Dissajee Lumbiganon

Objective: To determine the incidence, causative pathogens, risk factors, and clinical outcomes of early-onset sepsis (EOS) in very preterm (gestational age < 32 weeks) and very low birth weight (birth weight < 1500 g) neonates. Methods: This retrospective study analyzed data from the Thai Neonatal Network registry (2019–2024; total 22 neonatal units). EOS was defined as bacteremia or bacterial meningitis within 72 h of birth. Results: Among 792 neonates (median [interquartile range] gestational age, 28 [26–29] weeks; median [interquartile range] birth weight, 960 [779–1190] g), the incidence of EOS was 4.0% (n = 32). Predominant pathogens were Escherichia coli (n = 10) and Acinetobacter baumannii (n = 9). Antibiograms showed high non-susceptibility for E. coli and A. baumannii to gentamicin (44.4% and 83.3%, respectively) and cefotaxime (37.5% and 75.0%, respectively). Although E. coli remained susceptible to amikacin and meropenem (100%), A. baumannii exhibited extensive resistance (66.7% and 83.3%, respectively). Multivariable analysis identified chorioamnionitis (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI]: 1.07–1.18) and 5 min Apgar score < 7 (aOR 1.05; 95% CI: 1.02–1.18) as significant risk factors. EOS was independently associated with increased early neonatal mortality within 7 days of life (aOR, 1.26; 95% CI: 1.16–1.36). Conclusions: The incidence of EOS is high among very preterm infants in Thailand and significantly increases mortality rates. The prevalence of multidrug-resistant A. baumannii in neonatal EOS is a critical concern that limits the efficacy of empirical treatments. These findings highlight the urgent need for targeted interventions and enhanced antimicrobial stewardship to improve neonatal survival rates.

Background: Early‐onset neonatal sepsis (EOS) is defined as an infection with a positive blood culture within the first 7 days of life. The categorical risk assessment guideline from the Centers for Disease Control and Prevention is used to manage high‐risk infants, but it often results in a high rate of antibiotic use. A neonatal early‐onset sepsis calculator (EOS calculator) was developed to reduce the overuse of antibiotics. Methods: A retrospective study was conducted among infants born ≥35 weeks' gestation admitted to Vajira Hospital between October 1, 2018, and September 30, 2019. Infants were included if they had at least one risk factor for EOS or symptoms suggesting EOS. Relevant data were collected to assess antibiotic use rates based on the categorical risk assessment and the EOS calculator. Antibiotic use rates between the two methods were compared using the chi‐square test. Results: A total of 177 infants were included in this study. The mean gestational age (±SD) was 38.5 ± 1.7 weeks, and the mean birth weight (±SD) was 2923.9 ± 516.3 g. According to local guidelines, antibiotics were administered to 73 infants (41.2%). One infant had culture‐proven EOS, yielding a prevalence among the total live births born at ≥35 weeks' gestation of 0.49 per 1000 live births (1/2031). No deaths were observed. Antibiotic use rates were 45.2% using the categorical risk assessment and 31.6% using the EOS calculator ( p < 0.001). Conclusion: The rate of antibiotic use was lower with the EOS calculator than with the categorical risk assessment.

Background: The incidence of congenital syphilis is increasing worldwide, in parallel with the increase of syphilis in the general population. Objectives: This study aimed to determine the incidence and risk factors for congenital syphilis at a referral tertiary care center in Bangkok, Thailand. Methods: This is a case–control study using the hospital medical records of neonates born at our hospital, whose mothers had confirmed syphilis during pregnancy or at delivery between 2011 and 2018. Maternal and neonatal data were reviewed. Neonates were categorized into congenital syphilis according to CDC surveillance case definition for congenital syphilis 2015 and the American Academy of Pediatrics Congenital Syphilis 2018: confirmed and probable were assigned to the case group, while possible and less likely congenital syphilis were used as the control group. Factors associated with congenital syphilis were analyzed using univariable and multivariable analysis. Results: Among 19,558 live births, there were 126 neonates born to mothers with syphilis. Almost 40% of mothers were teenage mothers and 48.4% had inadequate or no syphilis treatment. Forty neonates met the criteria of congenital syphilis giving the incidence of 204 per 100,000 live births (95% confidence interval [CI]: 146–278). Factors associated with congenital syphilis were inadequate treatment of maternal syphilis and preterm birth (adjusted odd ratio [aOR]: 2.69, 95% CI: 1.02–7.11, P = 0.046 and aOR: 2.91; 95% CI: 1.01–8.39, P = 0.049, respectively). Conclusions: The incidence of congenital syphilis in our institution was high. Factors associated with congenital syphilis were inadequate treatment of maternal syphilis and preterm birth. Improvement of prenatal care should be emphasized.

Background: Acute liver failure (ALF) is a rare condition during neonatal period. Objective: To report a case of recipient twin with fulminant ALF secondary to hydrops fetalis caused by twin-to-twin transfusion syndrome (TTTS). Method: The patient was admitted to the neonatal intensive care unit (NICU) for respiratory failure requiring mechanical ventilation and fulminant ALF with prolonged international normalized ratio (INR) and elevated liver enzymes with highest aspartate aminotransferase of 4,580 U/L. Results: Laboratory investigation for secondary causes of liver failure was not revealing. Her liver enzymes and coagulation levels were dramatically normalized as the clinical symptoms of hypervolemia improved within 1 week. Conclusion: TTTS can be a possible cause of neonatal ALF. Early detection with proper management of TTTS is important to avoid adverse outcomes. However, pathogenesis of hepatic dysfunction in TTTS is rarely described, and further studies are needed to help understanding the correlation between liver diseases and TTTS.