Search

Unlabelled: Chronic lung disease (CLD) has been associated with chorioamnionitis and upper respiratory tract colonisation with Ureaplasma urealyticum. The aim of this review is to describe the increasing evidence that inflammation plays a critical role in the early stages of CLD of the neonate. Ongoing lung damage in the premature infant may be caused by failure to downregulate and control this inflammatory response. Tumour necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6) and IL-8 are important pro-inflammatory cytokines of which IL-8 is an important chemotactic factor in the lung. Data suggest that preterm newborns with lung inflammation may be unable to activate the anti-inflammatory cytokine IL-10. Therefore, early post-natal anti-inflammatory therapy could help in preventing development of CLD. Prophylactic dexamethasone therapy cannot yet be recommended. There are a number of potential interactions between surfactant and cytokine effects on the preterm lung which have not been evaluated. Surfactant protein A may be an important modulator of the immune response to lung injury. The role of high-frequency ventilation in the prevention of CLD still remains unclear.Conclusion: Many aspects of the pathogenesis of the inflammatory response in the development of chronic lung disease remain to be elucidated. Further research to identify preterm infants at highest risk for the development of this multifactorial and complex disease is needed. [ABSTRACT FROM AUTHOR]

How obstetricians' opinions regarding universal screening of pregnant woman for group B streptococcus and their attitude regarding chemoprophylaxis vary from the Centres for Disease Control (CDC) guidelines were studied, and the physician characteristics that predict divergent opinions were determined. Five hundred and eighty-two obstetricians in the Flanders region of Belgium were contacted by a postal survey. Ordinal logistic regression was used to assess obstetricians' characteristics that predict divergence.Only 44% agreed with routine prenatal screening for group B streptococcus of whom 72% would screen at 35 weeks. Intrapartum prophylaxis would be done on the basis of risk factors alone in 38%. Multivariate analysis revealed significant provincial differences (best in Antwerp, worst in West-Flanders) and increasing age was associated with decreasing compliance. It is concluded that a minority of the obstetricians believes in routine prenatal screening and one-third would give prophylaxis on the basis of risk factors alone. Obstetrician's age and province of practice predict divergent opinions. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption is prevalent among students, with a common tendency to overestimate peers' alcohol use, contributing to increased consumption. This misperception is evident among Flemish students. This study aimed to develop and assess a Social Norms Approach (SNA) intervention targeting Flemish students to correct misperceptions and subsequently reduce alcohol use., Methods: The 'Alcoholfacts' social media campaign was implemented using a quasi-experimental design from November 2022 to March 2023. A process evaluation followed Medical Research Council guidance, and intervention effects were evaluated using baseline and post-intervention surveys. Multiple linear regression with a Difference-in-Difference approach was performed for outcome assessment, using an intention-to-treat approach., Results: The process evaluation showed that 36.3% of the intervention group had seen the campaign and that most of the exposed students found the campaign credible (73.3%). However, 54.8% of the exposed students did not find the campaign appealing. Results of the outcome assessment indicated that students of the intervention group at endline estimated students' alcohol consumption significantly lower (bootstrapped p = 0.013; B = -1.93, bootstrapped CI = -3.620 to -0.565) compared to students of the control group. However, no significant intervention effect on student's alcohol consumption was found (bootstrapped p = 0.741; B = -0.32, bootstrapped CI = -2.101 to 1.534)., Conclusions: The study supports the efficacy of an SNA campaign in correcting misperceptions but did not yield an immediate reduction in alcohol consumption. Future research should involve the target group in campaign material development to enhance attractiveness and impact., (© 2024. The Author(s).)

Binge drinking among adolescents is common in Belgium, posing a risk of serious health consequences. Until today, only estimations of the prevalence of acute alcohol intoxication (AAI) in adolescents have been made. Research into potential risk factors has not yet been conducted in Belgium. Therefore, this study aims to gain more insight into the prevalence, medical characteristics and potential risk factors of AAI among adolescents. A retrospective multicentre chart study was performed on adolescents aged 10-17 years with AAI in Antwerp, Belgium (2015-2021). Patient's demographics, medical characteristics and information regarding the context of the AAI were collected from medical charts. Over the study period, a total of 1016 patients were admitted with AAI in Antwerp, having a median age of 16.6 years old, a median blood alcohol concentration of 1.95 g/L and combined drug use in 10% of cases. These findings did not significantly change over the study period. Multiple linear regression analysis indicated that after correcting for covariates, higher age, no combined drug use and decreased consciousness at admission were associated with more severe AAI cases (higher blood alcohol concentration). This study shows that AAI is prevalent among Belgian adolescents, and better targeted preventive measures and policies are needed. Our findings could be taken into account when developing preventive measures. However, data addressing the demographics and context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors associated with AAI.

Rationale: Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Lung function and imaging are classically used to assess BPD. Functional respiratory imaging (FRI) combines a structural and functional assessment of the airways and their vasculature. We aimed to assess BPD using FRI and to correlate these findings with the clinical presentation., Methods: We included 37 adolescents with a history of preterm birth (22 BPD cases and 15 preterm controls). The study protocol included a detailed history, lung function testing and computed tomography (CT) (at total lung capacity (TLC) and functional residual capacity (FRC)) with FRI. CT images were also assessed using the Aukland scoring system., Results: BPD patients had lower forced expiratory volume in 1 s to forced vital capacity ratio (p=0.02) and impaired diffusion capacity (p=0.02). Aukland CT scores were not different between the two groups. FRI analysis showed higher lobar volumes in BPD patients at FRC (p<0.01), but not at TLC. Airway resistance was significantly higher in the BPD group, especially in the distal airways. Additionally, FRI showed more air trapping in BPD patients, in contrast to findings on conventional CT images., Conclusion: This study is the first to use FRI in research for BPD. FRI analysis showed higher lobar volumes in BPD patients, indicating air trapping and reduced inspiratory capacity. In contrast to Aukland CT scores, FRI showed more air trapping in the BPD group, suggesting that FRI might be a more sensitive detection method. Importantly, we also showed increased distal airway resistance in BPD patients. By combining structural and functional assessment, FRI may help to better understand the long-term sequelae of BPD., Competing Interests: Conflict of interest: K. Vanhaverbeke has nothing to disclose. Conflict of interest: M. Slaats has nothing to disclose. Conflict of interest: M. Al-Nejar has nothing to disclose. Conflict of interest: N. Everaars has nothing to disclose. Conflict of interest: A. Snoeckx has nothing to disclose. Conflict of interest: M. Spinhoven has nothing to disclose. Conflict of interest: H. El Addouli has nothing to disclose. Conflict of interest: E. Lauwers has nothing to disclose. Conflict of interest: A. Van Eyck has nothing to disclose. Conflict of interest: B.Y. De Winter has nothing to disclose. Conflict of interest: K. Van Hoorenbeeck has nothing to disclose. Conflict of interest: J. De Dooy has nothing to disclose. Conflict of interest: L. Mahieu has nothing to disclose. Conflict of interest: B. Mignot is an employee of Fluidda. Conflict of interest: J. De Backer is an employee/shareholder of Fluidda. Conflict of interest: A. Mulder has nothing to disclose. Conflict of interest: S. Verhulst reports grants from Vitalaire Belgium and Josephine Neiman Foundation, during the conduct of the study., (Copyright ©ERS 2021. For reproduction rights and permissions contact permissions@ersnet.org.)

Objective: There is still no consensus regarding the treatment of empyema in children. Intrapleural combination of tissue plasminogen activator and dornase alfa is a promising treatment for empyema in adults. The aim of this pilot study was to determine whether this combination is safe and successful in pediatric empyema., Methods: Previous well children diagnosed with empyema as classified by the British Thoracic Society. After chest tube insertion, intrapleurally dornase alfa 2.5 mg for 2 days and tissue plasminogen activator 0.15 mg/kg for 3 days was given after which the chest tube was clamped for 4 h. Primary outcome was safety., Results: Ten consecutive children were included (4 boys, aged 3.2 (1.3-15.0) years old). No serious adverse events were seen. One child developed urticaria but additional intervention or cessation of the trial was not needed. There was no bleeding or mortality and no additional procedures were performed. The median hospital stay after intervention was 7.5 days., Conclusions: The intrapleural treatment of dornase alfa and tissue plasminogen activator as treatment of empyema was safe in ten children with empyema. If confirmed in further studies, this combination of intrapleural therapy may improve the management of pediatric empyema.

Prune belly syndrome (PBS) results in a total lack of abdominal musculature. Abdominal muscles have an important function during inspiration and expiration. This puts the patient at risk for respiratory complications since they have a very limited ability to cough up secretions. Patients in an intensive care unit (ICU) with PBS who receive mechanical ventilation are at even greater risk for respiratory complications. We review the function of the abdominal muscles in breathing and delineate why they are important in the ICU. We include an illustrative case of a long-term ventilated patient with PBS and offer respiratory management options., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Respiratory Syncytial Virus (RSV) is a very important viral pathogen in children, immunocompromised and cardiopulmonary diseased patients and the elderly. Most of the published research with RSV was performed on RSV Long and RSV A2, isolated in 1956 and 1961, yet recent RSV isolates differ from these prototype strains. Additionally, these viruses have been serially passaged in cell culture, which may result in adaptations that affect virus-host interactions. We have isolated RSV from mucosal secretions of 12 patients in the winters 2016-2017 and 2017-2018, of which eight RSV-A subtypes and four RSV-B subtypes. Passage 3 of the isolates was assessed for viral replication kinetics and infectious virus production in HEp-2, A549 and BEAS-2B cells, thermal stability at 37 °C, 32 °C and 4 °C, syncytia formation, neutralization by palivizumab and mucin mRNA expression in infected A549 cells. We observed that viruses isolated in one RSV season show differences on the tested assays. Furthermore, comparison with RSV A2 and RSV B1 reveals for some RSV isolates differences in viral replication kinetics, thermal stability and fusion capacity. Major differences are, however, not observed and differences between the recent isolates and reference strains is, overall, similar to the observed variation in between the recent isolates. One clinical isolate (BE/ANT-A11/17) replicated very efficiently in all cell lines, and remarkably, even better than RSV A2 in the HEp-2 cell line.

Aim: Bronchiolitis is one of the most common lower respiratory tract infections in young children, associated with significant morbidity, but limited therapeutic options. Nebulised hypertonic saline (HS) has been a supportive treatment until current guidelines advised against its routine use. Accordingly, the University Hospital of Antwerp recently changed their policies to stop using it, allowing us to evaluate retrospectively if HS influences the duration of respiratory support. Because, to our knowledge, the effect of HS on children with severe bronchiolitis admitted to a paediatric intensive care unit (PICU) has not been studied yet, we aimed to investigate the effect in this specific patient group., Methods: Retrospective study including children up to the age of 2, admitted to the PICU with bronchiolitis from October 2013 until March 2016. The primary end point is the duration of respiratory support, including high flow nasal cannula, continuous positive airway pressure and invasive ventilation., Results: A total of 104 children admitted to the PICU with bronchiolitis were included, with an average age of 3.4 months. In respiratory syncytial virus (RSV) positive patients, the use of nebulised HS was correlated with a decrease in the duration of respiratory support and the length of stay by factors 0.72 (P = 0.01) and 0.81 (P = 0.04), respectively., Conclusions: A significant correlation was found between the use of HS and a decreased duration of respiratory support and admission in the PICU in patients with RSV bronchiolitis. This finding may warrant new prospective studies investigating HS specifically in children with severe bronchiolitis., (© 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Sporadic cases of diphtheria are very rare throughout Europe. A 3-year-old incompletely vaccinated girl was admitted with pharyngotonsillitis caused by diphtheria. On day 9 of her illness, renal and cardiac failure with a third-degree AV-block occurred. Unfortunately, she died within 36 h of admission to intensive care, despite pacemaker placement, the administration of antibiotics and diphtheria antitoxin. The delayed antitoxin administration 7 days after admission to hospital was related to a lack of availability and knowledge of its availability in Europe and this is likely to have contributed to the unfavourable outcome.

BACKGROUND Achromobacter xylosoxidans is an aerobic, motile, Gram-negative, opportunistic pathogen that can be responsible for various severe nosocomial and community-acquired infections. It has been found in immunocompromised patients and patients with several other underlying conditions, but the clinical role of this microorganism in cystic fibrosis is unclear. CASE REPORT We describe a case of septic shock caused by A. xylosoxidans in a 10-year-old child with cystic fibrosis and severe lung disease. CONCLUSIONS As the prevalence of A. xylosoxidans in cystic fibrosis patients is rising and patient-to-patient transmission is highly probable, further studies are warranted to determine its role and to document the appropriate treatment strategy for eradication and long-term treatment of this organism.

Stroke and deep venous thrombosis are rare complications of varicella zoster infection. We report 3 cases of children with a stroke and 1 case of a boy with a deep venous thrombosis after recent chicken pox.

We present a case of a 3-year-old boy with neurodegeneration. Family history reveals Rendu-Osler-Weber disease. Magnetic resonance imaging (MRI) of the spinal cord and spinal angiography showed a spinal arteriovenous fistula with venous aneurysm, causing compression of the lumbar spinal cord. Embolisation of the fistula was executed, resulting in clinical improvement. A week after discharge he was readmitted with neurologic regression. A second MRI scan revealed an intraspinal epidural haematoma and increase in size of the aneurysm with several new arterial feeders leading to it. Coiling of the aneurysm and fistulas was performed. Postoperative, the spinal oedema increased despite corticoids, causing more extensive paraplegia of the lower limbs and a deterioration of his mental state. A laminectomy was performed and the aneurysm was surgically removed. Subsequently, the boy recovered gradually. A new MRI scan after two months showed less oedema and a split, partly affected spinal chord. This case shows the importance of excluding possible arteriovenous malformations in a child presenting with progressive neurodegeneration. In particular when there is a family history for Rendu-Osler-Weber disease, scans should be performed instantly to rule out this possibility. The case also highlights the possibility of good recovery of paraplegia in paediatric Rendu-Osler-Weber patients.

Spontaneous spinal epidural hematomas (SSEH) are a rare cause of spinal cord compression in childhood and especially in infancy. We reviewed the literature and describe a case of an 8-month-old boy with a large spontaneous cervico-thoracic epidural hematoma. With this review we want to detail the importance of early investigation, diagnosis and treatment in infants with SSEH. In our case the infant presented with irritability and crying and an ascending paralysis within four days. Magnetic resonance imaging (MRI) of the spine demonstrated an extensive epidural hematoma between C5 and L1, serious medullar compression and secondary cervical and thoracic medullar edema and hydromyelia. An emergency laminectomy was performed with evacuation of a well organized hematoma. There was a partial recuperation of the neurologic symptoms. Based on the scarce literature which only concerns seven case reports, SSEH is a rare cause of spinal compression in infancy. The presentation is often not specific and neurological symptoms are often lacking in the beginning. However early diagnosis with MRI and prompt neurosurgical intervention are important to improve outcome., (Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)

Blood sampling for laboratory testing is a major cause of iatrogenic blood loss and anemia in neonatal intensive care unit [NICU] patients. The objective of the study was to assess whether the implementation of a multi-parameter Point of Care Test [POCT] (Roche, Cobas b221) analyzer affected blood loss for central laboratory testing and need for red blood cell transfusion in our NICU. This was a retrospective observational cohort study in a NICU with comparison of two serial cohorts of 2 years each. Implementation of a multi-parameter POCT decreased central laboratory performed testing for bilirubin (-32% per patient) and electrolytes (-36% per patient). On average, the net blood volume taken per admitted patient for electrolyte testing decreased with 23.7% and 22.2% for bilirubin testing in the second cohort. After implementation of POCT, fewer very low birth weight infants [VLBWI] required blood transfusion (38.9% vs. 50%, p<.05) as the number of transfusion/infants decreased by 48% (1.57 vs. 2.53, p<0.01). The implementation of POCT was cost-efficient for the Belgian national health insurance, cost reduction -8.3% per neonate. We conclude that implementation of a bedside multi-parameter POCT analyzer decreases transfusions among VLBWI by reducing iatrogenic blood loss for central laboratory testing., (Copyright © 2011. Published by Elsevier B.V.)

Treatment for chronic inflammatory conditions in children should take into account the specific pathophysiological and clinical processes underlying these disorders. These guidelines provide a framework for both the medical and surgical treatment of chronic inflammatory diseases such as otitis media, allergic rhinitis and chronic rhinosinusitis, chronic inflammation of tonsils and adenoids, and laryngitis. In addition, the role of vaccinations and immunomodulatory therapies is discussed. Whenever possible, the evidence levels for specific treatments comply with the Oxford Levels of Evidence.

We investigated the relation between perinatal endotracheal colonization, the associated cytokine response and respiratory outcome in ventilated preterm neonates. Between September 1999 and March 2002, a cohort of 141 neonates with a gestational age <31 weeks requiring ventilation directly after birth, were followed prospectively. All were admitted to the Neonatal Intensive Care Unit, University Hospital of Antwerp, Belgium. A tracheal aspirate (TA) sample was collected soon after birth and was processed for microbiological examination, leukocyte count, and cytokine analysis (interleukins [IL] IL-1beta, IL-6, CXCL8 (formerly called IL-8), IL-10, IL-12p70 and tumor necrosis factor alpha [TNF-alpha]). Together with the prospectively registered patient's comorbidities and severity of disease, these inflammatory parameters were analyzed in a multivariate Cox proportional hazards model with time of extubation and duration of oxygen therapy as main outcome measures. Of the 141 patients included, 31 (22%) died before discharge from the unit and 37 (26%) had a positive TA culture. Independent predictors of duration of mechanical ventilation were: gestational age <28 weeks, degree of respiratory distress syndrome (RDS) at birth, significant patent ductus arteriosus (PDA), the SNAP-score, and high levels of CXCL8 (>4,153 pg/ml) in TA only in neonates with a gestational age <28 weeks. Variables associated with extended duration of oxygen therapy were gestational age <28 weeks, birth weight <1,000 g, degree of RDS at birth, and duration of mechanical ventilation., (2007 Wiley-Liss, Inc.)

The possible association between mediators of inflammation such as cytokines and perinatal colonization of the respiratory tract remains unclear. This prospective cohort study evaluated endotracheal colonization in 141 ventilated preterm infants at birth. The relation with cytokine response in the airways and C-reactive protein (CRP) in umbilical blood was investigated. Of the 141 preterm infants enrolled in this study, 37 (26%) were colonized. In addition to traditional pathogens (61%), commensal species (26%) and Mycoplasmataceae (13%) were isolated. Both the pro-inflammatory cytokines IL-1 beta, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha as well as the antiinflammatory IL-10 are increased in colonized patients in a dose-dependent manner, with the strongest response in neonates colonized with Gram-negative organisms. There was no antimicrobial IL-12p70 response in colonized infants. Commensal flora is associated with the same inflammatory response as traditional pathogens. Although the umbilical cord blood CRP level was significantly higher in neonates with endotracheal colonization, it was highest in those colonized with Gram-negative organisms but still close to normal limits. Microorganisms in the endotracheal fluid of ventilated preterm infants are associated with a pathogen-specific and dose-dependent cytokine response in the airways and systemic CRP response.

Histologic results of the placenta are usually not available within the first days of life. We identified inflammatory variables in tracheal aspirates and blood that were associated with histologic chorioamnionitis (HC). A derivation cohort consisted of 62 neonates and a validation cohort of 57 neonates with a gestational age < 31 wk and ventilated on d 1. Tracheal aspirates were taken on d 1 and on d 3, if the patient was still ventilated. HC was diagnosed by light microscopy. Logistic regression was used to identify independent factors in the derivation cohort associated with HC at d 1, 2, and 3. Model performance was studied using receiver operating characteristic curve analysis. Independent factors associated with HC were, at d 1, tracheal aspirate IL-8 >or= 917 pg/mL (odds ratio, 60.7; 95% confidence interval, 11-328); at d 2, blood C-reactive protein >or= 14 mg/L (odds ratio, 9.2; 95% confidence interval, 2-38), blood white blood cell count >or= 10400/mm3 (odds ratio, 7.4; 95% confidence interval, 2-28); and at d 3, blood neutrophil count >or= 4968/mm3 (odds ratio, 14; 95% confidence interval, 3-57). The association with HC was less at d 3 (area under receiver operating characteristic curve, 0.77) when compared with the d 1 model (area under the curve, 0.88; p = 0.09). The models performed equally well in the validation cohort (goodness-of-fit test, p > 0.05). We conclude that the d 1 and d 2 models can be used as diagnostic factors for HC. Tracheal aspirate IL-8 taken immediately after birth was equally accurate in the diagnosis of HC as systemic inflammatory response at d 2 and better than on d 3.

Objective: To identify risk factors and describe the microbiology of catheter exit-site and hub colonization in neonates., Design: During a period of 2 years, we prospectively investigated 14 risk factors for catheter exit-site and hub colonization in 862 central venous catheters in a cohort of 441 neonates. Cultures of the catheter exit-site and hub were obtained using semiquantitative techniques at time of catheter removal., Setting: A neonatal intensive care unit at a university hospital., Results: Catheter exit-site colonization was found in 7.2% and hub colonization in 5.3%. Coagulase-negative staphylococci were predominant at both sites. Pathogenic flora were found more frequently at the catheter hub (36% vs 14%; P<.05). Through logistic regression, factors associated with exit-site colonization were identified as umbilical insertion (odds ratio [OR], 8.1; 95% confidence interval [CI95], 2.35-27.6; P<.001), subclavian insertion (OR, 54.6; CI95, 12.2-244, P<.001), and colonization of the catheter hub (OR, 8.9; CI, 3.5-22.8; P<.001). Catheter-hub colonization was associated with total parenteral nutrition ([TPN] OR for each day of TPN, 1.056; CI95, 1.029-1.083; P<.001) and catheter exit-site colonization (OR, 6.11; CI95, 2.603-14.34; P<.001). No association was found between colonization at these sites and duration of catheterization and venue of insertion, physician's experience, postnatal age and patient's weight, ventilation, steroids or antibiotics, and catheter repositioning., Conclusion: These data support that colonization of the catheter exit-site is associated with the site of insertion and colonization of the catheter hub with the use of TPN. There is a very strong association between colonization at both catheter sites.

The aim of this study was to identify risk factors for catheter-associated bloodstream infection (CABSI) in neonates. We undertook a prospective investigation of the potential risk factors for CABSI (patient-related, treatment-related and catheter-related) in a neonatal intensive care unit (NICU) using univariate and multivariate techniques. We also investigated the relationship between catheter hub and catheter exit site colonization with CABSI.Thirty-five episodes of CABSI occurred in 862 central catheters over a period of 8028 catheter-days, with a cumulative incidence of 4.1/100 catheters and an incidence density of 4.4/1000 catheter days. Factors independently associated with CABSI were: catheter hub colonization (odds ratio [OR] = 44.1, 95% confidence interval [CI] = 14.5 to 134.4), exit site colonization (OR = 14.4, CI = 4.8 to 42.6), extremely low weight (< 1000 g) at time of catheter insertion (OR = 5.13, CI = 2.1 to 12.5), duration of parenteral nutrition (OR=1.04, CI=1.0 to 1.08) and catheter insertion after first week of life (OR = 2.7, CI = 1.1 to 6.7). In 15 (43%) out of the 35 CABSI episodes the catheter hub was colonized, in nine (26%) cases the catheter exit site was colonized and in three (9%) cases colonization was found at both sites. This prospective cohort study on CABSI in a NICU identified five risk factors of which two can be used for risk-stratified incidence density description (birthweight and time of catheter insertion). It also emphasized the importance of catheter exit site, hub colonization and exposure to parenteral nutrition in the pathogenesis of CABSI., (Copyright 2001 The Hospital Infection Society.)

A prospective cohort study was performed to evaluate the influence of catheter manipulations on catheter associated bloodstream infection (CABSI) in neonates. Neonates admitted between 1 November 1993 and 31 October 1994 at the neonatal intensive care unit of a university hospital were included in the study. Seventeen episodes of CABSI occurred in 357 central catheters over a period of 3470 catheter-days, with a cumulative incidence of 4.7/100 catheters and an incidence density of 4.9/1000 catheter-days. Patient and catheter-related risk factors independently associated with CABSI were: catheter hub colonization (odds ratio [OR] = 32.6, 95% confidence interval [95% CI] = 4.3-249), extremely low weight (

A comparative retrospective cohort study was performed to evaluate the influence of hospital-acquired infection (HAI) in neonates on additional charges and hospital stay. Neonates admitted between October 1993 and discharged alive before December 1995 at the neonatal intensive care unit of a university hospital were studied. Of 515 neonates, 69 (13%) had one or more HAI; 45 (20 with proven HAI, 25 with suspected HAI) were matched to 45 controls. After matching for gestational age, surgery, artificial ventilation and patent ductus arteriosus, central vascular catheter utilization was the only factor significantly associated with HAI. Charges were obtained from hospital discharge abstracts and the duration of hospitalization from patients' files. The mean additional length of hospital stay in neonates with HAI was 24 days (54 days vs. 30 days, P= 0.002) but did not differ significantly in patients with proven or suspected HAI (67 days vs. 51 days, P> 0.05). The mean extra charges for patients with a HAI were 11 750 EURO (9635 pounds). Accommodation accounted for 72%, fees for 22%, pharmaceuticals for 5% and ancillary items for 1% of these extra charges. The mean charges per day were similar for controls [443 EURO (363 pounds)] and HAI patients [453 EURO (372 pounds)]. Overall charges and charges per day were similar for neonates with proven and suspected HAI., (Copyright 2001 The Hospital Infection Society.)

The relationship between air contamination (cfu/m(3)) with fungal spores, especially Aspergillus spp., in three renovation areas of a neonatal intensive care unit (NICU) and colonization and infection rates in a high care area (HC) equipped with high efficiency particulate air (HEPA) filtration and a high pressure system, was evaluated. Data on the type and site of renovation works, outdoor meteorological conditions, patient crowding and nasopharyngeal colonization rate were collected. Factors not associated with Aspergillus spp. concentration were outdoor temperature, air pressure, wind speed, humidity, rainfall, patient density in the NICU, renovation works in the administrative area and in the isolation rooms. Multivariate analysis revealed that renovation works and air concentration of Aspergillus spp. spores in the medium care area (MC) resulted in a significant increase of the concentration in the HC of the NICU. The use of a mobile HEPA air filtration system (MedicCleanAir(R)Forte, Willebroek, Belgium) caused a significant decrease in the Aspergillus spp. concentration. There was no relationship between Aspergillus spp. air concentration and nasopharyngeal colonization in the neonates. Invasive aspergillosis did not occur during the renovation. This study highlights the importance of optimal physical barriers and air filtration to decrease airborne fungal spores in high-risk units during renovation works. The value of patient surveillance and environmental air sampling is questionable since no relationship was found between air contamination and colonization in patients.

Objective: To develop an easy-to-use bedside scoring system, composed of clinical variables, hematologic variables, and risk factors of infection, to predict nosocomial sepsis in neonatal intensive care unit patients., Setting: A neonatal intensive care unit in a university hospital, Antwerp, Belgium., Patients: Over 2 yrs, we analyzed two groups of patients. First, we prospectively studied 104 episodes of presumed nosocomial sepsis in 80 neonates (derivation cohort), and then we retrospectively studied 50 episodes in 39 neonates (validation cohort)., Interventions: None., Measurements and Main Results: We developed two versions of a scoring system to predict nosocomial sepsis in sick neonates. The first scoring system (NOSEP-1 score) was based on 15 clinical, 12 laboratory, and 17 historical variables potentially connected with infection; the second one (NOSEP-2 score) also included the culture results of central vascular catheters. Based on the odds ratios of all independent variables, an additive and weighted score was developed and validated in a cohort of 39 patients screened for nosocomial sepsis in the same center. The NOSEP-1 score consisted of three laboratory variables (C-reactive protein > or =14 mg/L, thrombocytopenia <150 x 10(9)/L, and neutrophil fraction >50%), one clinical factor (fever >38.2 degrees C [100.8 degrees F]), and one risk factor (parenteral nutrition for > or =14 days). The NOSEP-2 score consisted of the same variables plus catheter-hub and catheter insertion site colonization data. Receiver operating characteristic curve analysis demonstrated good predictor performance of the NOSEP-1 score (area under the curve [Az] = 0.82 +/- 0.04 [SEM]) and NOSEP-2 score (Az = 0.84 +/- 0.04, p < .05). We checked whether a complex computer-generated scoring system (CD-1 and CD-2 scores) based on the original numerical values of the items used in NOSEP-1 and NOSEP-2 would improve the prediction of nosocomial sepsis. The analysis showed the accuracy of bedside NOSEP-1 and NOSEP-2 scores to be comparable with the more cumbersome computer-generated CD-1 and CD-2 scores (receiver operating characteristic curve, Az: CD-1 score = 0.81 +/- 0.04, p = .69, and CD-2 score = 0.86 +/- 0.04, p = .96). Finally, in the validation cohort, we showed that the developed scoring system has a good prediction potential for nosocomial sepsis (Hosmer-Lemeshow goodness-of-fit test, chi2 [19] = 16.34, p > .75)., Conclusions: The simple bedside scoring system NOSEP-1 composed of C-reactive protein, neutrophil fraction, thrombocytopenia, fever, and prolonged parenteral nutrition exposure provides a valuable tool for early identification of nosocomial sepsis. Its predictive power can be improved by adding central vascular catheter insertion site and hub colonization to the score.