Does saline enema during the first stage of labour reduce the incidence of Clostridium difficile colonization in neonates? A randomized controlled trial

BACKGROUND

Maternal rectal enemas may reduce neonatal bacterial exposure during labour, which may reduce the risk of neonatal colonization with Clostridium difficile. The aim of this study was to determine the effectiveness of a saline enema during the first stage of labour in reducing neonatal colonization with C. difficile.

METHODS

This study was conducted at Cairo University Hospital, Egypt from January 2016 to July 2016. Asymptomatic mothers with uncomplicated vaginal delivery and their neonates without diarrhoea were included. The study group underwent saline enema, and the control group had no intervention. Stool samples were collected from neonates one week after delivery. The primary outcome was the detection of C. difficile in stool culture and direct detection of C. difficile Toxin A and Toxin B by enzyme-linked immunosorbent assay.

FINDINGS

The two groups were comparable (P>0.05) in terms of age, gravidity, parity, body mass index and gestational age. C. difficile was detected in 13.54% and 37.63% of stool cultures from the enema group and the control group, respectively (P<0.001). Direct detection of Toxins A and B was positive in 22.92% of cases in the enema group and 53.76% of cases in the control group (P<0.001).

CONCLUSION

This study suggests that a saline enema for the mother during the first stage of labour may be useful in reducing the risk of neonatal gut colonization by C. difficile.

Antenatal corticosteroid administration before elective caesarean section at term to prevent neonatal respiratory morbidity: a randomized controlled trial

OBJECTIVE

To assess the effect of prophylactic corticosteroid administration before elective caesarean section at term (between 38 and 38(+6) weeks) in reducing neonatal respiratory morbidity and admission to a neonatal intensive care unit (NICU) with respiratory complications.

METHODS

Women in this study (n=1290) were randomized into two groups: the dexamethasone group (n=645) and the control group (n=645). Women in the dexamethasone group received three doses of intramuscular dexamethasone 8mg, 12h apart, 48h before caesarean section. Women in the control group received intramuscular saline as a placebo in the same dosage as the dexamethasone group.

PRIMARY OUTCOME

Comparison of NICU admission rates and the occurrence of neonatal respiratory morbidity between the two groups.

RESULTS

The NICU admission rate for respiratory morbidity was significantly lower in the dexamethasone group compared with the control group [10/616 (1.6%) vs 24 (3.9%), respectively; p=0.014]. Antenatal administration of dexamethasone was significantly associated with almost 2.5-fold reduction in the risk of NICU admission for respiratory morbidity (relative risk 0.41, 95% confidence interval 0.2-0.86; number needed to treat ≅43).

CONCLUSION

Antenatal corticosteroids reduce the incidence of NICU admission with respiratory morbidity after elective caesarean section at term.

External auditory canal as an unusual site for metastasis of breast cancer: A case report

Metastatic breast cancer is one of most common cause of death in women worldwide. The estimated incidence of breast cancer to be metastatic at diagnosis is 6%, with a five year survival rate of about 21%. There are three types of breast cancer recurrence: local, regional and distant metastasis mainly to the lung, liver, bone or brain. Review of literature indicate a relatively few reported cases about metastatic breast cancer to soft tissue. We present a case of metastatic breast cancer to left external auditory canal.