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Fjalstad JW, Laukli E, van den Anker JN, Klingenberg C. High-dose gentamicin in newborn infants: is it safe? Eur J Pediatr 2013; 173:489-495. [PMID: 24233331 DOI: 10.1007/s00431-013-2194-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/21/2013] [Indexed: 12/17/2022]
Abstract
Dosing regimens often recommend lower gentamicin doses in neonates (3-5 mg/kg) than in older children (7 mg/kg or more) despite the higher volume of distribution in neonates. We studied an extended-interval high-dose (6 mg/kg) gentamicin regimen in a single tertiary neonatal unit from 2004-2012. During the first week of life, dosing interval was 24 h for term infants, 36 h for preterm infants with gestational age (GA) 29-36 weeks and 48 h for preterm infants with GA <29 weeks. After the first week of life, dosing interval was 24 h if corrected age (GA + postnatal age) ≥29 weeks and 36 h if corrected age <29 weeks. Outcome measures were trough plasma concentration (TPC), ototoxicity and prescription errors. In 546 treatment episodes, TPC was measured prior to the third gentamicin dose. There were 37 episodes (6.7 %) of prescription errors, mainly a too long dosing interval. We included 509 treatment episodes (440 infants) in the final analysis. Mean (standard deviation) gentamicin TPC during the first week of life was 1.1 (0.5) mg/L and after the first week of life 0.8 (0.6) mg/L. In 31 (6 %) episodes, TPC was ≥2.0 mg/L, predominantly among term infants with renal impairment. Thirty-eight patients failed the neonatal hearing screening, but only four of these 38 had permanent hearing loss. All four had a TPC <2.0 mg/L. Conclusions: This extended-interval high-dose gentamicin regimen was associated with low numbers of elevated TPCs, low numbers of prescription errors and no evidence for ototoxicity.
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Hooper SB, Fouras A, Siew ML, Wallace MJ, Kitchen MJ, Te Pas AB, Klingenberg C, Lewis RA, Davis PG, Morley CJ, Schmölzer GM. Correction: Expired CO2 Levels Indicate Degree of Lung Aeration at Birth. PLoS One 2013; 8. [PMID: 29220834 PMCID: PMC5729724 DOI: 10.1371/annotation/44f67041-2f8e-42df-826a-82172ae05a22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0070895.].
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Hooper SB, Fouras A, Siew ML, Wallace MJ, Kitchen MJ, te Pas AB, Klingenberg C, Lewis RA, Davis PG, Morley CJ, Schmölzer GM. Expired CO2 levels indicate degree of lung aeration at birth. PLoS One 2013; 8:e70895. [PMID: 23951032 PMCID: PMC3741323 DOI: 10.1371/journal.pone.0070895] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/24/2013] [Indexed: 11/18/2022] Open
Abstract
As neonatal resuscitation critically depends upon lung aeration at birth, knowledge of the progression of this process is required to guide ongoing care. We investigated whether expired CO2 (ECO2) levels indicate the degree of lung aeration immediately after birth in two animal models and in preterm infants. Lambs were delivered by caesarean section and ventilated from birth. In lambs, ECO2 levels were significantly (p<0.0001) related to tidal volumes and CO2 clearance/breath increased exponentially when tidal volumes were greater than 6 mL/kg. Preterm (28 days of gestation; term = 32 days) rabbits were also delivered by caesarean section and lung aeration was measured using phase contrast X-ray imaging. In rabbit kittens, ECO2 levels were closely related (p<0.001) to lung volumes at end-inflation and were first detected when ∼7% of the distal lung regions were aerated. ECO2 levels in preterm infants at birth also correlated with tidal volumes. In each infant, ECO2 levels increased to >10 mmHg 28 (median) (21–36) seconds before the heart rate increased above 100 beats per minute. These data demonstrate that ECO2 levels can indicate the relative degree of lung aeration after birth and can be used to clinically assess ventilation in the immediate newborn period.
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Klingenberg C, Olomi R, Oneko M, Sam N, Langeland N. Neonatal morbidity and mortality in a Tanzanian tertiary care referral hospital. ACTA ACUST UNITED AC 2013; 23:293-9. [PMID: 14738577 DOI: 10.1179/027249303225007806] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In developing countries, neonatal mortality accounts for 50-70% of infant mortality. The purpose of this study was to describe morbidity and mortality patterns, with a focus on neonatal infections, in a Tanzanian special care baby unit (SCBU). During a 3-month period, 246 consecutive admissions to the SCBU at Kilimanjaro Christian Medical Centre were audited. Prematurity, low birthweight and suspected infection accounted for 61% of all admissions. The overall mortality rate was 19%, but varied considerably according to gestational age, birthweight and diagnosis. Thirty-one neonates (two-thirds of all deaths) died during the 1st 24 hours of life. Of 27 infants admitted on grounds of perinatal asphyxia, 11 (41%) died, and, of 19 infants with a gestational age <31 weeks, 13 (68%) died. More than two-thirds of all infants were treated with antibiotics. Septicaemia confirmed by blood culture was found in 16 cases. The susceptibility pattern of bacterial isolates did not indicate high rates of resistance to commonly used antibacterial agents. A reduction in the number of preterm deliveries and improved perinatal care to avoid and treat perinatal asphyxia would be the two most important measures in reducing neonatal mortality in this setting.
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Cavanagh JP, Granslo HN, Fredheim EA, Christophersen L, Jensen PO, Thomsen K, Van Gennip M, Klingenberg C, Flaegstad T, Moser C. Efficacy of a synthetic antimicrobial peptidomimetic versus vancomycin in a Staphylococcus epidermidis device-related murine peritonitis model. J Antimicrob Chemother 2013; 68:2106-10. [DOI: 10.1093/jac/dkt161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Klingenberg C, Sobotka KS, Ong T, Allison BJ, Schmölzer GM, Moss TJM, Polglase GR, Dawson JA, Davis PG, Hooper SB. Effect of sustained inflation duration; resuscitation of near-term asphyxiated lambs. Arch Dis Child Fetal Neonatal Ed 2013; 98:F222-7. [PMID: 22782994 DOI: 10.1136/archdischild-2012-301787] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The 2010 ILCOR neonatal resuscitation guidelines do not specify appropriate inflation times for the initial lung inflations in apnoeic newborn infants. The authors compared three ventilation strategies immediately after delivery in asphyxiated newborn lambs. DESIGN Experimental animal study. SETTING Facility for animal research. SUBJECTS Eighteen near-term lambs (weight 3.5-3.9 kg) delivered by caesarean section. INTERVENTIONS Asphyxia was induced by occluding the umbilical cord and delaying ventilation onset (10-11 min) until mean carotid blood pressure (CBP) was ≤22 mm Hg. Animals were divided into three groups (n=6) and ventilation started with: (1) inflation times of 0.5 s at a ventilation rate 60/min, (2) five 3 s inflations or (3) a single 30 s inflation. Subsequent ventilation used inflations at 0.5 s at 60/min for all groups. MAIN OUTCOME MEASURES Times to reach a heart rate (HR) of 120 bpm and a mean CBP of 40 mm Hg. Secondary outcome was change in lung compliance. RESULTS Median time to reach HR 120 bpm and mean CBP 40 mm Hg was significantly shorter in the single 30 s inflation group (8 s and 74 s) versus the 5×3 s inflation group (38 s and 466 s) and the conventional ventilation group (64 s and 264 s). Lung compliance was significantly better in the single 30 s inflation group. CONCLUSION A single sustained inflation of 30 s immediately after birth improved speed of circulatory recovery and lung compliance in near-term asphyxiated lambs. This approach for neonatal resuscitation merits further investigation.
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Stabell N, Klingenberg C, Rushfeldt C. Duodenal perforation in an infant with rotavirus gastroenteritis. BMJ Case Rep 2013; 2013:bcr-2012-008421. [PMID: 23592811 DOI: 10.1136/bcr-2012-008421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe for the first time a case of an infant with rotavirus gastroenteritis complicated by a duodenal perforation. Awareness of the perforation risk may prevent severe or lethal outcomes in this common infection among infants and children.
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Cavanagh JP, Klingenberg C, Hanssen AM, Fredheim EA, Francois P, Schrenzel J, Flægstad T, Sollid JE. Core genome conservation of Staphylococcus haemolyticus limits sequence based population structure analysis. J Microbiol Methods 2012; 89:159-66. [DOI: 10.1016/j.mimet.2012.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/23/2012] [Accepted: 03/23/2012] [Indexed: 10/28/2022]
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Fredheim EGA, Granslo HN, Flægstad T, Figenschau Y, Rohde H, Sadovskaya I, Mollnes TE, Klingenberg C. Staphylococcus epidermidis polysaccharide intercellular adhesin activates complement. ACTA ACUST UNITED AC 2012; 63:269-80. [PMID: 22077230 DOI: 10.1111/j.1574-695x.2011.00854.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Staphylococcus epidermidis is a frequent cause of nosocomial infections. The central virulence factor of S. epidermidis is biofilm formation. Polysaccharide intercellular adhesin (PIA) constitutes the major biofilm matrix-component. PIA and biofilm have been implicated in S. epidermidis evasion of host immune defence. We examined the effects of S. epidermidis PIA on the inflammatory response with focus on complement activation. We used a human whole-blood ex vivo model of infection and compared the effects of a PIA-positive S. epidermidis strain (SE1457) and its PIA-negative isogenic mutant (M10). The independent effect of purified PIA on complement activation was investigated. In glucose-rich media, the mutant formed a proteinacious DNA-rich biofilm, whereas SE1457 formed a thick PIA-biofilm. In biofilm growth, SE1457 induced a stronger activation of the complement system compared with M10. We verified that purified PIA was independently responsible for a strong activation of the complement system. In contrast, M10 induced higher granulocyte activation by expression of CD11b and higher secretion of cytokines. We conclude that PIA has potent pro-inflammatory properties by activating the complement system. However, in a complex balance of the immune response, the decreased activation of granulocytes and cytokines by a PIA biofilm may limit host eradication of S. epidermidis.
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Klingenberg C, Embleton ND, Jacobs SE, O'Connell LAF, Kuschel CA. Enteral feeding practices in very preterm infants: an international survey. Arch Dis Child Fetal Neonatal Ed 2012; 97:F56-61. [PMID: 21856644 DOI: 10.1136/adc.2010.204123] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate enteral feeding practices in neonatal units in different countries and on different continents. DESIGN A web-based survey of 127 tertiary neonatal intensive care units in Australia, Canada, Denmark, Ireland, New Zealand, Norway, Sweden and the UK. RESULTS 124 units (98%) responded. 59 units (48%) had a breast milk bank or access to donor human milk (Australia/New Zealand 2/27, Canada 6/29, Scandinavia 20/20 and UK/Ireland 31/48). The proportion of units initiating enteral feeding within the first 24 h of life was: 43/124 (35%) if gestational age (GA) <25 weeks, 53/124 (43%) if GA 25-27 weeks and 88/124 (71%) if GA 28-31 weeks. In general, Scandinavian units introduced enteral feeds the earliest, followed by UK/Ireland. Continuous feeding was routinely used for infants below 28 weeks' gestation in almost half of the Scandinavian units and in approximately one sixth of units in UK/Ireland, but rarely in Australia/New Zealand and Canada. Minimal enteral feeding for 4-5 days was common in Canada, but rare in Scandinavia. Target enteral feeding volume in a 'stable' preterm infant was 140-160 ml/kg/day in most Canadian units and 161-180 ml/kg/day or higher in units in the other regions. There were also marked regional differences in criteria for use and timing when human milk fortifier was added. CONCLUSIONS This study highlights areas of uncertainty and demonstrates marked variability in feeding practices. It provides valuable data for planning collaborative feeding trials to optimise outcome in preterm infants.
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Klingenberg C, Wheeler KI, Owen LS, Kaaresen PI, Davis PG. An international survey of volume-targeted neonatal ventilation. Arch Dis Child Fetal Neonatal Ed 2011; 96:F146-8. [PMID: 20584800 DOI: 10.1136/adc.2009.181081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate clinical practice of volume-targeted ventilation (VTV). DESIGN Internet-based survey of all 50 tertiary neonatal units in Australia, New Zealand, Sweden, Denmark, Finland and Norway. RESULTS Response rate was 100%. VTV was routinely used in 25 (50%) units; 15/25 (60%) in Australasia and 10/25 (40%) in the Nordic countries. The most common reason given for using VTV was that it reduces bronchopulmonary dysplasia (13/25; 52%). The median (IQR) of upper limits of target tidal volume were (1) for initial ventilation of preterm infants with respiratory distress syndrome 5.0 (4.6-6.0) ml/kg and (2) for infants with ventilator-dependent bronchopulmonary dysplasia 6.0 (5.0-8.0) ml/kg. The median (IQR) maximum peak inspiratory pressure limit units were prepared to use in VTV-mode was 35 (30-42.5) cm H(2)O. CONCLUSION Half of the units used VTV routinely, but with a considerable variation in VTV practice. More studies are required to establish best VTV practice.
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Klingenberg C, Dawson JA, Gerber A, Kamlin COF, Davis PG, Morley CJ. Sustained inflations: comparing three neonatal resuscitation devices. Neonatology 2011; 100:78-84. [PMID: 21273792 DOI: 10.1159/000322983] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 11/18/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Some national resuscitation guidelines advocate using sustained initial inflations (2-3 s) for babies requiring resuscitation. Inflation times ≥10 s have been used for preterm infants. OBJECTIVES This study examines the ability of operators of varying experience to provide a sustained inflation using three different manual ventilation devices. METHODS We compared a self-inflating bag, a flow-inflating bag and a pressure-limited T-piece device. Fifty clinical staff members from five professional groups gave a sustained inflation with a target peak pressure of 30 cm H2O and target duration of 10 s to an internal leak-free manikin. We measured peak inflating pressure (PIP) and mean inflating pressure (MIP) during the sustained inflation, and the duration of inflating pressure (IP) >20 and 25 cm H2O. RESULTS Median (IQR) duration of IP >25 cm H2O was: self-inflating bag 2.5 s (0.8-5.7), flow-inflating bag 10.6 s (8.4-12.9) and the T-piece 10.7 s (8.9-11.9). There was a weak correlation between experience using a self-inflating bag and longer inflation times (R = 0.290, p = 0.041). When compared with the T-piece, the flow-inflating bag had lower mean MIP (27.0 ± 1.8 vs. 28.8 ± 2.0 cm H2O) and higher mean PIP (32.3 ± 3.7 vs. 29.8 ± 1.8 cm H2O). There were no differences in performance between operator groups. CONCLUSION The T-piece provided consistent PIP during a single 10 s sustained inflation with less variation in pressure compared with the flow-inflating bag. Sustained inflations >3 s were difficult to achieve with a self-inflating bag.
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Wheeler KI, Klingenberg C, Morley CJ, Davis PG. Volume-targeted versus pressure-limited ventilation for preterm infants: a systematic review and meta-analysis. Neonatology 2011; 100:219-27. [PMID: 21701210 DOI: 10.1159/000326080] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 02/14/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The causes of bronchopulmonary dysplasia (BPD) are multifactorial. Overdistension of the lung (volutrauma) is considered an important contribution. As an alternative to traditional pressure-limited ventilation (PLV), modern neonatal ventilators offer modes which can target a set tidal volume. OBJECTIVES To determine whether volume-targeted neonatal ventilation, compared with PLV, reduces death or BPD. METHODS We performed a systematic review and meta-analysis using the methodology of the Neonatal Review Group of the Cochrane Collaboration. A comprehensive literature search was undertaken, and data for prespecified outcomes were combined where appropriate using the fixed effects model. RESULTS Nine trials were eligible. Volume-targeted ventilation resulted in a reduction in: the combined outcome of death or BPD [typical relative risk, RR, 0.73 (95% confidence interval, 0.57-0.93), numbers needed to treat, NNT, 8 (95% CI 5-33)], the incidence of pneumothorax [typical RR 0.46 (95% CI 0.25-0.84), NNT 17 (95% CI 10-100)], days of ventilation [weighted mean difference 0.8 days (log-transformed data, p = 0.05)], hypocarbia (pCO(2) <35 mm Hg/4.7 kPa); [typical RR 0.56 (95% CI 0.33-0.96), NNT 4 (95% CI 2-25)], and the combined outcome of periventricular leukomalacia or grade 3-4 intraventricular hemorrhage [typical RR 0.48 (95% CI 0.28-0.84), NNT 11 (95% CI 7-50)]. CONCLUSIONS Compared with PLV, infants ventilated using volume-targeted ventilation had reduced death/BPD, duration of ventilation, pneumothoraces, hypocarbia and periventricular leukomalacia/severe intraventricular hemorrhage. Further studies are needed to assess neurodevelopmental outcomes.
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Wheeler K, Klingenberg C, McCallion N, Morley CJ, Davis PG. Volume-targeted versus pressure-limited ventilation in the neonate. Cochrane Database Syst Rev 2010:CD003666. [PMID: 21069677 DOI: 10.1002/14651858.cd003666.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Damage caused by lung overdistension (volutrauma) has been implicated in the development bronchopulmonary dysplasia (BPD). Modern neonatal ventilation modes can target a set tidal volume as an alternative to traditional pressure-limited ventilation using a fixed inflation pressure. Volume targeting aims to produce a more stable tidal volume in order to reduce lung damage and stabilise pCO(2) OBJECTIVES To determine whether volume-targeted ventilation (VTV) compared with pressure-limited ventilation (PLV) leads to reduced rates of death and BPD in newborn infants. Secondary objectives were to determine whether use of VTV affected outcomes including air leak, cranial ultrasound findings and neurodevelopment. SEARCH STRATEGY The search strategy comprised searches of the Cochrane Central Register of Controlled Trials, MEDLINE PubMed 1966 to January 2010, and hand searches of reference lists of relevant articles and conference proceedings. SELECTION CRITERIA All randomised and quasi-randomised trials comparing the use of volume-targeted versus pressure-limited ventilation in infants of less than 28 days corrected age. DATA COLLECTION AND ANALYSIS Two review authors assessed the methodological quality of eligible trials and extracted data independently. When appropriate, meta-analysis was conducted to provide a pooled estimate of effect. For categorical data the relative risk (RR) and risk difference (RD) were calculated with 95% confidence intervals. Number needed to treat was calculated when RD was statistically significant. Continuous data were analysed using weighted mean difference. MAIN RESULTS Twelve randomised trials met our inclusion criteria; nine parallel trials (629 infants) and three crossover trials (64 infants).The use of VTV modes resulted in a reduction in the combined outcome of death or bronchopulmonary dysplasia [typical RR 0.73 (95% CI 0.57 to 0.93), NNT8 (95% CI 5 to 33)]. VTV modes also resulted in reductions in pneumothorax [typical RR 0.46 (95% CI 0.25 to 0.84), NNT 17 (95% CI 10 to 100)], days of ventilation [MD -2.36 (95% CI -3.9 to -0.8)], hypocarbia [typical RR 0.56 (95%CI 0.33 to 0.96), NNT 4 (95% CI 2 to 25)] and the combined outcome of periventricular leukomalacia or grade 3-4 intraventricular haemorrhage [typical RR 0.48 (95% CI 0.28 to 0.84), NNT 11 (95% CI 7 to 50)]. AUTHORS' CONCLUSIONS Infants ventilated using VTV modes had reduced death and chronic lung disease compared with infants ventilated using PLV modes. Further studies are needed to identify whether VTV modes improve neurodevelopmental outcomes and to compare and refine VTV strategies.
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Granslo HN, Klingenberg C, Fredheim EGA, Rønnestad A, Mollnes TE, Flaegstad T. Arginine catabolic mobile element is associated with low antibiotic resistance and low pathogenicity in Staphylococcus epidermidis from neonates. Pediatr Res 2010; 68:237-41. [PMID: 20703143 DOI: 10.1203/pdr.0b013e3181eb01e0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The arginine catabolic mobile element (ACME) in Staphylococci encodes several putative virulence factors. ACME appears to have been transferred from Staphylococcus epidermidis into Staphylococcus aureus and is strongly associated with the epidemic and virulent S. aureus USA300. We sought to determine the distribution of ACME in 128 S. epidermidis blood culture isolates from neonates and to assess ACME's impact on antibiotic resistance, biofilm production, invasive capacity, and host inflammatory response. ACME was detected in 15/64 (23%) invasive blood culture isolates and 26/64 (40%) blood culture contaminants (p = 0.02). ACME-positive S. epidermidis isolates displayed less antibiotic resistance (p < 0.001) and were collected from more mature neonates (p = 0.001). Biofilm production was more prevalent among ACME-negative isolates (61/87) compared with ACME positive (18/41; p = 0.004). Among the 64 children considered having an invasive infection, ACME did not influence the maximum C-reactive protein level. In an in vitro whole-blood sepsis model, there were no differences in the inflammatory response between ACME-positive and ACME-negative isolates. We conclude that ACME in S. epidermidis from neonates was associated with less antibiotic resistance and also does not seem to be associated with increased pathogenicity.
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Sitras V, Raatiniemi L, Larsby K, Klingenberg C. Cardiopulmonary Collapse during Labour. Anesthesiol Res Pract 2010; 2010:707619. [PMID: 20811590 PMCID: PMC2929490 DOI: 10.1155/2010/707619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 05/18/2010] [Accepted: 06/28/2010] [Indexed: 11/17/2022] Open
Abstract
Cardiopulmonary collapse during labour is a catastrophic event caused by various medical, surgical and obstetrical conditions. It is an emergency that threatens the life of the mother and her unborn child. We present a case of a pregnant woman who suffered from preeclampsia and underwent induction of labour. Severe lung edema occurred early in labour that caused cardiopulmonary collapse. Advanced heart-lung resuscitation was established immediately and continued until an emergency cesarean section was performed few minutes later. The outcome was favourable for both mother and child. We further discuss some aspects of the pathophysiology and appropriate treatment of cardiorespiratory arrest during labour, which involves the coordinated action of the obstetric, pediatric and surgical ward personnel.
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Fry AE, Klingenberg C, Matthes J, Heimdal K, Hennekam RCM, Pilz DT. Connective tissue involvement in two patients with features of cranioectodermal dysplasia. Am J Med Genet A 2009; 149A:2212-5. [PMID: 19760620 DOI: 10.1002/ajmg.a.33027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cranioectodermal dysplasia (CED) is an infrequently described autosomal recessive disorder characterized by craniofacial, ectodermal and skeletal abnormalities, and associated with increased risk of chronic renal failure. A degree of joint laxity has been noted in some CED patients, but significant skin and soft-tissue laxity has not previously been highlighted as part of the syndrome. We report on two unrelated patients with CED and significant connective tissue involvement, including cutis laxa, hernias, and joint laxity. We conclude with a brief discussion of the differential diagnosis.
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Klingenberg C, Småbrekke L, Døllner H, Simonsen G. Peroral antibiotikabehandling av urinveisinfeksjon hos barn. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:1342-4. [DOI: 10.4045/tidsskr.09.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Granslo H, Gammelsrud KW, Fredheim EA, Flaegstad T, Klingenberg C. [Coagulase-negative staphylococci--biofilm and antibiotic resistance]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2008; 128:2746-2749. [PMID: 19079425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Coagulase-negative staphylococci (CoNS) may cause serious infections in immunocompromized patients. CoNS often display multiresistance to antibiotics, and biofilm production is the central virulence factor. Our aim was to investigate these factors in CoNS that colonize children with an increased risk of CoNS infections. MATERIAL AND METHOD We collected CoNS isolates from intravasal catheters (n = 19) and the skin (n = 47) from 30 hospitalized neonates, and CoNS skin isolates from 20 children with cancer before (n = 20) and after (n = 18) six months of cancer treatment. We analyzed antibiotic resistance and biofilm production with phenotypic methods. We used PCR to detect genes that encode antibiotic resistance and biofilm formation. RESULTS 11 of 19 (58 %) catheter isolates and 14 of 47 (30 %) skin isolates (p = 0.04) produced biofilm. We found an increasing prevalence of oxacillin resistance (20 % versus 67 %, p = 0.004) and gentamicin resistance (15 % versus 67 %, p = 0.003) after six months of cancer treatment. Biofilm positive CoNS isolates displayed higher levels of antibiotic resistance than biofilm-negative isolates. INTERPRETATION Our results indicate that sick neonates and children hospitalized with cancer are colonized with pathogenic CoNS strains demonstrating virulence- and antibiotic-resistance patterns that are different from those found in CoNS in healthy people who are not hospitalized.
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Flemming K, Klingenberg C, Cavanagh JP, Sletteng M, Stensen W, Svendsen JS, Flaegstad T. High in vitro antimicrobial activity of synthetic antimicrobial peptidomimetics against staphylococcal biofilms. J Antimicrob Chemother 2008; 63:136-45. [PMID: 19010828 DOI: 10.1093/jac/dkn464] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of the study was to investigate the antimicrobial effect of different antibiotics and synthetic antimicrobial peptidomimetics (SAMPs) on staphylococcal biofilms. METHODS Biofilms of six staphylococcal strains (two Staphylococcus haemolyticus, two Staphylococcus epidermidis and two Staphylococcus aureus isolates) were grown for 24 h in microtitre plates. They were washed and treated for 24 h with different concentrations of linezolid, tetracycline, rifampicin and vancomycin and four different SAMPs. After treatment, the redox indicator Alamar Blue was used to quantify metabolic activity of bacteria in biofilms, and confocal laser scanning microscopy with LIVE/DEAD staining was used to further elucidate any effects. RESULTS At MIC levels, rifampicin and tetracycline showed a marked reduction of metabolic activity in the S. epidermidis and S. haemolyticus biofilm. Linezolid had a moderate effect and vancomycin had a poor effect. MIC x10 and MIC x100 improved the antimicrobial activity of all antibiotics, especially vancomycin. However, metabolic activity was not completely suppressed in strong biofilm-producing strains. At MIC x10, the three most effective SAMPs (Ltx5, Ltx9 and Ltx10) were able to completely eliminate metabolic activity in the S. epidermidis and S. haemolyticus biofilms, which was also confirmed by complete cell death using confocal laser scanning microscopy investigations. Although none of the Ltx SAMPs could fully suppress metabolic activity in the S. aureus biofilm, their effect was superior to all tested antibiotics. CONCLUSIONS SAMPs had superior antimicrobial activity in staphylococcal biofilms compared with conventional antibiotics and are potential new therapeutic agents for biofilm-associated infections.
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Stabell N, Nordal E, Stensvold E, Gammelsrud KW, Lund B, Taxt A, Buhring F, Greve-Isdahl M, Fornebo HP, Simonsen GS, Klingenberg C. Febrile neutropenia in children with cancer: a retrospective Norwegian multicentre study of clinical and microbiological outcome. ACTA ACUST UNITED AC 2008; 40:301-7. [PMID: 17918015 DOI: 10.1080/00365540701670436] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Our objective was to describe clinical and laboratory characteristics, treatment and outcome among Norwegian children with cancer suffering from chemotherapy-induced febrile neutropenia (FN). We retrospectively reviewed data on paediatric FN episodes in 7 Norwegian hospitals during a 2.5-y period. A total of 236 episodes of FN occurred in 95 children. Acute lymphoblastic leukaemia was the most common diagnosis (49 patients). Blood cultures yielded growth in 39 episodes (17%). Primary empirical antibiotic regimens could be assigned to 2 main groups: 1) benzylpenicillin or ampicillin and an aminoglycoside (58%) or 2) a regimen based on third-generation cephalosporins (42%). There were no statistically significant differences in outcome between the 2 regimens in terms of need to change initial antibiotic treatment, d of fever or maximum C-reactive protein values. One infection-related death (fungal septicaemia) occurred during the study period. We conclude that incidence of septicaemia and clinical outcome is similar to recent international trials on paediatric FN, but antibiotic treatment in Norway differs from international guidelines. However, patients in our study were successfully and safely treated, irrespective of the primary empirical antibiotic regimen.
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Klingenberg C, Andersen WH. [The CHARGE syndrome]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2008; 128:1401-1405. [PMID: 18552902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND CHARGE syndrome is a rare congenital condition with multiple malformations. The acronym CHARGE summarizes six cardinal features: Coloboma, Heart defect, Atresia choanae, Retarded growth and development, Genital anomalies and Ear anomalies/deafness. Our aim is to present an update on clinical presentation, genetics and behavioural aspects in the CHARGE syndrome. Furthermore, we give recommendations regarding multidisciplinary management. MATERIAL AND METHOD The article is based on selected references retrieved from PubMed and the authors' own experience in following this patient group. RESULTS AND INTERPRETATION The CHARGE syndrome has an estimated incidence of 1 : 10 000. About 60 % of the patients have mutations in a recently characterized gene ( CHD7: ). C: oloboma, C: hoanal atresia and abnormal semicircular C:anals (3C-triad) are the most specific malformations. Serious cardiovascular and respiratory tract malformations also occur frequently and may be life-threatening, especially in the first year of life. Multiple cranial nerve dysfunctions affect sense of smell, swallowing, facial palsy and sensorineural hearing loss. CHARGE syndrome is recognized as one of the most common causes of dual sensory impairment (vision and hearing). Mental retardation is common, but a substantial group of patients only have limited intellectual impairment. Some patients have a distinct behavioural profile and specific cognitive problems. Coordinated multidisciplinary medical follow-up is needed. The combined sensory loss may render the rehabilitation offered for deaf and blind useful for these patients.
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Francois P, Hochmann A, Huyghe A, Bonetti EJ, Renzi G, Harbarth S, Klingenberg C, Pittet D, Schrenzel J. Rapid and high-throughput genotyping of Staphylococcus epidermidis isolates by automated multilocus variable-number of tandem repeats: A tool for real-time epidemiology. J Microbiol Methods 2008; 72:296-305. [DOI: 10.1016/j.mimet.2007.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 11/23/2007] [Accepted: 12/07/2007] [Indexed: 11/25/2022]
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Klingenberg C, Rønnestad A, Anderson AS, Abrahamsen TG, Zorman J, Villaruz A, Flaegstad T, Otto M, Sollid JE. Persistent strains of coagulase-negative staphylococci in a neonatal intensive care unit: virulence factors and invasiveness. Clin Microbiol Infect 2007; 13:1100-11. [PMID: 17850346 DOI: 10.1111/j.1469-0691.2007.01818.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coagulase-negative staphylococci (CoNS) are the major cause of nosocomial bacteraemia in neonates. The aim of this study was to investigate whether persistent strains of CoNS possess specific bacterial characteristics as compared with sporadic non-cluster isolates. In total, 180 blood culture isolates (95 contaminants and 85 invasive isolates) obtained from a single neonatal unit over a 12-year period were studied. Pulsed-field gel electrophoresis (PFGE) identified 87 persistent CoNS strains (endemic clones). The two largest PFGE clusters belonged to a single clonal complex according to multilocus sequence typing. Patients colonised or infected with endemic clones were of lower gestational age than those infected with non-cluster strains. One Staphylococcus haemolyticus cluster appeared to selectively colonise and infect the most extreme pre-term infants. Endemic clones were characterised by high levels of antibiotic resistance and biofilm formation. All 51 isolates belonging to the two largest PFGE clusters were ica operon-positive. Genes encoding Staphylococcus epidermidis surface protein B and the production of phenol-soluble modulins (PSMs) were also more prevalent among endemic clones than among non-cluster strains. However, endemic clones were not more prevalent among invasive isolates than among contaminants. These findings indicate that multiple selective factors, including antibiotic resistance, biofilm formation, surface proteins with adhesive properties, and PSMs regulated by agr, increase the ability of CoNS to persist in a hospital environment. It may be more prudent, when searching for new therapeutic targets, to focus on ubiquitous components of CoNS instead of putative virulence factors that do not clearly contribute to increased invasive capacity.
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Klingenberg C, Skadberg B. [Orientation programme for paediatric residents]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2007; 127:2105-8. [PMID: 17717576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Orientation programmes for new residents in paediatric departments are available in many Norwegian hospitals. The purpose of this study was to assess whether recently employed residents were content with the way they had been received and how these programmes were put into practice. MATERIAL AND METHODS Two different questionnaires were used; one was sent to residents who had been employed for less than 12 months ago and one to the directors of 22 Norwegian paediatric departments. The residents were asked about the reception at their new workplace and how they had been introduced to the paediatric field, whether the counselling functioned and when they started independent call duties. We asked the directors for information concerning their orientation programmes for new employees. RESULTS 20 of the directors answered the questionnaire. 13 departments had an orientation programme, and this was regularly followed in nine departments. 60 residents returned the questionnaire. 63% of the residents had been through some kind of orientation programme and a little more than half were assigned to a dedicated personal counsellor within two weeks after employment. The first personal counselling took place after a median of eight weeks. The residents' contentment with their reception in the department correlated significantly with the systematic use of an orientation programme. INTERPRETATION The results of this study demonstrate a substantial potential for improvement in how we introduce and guide recently employed paediatric residents during their first weeks in a new job.
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