Nosocomial meningitis: The reality in Neonatology Department of Hospital São João
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Abstract UENPS.174 Nosocomial meningitis: The reality in Neonatology Department of Hospital São João Andreia Lopes⁎, Joana Rebelo, Ana Vilan, Gustavo Rocha, Beatriz Guedes, Hercília Guimarães Hospital São João, Porto, Portugal Background and aim Major risk factors for neonatal nosocomial meningitis are premature delivery, low birth weight (LBW), central nervous system (CNS) malformations. The most frequent pathogenic agents are Staphylococcus and Gram-negative bacilli. Mortality rate has declined but neurological disabilities are still prevalent. The authors aimed to study the newborns with nosocomial meningitis admitted to Neonatology Department of Hospital São João, and to evaluate risk factors and outcome. Materials and methods Retrospective chart review of all cases admitted between January 1996 and April 2008 with diagnosis of nosocomial meningitis. Results The authors have analysed 14 cases, which represented about 25% of all cases of neonatal meningitis admitted in the study period (56 cases). Eight (57%) girls and 6 (47%) boys; 9 (64%) preterm and 5 (36%) term newborns were found. Eight (57%) were LBW and 6 (43%) were very low birth weight (VLBW). Most frequent associated pathologies were myelomeningocele (4 cases — 29%) and cardiopathy (2 cases — 14%). The pathogenic agent was isolated in cerebrospinal fluid in 9 cases (64%) and 8 (57%) had positive blood culture. The most frequently used antibiotic association was vancomicin and cefotaxime. The median treatment period was 21 days. Cerebral ultrasound revealed anomalies in 10 cases (71%); the majority (9 cases — 64%) were hydrocephalus. Ventriculo-peritoneal shunt and/or ventriculostomy with external drainage were placed in 6 (43%) cases. Mortality rate was 7% (1 case). Neurological development was normal in 8 cases (57%); 1 (7%) had cerebral palsy and 2 (14%) had lower limb palsy (myelomeningoceles). Conclusions Nosocomial meningitis occurred in newborns with great susceptibility to infections, especially preterms and those with myelomeningocele. Mortality was low (7%) and neurological disabilities occurred especially in newborns with CNS malformations and VLBW preterm. Early diagnosis and treatment are still essential and follow-up is important to early detection of neurological disabilities and prompt intervention. doi:10.1016/j.earlhumdev.2008.09.190 Abstract UENPS.175 Maternal risk factors of infection and intrauterine ureaplasmal infection of the infants Jolanta Uchman⁎ Marta Szymankiewicz, Poznan, Poland Background and aim In the group VLBW and ELBW newborns infections still determine one of the main reasons of mortality. That's why search of infections risk factors and abilities of its elimination are one of the challenges in contemporary perinatal medicine. The aim of the study was to estimate influence of maternal risk factors on intrauterine infections of their infants. Materials and methods 145 delivering women and 155 their infants (50 born at time and 105 preterm ones) were examined. The following risk factors were analysed: maternal age, marital status, social conditions, smoking cigarettes during pregnancy, PROM, mode of delivery and number of pregnancy. Results In the examined population 57 (60%) women delivering preterm had positive ureaplasmal test in the vaginal swabs. This group is dominated with women <21 years (26% vs 7.8% mothers with negative ureaplasmal test) with low education (72% vs 39%), smoking cigarettes (42% vs 24%), and living in poor socioeconomical conditions (44% vs 24%). Marital status and number of pregnancy have no influence on occurring of infection. In the group of women delivering at term 54% were Uu (+). Similar in the population of women with preterm labour which is dominated with mothers smoking cigarettes during pregnancy (33% vs 13%), and living in poor or average social conditions (37% vs 17%). There was no statistically significant difference in maternal age, marital status, number of pregnancy and education level in this group. In all of the women with positive ureaplasmal test the influence of PROM and spontaneous labour on intrauterine infection was confirmed. Conclusions The frequency of Ureaplasma urealyticum positive vaginal swabs in the group of delivering women was assessed at 60%. The risk factors of ureaplasmal fetal infection include PROM, spontaneous delivery, smoking cigarettes during pregnancy, and poor social conditions. Connection of young maternal age and low education level with intrauterine ureaplasmal infection was not proven. Marital status and number of pregnancy have no impact to intrauterine infections of the Ureaplasma urealyticum. doi:10.1016/j.earlhumdev.2008.09.191 Abstract UENPS.176 New directions in diagnostics and treatment of GR(-) abdominal sepsis in newborns Gennadiy Khanes⁎ ,a , Ivan Moroz a , Iryna Maksakova a , Valeriy Romashko a , Yelyzaveta Shunko a , Svitlana Bidnenko b , Olga Lutko b , Larysa Parkhomenko c a National Specialized Pediatric Hospital “OchMatDyt”, Kyiv, Ukraine b Kyiv Research Institute of Traumatology and Orthopedy, Kyiv, Ukraine c Institute of Epidemiology of Academy of Science of Ukraine, Kyiv, Ukraine Background and aim The abdominal sepsis is met in 40–50% of newborns with surgical pathology and despite modern antiinflammation therapy it leads to 60–70% lethality. It gives a reason for new technologies applying into diagnostics and treatment of abdominal sepsis. Materials and methods The Gr(−) infection (Psaevdomonas aerogenes 54%, Enterobacter − 60.8%) as etiologic factor was found in 62 investigations in 52 newborns up to 3 months old. This infection in 62.5% was combined with Staphilococcus epidermidis. The investigations were made by serologic methods. To evaluate the severity of sepsis and adequacy of antibiotics selection as well as microbiologic methods we used determination of procalcitonin level, in particular we determined levels >10 ng/ml with perforation and necrosis of abdominal wall. After suppression of severe sepsis and SIRS the level decreased to <0.5 ng/ml. The important role in diagnostics and evaluation of abdominal sepsis severity is played by immunologic evaluation of child body potential by PCR methods. Results Our investigations showed that Gr(−) microflora separated from abdominal cavity and tracheal fluid is of little sensitivity or insensible to the most of antibiotics. It gave us the reason to use high-purity screening plasma containing antibodies to the bacteria of Pseudomonas and Enter- Abstracts S74
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Transcript of Nosocomial meningitis: The reality in Neonatology Department of Hospital São João
Abstract UENPS.174Nosocomial meningitis: The reality in Neonatology Department ofHospital São João
Andreia Lopes⁎, Joana Rebelo, Ana Vilan, Gustavo Rocha,Beatriz Guedes, Hercília GuimarãesHospital São João, Porto, Portugal
Background and aim
Major risk factors for neonatal nosocomial meningitis are prematuredelivery, low birth weight (LBW), central nervous system (CNS) malformations.The most frequent pathogenic agents are Staphylococcus and Gram-negativebacilli.Mortality rate hasdeclined but neurological disabilities are still prevalent.
The authors aimed to study the newborns with nosocomial meningitisadmitted to Neonatology Department of Hospital São João, and to evaluaterisk factors and outcome.
Materials and methods
Retrospective chart review of all cases admitted between January 1996and April 2008 with diagnosis of nosocomial meningitis.
Results
The authors have analysed 14 cases, which represented about 25% of allcases of neonatal meningitis admitted in the study period (56 cases). Eight(57%) girls and 6 (47%) boys; 9 (64%) preterm and 5 (36%) term newbornswere found. Eight (57%) were LBW and 6 (43%) were very low birth weight(VLBW). Most frequent associated pathologies were myelomeningocele (4cases — 29%) and cardiopathy (2 cases — 14%). The pathogenic agent wasisolated in cerebrospinal fluid in 9 cases (64%) and 8 (57%) had positive bloodculture. The most frequently used antibiotic association was vancomicin andcefotaxime. The median treatment period was 21 days. Cerebral ultrasoundrevealed anomalies in 10 cases (71%); the majority (9 cases — 64%) werehydrocephalus. Ventriculo-peritoneal shunt and/or ventriculostomy withexternal drainage were placed in 6 (43%) cases. Mortality rate was 7% (1case). Neurological development was normal in 8 cases (57%); 1 (7%) hadcerebral palsy and 2 (14%) had lower limb palsy (myelomeningoceles).
Conclusions
Nosocomial meningitis occurred in newborns with great susceptibility toinfections, especially preterms and those with myelomeningocele. Mortalitywas low (7%) and neurological disabilities occurred especially in newbornswith CNS malformations and VLBW preterm. Early diagnosis and treatmentare still essential and follow-up is important to early detection ofneurological disabilities and prompt intervention.
doi:10.1016/j.earlhumdev.2008.09.190
Abstract UENPS.175Maternal risk factors of infection and intrauterine ureaplasmal infectionof the infants
Jolanta Uchman⁎Marta Szymankiewicz, Poznan, Poland
Background and aim
In the group VLBWand ELBW newborns infections still determine one of themain reasons ofmortality. That's why search of infections risk factors and abilitiesof its elimination are one of the challenges in contemporary perinatal medicine.
The aim of the study was to estimate influence of maternal risk factors onintrauterine infections of their infants.
Materials and methods
145 delivering women and 155 their infants (50 born at time and 105preterm ones) were examined. The following risk factors were analysed:
maternal age, marital status, social conditions, smoking cigarettes duringpregnancy, PROM, mode of delivery and number of pregnancy.
Results
In the examined population 57 (60%) women delivering preterm hadpositive ureaplasmal test in the vaginal swabs. This group is dominated withwomen <21 years (26% vs 7.8% mothers with negative ureaplasmal test) withlow education (72% vs 39%), smoking cigarettes (42% vs 24%), and living inpoor socioeconomical conditions (44% vs 24%). Marital status and number ofpregnancy have no influence on occurring of infection.
In the group of women delivering at term 54% were Uu (+). Similar in thepopulation of womenwith preterm labour which is dominated with motherssmoking cigarettes during pregnancy (33% vs 13%), and living in poor oraverage social conditions (37% vs 17%). There was no statistically significantdifference in maternal age, marital status, number of pregnancy andeducation level in this group.
In all of the women with positive ureaplasmal test the influence of PROMand spontaneous labour on intrauterine infection was confirmed.
Conclusions
The frequency of Ureaplasma urealyticum positive vaginal swabs in thegroup of delivering women was assessed at 60%.
The risk factors of ureaplasmal fetal infection include PROM, spontaneousdelivery, smoking cigarettes during pregnancy, and poor social conditions.
Connection of young maternal age and low education level withintrauterine ureaplasmal infection was not proven.
Marital status and number of pregnancy have no impact to intrauterineinfections of the Ureaplasma urealyticum.
doi:10.1016/j.earlhumdev.2008.09.191
Abstract UENPS.176New directions in diagnostics and treatment of GR(−) abdominal sepsisin newborns
Gennadiy Khanes⁎,a, Ivan Moroza, Iryna Maksakovaa, Valeriy Romashkoa,Yelyzaveta Shunkoa, Svitlana Bidnenkob, Olga Lutkob, Larysa ParkhomenkocaNational Specialized Pediatric Hospital “OchMatDyt”, Kyiv, UkrainebKyiv Research Institute of Traumatology and Orthopedy, Kyiv, UkrainecInstitute of Epidemiology of Academy of Science of Ukraine, Kyiv, Ukraine
Background and aim
The abdominal sepsis is met in 40–50% of newborns with surgicalpathology and despite modern antiinflammation therapy it leads to 60–70%lethality. It gives a reason for new technologies applying into diagnostics andtreatment of abdominal sepsis.
Materials and methods
The Gr(−) infection (Psaevdomonas aerogenes 54%, Enterobacter −60.8%) asetiologic factor was found in 62 investigations in 52 newborns up to3 months old. This infection in 62.5% was combined with Staphilococcusepidermidis. The investigations were made by serologic methods. To evaluatethe severity of sepsis and adequacy of antibiotics selection as well asmicrobiologic methods we used determination of procalcitonin level, inparticular we determined levels >10 ng/ml with perforation and necrosis ofabdominal wall. After suppression of severe sepsis and SIRS the leveldecreased to <0.5 ng/ml. The important role in diagnostics and evaluation ofabdominal sepsis severity is played by immunologic evaluation of child bodypotential by PCR methods.
Results
Our investigations showed that Gr(−) microflora separated fromabdominal cavity and tracheal fluid is of little sensitivity or insensible tothe most of antibiotics. It gave us the reason to use high-purity screeningplasma containing antibodies to the bacteria of Pseudomonas and Enter-
AbstractsS74
