Background Acinetobacter baumannii is an emerging pathogen capable of causing hospital-acquired infections (HAIs). It has the ability to survive on environmental surfaces for months, making transmission difficult to control. Our report describes the investigation and restriction of an outbreak of A.baumannii in the Neonatal Intensive Care Unit (NICU) using whole-genome sequencing (WGS) and multi-modal infection control measures. Methods A prospective surveillance of HAIs was initiated in the NICU at the Pauls Stradins Clinical University Hospital (PSCUH) in Latvia on 1/9/2012 and identified an outbreak of A.baumannii . Case definitions for A.baumannii bloodstream infection (BSI) and colonization were implemented; surveillance cultures were obtained from all admitted patients to monitor the rate of colonization; an infection prevention and control team was formed and infection control interventions implemented. Environmental sampling of the NICU and Labour ward was performed. We employed WGS to differentiate phenotypically identical multidrug-resistant A.baumannii (MDRAB) strains from simultaneous intrahospital outbreaks in the adult Intensive Care Unit and NICU. Results Between 1/9/2012 and 31/12/2017 the surveillance included 2157 neonates. A total of 17 neonates had A.baumannii BSI, with the highest rate of 30.0 cases per 1000 bed-days in November 2012. Rectal screening samples were positive for A.baumannii-complex in 182 neonates reaching 119.6 per 1000 bed-days in July 2015. All 298 environmental cultures were negative. Two phenotypically identical MDRAB isolates from the simultaneous intrahospital outbreaks were differentiated using WGS, ruling out an inter-ward transmission. Adherence to stringent infection control measures decreased BSI cases but colonization remained persistent. With several relapses, the outbreak was ongoing for four years. No new A.baumannii BSI cases were registered after total environmental decontamination in the NICU in July 2015. Colonization reappeared and persisted until in November 2016 when the ward was temporarily closed, relocated and renovated. No A.baumannii cases were registered after the renovation. Conclusion The HAI surveillance system successfully detected and facilitated the control of the A.baumannii outbreak. Whole-genome sequencing was found to be a useful method for differentiation of phenotypically identical A.baumannii strains from the intrahospital outbreak. Only multi-modal infection control program, including closure, temporary relocation, and renovation of the ward, restricted the outbreak.
BackgroundBody weight, length and head and thoracic circumference are routinely measured in obstetric and neonatal departments. Reference values for these measurements have been established for the neonatal population. Neonatal abdominal circumference is not routinely measured, and no reference values for this measurement have been determined. To evaluate the increase in abdominal circumference in newborns with abdominal pathology such as necrotizing enterocolitis, information about normal abdominal circumference in healthy neonates shortly after birth is needed. The aim of this study was to determine the correlation between abdominal circumference and birth weight by measuring the abdominal circumference of premature neonates soon after birth.MethodsAbdominal circumference was measured within 30 min of birth in 220 neonates born between 23 and 35 weeks’ gestation.ResultsThere was no statistically significant difference in abdominal circumference between boys and girls in the study population. A specific formula for estimating normal abdominal circumference was developed: y = 0.0053x + 14.83 (y = abdominal circumference in cm; x = body weight in g; 0.0053 = regression coefficient; 14.83 = regression constant).ConclusionA positive linear correlation between abdominal circumference and birth weight was found in infants at birth. The correlation can be summarized as a linear regression equation. Further studies are needed to investigate possible factors associated with abdominal circumference in fed versus unfed preterm infants.
47Summary Introduction. Neonatal anthropometric measurements, including body weight, length, head circumference and abdominal circumference are routine procedures in obstetric and neonatal departments. Standard values for neonatal population are established for body weight, length, head and thoracic circumference, however there are no reference values for neonatal abdominal circumference, futhermore, this measurement currently is not a routine procedure in every obstetric and neonatal unit. In order to evaluate the increase of abdominal circumference in newborns with a disease of organs of abdominal cavity including necrotizing enterocolitis (NEC), the abdominal girth of newborns soon after birth without pathology in the abdominal cavity should be ascertained. Thereby, the average value of the abdominal circumference of newborns in Latvia could be obtained. Aim of the Study. The aim of our study is to measure the abdominal circumference in premature and term-born neonates soon after birth and to define the correlation between abdominal circuit and birth weight. Materials and Methods. The measurement of waist girth was carried out in 460 neonates within 30 minutes after birth. Newborns were divided into 4 groups according to birth weight: extremely low birth weight (ELBW) -under 1000 g, very low birth weight (VLBW) -1001 g -1500 g, low birth weight (LBW) -1501 g -2500 g and term neonates with 2501 g -4590 g birth weight. The abdominal circumference was measured in 2 obstetric units in accordance with the previously established measurement methods.Results. There was no statistical difference between abdominal circumference in boys and girls in ELBW, VLBW and LBW groups (p>0.05). Mean abdominal circumference in ELBW group was 18,70 cm (SD=0,84) in boys and 18,67 cm (SD=1,40) in girls, VLBW group was 22,20 cm (SD=1,42) and 21,94 cm (SD=1,29) in boys and girls, respectively. Mean abdominal circumference in LBW group was 24.47 cm (SD=2.36) in boys, and 24.92 cm (SD=2.23) in girls. Independent Samples Test: Mean abdominal circumference was statistically different in boys and girls in 2500g -4590g birth weight group with median value 30.56 cm in boys, and 33.23 cm in girls (p<0,05). Mean value in girls was 3.33 cm higher than in boys. Dependent Variable linear regression: Specific formula for estimation of normal abdominal circumference was developed as a result of this study: y=0.0044x+16.38 (y -abdominal circumference, cm; x -body weight, grams; 0.0044 -regression coefficient; 16.38 -regression constant). Conclusions. The difference of mean abdominal circumference was not statistically significant in boys and girls in ELBW, VLBW and LBW groups, however, the difference was significant in the term-born neonates group. As a result of this study reference values and specific formula were established, which allows determination of normal abdominal circumference in neonates depending on birth weight.
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