Neonatal infections with coagulase negative staphylococci

Article Abstract:

The problem of neonatal infection by coagulase-negative staphylococci is discussed. Nineteen distinct species of the bacterial genus Staphylococcus have been identified, and the coagulase test is used to aid in identification of certain species. This test evaluates the ability of organisms to coagulate plasma (the liquid component of blood) under certain conditions; staphylococcal species that do not coagulate plasma are called ''coagulase-negative staphylococci.'' They are often isolated from blood cultures in neonates and are typically acquired in the hospital, where the most common species in neonatal infections is S. epidermis. Spread easily from infant to infant on the hands of medical and nursing staff, the organisms resist a range of antibiotics. They also colonize the neonatal bowel. Coagulase-negative staphylococci secrete an ''extracellular slime substance,'' which may help the organism adhere to the immature skin of premature babies. This substance is thought to counteract some of the body's immune functions, such as the actions of B and T cells (white blood cells that mediate immunity). The organisms do not appear to cross intact skin, but can enter the body through catheters inserted into blood vessels, the most common route of infection in neonates. Coagulase-negative staphylococci also cause wound and urinary tract infections. No specific symptoms are associated with infection by these agents: infants become lethargic, breathe faster, and may lose muscle tone. Mortality is generally low, but, if untreated, the disease spreads. Effective antibiotic therapy is discussed, a particular problem since so many isolates are antibiotic-resistant. Prevention relies on changing intravascular catheters frequently, avoiding contamination, and improving the management of catheters. (Consumer Summary produced by Reliance Medical Information, Inc.)

Disease transmission, Staphylococcal infections

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Quantitative changes in faecal microflora preceding necrotising enterocolitis in premature neonates

Article Abstract:

Necrotizing enterocolitis in neonates is a serious disorder of the gastrointestinal tract that is particularly common in very-low-birth-weight infants, with an incidence as high as a 13 percent. Although the cause has not been identified, the fact that cases tend to cluster geographically and around the same time suggests a transmissible agent. To learn more about this possibility, 752 specimens of fecal microflora (bacterial species) were collected from 90 neonates born prematurely (before 32 weeks' gestation) who were hospitalized with respiratory distress syndrome (severe impairment of breathing). Samples from neonates who developed signs of gastrointestinal disease (distension, blood in the stool, retention of food in the stomach) were analyzed for their bacterial content. During the eight-month study, samples from eight possible, and four definite, episodes of necrotizing enterocolitis (from 11 infants) were obtained. All episodes followed the introduction of nasogastric feeding by intervals ranging from 3 to 16 days; this usually leads to an increase in the numbers of bacterial strains found in feces. In many of these cases, the bacterial count actually declined during the days prior to the episode. All four definite cases were associated with the presence of species of the family Enterobacteriaceae; two were new isolates. Half of the possible episodes were not preceded by reductions in bacterial levels. It is likely that these results are associated with changes in the wall of the digestive tract, rather than with increased fermentation of intestinal contents by bacteria (which produces the gas that is a characteristic of necrotizing enterocolitis). (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Medical examination, Feces, Necrotizing enterocolitis, Enterocolitis, Neonatal necrotizing

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Circulatory effects of fast ventilator rates in preterm infants

Article Abstract:

Premature infants are being treated more frequently in neonatal intensive care units, and these infants are at high risk for developing respiratory distress syndrome (RDS). Many of the infants require artificial ventilation, and different patterns of ventilation are used to minimize complications of respiratory support. High frequency, or fast, ventilation has been reported to be more beneficial to neonates, but there are concerns that it may cause harmful effects by allowing insufficient time for the lungs to empty during expiration (positive end expiratory pressure or PEEP). The effects of fast ventilator rates on blood pressure and blood flow to the brain were evaluated in 20 premature infants. For therapeutic reasons these infants were paralyzed with medications, and respiratory rates varied from 30 to 100 inhalations per minute. No effects on circulatory function could be attributed to inadvertent PEEP, and the occurrence of PEEP appears rather unlikely. Changes in blood flow to the brain and in blood pressure were related to blood levels of oxygen and carbon dioxide. Under certain conditions, cerebral blood flow was dependent on blood pressure. Respirator rates greater than 50 or 60 per minute provided no particular benefit and may be detrimental. Further study of fast ventilator rates is appropriate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Complications and side effects, Infants (Premature), Premature infants, Newborn infants, Respiratory therapy, Ventilators, Ventilators (Medical equipment), Respiratory therapy for newborn infants

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