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Fulltext Predictors of failed closure of patent ductus arteriosus with indomethacin

Boo NY, Mohd-Amin I, Bilkis AA, Yong-Junina F

Singapore Med J, 2006 Sep;47(9):763-8.
PMID: 16924357

Introduction: The aim of this study was to determine predictors of failed closure of patent ductus arteriosus (PDA) following a single course of indomethacin in symptomatic preterm infants.
Methods: This prospective observational study was carried out on 60 preterm infants weighing less than 1,750 g with symptomatic PDA confirmed by echocardiography. At a median age of 7.0 days (interquartile range 4.0), they were given indomethacin of 0.1 mg/kg/day intravenously daily for six days. Closure of PDA was reassessed by echocardiography upon completion of therapy.
Results: The PDA of 40 percent (n=24) of these infants remained patent. Forward logistic regression analysis showed that the only significant predictors of failed PDA closure in these infants were: PDA size (adjusted odds-ratio [OR] is 7.0; 95 percent confidence interval [CI] of OR is 2.0, 24.8; p-value is 0.002), birth weight (adjusted OR is 0.996; 95 percent CI of OR is 0.993, 1.000; p-value is 0.03) and platelet count (adjusted OR is 0.987; 95 percent CI is 0.975, 1.000; p-value is 0.045). Gestational age, maternal age and left atrium/aorta ratios were not significant predictors.
Conclusion: Larger PDA, lower birth weight and lower platelet count were significant predictors of high failure in indomethacin therapy given late at one week of life.

Matched MeSH terms: Intensive Care Units, Neonatal
A case-control study of risk factors associated with rectal colonization of extended-spectrum beta-lactamase producing Klebsiella sp. in newborn infants

Boo NY, Ng SF, Lim VK

J Hosp Infect, 2005 Sep;61(1):68-74.
PMID: 15953660

To determine the risk factors for rectal colonization by extended-spectrum beta-lactamase (ESBL) Klebsiella sp. in 368 newborns admitted consecutively to a neonatal intensive care unit over six months, rectal swabs were cultured on admission and weekly until discharge. Eighty infants (21.7%) had ESBL Klebsiella sp. cultured from their rectal swabs. Eighty controls were selected at random from infants with negative cultures admitted within the 14-day period prior to the detection of ESBL Klebsiella sp. in the cases. Cases had significantly lower birth weight, gestational age, earlier age of admission, longer hospital stay, and higher proportions of congenital malformations, early-onset pneumonia and respiratory distress syndrome compared with controls. Significantly more cases received mechanical ventilation, nasal continuous positive airway pressure support, total parenteral nutrition, umbilical vascular catheterization, arterial line insertion, urinary bladder catheterization, and prior treatment with antibiotics. However, stepwise logistic regression analysis showed that only two independent risk factors were significantly associated with ESBL rectal colonization: duration of hospital stay [adjusted odds ratio (OR): 1.3; 95% confidence intervals (CI): 1.2, 1.4; P<0.0001) and early-onset pneumonia (adjusted OR: 8.3; 95% CI: 1.6, 43.4; P=0.01).

Matched MeSH terms: Intensive Care Units, Neonatal
Intestinal carriage of multidrug-resistant gram-negative bacteria in preterm-infants during hospitalization in neonatal intensive care unit (NICU)

Yap PS, Ahmad Kamar A, Chong CW, Yap IK, Thong KL, Choo YM, et al.

Pathog Glob Health, 2016 Sep;110(6):238-246.
PMID: 27650884

The prevalence and antibiotic susceptibility of intestinal carriage of Gram-negative bacteria among preterm infants admitted to the neonatal intensive care unit (NICU) in a tertiary teaching hospital in Malaysia were determined. A total of 34 stool specimens were obtained from preterm infants upon admission and once weekly up to two weeks during hospitalization. The presumptive colonies of Escherichia coli and Klebsiella pneumoniae were selected for identification, antibiotic susceptibility testing, and subtyping by using pulsed-field gel electrophoresis (PFGE). Out of 76 Gram-negative isolates, highest resistance was detected for amoxicillin/clavulanate (30.8%, n = 16), ceftriaxone (42.3%, n = 22), ceftazidime (28.8%, n = 15), cefoxitin (28.8%, n = 15), aztreonam (36.5%, n = 19), and polymyxin B (23.1%, n = 12). Three colistin resistant K. pneumoniae have also been detected based on E-test analysis. Thirty-nine isolates of K. pneumoniae and 20 isolates of E. coli were resistant to more than three antimicrobial classes and were categorized as multidrug resistant (MDR). PFGE analysis revealed a higher diversity in pulsotypes for K. pneumoniae (18 pulsotypes) in comparison to E. coli (four pulsotypes). In addition, a total of fifteen pulsotypes was observed from 39 MDR K. pneumoniae. The risk factors for antibiotic resistance were assessed using random forest analysis. Gender was found to be the most important predictor for colistin resistant while length, OFC, and delivery mode were showing greater predictive power in the polymyxin B resistance. This study revealed worrying prevalence rates of intestinal carriage of multidrug-resistant K. pneumoniae and E. coli of hospitalized preterm infants in Malaysia, particularly high resistance to polymyxins.

Matched MeSH terms: Intensive Care Units, Neonatal*
The performance of distortion product otoacoustic emissions and automated auditory brainstem response in the same ear of the babies in neonatal unit

Abdul Wahid SN, Md Daud MK, Sidek D, Abd Rahman N, Mansor S, Zakaria MN

Int J Pediatr Otorhinolaryngol, 2012 Sep;76(9):1366-9.
PMID: 22770594 DOI: 10.1016/j.ijporl.2012.06.008

OBJECTIVE: To identify the outcomes of hearing screening using different protocols of both Distortion Product Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Response (AABR) tests in the same ear of the babies in a neonatal unit population.
METHODS: A cross-sectional study was carried out on babies who were admitted into a neonatal unit. By using a formula of single proportion and considering 20% drop out, the number of sample required was 114. The subjects were chosen by using a systematic random sampling. The infants selected were subjected to DPOAE followed by AABR tests screening at the same setting before discharge.
RESULTS: There were 73 newborns (61.6% male and 38.4% female) participated in this study with a total of 146 ears screened. Ototoxic medication was the most common risk factor followed by hyperbilirubinaemia and low birth weight. AABR had higher passing rate (82.9%) as compared to DPOAE (77.4%). The highest passing rate was achieved if the protocol of either passed DPOAE or AABR was used (90.4%). The rate was lower when auditory neuropathy spectrum disorder (ANSD) has been considered (82.9%). Hyperbilirubinaemia, prematurity, craniofacial malformation and ototoxic drugs seem to be the high risk factors for auditory neuropathy.
CONCLUSION: AABR has a higher passing rate as compared to DPOAE. However, the use of both instruments in the screening process especially in NICU will be useful to determine the infants with ANSD who may need different approach to management. Therefore, a protocol in which newborns are tested with AABR first and then followed by DPOAE on those who fail the AABR is recommended.

Matched MeSH terms: Intensive Care Units, Neonatal
Human milk donation is an alternative to human milk bank

Hsu HT, Fong TV, Hassan NM, Wong HL, Rai JK, Khalid Z

Breastfeed Med, 2012 Apr;7(2):118-22.
PMID: 22011131 DOI: 10.1089/bfm.2011.0006

Human milk bank is a source of human milk supply in many neonatal intensive care units. However, there are some hospitals without this facility because of financial or religious impediments, such as the Muslim community.

Matched MeSH terms: Intensive Care Units, Neonatal
Reducing hypothermia in preterm infants with polyethylene wrap

Rohana J, Khairina W, Boo NY, Shareena I

Pediatr Int, 2011 Aug;53(4):468-74.
PMID: 21105964 DOI: 10.1111/j.1442-200X.2010.03295.x

Occlusive plastic applied immediately after birth to reduce evaporative heat loss has been proven effective in preterm infants <28 weeks' gestation. However its effectiveness on preterm infants >28 weeks' gestation has not been shown. This study aimed to determine the effect of occlusive wrap at birth on the temperature at neonatal intensive care unit (NICU) admission among infants of greater than or equal to 24 weeks' and less than 34 weeks' gestation.

Matched MeSH terms: Intensive Care Units, Neonatal
Short duration of skin-to-skin contact: effects on growth and breastfeeding

Boo NY, Jamli FM

J Paediatr Child Health, 2007 Dec;43(12):831-6.
PMID: 17803670

To compare weight gain and head growth in very-low-birthweight (VLBW, <1501 g) infants with or without exposure to short duration of skin-to-skin contact (STSC) during their stay in a neonatal intensive care unit.

Matched MeSH terms: Intensive Care Units, Neonatal
Fulltext Breastmilk feeding status and weight gain of low birth weight infants in a Neonatal Intensive Care Unit

Lim NL, Cheah IGS, Soosai AP

Med J Malaysia, 2001 Mar;56(1):65-70.
PMID: 11503299

A prospective observational study of feeding in low birth weight (LBW) infants with birth weight (BW) of at least 1.8 kg admitted to the Neonatal Intensive Care Unit (NICU) showed that nearly 80% of mothers provided expressed breastmilk (EBM) and a further 14% breastfed their infants before discharge. Weight gain was overall poor at a mean of 9.48 +/- 7.82 grams per kg per day with those on predominant EBM feeding (EBM > 70%) doing worse than those on predominant preterm formula (PTF) feeding (EBM < 31%), weight gain being 5.40 +/- 6.88 and 11.10 +/- 8.15 grams per kg per day respectively (p < 0.01). Weight gain was also poorer (7.72 +/- 5.55 grams per kg per day) in patients with respiratory distress syndrome (RDS) compared to those who did not have RDS (12.02 +/- 9.58 grams per kg per day). p < 0.05. Incidence of infants < 10th centile body weight at birth was 16.8% and at discharge was 69.1%.

Matched MeSH terms: Intensive Care Units, Neonatal
Fulltext Blood transfusion reactions in Malaysian newborn infants

Boo NY, Chan BH

Med J Malaysia, 1998 Dec;53(4):358-64.
PMID: 10971978

A prospective observational study was carried out over a seven month period in the neonatal intensive care unit (NICU) of a large Malaysian maternity hospital to determine the rate of blood transfusion and the incidence of transfusion reactions in newborn infants. During the study period, the rates of blood transfusion was 6.1% (n = 117) of NICU admission or 8.2 per 1,000 live births. The median birth weight of the infants who had received blood transfusion was 1,740 grams (range: 725-4,350), and their mean gestational age was 33.6 weeks (sd = 5.1, range = 24-41 weeks). The median age of infants when they first received blood transfusion was 4.0 days (range: 1-27 days). When compared with infants of birth weight between 3,000 and 3,499 grams, infants of birth weight less than 1,500 grams received significantly higher median number of transfusions per infant, (p < 0.001). The incidence of transfusion reaction was 2.7% (3/110) of all transfused infants or 1.3% (3/223) of all blood transfusions. Febrile nonhemolytic reaction was the only type of transfusion reaction detected during the study period. This study showed that transfusion reactions in newborn infants were not common.

Matched MeSH terms: Intensive Care Units, Neonatal
Fulltext Cost of preterm birth during initial hospitalization: A care provider's perspective

Zainal H, Dahlui M, Soelar SA, Su TT

PLoS One, 2019;14(6):e0211997.
PMID: 31237874 DOI: 10.1371/journal.pone.0211997

Preterm birth incidence has risen globally and remains a major cause of neonatal mortality despite improved survival. Demand and cost of initial hospitalization has also increased. This study assessed the cost of preterm birth during initial hospitalization from care provider perspective in neonatal intensive care units (NICU) of two hospitals in the state of Kedah, Malaysia. It utilized universal sampling and prospectively followed up preterm infants till discharge. Care provider cost was assessed using mixed method of top down approach and activity based costing. A total of 112 preterm infants were recruited from intensive care (93 infants) and minimal care (19 infants) units. Majority were from the moderate (23%) and late (36%) preterm groups followed by very preterm (32%) and extreme preterm (9%). Median cost per infant increased with level of care and degree of prematurity. Cost was dominated by overhead (fixed) costs for general (hospital), intermediate (clinical support services) and final (NICU) cost centers where it constituted at least three quarters of admission cost per infant while the remainder was consumables (variable) cost. Breakdown of overhead cost showed NICU specific overhead contributing at least two thirds of admission cost per infant. Personnel salary made up three quarters of NICU specific overhead. Laboratory investigation was the cost driver for consumables. Gender, birth weight and length of stay were significant factors and cost prediction was developed with these variables. This study demonstrated the inverse relation between resource utilization, cost and prematurity and identified personnel salary as the cost driver. Cost estimates and prediction provide in-depth understanding of provider cost and are applicable for further economic evaluations. Since gender is non-modifiable and reducing LOS alone is not effective, birth weight as a cost predictive factor in this study can be addressed through measures to prevent or delay preterm birth.

Matched MeSH terms: Intensive Care Units, Neonatal
Fulltext Simulation-Based Education in the Training of Newborn Care Providers-A Malaysian Perspective

Pong KM, Teo JT, Cheah FC

Front Pediatr, 2021;9:619035.
PMID: 33643974 DOI: 10.3389/fped.2021.619035

Simulation-based education (SBE) is increasingly used as an education tool to improve learning for healthcare providers. In newborn care practice, SBE is used in the Neonatal Resuscitation Program (NRP) and training in procedural skills. The NRP is a mandatory course in Malaysia for all house officers (interns) and medical officers (residents) during their pediatric rotation. Almost 30,000 of NRP providers have been trained over the last 5 years. The recent establishment of the Allied Healthcare Center of Excellence (AHCoE), an organization dedicated to promoting SBE, and Malaysian Society for Simulation in Healthcare (MaSSH) aims to enhance the integration of SBE into the healthcare training curriculum and set up a local healthcare simulation educator training program. Our experience in implementing SBE necessitated that we made several important choices. As there was no strong evidence to favor high-fidelity over low-fidelity simulation, and because simulation centers can be very costly to set up with limited resources, we chose SBE mainly in the form of low-fidelity and in situ simulation. We also identified an important developmental goal to train Malaysian instructors on structured debriefing, a critical activity for learning in SBE. Currently, debriefing is often carried out in our centers at an ad hoc basis because of time limitation and the lack of personnel trained. Finally, we aim to implement SBE further in Malaysia, with two axes: (1) the credentialing and recertification of physicians and nurses, and (2) the education of lay caregivers of high-risk infants before discharge from the neonatal intensive care unit.

Matched MeSH terms: Intensive Care Units, Neonatal
Risks and burdens of third-generation cephalosporin resistant Enterobacteriaceae in neonatal sepsis

Thatrimontrichai A, Premprat N, Janjindamai W, Dissaneevate S, Maneenil G

Trop Biomed, 2020 Sep 01;37(3):663-670.
PMID: 33612780 DOI: 10.47665/tb.37.3.663

Third-generation cephalosporin resistant Enterobacteriaceae (TCRE) is a global concern especially in neonatal sepsis. We performed a secondary data analysis in a Thai neonatal intensive care unit to identify the risk factors for acquisition of TCRE sepsis and mortality of Enterobacteriaceae sepsis between 1991 and 2017. Multivariate logistic and Cox proportional regression were used for analysis. Numbers of neonates with TCRE and nonTCRE sepsis were 100 and 41 patients, respectively. Medians (interquartile ranges) of gestational age, birthweight, onset of sepsis and total hospital stay of neonates with Enterobacteriaceae sepsis were 32 (28, 38) weeks, 1670 (1025, 2750) grams, 11 (6, 25) days and 41 (22, 74) days, respectively. Univariate and multivariate analysis, neonates with TCRE sepsis were more likely to have birth asphyxia (adjusted odds ratio [aOR] = 2.6; 95% confidence interval [CI] 1.1-6.0; p = 0.02) and history of aminoglycoside exposure (aOR = 2.9; 95% CI 1.3- 6.7; p = 0.01). In-hospital case fatality rate from Enterobacteriaceae sepsis was 26% (36/141). In Cox regression, neonates with TCRE sepsis was not an independent risk of non-survivors, but septic shock (adjusted hazard ratio = 9.9; 95% CI 5.0-19.7, p < 0.001) increased 30-day mortality in the final model. Asphyxia and previous aminoglycoside consumption were risks of acquisition for neonatal TCRE sepsis while the burden was not a significant difference. Infection prevention and control must be strictly implemented in high multidrug-resistant area.

Matched MeSH terms: Intensive Care Units, Neonatal
Fulltext A Prospective Cohort Study of Obstetric Immigrants in the Maternity Hospital Kuala Lumpur. A Pilot

Noraihan Mohd. Nordin, Sharda, Priya, Zainab Shamsuddin

International Medical Journal Malaysia, 2006;5(1):1-12.
MyJurnal

Objectives: The objectives of this study were to ascertain the prevalence of Indonesians obstetrics immigrant and to assess the fetal maternal outcome. Methodology: A prospective cohort study design was used to analyse 54 consecutive Indonesians obstetrics immigrant compared to 56 Malay women. Chi square and student t test were used where appropriate, p < 0.05 was considered to be of statistical significance. Results: There was a reducing trend in the incidence admission of Indonesians from 10.5 in 1999 to 6.5 % in 2002. The maternal mortality ratio showed an increasing trend from 1999 (40.0/100000) to 2001 (162.9/100000) but decreased to 5.8/100000 in 2002. The majority was between 20-40 years old, multiparous and booked, which was similar to the Malay population. Most Malays were in occupational class 1 to 3 and the husband has secondary and tertiary education compared to the Indonesians who were in class 4 and 5 and the husband has primary and no formal education. Significantly more immigrants were housewives compared to Malays who were working women. There was no significant difference in the antenatal complications. There were no significant difference in terms of delivery and most delivered vaginally. The perinatal outcome in terms of gestation, birth weight, Apgar score and admission to neonatal ICU were similar in both populations and there was no perinatal mortality. In conclusion, the incidence admission of Indonesian immigrant was on the decreasing trend. The outcome of these patients managed in MHKL was similar to the Malay population. Further studies with enrollment of a larger number of patients should be carried out to ascertain the significance of these findings.

Matched MeSH terms: Intensive Care Units, Neonatal
The effect of providing expressed breast milk on infection rates, mortality and breast feeding of preterm babies

Ram, S.P., Zabidi Azhar M Hussin

Malaysian Journal of Child Health, 1997;9(1):83-87.
MyJurnal

Two active interventions were carried out in order to encourage breast feeding of low birth weight (LBW) neonates who were admitted to the neonatal intensive care unit (NICU), Universiti Sains Malaysia. These were the establishment of (a) an effective transport system for conveying expressed breast milk (EBM) from the motherk home to the neonatal intensive care unit and (b) providing rooming-infacilities in the neonatal ward. The EBM was transported by a male health assistant, by the parents themselves or by the local bus company. A total of 473 babies were admitted from April 1994 to September 1995. Thirty-three babies weighed between 540-1000g and 440 were between 1001-2000g. A total of 226 (47.8%) babies were given mixed formula (less than 20% of daily needs) and EBM feeds (Group A) and 247 (52.2%) were given only formula feeds (Group B). A total of 79 babies died of which 5 were in Group A and 74 were in group B. (P value is 0.00). In Group A, 45 babies had clinical sepsis, 9 of whom were blood culture positive. Four of these babies died. In group B, out of 108 babies with clinical sepsis 36 were blood culture positive. 29 died because of the sepsis This study shows that by providing an effective transport system for breast milk expressed at home and the availability of roomingfacilities in the neonatal ward a significant number of LBW babies admitted to the NICU continue to receive their mothers' milk. The incidence of nosocomial sepsis and the over all mortality due to sepsis was significantly higher in those on full formulafeeding compared to those given mixed formula and expressed breast milk.

Matched MeSH terms: Intensive Care Units, Neonatal
Cholestasis in very low birth weight infants who received parenteral nutrition

Rohana, J., Latinah, M., Thambidorai, C.R., Kaur, B.

Malaysian Journal of Paediatrics and Child Health, 2005;14(1):21-26.
MyJurnal

A retrospective study was conducted to evaluate the magnitude, clinical course and risk factors of cholestasis in surviving very low birth weight (VLBW) infants who received parenteral nutrition at the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia. Cholestasis was defined as direct hyperbilirubinaemia of >34 mmol/L. Between 1St July 2000 to 31St March 2001, 58 VLBW infants received parenteral nutrition (PN). Forty seven infants survived to discharge. Complete data was obtained from 43 (90.1%) infants. Thirteen (30.2%) of these infants developed cholestasis. The cholestasis persisted beyond the age of 6 weeks in 8 infants and they underwent hepato imino diacetic acid (HIDA) scan. The HIDA scan was reported as normal in 2 infants and inconclusive in 6 infants. Operative cholangiography. (OTC) was then performed in these infants and were all normal. The cholestasis finally resolved in all infants. Analysis of risk factors revealed that duration of assisted ventilation and PN and the presence of patent ductus arteriosus (PDA) had significant correlation with the development of cholestasis. These factors together with lower mean gestational age increased the likelihood of persistent cholestasis beyond 6 weeks of life in these infants. In conclusion cholestasis is common in VLBW infants who received parenteral nutrition. Although the clinical course seems benign, in a significant proportion of these infants it may persist longer and put them at increased risk of requiring invasive investigations.

Matched MeSH terms: Intensive Care Units, Neonatal
Exchange transfusion for neonatal hyperbilirubinaemia: experience in an inborn neonatal intensive care unit

Lim, N.L., Boo, N.Y., Nur Atiqah, N.A., Padma Soosai, A., Musa Mohd Nordin, M Sham. Kasim

Malaysian Journal of Child Health, 1998;10(1):46-51.
MyJurnal

Severe jaundice (serum bilirubin level > 340 gmol/L) occurred in 81 infants admitted to the Neonatal Intensive Care Unit (NICU) of the Maternity Hospital Kuala Lumpur (MHKL) in 1993. Of these 46 (56.8%) underwent 53 exchange transfusions. In-patient case notes were available for study on 41 of them. Two infants had no cause identified while 12 were associated with prematurity, 13 ABO incompatibility, 8 G6PD deficiency, 6 sepsis 2 Rh isoimmunisation and 6 miscellaneous causes. In 14 infants it was felt that exchange transfusions might have been avoided if they were detected earlier and phototherapy instituted promptly. Twenty six (26) infants were deemed to have been given phototherapy at the appropriate time but jaundice increased to exchange transfusion levels, threshold values depending on the unit in charge. Use of higher intensity phototherapy might have been more effective in some of the cases. Available data showed similar outcomes in both groups.

Matched MeSH terms: Intensive Care Units, Neonatal
Fulltext Factors associated psychological well-being of mothers with low birth weight (LBW) infants who are admitted at neonatal intensive care units (NICU)

Rusnani Ab Latif

The Malaysian Journal of Nursing, 2018;9(3):39-45.
MyJurnal

Psychological well-being is relatively complex notions with a variety of components that may contribute to it. Individuals differ in their overall levels of psychological health and well-being. Mother with low birth weight (LBW) babies required hospitalization especially in the Neonatal Intensive Care Unit (NICU) more exposed to the experience of anxious symptoms. Therefore, it would become a stressful event that might cause psychological distress or even emotional crisis in mother's when their infants were LBW especially premature. Health promotion is very important to prevent this problem. Health promotion efforts aimed at improving infant health status must do so by improving women's health. Improving women's health before, during, and after pregnancy is the key to reduce the human and economic costs associated with infant mortality and morbidity. To improve both women's and infants' health, efforts should include an emphasis on preventive health care services, family-oriented work site options, changes in social norms, and individual behavior modification. Therefore, it is important for health care professionals in NICU to be able to assess the factors associated psychological well-being of mother's with LBWinfant.

Matched MeSH terms: Intensive Care Units, Neonatal
Early-onset sepsis in Malaysian neonatal intensive care units

Boo NY, Ang EBK, Neoh SH, Ang EL, Chee SC

Malays J Pathol, 2022 Dec;44(3):443-459.
PMID: 36591712

OBJECTIVES: To determine the incidence, causative pathogens, morbidities, mortality, and risk factors associated with blood culture-positive early-onset sepsis (EOS, ≤72 hours of age) in symptomatic neonates admitted to the neonatal intensive care units (NICUs) of a middle-income country.
STUDY DESIGN: Retrospective cohort study using data submitted prospectively to the Malaysian National Neonatal Registry (MNNR).
SETTING: 44 Malaysian NICUs.
PARTICIPANTS: All neonates born in 2015- 2020.
RESULTS: EOS was reported in 991 neonates. The annual incidence of EOS increased from 0.46 to 0.49/1000 livebirths over the six years. The most common pathogen was Streptococcus agalactiae or Group B haemolytic streptococcus (GBS) (n=388, 39.2%), followed by Escherichia coli (E. coli) (n=80, 8.1%), Klebsiella spp (n=73, 7.4%), coagulase negative staphylococcus (CONS) (n=73, 7.4%), Pseudomonas spp (n=44, 4.4%) and methicillin-sensitive Staphylococcus aureus (n=34, 3.4%). The incidence of EOS due to GBS increased from 0.17 to 0.22/1000 livebirths. Morbidities and mortality were higher in those with EOS than without EOS. Multiple logistic regression analysis showed that Indian ethnic group, chorioamnionitis, gestation≥37weeks, female, spontaneous vaginal delivery, instrumental delivery, and surfactant therapy were significantly associated with increased risk of EOS due to GBS. Four factors were significantly associated with increased risk of non-GBS EOS (outborns, birthweight lt;1000 g, vaginal delivery, and surfactant therapy). Early continuous positive airway pressure was associated with significantly lower risk of EOS.
CONCLUSION: The incidence of EOS showed an increasing trend in Malaysian NICUs. GBS was the most common causative pathogen. Several modifiable risk factors associated with EOS have been identified.

Matched MeSH terms: Intensive Care Units, Neonatal
Fulltext Usefulness of a semi-quantitative procalcitonin test kit for early diagnosis of neonatal sepsis

Boo NY, Nor Azlina AA, Rohana J

Singapore Med J, 2008 Mar;49(3):204-8.
PMID: 18363001

This study was designed to determine the sensitivity and specificity of a semi-quantitative procalcitonin (PCT) test kit for the diagnosis of neonatal sepsis.

Matched MeSH terms: Intensive Care Units, Neonatal
Contamination of breast milk obtained by manual expression and breast pumps in mothers of very low birthweight infants

Boo NY, Nordiah AJ, Alfizah H, Nor-Rohaini AH, Lim VK

J Hosp Infect, 2001 Dec;49(4):274-81.
PMID: 11740876

The objective of this study was to compare the rates of bacterial contamination of expressed breast milk (EBM) obtained by manual expression and breast pumps in mothers of very low birthweight (VLBW) infants (<1501 g). This was a randomized, controlled study carried out on 28 mothers of such babies and 92 specimens of EBM were collected: 41 specimens from 13 mothers assigned to the manual group and 51 specimens from 15 mothers in the breast-pump group. EBM was cultured quantitatively by the Miles and Misra method. Breast milk expressed by breast pumps (86.3% or 44/51 specimens) had a significantly higher rate of bacterial contamination than milk expressed by the manual method (61.0% or 25/41 specimens) (P= 0.005). When breast milk was expressed in the hospital, there was no significant difference in contamination rates between the two methods. When breast milk was expressed at home, the rates of bacterial contamination by staphylococci (P= 0.003) and Gram-negative bacilli (P= 0.002) were significantly higher in the breast-pump group than the manual group. In conclusion, the rate of bacterial contamination of EBM of mothers of VLBW infants was high, especially when EBM was obtained by the breast pump or when expression was carried out at home.

Matched MeSH terms: Intensive Care Units, Neonatal

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