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In 2015, an outbreak caused by OXA-48-producing Enterobacteriaceae affected a neonatal intensive care unit at a Swedish University Hospital. The aim was to explore the transmission of OXA-48-producing strains between infants and the transfer of resistance plasmids between strains during the outbreak. Twenty-four outbreak isolates from ten suspected cases were whole-genome sequenced. A complete assembly was created for the index isolate (Enterobacter cloacae) and used as a mapping reference to detect its plasmids in the remaining isolates (17 Klebsiella pneumoniae, 4 Klebsiella aerogenes, and 2 Escherichia coli). Strain typing was performed using core genome MLST and SNP analysis. As judged from sequencing and clinical epidemiological data, the outbreak involved nine cases (two developed sepsis) and four OXA-48-producing strains: E. cloacae ST1584 (index case), K. pneumoniae ST25 (eight cases), K. aerogenes ST93 (two cases), and E. coli ST453 (2 cases). Two plasmids from the index strain, pEclA2 and pEclA4, carrying blaOXA48 and blaCMY-4, respectively, were traced to all K. pneumoniae ST25 isolates. Klebsiella aerogenes ST93 and E. coli ST453 harboured either only pEclA2, or both pEclA2 and pEclA4. One suspected case harbouring OXA-162-producing K. pneumoniae ST37 could be excluded from the outbreak. Once initiated by an E. cloacae strain, the outbreak was caused by the dissemination of a K. pneumoniae ST25 strain and involved inter-species horizontal transfer of two resistance plasmids, one of which carried blaOXA-48. To our knowledge, this is the first description of an outbreak of OXA-48-producing Enterobacteriaceae in a neonatal setting in northern Europe. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis (NEC) is a life-threatening intestinal illness mostly affecting preterm infants, which commonly requires surgery. Anesthetic care for these patients is challenging, due to their prematurity and critical illness with hemodynamic instability. Currently, there are no guidelines for anesthetic care for these vulnerable patients. Therefore, this study aimed to describe current anesthesia practices across Europe for infants undergoing surgery for NEC. Cross-sectional survey study. Anesthesiologists working in centers where surgery for NEC is performed across Europe. A 46-item questionnaire assessing protocols for anesthesia practice, preoperative care, intraoperative care, postoperative care, and the respondent's opinion on the adequacy of anesthetic care for patients with NEC in their center. Out of the 173 responding anesthesiologists from 31 countries, approximately a third had a written standard protocol for anesthetic care in infants. Three quarters of the respondents screened all patients with NEC preoperatively, and a third structurally performed preoperative multidisciplinary consultation. For induction of general anesthesia, most respondents opted for intravenous anesthesia (n = 73, 43%) or a combination of intravenous and inhalation anesthesia (n = 57, 33%). For intravenous induction, they mostly used propofol (n = 58, 44%), followed by midazolam (n = 43, 33%) and esketamine (n = 42, 32%). For maintenance of anesthesia, inhalation anesthetic agents were more commonly used (solely: n = 71, 41%; in combination: n = 37, 22%), almost exclusively with sevoflurane. Postoperative analgesics mainly included paracetamol and/or morphine. Sixty percent of the respondents (n = 104) considered their anesthetic care for patients with NEC adequate. Suggestions for further improvement mainly revolved around monitoring, protocols, and collaboration. Anesthesia practice for infants undergoing surgery for NEC was highly variable. Most respondents considered the provided anesthetic care for patients with NEC adequate, but also recognized opportunities for further improvement, especially with regards to monitoring, protocols, and interdisciplinary collaboration. [Display omitted] • Anesthesia practice for preterm infants with NEC is highly variable. • Sixty percent of anesthesiologists are satisfied with current anesthetic care for NEC. • Advances in monitoring, protocols, and collaboration may drive further improvement. [ABSTRACT FROM AUTHOR]

Hearing is a special sense needed for appropriate mental, speech and language development and academic performance. Even among normal babies, 50% of cases of hearing loss are missed out if screening protocol is not followed. In this study, we assess the hearing of all neonates born and brought to the tertiary care hospital, and also find out how many well babies with hearing loss would have been missed if this screening had not been done. Hence, the study aims to estimate the prevalence of neonatal hearing loss and study the associated risk factors. Neonates (N = 1559) attended the outpatient department of paediatrics were included. A detailed history of the neonates with special emphasis on prenatal, natal, postnatal, family history, and maternal risk factors were elicited. Three-stage hearing testing protocol was followed with transient evoked otoacoustic emission testing, a gold standard test for stage 1 and 2 and brainstem evoked response audiometry for stage 3. Of 1559 neonates, 138 had hearing loss. History of drug intake, order of the child, place of delivery and maternal history were the significant factors associated with hearing loss in neonates. Bivariate analysis revealed order of child, maternal history, and history of drug taken were the significant factors affecting the hearing loss in the neonates (P < 0.001). The prevalence of hearing loss was 8.85%. Early detection of hearing loss is essential for timely intervention and development of optimal communication skills. Further studies are required to decide the essentiality of Universal New-born hearing screening. [ABSTRACT FROM AUTHOR]

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Pulse oximetry screening (POS) has been shown to be an effective, non-invasive investigation that can detect up to 50–70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on clinical practice. All eligible newborn infants born between 1 Jan 2015 and 31 Dec 2019 in a busy regional neonatal unit were included in this prospective observational study. A positive POS was classified as two separate measurements of oxygen saturation < 95%, or a difference of > 2% between pre- and post-ductal circulations. Overall, 23,614 infants had documented POS results. One hundred eighty nine (0.8%) infants had a true positive result: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 (83%) infants had significant non-cardiac conditions. Forty-three infants who had a normal POS were later diagnosed with the following categories of CHDs post-hospital discharge: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7%, whereas sensitivity was only 33% for detection of major CHDs (critical and serious) needing surgery during infancy; specificity was 99.3%. Conclusion: Pulse oximetry screening showed moderate to high sensitivity in detection of undiagnosed critical CHDs; however, it failed to detect two-third of major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods, such as perfusion index, to detect other major CHDs missed by current screening tools. What is Known: • Pulse oximetry screening is cost effective, acceptable, easy to perform and has moderate sensitivity and high specificity in detection of critical congenital heart defects. • Pulse oximetry screening has been implemented many countries including USA for detection of critical congenital heart defects, but it is not currently recommended by the UK National Screening Committee. What is New: • To our knowledge, this is the first study describing postnatal detection and presentation of all the infants with congenital heart defects over a period of 5 years, including those not detected on the pulse oximetry screening, on the clinical practice. • It emphasises that further research required to detect critical congenital heart defects and other major CHDs which can be missed on the screening tools currently employed in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Transitional adaptation of newborns delivered in controlled environments of developed countries has been studied extensively but there is a gap in knowledge regarding the thermal adaptation of the newborn immediately after birth delivered in resource poor conditions prevailing in developing countries. Objective: To observe the thermal adaptation of newborn infants by studying the temperature changes in central - abdominal skin temperature (Ta) and peripheral - sole of the foot temperature (Tf) in healthy term newborns in the delivery room and postnatal ward for the first 12 hours of life. Study Design: The study was conducted in KLE University Hospital, Belgaum, India, during the seasons (rainy and spring) that cause hypothermia due to the ambient conditions in these regions. The data was collected from two groups of infants - Group A (Rainy season) and Group B (Spring season) consisting of 20 and 31 infants respectively. The body temperature data was collected to observe variations at different locations of neonatal care in the hospital during the study period. Additionally the ambient temperature and humidity were also monitored to understand the prevailing conditions that the infants encounter. Result: Mean Ta was 35.9°C and 35.8°C in the delivery room in infants from Groups A and B, respectively. The major variations were observed around six hours of life. The mean Ta and Tf were 35.63°C and 30.38°C in Group A and 35.95°C and 32.51°C in Group B during this period. Conclusion: Healthy term infants are subjected to severe thermal stress during the first 12 hours of life in developing countries with no control over the environmental temperature in delivery room and postnatal ward that is also influenced by seasonal variation. These findings underscore the need to control the environmental temperature, ensure proper clothing and use of Kangaroo care to prevent hypothermia in healthy term infants. [ABSTRACT FROM AUTHOR]