Clinical predictors of urinary tract infection in the neonatal intensive care unit

Foglia EE, Lorch SA. J Neonatal Perinat Med. 2012;5:327-353.

In this retrospective nest-controlled study, researchers sought to identify clinical predictors associated with urinary tract infections in a neonatal population. The authors state that urine cultures are not routinely obtained from neonates and that no clear guidelines exist for the evaluation and treatment of neonates with a urinary tract infection, although many clinicians use The American Academy of Pediatrics practice parameters established for children aged 2 to 24 months.

Neonatal intensive care unit patients (n = 266) from January 1, 2007, to December 31, 2007, who had urine cultures obtained as part of late-onset sepsis evaluation were included in this study. Clinical factors and laboratory results were compared between subjects with positive urine cultures (cases, n = 27) and randomly selected subjects with negative cultures.

Cases were older than controls at time of urine culture (75 vs 29 days). Peripheral white blood cell count and C-reactive protein did not differ between cases and controls. Only 24% of cases had a simultaneously positive blood culture.

The authors concluded that clinicians should evaluate chronologically older neonatal intensive care unit patients, including urine culture to identify potential sources of infection.

Risk factors for mortality in children with abusive head trauma

Shein SL, Bell MJ, Kochanek PM, et al. J Pediatr. 2012;161(4):716-722.

The authors state that more than 120 000 children are the victims of physical abuse annually in the United States, with abusive head trauma being responsible for most of fatalities from physical trauma. The authors hypothesized that physical, neurologic, radiologic, and demographic factors are associated with mortality in this population.

In this study, the authors analyzed a large preexisting data set of children with abusive head trauma (n = 386). Multivariable analysis showed that patients with an initial Glasgow Coma Scale (GCS) score of either 3 or 4 to 5 had an increased mortality versus children with a GCS score of greater than 12 to 15 (odds ratio, 57.8; 95% confidence interval, 12.1-277.6; and odds ratio, 15.6; 95% confidence interval 2.6-95.1, respectively; P < .001). Retinal hemorrhage (RH), intraparenchymal hemorrhage, and cerebral edema were independently associated with mortality. In a subgroup of patients with abusive head trauma and RH (n = 117), cerebral edema and initial GCS scores of 3 or 4 to 5 were independently associated with mortality. Chronic subdural hematoma was independently associated with survival.

The authors concluded that an initial low GCS score, RH, intraparenchymal hemorrhage, and cerebral edema are independently associated with mortality in abusive head trauma and that knowledge of these risk factors may help improving care to these children.