Search

Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Human milk composition changes according to gestational age and stage of lactation, but infants fed banked human milk often receive pooled milk. We studied the changes in fat content and fatty acid proportions throughout lactation in very preterm, preterm, and full term milk, and the differences among gestational age groups. Methods: Samples from women delivering before 30 (n = 10), between 30 and 37 (n = 10), and between 38 and 42 (n = 23) weeks of gestation were analyzed. Results: Fat content was higher in very preterm than in preterm and full term samples (p < 0.05). Medium-chain saturated fatty acids, alpha-linolenic acid, and rumenic acid proportions increased (p < 0.05) during lactation, while those of most long-chain saturated fatty acids and most long-chain polyunsaturated fatty acids from the n-3 and n-6 families decreased (p < 0.05). In colostrum and transitional milk, medium-chain saturated fatty acid proportions were highest in the very preterm group, and decreased with gestational age (p < 0.05). Conclusions: The differences in fat and fatty acids of human milk obtained at different gestational ages and stages of lactation may impact preterm infants’ health. Therefore they could be taken into account when feeding newborns banked human milk and when designing infant formulas or human milk fortifiers. [ABSTRACT FROM AUTHOR]

Background: A model to predict hospitalization due to respiratory syncytial virus (RSV) of infants born at 33- 35 weeks' gestation was developed using seven risk factors from the Spanish FLIP study 'birth ±10 weeks from the beginning of the RSV season', 'birth weight', 'breast fed <=2 months', 'number of siblings >=2 years', 'number of family members with atopy', 'number of family members with wheezing', and 'gender'. The aim of this study was to validate the model using French data. Methods: The FLIP model [predictive accuracy 71%, receiver operating characteristic (ROC) 0.791] was tested against the French data (77 hospitalized infants with RSV born at 33-35 weeks and 154 age-matched controls) using discriminatory function analysis by applying the FLIP coefficients to the French data and by generating the seven variable model from the French data. Results: Applying the FLIP coefficients to the French dataset, the model correctly classified 69% of cases (ROC 0.627). The predictive power increased to 73% (ROC 0.654) when 'number of siblings >=2 years' was substituted for 'number of children at school'. The number needed to treat (NNT) in order to prevent 70% of hospitalizations was 18. The model derived using French data could correctly classify 62% of cases in the French data (ROC 0.658). Conclusions: The model was successfully validated and may potentially optimize immunoprophylaxis in French infants born at 33-35 week's gestation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of the study was to develop and validate a clinical instrument predicting the risk of respiratory syncytial virus (RSV)-associated hospitalization (RSV-H) in premature infants born at 33 through 35 completed weeks of gestation (33-35GA). DESIGN: An RSV risk scoring tool (RSV-RS) was developed by entering risk factors for RSV-H, determined in a Canadian prospective study, into a multiple logistic regression model. The scoring tool was then validated externally with data from a Spanish case-control study (FLIP). The Canadian cohort comprised 1758 RSV-positive infants born 33-35GA, of whom 66 (3.7%) had confirmed RSV-H. The FLIP data set comprised 186 (33.4%) RSV-H cases and 371 (66.7%) controls. METHOD: The primary outcome measure was RSV-H. The RSV-RS score was the sum of the weighted probabilities for each included risk factor multiplied by 100 and ranged from 0 to 100. Receiver operator characteristic curve analyses determined cutoff points to predict subjects at low, moderate, or high RSV-H risk. RESULTS: The RSV-RS included 7 risk factors and cutoff scores of 0-48, 49-64, and 65- 100 for low-, moderate-, and high-risk subjects, respectively. For the Canadian cohort, RSV-RS sensitivity in predicting RSV-H cases was 68.2%, with 71.9% specificity. With the FLIP data set, the RSV-RS had lower accuracy (61.3% sensitivity; 65.8% specificity) but showed significant positive association with increased risk for RSV-H. CONCLUSION: The RSV-RS accurately identified 33-35GA infants at increased risk for RSV-H in a Canadian cohort. External validation with Spanish case-control study data further confirmed that the scoring tool is appropriate for the estimation of RSV-H risk. [ABSTRACT FROM AUTHOR]