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Aspects of neonatal septicaemia: prevention and complications
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-0958-7341
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Study I was part of the Extremely Preterm Infants in Sweden Study (EXPRESS), a prospective national study including all infants born <27 weeks in Sweden in 2004-2007 that survived their first year of life (n=497). Neonatal sepsis was evaluated as a risk factor for neonatal morbidities. Definite sepsis was associated with severe bronchopulmonary dysplasia and prolonged hospital stay, but not with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.

Study II was a non-randomized single-centre intervention study evaluating possible preventive effects on coagulase-negative staphylococci (CoNS) sepsis when the scrub the hub method was used. During the intervention period, the incidence of CoNS sepsis decreased from 1.5% to 0% (CI: 0.53-2.58%, p=0.06).

Study III was an in-vitro study evaluating leakage of isopropanol (IPA) and ethanol when alcohol caps and scrub the hub were used to disinfect hubs. Alcohol leakage was measured using gas chromatography. IPA was detected in all samples from cap circuits, and mean leakage increased over time. Ethanol levels were low, and scrub the hub therefore seems safe to use.

Study IV was a survey study evaluating reported hygiene routines from Swedish neonatal intensive care units (NICUs) included in the EXPRESS study. Routines were compared between the EXPRESS period (2004- 2007) and 2013. Improvements were seen regarding basic hygiene routines, routines for work clothing, and follow-up of compliance. Antibiotic prophylaxis decreased while fungal prophylaxis increased, but the empiric treatment of suspected late-onset sepsis (LOS) showed heterogeneity.

Study V investigated the association between incidence in LOS in the EXPRESS cohort and the hygiene routines previously evaluated in Study IV. Strict catheter routines, blood culture routines, and non-use of antibiotic prophylaxis were associated with decreased sepsis risk.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 90
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 186
Keywords [en]
Neonatal sepsis, prevention, coagulase-negative staphylococci, nosocomial, hygiene, neonatal morbidity, alcohol toxicity
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-68986ISBN: 978-91-7529-265-6 (print)OAI: oai:DiVA.org:oru-68986DiVA, id: diva2:1249750
Public defence
2018-11-16, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2018-10-19Bibliographically approved
List of papers
1. Sepsis as a risk factor for neonatal morbidity in extremely preterm infants
Open this publication in new window or tab >>Sepsis as a risk factor for neonatal morbidity in extremely preterm infants
Show others...
2015 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 11, p. 1070-1076Article in journal (Refereed) Published
Abstract [en]

Aim: This study evaluated sepsis as a risk factor for neonatal morbidities and investigated the association between specific pathogens and neonatal morbidities.

Methods: This was a nationwide Swedish prospective cohort study, consisting of the 497 extremely premature children, who were born before 27weeks of gestation between 2004 and 2007 and survived their first year of life. Neonatal sepsis was evaluated as a risk factor for neonatal morbidity using multiple logistic linear regression analyses.

Results: We found that 326 (66%) of the infants had at least one sepsis episode and coagulase-negative staphylococci was the most common pathogen. Definite sepsis, with an odds ratio (OR) of 1.6, was associated with severe bronchopulmonary dysplasia, but not clinical sepsis (OR 1.1). Definite sepsis was also associated with a prolonged hospital stay (OR 1.6). Sepsis was not significantly associated with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.

Conclusion: Extremely preterm infants face a great risk of acquiring neonatal sepsis, with coagulase-negative staphylococci being the most common pathogen in this population. Definite sepsis seemed to be a risk factor for severe bronchopulmonary dysplasia and prolonged hospital stay, but the associations were weaker than in previous studies.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
Morbidity, Neonatal, Prematurity, Risk factor, Sepsis
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:oru:diva-46694 (URN)10.1111/apa.13104 (DOI)000363866200018 ()26118325 (PubMedID)2-s2.0-84945493792 (Scopus ID)
Funder
Swedish Research Council, 2006-3858
Note

Funding Agencies:

Lilla Barnets Fond

Evy and Gunnar Sandbergs Foundation

Birgit and Håkan Ohlssons Foundation

Available from: 2015-11-23 Created: 2015-11-23 Last updated: 2018-10-17Bibliographically approved
2. Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec reduced neonatal sepsis
Open this publication in new window or tab >>Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec reduced neonatal sepsis
2015 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 3, p. 232-236Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to investigate whether scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec could reduce the incidence of neonatal sepsis in a level-three neonatal intensive care unit.

Methods: We studied the incidence of neonatal sepsis caused by coagulase-negative staphylococci (CoNS) for 16.5 months before the initiative was launched on May 15, 2012 and then for a further 8.5 months after it was introduced. The hub routine was applied to all intravenous catheters.

Results: During the control period before the initiative was launched, there were nine cases of CoNS sepsis compared with no cases after it was introduced, resulting in a decrease in sepsis incidence from 1.5% to 0% with a risk reduction of 1.5% (0.53-2.58%) (p = 0.06). In the preterm infant population, the incidence of sepsis decreased from 3.6% to 0% (1.1-6.0%) (p = 0.11).

Conclusion: Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec seemed to be an efficient way of preventing sepsis caused by CoNS in newborn infants. However, the evidence for the benefits will remain weak until a large randomised trial has been completed.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2015
Keywords
Coagulase-negative staphylococci, Infection, Intravenous catheters, Neonatal sepsis, Prevention
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:oru:diva-43932 (URN)10.1111/apa.12866 (DOI)000350062400012 ()25399485 (PubMedID)2-s2.0-84923181512 (Scopus ID)
Available from: 2015-03-30 Created: 2015-03-30 Last updated: 2018-10-17Bibliographically approved
3. Leakage of isopropanol from port protectors used in neonatal intensive care
Open this publication in new window or tab >>Leakage of isopropanol from port protectors used in neonatal intensive care
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-69661 (URN)
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2018-11-19Bibliographically approved
4. Hygiene routines in the EXPRESS study: a Swedish national survey of hygiene practices in neonatal intensive care
Open this publication in new window or tab >>Hygiene routines in the EXPRESS study: a Swedish national survey of hygiene practices in neonatal intensive care
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-69662 (URN)
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2018-11-19Bibliographically approved
5. Hygiene routines in the EXPRESS study: impact of hygiene routines and antibiotic prophylaxis on neonatal sepsis incidence
Open this publication in new window or tab >>Hygiene routines in the EXPRESS study: impact of hygiene routines and antibiotic prophylaxis on neonatal sepsis incidence
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-69663 (URN)
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2018-11-19Bibliographically approved

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Björkman Hjalmarsson, Louise

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