DOI QR코드

DOI QR Code

Flora Colonization and Oral Glucose Levels During the Early Postnatal Period in High-Risk Newborns

고위험신생아의 생후 초기 구강 내 균집락 형성과 당농도 및 영향요인

  • 안영미 (인하대학교 간호학과) ;
  • 손민 (인하대학교 간호학과) ;
  • 전용훈 (인하대병원 소아청소년과) ;
  • 김남희 (인하대학교 간호학과)
  • Received : 2016.10.16
  • Accepted : 2016.10.25
  • Published : 2016.10.31

Abstract

Purpose: A longitudinal study was conducted to explore flora colonization and oral glucose high-risk newborns during the first 7 days after birth. Methods: Oral secretions of hospitalized newborns were obtained for microbial cultures and glucose test at days 1-7 after birth. Results: Among the total 112 newborns, 40% were girls and 73% were premature. Mean gestational age was $34.4{\pm}3.2$ weeks and weight was $2,266{\pm}697.5$ grams. The most common flora included Streptococcus (28.2%), Methicillin-resistant Staphylococcus aureus (MRSA, 10.9%), Staphylococcus (6.0%) and Coagulase-Negative Staphylococcus (CNS, 4.0%). The average oral glucose level was $29.2{\pm}23.0mg/dL{\sim}58.2{\pm}39.5mg/dL$. Newborns with higher oral glucose than serum (crude odds ratio [ORc] =1.75; 95% confidence interval [CI] =1.03-2.97), phototherapy (ORc=3.30; 95% CI=2.29-4.76) and prone position (ORc= 2.04; 95% CI=1.13-3.69) were more likely to be colonized. Having oral tubes (ORc=0.42; 95% CI=0.29-0.59), parental nutrition (ORc=0.21; 95% CI=0.13-0.32) and antibiotics (ORc=0.51; 95% CI=0.36-0.73) had protective effects. For oral glucose statistical significances existed on time effect among newborns with Streptococcus (F=9.78, p=.024), MRSA (F=7.60, p=.037) or CNS (F=11.15, p=.019) and interaction between time and colonization among newborns with all of four flora (F=2.73, p=.029) or colonization with only Staphylococcus (F=2.91, p=.034). Conclusion: High-risk newborns develop flora colonization at an early period of life. Their clinical features were associated with types and time of oral flora colonization. They need close monitoring and multifaceted intervention to improve oral environment and infection control.

Keywords

References

  1. Statistics Korea. Birthrate per gestation period of Korea [Internet]. Seoul: Statistics Korea; 2015 [cited 2016 June 23]. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B81A15 &conn_path=I3.
  2. Gardner SL, Carter B, Enzman-Hines MI, Hernandez JA. Merenstein & Gardner's handbook of neonatal intensive care. 8th ed. St. Louis, Missouri: Mosby; 2015. p. 337-359.
  3. Rosenblatt R, Steinberg D, Mankuta D, Zini A. Acquired oral microflora of newborns during the first 48 hours of life. Journal of Clinical Pediatric Dentistry. 2015;39(5):442-446. http://dx.doi.org/10.17796/1053- 4628-39.5.442
  4. Pearce C, Bowden GH, Evans M, Fitzsimmons SP, Johnson J, Sheridan MJ, et al. Identification of pioneer viridans Streptococci in the oral cavity of human neonates. Journal of Medical Microbiology. 1995; 42(1):67-72. http://dx.doi.org/10.1099/00222615-42-1-67
  5. Hospital Nurses Association. Oral care: Evidence-based clinical nursing practice guideline [Internet]. Seoul: Korean Hospital Nurses Association; 2014 [cited 2016 March 2]. Available from: http://www.khna.or.kr/web/information/data/khna_guide_ebp04.pdf.
  6. Park JH, Sohng KY. Comparison of oral care interventions on the oral status of intubated patients in intensive care units. Journal of Korean Academy of Fundamentals of Nursing. 2010;17(3):324-333.
  7. Koo MJ, Kim KN, Hwang SK. Effects of oral care with 0.12% chlorhexidine and saline solution on oral status, incidence of oral pathogens and clinical pulmonary infection score in children with cardiac surgery. Journal of Korean Academy of Fundamentals of Nursing. 2011;18(3):356-364.
  8. Jacomo AD, Carmona F, Matsuno AK, Manso PH, Carlotti AP. Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery. Infection Control & Hospital Epidemiology. 2011;32(6):591-596. http:// dx.doi.org/10.1086/660018
  9. Ahn Y, Sohn M, Jun Y, Lee E, Lee S. Two methods of cord care in high-risk newborns: Their effects on hydration, temperature, pH, and floras of the cord area. Journal of Child Health Care. 2015;19(1):118-129. http://dx.doi.org/10.1177/1367493513503580
  10. Sung MJ, Chang CH, Yoon TK, Park SE. Clinical aspects of an outbreak of Serratia marcescens infections in neonates. Korean Journal of Pediatrics. 2006;49(5):500-506. http://dx.doi.org/10.3345/kjp.2006.49.5.500
  11. Giuffre M, Amodio E, Bonura C, Geraci DM, Saporito L, Ortolano R, et al. Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors. American Journal of Infection Control. 2015;43(5):476-481. http://dx.doi.org/10.1016/j.ajic.2014.12.027
  12. Hurrell E, Kucerova E, Loughlin M, Caubilla-Barron J, Hilton A, Armstrong R, et al. Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae. BMC Infectious Diseases. 2009;9(1):146. http://dx.doi.org/10.1186/1471-2334-9-146
  13. Rosenthal VD, Rodriguez-Calderon ME, Rodriguez-Ferrer M, Singhal T, Pawar M, Sobreyra-Oropeza M, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), part II: Impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries. Infection Control & Hospital Epidemiology. 2012;33(7):704-710. http://dx.doi.org/10.1086/666342
  14. Oh W, Karecki H. Phototherapy and insensible water loss in the newborn infant. American Journal of Diseases of Children. 1972;124(2):230-232.
  15. Ullman A, Long D, Lewis P. The oral health of critically ill children: An observational cohort study. Journal of Clinical Nursing. 2011;20(21-22):3070-3080. http://dx.doi.org/10.1111/j.1365-2702.2011.03797.x
  16. Hegde A, Shenoy R, D’MeIlo P, Smitha A, Tintu A, Manjrekar P. Alternative markers of glycemic status in diabetes mellitus. Biomedical Research. 2010;21(3):252-256.
  17. Manzoni P, Farina D, Galletto P, Leonessa M, Priolo C, Arisio R, et al. Type and number of sites colonized by fungi and risk of progression to invasive fungal infection in preterm neonates in neonatal intensive care unit. Journal of Perinatal Medicine. 2007;35(3):220-226.
  18. Han MK. Decrease of healthcare-associated infections in neonatal intensive care unit by continuously enhanced infection control programs [master's thesis]. Ulsan: University of Ulsan; 2008. p. 1-79.
  19. Cortese F, Scicchitano P, Gesualdo M, Filaninno A, De Giorgi E, Schettini F, et al. Early and late infections in newborns: Where do we stand? A review. Pediatrics & Neonatology. 2015;S1875-9572(15): 00175-00178. http://dx.doi.org/10.1016/j.pedneo.2015.09.007
  20. Muley VA, Ghadage DP, Bhore AV. Bacteriological profile of neonatal septicemia in a tertiary care hospital from western India. Journal of Global Infectious Diseases. 2015;7(2):75-77. http://dx.doi.org/10.4103/0974-777X.154444
  21. Weber-Gasparoni K, Goebel BM, Drake DR, Kramer KW, Warren JJ, Reeve J. et al. Factors associated with mutans Streptococci among young WIC-enrolled children. Journal of Public Health Dentistry. 2012;72(4): 269-278. http://dx.doi.org/10.1111/j.1752-7325.2012.00335.x
  22. Sampaio N, Mello S, Alves C. Dental caries-associated risk factors and type 1 diabetes mellitus. Pediatric Endocrinology, Diabetes, and Metabolism. 2011;17(3):152-157.
  23. Mak W, Cheng TS, Chan KH, Cheung RT, Ho SL. Cerebrospinal fluid to serum glucose ratio in non-hypoglycorrhachic neurological conditions. Hong Kong Medical Journal. 2005;11(6):457-462.
  24. Akpata ES, Al-Attar A, Sharma PN. Factors associated with severe caries among adults in Kuwait. Medical Principles and Practice. 2009; 18(2):93-99. http://dx.doi.org/10.1159/000189805
  25. Voelker MA, Simmer-Beck M, Cole M, Keeven E, Tira D. Preliminary findings on the correlation of saliva pH, buffering capacity, flow, consistency and Streptococcus mutans in relation to cigarette smoking. Journal of Dental Hygiene. 2013;87(1):30-37.
  26. Wu PY, Moosa A. Effect of phototherapy on nitrogen and electrolyte levels and water balance in jaundiced preterm infants. Pediatrics. 1978;61(2):193-198.
  27. Thaden JT, Ericson JE, Cross H, Bergin SP, Messina JA, Fowler VG Jr, et al. Survival benefit of empirical therapy for Staphylococcus aureus bloodstream infections in infants. The Pediatric Infectious Disease Journal. 2015;34(11):1175-1179. http://dx.doi.org/10.1097/INF.0000000000000850
  28. Hawdon JM. Hypoglycaemia in newborn infants: Defining the features associated with adverse outcomes - a challenging remit. Biology of the Neonate. 2006;90(2):87-88. http://dx.doi.org/10.1159/000091949

Cited by

  1. 신생아 구강분비물의 당과 pH 및 영향 요인 탐색 vol.23, pp.3, 2016, https://doi.org/10.4094/chnr.2017.23.3.353