Neonatal Updates #35

Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Avery TR, et al. Targeted versus Universal Decolonization to Prevent ICU Infection. New England Journal of Medicine. 2013;368(24):2255-65. A cluster randomized study in adults in intensive care. There were 3 groups. 1. Screening for MRSA and isolation of positive patients (which was the standard of care before the study). 2. Screening for MRSA and treatment of positive adults with intra-nasal mupirocin and cleaning them with chlorhexidine wipes, for a 5-day period. 3. No screening, just treating all admitted adults with mupirocin for 5 days and chlorhexidine wipes for the entire ICU stay. The primary outcome was MRSA positive cultures (which I think includes for example positive nasal cultures after the first screening culture), and secondary outcomes included all serious nosocomial infections, MRSA bacteremia and bacteremia from all organisms. Universal treatment and body washes reduced serious nosocomial infections much more than the other approaches, both MRSA septicemia and all cause septicemia, by about 44%. It is starting to look like these chlorhexidine impregnated washcloths really work to reduce serious nosocomial infections. We need more studies to see  in which babies it would be safe to do this (by examining absorption and toxicity in preterm and very preterm infants), and we need to restrict their use to the ICUs, to avoid the evolution of resistance, which will surely, eventually, happen if they are too widely used (in domestic animals for example!)

Bertini G, Elia S, Ceciarini F, Dani C. Reduction of catheter-related bloodstream infections in preterm infants by the use of catheters with the AgION antimicrobial system. Early Human Development. 2013;89(1):21-5. Another RCT for infection control, this time in newborn infants, 86 of whom were randomized to get an umbilical venous catheter that was impregnated with an antiseptic silver compound, or control. There was a substantial, and significant reduction in infection related to the catheter with the silver impregnated catheter, but the control rate was extraordinarily high, 22% of the control group had a catheter related infection, during a mean catheter duration of about 8 days. This will need to be tested in NICUs with much lower UVC infection rates, and we really need to be sure that the exposure to silver zeolite is safe.

Boss RD, Kinsman HI, Donohue PK. Health-related quality of life for infants in the neonatal intensive care unit. J Perinatol. 2012;32(12):901-6. This interesting piece is a review of publications of quality of life, the main thrust of the article is that we have no data about quality of life of babies while they are still in the NICU.  They refer to the article that Antoine Payot and I wrote about quality of life of former preterm infants (and infants with other chronic conditions) throughout life, and make a plea to establish quality of life scales for babies while they are still in the NICU. I found that an interesting idea that I had not really considered, we have ways of measuring pain, and several other scores which are peripherally related to QoL, but no agreed method for analyzing QoL during our NICU treatment, which may last months, and, unfortunately, for some babies is the only life they ever know.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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