Resuscitation; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Sepsis

Category II fetal heart rate (FHR) tracings are considered indeterminate; thus, improved risk stratification of category II FHR tracings is needed. We estimated whether the presence of meconium increased the risk of adverse neonatal outcomes.. This study was conducted within a prospective cohort of 5000 women with singleton pregnancies who were admitted in labor at term. Pregnancies with category II FHR in the 60 minutes before delivery were included. FHR data were extracted by trained nurses who were blinded to clinical outcome. The exposure was the presence of meconium. The primary outcome was a composite neonatal morbidity defined as ≥1 of the following: neonatal death, neurologic morbidity, respiratory morbidity, hypotension that required treatment, and sepsis. Secondary outcomes were nursery admission, cord pH, 5-minute Apgar score, and components of the composite. Logistic regression was used to adjust for confounders.. Of the 3257 women with category II FHR tracings, 693 women (21.3%) had meconium, and 2564 women (78.7%) did not. Meconium was associated with higher risk of the composite morbidity (adjusted odds ratio, 2.49; 95% confidence interval, 1.78-3.48) and increased risks of the secondary outcomes. The associations remained significant when infants with meconium aspiration syndrome were excluded. Thick meconium was associated significantly with the composite morbidity.. The presence of meconium is associated with an increased risk of neonatal morbidity in women with category II FHR pattern. This clinical factor may assist clinicians in managing category II FHR patterns in labor.

Topics: Adult; Amniotic Fluid; Cardiotocography; Female; Heart Rate, Fetal; Humans; Hypotension; Infant, Newborn; Infant, Newborn, Diseases; Logistic Models; Meconium; Meconium Aspiration Syndrome; Multivariate Analysis; Obstetric Labor Complications; Odds Ratio; Perinatal Death; Pregnancy; Prospective Studies; Risk Assessment; Risk Factors; Sepsis; Young Adult

Neonatal sepsis due to intestinal bacterial translocation is a major cause of morbidity and mortality. Understanding microbial colonisation of the gut in prematurity may predict risk of sepsis to guide future strategies to manipulate the microbiome.. Prospective longitudinal study of premature infants. Stool samples were obtained weekly. DNA was extracted and the V6 hypervariable region of 16S rRNA was amplified followed by high throughput pyrosequencing, comparing subjects with and without sepsis.. Six neonates were 24-27 weeks gestation at birth and had 18 samples analysed. Two subjects had no sepsis during the study period, two developed late-onset culture-positive sepsis and two had culture-negative systemic inflammation. 324 350 sequences were obtained. The meconium was not sterile and had predominance of Lactobacillus, Staphylococcus and Enterobacteriales. Overall, infants who developed sepsis began life with low microbial diversity, and acquired a predominance of Staphylococcus, while healthy infants had more diversity and predominance of Clostridium, Klebsiella and Veillonella.. In very low birth weight infants, the authors found that meconium is not sterile and is less diverse from birth in infants who will develop late-onset sepsis. Empiric, prolonged antibiotics profoundly decrease microbial diversity and promote a microbiota that is associated not only with neonatal sepsis, but the predominant pathogen previously identified in the microbiome. Our data suggest that there may be a 'healthy microbiome' present in extremely premature neonates that may ameliorate risk of sepsis. More research is needed to determine whether altered antibiotics, probiotics or other novel therapies can re-establish a healthy microbiome in neonates.

Topics: Anti-Bacterial Agents; Bacterial Translocation; Base Sequence; Colony Count, Microbial; Enterobacteriaceae; Gastrointestinal Tract; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Longitudinal Studies; Meconium; Molecular Sequence Data; Risk Factors; RNA, Messenger; Sepsis; Staphylococcus

The amniotic fluid embolism (AFE) syndrome is a catastrophic complication of pregnancy frequently associated with maternal death. The causes and mechanisms of disease responsible for this syndrome remain elusive.. We report two cases of maternal deaths attributed to AFE: (1) one woman presented with spontaneous labor at term, developed intrapartum fever, and after delivery had sudden cardiovascular collapse and disseminated intravascular coagulation (DIC), leading to death; (2) another woman presented with preterm labor and foul-smelling amniotic fluid, underwent a Cesarean section for fetal distress, and also had postpartum cardiovascular collapse and DIC, leading to death.. Of major importance is that in both cases, the maternal plasma concentration of tumor necrosis factor-alpha at the time of admission to the hospital and when patients had no clinical evidence of infection was in the lethal range (a lethal range is considered to be above 0.1 ng/mL).. We propose that subclinical intraamniotic infection may be a cause of postpartum cardiovascular collapse and DIC and resemble AFE. Thus, some patients with the clinical diagnosis of AFE may have infection/systemic inflammation as a mechanism of disease. These observations have implications for the understanding of the mechanisms of disease of patients who develop cardiovascular collapse and DIC, frequently attributed to AFE. It may be possible to identify a subset of patients who have biochemical and immunological evidence of systemic inflammation at the time of admission, and before a catastrophic event occurs.

Topics: Adult; Chorioamnionitis; Diagnosis, Differential; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Fatal Outcome; Female; Humans; Meconium; Postpartum Period; Pregnancy; Sepsis; Shock; Shock, Septic; Tumor Necrosis Factor-alpha

Different biological matrices are suitable for drug testing in newborns presenting with an acute withdrawal syndrome.. The newborn of a mother reporting alprazolam use during pregnancy presented with respiratory distress and clinical features consistent with neonatal withdrawal syndrome or neonatal sepsis of vertical transmission. Alprazolam and its main metabolite (alpha-hydroxyalprazolam) were detected in cord serum, neonatal urine and also in neonatal hair, meconium and placenta, accounting for both acute and chronic exposure to this benzodiazepine during intrauterine life. At the same time, the clinical diagnosis of neonatal sepsis was confirmed by isolation of Streptococcus agalactiae from otic cultures. The infant received oxygen therapy and antibiotic treatment and recovered completely at the age of 11 days. Although no congenital anomalies or behavioral alterations were diagnosed during hospitalization, periodic follow-ups were requested to check for potential long-term effects of prenatal exposure to alprazolam.

Topics: Adult; Alprazolam; Anti-Anxiety Agents; Diagnosis, Differential; Female; Fetal Blood; Hair; Humans; Infant, Newborn; Male; Maternal Exposure; Maternal-Fetal Exchange; Meconium; Neonatal Abstinence Syndrome; Oxygen Inhalation Therapy; Placenta; Pregnancy; Sepsis; Streptococcal Infections; Streptococcus agalactiae; Substance Abuse Detection; Treatment Outcome; Urine

To investigate the impact of preterm premature rupture of membranes on neonatal outcome.. A retrospective study was conducted among singleton pregnancies with or without intact amniochorional membranes. The impact of maternal age, gestational age at birth, 1- and 5-min Apgar scores, birthweight, presence of meconium, use of tocolytics, corticosteroids and antibiotics, mode of delivery, umbilical artery pH, histologic presence of chorioamnionitis, and state of the membranes were analyzed in relation to neonatal outcome. Neonatal outcomes were categorized into: none, presence of respiratory distress syndrome, early neonatal sepsis, neonatal death, and days at neonatal intensive care unit.. A total of 180 preterm deliveries with ruptured (n=80) and intact membranes (n=100) constituted the study group (group 1) and the control group (group 2), respectively. Compared with group 2, there were more cases in group 1 of maternal antibiotic use (P<0.001), short-term tocolysis (P=0.03), and histologic chorioamnionitis (P<0.001). Multiple logistic regression analysis showed that gestational age at delivery (P=0.009), 1-min Apgar score (P=0.013), and umbilical artery pH (P=0.05) were the independent factors affecting neonatal outcome.. Neonatal outcome was mainly affected by prematurity rather than by preterm premature rupture of membranes.

Topics: Adult; Apgar Score; Case-Control Studies; Chorioamnionitis; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Length of Stay; Logistic Models; Maternal Age; Meconium; Obstetric Labor, Premature; Pregnancy; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Sepsis; Tocolysis

Of the 6,060 consecutive live births delivered at the University Maternity Unit of Guadeloupe (French West Indies) during a 30-month period, 635 newborns (10.4%) presented with meconium stained (MS) amniotic fluid, of which 595 (94%) received bacteriological screening at birth (light MS, n = 543; thick MS, n = 52). Thirty (5%) of MS newborns had a bacteraemia (n = 13, group B streptococcus, GBS), and 128 (21.5%) a bacterial positive gastric aspirate (n = 54, GBS). Sixty-six newborns among MS babies needed tracheal suctioning (11%) in the delivery room for meconium inhalation. Among these 595 screened MS newborns, 286 (48%) presented clinical signs of postmaturity at birth, having therefore an explanation for their MS condition. For the other MS newborns without the postmaturity explanation, we experienced twofold increased risk of neonatal sepsis (OR 1.88 for bacteraemia and 2.61 for external carriage p < 0.02, Chi square) as compared with their MS postmature counterparts. We conclude that when meconium stained deliveries are associated with postmaturity signs, one may not need to initiate prophylactic antibiotic treatment at birth unless they present with other traditional risk factors for neonatal sepsis such as intrapartum fever and prolonged rupture of membranes.

Topics: Humans; Infant, Newborn; Meconium; Neonatal Screening; Risk Factors; Sepsis; West Indies

Difficulty in the diagnosis of neonatal sepsis has lead to the practice of superficial cultures. The usefulness of this practice has been criticized repeatedly.. Results of 3881 cultures performed on 735 newborns (age < or = 48 hr) with early infection risk were reviewed. The types of samples chosen were urine (UR), gastric aspirate (GA), pharyngeal (PS), external ear (ES), umbilical swab (US), meconium (MC) and blood. BBV for sepsis for the different samples is calculated, as well as which ones better reflect vertical transmission.. At the time of the study, 342 newborns (46.5%) were already colonized. Bacteria most frequently isolated were: E. coli (92), PCN staphylococci (85), enterococci (83) and S. agalactiae (70). Twenty-nine newborns had bacteriemia, with S. agalactiae being the leading cause (16). ES correlated best with positive blood cultures (83.3%). UR culture sensitivity was significantly lower than that of all other samples. The Highest PPVs were for GA, PS and US. NPV was high and similar for all samples (98-99%). ES and US best reflected vertical transmission (p < 0.0001). MC provided the highest number of positive mixed cultures, most of them difficult to evaluate.. Body surface sample advantages are: 1) The possibility of discarding a vertically transmitted infection. 2) Quicker positive results than those in blood whenever liquid blood culture media are employed. 3) The possible identification of the etiologic agent when the mother has been given antibiotics intrapartum. 4). Information about dangerous colonization without infection. In order not to lose this useful information, but to save cost and effort, we advise that the number of surface cultures be reduced, keeping only ES and PS?

Topics: Escherichia coli; Haemophilus influenzae; Humans; Infant, Newborn; Meconium; Retrospective Studies; Sepsis; Staphylococcus; Streptococcus

Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy for neonatal pulmonary hypertension but carries a significant risk for transfusion-related complications. Packed red blood cell (PRBC) and platelet exposure were quantified and reviewed in 17 ECMO survivors prior (Group I, n = 9) and subsequent to (Group II, n = 8) changes in transfusion protocols. Blood product requirements included ECMO circuit priming, maintenance of haematocrit > 0.40 or platelet count > 50 x 10(9)/l, and colloid volume expansion. Group I was exposed to 13.8 +/- 10.2 (x +/- SD) different PRBC units. In Group II, multiple transfusions from single donor units decreased exposure 71% to 3.9 +/- 0.7 units (P < 0.05). Decreases in blood withdrawn (11%) and transfusion volume (7%) were coincident with a 15% reduction in mean bypass time. Platelet volume transfusion decreased from 159 +/- 213 to 93 +/- 64 ml using volume-reduced platelet packs. Total transfusion exposure decreased 59% from 20.8 +/- 17.8 units to 8.6 +/- 2.4 donor units. No transfusion complications occurred during the aggregate 1,926 h on bypass. We conclude that neonates on ECMO have a significant transfusion exposure risk increasing with prolonged duration of ECMO therapy. In addition we noted that concentrated platelet packs decreased transfusion volume by 41%, and multiple PRBC transfusions from single donor units decreased donor exposure by 71% while both strategies decreased the overall transfusion exposure risk by 59%.

Topics: Blood Component Transfusion; Blood Transfusion; Erythrocyte Transfusion; Extracorporeal Membrane Oxygenation; Female; Humans; Hypertension, Pulmonary; Infant, Newborn; Inhalation; Male; Meconium; Platelet Transfusion; Prospective Studies; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Retrospective Studies; Risk; Sepsis; Transfusion Reaction

The cause of fetal distress and neonatal respiratory distress (RD) in association with meconium-stained liquor is not always clear. To clarify this, a prospective study was undertaken in a tertiary referral maternity hospital for 1 year. In all infants born after meconium-stained liquor who developed RD, evidence was sought for 1) fetal distress (from the cardiotocograph (CTG), the cord blood pH, the Apgar score and the asphyxial complications in the neonate) 2) causes of fetal distress (including maternal risk factors, fetal infection and fetal malnutrition) 3) causes of respiratory distress (including meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN) and infection). Of 4,026 livebirths, 717 (17.8%) had meconium-stained liquor and 44 term and 5 preterm infants developed RD. In the 44 term infants, there was frequent evidence of fetal distress possibly caused by previously unrecognized factors such as fetal malnutrition with reduced neonatal skinfold thickness in 35% triceps and 41% subscapular measurements, and histological chorioamnionitis (CA) in 74%. The cause for respiratory distress was identified in only 48% of infants, and included clinical evidence of PPHN (41%), MAS (16%) and infection (2%). However in preterm infants, 80% had definite or suspected infection. The findings indicate that fetal distress is common in infants who develop respiratory distress after meconium-stained liquor. A role for histological CA and reduced nutrition in the fetus, as factors contributing to the vulnerability of the term infant to intrapartum fetal distress, is suggested.

Topics: Apgar Score; Chorioamnionitis; Female; Fetal Blood; Fetal Diseases; Fetal Distress; Heart Rate, Fetal; Hospitals, Maternity; Humans; Infant, Newborn; Infant, Premature; Kidney Diseases; Meconium; Meconium Aspiration Syndrome; New South Wales; Nutritional Status; Persistent Fetal Circulation Syndrome; Pregnancy; Prospective Studies; Radiography; Respiratory Distress Syndrome, Newborn; Risk Factors; Sepsis; Skinfold Thickness

Of 243 children born after premature rupture of the membranes (PROM) 61 (26%) had the same bacteria in placental arterial blood, in ear swabs (taken deep from the external auditory canal) and in meconium. The predominant organisms were E. coli, Bacteroides fragilis, Streptococcus faecalis (enterococci) and Streptococcus agalactiae (group B streptococci). The infection rate was only 10% if the membranes had ruptured within 24 h of the onset of labour and 30% if the interval was longer than 24 h. Of 131 children born without premature rupture of the membranes but with risk factors for sepsis 9 (7%) had a positive blood culture with the same organism in the ear swabs and in meconium. The organisms were Streptococcus agalactiae (6 cases) and E. coli, Streptococcus faecalis and Klebsiella pneumoniae (one case each). Contamination of placental blood cultures was rare.

Topics: Blood; Ear; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Meconium; Placenta; Pregnancy; Sepsis

Topics: Adult; Extraembryonic Membranes; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Maternal-Fetal Exchange; Meconium; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus; Umbilical Arteries

Topics: Catheterization; Diagnosis, Differential; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Intestinal Obstruction; Male; Meconium; Megacolon; Pregnancy; Respiratory Distress Syndrome, Newborn; Sepsis; Umbilical Veins

Topics: Humans; Infant, Newborn; Inhalation; Meconium; Meningitis; Occlusive Dressings; Polyvinyls; Preoperative Care; Sepsis; Spinal Dysraphism; Surgical Wound Infection

Topics: Abdomen, Acute; Collateral Circulation; Cystic Fibrosis; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Intestines; Male; Meconium; Peritoneum; Peritonitis; Pneumoperitoneum; Pregnancy; Radiography, Abdominal; Sepsis; Stomach Rupture

Topics: Agglutination Tests; Animals; Anti-Bacterial Agents; Diagnosis, Differential; Female; Granuloma; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Listeria monocytogenes; Listeriosis; Meconium; Meningitis, Listeria; Meningoencephalitis; Pregnancy; Sepsis; Zoonoses

Topics: Colostomy; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Jejunum; Male; Meconium; Peptic Ulcer Perforation; Peritonitis; Pneumoperitoneum; Radiography; Sepsis; Stomach

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Liver Diseases; Meconium; Megacolon; Peritonitis; Pseudomonas Infections; Radiography; Sepsis