Managing challenges in congenital CMV: current thinking - Peeref (2024)

Article Pediatrics

Outpatient parenteral antimicrobial therapy: how young is too young?

Kate Alison Hodgson, Ruth Lim, Julie Huynh, Ben Nind, Naomi Katz, Robin Marlow, Conor C. Hensey, Barry Scanlan, Laila F. Ibrahim, Penelope A. Bryant

Summary: This study aimed to evaluate the efficacy and outcomes of outpatient parenteral antimicrobial therapy (OPAT) in neonates and older infants. The study found that OPAT is a safe and effective way of providing antibiotics to clinically stable neonatal patients. Appropriate antibiotic use was common, but improvements can still be made.

Article Pediatrics

Predicting the likelihood of lower respiratory tract Ureaplasma infection in preterms

Rose Marie Viscardi, Laurence S. Magder, Michael L. Terrin, Natalie L. Davis

Summary: Predictive models were developed based on perinatal clinical information to determine the likelihood of lower respiratory tract Ureaplasma infection. These models may be useful in the design of clinical trials to prevent Ureaplasma-mediated BPD.

Review Pediatrics

What's New in the Management of Neonatal Early-Onset Sepsis?

Noa Fleiss, Kathleen Schwabenbauer, Tara M. Randis, Richard A. Polin

Summary: The expert guidelines mentioned in this review offer an evidence-based framework for managing high-risk infants and promote a more restricted and standardized approach to antibiotic usage. These guidelines have significantly reduced antibiotic utilization on a global scale, but the ideal method would be for each unit to tailor their approach to early-onset sepsis (EOS) based on their specific neonatal population and available resources. As research on EOS continues to advance and limitations in sepsis prediction tools are addressed, our risk stratification and management guidelines will inevitably become more accurate.

Article Pediatrics

Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study

Kia Hee Schultz Dungu, Stine Lund, Emma Louise Malchau Carlsen, Ulla Birgitte Hartling, Astrid Thaarup Matthesen, Kristina Traeholt Franck, Marianne Kragh Thomsen, Ulrik Stenz Justesen, Hans Linde Nielsen, Alex Christian Yde Nielsen, Tine Brink Henriksen, Ulrikka Nygaard

Summary: This nationwide population-based cohort study aimed to estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat with acyclovir. The results showed a higher incidence of neonatal HSV infection than in previous decades, but a high NNT with empiric acyclovir. Therefore, it is recommended not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest.

Review Pediatrics

Effect of chlorhexidine cleansing on healthcare-associated infections in neonates: a systematic review and meta-analysis

Jinyan Zhou, Lingli Mei, Shuohui Chen

Summary: This study found that chlorhexidine cleansing had no significant effect on neonatal sepsis, but was effective in reducing neonatal skin bacterial colonization. It also significantly reduced central line-associated bloodstream infection in neonates based on large-sample studies. Further research is needed to determine the optimal concentration and frequency of chlorhexidine cleansing.

Review Pediatrics

Incidence and aetiology of infant Gram-negative bacteraemia and meningitis: systematic review and meta-analysis

Luisa K. Hallmaier-Wacker, Amelia Andrews, Olisaeloka Nsonwu, Alicia Demirjian, Russell J. Hope, Theresa Lamagni, Simon M. Collin

Summary: This systematic review confirms that low and middle income countries bear a larger burden of Gram negative infections compared to high income countries. The incidence of infant Gram-negative bacteraemia is higher in LMIC, with Escherichia coli, Klebsiella, and Pseudomonas spp being the common pathogens causing early-onset infant bacteraemia and infant meningitis worldwide. Implementation of preventive measures could reduce the high incidence of Gram-negative bacteraemia in LMIC.

Article Pediatrics

2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheterisation: the ARCTIC randomised controlled feasibility trial

Paul Clarke, Aung Soe, Amy Nichols, Helen Harizaj, Mark A. Webber, Louise Linsell, Jennifer L. Bell, Catherine Tremlett, Priyadarsini Muthukumar, Santosh Pattnayak, Christopher Partlett, Andrew King, Ed Juszczak, Paul T. Heath

Summary: This study aimed to evaluate the best antiseptic for skin disinfection before percutaneous central venous catheter (PCVC) insertion in preterm neonates. It found that both 2% chlorhexidine gluconate-70% isopropyl alcohol and 2% chlorhexidine gluconate-aqueous were safe to use. However, conducting a large-scale randomized controlled trial may be challenging due to the very low catheter colonization rate.

Article Pediatrics

Early-onset neonatal sepsis in the Paris area: a population-based surveillance study from 2019 to 2021

Paola Sikias, Valerie Biran, Laurence Foix-L'Helias, Celine Plainvert, Pascal Boileau, Stephane Bonacorsi

Summary: This population surveillance study provides data on the incidence, causative organisms, and antibiotic susceptibilities of early-onset sepsis in infants born at ≥34 weeks' gestation. The study highlights the higher frequency of group B Streptococcus (GBS) compared to Escherichia coli (E. coli) in term infants, and the significantly elevated risk of early-onset sepsis in late preterm infants due to E. coli. The findings suggest the need for improvement in the prevention of GBS early-onset sepsis and empiric antibiotic treatment of sepsis.

Article Pediatrics

Incidence of infant Gram-negative invasive bacterial infections in England, 2011-2019: an observational study using population-wide surveillance data

Luisa K. Hallmaier-Wacker, Amelia Andrews, Russell Hope, Alicia Demirjian, Theresa L. Lamagni, Simon M. Collin

Summary: The incidence of invasive bacterial infections caused by Gram-negative pathogens in infants has increased in England from 2011-2019, primarily driven by an increase in late-onset infections. Escherichia coli is the most common Gram-negative pathogen and accounts for 27.2% of the overall rise in Gram-negative infant disease incidence.

Article Pediatrics

Switch from intravenous-to-oral antibiotics in neonatal probable and proven early-onset infection: a prospective population-based real-life multicentre cohort study

Emma Louise Malchau Carlsen, Kia Hee Schultz Dungu, Anna Lewis, Nadja Hawwa Vissing, Lise Aunsholt, Simon Trautner, Hristo Stanchev, Gholamreza Krog Dayani, Anne-Janet L. Pedersen, Mia Bjerager, Maria De Salas, Kristian Vestergaard, Pernille Pedersen, Niels Frimodt-Moller, Gorm Greisen, Bo Molholm Hansen, Ulrikka Nygaard

Summary: This study evaluated the implementation of switch therapy from intravenous to oral antibiotic treatment in neonates with early-onset infection. The results showed that switch therapy was safe and effective in relieving the treatment burden for neonates, caregivers, and healthcare systems.

Review Pediatrics

Neonatal varicella

Katherine Longbottom, Hermione Lyall

Summary: Primary infection with varicella zoster virus in the final stages of pregnancy can lead to neonatal varicella. It is important to administer post-exposure prophylaxis and treatment to infants at high risk, as well as encourage universal vaccination to reduce the incidence of neonatal varicella.

Article Pediatrics

Neuroimaging in infants with congenital cytomegalovirus infection and its correlation with outcome: emphasis on white matter abnormalities

Ana Alarcon, Linda S. de Vries, Alessandro Parodi, Juan Arnaez, Fernando Cabanas, Sylke J. Steggerda, Monica Rebollo, Luca Ramenghi, Izaskun Dorronsoro, Manuela Lopez-Azorin, Juliane Schneider, Antoni Noguera-Julian, Maria Rios-Barnes, Manuel Recio, Myriam Bickle-Graz, Miriam Martinez-Biarge, Claudia Fortuny, Alfredo Garcia-Alix, Anita C. Truttmann

Summary: This study evaluated the association between neuroimaging and outcome in infants with cCMV. The severity of neuroimaging was found to be correlated with the outcome. Specifically, in infants with isolated WMAs, TPWMAs provided guidance for prognosis.

Article Medicine, General & Internal

Evaluating safety and effectiveness of the early-onset sepsis calculator to reduce antibiotic exposure in Dutch at-risk newborns: a protocol for a cluster randomised controlled trial

Bo M. van der Weijden, Marijke C. van der Weide, Frans B. Plotz, Niek B. Achten

Summary: This study aims to investigate whether the use of the EOS calculator can safely reduce antibiotic exposure in newborns with suspected EOS compared to the Dutch guideline. The study will be conducted as a cluster randomised controlled trial with a total of 1830 newborns. Results will be disseminated through peer-reviewed journals and international conferences.

Article Pediatrics

Early initiation of antibiotic therapy and short-term outcomes in preterm infants: a single-centre retrospective cohort analysis

Natascha Koestlin-Gille, Lina Maria Serna-Higuita, Caren Bubser, Joerg Arand, Laura Haag, Christoph E. Schwarz, Martin Heideking, Christian F. Poets, Christian Gille

Summary: This study investigated whether the timing of antibiotic therapy in preterm infants influenced short-term outcomes. The results showed that early initiation of antibiotic therapy was associated with an increased risk of developing bronchopulmonary dysplasia. Therefore, improved identification of low-risk infants for early-onset sepsis is needed to reduce antibiotic exposure.

Article Pediatrics

Diagnosing early-onset neonatal sepsis in low-resource settings: development of a multivariable prediction model

Samuel R. Neal, Felicity Fitzgerald, Simba Chimhuya, Michelle Heys, Mario Cortina-Borja, Gwendoline Chimhini

Summary: The objective of this study was to develop a clinical prediction model for diagnosing neonatal sepsis in low-resource settings. The researchers used multivariable logistic regression to identify candidate predictors based on expert opinion and literature review. The results showed that the prediction model had high sensitivity and low specificity, suggesting its suitability for excluding early-onset sepsis.

Article Immunology

Using Dried Blood Spots for a Sero-Surveillance Study of Maternally Derived Antibody against Group B Streptococcus

Erick Auma, Tom Hall, Simran Chopra, Sam Bilton, Laxmee Ramkhelawon, Fahimah Amini, Anna Calvert, Gayatri Amirthalingam, Christine. E. E. Jones, Nick Andrews, Paul. T. T. Heath, Kirsty Le Doare

Summary: Vaccination during pregnancy can protect women and infants from invasive Group B Streptococcus (GBS) disease. A study in England showed that neonatal dried blood spots (DBS) can be used to determine the amount of maternally derived antibody protecting infants from GBS disease. However, due to suboptimal storage conditions, no difference in GBS IgG levels was found between DBS samples from cases and controls.

Review Acoustics

Outcome following laser surgery of twin-twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta-analysis

F. D'Antonio, D. Marinceu, S. Prasad, N. Eltaweel, A. Khalil

Summary: This systematic review examines the outcomes of laser surgery for twin-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin pregnancies complicated by selective fetal growth restriction (sFGR). The study finds that MCDA twin pregnancies with TTTS and sFGR have a higher risk of fetal loss after laser surgery, as well as a higher risk of neurological morbidity in the donor twin.

Article Acoustics

First-trimester choroid-plexus-to-lateral-ventricle disproportion and prediction of subsequent ventriculomegaly

S. Prasad, C. Di Fabrizio, N. Eltaweel, E. Kalafat, A. Khalil

Summary: The objective of this study was to assess the predictive accuracy of first-trimester choroid-plexus-to-lateral-ventricle/head ratios for development of ventriculomegaly at a later gestational age. The study found that first-trimester fetal choroid-plexus-to-lateral-ventricle/head ratios have good predictive accuracy for the development of ventriculomegaly.

Editorial Material Pediatrics

On the lookout for post-streptococcal complications in the UK

Justin Healy, Katherine Longbottom, Alison Kent, Elizabeth Whittaker, Tom Parks

Article Infectious Diseases

SARS-CoV-2 infection and pulmonary tuberculosis in children and adolescents: a case-control study

Jeremi Swanepoel, Marieke M. M. van der Zalm, Wolfgang Preiser, Gert van Zyl, Elizabeth Whittaker, Anneke C. C. Hesseling, David A. J. Moore, James A. A. Seddon

Summary: This study aimed to evaluate the relationship between SARS-CoV-2 infection and tuberculosis (TB) in children and adolescents. The results showed no significant association between SARS-CoV-2 infection and pulmonary TB. However, the study found a potential association between SARS-CoV-2 antibody levels and TB, indicating the need for further investigation on the interaction between these two infections.

Article Ethics

Biobanking and consenting to research: a qualitative thematic analysis of young people's perspectives in the North East of England

Fabian J. S. van der Velden, Emma Lim, Lily Gills, Jasmin Broadey, Louise Hayes, Eve Roberts, Jack Courtney, Joanne Ball, Jethro Herberg, Rachel Galassini, Marieke Emonts, DIAMONDS consortium

Summary: This study explores the views and knowledge of children and young people in the UK regarding biobanking and consent. The findings suggest that most children accept prospective and deferred consent, and prefer to reconsent when cognitively mature enough. Additionally, children wanted to be informed about the reuse of their biobanked biospecimens.

Article Infectious Diseases

National point-prevalence survey of healthcare-associated infections and antimicrobial use: UK-PAS/UKHSA joint call to action for all paediatric services

Samuel Channon-Wells, Jocelyn Elmes, Berit Muller-Pebody, Orlagh Mcgarrity, Faye Chappell, Simon B. Drysdale, Diane Ashiru-Oredope, Sanjay Patel, Alicia Demirjian, UK PAS

Summary: The negative impact of high antimicrobial use, resistance, and healthcare-associated infections on children is troubling. However, the lack of pediatric data hinders efforts to improve health outcomes and secure resources. The upcoming national survey in 2023 provides an opportunity to collect valuable information and optimize antimicrobial stewardship and infection prevention practices, highlighting the importance of pediatric representation in healthcare institutions.

Article Immunology

The Clinical and Economic Burden of Antibiotic Use in Pediatric Patients With Varicella Infection: A Retrospective Cohort Analysis of Real-World Data in England

Stephanie A. Kujawski, Victoria Banks, Caroline S. Casey, Simon B. Drysdale, Amisha Patel, Olivia Massey, Tim Holbrook, Manjiri Pawaskar

Summary: This study investigated the antibiotic use for varicella and its complications in a pediatric population in England. The results showed a significant proportion of patients with varicella-related complications were prescribed antibiotics.

Article Immunology

A Questionnaire-based Study Exploring Participant Perspectives in a Perinatal Human Challenge Trial

James H. J. Bevan, Anastasia A. Theodosiou, James Corner, Robert B. Dorey, Robert C. Read, Christine E. Jones

Summary: This study investigated the motivations, concerns, and experiences of healthy pregnant women participating in human challenge research. The results showed that participants were primarily motivated by altruism and perceived the research intervention as natural. Therefore, the involvement of healthy pregnant women in human challenge research is acceptable and feasible.

Article Materials Science, Composites

Friction and wear characteristics of Furcraea foetida fiber-reinforced epoxy composites

Haja Syed Hussain, Mohd Ridzuan Mohd Jamir, Mohd Shukry Abdul Majid, S. M. Sapuan, Ferriawan Yudhanto, Aris Widyo Nugroho, Muhammad Faiz Hilmi Rani

Summary: In this study, the friction and wear properties of Furcraea foetida fiber-reinforced epoxy composites were investigated. The effect of fiber content on the tribological behavior of the composites was evaluated. The results showed that the composite with 50 vol% of fibers had the lowest frictional force and coefficient of friction (COF), while the composite with 60 vol% demonstrated the best wear resistance. This study provides valuable insights into the tribological behavior of the composites and identifies the optimal volume fractions for improved friction and wear performance.