PubMed Health⌕ Search

Biomedical subjects

A Scarcella

Publications and source records attributed to A Scarcella.

At least 19 recordsLinked to original sources
PubMed2001

Molecular epidemiology of an outbreak of Serratia marcescens in a neonatal intensive care unit.

OBJECTIVE: To investigate and control a biphasic outbreak of Serratia marcescens in a neonatal intensive care unit (NICU). DESIGN: Epidemiological and laboratory investigation of the outbreak. SETTING: The NICU of the 1,470-bed teaching hospital of the University "Federico II," Naples, Italy. PATIENTS: The outbreak involved 56 cases of colonization by S marcescens over a 15-month period, with two epidemic peaks of 6 and 3 months, respectively. Fourteen (25%) of the 56 colonized infants developed clinical infections, 50% of which were major (sepsis, meningitis, or pneumonia). METHODS: Epidemiological and microbiological investigations, analysis of macrorestriction pattern of genomic DNA through pulsed-field gel electrophoresis (PFGE) of clinical and environmental isolates, and institution of infection control measures. RESULTS: Analysis of macrorestriction patterns of genomic DNA by PFGE demonstrated that the vast majority of S marcescens isolates, including three environmental strains isolated from two handwashing disinfectants and the hands of a nurse, were of the same clonal type. The successful control of the outbreak was achieved through cohorting of noncolonized infants, isolation of S marcescens-infected and -colonized infants, and an intense educational program that emphasized the need for adherence to glove use and handwashing policies. The NICU remained open to new admissions. CONCLUSIONS: Outbreaks caused by S marcescens are very difficult to eradicate. An infection control program that includes molecular typing of microorganisms and the proper dissemination among staff members of the typing results is likely to be very effective in reducing NICU-acquired infections and in controlling outbreaks caused by S marcescens, as well as other multiresistant bacteria.

Cross Infection↗
PubMed2000

Early death in two sisters with Hennekam syndrome.

We report on two sisters with facial anomalies, protein-losing enteropathy, and intestinal lymphangiectasia consistent with the diagnosis of Hennekam syndrome. Both patients had a number of other anomalies not previously described in this autosomal recessive disorder, i.e., primary hypothyroidism, hypertrophic pyloric stenosis, and an early fatal outcome. These cases support the autosomal recessive transmission and the expansion of the phenotype of the Hennekam syndrome.

Abnormalities, Multiple↗
PubMed1999

Gestational maturation of electrical activity of the stomach.

Gestational maturation of gastrointestinal motility is a key factor in readiness of the preterm neonates for enteral nutrition. Since gastric motility mainly depends on the electrical activity of the smooth muscle cells, it was of interest to investigate the developmental aspects of electrical activity of the stomach. The latter was recorded weekly through cutaneous electrogastrography in 27 preterm infants (aged 29-34 weeks of gestation). Recordings were done for 1 hr before and 1 hr after meal. The electrogastrographic variables measured were: percentage of normal gastric rhythm, ie, 2-4 cpm; percentage of tachygastria (>4 cpm); the fed-to-fasting ratio of the dominant electrogastrographic power; and the instability coefficient of the dominant frequency. Data were compared with those measured in 10 full-term infants. Peaks of normal electrical activity (2-4 cpm) were present in most of the recordings at all the gestational ages; however, percentages of both normal electrical rhythm and tachygastria in preterm infants were similar to those measured in full-term infants (mean +/- SD) (normal rhythm; fasting: 70.2 +/- 3.8, fed: 72.2 +/- 5.0; tachygastria: fasting: 24.6 +/- 4.0, fed: 19.1 +/- 3.5) by 35 weeks of gestation (normal rhythm; fasting: 67.5 +/- 2.0, fed: 69.6 +/- 4.4; tachygastria: fasting: 27.1 +/- 4.0, fed: 25.6 +/- 4.1). The coefficient of instability of the dominant frequency in preterm infants was also similar to the value measured in full-term infants by 35 weeks of gestation, whereas the EGG power showed a significant increase in the postprandial state at all the gestational ages. We conclude that a maturation pattern of the electrical activity of the stomach can be detected by means of a noninvasive tool such as cutaneous electrogastrography: a normal electrical rhythm can be detected at very early gestational ages; however, this activity becomes dominant at around the 35 weeks of gestational age. In preterm infants developmental changes of gastric electrical activity are a function of advancing postnatal age.

Electrodiagnosis↗
PubMed1998

Molecular epidemiology as an effective tool in the surveillance of infections in the neonatal intensive care unit.

OBJECTIVES: nosocomial infections result in considerable morbidity and mortality in Neonatal Intensive Care Units (NICUs). The aim of this study was to investigate the usefulness of the molecular epidemiology approach in the surveillance and control of infections in the NICU. METHODS: a 1-year prospective surveillance of nosocomial infections in a NICU was performed using traditional epidemiological methods as well as molecular typing of micro-organisms. RESULTS: the nosocomial infection rate among the 343 newborns was 24.8%. The risk of infection was associated with low birth weight, prolonged length of stay, empiric antibiotic treatment and nasopharyngeal colonization. Four pathogens (Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE) and methicillin-sensitive Staphylococcus aureus (MSSA) were responsible for more than 80% of the infections. Extended-spectrum beta-lactamase-producing (ESBL) K. pneumoniae and MRSA infections constituted outbreaks caused by a single clone, whereas MRSE and MSSA infections did not represent outbreaks but rather a series of sporadic infections caused by different strains. CONCLUSIONS: molecular epidemiology techniques are powerful tools that can elucidate modes of spread and reservoirs of infection in the NICU and identify effective measures to control epidemic or endemic situations.

Bacterial Infections↗
PubMed1998

Liposomal amphotericin B treatment for neonatal fungal infections.

BACKGROUND: Disseminated fungal infections are a major problem in high risk neonates. Conventional antifungal agents are often unsatisfactory and have a high incidence of severe adverse effects. METHODS: We administered liposomal encapsulated amphotericin B (AmBisome), which is an alternative to conventional amphotericin B, to 40 preterm (mean birth weight, 1090 +/- 313.6 g; mean gestational age, 28.35 +/- 2.13 weeks) and 4 full term (mean birth weight, 3080 +/- 118 g; mean gestational age, 39 +/- 0.7 weeks) newborn infants with a severe fungal infection. RESULTS: Candida albicans was the most frequent fungus isolated (70%). The duration of intravenous AmBisome therapy ranged from 7 to 49 days; the cumulative dose ranged from 7 to 138.8 mg/kg (median, 45.2 mg/kg). Administration of AmBisome was effective in 72.7% of patients; 5 of 6 cases of meningitis also recovered; 63.6% of 33 very low birth weight infants survived. No side effects were observed. CONCLUSIONS: To our knowledge this is the largest study of the treatment of neonates with liposomal amphotericin B, and the results confirm its effectiveness and safety. However, randomized clinical trials are required to establish the most effective administration protocol for AmBisome, i.e. the starting dosage, the maximum effective dosage and the cumulative dosage, and to verify whether the preparation should be associated with another antifungal agent.

Amphotericin B↗
PubMed1997

Neonatal sporadic hyperekplexia: a rare and often unrecognized entity.

We report the case of a newborn infant with transient generalized stiffness, obvious from the first days of life, increased muscle tone and repeated myoclonic jerks, who was unsuccessfully treated with phenobarbital until the diagnosis of neonatal sporadic hyperekplexia. To our knowledge this is the first case successfully treated with clobazam, a 1.5 dibenzodiazepine.

Acoustic Stimulation↗
PubMed1994

Renal tubular dysgenesis without pulmonary hypoplasia.

Only a few cases of renal tubular dysgenesis (RTD) have been diagnosed. RTD is associated with a very early death, always due to lethal pulmonary hypoplasia. We report an additional patient, interesting for two reasons: (1) the rarity of RTD, (2) the absence of microscopic and macroscopic anatomical alterations of the lungs. The infant had only a mild, transient pulmonary maladaptation; after a few days of life the pulmonary function returned to normal. Although renal function dramatically improved after institution of peritoneal dialysis at 6 days of life, the patient died after 2 weeks with an overwhelming Candida sepsis. We suggest that the lack of pulmonary hypoplasia might be due to a short exposure to oligohydramnios.

Fatal Outcome↗
PubMed1987

Passage of gliadin into human breast milk.

Samples of breast milk were taken from 53 women following the ingestion of 20 g of gluten. The samples were analysed for the presence of gliadin by a double-antibody sandwich enzyme immunoassay. Gliadin (5-95 ng/ml) was detected in 54/80 samples collected at various stages of lactation. Maximum levels in milk were found 2-4 hours after ingestion; gliadin could not be detected in serum. The transfer of gliadin from mother to infant might be critical for the development of an appropriate specific immune response to gliadin later in life.

Administration, Oral↗
PubMed1986

Partial exchange transfusion using peripheral vessels in polycythaemic newborn infants.

The authors detail their experience with partial exchange transfusion performed through peripheral vessels in 35 polycythaemic newborn infants. They suggest that this alternative procedure might be the method of choice for short term exchanges, since it is easy to apply and avoids the risks associated with umbilical vein catheterisation.

Exchange Transfusion, Whole Blood↗
PubMed1984

Epidemiological and bacteriological investigation of Serratia marcescens epidemic in a nursery and in a neonatal intensive care unit.

An epidemic caused by Serratia marcescens that involved 26 infants admitted to the Neonatal Intensive Care Unit (NICU) and 82 infants admitted to the Nursery of the 2nd Medical School of Naples is reported. Two different biotypes of S. marcescens with two completely different epidemiological patterns were identified. The prevalent biotype (A8b trigonelline-) was isolated in the delivery room, in the operating room, in the Nursery and in the NICU from items, healthy infant excreters and affected infants; the second biotype (A3a) was isolated only in the NICU from staff, two healthy infant excreters and two affected infants. Colonization of the throat and the gastrointestinal tract was frequent. Infected and colonized infants were the most important reservoir for serratia in the Nursery and in the NICU particularly for the type strain A3a. A mucus aspiration apparatus contaminated in the delivery room and the contamination of several instruments and items probably had a major role in the initiation and maintenance of the spread of the A8b strain. Mass contamination of the nursery has been related to overcrowding and a lack of the control measures; the transfer of high-risk colonized infants caused spread in the NICU. In the NICU the attack rate 26%; 69% of infants became ill; the case fatality ratio was 19%. Epidemiological investigation of the infants at risk showed some factors predisposing to infection with serratia. The hygienic measures failed to control the spread of serratia and it was necessary to refuse new admissions to pregnant women in order to decontaminate and re-organize the wards.

Anti-Bacterial Agents↗