MORTALITY AND MORBIDITY RELATED TO STAPHYLOCOCCAL DISEASE IN NEONATAL INTENSIVE CARE
Healy CM, Palazzi DL, Edwards MS, Campbell JR, Baker CJ. Features of invasive staphylococcal disease in neonates. Pediatrics. 2004;114:953-961.
Low-birthweight newborn infants are susceptible to infection. The most predominant microorganism seen is either Staphylococcus aureus (SA) or coagulase-negative staphylococci (CoNS). This study looked at the incidence of these infections in infants in an intensive care nursery over a 30-month period.
This retrospective chart review study investigated the records of 401 very-low-birth weight infants who had confirmed or presumed positive cultures from either SA or CoNS during their hospitalization. It was determined that SA caused disease in 40 neonates compared with 97 neonates ill with CoNS.
Overall, CoNS was more likely to cause problems in very-low-birth weight infants and in those who were the youngest based on gestational age. Soft tissue or bone sepsis was found more likely in infants with SA, whereas rash was more common in those with CoNS. Less than one half of the infants had positive cultures while they were receiving intravenous fluids. Treatment in both groups was more likely to be courses of vancomycin and gentamicin.
In general, the mortality rate in the neonatal intensive care unit due to the infection was about 10%, whereas the bacteremia illness rate was about 30%. Those infants who had bacteremia or who died were more likely to be infected with SA. Because infections tend to occur in cycles in neonatal intensive care units, the researchers recommend that infection rates be tracked so that sepsis can be recognized and treated more quickly.
TELEPHONE CONTACTS REMAIN BEST FOR EMERGENCY ROOM FOLLOW-UP
Goldman RD, Mehrotra S, Pinto TR, Mounstephen W. Follow-up after a pediatric emergency department visit:telephone versus e-mail? Pediatrics. 2004;114:988-991.
Children seen in emergency rooms need follow-up care. Parents are usually contacted by telephone and given pertinent information about their child's care. In this age of increasing use of the Internet for communication, this study tested whether sending an e-mail was more effective than calling parents via telephone to follow-up on the child after an emergency room visit.
The sample consisted of families of children who visited the emergency room over a 2-month period and who had both e-mail and telephone access. After exclusion of families whose child was admitted to the hospital, the sample (N = 198) was randomly divided into e-mail (n = 100) and telephone contact (n = 98) groups.
Those in the e-mail group were emailed once using a message and Internet address that indicated that it was coming from the hospital's emergency room. The parents in the telephone group were phoned up to 5 times until they answered the phone.
Results showed that just over half of those families answered the e-mail (53%), whereas 85% of the families contacted by telephone were spoken to. Although it is possible that more families in the e-mail group read the message sent and just did not send a reply, it is obvious that telephone contact was more beneficial because more families were contacted. However, no matter the route, a large proportion of families in both groups were never reached for follow-up. More efforts need to be tried to make follow-ups to emergency care more successful.