Stool samples were collected from infants nursed in two neonatal intensive care units (NICUs) in East London, United Kingdom. The aim of the study was to determine the incidence of and risk factors for the carriage of multiresistant Enterobacteriaceae strains (MRE; resistant to three or more classes of antibiotic) and the extent of the persistence of resistant strains following discharge. Sixty-two (50%) of 124 infants had acquired MRE by 2 weeks of postnatal age, and 69 (56%) infants had acquired MRE by discharge. The proportions of infants at 2 weeks carrying strains that were resistant to antibiotics were the following: tetracycline, 79%; amoxicillin, 78%; cephalosporins, 31%; trimethoprim, 20%; piperacillin-tazobactam, 11%; chloramphenicol, 9%; and aminoglycoside, 4%. A gestational age of less than 26 weeks was a risk factor for colonization with MRE at discharge, but not at 2 weeks. Analysis within a NICU showed that exposure of an infant to a specific antibiotic in the NICU was not a risk factor for the carriage of a strain resistant to that antibiotic. Estimates of persistence from discharge to 6 months were the following: for tetracycline, 57% ( Gram-negative infection is a major cause of mortality in infants (38). A recent report from the Israeli Neonatal Network (25) estimates that sepsis due to Enterobacter spp., Escherichia spp., and Klebsiella spp. is associated with a 4

Background: Accuracy of neonatal length measurement may be influenced by the reluctance of the measurer to forcefully extend both lower limbs against the normal flexor posture. On the other hand, during the first days after birth the measured length may increase because of the gradual decrease of the intrauterine state of flexion. Objective: To assess potential differences in discomfort during length measurement with one or both lower limbs extended and any variation in measured length within the first two days after birth.Methods: Seventy healthy full-term neonates born at Hospital Dona Estefânia were systematically sampled. Crown-heel length was measured using a 1 mm precision neonatometer, at circa 8 hours and 32 hours after birth, with one and both lower limbs completely extended. The Neonatal Facial Coding System was used to assess discomfort during measurements. Data were analyzed by parametric and nonparametric tests as appropriate.Results: Discomfort scores are significantly higher during length measurement than at baseline, whatever the measurement method. Whenever length measurements are performed, discomfort scores are significantly higher extending two rather than one lower limb (pϽ0.006). Measured length is higher with one lower limb extended, the difference decreases in time: at circa 32 hours of age 0.19 cm (95% CI: 0.1-0.3; pϭ0.000). No significant differences on length were found between measurements at circa 8 or 32 hours after birth, for both one and two lower limbs extended. The best correlation between measurements with one or two extended lower limbs was observed at circa 32 hours after birth (rϭ0.98). Conclusion:The best balance between the comfort of the neonate and the accuracy of crown-heel length measurement is achieved at circa 32 hours after birth extending one lower limb. OSMOLALITY OF PRETERM FORMULAS SUPPLEMENTED WITH GLUCOSE POLY-MERS AND MEDIUM CHAIN TRIGLYCERIDES PortugalBackground: Addition of energy supplements to preterm formulas is a possible strategy to increase the enteral energy intake, without exceeding the protein intake or the potential renal solute load, in infants submitted to fluid restriction, such as in bronchopulmonary dysplasia. This manipulation of standard formulas may lead to undesirable increase in osmolality of feedings, 400 mOsm/kg is the maximum recommended limit. Objective: To measure the osmolality of some commercialized preterm formulas supplemented with glucose polymers (PG) and medium chain triglycerides (MCT).Methods: Osmolality was measured by freezing point depression. Powdered formulas Aptamil Prematil® (NumicoMilupa), Enfamil Premature® (Mead-Johnson), Nenatal® (Numico-Nutricia) Nutribén Bajo Peso® (Alter) and Pre Nan® (Nestlé), at concentrations of 14g/100ml (14%) and 16g/100ml (16%), and the liquid formula Humana 0® (Humana) were analyzed. All powdered formulas at both mentioned concentrations, and the liquid formula, were supplemented with 10% (low supplementation -LS) and 20% (high supplementation -HS) of calories, respectively, as PG (Mod...

In this study we collected prostatectomy specimens from 20 men receiving selected preoperative antimicrobials: oral carbenicillin, norfloxacin, or ciprofloxacin. The prostatectomy specimens were then individually separated into stroma and epithelium. The intraprostatic differential concentrations were determined using High Performance Liquid Chromatography. The ratio of stromal to epithelial concentrations of the antimicrobials were calculated for carbenicillin (0.95), norfloxacin (1.28), and ciprofloxacin (1.1). The quinolones tended to have higher stromal concentrations (although this was not statistically significant). Carbenicillin was found in levels three times its MIC90 for Escherichia coli while the quinolones were detected in concentrations which greatly exceeded their E. coli MIC90S.

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Challenging conversations occur frequently within neonatology The aim of the study was to design a communication skill simulation course for neonatal trainees.We collected feedback from 10 neonatal trainees and 15 consultants regionally. 53% of consultants and no trainees had received formal communication skills training. Lack of confidence was the highest discussing end of life, post-mortem consent, breaking bad news and conflict resolution. Further feedback from 21 parents and 45 staff locally highlighted lack of privacy, sensitivity, clarity, consistency and empathy as areas to develop. We first trialled a virtual simulation workshop on antenatal counselling during the COVID-19 pandemic. A pre-recorded scenario was played and debriefed live. Two candidates then took part in a scenario, in break-out rooms, followed by a smaller group debrief. A face-to-face course was then developed. The day, designed for eight candidates, began with an introduction session focussed on psychological safety followed by ‘trauma-informed communication’ by a clinical psychologist. The candidates were then split into two groups for scenarios. Each had the opportunity to lead a scenario. Faculty utilized role play with a standardized faculty ‘parent’ and block simulation with an actor. The Diamond Model was used for debrief. A workshop on ‘post-mortem consent’ and a talk from a parent about their neonatal journey were also included.Ten trainees attended the virtual workshop. Nine strongly agreed that the pre-recorded and 10 that the live sessions were useful. All strongly agreed/agreed that the virtual learning environment worked well, was safe and comfortable, the debriefs were structured and educational, and that attendees’ confidence in antenatal counselling had improved. Seven candidates attended the face-to-face course. All strongly agreed/agreed that the sessions were relevant to their practice and skills learnt were transferrable. Self-rated confidence improved in all communication themes. All candidates strongly agreed that the learning environment was safe and supportive. Candidates found both methods of simulation valuable, four preferred block simulation. All would recommend the course to their colleagues. We addressed a training gap by developing this course. Despite using different styles of teaching and adapting to virtual training during the COVID-19 pandemic, feedback was consistently positive suggesting that flexibility enhances learning. A similar course could be developed in other regions to continue to strengthen communication skills training.