Showing papers by "Barbara J. Stoll published in 2002"
Emory University1, Research Triangle Park2, Case Western Reserve University3, National Institutes of Health4, University of Alabama at Birmingham5, Yale University6, Indiana University7, University of Cincinnati8, Boston Children's Hospital9, University of Texas Health Science Center at Houston10, Brown University11, University of Miami12, University of Tennessee Health Science Center13, Wayne State University14, University of Texas Southwestern Medical Center15, Stanford University16, University of New Mexico17
TL;DR: Infants who developed late-onset sepsis had a significantly prolonged hospital stay and were significantly more likely to die than those who were uninfected, especially if they were infected with Gram-negative organisms or fungi.
Abstract: Objective. Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 6956 VLBW (401–1500 g) neonates admitted to the clinical centers of the National Institute of Child Health and Human Development Neonatal Research Network over a 2-year period (1998–2000). Methods. The National Institute of Child Health and Human Development Neonatal Research Network maintains a prospective registry of all VLBW neonates admitted to participating centers within 14 days of birth. Expanded infection surveillance was added in 1998. Results. Of 6215 infants who survived beyond 3 days, 1313 (21%) had 1 or more episodes of blood culture-proven late-onset sepsis. The vast majority of infections (70%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 48% of infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of late-onset sepsis included patent ductus arteriosus, prolonged ventilation, prolonged intravascular access, bronchopulmonary dysplasia, and necrotizing enterocolitis. Infants who developed late-onset sepsis had a significantly prolonged hospital stay (mean length of stay: 79 vs 60 days). They were significantly more likely to die than those who were uninfected (18% vs 7%), especially if they were infected with Gram-negative organisms (36%) or fungi (32%). Conclusions. Late-onset sepsis remains an important risk factor for death among VLBW preterm infants and for prolonged hospital stay among VLBW survivors. Strategies to reduce late-onset sepsis and its medical, social, and economic toll need to be addressed urgently.
2,102 citations
Emory University1, RTI International2, Case Western Reserve University3, National Institutes of Health4, University of Alabama5, Yale University6, Indiana University – Purdue University Indianapolis7, University of Cincinnati8, Harvard University9, University of Texas at Austin10, University of Miami11, University of Tennessee Health Science Center12, Wayne State University13, Stanford University14, University of New Mexico15
TL;DR: Early-onset sepsis remains an uncommon but potentially lethal problem among very-low-birth-weight infants, and the change in pathogens over time from predominantly gram-positive to predominantly Gram-negative requires confirmation by ongoing surveillance.
Abstract: Background It is uncertain whether the rates and causes of early-onset sepsis (that occurring within 72 hours after birth) among very-low-birth-weight infants have changed in recent years, since antibiotics have begun to be used more widely during labor and delivery. Methods We studied 5447 very-low-birth-weight infants (those weighing between 401 and 1500 g) born at centers of the Neonatal Research Network of the National Institute of Child Health and Human Development between 1998 and 2000 who had at least one blood culture in the first three days of life and compared them with 7606 very-low-birth-weight infants born at centers in the network between 1991 and 1993. Results Early-onset sepsis (as confirmed by positive blood cultures) was present in 84 infants in the more recent birth cohort (1.5 percent). As compared with the earlier birth cohort, there was a marked reduction in group B streptococcal sepsis (from 5.9 to 1.7 per 1000 live births of infants weighing 401 to 1500 g, P<0.001) and an increase ...
708 citations
Wayne State University1, University of Texas Southwestern Medical Center2, National Institutes of Health3, Yale University4, University of Cincinnati5, Case Western Reserve University6, Brigham and Women's Hospital7, University of Texas Health Science Center at Houston8, Research Triangle Park9, University of Alabama at Birmingham10, Indiana University11, Emory University12, University of New Mexico13, University of Miami14, Stanford University15, University of Tennessee Health Science Center16
TL;DR: Animal studies showed that a simple modification of a commercially available cooling system results in stable core body and brain temperature when used in the automatic control mode and demonstrates feasibility of initiating whole-body hypothermia at <6 hours of age to a constant esophageal temperature using servo control.
Abstract: OBJECTIVE: Modest reduction in brain temperature is a promising therapy to reduce brain damage after neonatal encephalopathy as a result of acute perinatal asphyxia. The efficacy of modest hypothermia may in part be dependent on the stability of the desired brain temperature. The objective of this study was 1) to evaluate in newborn animals a commercially available cooling system (Blanketrol II Hyperthermia-Hypothermia system) to control brain temperature during whole-body hypothermia and 2) to use the results of the animal experiments to perform a pilot study evaluating the feasibility of whole-body hypothermia as a neuroprotective therapy for newborns with encephalopathy at birth. METHODS: In the animal investigation, 3 miniature swine were instrumented and ventilated, and temperature probes were placed in the esophagus and the brain (1 cm and 2 cm beneath the parietal cortical surface and the dura). Body cooling was achieved using the automatic control mode (servo) of the cooling system. In the human investigation, 19 term infants with moderate or severe encephalopathy were randomized to either normothermia (n = 10) or hypothermia (n = 9) within 6 hours of birth. Whole-body hypothermia was achieved using the hyperthermia-hypothermia cooling system with servo control of esophageal temperature to 34.5 degrees C for 72 hours followed by slow rewarming. RESULTS: In the animal investigation, body cooling with the animal lying on a single blanket resulted in rapid cooling of the body within 90 minutes. Repetitive cyclical swings in esophageal temperature of 1.7 +/- 0.2 degrees C (mean +/- standard deviation) around the set point of 33.5 degrees C were reduced to 0.7 +/- 0.2 degrees C when a second, larger blanket was attached and suspended. Esophageal temperature was a good marker of deep brain temperature (esophageal to 2-cm brain difference: 0.1 +/- 0.3 degrees C). In the human investigation, the infants were randomized at 4.1 +/- 1.3 hours (mean +/- standard deviation) after birth. Age at randomization was similar in the 2 groups. Cooling was initiated at an average age of 5.3 hours. Target temperature of 34.5 degrees C was achieved within 30 minutes and remained constant throughout the intervention period. Heart rate decreased to 108 +/- 14 beats per minute (bpm) at 60 minutes and remained between 115 and 130 bpm for the duration of cooling compared with 130 to 145 bpm in the normothermia group. Blood pressure was similar in the 2 groups. No adverse events occurred during 72 hours of cooling. The mortality rate and frequency of persistent pulmonary hypertension, renal failure, hepatic dysfunction, and need for pressor support were similar in both groups. CONCLUSIONS: Animal studies showed that a simple modification of a commercially available cooling system (2 blankets attached, subject lying on 1 and the second hanging freely) results in stable core body and brain temperature when used in the automatic control mode. The pilot study in term infants with encephalopathy using this cooling system demonstrates feasibility of initiating whole-body hypothermia at <6 hours of age to a constant esophageal temperature using servo control and provides no evidence that hypothermia involved greater hazard than benefit.
235 citations
TL;DR: With the sample size studied, minimal ventilation did not reduce the incidence of death or BPD, and the reduced ventilator support at 36 weeks in the minimal ventilation group warrants further study of this intervention.
186 citations
TL;DR: Effective strategies to prevent nosocomial infection must include continuous monitoring and surveillance of infection rates and distribution of pathogens; strategic nursery design and staffing; emphasis on handwashing compliance; minimizing central venous catheter use and contamination, and prudent use of antimicrobial agents.
Abstract: Nosocomial infections are responsible for significant morbidity and late mortality among neonatal intensive care unit patients. The number of neonatal patients at risk for acquiring nosocomial infections is increasing because of the improved survival of very low birthweight infants and their need for invasive monitoring and supportive care. Effective strategies to prevent nosocomial infection must include continuous monitoring and surveillance of infection rates and distribution of pathogens; strategic nursery design and staffing; emphasis on handwashing compliance; minimizing central venous catheter use and contamination, and prudent use of antimicrobial agents. Educational programs and feedback to nursery personnel improve compliance with infection control programs.
126 citations
Wayne State University1, Case Western Reserve University2, National Institutes of Health3, Stanford University4, University of Cincinnati5, Yale University6, RTI International7, Research Triangle Park8, University of Texas Southwestern Medical Center9, Emory University10, University of Miami11, Indiana University12, University of New Mexico13
TL;DR: Early death (<12 hours of age) among extremely low-birth-weight infants may reflect an assessment of non-viability by obstetricians and neonatologists.
118 citations
TL;DR: The nutritional support of gastrointestinal growth and function is an important consideration in the clinical care of neonatal infants and the emergence of GLP-2 as a trophic peptide that seems to target the gut is a promising candidate on the horizon.
104 citations
TL;DR: In the total cohort of 436 infants, the presence of intracranial hemorrhage or periventricular leukomalacia was associated with lower mental developmental index and psychomotor developmental index scores; the presenceof increasing birth weight, maternal education, and a complete course of antenatal steroids was associatedwith a higher mental developmentalIndex score.
38 citations