Over a period of 18 months, 100 full-term newborns developed an axillary or a rectal temperature greater than or equal to 37.8 C during the first four days of postnatal life. These febrile term newborns represented 1% of all full-term newborns in the normal nursery. Of the febrile newborns, 10% had culture-proven bacterial disease (BD). Fever developed in 54%, 27%, 13%, and 6% on the first, second, third, and fourth days, respectively. In 17 newborns fever developed within the first hour of life; 13 of these had mothers with fever and two others were under a radiant warmer in the birth room. Fever occurring on the third day of postnatal life had a significantly higher chance of being associated with BD than fever occurring at any other time in the first four days of postnatal life. Newborns with temperature greater than or equal to 39 C had a significantly higher incidence of BD than newborns with temperature less than 39 C. The incidence of fever among breast-fed newborns (0.98%) was similar to that of formula-fed newborns (1.01%). Of the 100 febrile newborns, 45 had other symptoms compatible with BD, and eight of these had proven BD (group B Streptococcus in five, group D Streptococcus in one, Shigella D in one, and Propionibacterium species in one). The two other febrile newborns with proven BD had no other symptoms of infection (group B Streptococcus and Escherichia coli). Mean WBC count of febrile newborns with BD was significantly lower than that of febrile newborns without BD. Only three febrile newborns had WBC count less than 5,000/cu mm and two of them had proven BD. Febrile newborns should be evaluated and treated with antibiotics when they have symptoms of infection other than fever or when the fever persists or recurs.
Latest citations:
Emerg Med J. 2005 Apr ;22 (4):256-9
15788823
Cit:4
Department of Emergency Medicine, A-108, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA. LBROWNMD@AOL.com
OBJECTIVE This study was undertaken to evaluate the discriminatory power of the peripheral white blood cell (WBC) count to identify bacterial infections in a cohort of febrile neonates (<or=28 days of age) presenting to an emergency department. METHODS Retrospective medical record review using descriptive statistics and a receiver operating characteristic (ROC) curve. Neonates who presented to a tertiary care paediatric emergency department between 1 January 1999 and 22 August 2002, had a temperature >or=38 degrees C, underwent lumbar puncture, and had a WBC count obtained were included. They were divided according to microbiological and radiographic findings into four groups: bacterial infections, viral infections, pneumonia, and negative sepsis evaluations. RESULTS A total of 69 febrile neonates met the inclusion criteria. The number of neonates in each group was as follows: 8 with bacterial infections, 10 with viral infections, 3 with pneumonias, and 48 with negative sepsis evaluations. There was substantial overlap in WBC counts among the groups. The area under the ROC curve was 0.7231 (95% CI 0.5665 to 0.8797). CONCLUSION In a cohort of febrile neonates evaluated in the emergency department, the WBC count had modest discriminatory power in identifying neonates with bacterial infections and demonstrated substantial overlap among groups. The present data suggest against the use of any WBC count threshold to identify bacterial infections in febrile neonates presenting to the emergency department.
Department of Neonatology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel. maayan@flashmail.com
OBJECTIVE To determine the characteristics of febrile full term infants during the first days of life, and to discover the rate of serious bacterial infections among low risk neonates with systemic fever. DESIGN A retrospective case-control study of 122 cases and 122 controls in a single institution. RESULTS Weight loss, breast feeding, caesarean section delivery, and high birth weight were found to be the most significant predictors of developing fever during the first days of life. Of the 122 patients in the study group, only one had a serious bacterial infection (a positive urine culture for group B streptococcus). CONCLUSIONS In low risk full term infants, fever with no other symptoms during the first days of life (but after the first day) is related primarily to dehydration, breast feeding, caesarean section, and high birth weight. Infection is the least common explanation.
Other papers by authors:
Fifteen studies were performed in ten premature infants whose birth weight (mean +/- SD) was 1,444 +/- 250 gm, gestational age 32.7 +/- 1.0 weeks, and postnatal age 10.7 +/- 3.3 days. Each study consisted of three hours simultaneous measurement of insensible water loss and oxygen consumption under two conditions for the same infant:(1) inside a single-walled incubator and (2) inside a double-walled incubator. The double-walled incubator provided significantly (P < 0.001) higher operative temperature and incubator wall temperature than did the single-walled incubator. Infants inside the double-walled incubator had significantly lower (P < 0.01) IWL (30% reduction) and lower (P < 0.05) VO2 (17% reduction) than inside the single-walled incubator--a net caloric saving of 11.8 kcal/kg/day. This saving of energy expenditure may be important in affecting the growth and outcome of the low-birth-weight infants.
In the course of a double-blind controlled trial of intravenous indomethacin therapy in premature infants with patent ductus arteriosus, plasma glucose was evaluated in 47 infants before and at 24, 48, and 72 hours following the medication. Twenty-two infants were assigned to the control group and 25 were in the indomethacin group. Significantly lower plasma glucose was noted at 24 (P less than 0.01) and 48 (P less than 0.05) hours in the indomethacin group as compared to the control group. There was a significant inverse correlation between the plasma glucose and the corresponding plasma indomethacin concentration (P less than 0.05) and between the plasma glucose and the corresponding plasma indomethacin concentration-time integral (P less than 0.01) at 24, 48, and 72 hours after drug administration, suggesting that the decreased plasma glucose may be related to indomethacin therapy. The results of this study indicate that endogenous prostaglandin may play a role in glucose homeostasis in premature infants.
The effect of indomethacin on carbohydrate metabolism was studied in six premature infants with significant patent ductus arteriosus (mean +/- S.D., birth weight 1,066 +/- 244 gm, gestational age 30 +/- 1.6 weeks). All infants were in a glucose steady state between 50 and 100 mg/dl over a 2-hour period before indomethacin administration. There was a significant fall in plasma glucose at 1, 6, 12, and 24 hours following intravenous indomethacin infusion. Since there was no significant change in insulin levels from the baseline, the mechanism of indomethacin-mediated lack of prostaglandin inhibition of insulin release was not substantiated. Based on this study, plasma glucose levels should be followed closely in the first 24 hours following intravenous indomethacin administration.
From June 1980 to September 1984, forty-five newborns (weight greater than or equal to 2000 g), initially presumed normal, were seen with bilious vomiting in the first 72 hours and were prospectively followed up. Nine (20%) required surgical intervention, five (11%) had nonsurgical obstruction such as meconium plug or left microcolon, and the remaining 31 (69%) had idiopathic bilious vomiting. Infants with idiopathic bilious vomiting had a benign transient course and resumed feedings by 1 week of age; 30 of the 31 had normal or nonspecific findings on initial plain abdominal roentgenogram. Specific findings on the initial plain abdominal roentgenogram were noted in five infants, and four (80%) of these had a lesion requiring surgical intervention; 56%(5/9) of neonates with surgical lesions had normal or nonspecific findings on the plain abdominal roentgenograms. None developed bowel ischemia or midgut infarction secondary to a volvulus as they were identified by contrast studies shortly after the initial episode of bilious vomiting. Although the majority of "normal" neonates with bilious vomiting do not have a surgical lesion, this study indicates that 56% of surgical cases will be missed if contrast studies are not done.
Serial measurements of pulmonary function and arterial blood gases during the first 3 postnatal days of life were obtained in 12 infants with meconium aspiration syndrome (MAS). Nine normal neonates with similar weight and gestational age were studied as controls. Infants with MAS has significantly lower pH on day 1, and had greater P(A-a)O2 throughout the study period than that of normal controls. The PCO2 was comparable between the groups. Both dynamic lung compliance (Cdyn) and specific lung compliance (C/VL) were lower in infants with MAS as compared with those of normal infants. The functional residual capacity (FRC) for normal infants on days 1, 2, and 3 were 2.0 +/- 0.3, 2.1 +/- 0.3, and 2.2 +/- 0.3 ml/cm, respectively, and for infants with MAS were 1.8 +/- 0.4, 2.3 +!- 1.1, and 2.2 +/- 0.6 ml/cm, respectively. Radiographic hyperinflation of the lungs was seen in 6 infants with MAS on day 1; 3 were associated with high FRC (greater than 2 SD of normal) and 2 with low FRC, indicating air trapping. The early use of PEEP should be cautious if hyperinflation or air trapping is present.
A loading dose of theophylline produces significant metabolic changes, including increase of plasma glucose concentration and an early rise in serum insulin in some infants. The chronic effects of theophylline on plasma glucose, serum insulin, and glucagon are not known at this time. The potential for development of metabolic derangements must be kept in mind when theophylline is used for protracted periods in premature infants.
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Eur J Pediatr. 2010 Mar 25;:
20336465
Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland, hanna.soukka@tyks.fi.
In neonates, recurrent group B streptococcal infection is uncommon, and two relapses are extremely rare. We report a case of three distinct episodes of Streptococcus agalactiae bacteremia in a healthy full-term infant over a 4-week period. The newborn had no apparent predisposing condition or infectious focus, and the recurrences occurred after adequate antimicrobial treatment, the second occurring after withdrawal of colonized breast milk. Finally, oral rifampin was combined to his antibiotic regimen, his colonization cultures turned negative, and no further relapses have occurred during the 11-month follow-up. Conclusion In this report, we describe a newborn with two exceptionally rapid recurrences of group B streptococcal septicemias, and who was successfully treated with combining rifampin to the antibiotic regimen.
Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., Cincinnati, OH 45229-3039, USA. melissa.klein@cchmc.org
BACKGROUND Fever is a common symptom in children. Assessment of accuracy of parental temperature measurement is integral in determining proper medical management. METHODS The authors recruited 25 afebrile and 13 febrile children from outpatient sites. Participants had rectal temperatures measured by a trained study staff, followed by axillary temperature measurements by trained study staff and parent. Analysis of variance was used to compare the afebrile and febrile groups; the paired t test was used to compare parent and study personnel's axillary temperature measurements. Analysis included the statistical significance of Pearson's correlation coefficients for the various comparisons. RESULTS In both febrile and afebrile groups, the rectal temperatures were greater than axillary temperature measurements, but the difference was not consistent. There was a very high correlation (correlation coefficient range =.86-.96) between axillary temperature measurements performed by trained study staff and parents. CONCLUSIONS Parental report of axillary temperature measurement can be considered reliable.
Eur J Clin Pharmacol. 2007 May 12;:
17497144
Cit:4
Christele Gras-Le Guen,
Cecile Boscher,
Nathalie Godon,
J Caillon,
C Denis,
J Nguyen,
M Kergueris,
J Roze
Pediatric and Neonatal Critical Care Division,Department of Perinatology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, 38 Bd J Monnet, 44099, Nantes, Cedex, France.
AIMS: The standard treatment of neonatal group B Streptococcus infection is intravenous amoxicillin for 10 days. We investigated whether effective serum amoxicillin concentrations could be reached by switching to oral amoxicillin after 48 h of intravenous administration in full-term neonates with group B Streptococcus infection. METHODS: Over 2 years, we included 222 full-term neonates who had early onset group B streptococcal disease responsive to 48 h of intravenous amoxicillin, at which point they were asymptomatic and fed orally. They were switched to oral amoxicillin (300 or 200 mg/kg per day in four divided doses). Steady-state serum amoxicillin concentrations were determined 48 h later by high-performance liquid chromatography; values >/=5 mg/l were considered effective. RESULTS: Mean gestational age was 39.32 +/- 1.5 weeks ,and mean birth weight was 3,422 +/- 533 g; 29 newborns were bacteremic. Median serum amoxicillin concentration on oral therapy was 31,.15 (range 11-118) and 25.80 (range 5-84.8) with 300 and 200 mg/kg per day, respectively. None of the infants had a concentration <5 mg/l (p < 0.001). Gastrointestinal tolerance was satisfactory; 216 patients were discharged at 5 days of age, and none was readmitted within the 3-month follow-up. CONCLUSION: Early switching to the oral route in asymptomatic full-term newborns with early onset group B streptococcal disease maintained serum amoxicillin concentrations within our predefined therapeutic range (error risk<0.001). This strategy may hold potential for reducing treatment invasiveness and shortening hospital length of stay.
Neonatal Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
AIM The value of polythene film ('cling wrap') to improve thermal control and reduce postnatal weight loss in preterm, very low-birthweight babies was investigated. METHODS Consecutively born babies with birthweights between 750 and 1500 g were stratified by birthweight (<1250 g, 1251-1500 g) and randomised either to the cling wrap (CW) or no cling wrap (NCW) group. The baby bassinette of the RW was covered with cling wrap up to the level of the neck in the CW group for the 1st 7 days. The primary outcome variables were the incidence of hypothermia (axillary temperature < or = 36 degrees C) after initial stabilisation during the first 7 days and cumulative weight loss (percentage of birthweight) at 48 hours of age. RESULTS Of 51 babies, 26 were randomised to the CW and 25 to the NCW group. None of the babies in the CW group developed hypothermia in the 1st 7 days but 36% in the NCW group (p = 0.001) did. Babies who were hypothermic on admission took less time to reach normal temperature in the CW group. Cumulative weight loss in the 1st 48 hours was 5.0 + 5.6% in the CW group and 8.6 + 7.0% in the NCW group (p = 0.06). CONCLUSION Use of CW might be a simple method of maintaining temperature in very low-birthweight babies in developing countries.
The Children's Hospital of New York-Presbyterian, Columbia University, College of Physicians and Surgeons, USA. psd6@columbia.edu
OBJECTIVES Although often managed differently than older children, no study has specifically described the clinical course of urinary tract infections (UTIs) in young infants. Our objective was to determine the risk of progression of illness and the pattern of fever resolution in infants younger than 60 days of age with Gram-negative rod UTIs. METHODS We completed a retrospective medical chart review. Patients younger than 60 days of age presenting to an urban, tertiary care pediatric hospital were included if they had single organism growth of Gram-negative rods in any amount from suprapubic aspiration samples or more than 10,000 cfu/mL from catheterized specimens. Significant progression of illness was defined as the need for transfer to an intensive care setting. Fever was defined as a rectal temperature of 38.0 degrees C or higher or an axillary temperature 37.0 degrees C or higher. Temperatures were assigned to blocks of 4 hours. RESULTS Of 128 patients with available records, none were transferred from the general pediatric ward to the intensive care unit and 2 were transferred to a step-down unit for events potentially unrelated to the UTI. No patient had a positive repeat urine culture. For patients with fever, median time to fever resolution was within the 4 to 8 hour time block. Eighty-five percent of the febrile patients became afebrile within 24 hours and only 3.6% were febrile after 48 hours. CONCLUSIONS Progression of illness in infants with Gram-negative rod UTIs is unlikely. Fever resolution is rapid. If subsequent studies concur with our findings, outpatient therapy or short-stay unit admission may become a viable management strategy.
Department of Neonatology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel. maayan@flashmail.com
OBJECTIVE To determine the characteristics of febrile full term infants during the first days of life, and to discover the rate of serious bacterial infections among low risk neonates with systemic fever. DESIGN A retrospective case-control study of 122 cases and 122 controls in a single institution. RESULTS Weight loss, breast feeding, caesarean section delivery, and high birth weight were found to be the most significant predictors of developing fever during the first days of life. Of the 122 patients in the study group, only one had a serious bacterial infection (a positive urine culture for group B streptococcus). CONCLUSIONS In low risk full term infants, fever with no other symptoms during the first days of life (but after the first day) is related primarily to dehydration, breast feeding, caesarean section, and high birth weight. Infection is the least common explanation.
Department of Pediatrics, University of Valladolid, Spain.
Heart rate (HR) was recorded in healthy full-term newborns aged 1-90 days. The aim of this study was to study the existence of circadian and/or ultradian rhythms in HR to determine maturity. HR was recorded during 24 h, at 30-min intervals, at different postnatal ages. Six-groups were investigated: day 1 (group 1); day 7 (group 7); day 15 (group 15); day 30 (group 30); day 60 (group 60), and day 90 (group 90). The chronograms for HR showed peaks and nadirs along the 24-hour periods, and the cosinor analysis proved the existence of 3-hour ultradian rhythm in groups 1, 7 and 30, and a 12-hour ultradian rhythm in group 90 (p < 0.01 in all cases). The same type of analysis confirmed the existence of a circadian rhythm in group 30. Similar results were obtained for groups 60 and 90 (p < 0.05). In conclusion: at birth, newborns have an endogenous ultradian period of 3 h. A circadian rhythm appears within 15-30 days of postnatal life.
West Afr J Med. ;15 (3):165-9
9014507
Cit:2
Department of Microbiology, University of Ghana Medical School, Accra, Ghana.
An outbreak of nosocomial infection due to multiple-resistant Salmonella Group "G' infection in a neonatal intensive care unit in a temporary ward is reported. It started with five cases of Septicaemia and one case of meningitis over a period of about six weeks. Investigation of the outbreak resulted in isolation of a multiple-resistant Salmonella Group G from the rectal swab of 21 out of 72 babies (29%). Surveillance culture from staff yielded two fully-sensitive salmonella species. Stool culture from mother of colonised babies were all negative. Environmental cultures from the nursery grew multiple-resistant Salmonella Group G from three of four incubator mattresses and also from the radiant warmer. Institution of strict aseptic measures, followed by closure of the ward was able to stop the epidemic.
Maternal-Child Unit, St. Martha's Regional Hospital, Antigonish, Nova Scotia, Canada.
OBJECTIVE: To determine the effects of early admission bathing on thermoregulation in newborns. DESIGN: Randomized, comparative study. SETTING: A regional hospital providing primary and secondary newborn care. PARTICIPANTS: One hundred healthy, full-term newborns. INTERVENTIONS: Newborns in the investigational group with a minimum rectal temperature of 36.5 degrees C. were bathed after the newborn admission assessment examination was completed (M = 61.15 minutes of age), whereas newborns in the control group were bathed at the standard of 4 hours of age (M = 252.12 minutes of age). MAIN OUTCOME MEASURE: Rectal temperatures were measured using a Diatek thermometer. Rectal temperatures were recorded during the newborn admission assessment examination, immediately before bathing, immediately after bathing, 1 hour after bathing, and 2 hours after bathing. RESULTS: No significant differences (p <.05) in rectal temperatures, were found between the groups during the admission assessment examination, before bathing, immediately after bathing, 1 hour after bathing, or 2 hours after bathing. No significant differences were found between the groups in type of delivery, time of birth, gestational age, birth weight, Apgar scores at 1 and 5 minutes, air temperature, apical heart rate, or respiratory rate. CONCLUSIONS: Healthy, full-term newborns whose rectal temperatures are greater than 36.5 degrees C can be bathed immediately after the admission assessment examination.
The accuracy of axillary temperature measurement using an electronic thermometer in the predictive mode was investigated in term and preterm infants. Predictive mode measurements were compared to axillary monitoring mode measurements and to rectal temperature recordings. Fifty temperature recordings were obtained in each of four groups of neonates (full-term/radiant warmer, full-term/open crib, preterm/radiant warmer, preterm/incubator). Correlation of axillary predictive and monitoring mode temperatures ranged from r = 0.83 to 0.90. Correlations between axillary monitoring mode and rectal measurements were r = 0.69 to 0.80, and between predictive mode and rectal measurements were r = 0.59 to 0.80. Small, statistically significant differences were found between predictive and monitoring mode axillary temperatures in preterm neonates (0.1 to 0.2 degrees F). Rectal temperatures were higher than axillary predictive temperatures by 0.5 degrees F and higher than axillary monitoring mode temperatures by 0.7 degrees F. Ranges of variation of +/- 0.8 to 1.1 degrees F were similar in comparisons of rectal with axillary predictive and monitoring mode measurements. The results of this study support the use of axillary measurement in the predictive mode for clinical measurement of temperature in neonates. Clinicians should be aware of the expected differences between measurements at axillary and rectal sites and the potential for variation in measurements across measurement modes and sites.
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