Group B streptococcal disease in the mother and newborn-A review.

Group B Streptococcus, a common commensal in the gut of humans and in the lower genital tract in women, remains an important cause of neonatal mortality and morbidity. The incidence of early onset disease has fallen markedly in countries that test women for carriage at 35-37 weeks of pregnancy and then offer intrapartum prophylaxis with penicillin during labour. Countries that do not test, but instead employ a risk factor approach, have not seen a similar fall.

PCR for the detection of pathogens in neonatal early onset sepsis.

Background: A large proportion of neonates are treated for presumed bacterial sepsis with broad spectrum antibiotics even though their blood cultures subsequently show no growth. This study aimed to investigate PCR-based methods to identify pathogens not detected by conventional culture.

Methods: Whole blood samples of 208 neonates with suspected early onset sepsis were tested using a panel of multiplexed bacterial PCRs targeting Streptococcus pneumoniae, Streptococcus agalactiae (GBS), Staphylococcus aureus, Streptococcus pyogenes (GAS), Enterobacteriaceae, Enterococcus faecalis, Enterococcus faecium, Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis and Mycoplasma genitalium, a 16S rRNA gene broad-range PCR and a multiplexed PCR for Candida spp.

Pathophysiological Mechanism of Extravasation via Umbilical Venous Catheters.

A rare complication of umbilical venous catheter (UVC) insertion is the extravasation of the infusate into the peritoneal cavity. We report 3 cases of abdominal extravasation of parenteral nutrition (PN) fluid via UVCs. Two of these cases presented as "acute abdomen" which were assumed to be necrotizing enterocolitis clinically; however, during postmortem, PN ascites and liver necrosis were found.

Epidemiology of UK neonatal infections: the neonIN infection surveillance network.

Objective: To describe the epidemiology of neonatal infection over the past decade in UK neonatal units.

Design: Retrospective analysis of prospectively collected infection surveillance network data from 2005 to 2014.

Setting: 30 neonatal units in the UK.

Antimicrobial resistance in UK neonatal units: neonIN infection surveillance network.

Objective: To define the susceptibilities of the common causative pathogens of neonatal sepsis in the UK.

Design: Retrospective analysis of the prospectively collected neonIN infection surveillance network data between 2005 and 2014.

Setting: 30 neonatal units in the UK.

AN AUDIT OF VANCOMYCIN PLASMA CONCENTRATIONS WHEN VANCOMYCIN IS ADMINISTERED BY CONTINUOUS INTRAVENOUS INFUSION IN NEONATES.

Aim: To compare continuous intravenous infusions of vancomycin in achieving desired therapeutic plasma concentrations against an intermittent bolus regimen.

Method: Data were collected for all babies who received a continuous infusion of vancomycin on our Neonatal Intensive Care Unit (NICU) between October 2014 and March 2015. The regimen is based on that of another hospital (Hospital A) and comprised of a loading dose of 15 mg/kg over 1 hour followed by a continuous infusion of 20-50 mg/kg/day according to creatinine and corrected gestational age (CGA).

ASSESSMENT OF VANCOMYCIN CONCENTRATIONS IN SYRINGES PREPARED WITHIN A WARD SETTING.

Aim: Vancomycin is used as a second line antibiotic in the treatment of late onset neonatal infection for its activity against coagulase negative staphylococci. Vancomycin infusions are prepared within a ward setting for administration to neonates. Differences in preparation techniques on the ward have previously been recognised as a potential source of variation in vancomycin concentrations, as compared to concentrations in pre-made preparations.

GATA1-mutant clones are frequent and often unsuspected in babies with Down syndrome: identification of a population at risk of leukemia.

Transient abnormal myelopoiesis (TAM), a preleukemic disorder unique to neonates with Down syndrome (DS), may transform to childhood acute myeloid leukemia (ML-DS). Acquired GATA1 mutations are present in both TAM and ML-DS. Current definitions of TAM specify neither the percentage of blasts nor the role of GATA1 mutation analysis.

Managing and preventing outbreaks of Gram-negative infections in UK neonatal units.

De novo guidance on the management of Gram-negative bacteria outbreaks in UK neonatal units was developed in 2012 by a Department of Health, England Antimicrobial Resistance and Healthcare Associated Infection working group. The recommendations included activation of an organisational response and establishing a control team when an outbreak is suspected; screening for the specific organism only during an outbreak; undertaking multidisciplinary reviews of cleaning routines, hand hygiene and Gram-negative bacteria transmission risks; considering deep-cleaning; cohorting colonised and infected babies preferably but not necessarily in isolation cubicles; and considering reducing beds or closing a unit to new admissions as a way of improving spacing and staff:patient ratios until the outbreak is under control. The group advised establishing mechanisms to communicate effectively across the network; informing parents of the outbreak as early as possible, and providing prewritten 'infection outbreak' information sheets.

Improving antibiotic prescribing in neonatal units: time to act.

Antibiotics are increasingly prescribed in the peripartum period, for both maternal and fetal indications. Their effective use can be life-saving, however, injudicious use drives antibiotic resistance and contributes to the development of abnormal faecal flora and subsequent immune dysregulation. Neonatal units are a high risk area for the selection and transmission of multi-resistant organisms.

Neonatal infections in England: the NeonIN surveillance network.

Introduction: Neonatal infection is an important cause of morbidity and mortality. Neonatal infection surveillance networks are necessary for defining the epidemiology of infections and monitoring changes over time.

Design: Prospective multicentre surveillance using a web-based database.

Perinatal and neonatal mortality in the advent of the neonatal network.

Infant mortality is highest during the neonatal period. The provision of medical care for low birth weight and premature babies is challenging. Neonatal networks aim to improve outcome, optimize efficiency and increase the quality of care for these infants.

Mosaic trisomy 1q: The longest surviving case.

We present the longest known surviving case of a male infant with a mosaic complete trisomy 1q. Born at 39 weeks of gestation with respiratory distress, his weight was 3,330 g (25th centile); he had micrognathia, a posterior cleft of palate, abnormal ears and left thumb, syndactyly, and an absent corpus callosum. Initial blood karyotype was normal (46,XY).

Response of steroid-treated former preterm infants to a single dose of meningococcal C conjugate vaccine.

Attenuated antibody responses have been reported in preterm infants who received neonatal dexamethasone treatment. The duration of immunosuppression may extend into later infancy. This study assessed the immune response of former preterm infants to a single meningococcal serogroup C conjugate (MCC) immunisation given after infancy.

Estimated early-onset group B streptococcal neonatal disease.

Estimates of incidence of early-onset group B streptococcal (EOGBS) infection are based on blood or cerebrospinal fluid culture-proven cases, which can be falsely negative and hence underestimate the true burden of disease. Probable EOGBS infection can be defined as colonisation by group B streptococci accompanied by features of clinical sepsis. Data collected prospectively in the UK over 1 year for neonates who required a septic screen in the first 72 h of life indicated a combined rate of definite and probable EOGBS infection of 3.