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Gowda H, Norton R, White A, Kandasamy Y. Late-onset Neonatal Sepsis-A 10-year Review From North Queensland, Australia. Pediatr Infect Dis J 2017; 36:883-888. [PMID: 28178107 DOI: 10.1097/inf.0000000000001568] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Late-onset sepsis (LOS) in neonates contributes significantly to both morbidity and mortality. To determine the incidence of LOS, risk factors for disease and the impact on subsequent hospital course, we evaluated a cohort of 6340 neonates admitted to the neonatal intensive care unit and of neonates (3-28 days) admitted from the community between January 2005 and January 2016. METHODS This was a retrospective case review of all neonates admitted with suspected LOS who had positive blood culture and/or cerebrospinal fluid cultures, for an organism determined to be a pathogen. RESULTS Of 6340 neonates who survived beyond 3 days, 2271 (35.8%) had 1 or more blood cultures collected for suspected LOS. Of these, 146 (6.4%) positive blood cultures were thought to represent true bacteremia. The vast majority of infections (73%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 39.8% of infections. Late-onset neonatal sepsis occurred predominantly in the 24-28-week age group (75.9%) and in neonates who weighed less than 1000 g (73.6%). The incubation time for positive blood cultures for Gram-negative sepsis was less (13 hours) when compared with Gram-positive sepsis (20 hours). Thrombocytopenia, elevated C-reactive protein and chorioamnionitis were consistently associated with late-onset Gram-negative sepsis (P < 0.05). Eight neonates (6%) died secondary to LOS. CONCLUSIONS LOS contributes significantly to mortality and morbidity in neonates and remains a challenge to clinicians. Necessary steps to reduce late-onset neonatal sepsis should be undertaken.
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Affiliation(s)
- Harsha Gowda
- From the *Department of Neonatology, †Department of Microbiology and Pathology, and ‡Department of Pediatrics, Townsville Hospital, Douglas, Queensland, Australia
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52
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Koller-Smith LI, Shah PS, Ye XY, Sjörs G, Wang YA, Chow SSW, Darlow BA, Lee SK, Håkanson S, Lui K. Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants. BMC Pediatr 2017; 17:166. [PMID: 28709451 PMCID: PMC5512978 DOI: 10.1186/s12887-017-0921-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81–0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50–0.65; ≥1500 g and <32 weeks, AUC 0.60–0.62). Conclusion There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0921-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.,Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Xiang Y Ye
- Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Yueping A Wang
- Faculty of Health Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Sharon S W Chow
- Faculty of Health Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.,Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Kei Lui
- Faculty of Health Science, University of Technology Sydney, Sydney, NSW, Australia. .,Department of Newborn Care, Royal Hospital for Women, Barker St, Sydney, NSW, 2031, Australia.
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Jong E, Strunk T, Burgner D, Lavoie PM, Currie A. The phenotype and function of preterm infant monocytes: implications for susceptibility to infection. J Leukoc Biol 2017. [DOI: 10.1189/jlb.4ru0317-111r] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Emma Jong
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
| | - Tobias Strunk
- School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia
- Neonatal Clinical Care Unit, King Edward Memorial and Princess Margaret Hospitals, Subiaco, Australia
| | - David Burgner
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Paediatrics, Monash University, Clayton, Australia; and
| | - Pascal M. Lavoie
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Andrew Currie
- School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia
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Ichikawa S, Hoshina T, Kinjo T, Araki S, Kusuhara K. Efficacy of periodic surveillance culture in a neonatal intensive care unit in the presumption of causative pathogens of late-onset bacterial infection. Am J Infect Control 2017; 45:251-254. [PMID: 27793364 DOI: 10.1016/j.ajic.2016.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surveillance cultures have been recommended for infection control of resistant bacteria in neonatal intensive care units (NICUs). However, the utility of surveillance cultures in the presumption of causative bacteria in late-onset bacterial infection has been controversial. The aim of the present study was to investigate the relationship between the causative pathogens of late-onset bacterial infection and the results of periodic surveillance cultures in a NICU. METHODS A retrospective study was performed on 600 patients hospitalized in the NICU of a large metropolitan hospital from 2010-2013. The correspondence of the results of surveillance cultures with causative pathogens was analyzed in patients who developed late-onset bacterial infection. RESULTS Staphylococcus species and enterobacterium were the most prevalent in the samples obtained from the oropharynx and rectum, respectively, during the investigation period. Twenty patients (3.3%) developed late-onset bacterial infection. The causative pathogens in 15 patients (75%) were also detected from the final surveillance cultures; these patients tended to be older than the other 5 patients (P = .003). CONCLUSIONS Surveillance cultures might be useful for the presumption of causative pathogens of late-onset bacterial infection in patients with risk factors for the development of nosocomial bacterial infection.
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Affiliation(s)
- Shun Ichikawa
- Department of Pediatrics, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Takayuki Hoshina
- Department of Pediatrics, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
| | - Tadamune Kinjo
- Department of Pediatrics, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shunsuke Araki
- Department of Pediatrics, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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55
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Boo NY, Cheah IGS. Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units. Singapore Med J 2017; 57:144-52. [PMID: 26996633 DOI: 10.11622/smedj.2016056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR). METHODS This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture. RESULTS Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition. CONCLUSION Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis.
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Affiliation(s)
- Nem-Yun Boo
- Department of Population Health, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Irene Guat-Sim Cheah
- Department of Paediatrics, Paediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Tröger B, Härtel C, Buer J, Dördelmann M, Felderhoff-Müser U, Höhn T, Hepping N, Hillebrand G, Kribs A, Marissen J, Olbertz D, Rath PM, Schmidtke S, Siegel J, Herting E, Göpel W, Steinmann J, Stein A. Clinical Relevance of Pathogens Detected by Multiplex PCR in Blood of Very-Low-Birth Weight Infants with Suspected Sepsis - Multicentre Study of the German Neonatal Network. PLoS One 2016; 11:e0159821. [PMID: 27472282 PMCID: PMC4966931 DOI: 10.1371/journal.pone.0159821] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/09/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction In the German Neonatal Network (GNN) 10% of very-low-birth weight infants (VLBWI) suffer from blood-culture confirmed sepsis, while 30% of VLBWI develop clinical sepsis. Diagnosis of sepsis is a difficult task leading to potential over-treatment with antibiotics. This study aims to investigate whether the results of blood multiplex-PCR (SeptiFast®) for common sepsis pathogens are relevant for clinical decision making when sepsis is suspected in VLBWI. Methods We performed a prospective, multi-centre study within the GNN including 133 VLBWI with 214 episodes of suspected late onset sepsis (LOS). In patients with suspected sepsis a multiplex-PCR (LightCycler SeptiFast MGRADE-test®) was performed from 100 μl EDTA blood in addition to center-specific laboratory biomarkers. The attending neonatologist documented whether the PCR-result, which was available after 24 to 48 hrs, had an impact on the choice of antibiotic drugs and duration of therapy. Results PCR was positive in 110/214 episodes (51%) and blood culture (BC) was positive in 55 episodes (26%). Both methods yielded predominantly coagulase-negative staphylococci (CoNS) followed by Escherichia coli and Staphylococcus aureus. In 214 BC—PCR paired samples concordant results were documented in 126 episodes (59%; n = 32 were concordant pathogen positive results, n = 94 were negative in both methods). In 65 episodes (30%) we found positive PCR results but negative BCs, with CoNS being identified in 43 (66%) of these samples. Multiplex-PCR results influenced clinical decision making in 30% of episodes, specifically in 18% for the choice of antimicrobial therapy and in 22% for the duration of antimicrobial therapy. Conclusions Multiplex-PCR results had a moderate impact on clinical management in about one third of LOS-episodes. The main advantage of multiplex-PCR was the rapid detection of pathogens from micro-volume blood samples. In VLBWI limitations include risk of contamination, lack of resistance testing and high costs. The high rate of positive PCR results in episodes of negative BC might lead to overtreatment of infants which is associated with risk of mortality, antibiotic resistance, fungal sepsis and NEC.
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Affiliation(s)
- Birte Tröger
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
- * E-mail:
| | - Christoph Härtel
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Michael Dördelmann
- Department of Pediatrics at Diakonissen Hospital Flensburg, Flensburg, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Höhn
- Department of Pediatrics at the University of Düsseldorf, Düsseldorf, Germany
| | - Nico Hepping
- Department of Pediatrics at St. Marien Hospital Bonn, Bonn, Germany
| | - Georg Hillebrand
- Department of Pediatrics at Hospital of Itzehoe, Itzehoe, Germany
| | - Angela Kribs
- Department of Pediatrics at the University of Cologne, Cologne, Germany
| | - Janina Marissen
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Dirk Olbertz
- Neonatology Unit at Südstadt Hospital Rostock, Rostock, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Susanne Schmidtke
- Neonatology Unit at Asclepios Hospital Hamburg-Barmbek, Hamburg, Germany
| | - Jens Siegel
- Neonatology Unit at the Children´s Hospital Hannover Auf der Bult, Hannover, Germany
| | - Egbert Herting
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Anja Stein
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Cole LE, Zhang J, Kesselly A, Anosova NG, Lam H, Kleanthous H, Yethon JA. Limitations of Murine Models for Assessment of Antibody-Mediated Therapies or Vaccine Candidates against Staphylococcus epidermidis Bloodstream Infection. Infect Immun 2016; 84:1143-1149. [PMID: 26857577 PMCID: PMC4807487 DOI: 10.1128/iai.01472-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/29/2016] [Indexed: 02/02/2023] Open
Abstract
Staphylococcus epidermidis is normally a commensal colonizer of human skin and mucus membranes, but, due to its ability to form biofilms on indwelling medical devices, it has emerged as a leading cause of nosocomial infections. Bacteremia or bloodstream infection is a frequent and costly complication resulting from biofilm fouling of medical devices. Our goal was to develop a murine model of S. epidermidis infection to identify potential vaccine targets for the prevention of S. epidermidis bacteremia. However, assessing the contribution of adaptive immunity to protection against S. epidermidis challenge was complicated by a highly efficacious innate immune response in mice. Naive mice rapidly cleared S. epidermidis infections from blood and solid organs, even when the animals were immunocompromised. Cyclophosphamide-mediated leukopenia reduced the size of the bacterial challenge dose required to cause lethality but did not impair clearance after a nonlethal challenge. Nonspecific innate immune stimulation, such as treatment with a Toll-like receptor 4 (TLR4) agonist, enhanced bacterial clearance. TLR2 signaling was confirmed to accelerate the clearance of S. epidermidis bacteremia, but TLR2(-/-)mice could still resolve a bloodstream infection. Furthermore, TLR2 signaling played no role in the clearance of bacteria from the spleen. In conclusion, these data suggest that S. epidermidis bloodstream infection is cleared in a highly efficient manner that is mediated by both TLR2-dependent and -independent innate immune mechanisms. The inability to establish a persistent infection in mice, even in immunocompromised animals, rendered these murine models unsuitable for meaningful assessment of antibody-mediated therapies or vaccine candidates.
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Affiliation(s)
- Leah E Cole
- Sanofi Pasteur, Cambridge, Massachusetts, USA
| | | | | | | | - Hubert Lam
- Sanofi Pasteur, Cambridge, Massachusetts, USA
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Early-onset Sepsis and Antibiotic Exposure in Term Infants: A Nationwide Population-based Study in Norway. Pediatr Infect Dis J 2016; 35:1-6. [PMID: 26368059 DOI: 10.1097/inf.0000000000000906] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sepsis is a leading cause of neonatal morbidity and mortality. Clinical suspicion may lead to overuse of antibiotics. The objective of this study was to assess the epidemiology of early-onset sepsis (EOS) and antibiotic exposure during the first week of life in Norwegian term infants. METHODS This is a nationwide population-based study from the Norwegian Neonatal Network. During the 3-year study period (2009-2011), 20 of Norway's 21 neonatal units prospectively collected data. Among 168,877 live-born (LB) term infants born during the study period, 10,175 (6.0%) infants were hospitalized in the first week of life and included in the study. RESULTS There were 91 cases of culture-confirmed EOS (0.54 per 1000 LB) and 1447 cases classified as culture-negative EOS (8.57 per 1000 LB). The majority of culture-confirmed EOS cases were caused by Gram-positives (83/91; 91%), most commonly group B streptococci (0.31 per 1000 LB). Intravenous antibiotics were administered to 3964 infants; 39% of all admissions and 2.3% of all LB term infants. Empiric therapy consisted of an aminoglycoside and either benzylpenicillin or ampicillin in 95% of the cases. The median (interquartile range) treatment duration was 8 (7-10) days for culture-confirmed EOS and 6 (5-7) days for culture-negative EOS. There was 1 EOS-attributable death (group B streptococcal EOS) during the study period. CONCLUSIONS In this registry-based study, the incidence of culture-confirmed EOS was in line with previous international reports and the mortality was very low. A large proportion of infants without infection were treated with antibiotics. Measures should be taken to spare neonates unnecessary antibiotic treatment.
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Verstraete EH, De Coen K, Vogelaers D, Blot S. Risk Factors for Health Care-Associated Sepsis in Critically Ill Neonates Stratified by Birth Weight. Pediatr Infect Dis J 2015; 34:1180-6. [PMID: 26244835 DOI: 10.1097/inf.0000000000000851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Health care-associated bloodstream infection (HABSI) is a frequent complication in neonatal intensive care. Research on risk factors stratified by birth weight and adjusted for severity of illness and comorbidities is limited. Our objective is to describe independent risk factors for HABSI in critically ill neonates with emphasis on risk variation between birth weight groups. METHODS We performed a single-center historical cohort study in a tertiary referral center. A neonatal intensive care-audit system was used to identify eligible neonates admitted for ≥72 hours (2002-2011). HABSI is defined according to National Institute of Child Health and Human Development criteria. Risk factors for HABSI were assessed by univariate and logistic regression analysis for the total cohort and for birth weight subgroups, that is, neonates ≤1500 g and >1500 g. RESULTS A total of 342 neonates developed HABSI in 5134 admissions of ≥72 hours (6.7%). Very low birth weight, total parenteral nutrition (TPN), mechanical ventilation, gastrointestinal disease, surgery (cardiac and other type), and renal insufficiency are independent risk factors for the total cohort. Gastrointestinal disease and cardiac surgery are independent risk factors in both birth weight groups; mechanical ventilation (odds ratio [OR]: 2.6; confidence interval [CI]: 1.6-4.0) and other type of surgery (OR: 4.3; CI: 2.1-8.8) are solely independent risk factors in the ≤1500-g cohort; TPN is exclusively an independent risk factor (OR: 7.9; CI: 3.9-16.2) in the >1500-g cohort. CONCLUSIONS In our neonatal intensive care unit, risk stratification by birth weight revealed some difference. Special attention concerning infection control practices is for neonates receiving TPN, mechanical ventilation, cardiac surgery, and with a gastrointestinal disease.
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Affiliation(s)
- Evelien Hilde Verstraete
- From the *Department of Internal Medicine, Ghent University, Belgium; †Department of Neonatal Medicine, ‡Department of General Internal Medicine, Infectious Diseases and Psychosomatic Disorders, Ghent University Hospital, Belgium; and §Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
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Wang Y, Wang HL, Chen J, Sun JX. Clinical and prognostic value of combined measurement of cytokines and vascular cell adhesion molecule-1 in premature rupture of membranes. Int J Gynaecol Obstet 2015; 132:85-8. [PMID: 26604160 DOI: 10.1016/j.ijgo.2015.06.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2001] [Revised: 06/08/2015] [Accepted: 10/01/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate whether levels of interleukin 6 (IL-6), interleukin 8 (IL-8), and vascular cell adhesion molecule-1 (VCAM-1) in women with premature rupture of membranes (PROM) differ from those in women without PROM. METHODS An observational study of full-term primiparous pregnant women with PROM (PROM group) and those undergoing elective cesarean delivery (control group) was performed at a center in Yangzhou, China, between January 2003 and July 2006. IL-6, IL-8, and VCAM-1 levels were measured in maternal blood, cord blood, and amniotic fluid. A pathologic examination of fetal membranes was conducted. RESULTS The IL-6, IL-8, and VCAM-1 levels in maternal serum, amniotic fluid, and cord blood were significantly higher in the PROM group (n=58) than in the control group (n=38; P<0.05 for all comparisons). In the PROM group, the levels increased with duration of membrane rupture (P<0.05 for all). Women with chorioamnionitis had significantly higher levels than women without chorioamnionitis (P<0.05 for all), and women with PROM whose newborns had low Apgar score (≤7) had higher levels than those whose newborns had a higher Apgar score (P<0.05 for all). CONCLUSION Combined measurements of IL-6, IL-8, and VCAM-1 might help to improve early diagnosis of PROM and chorioamnionitis, and to evaluate the prognosis of newborns.
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Affiliation(s)
- Ying Wang
- Department of Antenatal Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong-Ling Wang
- Department of Antenatal Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jie Chen
- Department of Antenatal Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing-Xia Sun
- Department of Antenatal Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015; 100:F257-63. [PMID: 25425653 PMCID: PMC4413803 DOI: 10.1136/archdischild-2014-306213] [Citation(s) in RCA: 277] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 01/28/2023]
Abstract
The incidence of neonatal late-onset sepsis (LOS) is inversely related to the degree of maturity and varies geographically from 0.61% to 14.2% among hospitalised newborns. Epidemiological data on very low birth weight infants shows that the predominant pathogens of neonatal LOS are coagulase-negative staphylococci, followed by Gram-negative bacilli and fungi. Due to the difficulties in a prompt diagnosis of LOS and LOS-associated high risk of mortality and long-term neurodevelopmental sequelae, empirical antibiotic treatment is initiated on suspicion of LOS. However, empirical therapy is often inappropriately used with unnecessary broad-spectrum antibiotics and a prolonged duration of treatment. The increasing number of multidrug-resistant Gram-negative micro-organisms in neonatal intensive care units (NICU) worldwide is a serious concern, which requires thorough and efficient surveillance strategies and appropriate treatment regimens. Immunological strategies for preventing neonatal LOS are not supported by current evidence, and approaches, such as a strict hygiene protocol and the minimisation of invasive procedures in NICUs represent the cornerstone to reduce the burden of neonatal LOS.
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Affiliation(s)
- Ying Dong
- Department of Paediatrics, Children's Hospital of Fudan University, Shanghai, China
| | - Christian P Speer
- University Children's Hospital, University of Würzburg, Würzburg, Germany
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Demmert M, Schaper A, Pagel J, Gebauer C, Emeis M, Heitmann F, Kribs A, Siegel J, Müller D, Keller-Wackerbauer A, Gerleve H, Wieg C, Herting E, Göpel W, Härtel C. FUT 2 polymorphism and outcome in very-low-birth-weight infants. Pediatr Res 2015; 77:586-90. [PMID: 25642664 DOI: 10.1038/pr.2015.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 09/02/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine whether the secretor gene fucosyltransferase (FUT)2 polymorphism G428A is predictive for adverse outcomes in a large cohort of very-low-birth weight (VLBW) infants. METHODS We prospectively enrolled 2,406 VLBW infants from the population-based multicenter cohort of the German Neonatal network cohort (2009-2011). The secretor genotype (rs601338) was assessed from DNA samples extracted from buccal swabs. Primary study outcomes were clinical sepsis, blood-culture confirmed sepsis, intracerebral hemorrhage (ICH), necrotizing enterocolitis (NEC) or focal intestinal perforation requiring surgery, and death. RESULTS Based on the assumption of a recessive genetic model, AA individuals had a higher incidence of ICH (AA: 19.0% vs. GG/AG 14.9%, P = 0.04) which was not significant in the additive genetic model (multivariable logistic regression analysis; allele carriers: 365 cases, 1,685 controls; OR: 1.2; 95% CI: 0.99-1.4; P = 0.06). Other outcomes were not influenced by FUT2 genotype in either genetic model. CONCLUSION This large-scale multicenter study did not confirm previously reported associations between FUT2 genotype and adverse outcomes in preterm infants.
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Affiliation(s)
- Martin Demmert
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
| | - Anne Schaper
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
| | - Julia Pagel
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
| | - Corinna Gebauer
- Department of Pediatrics, University of Leipzig, Leipzig, Germany
| | - Michael Emeis
- Department of Neonatology, Vivantes-Klinikum Berlin-Neukölln, Berlin, Germany
| | | | - Angela Kribs
- Department of Pediatrics, University of Cologne, Köln, Germany
| | - Jens Siegel
- Department of Neonatology, Children´s Hospital Auf der Bult, Hanover, Germany
| | - Dirk Müller
- Department of Neonatology, Klinikum Kassel, Kassel, Germany
| | | | - Hubert Gerleve
- Department of Neonatology, Klinikum Coesfeld, Coesfeld, Germany
| | - Christian Wieg
- Department of Neonatology, Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Egbert Herting
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
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Pick V, Halstenberg K, Demel A, Kirchberger V, Riedel R, Schlößer R, Wollny C, Woopen C, Kuntz L, Roth B. Staff and parents are discriminators for outcomes in neonatal intensive care units. Acta Paediatr 2014; 103:e475-83. [PMID: 25060653 DOI: 10.1111/apa.12762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/06/2013] [Accepted: 07/23/2014] [Indexed: 11/27/2022]
Abstract
AIM We investigated the associations between staff work characteristics, parents' experiences and a number of medical outcome measures. METHODS This explorative multicentre study took place in the neonatal intensive care units (NICUs) of five German university hospitals between 2009 and 2011. We assessed staff work characteristics by surveying 126 NICU nurses and 57 physicians and asked 214 parents about their relationships with staff. The outcome variables of 230 premature infants with birth weights of less than 1500 g were collected over a period of 18 months. We used analysis of variance (ANOVA) and regression analyses for statistical purposes. RESULTS We found differences in outcome measures between the NICUs, particularly parameters of respiratory support, weight gain and length of stay. When we controlled for the NICUs' baseline factors, perceptions of the relationship between staff and parents (empathy, p < 0.001; conversation duration and frequency, p < 0.05; familiarity, p < 0.05) and staff work characteristics (workload, p < 0.05) were associated with at least one of these outcome measures. CONCLUSION Staff and parents were discriminators for neonatal outcomes through perceptions of work characteristics and the relationship between staff and parents, respectively. Respiratory support and nutrition measures were particularly sensitive. This research has prompted a nationwide, multicentre study of 66 NICUs.
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Affiliation(s)
- Verena Pick
- Department of Business Administration and Healthcare Management; University of Cologne; Cologne Germany
| | - Katrin Halstenberg
- Neonatology and Paediatric Intensive Care; University Hospital of Cologne; Cologne Germany
| | - Anja Demel
- Department of Neonatology; University Hospital Tübingen; Tübingen Germany
| | | | - Rainer Riedel
- Institute for Medical Economics and Health Services Research; University of Applied Sciences; Cologne Germany
| | - Rolf Schlößer
- Neonatology; University Hospital Frankfurt; Frankfurt Germany
| | - Caroline Wollny
- Department of Paediatrics; Saarland University Medical Centre; Homburg Germany
| | - Christiane Woopen
- Institute for the History of Medicine and Medical Ethics; Research Unit Ethics; University Hospital of Cologne; Cologne Germany
| | - Ludwig Kuntz
- Department of Business Administration and Healthcare Management; University of Cologne; Cologne Germany
| | - Bernhard Roth
- Neonatology and Paediatric Intensive Care; University Hospital of Cologne; Cologne Germany
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Testoni D, Hayashi M, Cohen-Wolkowiez M, Benjamin DK, Lopes RD, Clark RH, Benjamin DK, Smith PB. Late-onset bloodstream infections in hospitalized term infants. Pediatr Infect Dis J 2014; 33:920-3. [PMID: 24618934 PMCID: PMC4160433 DOI: 10.1097/inf.0000000000000322] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology and incidence of late-onset blood stream infections (BSIs) in premature infants have been described, but studies describing late-onset BSI in term infants are sparse. We sought to describe the pathogens, incidence, risk factors and mortality of late-onset BSI in hospitalized term infants. METHODS A cohort study was conducted of infants ≥37 weeks gestational age and ≤120 days of age discharged from Pediatrix Medical Group neonatal intensive care units from 1997 to 2010. We examined all cultures obtained from day of life 4-120 and used multivariable regression to assess risk factors for late-onset BSI. RESULTS We found a total of 206,019 infants cared for between day of life 4 and 120, and the incidence of late-onset BSI was 2.7/1000 admissions. We identified Gram-positive organisms in 64% of the cultures and Gram-negative organisms in 26%. We found a decreased risk of late-onset BSI in infants with the following characteristics: small for gestational age, delivery by Cesarean, antenatal antibiotic use and discharged in the later years of the study. Late-onset BSI increased the risk of death after controlling for confounders [odds ratio 8.43 (95% confidence interval 4.42-16.07)]. CONCLUSION Our data highlight the importance of late-onset BSI in hospitalized term infants. We identified Gram-positive organisms as the most common pathogen, and late-onset BSI was an independent risk factor for death.
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Affiliation(s)
- Daniela Testoni
- Duke Clinical Research Institute, Durham, NC
- Division of Neonatal Medicine, Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil
| | - Madoka Hayashi
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | | | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | | | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
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Härtel C, Pagel J, Rupp J, Bendiks M, Guthmann F, Rieger-Fackeldey E, Heckmann M, Franz A, Schiffmann JH, Zimmermann B, Hepping N, von der Wense A, Wieg C, Herting E, Göpel W. Prophylactic use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics and outcome in very low birth weight infants. J Pediatr 2014; 165:285-289.e1. [PMID: 24880888 DOI: 10.1016/j.jpeds.2014.04.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/28/2014] [Accepted: 04/15/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate outcome data in an observational cohort of very low birth weight infants of the German Neonatal Network stratified to prophylactic use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics. STUDY DESIGN Within the observational period (September 1, 2010, until December 31, 2012, n=5351 infants) study centers were categorized into 3 groups based on their choice of Lactobacillus acidophilus/Bifidobacterium infantis use: (1) no prophylactic use (12 centers); (2 a/b) change of strategy nonuser to user during observational period (13 centers); and (3) use before start of observation (21 centers). Primary outcome data of all eligible infants were determined according to center-specific strategy. RESULTS The use of probiotics was associated with a reduced risk for necrotizing enterocolitis surgery (group 1 vs group 3: 4.2 vs 2.6%, P=.028; change of strategy: 6.2 vs 4.0%, P<.001), any abdominal surgery, and hospital mortality. Infants treated with probiotics had improved weight gain/day, and probiotics had no effect on the risk of blood-culture confirmed sepsis. In a multivariable logistic regression analysis, probiotics were protective for necrotizing enterocolitis surgery (OR 0.58, 95% CI 0.37-0.91; P=.017), any abdominal surgery (OR 0.7, 95% CI 0.51-0.95; P=.02), and the combined outcome abdominal surgery and/or death (OR 0.43; 95% CI 0.33-0.56; P<.001). CONCLUSIONS Our observational data support the use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics to reduce the risk for gastrointestinal morbidity but not sepsis in very low birth weight infants.
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Affiliation(s)
- Christoph Härtel
- Department of Pediatrics, University at Lübeck, Lübeck, Germany.
| | - Julia Pagel
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
| | - Jan Rupp
- Institute for Medical Microbiology and Hygiene of the University at Lübeck, Lübeck, Germany
| | - Meike Bendiks
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
| | - Florian Guthmann
- Department of Neonatology, University of Tübingen, Tübingen, Germany
| | | | | | - Axel Franz
- Department of Pediatrics, University of Greifswald, Greifswald, Germany
| | | | - Beate Zimmermann
- Department of Pediatrics, GFO Hospitals Bonn, St. Marien Hospital, Bonn, Germany
| | - Nico Hepping
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
| | - Axel von der Wense
- Department of Neonatology, Children's Hospital Hamburg-Altona, Hamburg-Altona, Germany
| | - Christian Wieg
- Department of Neonatology and Pediatric Intensive Care, Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Egbert Herting
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University at Lübeck, Lübeck, Germany
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Neurodevelopmental impairment in preterm infants with late-onset infection: not only in extremely preterm infants. Eur J Pediatr 2014; 173:1017-23. [PMID: 24573573 DOI: 10.1007/s00431-014-2284-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Late-onset infection is known to increase the risk of neurodevelopmental impairment in infants born extremely preterm. However, little data is available regarding infants born moderately preterm. The aim of this study was to determine whether late-onset infection in moderately preterm infants (<35 weeks of gestation) was associated with a non-optimal neurodevelopmental outcome at 2 years of age. We analyzed a regional, population-based cohort of infants (LIFT cohort) between January 2003 and December 2009, and we used a propensity score method to reduce bias. Among the 4,618 preterm infants assessed at 2 years, 618 had acquired late-onset infection (13.4 %), and 764 had a non-optimal outcome (16.5 %). The rate of non-optimal outcomes was significantly higher in preterm infants with late-onset infection, irrespective of subgroups of gestational age and birth weight Z-score. After adjusting for the propensity score, the relationship between late-onset infection and non-optimal neurodevelopmental outcome at 2 years among infants born before 35 weeks of gestation remained significant (aOR = 1.3; 95 % CI 1.01-1.7; p = .04). CONCLUSION Late-onset infection is associated with poor neurological outcome at 2 years of age among infants born moderately preterm before and after adjustment for the propensity score.
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Abrams SA, Schanler RJ, Lee ML, Rechtman DJ. Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products. Breastfeed Med 2014; 9:281-5. [PMID: 24867268 PMCID: PMC4074755 DOI: 10.1089/bfm.2014.0024] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Provision of human milk has important implications for the health and outcomes of extremely preterm (EP) infants. This study evaluated the effects of an exclusive human milk diet on the health of EP infants during their stay in the neonatal intensive care unit. SUBJECTS AND METHODS EP infants <1,250 g birth weight received a diet consisting of either human milk fortified with a human milk protein-based fortifier (HM) (n=167) or a diet containing variable amounts of milk containing cow milk-based protein (CM) (n=93). Principal outcomes were mortality, necrotizing enterocolitis (NEC), growth, and duration of parenteral nutrition (PN). RESULTS Mortality (2% versus 8%, p=0.004) and NEC (5% versus 17%, p=0.002) differed significantly between the HM and CM groups, respectively. For every 10% increase in the volume of milk containing CM, the risk of sepsis increased by 17.9% (p<0.001). Growth rates were similar between groups. The duration of PN was 8 days less in the subgroup of infants receiving a diet containing <10% CM versus ≥10% CM (p<0.02). CONCLUSIONS An exclusive human milk diet, devoid of CM-containing products, was associated with lower mortality and morbidity in EP infants without compromising growth and should be considered as an approach to nutritional care of these infants.
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Affiliation(s)
- Steven A Abrams
- 1 Children's Nutrition Research Center, U.S. Department of Agriculture, Agricultural Research Service; and Department of Pediatrics, Baylor College of Medicine , Houston, Texas
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