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Papers by Phillip Wozniak

Pediatric Pulmonology, Dec 4, 2023

Revista Paulista de Pediatria, Sep 1, 2016

Cureus, Jul 3, 2023

Wozniak et al. This is an open access article distributed under the terms of the Creative Commons... more Wozniak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Neonatal Infections, 2018

The Journal of Pediatrics

Journal of Medical Ethics

Research teams have used extra-uterine systems (Biobags) to support premature fetal lambs and to ... more Research teams have used extra-uterine systems (Biobags) to support premature fetal lambs and to bring them to maturation in a way not previously possible. The researchers have called attention to possible implications of these systems for sustaining premature human fetuses in a similar way. Some commentators have pointed out that perfecting these systems for human fetuses might alter a standard expectation in abortion practices: that the termination of a pregnancy also (inevitably) entails the death of the fetus. With Biobags, it might be possible, some argue, that no woman has the right to expect that outcome if the technology is able to sustain fetal lifeafteran abortion. In order to protect the expectation that the termination of a pregnancy always entails the death of the fetus, Elizabeth Romanis has argued that fetuses sustained in Biobags have a status different than otherwise ‘born’ children. In support of that view, she argues that these ‘gestatelings’ are incapable of inde...

Journal of Medical Ethics

Since the publication of the successful animal trials of the Biobag, a prototypical extrauterine ... more Since the publication of the successful animal trials of the Biobag, a prototypical extrauterine support for extremely premature neonates, numerous ethicists have debated the potential implications of such a device. Some have argued that the Biobag represents a natural evolution of traditional newborn intensive care, while others believe that the Biobag would create a new class of being for the patients housed within. Kingma and Finn argued in Bioethics for making a categorical distinction between fetuses, newborns and ‘gestatelings’ in a Biobag on the basis of a conceptual distinction between ectogenesis versus ectogestation. Applying their arguments to the clinical realities of newborn intensive care, however, demonstrates the inapplicability of their ideas to the practice of medicine. Here, I present three clinical examples of the difficulty and confusion their argument would create for clinicians and offer a possible remedy: namely, discarding the term ‘artificial womb’ in favou...

Respiratory Outcomes in Preterm Infants, 2017

EClinicalMedicine, 2021

Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal inten... more Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0À100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8À14) and 7 days (median; IQR, 5À10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0¢02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide.

Background. Antibiotic exposure in term infants has been associated with later obesity. Premature... more Background. Antibiotic exposure in term infants has been associated with later obesity. Premature, very-low-birth-weight (birth weight ≤1500 grams) infants in the neonatal intensive care unit frequently are exposed to antibiotics. Our hypothesis was that in preterm infants, there is a positive linear and dose-dependent relationship between antibiotic exposure and growth from birth through 12 months’ corrected age.Methods. Retrospective analysis of prospectively collected data of all antibiotic use among inborn, preterm (≤32 weeks’ gestation), very-low-birth-weight infants admitted to the neonatal intensive care unit at Parkland Memorial Hospital and followed in the Low Birth Weight Clinic at Children’s Medical Center, Dallas, TX. Antibiotic use was quantified by days of therapy which was compared with weight and length parameters at birth, 36 weeks’ postmenstrual age, and 2, 4, 6, and 12 months’ corrected age. The change in weight and length z-scores from birth to all subsequent age...

Open Forum Infectious Diseases, 2020

Background Antimicrobials are one of the most commonly used medications in the NICU. We aimed to ... more Background Antimicrobials are one of the most commonly used medications in the NICU. We aimed to gather baseline global data on antimicrobial use to facilitate subsequent antimicrobial stewardship efforts. Methods We conducted a one-day global NICU point prevalence study on July 1, 2019 with a 30-day follow up. Data collection included patient demographics, antimicrobial therapy, site location, antimicrobial stewardship (AS) practices as well as the duration of antimicrobial therapy and in-hospital mortality were recorded. Results Eighty-one NICUs from twenty-eight different countries identified 2,163 admitted patients of which 570 (26%) were prescribed at least one antimicrobial. Three NICUs did not have any patients on antimicrobial therapy, all had less than 20 patients admitted. Level 3 and Level 4 NICUs comprised 51% and 48% respectively. Delivery units comprised 74%, the rest were referral centers. AS programs were in place in 62% of the hospitals and 47% of the units had NICU...

American Journal of Perinatology, 2019

Respiratory syncytial virus (RSV) remains the leading cause for hospitalizations in infants world... more Respiratory syncytial virus (RSV) remains the leading cause for hospitalizations in infants worldwide, resulting in significant health and financial burden. Since 1998, the humanized monoclonal antibody palivizumab remains the only available option licensed for the prevention of severe RSV disease in high-risk children, namely premature infants and those with chronic lung disease and congenital heart disease. In 2014, the American Academy of Pediatrics modified the recommendations on the use of RSV prophylaxis in these high-risk children, and limited its use to premature infants born at < 28 weeks' gestational age (wGA). Following this last guidance update, studies have confirmed that premature infants of 29 to 34 wGA remain at high risk for severe RSV disease, especially those of younger chronologic age. New and more cost-effective strategies are being developed that would help alleviate both the health and financial burden associated with severe RSV disease.

Open Forum Infectious Diseases, 2017

Background. Congenital cytomegalovirus (cCMV) infection is the major cause of sensorineural heari... more Background. Congenital cytomegalovirus (cCMV) infection is the major cause of sensorineural hearing loss and the most frequent viral origin of neurodevelopmental impairment. The aim of this study was to evaluate incidence and characteristics of symptomatic cCMV infection in neonates in Korea with high maternal CMV seroprevalence up to 95%. Methods. From January 2001 to February 2015, all neonates born from 7 university hospitals were included. Symptomatic cCMV infection was diagnosed in neonates within 14 days after birth. A retrospective chart review was performed. Results. For 15 years, a total of 81,229 neonates were born in the 7 centers. Fortynine neonates were identified as symptomatic cCMV and estimated incidence was 0.06% (49/81,229). The median age at CMV detection was postnatal age 1 day (range, 0-12). Small for Gestational age (47%, 23/49) was the most frequent symptom at diagnosis followed by jaundice (16%, 8/49), petechiae (14%, 7/49), and microcephaly (12%, 6/49). Thrombocytopenia (47%, 23/49) was observed in the initial laboratory evaluation. Among 69% (34/49) of the patients with neuroimaging abnormalities, ventriculomegaly (37%, 18/49) and periventricular white matter injury (18%, 9/49) were most common. Twenty-one patients (43%) received ganciclovir or valganciclovir treatment (median 41 days; range, 2-188 days). Hearing function evaluation was performed in forty-one patients (84%, 41/49). Among them, 34% (14/41) had abnormality in the first hearing examination (median 21.5 days; range, 0-239 days). Four patients eventually received cochlear implantations. Retinitis was shown only in 4% (2/49). Overall mortality was 8% (4/49) within 30 days after birth. Conclusion. This study would provide the baseline information for epidemiology of symptomatic cCMV in Korean newborns. A prospective study in larger population is needed to estimate the true incidence of cCMV infection among Korean newborns and measurement of disease burden of cCMV disease in Korea is warranted.

Journal of Perinatology, 2017

Infants whose mothers had syphilis during pregnancy were studied to determine how often exposed n... more Infants whose mothers had syphilis during pregnancy were studied to determine how often exposed newborns with normal physical examinations and nonreactive nontreponemal serologic tests had abnormal laboratory or radiographic studies. STUDY DESIGN: Retrospective analysis of prospectively collected data from infants born to mothers with syphilis and had a normal examination and a nonreactive nontreponemal test. Some infants had IgM immunoblotting, PCR testing or rabbit infectivity testing (RIT) performed. RESULTS: From 1984 to 2002, 115 infants had a nonreactive serum Venereal Disease Research Laboratory (VDRL)/rapid plasma reagin (RPR) test and a normal physical examination at birth. Among 87 infants born to mothers who had untreated syphilis, 4 had a positive serum IgM immunoblot or PCR test, but none had spirochetes recovered by RIT. Two infants had anemia, one had an elevated serum alanine aminotransferase concentration and one with Down's syndrome had direct hyperbilirubinemia. Among 14 infants born to mothers treated o 4 weeks before delivery, none had abnormal laboratory or radiographic tests, although 1 of 11 had a reactive serum IgM immunoblot. Among 14 infants born to mothers treated ⩾ 4 weeks before delivery, none had abnormal laboratory or radiographic tests. CONCLUSION: Newborns with normal physical examination and nonreactive nontreponemal test results are unlikely to have abnormalities detected on conventional laboratory and radiographic testing.

The Journal of pediatrics, Jan 29, 2018

To determine whether antibiotic use in the first 14 postnatal days in preterm, very low birth wei... more To determine whether antibiotic use in the first 14 postnatal days in preterm, very low birth weight (birth weight of ≤1500 g) infants is associated with risk after 14 days of age for late-onset sepsis, necrotizing enterocolitis (NEC), or death after controlling for severity of illness using the Clinical Risk Index in Babies II score, and determine whether duration of antibiotic exposure was associated with risk of adverse outcomes. This retrospective cohort study included very low birth weight infants born at ≤32 weeks of gestation admitted to the neonatal intensive care unit from September 2010 to June 2014. Infants were excluded if they had major congenital anomalies or culture-proven sepsis, NEC, or death during the first 14 days of life. Antibiotic exposure was recorded as days of therapy and length of therapy in days. Of 374 infants, 70 (19%) had late-onset sepsis, NEC, or death after 14 days of age. The median number of antibiotic days of therapy and length of therapy were 5....

Open Forum Infectious Diseases, 2014

Revista Paulista de Pediatria, 2016

Apesar de décadas de experiência epidemiológica e clínica com sífilis materna e congênita, ambas ... more Apesar de décadas de experiência epidemiológica e clínica com sífilis materna e congênita, ambas continuam a ser importantes problemas de saúde pública no Brasil e no resto das Américas. Em 2010, com o apoio da Organização Mundial de Saúde (OMS), os Estados-Membros da Organização Pan-Americana da Saúde (Opas) aprovaram a Estratégia e Plano de Ação para a Eliminação da Transmissão Materno-Infantil do HIV e da Sífilis Congênita, com o objetivo de reduzir a incidência de sífilis congênita para ≤0,5 casos para 1.000 nascidos vivos em 2015. 1 Em 2014, 17.400 casos (1,3/1.000 nascidos vivos) de sífilis congênita foram notificados nas Américas e 17 países podem ter eliminado a transmissão materno-infantil da sífilis. 2 Apesar de alguns progressos, o Brasil não cumpriu a meta de eliminação da sífilis congênita, mas, ao contrário, a epidemia continua e resulta em mortalidade neonatal e fetal significativa. Em 2010, 6.916 casos (2,27/1.000 nascidos vivos) de sífilis congênita foram notificados ao Ministério da Saúde e à Opas, enquanto que em 2013 o número de casos aumentou para 13.705 (4,70/1.000 nascidos vivos) antes de diminuir para 6.793 casos em 2014. 2,3

The Lancet. Infectious diseases, Jan 21, 2016

Antibiotics are used frequently in the neonatal intensive care unit. We aimed to inform antibioti... more Antibiotics are used frequently in the neonatal intensive care unit. We aimed to inform antibiotic stewardship strategies in a level 3 neonatal intensive care unit by surveillance and assessment of all antibiotic use during a 14-month period, identifying scenarios where antibiotic use can be reduced, and implementing interventions while monitoring safety. The SCOUT study is an observational study in the level 3 neonatal intensive care unit at Parkland Hospital, Dallas, TX, USA. All antibiotic use in infants admitted to the neonatal intensive care unit between March 1, 2012, and Nov 30, 2012 (9 months), was monitored and analysed. After the baseline period (Oct 3, 2011, to Nov 30, 2012), continuation of empirical antibiotic therapy for ruled-out sepsis courses beyond 48 h, pneumonia, and "culture-negative" sepsis were selected as targets for antibiotic stewardship interventions. During the intervention period (Oct 1, 2013, to June 30, 2014), empirical antibiotic therapy was...

Pediatric Infectious Disease Journal, 2015

AntimicrobiAl report Background: Prolonged or unnecessary antibiotic use is associated with adver... more AntimicrobiAl report Background: Prolonged or unnecessary antibiotic use is associated with adverse outcomes in neonates. Our objectives were to quantify all antibiotic use in a Level-III neonatal intensive care unit and to identify scenarios where their use could be reduced. Methods: Surveillance and evaluation of all antibiotic use provided to every infant admitted to a Level-III neonatal intensive care unit from 10/3/11 to 11/30/12 was performed. Types of antibiotics, reasons for their initiation, discontinuation and duration, as well as clinical, laboratory and outcome data were recorded. Antibiotic use was quantified by days of therapy (DOT) per 1000 patient-days (PD). Results: A total of 1607 infants were included. The total antibiotic use was 9165 DOT (343.2 DOT/1000 PD; 5.7 DOT/infant). Seventy-two percent of infants received 1 (43%) or more (29%) courses of antibiotics. Gentamicin (46%), ampicillin (39%) and oxacillin (8%) were the most frequently used agents. Ninety-four percent of antibiotic use (323 DOT/1000 PD) was empiric therapy for suspected infection. Sixty-three percent (216.2 DOT/1000 PD) was discontinued at approximately 48 hours when cultures were sterile (68% >48 hours, 32% ≤48 hours). Twenty-six percent of all antibiotic use (89.4 DOT/1000 PD) was therapy for ≥5 days despite sterile cultures; pneumonia (16%) and "culture-negative" sepsis (8%) were the major contributors. Five percent (17.4 DOT/1000 PD) of antibiotic use was for culture-proven sepsis, 5% (16.6 DOT/1000 PD) was penicillin prophylaxis for group B Streptococcus and 1% (3.5 DOT/1000 PD) was preprocedural prophylaxis. Conclusions: Narrow-spectrum therapy accounted for >92% of antibiotic use and would not be monitored by most stewardship programs. Only 5% of antibiotic usage was due to culture-proven infection. Pneumonia and "culture-negative" sepsis were frequent reasons for prolonged therapy; further study of these conditions may allow reduction in treatment duration.

Pediatric Pulmonology, Dec 4, 2023

Revista Paulista de Pediatria, Sep 1, 2016

Cureus, Jul 3, 2023

Wozniak et al. This is an open access article distributed under the terms of the Creative Commons... more Wozniak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Neonatal Infections, 2018

The Journal of Pediatrics

Journal of Medical Ethics

Research teams have used extra-uterine systems (Biobags) to support premature fetal lambs and to ... more Research teams have used extra-uterine systems (Biobags) to support premature fetal lambs and to bring them to maturation in a way not previously possible. The researchers have called attention to possible implications of these systems for sustaining premature human fetuses in a similar way. Some commentators have pointed out that perfecting these systems for human fetuses might alter a standard expectation in abortion practices: that the termination of a pregnancy also (inevitably) entails the death of the fetus. With Biobags, it might be possible, some argue, that no woman has the right to expect that outcome if the technology is able to sustain fetal lifeafteran abortion. In order to protect the expectation that the termination of a pregnancy always entails the death of the fetus, Elizabeth Romanis has argued that fetuses sustained in Biobags have a status different than otherwise ‘born’ children. In support of that view, she argues that these ‘gestatelings’ are incapable of inde...

Journal of Medical Ethics

Since the publication of the successful animal trials of the Biobag, a prototypical extrauterine ... more Since the publication of the successful animal trials of the Biobag, a prototypical extrauterine support for extremely premature neonates, numerous ethicists have debated the potential implications of such a device. Some have argued that the Biobag represents a natural evolution of traditional newborn intensive care, while others believe that the Biobag would create a new class of being for the patients housed within. Kingma and Finn argued in Bioethics for making a categorical distinction between fetuses, newborns and ‘gestatelings’ in a Biobag on the basis of a conceptual distinction between ectogenesis versus ectogestation. Applying their arguments to the clinical realities of newborn intensive care, however, demonstrates the inapplicability of their ideas to the practice of medicine. Here, I present three clinical examples of the difficulty and confusion their argument would create for clinicians and offer a possible remedy: namely, discarding the term ‘artificial womb’ in favou...

Respiratory Outcomes in Preterm Infants, 2017

EClinicalMedicine, 2021

Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal inten... more Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0À100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8À14) and 7 days (median; IQR, 5À10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0¢02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide.

Background. Antibiotic exposure in term infants has been associated with later obesity. Premature... more Background. Antibiotic exposure in term infants has been associated with later obesity. Premature, very-low-birth-weight (birth weight ≤1500 grams) infants in the neonatal intensive care unit frequently are exposed to antibiotics. Our hypothesis was that in preterm infants, there is a positive linear and dose-dependent relationship between antibiotic exposure and growth from birth through 12 months’ corrected age.Methods. Retrospective analysis of prospectively collected data of all antibiotic use among inborn, preterm (≤32 weeks’ gestation), very-low-birth-weight infants admitted to the neonatal intensive care unit at Parkland Memorial Hospital and followed in the Low Birth Weight Clinic at Children’s Medical Center, Dallas, TX. Antibiotic use was quantified by days of therapy which was compared with weight and length parameters at birth, 36 weeks’ postmenstrual age, and 2, 4, 6, and 12 months’ corrected age. The change in weight and length z-scores from birth to all subsequent age...

Open Forum Infectious Diseases, 2020

Background Antimicrobials are one of the most commonly used medications in the NICU. We aimed to ... more Background Antimicrobials are one of the most commonly used medications in the NICU. We aimed to gather baseline global data on antimicrobial use to facilitate subsequent antimicrobial stewardship efforts. Methods We conducted a one-day global NICU point prevalence study on July 1, 2019 with a 30-day follow up. Data collection included patient demographics, antimicrobial therapy, site location, antimicrobial stewardship (AS) practices as well as the duration of antimicrobial therapy and in-hospital mortality were recorded. Results Eighty-one NICUs from twenty-eight different countries identified 2,163 admitted patients of which 570 (26%) were prescribed at least one antimicrobial. Three NICUs did not have any patients on antimicrobial therapy, all had less than 20 patients admitted. Level 3 and Level 4 NICUs comprised 51% and 48% respectively. Delivery units comprised 74%, the rest were referral centers. AS programs were in place in 62% of the hospitals and 47% of the units had NICU...

American Journal of Perinatology, 2019

Respiratory syncytial virus (RSV) remains the leading cause for hospitalizations in infants world... more Respiratory syncytial virus (RSV) remains the leading cause for hospitalizations in infants worldwide, resulting in significant health and financial burden. Since 1998, the humanized monoclonal antibody palivizumab remains the only available option licensed for the prevention of severe RSV disease in high-risk children, namely premature infants and those with chronic lung disease and congenital heart disease. In 2014, the American Academy of Pediatrics modified the recommendations on the use of RSV prophylaxis in these high-risk children, and limited its use to premature infants born at < 28 weeks' gestational age (wGA). Following this last guidance update, studies have confirmed that premature infants of 29 to 34 wGA remain at high risk for severe RSV disease, especially those of younger chronologic age. New and more cost-effective strategies are being developed that would help alleviate both the health and financial burden associated with severe RSV disease.

Open Forum Infectious Diseases, 2017

Background. Congenital cytomegalovirus (cCMV) infection is the major cause of sensorineural heari... more Background. Congenital cytomegalovirus (cCMV) infection is the major cause of sensorineural hearing loss and the most frequent viral origin of neurodevelopmental impairment. The aim of this study was to evaluate incidence and characteristics of symptomatic cCMV infection in neonates in Korea with high maternal CMV seroprevalence up to 95%. Methods. From January 2001 to February 2015, all neonates born from 7 university hospitals were included. Symptomatic cCMV infection was diagnosed in neonates within 14 days after birth. A retrospective chart review was performed. Results. For 15 years, a total of 81,229 neonates were born in the 7 centers. Fortynine neonates were identified as symptomatic cCMV and estimated incidence was 0.06% (49/81,229). The median age at CMV detection was postnatal age 1 day (range, 0-12). Small for Gestational age (47%, 23/49) was the most frequent symptom at diagnosis followed by jaundice (16%, 8/49), petechiae (14%, 7/49), and microcephaly (12%, 6/49). Thrombocytopenia (47%, 23/49) was observed in the initial laboratory evaluation. Among 69% (34/49) of the patients with neuroimaging abnormalities, ventriculomegaly (37%, 18/49) and periventricular white matter injury (18%, 9/49) were most common. Twenty-one patients (43%) received ganciclovir or valganciclovir treatment (median 41 days; range, 2-188 days). Hearing function evaluation was performed in forty-one patients (84%, 41/49). Among them, 34% (14/41) had abnormality in the first hearing examination (median 21.5 days; range, 0-239 days). Four patients eventually received cochlear implantations. Retinitis was shown only in 4% (2/49). Overall mortality was 8% (4/49) within 30 days after birth. Conclusion. This study would provide the baseline information for epidemiology of symptomatic cCMV in Korean newborns. A prospective study in larger population is needed to estimate the true incidence of cCMV infection among Korean newborns and measurement of disease burden of cCMV disease in Korea is warranted.

Journal of Perinatology, 2017

Infants whose mothers had syphilis during pregnancy were studied to determine how often exposed n... more Infants whose mothers had syphilis during pregnancy were studied to determine how often exposed newborns with normal physical examinations and nonreactive nontreponemal serologic tests had abnormal laboratory or radiographic studies. STUDY DESIGN: Retrospective analysis of prospectively collected data from infants born to mothers with syphilis and had a normal examination and a nonreactive nontreponemal test. Some infants had IgM immunoblotting, PCR testing or rabbit infectivity testing (RIT) performed. RESULTS: From 1984 to 2002, 115 infants had a nonreactive serum Venereal Disease Research Laboratory (VDRL)/rapid plasma reagin (RPR) test and a normal physical examination at birth. Among 87 infants born to mothers who had untreated syphilis, 4 had a positive serum IgM immunoblot or PCR test, but none had spirochetes recovered by RIT. Two infants had anemia, one had an elevated serum alanine aminotransferase concentration and one with Down's syndrome had direct hyperbilirubinemia. Among 14 infants born to mothers treated o 4 weeks before delivery, none had abnormal laboratory or radiographic tests, although 1 of 11 had a reactive serum IgM immunoblot. Among 14 infants born to mothers treated ⩾ 4 weeks before delivery, none had abnormal laboratory or radiographic tests. CONCLUSION: Newborns with normal physical examination and nonreactive nontreponemal test results are unlikely to have abnormalities detected on conventional laboratory and radiographic testing.

The Journal of pediatrics, Jan 29, 2018

To determine whether antibiotic use in the first 14 postnatal days in preterm, very low birth wei... more To determine whether antibiotic use in the first 14 postnatal days in preterm, very low birth weight (birth weight of ≤1500 g) infants is associated with risk after 14 days of age for late-onset sepsis, necrotizing enterocolitis (NEC), or death after controlling for severity of illness using the Clinical Risk Index in Babies II score, and determine whether duration of antibiotic exposure was associated with risk of adverse outcomes. This retrospective cohort study included very low birth weight infants born at ≤32 weeks of gestation admitted to the neonatal intensive care unit from September 2010 to June 2014. Infants were excluded if they had major congenital anomalies or culture-proven sepsis, NEC, or death during the first 14 days of life. Antibiotic exposure was recorded as days of therapy and length of therapy in days. Of 374 infants, 70 (19%) had late-onset sepsis, NEC, or death after 14 days of age. The median number of antibiotic days of therapy and length of therapy were 5....

Open Forum Infectious Diseases, 2014

Revista Paulista de Pediatria, 2016

Apesar de décadas de experiência epidemiológica e clínica com sífilis materna e congênita, ambas ... more Apesar de décadas de experiência epidemiológica e clínica com sífilis materna e congênita, ambas continuam a ser importantes problemas de saúde pública no Brasil e no resto das Américas. Em 2010, com o apoio da Organização Mundial de Saúde (OMS), os Estados-Membros da Organização Pan-Americana da Saúde (Opas) aprovaram a Estratégia e Plano de Ação para a Eliminação da Transmissão Materno-Infantil do HIV e da Sífilis Congênita, com o objetivo de reduzir a incidência de sífilis congênita para ≤0,5 casos para 1.000 nascidos vivos em 2015. 1 Em 2014, 17.400 casos (1,3/1.000 nascidos vivos) de sífilis congênita foram notificados nas Américas e 17 países podem ter eliminado a transmissão materno-infantil da sífilis. 2 Apesar de alguns progressos, o Brasil não cumpriu a meta de eliminação da sífilis congênita, mas, ao contrário, a epidemia continua e resulta em mortalidade neonatal e fetal significativa. Em 2010, 6.916 casos (2,27/1.000 nascidos vivos) de sífilis congênita foram notificados ao Ministério da Saúde e à Opas, enquanto que em 2013 o número de casos aumentou para 13.705 (4,70/1.000 nascidos vivos) antes de diminuir para 6.793 casos em 2014. 2,3

The Lancet. Infectious diseases, Jan 21, 2016

Antibiotics are used frequently in the neonatal intensive care unit. We aimed to inform antibioti... more Antibiotics are used frequently in the neonatal intensive care unit. We aimed to inform antibiotic stewardship strategies in a level 3 neonatal intensive care unit by surveillance and assessment of all antibiotic use during a 14-month period, identifying scenarios where antibiotic use can be reduced, and implementing interventions while monitoring safety. The SCOUT study is an observational study in the level 3 neonatal intensive care unit at Parkland Hospital, Dallas, TX, USA. All antibiotic use in infants admitted to the neonatal intensive care unit between March 1, 2012, and Nov 30, 2012 (9 months), was monitored and analysed. After the baseline period (Oct 3, 2011, to Nov 30, 2012), continuation of empirical antibiotic therapy for ruled-out sepsis courses beyond 48 h, pneumonia, and "culture-negative" sepsis were selected as targets for antibiotic stewardship interventions. During the intervention period (Oct 1, 2013, to June 30, 2014), empirical antibiotic therapy was...

Pediatric Infectious Disease Journal, 2015

AntimicrobiAl report Background: Prolonged or unnecessary antibiotic use is associated with adver... more AntimicrobiAl report Background: Prolonged or unnecessary antibiotic use is associated with adverse outcomes in neonates. Our objectives were to quantify all antibiotic use in a Level-III neonatal intensive care unit and to identify scenarios where their use could be reduced. Methods: Surveillance and evaluation of all antibiotic use provided to every infant admitted to a Level-III neonatal intensive care unit from 10/3/11 to 11/30/12 was performed. Types of antibiotics, reasons for their initiation, discontinuation and duration, as well as clinical, laboratory and outcome data were recorded. Antibiotic use was quantified by days of therapy (DOT) per 1000 patient-days (PD). Results: A total of 1607 infants were included. The total antibiotic use was 9165 DOT (343.2 DOT/1000 PD; 5.7 DOT/infant). Seventy-two percent of infants received 1 (43%) or more (29%) courses of antibiotics. Gentamicin (46%), ampicillin (39%) and oxacillin (8%) were the most frequently used agents. Ninety-four percent of antibiotic use (323 DOT/1000 PD) was empiric therapy for suspected infection. Sixty-three percent (216.2 DOT/1000 PD) was discontinued at approximately 48 hours when cultures were sterile (68% >48 hours, 32% ≤48 hours). Twenty-six percent of all antibiotic use (89.4 DOT/1000 PD) was therapy for ≥5 days despite sterile cultures; pneumonia (16%) and "culture-negative" sepsis (8%) were the major contributors. Five percent (17.4 DOT/1000 PD) of antibiotic use was for culture-proven sepsis, 5% (16.6 DOT/1000 PD) was penicillin prophylaxis for group B Streptococcus and 1% (3.5 DOT/1000 PD) was preprocedural prophylaxis. Conclusions: Narrow-spectrum therapy accounted for >92% of antibiotic use and would not be monitored by most stewardship programs. Only 5% of antibiotic usage was due to culture-proven infection. Pneumonia and "culture-negative" sepsis were frequent reasons for prolonged therapy; further study of these conditions may allow reduction in treatment duration.