Culture-Proven Neonatal Sepsis in Japanese Neonatal Care Units in 2006-2008
ABSTRACT Recent Japanese epidemiology of neonatal sepsis and its predominant pathogens has not been reported. It is also unknown whether there are center differences in the incidence of neonatal sepsis, including early-onset sepsis (EOS) and late-onset sepsis (LOS) in Japan.
To investigate the morbidity and characteristics of neonatal sepsis in recent years and the differences in the incidence of sepsis among Japanese neonatal care units.
We retrospectively collected the data of newborn infants with culture-proven sepsis that occurred in five Japanese centers of perinatal care from 2006 to 2008. The incidence of sepsis was calculated, including EOS and LOS, and compared among centers.
Morbidity from sepsis occurred in 51/6,894 (0.74%) infants. The incidence of EOS and LOS was 0.13 and 0.61%, respectively. The incidence of total sepsis and LOS in infants <1,000 g of birth weight was significantly higher than that in infants who weighed >1,000 g at birth, whereas there were no significant differences in the incidence of EOS between the different birth weights. Methicillin-resistant Staphylococcus aureus was the most common pathogen involved in morbidity and mortality of neonatal sepsis. Significant center differences were observed in the incidence of LOS, but not EOS.
The majority of culture-proven neonatal sepsis is LOS, which differs among centers, especially in infants who weigh <1,000 g at birth in Japan. We consider that it is important to control nosocomial infection in newborn care units to further reduce the morbidity of neonatal sepsis in Japan.
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ABSTRACT: BACKGROUND: Serum unbound bilirubin (UB) level measures bilirubin not bound to albumin, and has been reported to be better than total bilirubin level at identifying infants at risk of developing bilirubin-induced neurotoxicity, including auditory abnormalities. A detailed treatment strategy for newborns with high serum UB levels has not been established. Our objective was to assess auditory outcomes in newborns with serum UB levels of ≥1.00 μg/dL who were treated according to our novel treatment protocol. METHODS: A prospective clinical study was conducted in newborns weighing >1,500 g with serum UB levels of ≥1.00 μg/dL who were admitted to Kobe University Hospital and Kakogawa Municipal Hospital, Japan from 2006 to 2011. Enrolled newborns were treated as follows: (1) if the serum UB level was 1.00-1.50 μg/dL, phototherapy and infusion were administered with or without albumin or immunoglobulin therapy; and (2) if the serum UB level was >1.50 μg/dL, exchange transfusion was performed immediately. Auditory brainstem responses were evaluated at the time of discharge. RESULTS: A total of 89 Japanese newborns with UB levels of ≥1.00 μg/dL were enrolled at a median age of 4 days. Of these, 85 had UB levels of 1.00-1.50 μg/dL and four had UB levels of >1.50 μg/dL. After being treated according to our protocol, no newborns were diagnosed with auditory brainstem response abnormalities. CONCLUSIONS: Our treatment protocol for Japanese newborns with serum UB levels of ≥1.00 μg/dL may be useful for the prevention of bilirubin-induced auditory abnormalities.Pediatrics International 09/2012; 55(1). DOI:10.1111/j.1442-200X.2012.03726.x · 0.73 Impact Factor
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ABSTRACT: BACKGROUND: The neonatal intensive care unit (NICU) is a high-risk setting for transmission of meticillin-resistant Staphylococcus aureus (MRSA). Very few studies have investigated the impact of pre-emptive contact precautions applied to outborn neonates transferred to an NICU on the incidence of healthcare-associated (HA)-MRSA transmission. AIM: To assess the efficacy of pre-emptive contact precautions for outborn neonates implemented in an NICU. METHODS: A before-and-after intervention study was conducted in the NICU of Kobe University Hospital. Pre-emptive contact precautions for outborn neonates were introduced in September 2008. The period before the introduction of pre-emptive contact precautions (January 2007-August 2008) was compared with the period after the introduction of pre-emptive contact precautions (September 2008-December 2010). Data for all admitted neonates, neonates who stayed in the NICU for more than three days, length of NICU stay, incidence of MRSA-positive outborn neonates on admission, hand hygiene compliance and incidence of HA-MRSA transmission were compared between the two periods. FINDINGS: There were no significant differences in the percentage of outborn patients admitted to the NICU, percentage of patients who stayed in the NICU for more than three days, length of NICU stay, and incidence of MRSA-positive outborn patients at NICU admission between the groups enrolled before and after the introduction of pre-emptive contact precautions. However, hand hygiene compliance increased, and the incidence of HA-MRSA transmission reduced significantly from 3.5/1000 to 1.3/1000 patient-days after the introduction of pre-emptive contact precautions (P < 0.0001). CONCLUSION: Pre-emptive contact precautions for outborn neonates were effective in reducing the incidence of HA-MRSA transmission in a Japanese NICU.The Journal of hospital infection 04/2013; 84(1). DOI:10.1016/j.jhin.2012.12.016 · 2.78 Impact Factor
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ABSTRACT: The neonatal intensive care unit (NICU) is a high-risk setting for transmission of methicillin-resistant Staphylococcus aureus (MRSA). The recent prevalence of colonization with MRSA and its control measures are unknown in Japanese NICUs. We aimed to investigate the prevalence of MRSA-colonized patients and measures to control and prevent healthcare-associated transmission in Japanese NICUs in 2011. A nationwide survey was performed in facilities certified as training hospitals for neonatologists. Data in NICUs and growing care units (GCUs) were collected and analysed regarding surveillance cultures for MRSA and the proportion of MRSA-colonized patients in September 2011. Trends in the proportions of MRSA-colonized patients and the measures to control and prevent healthcare-associated MRSA transmission were investigated in the surveyed NICUs in 2000, 2003, and 2011. A total of 168 NICUs and 158 GCUs were analysed. The proportions of NICUs and GCUs that conducted regular surveillance cultures for MRSA were 81% and 66%, respectively. They demonstrated that MRSA colonization was not found in 53% of NICUs and 45% of GCUs. The percentage of NICUs reported to be free of MRSA-colonized patients increased over time. Use of alcohol-based hand rub and gloves by clinical staff and cohorting for identified MRSA-positive patients became more common in 2011 than those in 2000 or 2003. Approximately a half of Japanese NICUs did not observe any patients with MRSA colonization in September 2011. Control and prevention measures had changed to use of alcohol-based hand rub and gloves in the last decade.Pediatrics International 10/2013; 56(2). DOI:10.1111/ped.12232 · 0.73 Impact Factor