Dwell time and bloodstream infection incidence of umbilical venous catheterization in China

Importance:Central line-associated bloodstream infection(CLABSI)is one of the most serious complications of central venous access devices.Reducing the risk of CLABSI is of utmost significance in efforts to improve neonatal mortality rates and enhance long-term prognosis.Objective:To determine the dwell time and incidence of CLABSI of umbilical venous catheterization(UVC)for preterm infants in China.Methods:Preterm infants with UVC admitted to 44 tertiary neonatal intensive care units in 24 provinces in China were enrolled.Study period was from November 2019 to August 2021.The end point of observations was 48 h after umbilical venous(UV)catheter removal.The primary outcomes were dwell time of UV catheter and UVC-associated CLABSI.Data between infants with UV catheter dwell time≤7 days and>7 days,and with birth weight(BW)≤1000 g and>1000 g were compared.Results:In total,2172 neonates were enrolled(gestational age 30.0±2.4 weeks,BW 1258.5±392.8 g).The median UV catheter dwell time was 7(6–10)days.The incidence of UVC-associated CLABSI was 3.03/1000 UV catheter days.For infants with UV catheter dwell time≤7 days and>7 days,the UVC-associated CLABSI incidence was 3.71 and 2.65 per 1000 UV catheter days,respectively,P=0.23.For infants with UVC dwell times of 3–6,7–12,and 13–15 days,the UVC-associated CLABSI rates were 0.14%,0.68%,and 2.48%(P<0.01).The Kaplan–Meier plot of UV catheter dwell time to CLABSI showed no difference between infants with BW≤1000 g and>1000 g(P=0.60).Interpretation:The median dwell time of UV catheter was 7 days,and the incidence of UVC-associated CLABSI was 3.03/1000 catheter days in China.The daily risk of UVC-associated CLABSI and other complications increased with the dwell time.

Patient outcomes after neonatal tracheotomy: A retrospective case-control study

To the Editor:Although reports of neonatal upper airway obstruction in patients in neonatal intensive care units(NICUs)are common,neonatal tracheotomy is rare,possibly due to the small number of patients and the even smaller number of well-equipped hospitals to do a successful operation in neonates.However,despite the extensive efforts of qualified,skilled neonatologists and pediatric otorhinolaryngologists in performing a neonatal tracheotomy,some neonates did not undergo this surgery.When a neonate meets the indications of tracheotomy but his/her parent refuses to do the operation,he/she is facing a higher risk to be discharged against medical advice(DAMA)as per their parents’wish.To explore the preliminary evidence of neonatal tracheotomy in China,as well as to find out the outcome difference between neonates who underwent tracheotomy and those who did not undergo tracheotomy when they met the surgical indications,we conducted a retrospective study.Patients were treated in Beijing Children’s Hospital.Patients were categorized into the tracheotomy group or non-tracheotomy group according to whether their parents signed the tracheotomy consent and finally completed the tracheotomy.This study was approved by the Ethics Committee of Beijing Children’s Hospital,Capital Medical University(No.[2021]-E-139-R)and was registered in the Chinese Clinical Trial Registry(No.ChiCTR2100050720).All parents/guardians of participants provided written informed consent.

Clinical characteristics and post-discharge follow-up analyses of 10 infants with congenital tuberculosis:A retrospective observational study

Importance Congenital tuberculosis(TB)is a rare,potentially fatal disease.There is currently a lack of detailed clinical information available regarding this disease.Objective This retrospective study investigated the clinical manifestations,treatment,and long-term prognosis of congenital TB.Methods Patients were treated in Beijing Children’s Hospital,Capital Medical University(Beijing,China)between 2009 and 2018.Their demographic data,maternal and family histories,symptoms and signs,treatment information,and follow-up data were retrospectively collected using the hospital’s electronic information system.Results Ten infants with congenital TB were enrolled.The mean gestational age was 36.6±2.2 weeks and mean birth weight was 2517±487 g.All 10 patients exhibited fever,nine patients(90%)had anemia,and six patients(60%)had extrauterine growth retardation.On chest computed tomography scans,all 10 patients presented multiple pulmonary nodules and four patients(40%)had mediastinal adenopathy.Nine out of ten(90%)completed the T-spot test,and eight of them(8/9,89%)were positive.Anti-TB treatment was initiated upon diagnostic confirmation.All patients(100%)received combined treatment with isoniazid(INH)and rifampicin(RIF).Eight of 10 patients(80%)received combined treatment with INH,RIF,and pyrazinamide.The survival rate was 100%.One patient was lost to follow-up and four patients are currently continuing treatment.Three of nine patients(33%)achieved normal developmental milestones at 6 months of age.Interpretation Early diagnosis based on maternal history,typical imaging results,and timely treatment can improve outcomes in infants with congenital TB.