BACKGROUND:: Male circumcision can reduce the risk of heterosexually-acquired HIV-1 infection in men. Neonatal male circumcision (NMC) has many potential advantages over circumcision at older ages but little is known about its feasibility and safety in resource-limited settings. METHODS:: We performed a randomized trial in southeastern Botswana of Mogen clamp ...

Necrotizing fasciitis (NF) is a severe infection involving the superficial fascia, subcutaneous tissue, and, occasionally, deeper tissue layers. Usual treatment is with surgical debridement in combination with antibiotics. In review of the literature there is one neonatal report of NF associated with necrotizing enterocolitis. We present a case report of ...

Purpose: Epidemic adenoviral keratoconjunctivitis can spread rapidly among preterm infants who frequently undergo ophthalmological examination. Here we present our experience on a nosocomial outbreak that affected 8 nursery staff members and 26 premature infants. We focus on the presentation and progress of the outbreak, the diagnosis of the disease and ...

Abstract Objectives: To study the impact of interrupted loud noise in Neonatal Intensive Care Unit (NICU) on neonatal physiologic parameters, and apply methods to alleviate noise sources through teaching NICU's staff. Methods: Noise level measured at different day times and during different noisy events in the NICU. Changes in the ...

OBJECTIVE: To evaluate the effects of estimated breastfeeding on infant outcomes in comparison to test weighing and to describe staff members' experiences of estimated breastfeeding as a method for supporting the transition from tube feeding to breastfeeding. DESIGN: A mixed method evaluation. SETTING: Neonatal Intensive Care Unit (NICU) in Sweden. ...

Background. Candidemia is common and associated with high morbidity and mortality; changes in population-based incidence rates have not been reported.Methods. We conducted active, population-based surveillance in metropolitan Atlanta, Georgia, and Baltimore City/ County, Maryland (combined population 5.2 million), during 2008-2011. We calculated candidemia incidence and antifungal drug resistance compared to prior surveillance ...

The prevention and treatment of pediatric fungal infections are limited by the fact that not all antifungal drugs are approved for the pediatric age and appropriate dosages have not been established for each age group The management of neonates and infants with invasive fungal infection is becoming more complex with ...

Abstract Premature infants frequently present with respiratory instability, which is associated with fluctuations in ventilation and gas exchange. Adjustment of respiratory support to the infant's needs is limited by staff availability and workload. Hence, automation is being explored as a way to improve the care of the premature infants. New ...

OBJECTIVES:To assess trends in incidence of Candida spp. central line-associated bloodstream infections (CLABSIs) in US NICUs, 1999-2009.METHODS:Data from NICUs participating in the National Nosocomial Infections Surveillance (1999-2004) and National Healthcare Safety Network (2006-2009) were analyzed. Overall and birth weight-specific incidence rates of Candida spp. CLABSIs per 1000 central line-days were ...

Invasive craniocerebral aspergillosis, often encountered in an immunocompromised setting, is almost uniformly fatal despite radical surgical and medical management, and is frequently a necropsy finding. The authors report a unique, self-resolving clinical course of this aggressive infection in a 10-month-old infant. The infant was brought to the emergency services in ...

Antifungal prophylaxis is increasingly used in very low birth weight (VLBW) infants who are at risk for severe fungal infections. Our objective was to assess the effectiveness of targeted fluconazole prophylaxis for high-risk VLBW infants. A retrospective cohort study with historical controls was performed. During the period 2007-2008, all high-risk ...

Fluconazole is a triazole antifungal agent that is widely used in the nursery. It is available in both intravenous and oral formulation, and is active against most of the fungal pathogens that require treatment when retrieved from culture samples in neonatal intensive care units. Although clinical use has been wide ...

Invasive disseminated neonatal aspergillosis is an uncommon disease, with only scattered reports in literature in the last few years. Here we report on a 25-week gestational age, 730 g at birth preterm female infant who developed on day-of-life 10 multiple cutaneous exhulcerative lesions in her right arm, trunk and abdomen. ...

Fungal colonisation by Candida spp. affects a high proportion of VLBW neonates in NICU. However, few data are available on the clinical characteristics of colonisation in preterm infants who are colonised at baseline via vertical transmission, compared to preterms who become colonised during their stay in NICU via horizontal transmission. ...

Prevention of invasive Candida infections (ICI) is an achievable goal for every NICU and supported by A-1 evidence. Due to the incidence of ICI, high infection-associated mortality and neurodevelopmental impairment, antifungal prophylaxis should be targeted to infants <1000 g or ≤27 weeks gestation. There is A-1 evidence for both fluconazole ...

To assess the impact of empiric antifungal therapy for invasive candidiasis on subsequent outcomes in premature infants. This was a cohort study of infants with a birth weight ≤ 1000 g receiving care at Neonatal Research Network sites. All infants had at least one positive culture for Candida. Empiric antifungal ...

Invasive fungal infections represent the third-leading cause of late-onset sepsis in very-low-birth-weight infants (VLBWI) and have a high rate of infection-associated mortality. The infants at high risk for fungal sepsis are VLBWI with presence of additional risk factors that contribute to increased colonization and concentration of fungal organisms. Colonization with ...

Background:  The aim of this study is to evaluate the risk factors, demographic features, treatment and clinical outcome associated with candidemia in neonatal intensive care unit (NICU) within a 8-year period. Methods:  The data of infants who were diagnosed as candidemia, were evaluated. Results:  Between January 2000 and December 2007, ...

Context:According to a recent nationwide survey in Japan, a significant proportion of very low birth weight infants (VLBWI) develop late-onset circulatory collapse after the first week of life. Small doses of glucocorticoid are very effective in these patients, and relative adrenal insufficiency is suspected to be the main cause of ...

Invasive fungal infections remain a significant cause of infection-related mortality and morbidity in preterm infants. Central nervous system involvement is the hallmark of neonatal candidiasis, differentiating the disease's impact on young infants from that among all other patient populations. Over the past decade, the number of antifungal agents in development ...

To evaluate Candida parapsilosis candidaemia in a neonatal unit over 7 years. Case series study. A 2000-bed tertiary-care university hospital at São Paulo, Brazil. Neonates hospitalised in a 63-bed neonatal unit. PRIMARY AND SECONDARY OUTCOME MEASURES: We evaluated the incidence of C parapsilosis fungemia in a neonatal unit from 2002 ...

Systemic fungal infections have high morbidity and mortality rates in neonates, especially neonates with an extremely low birth weight (ELBW). Here, we describe a 21-day-old ELBW female infant with an amphotericin B-unresponsive congenital Candida albicans infection that was treated with caspofungin. Blood sterilization was performed during the first episode, but ...

A variety of antifungal drugs, drug preparations and drug combinations are available to treat newborn infants with suspected or confirmed invasive fungal infection. There is a need to assess their relative merits. To assess the effect of treatment with different antifungal drugs, drug preparations or drug combinations on mortality and ...

Invasive candidiasis (IC) in the premature infant population is a common infection that results in substantial morbidity and mortality. For these patients, fluconazole is among the first line therapies to treat and prevent IC, and yet few prospective studies investigating its pharmacokinetics (PK) and safety have been performed in this ...

Context:Postnatal pituitary-testicular activation in infant boys is well characterized. However, the ovarian response to pituitary activation in infancy is less well understood.Objective:The aim of the study was to compare postnatal developmental changes in the pituitary-ovarian axis in preterm and term infant girls.Participants and Design:Sixty-three infant girls, divided into three groups ...

Neural correlates of stress regulation via the hypothalamic-pituitary-adrenal (HPA) axis have been identified, but little is known about how these apply to real-world interpersonal stress contexts such as mother-infant interaction. We extended stress regulation research by examining maternal neural activation to infant cry related to HPA regulation with their infants. ...

So far, only a few studies investigated occupational exposure to ionizing radiation in pregnancy to cause birth defects (BDs). No association between BDs and ionizing radiation, although described for high-dose exposure, could ever be confirmed for employees, or specific job titles. Here, an explorative analysis of a prospective population-based birth ...

To determine the independent impact of acute kidney injury (AKI) and renal replacement therapy (RRT) in infants and children who receive extracorporeal membrane oxygenation. Despite continued expertise/technological advancement, patients who receive extracorporeal membrane oxygenation have high mortality. AKI and RRT portend poor outcomes independent of comorbidities and illness severity in ...

The spiral scan with a wide detector row such as the 64-detector row computed tomography (CT) system may increase radiation exposure for infants because the irradiation range is wider than the planned range. The adaptive dose shield (ADS) prevents radiation exposure greater than the planned range. We examined the usefulness ...

With rising numbers of extremely premature infants in the neonatal intensive care unit (NICU) who require multiple radiologic examinations for their complex medical conditions, concerns the risk of radiation exposure become a more prevalent issue. The biological effects from cumulative doses of both primary and secondary radiation can be particularly ...

Shock defines a complex dysfunction of organ perfusion, that produces a status of cellular energy failure, resulting from an insufficient supply of oxygen and nutrients to tissues. The diagnosis of shock is very difficult because of the lack of sufficiently sensitive and specific clinical criteria, and is substantially based on ...

Inhaled nitric oxide (iNO), commonly used for hypoxic neonates, may react with haemoglobin to form methaemoglobin (MetHb). MetHb monitoring during iNO therapy has been questioned since low doses of iNO are used. To evaluate the incidence of and identify risk factors associated with elevated MetHb in neonates treated with iNO. ...

To evaluate the use of oxygen in neonates in the past, present and future. The data are mainly from Pubmed with relevant published articles from the 1940s to the present with some information gathered from web searches. Studies evaluating the use of oxygen in premature and term infants through history ...

Melatonin, an endogenously produced indoleamine, is a highly effective antioxidant, free radical scavenger, and a primary circadian regulator. Melatonin has important antioxidant properties owing to direct and indirect effects. It directly scavenges reactive oxygen and reactive nitrogen species, prevents molecular oxidation, improves mitochondrial physiology, and restores glutathione homeostasis. Its indirect ...

Background. Diagnosis of necrotizing enterocolitis (NEC) in preterm neonates is challenging. We hypothesized that regional splanchnic oxygen saturation (rsSO(2)) measured by near-infrared spectroscopy (NIRS) is a biomarker for mesenteric perfusion. Objective. To evaluate feasibility and safety of continuous rsSO(2) monitoring in preterm infants in the first 14 days of life. Methods. Preterm neonates ...

Bordetella pertussis is a common, underrecognized, and vaccine-preventable cause of critical illness with a high mortality in infants worldwide. Patients with severe cases present with extreme leukocytosis and develop refractory hypoxemia and pulmonary hypertension that is unresponsive to maximal intensive care. This may reflect a hyperviscosity syndrome from the raised ...

The purpose of this observational study was to characterize the clinical course of newborn infants with spontaneous pneumothorax and to identify those infants who eventually required further interventions. We performed a retrospective review of newborns with symptomatic spontaneous pneumothorax, born between January 2002 and December 2007. Seventy-six infants ≥36 weeks' ...

Pulse oximetry is commonly used to assist clinicians in assessment and management of newly born infants in the delivery room (DR). In many DRs, pulse oximetry is now the standard of care for managing high risk infants, enabling immediate and dynamic assessment of oxygenation and heart rate. However, there is ...

In the clinical setting, episodes of desaturation in newborn infants are often treated by increasing the fraction of inspired oxygen (FiO(2)). To study the effect of an increase in FiO(2) on cerebral oxygenation during recovery from desaturation, as measured by near-infrared spectroscopy (NIRS). Peripheral arterial saturation (SaO(2)), NIRS-monitored cerebral saturation ...

OBJECTIVE: To evaluate regional tissue oxygenation of the brain and preductal and postductal peripheral (muscle) tissue during immediate transition after birth, and to correlate with peripheral preductal and postductal arterial oxygen saturation. STUDY DESIGN: We conducted a prospective observational study. With near-infrared spectroscopy (NIRS), changes in regional oxygen saturation of ...

The intravenous lipid emulsion (LIP) is a source of oxidants which may stimulate inflammation. Co-administration of parenteral multivitamins (MVP) with LIP prevents lipid peroxidation in light exposed TPN. We hypothesised that this modality of TPN administration affects systemic inflammation, which may be modulated by exposure to oxygen. Premature infants were ...

BACKGROUND/PURPOSE: Survival of patients with congenital diaphragmatic hernia (CDH) depends both on non-modifiable congenital conditions and on modifiable pre and postnatal management. ECMO improves survival up to 80% in neonates with CDH in the best ECMO centers worldwide. The first Neonatal ECMO Program in Chile was started in our University ...

Neonatal intensive care unit (NICU) stabilization strategies which normalize physiology according to predetermined blood gas targets may contribute to observed improved survival rates of patients with CDH. The purpose of our study was to compare risk-adjusted outcomes of CDH patients managed with or without blood gas targets established at NICU ...

CONTEXT: Low oxygen saturation appears to decrease the risk of severe retinopathy of prematurity (ROP) in preterm newborns when administered during the first few weeks after birth. High oxygen saturation seems to reduce the risk at later postmenstrual ages (PMAs). However, previous clinical studies are not conclusive individually. OBJECTIVE: To ...

Previous studies have suggested that the incidence of retinopathy is lower in preterm infants with exposure to reduced levels of oxygenation than in those exposed to higher levels of oxygenation. However, it is unclear what range of oxygen saturation is appropriate to minimize retinopathy without increasing adverse outcomes. We performed ...

This case series describes the clinical management of 5 infants who underwent whole-body cooling during extracorporeal membrane oxygenation (ECMO). In all 5 infants, systemic hypothermia was maintained during ECMO with acceptable clinical outcomes.

Preterm and term infants are frequently exposed to high concentrations of oxygen for prolonged periods. In experimental models, high and prolonged oxygen exposures cause delayed alveolar septation and a bronchopulmonary dysplasia phenotype. Often, however, the oxygen exposure is tolerated in that the infants recover without severe lung or systemic injury. ...

OBJECTIVE: The goal was to define reference ranges for pulse oxygen saturation (Spo(2)) values in the first 10 minutes after birth for infants who received no medical intervention in the delivery room. METHODS: Infants were eligible if a member of the research team was available to record Spo(2) immediately after ...

The normal range of heart rate (HR) in the first minutes after birth has not been defined. Objective To describe the HR changes of healthy newborn infants in the delivery room (DR) detected by pulse oximetry. Study Design All inborn infants were eligible and included if a member of the ...

AIMS: Intraventricular haemorrhage (IVH) and cerebral injury are major neurological disorders of premature infants. The effect of hyperoxic resuscitation on the occurrence of IVH and cerebral injury is elusive. Therefore, we asked whether hyperoxia during neonatal resuscitation increased the incidence and severity of IVH and cerebral injury in premature newborns. ...