Volume 2 Issue 2

Research Article: Evaluation and Management of Infants Transferred from Newborn Nursery to NICU to Rule out Neonatal Sepsis

Tarik Zahouani*, Cihangir Buyukgoz, Samantha Arevalo, Arkar Y. Hlaing, Hoda Karbalivand, Juan G. Hernandez, Benamanahalli Rajegowda

Background: Neonatal sepsis is one of the major causes of morbidity and mortality in neonates. Management of infants with risk factors remains controversial for pediatricians and neonatologists. The objective of this study is to evaluate infants who were initially admitted to the Well-Baby Nursery (WBN) and subsequently transferred to the Neonatal Intensive Care Unit (NICU) for further evaluation and management of neonatal sepsis.
Methods: A retrospective data review was conducted from January 2005 to December 2014. Collected data included maternal risk for infection, fetal medical issues, delivery characteristics, gestational age, birth parameters, clinical condition of the infant, initial complete blood count, blood culture, the reason for transfer to NICU and the outcome.
Results: A total of 97 infants were transferred from WBN to NICU to rule out neonatal sepsis. All infants received antibiotic therapy with ampicillin and gentamycin until cultures were negative. The average length of stay in the NICU was 5.3 days and it ranged between 1 and 25 days. Of those 97 infants, 6 were treated for culture-positive sepsis. Identified organisms were three group B streptococcus, one Staphylococcus aureus, one with Escherichia coli and one with Streptococcus mitis.
Conclusion: Neonatal sepsis is an important cause of morbidity for neonates and remains a clinical challenge especially for asymptomatic infants. Observing these babies is crucial and any symptoms or abnormal laboratory result will prompt transfer to NICU. On the other hand, keeping the infant who are asymptomatic in the WBN will facilitate mother-infant bonding, increase breastfeeding rates while decreasing antibiotic exposure at this early age. Consequently, high index of suspicion has a great significance when evaluating these infants at risk.

Cite this Article: Zahouani T, Buyukgoz C, Arevalo S, Hlaing AY, Karbalivand H, et al. Evaluation and Management of Infants Transferred from Newborn Nursery to NICU to Rule out Neonatal Sepsis. Open J Pediatr Neonatal Care. 2017;2(2): 051-054.

Published: 15 September 2017

Case Report: Congenital Candidiasis: A Rare and Detrimental Disease

Wai Quen Lee*, Lip Yuen Teng, Pauline Poh Ling Choo and Kah Kee Tan

Congenital Candidiasis is extremely rare, with clinical manifestations ranging from localized skin disease to systemic involvement. Firm recommendations for the management of congenital Candidiasis are difficult to be made due to rarity of the disease. We are reporting a preterm infant who was diagnosed with invasive congenital Candidiasis with no mucocutaneous involvement but rapid clinical deterioration, resulting in early neonatal death. A baby girl, the first twin of a monochorionic diamniotic pregnancy with a gestation of 29 weeks and 5 days, was born not vigorous and intubated at birth. The child had hepatomegaly and pancytopenia from birth. At 15 hours of life, she was transfused with packed cells as haemoglobin was only 7.4 g/dl. She further deteriorated at 21 hours of life, with frequent desaturation and poor perfusion that required high ventilator settings and multiple crystalloid boluses. She developed coagulopathy, hemodynamic instability and succumbed at 32 hours of life. The baby's blood culture taken at 27 hours of life, peripheral and intracardiac post-mortem samples all showed pure growth of albicans. Mother's vaginal swab also showed pure growth of albicans but never treated with topical or systemic anti-fungal therapy. One of the most striking features of this infant is the rapid deterioration and pancytopenia from birth. Retrospectively, this made us consider whether systemic anti-fungal should have been started at birth.

Cite this Article: Lee WQ, Teng LY, Pauline Choo PL, Tan KK. Congenital Candidiasis: A Rare and Detrimental Disease. Open J Pediatr Neonatal Care. 2017;2(2): 046-050.

Published: 05 September 2017

Review Article: Extubation in Kangaroo Mother Care. Clinical Trial

Eva Fuentetaja-DeLaFlor*, Carmen Pena-Peloche, Juliana Acuna-Muga, Beatriz Bellon-Vaquerizo, Carmen Maillo-Canadas, Maria Lopez-Maestro, Carmen R. Pallas-Alonso

Rationale: The prognosis for premature children is associated, in part, with a successful early extubation. Furthermore, it is know that the Kangaroo Mother Method (KME) decreases the stress of the children.
Objective: To test the feasibility and safety of kangaroo extubation versus the conventional incubator extubation method.>br> Material and Methods: Pilot clinical trial. Newborns = 1500 grams and/or = 32 weeks of gestation who required mechanical ventilation during the first 7 days of life and their first extubation was in the first 6 weeks of age were included. The children were randomized to the kangaroo extubation group (KME) or Incubator Extubation (IE). Data was collected on Oxygen Saturation (SatO2), Heart Rate (HR) and Fraction of Inspired Oxygen (FiO2) as well as the need for reintubation.
Results: The study protocol ended with 5 children in the KME group and 5 in the IE group. After 10 minutes, the HR in the KME group was 143 (± ± 35) bpm and in the IE group it was 153 (± ± 8) bpm (p = 0.6), SatO2 was 94% (± ± 2) in the KME group and 94% (± ± 6) in the IE group (p = 0.8), and FiO2 was 0.48 (± ± 0.25) and 0.36 (± ± 0.14) (p = 0.037). There was no need for reintubation in either of the two groups.
Conclusions: With this small study it is shown that kangaroo extubation is feasible and it provides us with information for the design of a study with a larger number of cases.
Keywords: Newborn; Kangaroo; Extubation; Parental involvement

Cite this Article: Fuentetaja-DeLaFlor E, Pena-Peloche C, Acuna-Muga J, Bellon-Vaquerizo B, Maillo-Canadas C, et al. Extubation in Kangaroo Mother Care. Clinical Trial. Open J Pediatr Neonatal Care. 2017;2(2): 042-045.

Published: 31 August 2017

Case Report: Stress Fracture of The Lamina: A Diagnosis of Suspicion

Jorge Lopez-Subias*, Jorge Gil-Albarova, Marina Lillo-Adan, Victoria-Eugenia Gomez Palicio

Lumbar laminolysis, a stress fracture of the lamina, is one of the causes of chronic low back pain in adolescents. Its prevalence is very low, and it is described as an incidental finding in most cases. The authors report the case of a 14-year-old girl with a symptomatic stress fracture of the left lamina of the fifth lumbar vertebra. Recent advances in diagnostic tools and techniques enable early diagnosis. Multimodal radiological examinations of the whole lumbar spine are recommended in cases of symptomatic patients with low back pain who do not respond to initial treatment with basic physiotherapy or analgesic medical treatment. Knowledge of laminolysis in adolescent patients with low back pain is necessary to prevent it from being overlooked or late diagnosis. In almost all cases, conservative treatment may be sufficient to achieve bone healing.
Keywords: Retroishmic cleft; Laminolysis; Stress fracture.

Cite this Article: Lopez-Subias J, Gil-Albarova J, Lillo-Adan M, Gomez Palicio VE. Stress Fracture of The Lamina: A Diagnosis of Suspicion. Open J Pediatr Neonatal Care. 2017;2(2): 038-041.

Published: 29 August 2017

Research Article: Which Airway and Vascular Access Procedures Should New Neonatal Resuscitation Program Trainees be taught?

Bobbi J Byrne*, Reisha S Patel, Cynthia S Johnson and Elizabeth A Wetzel

Background and Objectives: Endotracheal intubation and umbilical venous catheter (UVC) placement are currently the preferred methods for obtaining an advanced airway and emergent vascular access in neonatal resuscitation. Laryngeal Mask Airway (LMA) and Intraosseous Needle (IO) insertion may be less complicated for inexperienced providers. We compared time to placement for Endotracheal Tube (ETT) and UVC versus LMA and IO in a high-fidelity simulated neonatal resuscitation environment.
Methods: Twenty-seven fourth-year medical students viewed a video on four skills (ETT, LMA, IO, UVC) and completed a brief guided practice of each skill on a low-fidelity mannequin immediately before being randomized to an ETT/UVC or LMA/IO intervention in a standardized, simulated delivery room scenario. Time to placement, success in placement, the number of attempts, and critical errors were documented. Participants' prior experience and confidence with each skill were surveyed afterward.
Results: The median procedure time for the LMA/IO intervention was 106 seconds shorter than ETT/UVC (p = 0.009). Success rates were higher for LMA and IO compared to ETT and UVC, although they did not reach statistical significance. Median time to place an LMA successfully was 108 seconds shorter than ETT (p < 0.001).
Conclusions: In this pilot study, LMA/IO placement was significantly faster thanETT/UVC placement, primarily due to the speed of LMA insertion. Inexperienced providers could benefit from utilizing LMA and IO in neonates requiring emergent airway and vascular access.

Cite this Article: Byrne BJ, Patel RS, Johnson CS, Wetzel EA. Which Airway and Vascular Access Procedures Should New Neonatal Resuscitation Program Trainees be taught? Open J Pediatr Neonatal Care. 2017;2(2): 031-037.

Published: 01 June 2017

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