[Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants]

A Framework for Neonatal Prematurity Information System Development Based on a Systematic Review on Current Registries: An Original Research

Background

Registries are regarded as a just valuable fount of data on determining neonates suffering prematurity or low birth weight (LBW), ameliorating provided care, and developing studies.

Objective

This study aimed to probe the studies, including premature infants' registries, adapt the needed minimum data set, and provide an offered framework for premature infants' registries.

Material and Methods

For this descriptive study, electronic databases including PubMed, Scopus, Web of Science, ProQuest, and Embase/Medline were searched. In addition, a review of gray literature was undertaken to identify relevant studies in English on current registries and databases. Screening of titles, abstracts, and full texts was conducted independently based on PRISMA guidelines. The basic registry information, scope, registry type, data source, the purpose of the registry, and important variables were extracted and analyzed.

Results

Fifty-six papers were qualified and contained in the process that presented 51 systems and databases linked in prematurity at the popular and government levels in 34 countries from 1963 to 2017. As a central model of the information management system and knowledge management, a prematurity registry framework was offered based on data, information, and knowledge structure.

Conclusion

To the best of our knowledge, this is a comprehensive study that has systematically reviewed prematurity-related registries. Since there are international standards to develop new registries, the proposed framework in this article can be beneficial too. This framework is essential not only to facilitate the prematurity registry design but also to help the collection of high-value clinical data necessary for the acquisition of better clinical knowledge.

Health care-associated infections in neonatology

Health care-associated infections are common in neonatology, but there is no consensus on their definitions. This makes it difficult to compare their incidence or assess the effectiveness of prevention bundles. This is why we think it is very important to achieve a consensus on the definitions and diagnostic criteria for one of the most frequent causes of morbidity in hospitalised neonates. This document aims to standardise the definitions for the most frequent health care-associated infections, such as catheter-associated bloodstream infection, ventilator-associated pneumonia and surgical wound infection, as well as the approach to their diagnosis and treatment.

Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line-associated bloodstream infection in preterm infants

The objective of this study was to assess the risk of central line-associated bloodstream infection (CLABSI) of ultrasound (US)-guided cannulation of the brachiocephalic vein (BCV) compared to standard epicutaneous cava catheters (ECCs) in preterm infants. This was a retrospective cohort study in preterm infants with a birth weight of less than 1500 g. Each BCV catheter was matched 1:3 with ECCs according to sex, birth weight, and year of insertion. The main outcome was the CLABSI density rate per 1000 days. Secondary outcomes included CLABSI episodes, CLABSI episodes per infant, and CLABSI/death. A multivariate Cox regression analysis was performed to assess whether the type of catheter (ECC vs. BCV) was associated with CLABSI risk. Ninety-six catheters (21 BCVs and 75 ECCs) in 79 infants were included (993 catheter days). BCV catheters were associated with a reduced CLABSI density rate compared to ECCs (3.05/1000 days vs 21.1/1000 days; p < 0.001). ECCs were associated with increased CLABSI risk compared to BCV catheters in multivariate analysis (hazard ratio 36; (95% CI, 2.5-511); p = 0.008).Conclusion: US-guided supraclavicular cannulation of the BCV was associated with a reduced risk of CLABSI compared to ECCs. This finding deserves further multicenter research. What is Known: • An epicutaneous-cava catheter (ECC) is commonly used in preterm infants for routine care (eg. delivery of nutrition and antibiotics) but this device may not suffice in infants who need high-intensity care (multiple drugs, hemodynamic monitoring, fluid resuscitation etc.). • Ultrasound-guided brachiocephalic vein (BCV) catheterization has shown a high success rate and few immediate complications in neonates and small infants but it has never been compared to standard ECCs. What is New: • When the operator in properly trained, US guided cannulation of the BCV in preterm infants is feasible, safe and may reduce the risk of CLABSI compared to standard ECCs. • This fact may expand the use of BCV catheters in selected high-risk preterm infants who need a large bore venous access.