Day 1 :
- Neonatology | Diabetes Mellitus | Neonatal Heart Diseases | Chronic Metabolic Diseases | Diabetic Disorders & Treatment | Cosmetic Dermatology | Type 2 Diabetes | Surgical Dermatology | Neonatal Infections | Pediatrics
University of Ferrara, Italy
Laura Mezzalira is a graduate student in medicine and surgery at University of Padua (Italy) in September 2020. In November 2021, I started attending the specialization course in Pediatrics and neonatology at the University of Ferrara (Italy). My first work experience was at the Polyclinic of Abano Terme (Padua, Italy) where I was able to witness the use of home phototherapy in the treatment of Hyperbilirubinemia in full-term babies.
Introduction. Approximately 60% of term babies develop jaundice. This often requires inpatient hospital treatment with phototherapy. Home phototherapy is not well-established within Italy as routine care for the management of neonatal jaundice. The 2019 outbreak of the coronavirus disease has changed hospitals' policies around perinatal care, banning fathers and extra people from entering the neonatal ward to keep mothers and babies safe. The prolonging hospital stay for phototherapy would increase by the stress of isolation, making lockdown in hospital challenging for maternal mental health and breastfeeding initiation. The purpose of this study is to report a patient-centered pilot project of phototherapy at home during the COVID-19 pandemic, to promote mother and baby bonding and experience of neonatal jaundice by reducing hospital stay.
Methods: newborn babies were considered for home phototherapy during the COVID-19 outbreak following the guideline (‘Home Phototherapy’: ST-MD-01, 03.15.2018, Policlinico Abano Terme). Inclusion criteria: feeding established, bilirubin levels at >75 <90 percentile (Bhutani nomogram), weight loss <10%, parents motivated, no social concerns, and lived within a pre-defined surrounding area (the Euganean Hills). The equipment used for phototherapy at home is Mira®, GINEVRI srl. Albano Laziale, Rome. The baby was visited 24 hours after hospital discharge
Results: 21 babies were included between January and May 2021. Mean gestational age was 39.73 ± 1.13 weeks, average weight 3,355.90 ±419 g, average discharged home day 2.3±04, and average days received phototherapy at home 1.27±0.43. No adverse events were noted. Two additional babies could be included but they did not live within the pre-defined area. Conclusion: The pilot project of ‘Home Phototherapy’ was well appreciated by parents and cost-effective to improve maternal and newborn health. It has given us the basis to roll this project out to different Level 1–3 neonatal units across the country after the Covid-19 outbreak.
Rainbow children hospital, Hyderabad.
Jagan Mohan Varakala is affiliated to Department of Neonatology and Microbiology Rainbow children hospital, Hyderabad. He is a recipient of many awards and grants for his valuable contributions and discoveries in major area of subject research. His international experience includes various programs, contributions and participation in different countries for diverse fields of study. His research interests reflect in his wide range of publications in various national and international journals.
Elizabethkingia meningosepticum is a non-fermentative gram negative bacillus, ubiquitous in nature (1, 2). E. meningosepticum causes meningitis, pneumonia, bacteremia, and sepsis in pneumonia, endocarditis, postoperative bacteremia, meningitis and endopthalmitis (1–3). Among the different infections, a high mortality and severe post infection sequelae including hydrocephalus, deafness, and developmental delay have been reported in neonates with meningitis due to E. meningosepticum (2). Infections caused by E. meningosepticum are difficult to treat because of its resistance to extended spectrum 𝛽-lactam agents and aminoglycosides (1–3). Peculiarity is that it behaves like gram positive on susceptibility pattern. The underlying host factors associated with E. meningosepticum meningitis in neonates is prematurity and low birth weight (4, 5).
MATERIALS AND METHODS:
Case series of 14 neonates with E. meningosepticum across various centers in who presented to the Neonatal Intensive Care Unit of RAINBOW children’s hospital Hyderabad, between January 2016 and JUNE 2019, were included in the study.
A total of 14 E, meningosepticum species identified using Standard biochemical reactions and species identified by automated BD phoenix machine. Sample was collected using Bactec culture media for blood samples.12 babies have survived with a survival rate of 85 % which is far better when compared to all existing survival rates across varies centre. Among two Neonatal deaths (15%) one baby was preterm 26 weeks and other baby was term. There were 5 out of 14 Neonates were extreme preemies less than 27 weeks. Among them 2 were 25 weeks and 3 were 26 weeks. Among extreme preemies (<27weekers) 3 babies have survived. Isolates were from blood in 11 babies. 3 babies had both CSF and Blood positive. Isolated from ET culture in 3 babies. Among survivor’s 7 babies had Neurological sequelae(50%).5 babies had hydrocephalus(35.7%) , IVH in 1 neonate and Cerebral oedema in 1 baby. 6(42.7%) babies had Neonatal seizures. Other associations were Endopthalmitis in one case, pericardial effusion in one case, PPHN in one case .4 neonates had hemodynamically significant PDA among them 2 babies were term.
Among the E. meningosepticum isolates, 1 out of 16 was resistant to Vancomycin with high MIC (64). 100% were Resistant to piperacillin-tazobactam, respectively, but only 23% were susceptible to fluoroquinolones . Although most of the species were susceptible to vancomycin, Clinical response was not adequate. One neonate responded to Rifampin and cotrimoxazole, which were the promising drugs were we could see clinical response.
The data on antibiotic susceptibility of E. meningosepticum is limited because it is rarely isolated from clinical specimen and there are no standard guidelines on antibiotic susceptibility testing and reporting and interpretation of the susceptibility data. Infection is associated with high mortality and Sequelae. This outcome is confirmed in the literature review which showed 57% mortality rate and 69% hydrocephaly rate in survivors [6, 7, 8]. The antibiotic profile of Elizabethkingia meningosepticum is different from other Gram-negative rods. The bacterium is characterized by its inherent resistance to aminoglycosides, β-lactam agents, Chloramphenicol and carbapenems, but also by its susceptibility to Rifampicin, Ciprofloxacin, Vancomycin and Trimethoprim–Sulfamethoxazole [9, 10].
Elizabethkingia meningosepticum is an emerging infection and a nosocomial threat, with high risk for complications and mortality in premature neonates. The improvement of accuracy in bacterial identification and standardization of antibiotic susceptibility tests are essential for early diagnostic and etiologic treatment, in order to reduce mortality and neurological complications.. Active infection control in hospital environments, especially of water sources, is necessary to prevent Elizabethkingia meningosepticum epidemics.