ALL THINGS NICU

NEW STUDY: CANNULAS WITH LONG NARROW TUBING SIGNIFICANTLY LESS COMMON NASAL TRAUMA

2020-12-04T06:31:00.001-08:00

Cannulas with long, narrow tubing noninferior to short binasal prongs in preterm infants

November 30, 2020

Use of cannulas with long and narrow tubing was noninferior to short binasal prongs and masks for providing nasal intermittent positive pressure ventilation in preterm infants, according to a study published in JAMA Pediatrics.

There was significantly less nasal trauma with use of the cannulas with long and narrow tubing, researchers reported.

“There is concern that this long, thin interface delivers reduced and suboptimal pressure transmission, tidal volume and support compared with short binasal prongs and masks, especially when leak at the nose is more than minimal,” Ori Hochwald, MD,senior physician in the neonatal ICU at Rambam Medical Center in Haifa, Israel, and colleagues wrote. “Despite its widespread use, the clinical efficacy of cannulas with long and narrow tubing was not thoroughly studied.”

The randomized, controlled, unblinded, prospective, noninferiority trial included 166 preterm infants born between 24 and 33 weeks and 6 days’ gestation who presented with respiratory distress syndrome requiring noninvasive ventilatory support as initial treatment after birth or following first extubation. Preterm infants were recruited from two tertiary neonatal ICUs from December 2017 to December 2019.

The primary outcome was intubation requirement within 72 hours after nasal intermittent positive pressure ventilation treatment began. Researchers defined the noninferiority margin as 15% or less absolute difference.

Preterm infants were randomly assigned to use of cannulas with long and narrow tubing (n = 83) or short binasal prongs and masks (n = 83). In the cannula tubing group, mean gestational age was 29.3 weeks and mean birth weight was 1,237 g; in the short binasal prongs and masks group, it was 29.2 weeks and 1,254 g, respectively.

In the cannula tubing group, the primary endpoint was reached in 12 (14%) infants compared with 15 (18%) in the short binasal prongs and masks group (risk difference = –3.6%; 95% CI, –14.8 to 7.6; P = .53).

Moderate to severe nasal trauma caused by ventilation was significantly less common in the cannula tubing group in four infants compared with 17 infants in the short binasal prongs and masks group (P = .01). Researchers observed no differences in other adverse events during hospitalization.

The researchers reported no differences in other adverse events between the two groups.

“Further larger studies are needed to establish the noninferiority and possible advantage of performing initial nasal intermittent positive pressure ventilation with cannulas with long and narrow tubing in the group of infants with lower gestational age and more severe respiratory distress syndrome,” the researchers wrote.

Article found here.

PREOPERATIVE BLOOD TRANSFUSION NOT BENEFICIAL FOR SURGERY IN NEONATES

2020-10-30T07:39:00.002-07:00

PBT independently associated with increased morbidity and mortality in neonates undergoing surgery

WEDNESDAY, Oct. 28, 2020 (HealthDay News) -- For neonates undergoing surgery, preoperative blood transfusions (PBTs) are associated with increased 30-day morbidity and mortality, according to a study published online Oct. 21 in Pediatrics.

Katerina Dukleska, M.D., from the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, and colleagues identified all neonates who underwent surgery using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Participant Use Data Files from 2012 to 2015. Mortality and composite morbidity (defined as any postoperative complication) were compared for neonates who did and those who did not receive a PBT within 48 hours of surgery.

The researchers found that 9.9 percent of the 12,184 neonates identified received a PBT. Compared with those who did not receive a transfusion, neonates who received a PBT had higher rates of preoperative comorbidities and worse postoperative outcomes (composite morbidity: 46.2 versus 16.2 percent). PBTs were independently associated with 30-day morbidity and mortality in a multivariate regression analysis (odds ratios, 1.90 and 1.98, respectively). The associations persisted in a propensity score-matched analysis (odds ratios, 1.53 and 1.58, respectively).

"In some cases, blood transfusions may be doing more harm than good when used before surgery in our most critically ill infants," a coauthor said in a statement. "Giving a transfusion in anticipation of blood loss may seem prudent, but our findings suggest that a 'wait and see' approach to giving infants blood during surgery may reduce surgical complications and the risk of death."

Abstract/Full Text (subscription or payment may be required)

MOST NEWBORNS OF COVID-19-INFECTED MOMS FARE WELL

2020-10-01T16:31:00.001-07:00

Article found here

MONDAY, Sept. 28, 2020 (HealthDay News) -- Babies born to mothers with COVID-19 only rarely suffer from effects of the virus, a new study suggests.

These newborns generally do well in the six to eight weeks after birth, but more are admitted to the neonatal intensive care unit (NICU) if their mothers had COVID-19 in the two weeks before delivery.

Of more than 200 babies studied, complications including preterm birth and NICU admission didn't differ among mothers with and without COVID-19. No pneumonia or lower respiratory infections were reported through 8 weeks of age.

"The babies are doing well, and that's wonderful," said lead author Dr. Valerie Flaherman, an associate professor of pediatrics at the University of California, San Francisco (UCSF).

"When coronavirus first hit, there were so many strange and unfortunate issues tied to it, but there was almost no information on how COVID-19 impacts pregnant women and their newborns. We didn't know what to expect for the babies, so this is good news," Flaherman said in a university news release.

Of 263 infants, 44 were admitted to a NICU, but no pneumonia or lower respiratory tract infections were reported. Among 56 infants assessed for upper respiratory infection, this type of infection was reported in two babies born to COVID-19-positive mothers and one born to a COVID-19-negative mother.

According to senior study author Dr. Stephanie Gaw, "Overall, the initial findings regarding infant health are reassuring, but it's important to note that the majority of these births were from third-trimester infections." Gaw is an assistant professor of obstetrics, gynecology and reproductive sciences at UCSF.

Two infants born to mothers who tested positive in the third trimester had birth defects. One had heart, kidney, lung and vertebral abnormalities. The other had facial, genital, kidney, brain and heart issues.

One mother who tested negative delivered an infant with gastrointestinal, kidney and heart issues, the researchers noted.

The findings were published online Sept. 22 in the journal Clinical Infectious Diseases.

BATHING BABIES MORE THAN ONCE A WEEK NEARLY DOUBLES ECZEMA RISK

2020-06-26T05:25:00.000-07:00

Bathing Babies More Than Once a Week Nearly Doubles Eczema Risk

Ingrid Hein

June 23, 2020

Bathing an infant more than once a week nearly doubles the risk for eczema, and each additional bath increases the risk for skin-barrier dysfunction, according to new research.

"More bathing results in higher transdermal water loss," said investigator Thomas Marrs, PhD, from King's College London.

Maybe we are only meant to bath weekly, he told Medscape Medical News.

Previous studies have looked at bathing frequency in infants with eczema, but this is the first time investigators have looked at bathing in a general population of infants at a time when eczema typically develops, he said.

"Different professionals advise differently. Wash less? Wash more? There's a wide range of difference in awareness of the importance of this," he said. And although this is an observational study, it "tells us there is a relationship between bathing and skin dryness."

Marrs presented results from a recent study on the link between bathing, skin-barrier dysfunction, and eczema at the European Academy of Allergy and Clinical Immunology 2020 Digital Congress.

For their study, he and his colleagues assessed babies from England and Wales who were part of the Enquiring About Tolerance (EAT) study, which evaluated the early introduction of food and allergy development.

Parents completed a questionnaire when their 3-month-old infants were enrolled in EAT, and again at 12 months. They were asked about the use of moisturizer, shampoo, soap, bubble baths, bath oil, and baby wipes, bathing frequency, and their assessment of how dry the baby's skin was.

Infants were assessed at 3 months and 12 months for eczema, using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol, and for transdermal water loss on the left forearm skin.

The risk for eczema at 3 months was significantly higher in babies bathed more than once weekly than in those bathed less often (adjusted odds ratio [aOR], 1.69; P = .03).

Risk for Atopic Dermatitis
Baths per Week	Prevalence of Eczema, %
≤1	14.6
2–4	26.9
5–6	25.2
≥7	23.2

"In the first few months of life, there's a pride in routine, in bath, story, bed," Marrs said. However, "I would caution against a daily bathing routine; once a week is enough for a young baby, particularly if they have risk factors for developing eczema."

But for babies who have eczema, bathing should perhaps be done more frequently to avoid infection. For these infants, "this is more complicated," he explained. "Eczema gets more angry when it is left to be infected. The more staph on the skin, the more inflamed. So it may be important to wash more, but we don't know where the balance lies."

At 3 months, skin-barrier dysfunction — transdermal water loss of at least 15 g/m² per h — was higher in the 317 infants (24.4%) who had eczema than in the 986 who did not (15.7 vs 12.4 g/m² per h; P < .001).

And each additional bath per week was independently associated to skin-barrier dysfunction after adjustment for family history of eczema, inherited filaggrin mutation, and family reporting of dry skin and use of emollients (aOR, 1.21; P < .001).

Skin-barrier dysfunction was seen in 14.6% of those bathed no more than once a week, 26.4% in those bathed two to four times a week, 30.4% of those bathed five or six times a week, and 44.0% of those bathed at least daily.

The association between bathing frequency and eczema was lost at 12 months.

"This is really an observational study showing an association in early life," Marrs said. "We need a more robust study. Bathing wasn't absolutely stable from 3 to 12 months of age."

Food Sensitization and Bathing

Although less bathing improved transdermal water loss and eczema, it did not improve rates of food sensitization. I

n fact, at 12 months, food sensitization scores were better in frequent bathers.

On skin-prick tests, sensitization was reduced in frequent bathers for peanut (≥3 mm; aOR, 0.22; P = .004) and egg (≥3 mm; aOR, 0.43; P = .04), even after correction for the presence of eczema at 3 months.

"What struck me is that while there was a big decrease in skin sensitization, it wasn't there when we looked in the blood. We can't say there's cause and effect without a clinical trial," Marrs said. "These results were a surprise. It may be that the skin acts as a physical barrier, and if it's dry it's more permeable and more allergens can disrupt skin, which makes it more likely to get sensitization."

The strongest known risk factor of atopic dermatitis is a family history of atopic disease.

"We need to look further at this," he added. Although the study was not powered to look at this, it's "a very good thought teaser."

Around the world, eczema is on the rise, said Umit Sahiner, MD, from Hacettepe University in Ankara, Turkey, during his presentation on causes and current treatment approaches for eczema in children.

"The strongest known risk factor of atopic dermatitis is a family history of atopic disease," he said. "If one or both of the parents have it, the risk for the child is five- or sixfold."

In urban settings, ultraviolet exposure, a dry climate, a diet high in sugars, repeat use of antibiotics, and higher education have all been associated with increased risk for eczema, he said. To date, bathing has not been considered as a risk factor.

Marrs and Sahiner have disclosed no relevant financial relationships.

European Academy of Allergy and Clinical Immunology (EAACI) 2020 Digital Congress.

https://www.medscape.com/viewarticle/932836

Long-Term Neurodevelopmental Impacts of Prenatal Opioid Exposure

2020-02-13T08:07:00.000-08:00

Long-Term Neurodevelopmental Impacts of Prenatal Opioid Exposure

Amit Akirov, MD

February 7, 2020

Article published here

Opioid use disorder is on the rise among women of reproductive age, contributing markedly to the opioid epidemic and increasing the incidence of adverse health outcomes in pregnant women and children. It is estimated that up to 14.4% of pregnant women have opioids dispensed during pregnancy. Perinatal exposure to opioids may have significant immune, neural, and behavioral effects that can alter central nervous system (CNS) development, as well as induce long-term changes in brain structure and function, according to a preclinical animal model study published in Brain, Behavior, and Immunity.

In light of the marked increase in the use of prescription opioids among women of childbearing age, there is evidence for a rapid increase in the rates of opioid use disorder during pregnancy and the risk for neonatal opioid withdrawal syndrome. Opioid exposure includes the use and misuse of various opioids, including oxycodone, morphine, codeine, illicit opioids, and medications used to manage opioid use disorders, such as methadone and buprenorphine.

Limited data are available on the direct effects of perinatal opioid exposure on developing neural circuitry and neurodevelopment outcomes. Because opioids rapidly cross the placenta, perinatal opioids can have a direct impact on the CNS.

The researchers completed a literature review to assess the effects of opioids on the developing brain. They used an animal model that included 200 male and female rat pups; 86 saline-exposed and 114 methadone-exposed offspring were used for outcome measures.

Similar to what was previously observed in human neonates after methadone exposure, rat pups of both sexes born to methadone-exposed mothers with methadone exposure in utero, and continuing through the perinatal and neonatal periods, had significantly reduced body weight. Methadone concentration in the urine also increased proportionally to maternal dose.

Methadone was found to induce systemic inflammatory response syndrome that persisted for weeks postnatally, with evidence for increased inflammatory proinflammatory cytokines in peripheral circulation, including a 19-fold (1954%) increase in interleukin (IL)-1β, 36% increase in tumor necrosis factor (TNF)-α, and more than 2-fold (225%) increase in IL-6 at approximately 17 days of methadone exposure. Although at a later time point there was no difference in TNFα, IL-6, and CXCL1, levels of IL-1β remained significantly increased (188%), compared with the saline-exposed pups.

Compared with peripheral bone marrow cells (PMBCs) from saline-exposed pups, PMBCs from methadone-exposed pups hypersecreted proinflammatory cytokines, including TNF-α and IL-1β. These findings support enhanced immune activation and lymphocyte hyperreactivity after methadone exposure. This sustained peripheral immune hyperreactivity was blocked by pretreatment of PMBCs with naloxone.

Perinatal methadone exposure leads to an increase in several cerebral molecular and cellular inflammatory mediators, including a 42% increased cerebral cortical Toll-like receptor 4 (TLR4) mRNA expression and an 87% increased MyD88 mRNA expression in the brains of methadone-exposed pups, compared with saline-exposed rats. Furthermore, there was an increase in cortical IL-1β and cortical CXCL1 among methadone-exposed rats, but brain levels of TNFα and IL-6 were unchanged with methadone exposure. Perinatal methadone exposure was also associated with increased microglial activation.

Regarding structural effects of methadone exposure in the CNS, there was a significant reduction in axonal integrity and myelin expression in methadone-exposed pups compared with saline-exposed pups. Diffusion tensor imaging was used to examine the brain ex vivo, with evidence for decreased fractional anisotropy in methadone-exposed rat offspring compared with saline-exposed pups, an indication for abnormal diffusion in the corpus callosum and external capsule.

After the data pointed to structural and microstructural brain injury, the researchers used a touchscreen operant platform to assess cognition and executive function. Methadone exposure during the perinatal period was associated with widespread associative learning and executive control dysfunction among adult rats. Importantly, these impairments were not secondary to sensorimotor-related problems or lack of motivation, as the data showed normal response reaction times and reward retrieval latencies.

The researchers acknowledged several study limitations, including lack of power to assess for sex differences in outcome measures and limitations secondary to the use of an ELISA kit to perform urinalysis for methadone levels.

“We provide evidence that methadone exposure in the perinatal period leads to a unique immune, neural and behavioral phenotype, associated with a systemic pro-inflammatory signature indicative of widespread brain and immune system injury. This signature reflects a significantly altered cerebral and immune microenvironment concomitant with dysregulated developmental homeostasis in the perinatal period,” concluded the researchers.

Reference

Jantzie LL, Maxwell JR, Newville JC, et al. Prenatal opioid exposure: the next neonatal neuroinflammatory disease[published online ahead of print, 2019 Nov 22]. Brain Behav Immun. doi: 10.1016/j.bbi.2019.11.007

Study into skin collection of blood chemistry from babies aims to replace invasive blood tests

2019-10-03T08:04:00.000-07:00

Scientists at the University of Strathclyde are researching a system to measure and monitor blood chemistry levels in premature and sick babies through their skin, which if successful, could eventually replace the need for invasive blood tests.

When babies are born early or sick there is a medical need to track levels of electrolytes such as glucose, lactate, sodium and potassium in their bodies, as the balance of these can be critical.

The levels are currently measured by heel stick blood tests or blood taken from a vein, which can be distressing and risk depleting the blood at the time when the infants in the neonatal intensive care unit are already vulnerable.

For full article, click here.

STUDY: LIBERAL PLATELET USE IN PRETERM INFANTS AND IVH

2019-04-04T12:21:00.000-07:00

1. For preterm infants with echocardiographically-confirmed patent ductus arteriosus (PDA) within the first 14 days of life, there was no significant difference in the timing of PDA closure between infants who received liberal versus restrictive platelet transfusions.

2. Infants in the liberal transfusion group had significantly higher rates of intraventricular hemorrhage (IVH) of any grade compared to the restrictive group. There was no significant difference between groups for IVH grade III-IV. The cumulative volume of platelet transfusion was a significant risk factor in developing any grade IVH.

Evidence Rating: Level 1 (Excellent)

Liberal platelet transfusion does not expedite patent ductus arterious closure

April 2, 2019 | Matthew Lin, MD and Leah H. Carr, MD

Study Rundown: Prospective data has supported a positive association between thrombocytopenia and PDA. One theory, based on animal studies, is that platelet accumulation within the PDA may lead to thrombus formulation and vascular remodeling, resulting in PDA closure. The purpose of this randomized controlled trial was to evaluate whether maintaining a platelet count of >100 000/uL in thrombocytopenic preterm infants with PDA identified in the first 14 days of life would result in the primary outcome of earlier PDA closure. Preterm infants with PDA were randomized into a “liberal” versus “restrictive” platelet transfusion group. Researchers found no statistically significant difference between groups for time to closure of the PDA. Significant secondary outcomes included higher volume of platelets transfused and higher rates of any grade IVH in the liberal group. However, there was no difference between groups for IVH grades III-IV. Follow-up analyses showed that cumulative volume of platelets received was a significant risk factor for any grade IVH. This study is limited by an inability to account for potential platelet dysfunction, which may explain why groups had similar outcomes. For neonatologists, these data suggest that liberal use of platelets in preterm infants with PDAs in the first 14 days of life will not increase time to closure and may increase risk of any grade of IVH.

Click to read the study, published today in Pediatrics

WIRELESS MONITORING IN THE NICU

2019-03-01T10:27:00.000-08:00

Wireless Monitoring in the NICU

REASSURING DATA ON TRIPLET NEONATAL OUTCOMES

2018-12-07T08:32:00.000-08:00

"Reassuring" Data on Neonatal Outcomes of Triplets

NEW YORK (Reuters Health) - A large retrospective study provides reassuring data on neonatal outcomes of very preterm and very low birth weight triplets.

"Our results identified that, when matched by country of birth, gestational age and sex, the outcomes of preterm triplets were similar to those of singletons, meaning that their risk of mortality and illnesses common to preterm neonates are similar," Dr. Prakesh Shah of Mount Sinai Hospital, part of Sinai Health System, in Toronto, Canada, told Reuters Health by email.

"The literature on this topic of outcome of triplets vs. singletons is marred by small, single-center studies and some showing that the outcomes are worse and some showing they are similar," Dr. Shah explained.

He and his colleagues compared neonatal outcomes of more than 6,000 triplets born between 24 to 32 weeks' gestation or weighing 500 to 1,499 g at birth with that of three times as many singletons from 11 high-income countries.

"This is the largest set of premature triplets studied in the world," Dr. Shah said.

The results showed no difference in the primary outcome (a composite of mortality or severe neonatal morbidity (severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia) between triplets and singletons (23.4% vs. 24.0%).

The odds ratio was 0.91 in a model adjusted for maternal hypertension and birth weight z-score and 1.00 in a model adjusted for these factors plus cesarean birth and antenatal steroid use.

There were also no significant between-group differences in rates of severe neonatal morbidities. The results were also similar for a subsample of 1,648 triplets and 4,944 matched singletons born at 24 to 28 weeks' gestation.

"Our findings from a large cohort of neonates can be used to provide reassuring results for families and care providers that although triplets do incur strain to already resource-limited neonatal units, their outcomes are similar to those of singletons," the authors conclude.

The study had no commercial funding and the authors have declared no relevant conflicts of interest.

SOURCE: https://bit.ly/2R3jJOv

Pediatrics 2018.

METH, OPIOID USE IN PREGNANCY ON RISE

2018-12-07T08:25:00.001-08:00

THURSDAY, Nov. 29, 2018 (HealthDay News) -- Methamphetamine and opioid use has soared among pregnant American women, putting the health of baby and mother at risk, a new study finds.

While addiction among pregnant women has dramatically increased across the country, it disproportionally affects women living in rural America, where access to addiction treatment and prenatal care is limited, the researchers added.

"Use of both substances represents worsening public health crises," said lead researcher Dr. Lindsay Admon, an assistant professor of obstetrics and gynecology at the University of Michigan in Ann Arbor.

Although government efforts to curb methamphetamine use have been effective in the past, its use has spiked once more, she said.

Some data suggests that stopping amphetamine use in pregnancy can improve outcomes, Admon said. "But as clinicians, we need clear guidance on how to best promote cessation among pregnant patients with amphetamine use disorders."

Moreover, doctors need ways to guide patients to treatment services, particularly in rural areas where obstetric and addiction treatment services may be harder to access. In addition, addicted women may not tell their doctors about their drug use for fear of the legal consequences, Admon noted.

Another women's health expert agreed with the findings.

"This study confirms what I have been hearing clinically from providers and patients in the West that there is an unrecognized problem with amphetamines, and that the opioid crisis is now coupled with an amphetamine crisis that desperately needs monetary, treatment and recovery infrastructure support to reduce it," said Hendree Jones, a professor of obstetrics and gynecology at the University of North Carolina in Chapel Hill.

Furthermore, the study provides compelling data that underscores the lack of addiction treatment resources for women of childbearing age, said Jones, who wasn't involved with the research.

For the study, Admon and colleagues collected data on 47 million births in U.S. hospitals over 12 years.

They found that the number of births among women addicted to amphetamine, mostly methamphetamine, doubled from 2008 to 2015, from 1.2 per 1,000 births to 2.4 per 1,000 births.

In addition, opioid use more than quadrupled from 1.5 per 1,000 births between 2004 and 2005 to 6.5 per 1,000 between 2014 and 2015.

Using amphetamine during pregnancy increases the odds of moms dying or having serious medical complications by nearly two times of that of women using opioids, the researchers found.

Also the risk of preterm delivery, preeclampsia or eclampsia, heart failure or heart attack, and the need for a blood transfusion were higher among moms using amphetamine, compared with those using opioids, according to the study.

The main risk to infants born to addicted mothers is neonatal abstinence syndrome. Basically, the infants are born addicted to the drug mom was using and they go through withdrawal, much as an adult does when they stop taking the drug.

Symptoms such as body shakes, tremors, breathing problems, diarrhea or throwing up and fever and sweating can last up to six months, according to the March of Dimes.

Often these babies need to be in neonatal intensive care units for an extended period.

Between 2014 and 2015, amphetamine use caused delivery complications in roughly 1 percent of all births in the rural West (11 per 1,000 deliveries), which was higher than the number of complications among women using opioids in most areas.

Opioid use during pregnancy was highest in rural areas of the Northeast, causing complications in nearly 3 percent of all births (29 per 1,000 deliveries).

Poor, white women on public assistance were the ones most likely to be using amphetamine and opioids, the researchers found.

In addition to using amphetamine and opioids, many of these women are also using marijuana and tobacco, said Dr. Rahul Gupta, chief medical and health officer at the March of Dimes.

"It's very troubling that of all the times in the lifecycle of an individual during pregnancy, women who are using opioids are also using tobacco," he said. "That almost seals the fate of the infant, as well as the health of the mother and the ability of the mother to take care of the child," Gupta said.

The report was published Nov. 29 in the American Journal of Public Health

Full article here

FUNGAL OUTBREAK BLAMED ON REUSABLE THERMOMETERS

2018-10-11T12:31:00.000-07:00

Hospital's Fungal Outbreak Blamed on Reusable Thermometers

Candida auris superbugs found on skin-surface axillary probes

By Salynn Boyles, Contributing WriterOctober 03, 2018
C. auris is an emerging multidrug-resistant fungus that has recently been linked to outbreaks across the globe, often in ICUs. Healthcare facilities in New York City recently suffered a citywide outbreak of the pathogen that is known to survive on hospital surfaces for extended periods. According to the CDC, most C. auris cases in the U.S. have been detected in New York City, New Jersey, and the Chicago area, and are largely traced to strains linked to other parts of the world introduced by patients who recently received healthcare overseas.Eyre and colleagues employed multivariable logistic regression to identify predictors of C. auris colonization and infection following implementation of an intensive patient screening and infection control program.Of the 70 patients identified as being colonized with C. auris during the study period, 66 (94%) had been admitted to the neurosciences ICU before diagnosis.With adjustments for length of stay in the neurosciences ICU and patient vital signs and laboratory results, predictors of C. auriscolonization or infection also included systemic fluconazole exposure (multivariable OR 10.34; 95% CI 1.64-65.18; P=0.01) as well as use of reusable skin-surface axillary temperature probes."C. auris was rarely detected in the general environment. However, it was detected in isolates from reusable equipment, including multiple axillary skin-surface temperature probes," Eyre and colleagues wrote. "Despite a bundle of infection-control interventions (which included enhanced cleaning with chlorine-based products, removal of unnecessary bedside equipment, fans and forced-air convection blankets), the incidence of new cases was reduced only after removal of the temperature probes.”
Full article here.

Early caffeine citrate administration linked to reduced acute kidney injury risk in preterm neonates

2018-04-06T10:57:00.000-07:00

Early caffeine citrate administration linked to reduced acute kidney injury risk in preterm neonates

April 2, 2018

According to a recently published study, caffeine administration in preterm neonates was associated with reduced incidence and severity of acute kidney injury.

Acute kidney injury is common among preterm neonates and is associated with increased morbidity and mortality; however, injury occurred less frequently among neonates who received caffeine administration than those who did not.

Between October 2016 and December 2017, researchers examine data from 675 neonates born between January 1 and March 31, 2014 as part of a retrospective, international multicenter cohort study called AWAKEN. The analysis revealed that 30% of neonates admitted to an intensive care unit developed acute kidney injury and had almost 5 times higher adjusted odds for mortality compared with neonates without acute kidney injury.

According to the investigators, 447 neonates received at least one dose of caffeine during the first 7 days after birth and before AKI. Regarding the 228 neonates considered to have not received caffeine, 199 received no caffeine during the first 7 days after birth, whereas 29 received caffeine only after AKI. Further, 249 of the 675 received their first dose of caffeine on day 1 after birth, and 363 of 675 received their first dose within the first 2 days after birth.

Investigators noted that, while caffeine administration in the first 7 days after birth may correlate with less frequent acute kidney injury in preterm neonates, further studies on dosage, timing of administration, and long-term outcomes are required.

"In this large multicenter, retrospective study, we found that only 4 neonates needed to be treated with caffeine to prevent one-episode acute kidney injury. Surprising to our group, the caffeine-treated neonates were the ‘sicker’ group yet still had a lower rate of AKI. We also saw a reduction of AKI which extended to the very preterm group (including 28- to 32-week neonates), a population that does not routinely receive caffeine,” Jennifer R. Charlton, MD, MSc, University of Virginia, department of pediatrics, division of nephrology, and senior author of the study, told Healio Nephrology. “This study highlights the need for a prospective study to determine if caffeine can prevent AKI and more importantly, if caffeine could have a role in reducing the longer-term burden of chronic kidney disease in this vulnerable population." – by Jake Scott

Disclosure: The authors report no relevant financial disclosures.

Full article here.

https://www.healio.com/nephrology/acute-kidney-injury/news/online/%7B1cec6448-afa6-4781-b6b6-cc1e55d0a11f%7D/early-caffeine-citrate-administration-linked-to-reduced-acute-kidney-injury-risk-in-preterm-neonates

CONTINUOUS GLUCOSE MONITORING HELPFUL IN VERY PRETERM INFANTS

2017-09-22T07:29:00.000-07:00

NEW YORK (Reuters Health) - In very preterm infants, glucose administration guided by continuous glucose monitoring (CGM) and a computer-based algorithm for adjusting glucose infusion is more effective in maintaining normal blood sugar than standard intermittent blood glucose monitoring, a new clinical trial suggests.

CGM-guided glucose titration also cut the risk of hypoglycemia and hyperglycemia and lowered glucose variability, report Dr. Alfonso Galderisi from the University of Padova, in Italy, and colleagues.

“Impaired glucose control in very preterm infants is associated with increased morbidity, mortality and poor neurologic outcomes. To date, there are no effective strategies for effectively and continuously adapting glucose infusion that ensures tight glucose control,” they note in their report, online September 15 in Pediatrics.

Dr. Galderisi and colleagues conducted a randomized controlled trial involving 50 newborns born at or before 32 weeks' gestation or weighing 1,500 grams or less at birth. Within 48 hours after birth, they were randomly allocated either to a treatment group in which glycemic control was achieved by using an unblinded CGM with active alarms, coupled with a computer-guided glucose infusion algorithm (UB-CGM group); or to a control group in which a blinded CGM was used and the glucose-infusion rate was calculated based on standard-of-care blood glucose levels measured with a glucometer (B-CGM group).

Babies in the UB-CGM treatment group spent a greater percentage of time in the euglycemic range than their peers in the control group (median, 84 percent vs. 68 percent, P less than 0.001). Babies managed with CGM-guided glucose titration also had less variability in blood sugar levels than did controls (coefficient of variation, 22.8 percent vs. 27.9 percent, P less than 0.001).

“Previous studies on preterm infants have largely been focused on insulin administration for hyperglycemia management and have not explicitly linked a CGM with a control algorithm to guide adjustments in the insulin infusion rate,” Dr. Galderisi and colleagues note in their paper.

“In contrast, we highlight that linking a CGM to control algorithm guiding glucose titration alone can successfully achieve glucose control in this population without need for insulin. Moreover, it can do so without sacrificing adequate nutrition to sustain growth in very preterm infants, as evidenced by loss of less than 10 percent of birth weight in neonates belonging to the UB-CGM treatment group,” they say.

The ability to rapidly change glucose infusion rates allows for the prevention of both hypoglycemia and hyperglycemia while maintaining glucose intake and weight gain, they add.

The researchers say further studies in larger samples are needed to assess long-term clinical outcomes related to this form of glucose management in very preterm infants.

Continuous glucose monitoring materials for the study were provided by Dexcom Inc. The company had no role in study design, data collection, data analysis, data interpretation, or writing the report. One author reported research support from Dexcom.

SOURCE: http://bit.ly/2wg1teJ

Pediatrics 2017.

EARLY EPO AND NEUROPROTECTION FOR PREEMIES

2017-05-04T07:22:00.000-07:00

Early EPO Offers Neuroprotection for Preemies: Meta-analysis

By Reuters Staff

April 10, 2017

NEW YORK (Reuters Health) - Early prophylactic administration of recombinant human erythropoietin (rhEPO) improves neurodevelopmental outcomes in very preterm babies, a meta-analysis of randomized controlled trials confirms. However, more work is needed to figure out optimal dosing and timing of administration, the authors say in a report online April 7 in Pediatrics. Improving neurodevelopmental outcomes is a “major goal” in neonatology, especially with regard to the increasing survival rate of very premature infants, and rhEPO is one of the most promising agents to accomplish this, they point out.

Dr. Christof Dame and colleagues from the neonatology department at Charite University Medical Center in Berlin did a pooled analysis of four randomized controlled trials that investigated the use of rhEPO in preterm infants (<= 32 weeks' gestational age) and reported neurodevelopmental outcomes at 18 to 24 months' corrected age. The studies were mostly of high methodological quality with a low risk of bias, they say.

Their analysis showed a significant reduction in the incidence of a Mental Developmental Index (MDI) score lower than 70 on the Bayley Scales of Infant Development with prophylactic rhEPO administration. “The beneficial effect of prophylactic rhEPO on the incidence of MDI lower than 70 at 18 to 24 months' corrected age was consistent across all studies. With an absolute risk reduction from 15.7% to 8.4% and a number needed to treat of 14 patients, the estimated effect is clinically relevant. The observed benefits of rhEPO are robust, because they are in agreement with available evidence from longer-term follow-up studies, which also reported improved cognitive outcomes,” the authors say.

Full article may be accessed at link below.

SOURCE: http://bit.ly/2oIBNTR

Pediatrics 2017.

Cite this article: Early EPO Offers Neuroprotection for Preemies: Meta-analysis - Medscape - Apr 07, 2017.

STUDY FINDS PETS REDUCE THE RISK OF DEVELOPING ALLERGIES AND OBESITY

2017-05-04T06:45:00.000-07:00

USA TODAY Published 11:51 a.m. ET April 7, 2017 | Updated 12:38 p.m. ET April 7, 2017

A study at the University of Alberta in Canada found that being exposed to pets early in life may reduce the risk of developing allergies and obesity. Researchers found that babies from families with pets, especially dogs, had higher levels of two types of microbes that are known to lower risks of allergies and obesity.

Families with cats or dogs running around the house may unwittingly be protecting their infant children from future allergies and obesity.

Research out of Canada shows babies born into families with pets have higher amounts of microbes tied to lower risks of obesity and allergies.

University of Alberta epidemiologist Anita Kozyrskyj and a team of researchers analyzed more than 700 Canadian children. They found babies exposed to pets while in the womb or up to three months recorded an "abundance" of ruminococcus and oscillospira, the latter of which is associated with leanness or lower body mass index, notes the study published in the journal Microbiome.

Kozyrskyj said the two types of bacteria increased "twofold" when a pet was in the house. The team said the theory is that early exposure to bacteria — like that from a dog — creates a type of resistance.

Kozyrskyj said unborn babies and newborns often are indirectly exposed, with the microbes passing from pet, to mother to baby. This means a child could get the benefits of the microbes even if the pet were removed from the home before the baby was born.

The findings also suggest pet exposure could cut down the risk of group B strep, which the Centers for Disease Control and Prevention said could cause blood infection, pneumonia and meningitis in newborns. Doctors treat against group B strep by giving mothers antibiotics during the delivery process.

Kozyrrskyj said she wouldn't be surprised if the pharmaceutical industry created a "dog in a pill" to reap the benefits of the microbes.

Article found here.

2017 CDC IMMUNIZATION GUIDELINES

2017-02-09T11:46:00.000-08:00

Easy-to-Read Schedule for Children, Birth through 6 Years

Recommended Vaccinations Indicated for Persons Aged 0 Through 18 Years Based on Medical and Other Indications

ANEMIA DRUG MAY HELP BRAIN DAMAGE IN HYPOXIC INFANTS

2016-05-12T21:35:00.000-07:00

SAN FRANCISCO, May 3 (UPI) -- Brain damage caused by a condition at birth may be preventable, based on a recent study showing a nearly 30-year-old anemia drug helps the brain heal.

The drug erythropoietin, referred to as EPO, prevents damage and helps the brain heal after hypoxic-ischemic encephalopathy, researchers at the University of California San Francisco report in the study, published in the journal Pediatrics.

HIE is a dysfunction of the nervous system causing a drop in oxygen and blood flow to the brain and other organs, causing disabilities such as cerebral palsy or death in about 40 percent of newborns who have it, regardless of treatment.

EPO is a man-made version of erythropoietin, a hormone made in the kidney that tells stem cells in bone marrow to produce red blood cells. The drug was approved by the U.S. Food and Drug Administration in 1989 to treat anemia, but has been shown in studies to promote nervous tissue recovery and development after oxygen deprivation.

The standard treatment for HIE is hypothermia -- cooling the body to 33.5 degrees Celsius, or 92.3 degrees Fahrenheit, to speed healing -- but one-third of newborns in the new study given EPO as well had no injury to their brains after recovery, and just one in the group had a severe or moderate injury.

"We're hopeful that EPO not only reduces the extent of brain injury, but also allows the brain to be more effective at repairing itself during the recovery process," Dr. Yvonne Wu, a child neurologist and professor neurology and pediatrics at the University of California San Francisco, said in a press release. "While research with more participants is needed to determine whether EPO saves lives, we are heartened by the fact that among those infants that survived, the degree of brain injury was generally less severe than in the placebo group."

For the study, researchers treated 50 16.5-hour-old newborns with HIE, giving 26 hypothermia and placebo and 24 hypothermia and five injections of EPO.

At five days old, 33.3 percent of children in the EPO group had no brain injury detected on MRI, compared to 11.5 percent in the placebo group. In the placebo group, 11 children had moderate or severe brain injuries, compared to just one in the EPO group.

At around 12 months old, the researchers also found motor performance and developmental progress was better among children treated with EPO, compared to those only receiving hypothermia.

"It is clear that this therapy is safe as used in this study and there is a strong suggestion that the patients are doing better than would be expected long term," said Dr. Roberta Ballard, a neonatologist and professor of pediatrics at UCSF. "It would be very encouraging if we find that an inexpensive old drug, costing $60 per infusion, rather than a new drug that costs more than $2 billion to develop may prevent untold suffering. A larger trial will allow a definitive answer to whether there should be a change in clinical care for this devastating condition."

STUDY FINDS NO INCREASED RISK OF NEC WITH BLOOD TRANSFUSIONS

2016-03-05T06:23:00.000-08:00

Severe Anemia Linked to Increased Risk of Necrotizing Enterocolitis Among VLBW Infants

by GEN Staff

Severe anemia significantly increases the rate of necrotizing enterocolitis (NEC) in infants with very low-birth-weight (VLBW), new research shows today.

Ravi M. Patel, MD, MSc, and his team of researchers at Emory University School of Medicine, in Atlanta, studied the potential relationship between NEC and VLBW infants who had red blood cell transfusions and severe anemia. They found that severe anemia was a greater risk factor for NEC than for those who did not have severe anemia (adjusted cause-specific hazard ratio, 5.99 [95% CI, 2.00-18.0]; P=.001).

NEC is the leading cause of death among preterm infants, with a mortality rate of at least 50%, according to Medscape. How NEC originates and develops is largely unknown. However, because more than half of VLBW infants receive one or more transfusions during hospitalization, more information is needed on risk factors for the condition, according to Dr. Patel.

The latest study included data from 600 VLBW infants, who were about five days old and weighed less than three pounds. Of those, 44 developed NEC and 32 died. Each infant was followed for 90 days or until they were discharged or transferred from the hospital, or died.

Dr. Patel said that preventing severe anemia may be more important for decreasing the risk of NEC than reducing RBC transfusion exposures.

“Among very low-birth-weight infants, severe anemia but not red blood cell transfusion was associated with an increased risk for necrotizing enterocolitis,” Dr. Patel and his colleagues wrote. “Ongoing clinical trials comparing liberal versus conservative transfusion practices may provide additional experimental data regarding the risks of both severe anemia and RBC transfusion to NEC.”

RSV AND VISITOR/PARENT CLOTHING

2015-08-28T10:11:00.001-07:00

TUESDAY, Aug. 25, 2015 (HealthDay News) -- The clothing of parents and visitors may spread dangerous respiratory infections to infants in an neonatal intensive care unit (NICU), a Australian study suggests.

Four percent of swabs taken from the personal clothing of caregivers and visitors in the NICU at Royal Hospital for Women in Sydney had detectable respiratory syncytial virus (RSV), researchers found. RSV is the leading cause of respiratory-related hospitalizations among premature babies, the researchers said.

The investigators also found RSV on 9 percent of high-touch areas in the NICU, including nurses' computers, chairs next to infants' beds and bed rails. RSV was not detected on the hands of doctors, nurses or visitors in the NICU.

"Though the detection rate is low, personal clothing of caregivers/visitors do get contaminated with RSV," study author Nusrat Homaira, of the University of New South Wales, said in an American Society for Microbiology news release.

Currently, caregivers and visitors aren't required to change their clothes when they enter the neonatal intensive care unit, the researchers said.

"There is a need for further research to evaluate how long the virus remains infectious on personal clothing, which will have policy implications in terms of need for use of separate gowns by the visitors while they are in the NICU," Homaira said.

The study was presented Monday at the International Conference on Emerging and Infectious Diseases, in Atlanta. Studies presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

IMMUNE SYSTEM STAYS DEPLETED UP TO 3 YEARS AFTER MEASLES

2015-05-14T13:05:00.001-07:00

IMPORTANCE OF MEASLES VACCINE TO PREVENT DAMAGING INFECTIONS

FRIDAY, May 8, 2015 (HealthDay News) -- Children who survive a measles infection remain vulnerable to other potentially deadly infections for as long as two or three years after the measles infection, according to research published in the May 8 issue of Science.

Michael Mina, Ph.D., of Princeton University in New Jersey, and colleagues analyzed public health data from before and after mass measles vaccinations began in Denmark, England, Wales, and the United States. They verified that the childhood mortality rate in those countries did indeed fall by about 50 percent following the introduction of the measles vaccine. Further, they found that children in those countries who contracted and survived the measles were more likely to subsequently die from another infectious disease.

Children's immune systems in England and Wales appeared to be weakened for as long as 28 months following a measles infection, during which time they were at increased risk for death from a viral or bacterial disease, the researchers reported. In the United States, the effect lasted about 31 months, and in Denmark, about 26 months.

"These results provide population evidence for a generalized prolonged (roughly two- to three-year) impact of measles infection on subsequent mortality from other infectious diseases," the authors write. The effect appears specific to measles. The research team conducted a similar analysis on pertussis, and found no association between a country's pertussis rate and subsequent childhood deaths due to other infectious diseases.

AUTISM AND PREECLAMPSIA LINK: NEW STUDY

2014-12-11T18:07:00.001-08:00

Dec 9, 2014

Preeclampsia is a condition that appears during pregnancy and is characterized by high blood pressure and protein in the urine. Now, in a new study, researchers have found that children with autism spectrum disorder were more than twice as likely to be born to mothers with preeclampsia during pregnancy, suggesting a link between the two.

The researchers, from the University of California-Davis' MIND Institute, published their results in the journal JAMA Pediatrics. They also found that the likelihood of a diagnosis for autism spectrum disorder (ASD) increased further if the mother experienced more severe disease.

Preeclampsia typically occurs during middle to late pregnancy and up to 6 weeks after delivery, though it can sometimes appear earlier than 20 weeks. Symptoms for the condition include swelling, sudden weight gain, headaches and changes in vision.

In the US, preeclampsia affects 3-5% of pregnant women, but among women who have had it, around 20-40% of their daughters and 11-37% of their sisters will also get the disorder, according to the World Health Organization (WHO).

Preeclampsia accounts for around 40-60% of maternal deaths in developing countries, and it can develop into eclampsia, a life-threatening condition often accompanied by seizures.

According to Cheryl Walker, senior author and researcher from the MIND Institute, preeclampsia can affect the developing brain in several ways. For example, limited nutrients and oxygen can cause oxidative stress, which encourages the release of proteins into the maternal bloodstream in an attempt to improve circulation.

The latest study involved over 1,000 children, between 2 and 3 years old, who were part of the Childhood Risks of Autism from Genetics and the Environment (CHARGE) Study in Northern California.
Though preeclampsia has previously been studied as an autism risk factor, the researchers say previous research has been inconsistent.
However, theirs is a population-based, case-controlled study that investigates not only links between autism and preeclampsia, but also whether autism risk is associated with preeclampsia severity.
In more than 500 male and female children who were diagnosed with autism, 200 were diagnosed with development delay and 350 were developing typically. All of the mothers of these children had confirmed preeclampsia.
Results showed that mothers of children who were diagnosed with autism were over twice as likely to have had preeclampsia during pregnancy.
Furthermore, mothers of autistic children or those with developmental delay were more likely to have had placental insufficiency, severe preeclampsia or both, compared with the mothers of children who developed typically.
Walker and her team also found that children with autism whose mothers had preeclampsia were more likely to have lower cognitive functioning. Additionally, they observed a correlation between preeclampsia and developmental delay without autism. "The level of detail obtained by the CHARGE Study on predictors, confounders and outcomes enabled a comprehensive exploration of this topic. While single studies cannot establish causality, the cumulative evidence supports efforts to reduce preeclampsia and diminish severity, to improve neonatal outcomes."

Slow Feeding Helps Prevent NEC in Smallest Preterm Infants

2014-10-30T18:28:00.001-07:00

NEW YORK (Reuters Health) - 10-27-2014 Standardized slow enteral feeding (SSEF) is associated with a reduced risk of necrotizing enterocolitis (NEC) in infants born weighing less than 750 grams, compared with early enteral feeding, new findings show.

NEC remains a leading cause of mortality and morbidity in extremely preterm infants, although growing use of human breast milk to feed these babies and standardized feeding protocols have helped to reduce the disease's incidence, Dr. Sreekanth Viswanathan of Rainbow Babies and Children's Hospitals at Case Western Reserve University in Cleveland and colleagues note in their report.

Among infants born weighing less than 1,500 grams, the incidence of NEC is 7% to 9%, with a fatality rate of 15% to 30%, the team writes in the Journal of Parenteral and Enteral Nutrition, online October 14.

Some observational studies have shown an increased incidence of NEC in centers where babies are started earlier on enteral feeding and feeding volumes are advanced more rapidly, the researchers add. Dr. Viswanathan and his team hypothesized that introducing feeding more slowly to extremely low birthweight (ELBW) infants might reduce NEC risk.

To investigate, the researchers looked at 125 ELBW infants born at MetroHealth Medical Center in Cleveland who underwent the SSEF protocol, as well as 294 historic controls born at the same hospital who had received early enteral feeding. Babies were fed their mother's breast milk, when available, or formula, but donor breast milk was not used.

Under the SSEF protocol, infants born weighing less than 750 grams had 14 NPO days, followed by seven trophic feeding days; infants weighing 750 to 1,000 grams at birth had seven NPO days followed by seven trophic feeding days. While feeding advancement was 15 to 20 milliliter per kilogram per day in the historic controls, infants in the SSEF group received an additional 0.5 ml per feed every other day (less than 750 g) or every day (750-1,000 g).

Days to full feeds ranged from 16 to 22 for the historic controls, and 44 to 52 days for the babies weighing less than 750 g in the SSEF group and 32 to 36 days for the larger babies.

NEC occurred in 5.6% of the SSEF group and 11.2% of the controls (p=0.10), while 1.6% of SSEF babies and 4.8% of the controls required surgery to treat NEC (p=0.17).

When the researchers looked at babies born weighing less than 750 g, however, differences were significant. The risk of NEC was 2.1% in the smallest SSEF babies, compared to 16.2% for the smallest control infants (p<0.01). The risk of combined NEC and death was 12.8% for the SSEF group weighing less than 750 g, and 29.5% for the controls (p=0.03).

The babies in the study on the SSEF protocol who did develop NEC got sick at 60 days of age, on average, compared to 30 days for the control infants, according to Dr. Viswanathan.

Among the surviving babies, adjusted analysis showed no difference between the SSEF and control groups in discharge weight or length.

Nearly 50 babies weighing less than 750 g have been born at the study hospital over the past five years, Dr. Viswanathan noted in a telephone interview with Reuters Health, and all were treated with the SSEF protocol.

"We had only one case of NEC and that baby survived. No one died and no one required surgery for NEC," he said. "That is the group that I think benefits the most from the slow feeding protocol."

Feeding of VLBW infants varies from hospital to hospital, Dr. Viswanathan said. "There is no consensus on how to feed small babies," he added. "That's why the study is important, because in most of the centers the idea is to start early."

But any protocol is better than none, Dr. Viswanathan said. "One of the most important things if you want to reduce the NEC rate is having a standardized feeding protocol," he said. "If everyone in the unit follows the same protocol that actually itself reduces your NEC rate, but it won't eliminate NEC."

The new findings may not be generalizable to centers that use donor breast milk instead of formula, Dr. Viswanathan said. "What we believe is especially in small babies, when you switch to formula, you need to slow down so they can get adapted, and they tolerate it much better," he added.

CAUSE OF MOST PRETERM BIRTHS FOUND

2014-10-22T08:22:00.001-07:00

British scientists may have found the cause of pre-term premature rupture of fetal membranes (PPROM), which accounts for 40 per cent of pre-term births worldwide, and often leads to the infant's death. The study, which was carried out by researchers from Queen Mary University of London (QMUL) and University College London (UCL), was presented in "Placenta".

The researchers discovered that stretching the amniotic membrane leads to the overproduction of prostaglandin E2 (PGE2), which is damaging to both the cells and the mechanical structure of the tissue. In turn, the protein connexin 43 (Cx43) reacts to this overextension, which reduces the mechanical properties of the membrane even more. According to the researchers, this probably leads to premature rupture and pre-term birth.

Hence, the researchers believe to have found an approach to prevent many pre-term births. "Our findings have provided a new understanding of why pregnant women who have pre-term contractions go on to rupture their membranes early", said co-author Anna David.

COMMON CHILDHOOD VACCINE CUTS CHANCE FOR "SUPERBUG" - STUDY SAYS

2014-10-16T11:44:00.001-07:00

FRIDAY, Oct. 10, 2014 (HealthDay News) -- The childhood pneumococcal vaccine helps children avoid the suffering and danger of ear infections, meningitis and pneumonia. And a new study suggests it may provide an added bonus: cutting down on infections from antibiotic-resistant "superbugs."

First used in children in 2010, the pneumococcal vaccine was linked to a 62 percent reduction between 2009 and 2013 of drug-resistant infections of bacterial pneumonia, meningitis and bloodstream infections for children under 5.

"The vaccine is an important tool against antibiotic resistance," said lead researcher Sara Tomczyk, an epidemic intelligence service officer in the Respiratory Diseases Branch of the U.S. Centers for Disease Control and Prevention.

"Along with appropriate antibiotic use, it is part of the solution to protecting ourselves against the growing threat of antibiotic resistance," she added.

The pneumococcal vaccine is currently recommended for all children age 5 and younger. Pneumococcal bacteria can cause ear infections, pneumonia and meningitis. It is the most common vaccine-preventable bacterial cause of death, the researchers noted.

Antibiotic-resistant strains are especially worrisome because standard drugs do not seem to help fight these bacteria.

But the advent of the pneumococcal vaccine may have lessened the danger. According to Tomczyk, more than 4,400 cases of antibiotic-resistant, invasive pneumococcal disease were prevented between 2010 to 2013.

"Not only does this vaccine prevent pneumococcal infection, which means fewer antibiotics are prescribed, but it also prevents antibiotic-resistant infections," she added.

Tomczyk said the vaccine has been so effective that the U.S. government's Healthy People 2020 goal of reducing bacteria-resistant pneumococcal disease from 9.3 to 6 cases per 100,000 children was achieved nine years early and has since dropped to 3.5 cases per 100,000.

The vaccine is required in three-quarters of states before a child can be admitted to day care, Tomczyk noted, and 85 percent of U.S. children have by now received the recommended four doses.

Pneumococcal conjugate vaccine is given in four doses, at 2, 4 and 6 months of age and at 12 through 15 months.

The results of the study were scheduled to be presented in Philadelphia on Oct. 8 at IDWeek, the annual meeting of a number of groups focused on infectious disease. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Dr. Adriana Cadilla, a pediatrician at Miami Children's Hospital, said, "It's wonderful news that we have proof that the vaccine works as well as it does."

It has clearly reduced antibiotic-resistant pneumococcal disease, she added. "It seems to be doing a great job. It is something parents should make sure their children have."

The vaccine is not just for kids, Tomczyk stressed. One dose is recommended for all adults 65 and older, followed by a dose of the pneumococcal polysaccharide vaccine six to 12 months later.

There are more than 90 types of pneumococcal bacteria, she noted. The pneumococcal conjugate vaccine protects against 13 of the most common severe pneumococcal infections among children, while the pneumococcal polysaccharide vaccine protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease, which is why both are recommended for older adults.

Additionally, one dose of the pneumococcal vaccine is recommended for adults 19 and older who have certain cancers, HIV or kidney failure, followed by doses of polysaccharide vaccine, Tomczyk said.

CMV and Breastfeeding Link

2014-09-25T12:46:00.001-07:00

Breast Milk a Risk for Spreading Common Virus to Preemies, Study Finds

CMV dangerous for low birth weight infants, but mom can be tested before delivery to see if she carries virus

TUESDAY, Sept. 23, 2014 (HealthDay News) -- For babies born at very low birth weights, breast milk is more likely than a blood transfusion to lead to a potentially dangerous infection known as cytomegalovirus (CMV), a new study finds.

The researchers evaluated more than 500 very low birth weight infants -- all of whom weighed 3.3 pounds or less and many who were born to mothers with a history of CMV infection, to see whether breast milk or transfusions carried the bigger risk. Infants born at very low birth weights are especially vulnerable to this viral infection, the study authors noted.

Of 29 babies who developed CMV, none were linked to blood transfusions. But, 27 were linked to breast milk, the study found.

"We didn't know we were going to find so much CMV in breast milk," said study corresponding author Dr. Cassandra Josephson, a professor of pathology and pediatrics at Emory University School of Medicine in Atlanta.

Of the 29 babies who got CMV infections, five developed serious illness and three died. By testing blood, urine and breast milk, the researchers learned that one of the 29 babies developed the infection through the placenta. In another infected baby, the source of infection could not be determined. Infections in the other 27 babies were linked to CMV-positive breast milk.

The study was published Sept. 22 in the journal JAMA Pediatrics.

Just over 300 of the babies in the study needed one or more blood transfusions. A total of more than 2,000 transfusions were given.

Preventive measures were taken before the babies were given blood. The blood was screened for CMV before being given to the infants, and the white blood cells were removed to further reduce the risk of CMV transmission, Josephson explained.

Among all of the mothers in the study, about three-quarters were CMV-positive. CMV is a type of herpes virus. It often has no symptoms, but can lead to infection and serious illness in people with compromised immune systems. CMV can be spread through sexual contact, organ transplants, saliva, urine and respiratory droplets, according to the National Library of Medicine (NLM).

Most people recover in a month or so without medicine, according to the NLM. But, very low birth weight babies can develop serious illness and even die, the researchers noted.

Mothers who know in advance that they may deliver a low birth weight baby can talk to their doctor about preventive measures, Josephson said.

"If they know they are going to deliver early, I would suggest finding out if they are CMV-positive," she said. CMV can be detected through a blood test, according to the NLM.

The study shows that the current standard of care to screen blood is working, said Dr. Deborah Campbell, professor of clinical pediatrics and chief of neonatology at Children's Hospital at Montefiore in New York City.

"It would be helpful for moms to know their CMV status," she said. "Even though CMV can be transmitted to the baby in breast milk, it is still very important for the low birth weight baby if at all possible to receive mother's milk or donor milk."

"Given the benefits of breast-feeding, new strategies to prevent [CMV] are needed, because freezing and thawing breast milk did not completely prevent transmission in the present study," the study authors wrote.

They also noted that the Austrian Society of Pediatrics recommends that premature infants should be fed pasteurized breast milk until they reach 34 weeks of gestational age.