Allocating 1 mL of blood into 2 bottles, aerobic and anaerobic, improved the yield of the culture compared with 1 mL in a single aerobic bottle.

Background Suboptimal fat intake during the early postnatal weeks significantly affects brain growth and maturation. Studies to date have focused on the quantity rather than the quality of fat intake. Objective We hypothesized that early nutrition of premature neonates should also include optimization of the type of fat intake, and thus those receiving SMOFlipid, a balanced multicomponent lipid emulsion, would have improved head growth as measured by head circumference (HC) at discharge. Study Design We retrospectively reviewed HC in infants weighing <1,500 g who were hospitalized for two or more weeks during a 20-month period, in which all preterm infants received fat as Lipofundin, and the following 20-month period, in which all such infants received SMOFlipid.Lipids were dosed up to 3 g/kg/day and reduced as enteral nutrition progressed. Parenteral fish oil (Omegaven) was permitted as rescue therapy during both periods. Results Period 2 infants had better head growth (0.79 [0.69,0.90] vs. 0.75 [0.64,0.86] cm/week; p = 0.0158). More infants reached discharge with an HC of ≥50 percentile (51 vs. 31%; p = 0.0007), and fewer infants had an HC of ≤3 percentile (11 vs. 14%; p = 0.023). Median length of stay was reduced by more than 1 week.A multivariable regression was performed using the weekly increase in HC as the dependent variable, and the time epoch, birth weight, gestational age, hospitalization days, and gender as independent variables. Only the time epoch and days of hospitalization were significant (both p < 0.0001). Conclusion Our data offer preliminary evidence of improved brain growth in those receiving a balanced lipid emulsion as compared with a soybean oil emulsion.

Congenital hyperinsulinism (CHI) is the most common cause of prolonged hypoglycemia in the neonate. It is caused by several genetic mutations that interfere with the cascade of normal insulin secretion from pancreatic beta cells. Octreotide, a somatostatin analog, suppresses insulin secretion from pancreatic beta cells, and is an effective therapy used for both short and long term in the treatment of CHI. It is well tolerated in most patients; however, several adverse effects have been reported, most of them mild and transient. Impaired liver function has been described previously in few children. Here, we describe about a child with CHI treated with continuous intravenous octreotide who developed cholestasis and hepatitis after a short period of treatment. This combination of liver effects with a short duration of treatment has not been reported previously with octreotide use in this population.

Objective Environmental surface sampling in healthcare settings is not routinely recommended. There are several methods for environmental surface sampling, however the yield of these methods is not well defined. The aim of the present study is to compare two methods of environmental surface sampling, to characterize the neonatal intensive care unit (NICU) flora, compare it with rates of infection and colonization and correlate it with the workload. Design and setting First, the yield of the swab and the gauze-pad methods were compared. Then, longitudinal surveillance of environmental surface sampling was performed over 6 months,once weekly, from pre-specified locations in the NICU. Samples were streaked onto selective media and bacterial colonies were identified using matrix-assisted laser desorption-ionization time-of-flight (MALDI-TOF). Results The number of colonies isolated using the gauze pad method was significantly higher compared with the swab method. Overall, 87 bacterial species of 30 different bacterial genera were identified on the NICU environmental surfaces. Of these, 18% species were potential pathogens, and the other represent skin and environmental flora. In 20% of clinical cultures and in 60% of colonization cultures, the pathogen was isolated from the infant’s environment as well. The number of bacteria in environmental cultures was negatively correlated with nurse/patient ratio in the day prior to the culture. Conclusion The gauze pad method for environmental sampling is robust and readily available. The NICU flora is very diverse and is closely related with the infants’ flora, therefore it may serve as a reservoir for potential pathogens.

Aim:The SFR (SpO 2 /FiO 2 ratio) offers a continuous, noninvasive reflection of pulmonary function regardless of whether the baby is ventilated or breathing spontaneously. We hypothesized that significant patent ductus arteriosus (PDA) shunting would impair pulmonary oxygen diffusion, reflected by decreased SFR; and that early PDA related decreases in SFR predict subsequent chronic lung disease (CLD).Methods: We retrospectively examined records from preterm neonates ≤30 weeks gestational age. Ductal shunting was graded for severity by first week echocardiogram. SFR was calculated as SpO 2 /FiO 2 and recorded on Day 7 of life and 36 weeks postmenstrual age (PMA).Results: We studied 104 infants: 65 with closed duct, 17 with hemodynamically insignificant PDA, and 22 with hemodynamically significant (hsPDAs). CLD developed in 9 (14%) of those with closed ducts; 6 (35%) of those with hisPDA; and in 12 (55%) of those with hsPDA (p = 0.005). SFR values at 1 week postnatally were decreased in those with hsPDA and with hisPDA as compared with those with closed ducts ; p = 0.00001). However, at 36 weeks only SFRs of babies with hsPDA remained significantly lower (467 [461−467] vs. 467 [413−471] vs. 369 [262−436] for closed vs. hisPDA vs. hsPDA respectively; p = 0.000148). Using ROC curve analysis, Week 1 SFR was strongly associated with hsPDA (area under curve [AUC] = 0.770; p < 0.0001) and highly predictive (AUC = 0.801; p < 0.0001) of CLD at 36 weeks PMA. Conclusion:Early decreases in SFR reflect both the acute and chronic pulmonary impact of PDA shunting, possibly providing the missing link supporting an association between hemodynamically significant PDA and subsequent CLD.