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Mäkelä PM, Immeli L, Leskinen M, Rinta-Koski OP, Sund R, Andersson S, Luukkainen P. Actual electrolyte intake during the first week of life and morbidity in very-low-birthweight infants. Acta Paediatr 2024. [PMID: 38807279 DOI: 10.1111/apa.17298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
AIM To describe sodium and potassium intake, their sources and plasma concentrations, and the association between intake and morbidity in very-low-birthweight (VLBW, <1500 g) infants during the first week of life. METHODS This retrospective cohort study comprised 951 VLBW infants born at <32 weeks. Infants were divided into three groups according to gestational age: 23-26 (n = 275), 27-29 (n = 433) and 30-31 (n = 243) weeks. Data on fluid management and laboratory findings were acquired from an electronic patient information system. RESULTS The median sodium intake was highest in the 23-26 week group, peaking at 6.4 mmol/kg/day. A significant proportion of sodium derived from intravascular flushes; it reached 27% on day 1 in the 23-26 week group. High cumulative sodium intake in the first postnatal week was associated with weight gain from birth to day 8 in the 23-26 week group. High intake of sodium associated with an increased risk of surgically ligated patent ductus arteriosus (PDA), bronchopulmonary dysplasia and intraventricular haemorrhage, whereas low intake of potassium associated with an increased risk of PDA. CONCLUSION Sodium intake in the most premature infants exceeded recommendations during the first postnatal week. Saline flushes accounted for a significant proportion of the sodium load.
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Affiliation(s)
- Pauliina M Mäkelä
- New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Lotta Immeli
- New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Markus Leskinen
- New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | | | - Reijo Sund
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sture Andersson
- New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Luukkainen
- New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Immeli L, Mäkelä PM, Leskinen M, Sund R, Andersson S, Luukkainen P. Very low birthweight infants receive less enteral feeding than what is prescribed. Acta Paediatr 2023; 112:2084-2092. [PMID: 37341644 DOI: 10.1111/apa.16885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/22/2023]
Abstract
AIM Feeding a very low birthweight (VLBW, <1500 g) infant is challenging. Our aims were to study how prescribed enteral feeding is implemented in VLBW infants and to identify factors associating with slow enteral feeding progression. METHODS Our retrospective cohort included 516 VLBW infants born before 32 weeks of gestation during 2005-2013 and admitted to Children's Hospital, Helsinki, Finland, for at least the two first weeks of life. Nutritional data were collected from birth until the age of 14-28 days, depending on the length of stay. RESULTS We found that enteral feeding progressed slower than recommended and implementation differed from the prescriptions, especially during the parenteral nutrition phase (milk intake 10-20 mL/kg/day): 71% [40-100], median [IQR], of the prescribed enteral milk was administered. The full prescribed amount was less likely administered if a higher volume of gastric residual was aspirated or if the infant did not pass stool during the same day. Longer opiate use, patent ductus arteriosus, respiratory distress syndrome and slower passage of the first meconium associated with slower enteral feeding progression. CONCLUSION Enteral feeding of a VLBW infant is often not administered as prescribed, which possibly plays a significant role in the slow progression of enteral feeding.
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Affiliation(s)
- Lotta Immeli
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Pauliina M Mäkelä
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Markus Leskinen
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Reijo Sund
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sture Andersson
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Luukkainen
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Cao I, Lippmann N, Thome UH. The Value of Perinatal Factors, Blood Biomarkers and Microbiological Colonization Screening in Predicting Neonatal Sepsis. J Clin Med 2022; 11:jcm11195837. [PMID: 36233706 PMCID: PMC9571877 DOI: 10.3390/jcm11195837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Neonatal sepsis is one of the most important causes of elevated morbidity and mortality rates in neonatal intensive care units worldwide. While the clinical manifestations of neonatal sepsis tend to be nonspecific, its rapid development and life-threatening potential call for reliable markers for early detection. Methods: We conducted a retrospective single-center study including all neonates suspected of having developed neonatal sepsis from 2013 to 2016. Perinatal and clinical characteristics as well as microbiological and laboratory findings were evaluated. Neonatal sepsis was defined as either culture-proven sepsis (positive blood culture) or clinical sepsis (at least one symptom and elevated C-reactive protein (CRP) concentrations within 72 h with negative blood culture). We further differentiated between early-onset (EOS) and late-onset (LOS) sepsis. Results: Microbiological colonization screening by throat and rectal swabs frequently did not detect the organism that subsequently caused the sepsis. Depending on the age of the newborn with sepsis (EOS or LOS), associations between different anamnestic and clinical factors (prenatal or postnatal ones) were found. In particular, the central−peripheral temperature difference showed a strong association with LOS. Laboratory results useful for the early detection of neonatal sepsis included interleukin-6 (IL-6) and CRP concentrations. Conclusions: Elevated IL-6 >100 ng/L was a strong marker for neonatal sepsis. When choosing the antibiotics for treatment, data from microbiological colonization screening should be considered but not solely relied on. Some indicators of infection also depended on postnatal age.
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Affiliation(s)
- Isabel Cao
- Divison of Neonatology, Center for Pediatric Research, University Hospital for Children, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University of Leipzig, 04103 Leipzig, Germany
| | - Ulrich H. Thome
- Divison of Neonatology, Center for Pediatric Research, University Hospital for Children, Liebigstraße 20a, 04103 Leipzig, Germany
- Correspondence:
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Automated Complete Blood Cell Count Using Sysmex XN-9000 ® in the Diagnosis of Newborn Infection. J Clin Med 2022; 11:jcm11195507. [PMID: 36233375 PMCID: PMC9571258 DOI: 10.3390/jcm11195507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
The early identification of septically infected newborn infants is important for ensuring good outcomes. Blood cell differentiations are helpful, but they are often time consuming and inaccurate. In this study, we evaluated the use of automatic white blood cell differentiations by flow cytometry for the diagnosis of neonatal sepsis. Episodes of suspected infection in neonates were retrospectively classified into two groups, unlikely infection (UI, levels of Interleukin-6 < 400 pg/mL or CRP within 48 h < 10 mg/L), n = 101 and probable infection (PI, Interleukin-6 ≥ 400 pg/mL or CRP within 48 h ≥ 10 mg/L), n = 98. Complete blood cell counts were performed by Sysmex XN-9000® using flow cytometry. Relative and absolute proportions of immature granulocytes were evaluated. Unexpectedly, the absolute count of immature granulocytes was significantly lower in the group of PI compared to UI neonates. Similar results were found when analysing the relative proportion of immature granulocytes among all neutrophil granulocytes. On the other hand, manually counted immature to total (I/T) ratios of granulocytes were higher in PI than in UI infants. Therefore, we conclude that differentiations of granulocytes by Sysmex XN-9000® can be used to distinguish between infected and uninfected neonates if the results are interpreted according to our findings. A low count of immature granulocytes as determined by Sysmex XN-9000® may indicate neonatal infection.
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Eichberger J, Resch E, Resch B. Diagnosis of Neonatal Sepsis: The Role of Inflammatory Markers. Front Pediatr 2022; 10:840288. [PMID: 35345614 PMCID: PMC8957220 DOI: 10.3389/fped.2022.840288] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 01/12/2023] Open
Abstract
This is a narrative review on the role of biomarkers in the diagnosis of neonatal sepsis. We describe the difficulties to obtain standardized definitions in neonatal sepsis and discuss the limitations of published evidence of cut-off values and their sensitivities and specificities. Maternal risk factors influence the results of inflammatory markers as do gestational age, the time of sampling, the use of either cord blood or neonatal peripheral blood, and some non-infectious causes. Current evidence suggests that the use of promising diagnostic markers such as CD11b, CD64, IL-6, IL-8, PCT, and CRP, either alone or in combination, might enable clinicians discontinuing antibiotics confidently within 24-48 h. However, none of the current diagnostic markers is sensitive and specific enough to support the decision of withholding antibiotic treatment without considering clinical findings. It therefore seems to be justified that antibiotics are often initiated in ill term and especially preterm infants. Early markers like IL-6 and later markers like CRP are helpful in the diagnosis of neonatal sepsis considering the clinical aspect of the neonate, the gestational age, maternal risk factors and the time (age of the neonate regarding early-onset sepsis) of blood sampling.
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Affiliation(s)
- Julia Eichberger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Immeli L, Sankilampi U, Mäkelä PM, Leskinen M, Sund R, Andersson S, Luukkainen P. Length of Nutritional Transition Associates Negatively with Postnatal Growth in Very Low Birthweight Infants. Nutrients 2021; 13:nu13113961. [PMID: 34836216 PMCID: PMC8622897 DOI: 10.3390/nu13113961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 01/12/2023] Open
Abstract
Very low birthweight (VLBW, <1500 g) infants may be predisposed to undernutrition during the nutritional transition phase from parenteral to enteral nutrition. We studied the associations among the length of the transition phase, postnatal macronutrient intake, and growth from birth to term equivalent age in VLBW infants. This retrospective cohort study included 248 VLBW infants born before 32 weeks of gestation and admitted to the Children’s Hospital, Helsinki, Finland during 2005–2013. Daily nutrient intakes were obtained from computerized medication administration records. The length of the transition phase correlated negatively with cumulative energy, protein, fat, and carbohydrate intake at 28 days of age. It also associated negatively with weight and head circumference growth from birth to term equivalent age. For infants with a long transition phase (over 12 d), the estimates (95% CI) for weight and head circumference z-score change from birth to term equivalent age were −0.3 (−0.56, −0.04) and −0.44 (−0.81, −0.07), respectively, in comparison to those with a short transition phase (ad 7 d). For VLBW infants, rapid transition to full enteral feeding might be beneficial. However, if enteral nutrition cannot be advanced, well-planned parenteral nutrition during the transition phase is necessary to promote adequate growth.
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Affiliation(s)
- Lotta Immeli
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland; (P.M.M.); (M.L.); (S.A.); (P.L.)
- Correspondence:
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital, University of Eastern Finland, 70210 Kuopio, Finland;
| | - Pauliina M. Mäkelä
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland; (P.M.M.); (M.L.); (S.A.); (P.L.)
| | - Markus Leskinen
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland; (P.M.M.); (M.L.); (S.A.); (P.L.)
| | - Reijo Sund
- Faculty of Health Sciences, Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, 70210 Kuopio, Finland;
| | - Sture Andersson
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland; (P.M.M.); (M.L.); (S.A.); (P.L.)
| | - Päivi Luukkainen
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland; (P.M.M.); (M.L.); (S.A.); (P.L.)
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Ortgies T, Rullmann M, Ziegelhöfer D, Bläser A, Thome UH. The role of early-onset-sepsis in the neurodevelopment of very low birth weight infants. BMC Pediatr 2021; 21:289. [PMID: 34172028 PMCID: PMC8229301 DOI: 10.1186/s12887-021-02738-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
AIMS The study investigated a putative association between early-onset-sepsis (EOS) and poor neurodevelopmental outcomes at 2 years corrected age in very low birth weight infants. METHODS This was a single-center cohort study on infants weighing less than 1500 g with a gestational age below 35 weeks at birth born between 2008 and 2011. Neurodevelopmental outcomes were assessed at follow-up with the Bayley Scales of Infant Development-II. EOS was defined as either culture-proven EOS or clinical EOS using blood culture, CrP levels, and clinical symptoms and treatment. Neurodevelopmental impairment (NDI) was defined as one or more of the following: Mental Developmental Index (MDI) and/or Psychomotor Developmental Index (PDI) scores lower than 70; presence of cerebral palsy. RESULTS Of 405 eligible newborns in the study period 166 were included. Two had culture-proven and 29 clinical EOS. Median MDI scores in patients with EOS were 96 (IQR: 86-106) and in the control group 94 (84-106, p = 0.77). PDI scores in patients with EOS were 96 (86-106) and in the control group 99,5 (92-103, p = 0.03). Of infected patients 7/31 (24%) showed NDI as defined, whereas only 11/135 (8%) showed NDI in the control group (OR 3.3, p = 0.03). Multiple regression analyses identified chorioamnionitis and poor CRIB-Scores as individual risk factors for MDI or PDI values < 70. CONCLUSION In our study, EOS among VLBW-infants significantly impaired the neurodevelopment at 2 years corrected age. As shown in previous reports infection continues to be a problem and strategies for a reduction need further improvement.
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Affiliation(s)
- Tjark Ortgies
- Division of Neonatology, University Children's Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Michael Rullmann
- Department of Nuclear Medicine, University Hospital Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Dorothée Ziegelhöfer
- Division of Neonatology, University Children's Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Annett Bläser
- Division of Neonatology, University Children's Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Ulrich H Thome
- Division of Neonatology, University Children's Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Sabry A, Ibrahim M, Khashana A. Assessment of pentraxin 3 in a systemic inflammatory response occurring with neonatal bacterial infection. J Neonatal Perinatal Med 2021; 14:563-568. [PMID: 33523023 DOI: 10.3233/npm-200550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION In the developing countries, neonatal sepsis is the most common complication in neonatal period. It is as a systemic inflammatory response because of infection. Laboratory indicators, do not have satisfactory sensitivity. Thus, early identification of sepsis is still needed. Because PTX3 may be a faster acute-phase protein that is not liver-dependent, it is probable that it is superior to traditional biomarkers for mirroring rapid inflammatory courses. METHODS A prospective case control study design was used to determine the sensitivity of pentraxin 3 in the diagnosis of neonatal sepsis to allow early diagnostic tool. This study was carried out on neonatal ICU unit in Suez Canal University Hospital and the studied population were divided into two groups, including patients diagnosed with neonatal sepsis, based on clinical, laboratory and positive blood culture results, and control groupRESULTS:The study found that there was statistically significant differences between both groups in serum CRP values in diseased and control group (Mean = 49.3±37.4 mg/L, 26.8±17.2 mg/L, p < 0.05), and pentraxin values in diseased and control group (Mean = 5.2±3.7 mg/L, 2.3±0.78 mg/L, p < 0.0001). In addition, there were statistically significant correlations between pentraxin and serum CRP concentrations (p < 0.05) in diseased group. ROC curve showed that serum CRP demonstrated good diagnostic accuracy in predicting neonatal sepsis AUC = 0.875 with sensitivity of 100% and specificity of 92.3%. CONCLUSION Serum PTX3 may be a promising acute-phase protein for interpretation of affected newborns with symptoms and signs of sepsis.
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Affiliation(s)
- A Sabry
- Department of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Egypt
| | | | - A Khashana
- Department of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Egypt
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Bianco B, François-Garret B, Butin M, Dalmasso C, Casagrande F, Mokhtari M, Eleni Dit Trolli S. Procalcitonin in Preterm Neonates: A Different Threshold and Prolonged Interpretation. Front Pediatr 2021; 9:623043. [PMID: 34079778 PMCID: PMC8165309 DOI: 10.3389/fped.2021.623043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the positive threshold of PCT for neonates of <32 weeks of gestation for the diagnosis of early-onset sepsis and to determine if the level of PCT collected within 6 h of life could be used. Design: Retrospective and bicentric study from May 2016 to April 2018. Setting: Two groups were established, neonates evaluated for PCT at birth (CordPCT) and within 6 h of life (delPCT). Patients: Two hundred and sixty neonates of <32 weeks of gestation born in Nice and South Paris (Bicêtre) University Hospitals, had been evaluated for PCT level. Main Outcomes Measures: The value of the PCT positive threshold was determined for the total population and each groups thanks ROC curves. Results: The threshold level of PCT for the total population was 0.98 ng/mL. The threshold value of cordPCT group was 1.00 vs. 0.98 ng/mL for delPCT group. The area under the Receiver Operating Characteristics curve for PCT sampled in delPCT group was significantly higher than in cordPCT group (0.94 compared to 0.75). Conclusions: The threshold level of PCT was higher in this cohort of neonates of <32 weeks of gestation compared to the value generally described for term neonates. The secondary sampling PCT level seems to be usable in screening algorithm for early-onset neonatal sepsis.
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Affiliation(s)
- Blandine Bianco
- Neonatal Intensive Care Unit, CHU de Nice, Archet 2 Hospital, Nice, France
| | | | - Marine Butin
- Neonatal Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Cyril Dalmasso
- Laboratoire de Mathématiques et Modélisation d'Evry (LaMME), Université d'Evry Val d'Essonne, UMR CNRS 8071, Evry, France
| | | | - Mostafa Mokhtari
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre Hospital, University Paris Sud, Kremlin-Bicêtre, France
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Naramura T, Tanaka K, Inoue T, Imamura H, Yoshimatsu H, Mitsubuchi H, Nakamura K, Iwai M. New reference ranges of procalcitonin excluding respiratory failure in neonates. Pediatr Int 2020; 62:1151-1157. [PMID: 32365428 DOI: 10.1111/ped.14282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/18/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Existing reference data on serum procalcitonin (PCT) in neonates include the effects of respiratory disorders commonly occurring during birth. We aimed to determine new 95% reference intervals in neonates after excluding the influence of respiratory failure at birth, and to investigate the effects of gestational age (GA) and respiratory condition at birth on postnatal transient serum PCT elevation. METHODS Samples were obtained from term and preterm neonates during the first 3 days of life. Neonates were classified into reference, respiratory failure, and bacterial infection groups. In the reference group, the correlation between PCT level and GA was investigated. RESULTS The median PCT level within the 95% range 12-36 h after birth was 1.05 ng/mL (0.14-4.39) in term neonates (143 samples) and 1.01 ng/mL (0.15-4.44) in preterm neonates (95 samples). There was no correlation between GA and serum PCT level during 1-48 h after birth. There was a significant difference in median serum PCT level during 12-36 h after birth between the respiratory failure (9.56 ng/mL) and bacterial infection (49.82 ng/mL) groups in preterm neonates but no difference between term neonates (respiratory failure 6.83 ng/mL, and bacterial infection 7.43 ng/mL). CONCLUSIONS Respiratory failure is the main effector for the transient elevation in serum PCT levels at 3 days of life. After excluding the influence of respiratory failure, the chronological pattern and range were very similar between term and preterm neonates. Procalcitonin can be useful for clinicians in distinguishing bacterial infection from respiratory failure, aiding decisions on appropriate antibiotic use.
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Affiliation(s)
- Tetsuo Naramura
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tanaka
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Takeshi Inoue
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hiroko Imamura
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hidetaka Yoshimatsu
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Mitsubuchi
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Masanori Iwai
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
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Hoeller N, Baik-Schneditz N, Schwaberger B, Mileder L, Urlesberger B, Pichler G. Cerebral and peripheral muscle oxygenation and perfusion: Course in moderate and late preterm neonates during the first day after birth. Physiol Int 2020; 107:267-279. [PMID: 32692715 DOI: 10.1556/2060.2020.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/07/2020] [Indexed: 11/19/2022]
Abstract
Aim To investigate the ratio of cerebral tissue oxygenation index (cTOI) to peripheral muscle tissue oxygenation index (pTOI) measured by near-infrared spectroscopy (NIRS) in cardio-circulatory stable preterm neonates without signs of inflammation/infection on the first day after birth. Methods Observational study analysing secondary outcome parameters of the 'Avoiding Hypotension in Preterm Neonates (AHIP)' trial (ClinicalTrials.gov identifier: NCT01910467). Preterm neonates, who had cTOI and pTOI measurements during 24 h after birth, were included. In each neonate the mean of the cTOI/pTOI-ratio, cTOI, pTOI and routine monitoring parameters were calculated for each hour and for the 24-h measuring period. Courses of all measured parameters were analysed. Results Eighty-seven stable preterm neonates (33.1 [32.1-34.1] weeks of gestation) were included. The mean value over the 24-h measuring period for the cTOI/pTOI-ratio was 0.96 ± 0.02, for cTOI 70.1 ± 1.4 and for pTOI 73.4 ± 0.9. Routine monitoring parameters were in the normal ranges over 24 h. The courses of the cTOI/pTOI-ratio and cTOI showed significantly lower values from hour 5 to 15 compared to the first hours after birth. Heart rate decreased significantly over time, whereas mean arterial blood pressure increased significantly. pTOI, arterial oxygen saturation and body temperature showed no significant change over time. Conclusion We are the first to report on cTOI/pTOI-ratios for cardio-circulatory stable preterm neonates over a 24-h period after birth, showing significantly lower values from hour 5 to 15 compared to the first hours after birth.
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Affiliation(s)
- N Hoeller
- 1Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - N Baik-Schneditz
- 1Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - B Schwaberger
- 1Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - L Mileder
- 1Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - B Urlesberger
- 1Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - G Pichler
- 1Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Yıldırım E, Turkler C, Demir E, Tuten A, Akcay A. Umbilical arterial endocan levels can predict early neonatal pneumonia: A prospective case control study. Early Hum Dev 2020; 142:104952. [PMID: 31955030 DOI: 10.1016/j.earlhumdev.2020.104952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Engin Yıldırım
- Hitit University, Faculty of Medicine, Department of Obstetrics and Gynecology, Çorum, Turkey.
| | - Can Turkler
- Erzincan Binali Yıldırım University, Faculty of Medicine, Department of Obstetrics and Gynecology, Erzincan, Turkey
| | - Emre Demir
- Hitit University, Faculty of Medicine, Department of Biostatistics, Çorum, Turkey
| | - Abdulhamit Tuten
- Hitit University, Faculty of Medicine, Department of Pediatrics, Neonatal Intensive Care Unit, Çorum, Turkey
| | - Ahmet Akcay
- Hitit University, Faculty of Medicine, Department of Pediatrics, Neonatal Intensive Care Unit, Çorum, Turkey
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13
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Kitano T, Takagi K, Arai I, Yasuhara H, Ebisu R, Ohgitani A, Minowa H. Elevated C-reactive protein in umbilical cord blood: Neonatal case review. Pediatr Int 2019; 61:583-586. [PMID: 30993850 DOI: 10.1111/ped.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/06/2019] [Accepted: 04/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND C-reactive protein (CRP) has limited placental transportability. Relying on CRP level in umbilical cord blood alone is an inaccurate way to predict early onset neonatal sepsis, and we retrospectively reviewed the clinical courses of neonates with elevated CRP in umbilical cord blood. METHODS This study was a retrospective case review of neonates with elevated CRP in umbilical cord blood (>0.5 mg/dL) in the Nara Prefecture General Medical Center, Nara, Japan between February 2013 and August 2017. We investigated the association of maternal and neonatal factors with neonatal clinical course. Then, we compared the cases of neonates with and without elevated CRP in umbilical cord blood. RESULTS The subjects consisted of a total of 22 neonates with elevated CRP in umbilical cord blood and 344 neonates without elevated CRP in umbilical cord blood. Of the 22 neonates with elevated CRP, 18 had some symptoms of sepsis at birth, but the symptoms of 85% of the symptomatic patients resolved ≤24 h after birth. Two neonates with elevated CRP in umbilical cord blood had bacteremia, and they had poor prognoses. Elevated CRP in umbilical cord blood was associated with length of antimicrobials (P = 0.021), immature/total neutrophil ratio (P = 0.017), and pathological chorioamnionitis (CAM; P = 0.028) on multivariable logistic regression analysis. CONCLUSION Elevated CRP in umbilical cord blood was associated with pathological CAM. Most symptoms of sepsis resolved <24 h after birth.
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Affiliation(s)
- Taito Kitano
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kumiko Takagi
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Ikuyo Arai
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Hajime Yasuhara
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Reiko Ebisu
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Ayako Ohgitani
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Hideki Minowa
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
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Dell'Orto V, Bourgeois-Nicolaos N, Rouard C, Romain O, Shankar-Aguilera S, Doucet-Populaire F, De Luca D. Cell Count Analysis from Nonbronchoscopic Bronchoalveolar Lavage in Preterm Infants. J Pediatr 2018; 200:30-37.e2. [PMID: 29793870 DOI: 10.1016/j.jpeds.2018.04.074] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To establish the reference values, diagnostic accuracy, and effect of various factors on cell count in intubated preterm neonates subjected to nonbronchoscopic bronchoalveolar lavage. STUDY DESIGN This prospective, cross-sectional, blinded study included preterm neonates ventilated for any reason who underwent nonbronchoscopic bronchoalveolar lavage if they had not previously received postnatal antibiotics or steroids. Lavage was performed before surfactant replacement, if any. A gentle ventilation policy was applied. Pneumonia was diagnosed using clinical criteria, without considering cell count. Investigators performing cell counts were blinded to the clinical data. RESULTS There were 276 neonates enrolled; 36 had congenital or ventilator-associated pneumonia. In the 240 noninfected babies, median neutrophil count increased significantly after the first 2 days of ventilation (day 1, 2 cells per field [IQR, 0.0-9.5 cells per field]; day 2, 2 cells per field [IQR, 0-15 cells per field]; day 3, 20 cells per field [IQR, 2-99 cells per field]; day 4, 15 cells per field [IQR, 2-96 cells per field]; P < .0001). No significant difference was seen over time in infected babies. Multivariate analysis indicated pneumonia (standardized β = 0.134; P = .033) and the time spent under mechanical ventilation before nonbronchoscopic bronchoalveolar lavage as factors significantly influencing neutrophil count (standardized β = 0.143; P = .027). Neutrophil count was correlated with the duration of ventilation (rho = 0.28; P <.001). Neutrophil counts were higher in infected (24 cells/field [IQR, 5-78] cells/field) than in noninfected babies (4 cells/field [IQR, 1-24 cells/field]; P <.001) and had an moderate reliability for pneumonia within the first 2 days of ventilation (area under the curve, 0.745; (95% CI, 0.672-0.810; P = .002). CONCLUSIONS We provide reference values for airway neutrophil counts in ventilated preterm neonates. Bronchoalveolar lavage neutrophils significantly increase after 2 days of ventilation. Neutrophil count has moderate accuracy to diagnose pneumonia, but only within the first 2 days of ventilation.
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Affiliation(s)
- Valentina Dell'Orto
- Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Pediatrics and Neonatal Critical Care, Paris, France
| | - Nadege Bourgeois-Nicolaos
- Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Microbiology, Paris, France; Division of Microbiology, School of Pharmacy, Paris Sud-Saclay University, Paris, France
| | - Caroline Rouard
- Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Microbiology, Paris, France; Division of Microbiology, School of Pharmacy, Paris Sud-Saclay University, Paris, France
| | - Olivier Romain
- Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Pediatrics and Neonatal Critical Care, Paris, France
| | - Shivani Shankar-Aguilera
- Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Pediatrics and Neonatal Critical Care, Paris, France
| | - Florence Doucet-Populaire
- Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Microbiology, Paris, France; Division of Microbiology, School of Pharmacy, Paris Sud-Saclay University, Paris, France
| | - Daniele De Luca
- Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Pediatrics and Neonatal Critical Care, Paris, France; School of Medicine, Paris Sud-Saclay University, Paris, France.
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15
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Hilgendorff A, Windhorst A, Klein M, Tchatalbachev S, Windemuth-Kieselbach C, Kreuder J, Heckmann M, Gkatzoflia A, Ehrhardt H, Mysliwietz J, Maier M, Izar B, Billion A, Gortner L, Chakraborty T, Hossain H. Gene expression profiling at birth characterizing the preterm infant with early onset infection. J Mol Med (Berl) 2016; 95:169-180. [PMID: 27576916 PMCID: PMC5239802 DOI: 10.1007/s00109-016-1466-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 08/09/2016] [Accepted: 08/18/2016] [Indexed: 12/02/2022]
Abstract
Abstract Early onset infection (EOI) in preterm infants <32 weeks gestational age (GA) is associated with a high mortality rate and the development of severe acute and long-term complications. The pathophysiology of EOI is not fully understood and clinical and laboratory signs of early onset infections in this patient cohort are often not conclusive. Thus, the aim of this study was to identify signatures characterizing preterm infants with EOI by using genome-wide gene expression (GWGE) analyses from umbilical arterial blood of preterm infants. This prospective cohort study was conducted in preterm infants <32 weeks GA. GWGE analyses using CodeLink human microarrays were performed from umbilical arterial blood of preterm infants with and without EOI. GWGE analyses revealed differential expression of 292 genes in preterm infants with EOI as compared to infants without EOI. Infants with EOI could be further differentiated into two subclasses and were distinguished by the magnitude of the expression of genes involved in both neutrophil and T cell activation. A hallmark activity for both subclasses of EOI was a common suppression of genes involved in natural killer (NK) cell function, which was independent from NK cell numbers. Significant results were recapitulated in an independent validation cohort. Gene expression profiling may enable early and more precise diagnosis of EOI in preterm infants. Key message Gene expression (GE) profiling at birth characterizes preterm infants with EOI. GE analysis indicates dysregulation of NK cell activity. NK cell activity at birth may be a useful marker to improve early diagnosis of EOI.
Electronic supplementary material The online version of this article (doi:10.1007/s00109-016-1466-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Hilgendorff
- Department of Neonatology, Grosshadern, Ludwig-Maximilian University Munich, Germany and the Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Munich, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany.,Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Germany, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Anita Windhorst
- Institute for Medical Microbiology, Justus-Liebig University Giessen, Member of the German Center for Infection Research (DZIF), Schubertstr. 81, 35392, Giessen, Germany.,Institute for Medical Informatics, Justus-Liebig-University Giessen, Giessen, Germany
| | - Manuel Klein
- Hospital Barmherzige Brueder, Regensburg, Germany
| | - Svetlin Tchatalbachev
- Institute for Medical Microbiology, Justus-Liebig University Giessen, Member of the German Center for Infection Research (DZIF), Schubertstr. 81, 35392, Giessen, Germany
| | | | - Joachim Kreuder
- Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Germany, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine, Greifswald, Germany
| | - Anna Gkatzoflia
- Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Germany, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Harald Ehrhardt
- Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Germany, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Josef Mysliwietz
- Institute for Molecular Immunology, Helmholtz Center Munich, Munich, Germany
| | - Michael Maier
- Institute for Medical Microbiology, Justus-Liebig University Giessen, Member of the German Center for Infection Research (DZIF), Schubertstr. 81, 35392, Giessen, Germany
| | - Benjamin Izar
- Institute for Medical Microbiology, Justus-Liebig University Giessen, Member of the German Center for Infection Research (DZIF), Schubertstr. 81, 35392, Giessen, Germany.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Andre Billion
- Institute for Medical Microbiology, Justus-Liebig University Giessen, Member of the German Center for Infection Research (DZIF), Schubertstr. 81, 35392, Giessen, Germany
| | - Ludwig Gortner
- Department of Pediatrics and Neonatology, University of Saarland, Homburg, Germany
| | - Trinad Chakraborty
- Institute for Medical Microbiology, Justus-Liebig University Giessen, Member of the German Center for Infection Research (DZIF), Schubertstr. 81, 35392, Giessen, Germany
| | - Hamid Hossain
- Institute for Medical Microbiology, Justus-Liebig University Giessen, Member of the German Center for Infection Research (DZIF), Schubertstr. 81, 35392, Giessen, Germany.
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El-Sonbaty MM, AlSharany W, Youness ER, Mohamed NA, Abdel-Hamid TA, Abdel-Razek ARA. Diagnostic utility of biomarkers in diagnosis of early stages of neonatal sepsis in neonatal intensive care unit in Egypt. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Green RJ, Kolberg JM. Neonatal pneumonia in sub-Saharan Africa. Pneumonia (Nathan) 2016; 8:3. [PMID: 28702283 PMCID: PMC5469193 DOI: 10.1186/s41479-016-0003-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/24/2015] [Indexed: 01/26/2023] Open
Abstract
Neonatal pneumonia is a devastating condition. Most deaths in sub-Saharan Africa can be attributed to preventable diseases, including pneumonia, diarrhoea and malaria, which together killed an estimated 2.2 million children under the age of 5 years in 2012, accounting for a third of all under-five deaths in this region. Some countries are making progress in reducing mortality through community-based health schemes; however, most countries in this region are far from achieving the World Health Organization Sustainable Development Goals for reducing childhood morbidity and mortality. The microorganisms causing neonatal pneumonia are well known. Both bacteria and viruses are commonly responsible, while fungal organisms occur in the context of nosocomial disease, and parasites occur in HIV-infected children. The common bacterial pathogens are group B streptococci (and other streptococcal species) and Gram-negative organisms, most notably Escherichia coli and Klebsiella spp. The viruses that predominate are the common respiratory pathogens, namely respiratory syncytial virus, human rhinovirus, and influenza virus. Viral disease is often nosocomial and transmitted to infected neonates in the neonatal intensive care unit or other neonatal facilities by infected parents and staff. Neonatal pneumonia often presents with non-specific respiratory distress in newborns. In the premature infant it is often indistinguishable from surfactant deficiency-associated respiratory distress syndrome. Therefore, diagnostic testing that is cheap and reliable is urgently sought in this region. All neonates with pneumonia must receive broad-spectrum antibiotic cover. This usually entails the combination of penicillin and an aminoglycoside. A lack of appropriate drugs and neonatal intensive care unit facilities are hampering progress in managing neonatal pneumonia.
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Affiliation(s)
- Robin J Green
- Department of Paediatrics and Child Health, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Jessica M Kolberg
- Department of Paediatrics and Child Health, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
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18
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Pai VV, Vella LA, Fieldston ES. The Cost of a Culture and Doctoring at a Distance. Hosp Pediatr 2015; 5:597-9. [PMID: 26526807 DOI: 10.1542/hpeds.2015-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Evan S Fieldston
- General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia Pennsylvania; and Perelman School of Medicine at the University of Pennsylvania, Philadelphia Pennsylvania
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Suryawanshi S, Pandit V, Suryawanshi P, Panditrao A. Antibiotic Prescribing Pattern in a Tertiary Level Neonatal Intensive Care Unit. J Clin Diagn Res 2015; 9:FC21-4. [PMID: 26672773 DOI: 10.7860/jcdr/2015/14764.6807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/07/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neonatal sepsis is a major cause of morbidity and mortality worldwide especially in developing countries, which justifies early diagnosis and prompt treatment with antibiotics. Antibiotics are the most frequently used medicines in Neonatal Intensive care units. Data regarding rational antibiotic use in neonates is very limited. Hence, it is essential that the antibiotic prescribing patterns be evaluated periodically for its rational use. Therefore, the present study been carried out to identify the prescribing patterns of antibiotics in neonatal intensive care unit of a tertiary care hospital, Western Maharashtra, India. MATERIALS AND METHODS A prospective observational study was carried out for 6 months between April to September 2014. The data regarding patient demographics and antibiotic use was collected daily in a structured proforma. Collected data was subjected to statistical analysis. RESULTS Out of total 528 neonates with male preponderance (62%), 370 received antibiotics. Mean gestational age and birth weight were 35±3.2 weeks and 2±0.7 kg respectively. Mean length of hospital stay was 14.26±15.36 days (range 1 to 136 days). A total of 1123 antibiotics were prescribed to 370 neonates. The majority of neonates (55.9%) received between 1-2 antibiotics, 37.3% had 3 to 5 antibiotics prescribed, while 6.7% neonates were prescribed more than 5 antibiotics. Number of antibiotics used had statistically significant inverse relationship with gestational age. Among antibiotics; Amikacin, Cefotaxime and Levofloxacin were the drugs most often prescribed. Amikacin and Cefotaxime were given more to term infants whereas other antibiotics like Levofloxacin, Pipercillin- tazobactam and Meropenem were prescribed more to preterm and outborn neonates. CONCLUSION The use of a high number of antibiotics is a common practice. Although the indications for use of most antibiotics could be justified, the increased frequency of anbiotics use in some neonates was of concern. Guidelines for the use of antibiotics in neonates are required and larger studies are needed on this issue.
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Affiliation(s)
- Sonali Suryawanshi
- Assistant Professor, Department of Pharmacology, Bharati Vidyapeeth Deemed University , Medical College Pune, India
| | - Vijaya Pandit
- Professor and Head of Department, Department of Pharmacology, Bharati Vidyapeeth Deemed University, Medical College Pune, India
| | - Pradeep Suryawanshi
- Professor and Head of Department, Department of Neonatology, Bharati Vidyapeeth Deemed University, Medical College Pune, India
| | - Aditi Panditrao
- Post Graduate Student, Department of Pharmacology, Bharati Vidyapeeth Deemed University, Medical College Pune, India
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20
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Hisamuddin E, Hisam A, Wahid S, Raza G. Validity of C-reactive protein (CRP) for diagnosis of neonatal sepsis. Pak J Med Sci 2015; 31:527-31. [PMID: 26150837 PMCID: PMC4485264 DOI: 10.12669/pjms.313.6668] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/14/2015] [Accepted: 03/11/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the validity of C-reactive protein levels for diagnosis of neonatal sepsis. METHODS A cross sectional (Validation) study was conducted at Neonatology unit in KRL general hospital (emergency/OPD) of 7 months duration from February 2012 to August 2012. By using purposive sampling technique, 147, sample size was calculated by using WHO sample size calculator taking sensitivity 75%, specificity 95%, expected prevalence 50%, desired precision 10% and confidence level 95%. RESULTS Mean age of the neonates was 5.72 days + 3.86. Male patients were 81(55.1%) while 66(44.9%) were female. Neonatal sepsis was observed in 43(29.25%) and were confirmed through blood culture while 104(70.75%) were not confirmed on blood culture as neonatal sepsis. The sensitivity and specificity of CRP in diagnosis of acute neonatal sepsis was 76.92% and 53.49% respectively while it had a positive predictive value of 80% and negative predictive value of 48.94%. Over all the diagnostic accuracy of CRP in diagnosis of neonatal sepsis was 70.07%. CONCLUSION CRP estimation does have a role in the diagnosis of neonatal sepsis but the test is not specific enough to be relied upon as the only indicator.
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Affiliation(s)
- Effat Hisamuddin
- Effat Hisamuddin, MBBS, FCPS (Paeds), Consultant Paediatrician, Tehsil Headquarter Hospital (THQ), Chakdara, Khyber Pakhtunkhwa, Pakistan
| | - Aliya Hisam
- Aliya Hisam, MBBS, MPH, Assistant Professor, Community Medicine Department, National University of Sciences and Technology (NUST), Army Medical College, Rawalpindi, Pakistan
| | - Sughra Wahid
- Sughra Wahid, MBBS, FCPS (Paeds), MRCPCH, Head of Pediatric Department, Kahuta Research Laboratories (KRL) Hospital, G9/1, Islamabad, Pakistan
| | - Ghulam Raza
- Ghulam Raza, MBBS, MSc (Medical Administration), Vice Principal, Army Medical College, Rawalpindi, Pakistan
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21
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Iyengar A, Maron JL. Detecting infection in neonates: promises and challenges of a salivary approach. Clin Ther 2015; 37:523-8. [PMID: 25754877 DOI: 10.1016/j.clinthera.2015.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
Abstract
Premature newborns present unique challenges for the caregiver. Their clinical fragility and immature immune system places them at increased risk for bacterial and viral infections. Current clinical standard of care mandates invasive phlebotomy to assess an infant for an infection. However, serial blood draws can lead to blood transfusions and the infliction of noxious stimuli to this vulnerable population. Salivary screening for common neonatal morbidities, such as infections, could vastly improve the care for these infants and positively affect their long-term clinical outcomes. Recent technological advancements have improved our ability to detect thousands of proteins and/or microbes from a single salivary sample, making noninvasive assessment in neonates a possibility. This article reviews the clinical applications and challenges associated with integrating salivary analysis for infectious surveillance into the neonatal population.
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Affiliation(s)
| | - Jill L Maron
- Mother Infant Research Institute at Tufts Medical Center, Boston, Massachusetts
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22
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23
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Bellieni CV, Liuzzo LP, Giomi S, Tei M, Stazzoni G, Bertrando S, Cornacchione S, Braconi F, Zurli L, Buonocore G. C-reactive protein: a marker of neonatal stress? J Matern Fetal Neonatal Med 2013; 27:612-5. [PMID: 23859542 DOI: 10.3109/14767058.2013.823937] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To assess whether blood values of C-reactive protein (CRP) in healthy term newborns, are influenced by stress. MATERIAL AND METHODS Since different types of delivery (vaginal delivery [VD], emergency C-section [EMCS] and elective C-section [ELCS]) are notoriously characterized by different levels of stress for the baby, these three groups were used as models of different levels of stress. The mean CRP values of the three groups obtained in the first hours of life were compared. RESULTS We retrieved 1012 babies. Median values (3rd-97th ct) were: 0.05 (0.01-0.46), 0.17 (0.02-1.54), 0.30 (0.04-1.77), 0.43 (0.05-1.31), 0.40 (0.04-1.13) at 12, 24, 48, 72 and 96 h, respectively. Mean values in babies born after VD were statistically higher than those born after C-section, and higher CRP values were present in EMCS with respect to ELCS. CONCLUSION This study described normal blood CRP values in a wide population of term babies. An influence of the type of delivery on blood CRP is evident, and this may be explained by the different amount of perinatal stress induced by anyone of the three types of delivery we considered.
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Affiliation(s)
- C V Bellieni
- Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena , Siena , Italy
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Palmer A, Carlin JB, Freihorst J, Gatchalian S, Muhe L, Mulholland K, Weber MW. The use of CRP for diagnosing infections in young infants < 3 months of age in developing countries. ACTA ACUST UNITED AC 2013; 24:205-12. [PMID: 15479569 DOI: 10.1179/027249304225018948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The diagnosis of severe bacterial infection in young infants in developing countries is difficult because of the lack of sensitivity and specificity of the presenting symptoms and signs. Whether C-reactive protein (CRP) might help with the early detection of neonatal sepsis was investigated in a prospective study in The Gambia, Ethiopia and The Philippines. Infants < 3 months of age with symptoms or signs of possible sepsis were evaluated; CRP was measured and assessed for its ability to predict proven invasive bacterial infection. Of 966 children < 3 months of age, 54 had a positive blood culture, 13 a positive CSF culture, 15 a positive blood and CSF culture and 884 had negative cultures. Median (interquartile range) CRP values were 42 (9-173), 14 (6-36), 209 (135-286) and 8 (3-27) mg/L in the four groups, respectively. Taking a CRP cut-off of 10 mg/L, the sensitivity and specificity of an elevated CRP to predict a positive blood or CSF culture were 77% and 55%, respectively, and 55% and 82%, respectively, for a cut-off of 40 mg/L. CRP lacks the sensitivity and specificity to be used alone as a predictor of serious infections in young infants.
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Affiliation(s)
- Ayo Palmer
- Royal Victoria Hospital, Banjul, The Gambia
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25
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Abdollahi A, Shoar S, Nayyeri F, Shariat M. Diagnostic Value of Simultaneous Measurement of Procalcitonin, Interleukin-6 and hs-CRP in Prediction of Early-Onset Neonatal Sepsis. Mediterr J Hematol Infect Dis 2012; 4:e2012028. [PMID: 22708043 PMCID: PMC3375671 DOI: 10.4084/mjhid.2012.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/30/2012] [Indexed: 11/23/2022] Open
Abstract
Neonatal sepsis is a major cause of morbidities and mortalities mostly remarkable in the third world nations.We aimed to assess the value of simultaneous measurement of procalcitonin (PCT) and interleukin-6 (IL-6) in association with high sensitive- C reactive protein(hs-CRP) in prediction of early neonatal sepsis.A follow-up study was performed on 95 neonates who were below 12 hours (h) of age and had clinical signs of sepsis or maternal risk factors for sepsis. Neonates were assigned to 4 groups including "proven early-onset sepsis", "clinical early-onset sepsis", "negative infectious status", and "uncertain infectious status". Blood samples were obtained within the first 12 h of birth repeated between 24 hours and 36 hours of age for determination of serum levels of PCT, IL-6, hs-CRP, and white blood cell (WBC) count.On admission, neonates with sepsis had a higher WBC count, IL-6, PCT, and hs-CRP levels compared with those neonates without sepsis. This remained significant even after 12-24 hours of admission. Also, patients with clinical evidences of sepsis had a higher serum level of PCT and IL-6 within 12-24 hours after admission compared to the patients with uncertain sepsis.The combination of PCT and IL-6 yielded had a sensitivity of 88% and PCT and CRP (using the cutoff value of 8 mg/L) a sensitivity of 82%.The areas under the ROC curve for the two periods were 0.801, and 0.819 respectively.In final The combination of IL-6, hs-CRP, and PCT seems to be predictive in diagnosis of early onset neonatal sepsis.
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Affiliation(s)
- Alireza Abdollahi
- Division of Pathology, Imam Hospital Complex, Tehran University of Medical Sciences Tehran, Iran
| | - Saeed Shoar
- Division of Pathology, Imam Hospital Complex, Tehran University of Medical Sciences Tehran, Iran
| | - Fatemeh Nayyeri
- Division of Neonatalogy, Imam Hospital Complex, Tehran University of Medical Sciences Tehran, Iran
| | - Mamak Shariat
- Division of Neonatalogy, Imam Hospital Complex, Tehran University of Medical Sciences Tehran, Iran
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Hassanein SMA, El-Farrash RA, Hafez HM, Hassanin OM, Abd El Rahman NAE. Cord blood interleukin-6 and neonatal morbidities among preterm infants with PCR-positive Ureaplasma urealyticum. J Matern Fetal Neonatal Med 2012; 25:2106-10. [PMID: 22489672 DOI: 10.3109/14767058.2012.678435] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the clinical significance of Ureaplasma urealyticum recovery from umbilical cord blood, using Polymerase Chain Reaction (PCR), and its association with umbilical cord interleukin-6 (IL-6) levels and neonatal morbidity in preterm infants. METHODS Cord blood PCR for Ureaplasma urealyticum, and IL-6 were assessed in relation to neonatal outcomes of 30 preterm deliveries of less than 35 weeks' gestation. RESULTS Ureaplasma urealyticum was present in 43.3% of the examined cord blood samples. Positive neonatal Ureaplasma urealyticum was more common in association with premature rupture of membranes, chorioamnionitis, antenatal maternal use of antibiotics, and earlier gestation. Ureaplasma urealyticum was also associated with an early pro-inflammatory immune response (i.e. elevated IL-6 and positive C-reactive protein). Cutoff level of interleukin-6 of 240 pg% predicts the occurrence of respiratory distress syndrome (RDS), in neonates with positive PCR for Ureaplasma urealyticum. CONCLUSIONS Preterm patients with positive cord blood PCR for Ureaplasma urealyticum were more likely to have premature rupture of membrane, antenatal antibiotics, chorioamnionitis, earlier gestation, pro-inflammatory response, and RDS than those with a negative PCR. High IL-6 is more likely associated with RDS in Ureaplasma urealyticum positive neonates.
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Affiliation(s)
- Sahar M A Hassanein
- Department of Pediatrics, Ain Shams University School of Medicine, Abassia, Cairo, Egypt.
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Petit E, Abergel A, Dedet B, Subtil D. [The role of infection in preterm birth]. ACTA ACUST UNITED AC 2011; 41:14-25. [PMID: 22192232 DOI: 10.1016/j.jgyn.2011.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 10/08/2011] [Accepted: 10/13/2011] [Indexed: 12/26/2022]
Abstract
Intrauterine infection could be responsible for 25% up to 40% of preterm births. This relationship was initially demonstrated using animal models, inducing their abortion by injecting bacteria or endotoxins. In human research, examination of amniocentesis fluid showed the anteriority of infection over labor induction, and the existence of a subclinical latency phase between these two phenomena. The ascending route is preponderant, and four stages can be distinguished: cervical and vaginal infection, chorio-decidual infection, intra-amniotic infection, fetal infection. The intrauterine infection is very frequent in case of early preterm birth (<30 WG). It is associated with an increase of neurological and pulmonary morbidity. Most commonly found bacterial species are mycoplasma species, but also Escherichia coli, Gardnerella vaginalis and streptococcus B. Several markers of the infection have been studied: a maternal leukocytosis>15,000/mm(3) or a C-Reactive Protein (CRP)>20mg/l, an increase of fibronectin and/or IL-6 cervical, a short cervical length especially before 32 WG, a leukocytosis of the amniotic fluid, and/or high interleukin concentrations. The main marker used for the newborn is the CRP, but other markers can also be used for an early diagnosis of an infection, especially interleukin 6.
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Affiliation(s)
- E Petit
- Pôle d'obstétrique, clinique d'obstétrique, hôpital Jeanne-de-Flandre, université Lille II, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Meem M, Modak JK, Mortuza R, Morshed M, Islam MS, Saha SK. Biomarkers for diagnosis of neonatal infections: A systematic analysis of their potential as a point-of-care diagnostics. J Glob Health 2011; 1. [PMID: 23198119 PMCID: PMC3484777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Neonatal infections annually claim lives of 1.4 million neonates worldwide. Until now, there is no ideal diagnostic test for detecting sepsis and thus management of possible sepsis cases often depends on clinical algorithm leading to empirical treatment. This often results in unnecessary antibiotic use, which may lead to emergence of antibiotic resistance. Biomarkers have shown great promise in diagnosis of sepsis and guiding appropriate treatment of neonates. In this study, we conducted a literature review of existing biomarkers to analyze their status for use as a point-of-care diagnostic in developing countries. METHODS PubMed and EMBASE database were searched with keywords, 'infections', 'neonates', and 'biomarkers' to retrieve potentially relevant papers from the period 1980 to 2010. Leading hospitals and manufacturers were communicated to inquire about the cost, laboratory requirements and current standing of biomarkers in clinical use. RESULTS The search returned 6407 papers on biomarkers; 65 were selected after applying inclusion and exclusion criteria. Among the studies, C-reactive protein (CRP), procalcitonin (PCT) and interleukin 6 (IL-6) were the most widely studied biomarkers and were considered to be most promising for diagnosing neonatal infections. About 90% of the studies were from developed countries; more than 50% were from Europe. CONCLUSIONS Extensive work is being performed to find the diagnostic and prognostic value of biomarkers. However, the methodologies and study design are highly variable. Despite numerous research papers on biomarkers, their use in clinical setting is limited to CRP. The methods for detection of biomarkers are far too advanced to be used at the community level where most of the babies are dying. It is important that a harmonized multi-site study is initiated to find a battery of biomarkers for diagnosis of neonatal infections.
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Chiesa C, Osborn JF, Pacifico L, Natale F, De Curtis M. Gestational- and age-specific CRP reference intervals in the newborn. Clin Chim Acta 2011; 412:1889-90. [PMID: 21723856 DOI: 10.1016/j.cca.2011.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 06/17/2011] [Indexed: 10/18/2022]
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Robert Lee SY, Leung CW. Histological chorioamnionitis – implication for bacterial colonization, laboratory markers of infection, and early onset sepsis in very-low-birth-weight neonates. J Matern Fetal Neonatal Med 2011; 25:364-8. [DOI: 10.3109/14767058.2011.579208] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, De Curtis M. C reactive protein and procalcitonin: Reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta 2011; 412:1053-9. [DOI: 10.1016/j.cca.2011.02.020] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 01/19/2011] [Accepted: 02/14/2011] [Indexed: 02/02/2023]
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Rego MAC, Martinez FE, Elias J, Mussi-Pinhata MM. Diagnostic value of interleukin-6 and C-reactive protein on early onset bacterial infection in preterm neonates with respiratory distress. J Perinat Med 2010; 38:527-33. [PMID: 20443669 DOI: 10.1515/jpm.2010.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To evaluate the C-reactive protein (CRP) and interleukin-6 (IL-6) as diagnostic tools for early onset infection in preterm infants with early respiratory distress (RD). METHODS CRP and IL-6 were quantified at identification of RD and 24 h after in 186 newborns. Effects of maternal hypertension, mode of delivery, Apgar score, birth weight, gestational age, mechanical ventilation, being small for gestational age (SGA), and the presence of infection were analyzed. RESULTS Forty-four infants were classified as infected, 42 as possibly infected, and 100 as uninfected. Serum levels of IL-6 (0 h), CRP (0 h), and CRP (24 h), but not IL-6 (24 h) were significantly higher in infected infants compared to the remaining groups. The best test for identification of infection was the combination of IL-6 (0 h) 36 pg/dL and/or CRP (24 h) 0.6 mg/dL, which yielded 93% sensitivity and 37% specificity. The presence of infection and vaginal delivery independently increased IL-6 (0 h), CRP (0 h) and CRP (24 h) levels. Being SGA also increased the CRP (24 h) levels. IL-6 (24 h) was independently increased by mechanical ventilation. CONCLUSIONS The combination of IL-6 (0 h) and/or CRP (24 h) is helpful for excluding early onset infection in preterm infants with RD but the poor specificity limits its potential benefit as a diagnostic tool.
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Affiliation(s)
- Maria Aparecida C Rego
- Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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İpek İÖ, Saracoglu M, Bozaykut A. α1-Acid glycoprotein for the early diagnosis of neonatal sepsis. J Matern Fetal Neonatal Med 2010. [DOI: 10.3109/14767050903258720] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pfäfflin A, Schleicher E. Inflammation markers in point-of-care testing (POCT). Anal Bioanal Chem 2008; 393:1473-80. [PMID: 19104782 DOI: 10.1007/s00216-008-2561-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 01/13/2023]
Abstract
Inflammation is a central issue in medicine. Inflammatory processes may be local or systemic, acute or chronic, and they may be benign or fatal. In bacterial or viral infections fast and reliable diagnosis is essential for appropriate treatment, e.g. antimicrobial therapy. The time to diagnosis is critical because uncontrolled infections may lead to sepsis with a mortality rate close to 50%. Beside clinical signs, laboratory markers are important in detecting, differentiating, and monitoring inflammation, particularly acute infections. Currently several inflammation markers including leukocyte count and leukocyte differentiation, C-reactive protein (CRP), procalcitonin (PCT), and interleukins (IL) 6 and 8, is available, and potential future serum markers are under development. In this article the clinical use of these markers in routine laboratory and in point-of-care testing is described and the diagnostic value of the four groups of laboratory marker is compared. Current data show that leukocyte count or, better, neutrophil count, CRP, and PCT are well suited to support of rapid diagnosis of inflammation and infections in children and adults whereas measurement of IL-6 and 8 are preferable for detection of sepsis in neonates.
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Affiliation(s)
- Albrecht Pfäfflin
- Department of Internal Medicine IV, Clinical Chemistry Unit, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Abstract
OBJECTIVE Morbidity and mortality in preterm infants is significantly determined by the development of pulmonary complications. We thus investigated the impact of obstructive ventilatory disorders on lung function in very preterm infants with a history of respiratory distress syndrome and/or bronchopulmonary dysplasia using repeated body plethysmographic measurements before and after bronchodilation. DESIGN Lung function, including effective airway resistance (Raw), specific conductance (SGaw), functional residual capacity (FRCbox), and total respiratory system compliance (Crs, multiple occlusion technique) was assessed in 27 preterm infants pound31 wks gestational age at a median postmenstrual age of 38 wks after mild oral sedation before and after inhalation of nebulized salbutamol (1.25 mg/2.5 mL; PARI JuniorBOY N) using the MasterScreen Baby Body (Jaeger, Hoechberg, Germany). RESULTS In preterm infants median Raw was initially found to be within the normal range as determined for healthy term newborns, but decreased significantly after administration of salbutamol; SGaw changed accordingly. FRCbox was significantly reduced compared with healthy term newborns (16.6 vs. 19.6 mL/kg, mean) and decreased further after bronchodilation, whereas Crs was not significantly altered. CONCLUSIONS This is the first report quantifying the important impact of obstructive ventilatory disorders on lung function in very preterm infants at term. Besides its important role in preterm lung function consecutive overinflation could furthermore be shown to mask reduction of lung volume in these infants. Thus, body plethysmographic measurements seem to be an important diagnostic tool in preterm infants at term before hospital discharge in order to quantify ventilation disorders and to define therapeutic strategies.
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Shah DK, Doyle LW, Anderson PJ, Bear M, Daley AJ, Hunt RW, Inder TE. Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term. J Pediatr 2008; 153:170-5, 175.e1. [PMID: 18534228 DOI: 10.1016/j.jpeds.2008.02.033] [Citation(s) in RCA: 290] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Revised: 02/04/2008] [Accepted: 02/18/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To test the hypothesis that the impact of postnatal sepsis/necrotizing enterocolitis (NEC) on neurodevelopment may be mediated by white matter abnormality (WMA), which can be demonstrated with magnetic resonance imaging (MRI). STUDY DESIGN A prospective cohort of 192 unselected preterm infants (gestational age <30 weeks), who were evaluated for sepsis and NEC, underwent imaging at term-equivalent age and neurodevelopmental outcome at 2 years corrected age with the Bayley Scales of Infant Development. RESULTS Sixty-eight preterm (35%) infants had 100 episodes of confirmed sepsis, and 9 (5%) infants had confirmed NEC. Coagulase-negative staphylococci accounted for 73% (73/100) of the episodes of confirmed sepsis. Infants with sepsis/NEC had significantly more WMA on MRI at term compared with infants in the no-sepsis/NEC group. They also had poorer psychomotor development that persisted after adjusting for potential confounders but which became nonsignificant after adjusting for WMA. CONCLUSIONS Preterm infants with sepsis/NEC are at greater risk of motor impairment at 2 years, which appears to be mediated by WMA. These findings may assist in defining a neuroprotective target in preterm infants with sepsis/NEC.
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Affiliation(s)
- Divyen K Shah
- Department of Pediatrics, Washington University, St Louis, MO 63105, USA.
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Abstract
SEPSIS IS ONE OF THE MOST COMMON diagnostic challenges in the NICU. Currently a definitive diagnosis can be made only with the gold-standard blood culture, which is generally not available for 48 hours.1,2 Difficulty obtaining a large enough sample to detect a positive blood culture, as well as increased use of antenatal antibiotics, has complicated the ability to make a definitive diagnosis of sepsis.3 If left untreated, sepsis can increase morbidity and mortality. Therefore, many infants are treated empirically with broad-spectrum antibiotics.4,5 Two kinds of tests would be most helpful in the diagnosis of neonatal sepsis: one that quickly confirms the diagnosis and one that conclusively rules it out. In fact, a diagnostic sepsis marker with a high negative predictive value (the value representing patients without sepsis who are correctly diagnosed) might reduce the short- and long-term adverse effects of antibiotics, health care costs, and length of hospital stay.6 Despite extensive investigation no single test meets the criteria that would make it an ideal marker for the early diagnosis of sepsis in the newborn.5,7,8 Generally, screening includes a complete blood count with differential and may be accompanied by other adjunctive tests such as a C-reactive protein (CRP).9–11 This column examines CRP, an acute phase reactant (APR), as a diagnostic marker for neonatal sepsis.
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Serum IL-1beta, IL-6, IL-8, and TNF-alpha levels in early diagnosis and management of neonatal sepsis. Mediators Inflamm 2008; 2007:31397. [PMID: 18274637 PMCID: PMC2220039 DOI: 10.1155/2007/31397] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 10/31/2007] [Indexed: 12/02/2022] Open
Abstract
Aim. To determine serum IL-1β, IL-6, IL-8, and TNF-α levels in neonatal sepsis at the time of diagnosis and after therapy, and to show the meaningful on the follow up. Methods. This prospective study was performed on newborns who were hospitalized for neonatal sepsis and who were classified as culture-proven sepsis (n=12), as culture-negative sepsis (n=21), and as healthy newborns (n=17). Results. At the time of diagnosis, serum IL-1β, IL-6, IL-8, and TNF-α levels of culture-proven sepsis were significantly higher than those of the control groups (P<.05). At the time of diagnosis, IL-1β, IL-6, IL-8, and TNF-α levels of culture-proven sepsis and culture-negative sepsis were significantly higher than levels at the seventh day after antibiotic treatment. Conclusion. Serum IL-1β, IL-6, IL-8, and TNF-α are mediators of inflammation and can be used at the diagnosis and at the evaluation of the therapeutic efficiency in neonatal sepsis.
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Muenzenmaier M, Depperschmid M, Gille C, Poets CF, Orlikowsky TW. C-Reactive Protein, Detected with a Highly Sensitive Assay, in Non-Infected Newborns and Those with Early Onset Infection. Transfus Med Hemother 2008; 35:37-41. [PMID: 21547109 DOI: 10.1159/000112420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 11/11/2007] [Indexed: 11/19/2022] Open
Abstract
SUMMARY: BACKGOUND: The aim of this study was to investigate C-reactive protein (CRP), measured by a highly sensitive method (hsCRP) in non-infected newborns and in those with suspected early onset bacterial infection (EOBI) as well as to test whether EOBI would be detectable earlier by hsCRP than by a nephelometric CRP (nsCRP) assay (thresholds > 10 mg/l) or IL-8. PATIENTS AND METHODS: 106 neonates with signs of infection comprised the suspected EOBI group. 134 neonates with risk factors but confirmed exclusion of EOBI served as non-infected controls. RESULTS: In the non-infected group, hsCRP in the first 6 h after birth was low (0.7 mg/l; SD 0.16 mg/l) but showed an increase to 4.11 mg/l (SD 3.33 mg/l) at 72 h (p < 0.001 vs. 6 h). The sensitivity of hsCRP (cut-off 0.3 mg/l) vs. nsCRP for EOBI was 0.46 vs. 0.23 at 6 h after clinical suspicion. Of all parameters measured, IL-8 had the highest sensitivity and specificity to detect EOBI at 6 h (0.60 and 0.90), but declined after 12 and 24 h. CONCLUSION: Lowering the CRP detection threshold by a highly sensitive assay did not improve diagnostic accuracy for EOBI.
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Hilgendorff A, Heidinger K, Pfeiffer A, Bohnert A, König IR, Ziegler A, Merz C, Frey G, Chakraborty T, Gortner L, Bein G. Association of polymorphisms in the mannose-binding lectin gene and pulmonary morbidity in preterm infants. Genes Immun 2007; 8:671-7. [PMID: 17898783 DOI: 10.1038/sj.gene.6364432] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deficiency in the collectin mannose-binding lectin (MBL) increases the risk for pulmonary and systemic infections and its complications in children and adults. The aim of this prospective cohort study was to determine the genetic association of sequence variations within the MBL gene with systemic infections and pulmonary short- and long-term complications in preterm infants below 32 weeks gestational age (GA). Three single-nucleotide polymorphisms (SNPs) in the coding region and one SNP in the promotor region of MBL2 were genotyped by direct sequencing and with sequence-specific probes in 284 newborn infants <32 weeks GA. Clinical variables were comprehensively monitored. An association was found between two SNPs and the development of bronchopulmonary dysplasia (BPD), defined as persistent oxygen requirement at 36 weeks postmenstrual age, adjusting for covariates GA, grade of respiratory distress syndrome and days on mechanical ventilation (rs1800450 (exon 1 at codon 54, B variant): odds ratio dominant model (OR)=3.59, 95% confidence interval (CI)=1.62-7.98; rs7096206 (-221, X variant): OR=2.40, 95% CI=1.16-4.96). Haplotype analyses confirmed the association to BPD, and a single haplotype (frequency 56%) including all SNPs in their wild-type form showed a negative association with the development of BPD. We detected no association between the MBL gene variations and the development of early-onset infections or further pulmonary complications. Frequent variants of the MBL gene, leading to low MBL concentrations, are associated with the diagnosis of BPD in preterm infants. This provides a basis for potential therapeutic options and further genetic and proteomic analysis of the function of MBL in the resistance against pulmonary long-term complications in preterm infants.
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Affiliation(s)
- A Hilgendorff
- Department of Paediatrics, University of Giessen and Marburg, Giessen, Germany.
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Orlikowsky TW, Trüg C, Neunhoeffer F, Deperschmidt M, Eichner M, Poets CF. Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection. J Perinatol 2006; 26:115-9. [PMID: 16407966 DOI: 10.1038/sj.jp.7211422] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate postnatal lipopolysaccharide-binding protein (LBP) kinetics in term neonates and to test its diagnostic accuracy for early-onset bacterial infection (EOBI). STUDY DESIGN A total of 99 neonates with clinical and serological signs of EOBI comprised the study group; 198 neonates with risk factors, but without EOBI, served as controls. LBP, C-reactive protein (CRP) and interleukin-8 (IL-8) were determined. RESULTS LBP in the noninfected group increased until 24 h after birth (P < 0.05 vs 6 h). LBP and CRP correlated strongly in neonates with suspected EOBI (r = 0.63). Although LBP reached a higher sensitivity than CRP 6 and 12 h after clinical suspicion (45 (24-68) and 79% (54-94) vs 9 (0-24) and 39% (17-64); P < 0.05)), EOBI was most reliably detected by IL-8. CONCLUSION LBP kinetics were age-dependent. LBP was not sufficiently sensitive in the prediction of EOBI.
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Affiliation(s)
- T W Orlikowsky
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
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Joram N, Boscher C, Denizot S, Loubersac V, Winer N, Roze JC, Gras-Le Guen C. Umbilical cord blood procalcitonin and C reactive protein concentrations as markers for early diagnosis of very early onset neonatal infection. Arch Dis Child Fetal Neonatal Ed 2006; 91:F65-6. [PMID: 16371391 PMCID: PMC2672656 DOI: 10.1136/adc.2005.074245] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Procalcitonin (PCT) and C reactive protein (CRP) concentrations in umbilical cord blood of 197 neonates were measured to evaluate their value as markers of infection. Sixteen of the neonates were infected. The sensitivity, specificity, and negative and positive predictive values were respectively 87.5%, 98.7%, 87.5%, and 98.7% for PCT and 50%, 97%, 67%, and 94% for CRP. Serum PCT in cord blood seems to be a useful and early marker of antenatal infection.
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Affiliation(s)
- N Joram
- Département de Périnatologie, Hôpital Mère Enfant, Nantes, France
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Abstract
AIM Deficiency in collectins is discussed as a risk factor for pulmonary and systemic infections in children and adults. The objective of this study was to determine serum concentrations of surfactant protein D (SP-D) and mannose-binding lectin (MBL) in preterm and term infants at birth. METHODS 47 preterm infants below 32 wk gestational age (GA) and 19 healthy, term newborn infants at birth have been included in the study, and SP-D as well as MBL concentrations have been determined in umbilical cord blood samples using sandwich ELISA technique. In addition, SP-D concentrations were assessed in tracheal aspirates (TA) of 24 mechanically ventilated preterms and in infants without pulmonary complications before elective surgery. RESULTS MBL serum concentrations were significantly lower in preterms <32 wk GA (756.7 ng/ml; 14.6-11 184 ng/ml) compared to term newborns (3168.9 ng/ml; 282.3-7679.5 ng/ml; p=0.005; median and range, respectively). Serum SP-D concentrations were significantly decreased in preterms between 28 and 32 wk GA (1.4 ng/ml; 0-4.6 ng/ml; n=26) compared to term infants (2.2 ng/ml; 1.2-3.3 ng/ml; p=0.05) and were found to positively correlate with history of antenatal corticosteroids and chorioamnionitis. SP-D concentrations in TA were increased in preterm infants between 28 and 32 wk GA with respiratory distress syndrome (RDS) (25.0 ng/ml; 0.9-44.7 ng/ml; n=12) compared to control subjects (6.6 ng/ml; 0.5-30.4 ng/ml; n=12) in contrast to extremely immature infants <28 wk GA suffering from RDS (4.4 ng/ml; 0.8-78.4 ng/ml; n=12). CONCLUSION In preterm infants, significant changes occur in collectin umbilical cord blood concentrations and pulmonary SP-D levels. Functional aspects of these findings need to be addressed further.
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Affiliation(s)
- Anne Hilgendorff
- Department of Paediatrics and Neonatology, Immunology and Transfusion Medicine, and Medical Microbiology, Giessen Research Centre in Infectious Diseases (GRID), Justus-Liebig-University Giessen, Germany.
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Kafetzis DA, Tigani GS, Costalos C. Immunologic markers in the neonatal period: diagnostic value and accuracy in infection. Expert Rev Mol Diagn 2005; 5:231-9. [PMID: 15833052 DOI: 10.1586/14737159.5.2.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diagnosis of early-onset neonatal infection has led to the development of several screening tests including C-reactive protein, a very commonly used marker, and cytokines (mainly interleukin-6 and -8), alone or in combination with C-reactive protein, based on the premise that their increases in response to infection may precede that of C-reactive protein. In recent years the search for diagnostic tests has turned to procalcitonin, a propeptide of calcitonin, which appears to be a promising marker of infection in newborn infants. Additionally, specific leukocyte cell surface antigens (mainly CD11b and CD64), detected by flow cytometry, are evaluated as markers of neonatal infection, since their expression on the cell membrane increases in substantial quantities after leukocyte activation by bacteria or their cellular products. This review aims to examine the role of these newly available immunologic indices and to assess their validity as diagnostic markers of infection during the neonatal period.
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Affiliation(s)
- Dimitris A Kafetzis
- University of Athens, Second Department of Pediatrics, P & A Kyriakou Children's Hospital, Thevon & Livadias St, GR-115 27, Athens, Greece.
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Orlikowsky TW, Neunhoeffer F, Goelz R, Eichner M, Henkel C, Zwirner M, Poets CF. Evaluation of IL-8-concentrations in plasma and lysed EDTA-blood in healthy neonates and those with suspected early onset bacterial infection. Pediatr Res 2004; 56:804-9. [PMID: 15319462 DOI: 10.1203/01.pdr.0000141523.68664.4a] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Plasma IL-8 is a diagnostic parameter of early-onset bacterial infection (EOBI) in neonates but has a short half-life. The detergent-lysed whole-blood (DLWB) IL-8 consists of both extracellular and cell-bound IL-8. The objective of this study was to investigate kinetics of plasma and DLWB IL-8 in healthy newborns and those with suspected EOBI and to test the hypothesis that determination of DLWB IL-8 results in higher sensitivity for EOBI detection. Sixty-one neonates with clinical and serologic signs of EOBI composed the study group; 188 neonates with risk factors but without EOBI served as control subjects. IL-8 concentrations were determined in plasma and DLWB. In the control group, DLWB IL-8 concentrations were 280-fold higher (9599 pg/mL; SD 4433) up to 24 h post partum than corresponding plasma levels (34.2 pg/mL; SD 18.1). The sensitivity of DLWB versus plasma IL-8 for EOBI was 0.97 versus 0.71 after 6 h and 0.70 versus 0.32 after 24 h. Corresponding values for specificity were 0.95 versus 0.90 after 6 h and 0.92 versus 0.99 after 24 h. After 24 h, the negative predictive value for DLWB versus plasma IL-8 was 0.80 versus 0.66. DLWB IL-8 showed a higher sensitivity for EOBI within 6 h after first clinical suspicion than plasma IL-8. It also remained elevated longer. Our results suggest that DLWB IL-8 results in a higher sensitivity for EOBI.
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Behrendt D, Dembinski J, Heep A, Bartmann P. Lipopolysaccharide binding protein in preterm infants. Arch Dis Child Fetal Neonatal Ed 2004; 89:F551-4. [PMID: 15499153 PMCID: PMC1721788 DOI: 10.1136/adc.2003.030049] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess serum concentrations of lipopolysaccharide binding protein (LBP) in preterm infants with neonatal bacterial infection (NBI). METHODS Blood samples were analysed of 57 preterm (28(+1) to 36(+6), median 33(+2) weeks gestation) and 17 term infants admitted to the neonatal intensive care unit within the first 72 hours of life with suspicion of NBI. Samples were obtained at first suspicion of sepsis and after 12 and 24 hours. Diagnosis of NBI was confirmed by raised concentrations of C reactive protein and/or interleukin 6. The influence of gestational age and labour was analysed. RESULTS Maximum LBP concentrations in infants with NBI were greatly increased compared with infants without NBI (13.0-46.0 microg/ml (median 20.0 microg/ml) v 0.6-17.4 microg/ml (median 4.2 microg/ml)). LBP concentrations in infected infants were not yet significantly raised when NBI was first suspected. The LBP concentrations of preterm infants were comparable to those of term infants. Regression analysis revealed no significant effect of labour or gestational age on LBP. CONCLUSIONS Raised LBP concentrations indicate NBI in preterm and term infants. Preterm infants of > 28 weeks gestation seem to be capable of producing LBP as efficiently as term infants. Neonatal LBP concentrations are not influenced by labour. LBP may be a useful diagnostic marker of NBI in preterm infants.
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Affiliation(s)
- D Behrendt
- Department of Neonatology, University Children's Hospital, University of Bonn, D-53113 Bonn, Germany.
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Franz AR, Bauer K, Schalk A, Garland SM, Bowman ED, Rex K, Nyholm C, Norman M, Bougatef A, Kron M, Mihatsch WA, Pohlandt F. Measurement of interleukin 8 in combination with C-reactive protein reduced unnecessary antibiotic therapy in newborn infants: a multicenter, randomized, controlled trial. Pediatrics 2004; 114:1-8. [PMID: 15231900 DOI: 10.1542/peds.114.1.1] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Neonatal bacterial infections carry a high mortality when diagnosed late. Early diagnosis is difficult because initial clinical signs are nonspecific. Consequently, physicians frequently prescribe antibiotic treatment to newborn infants for fear of missing a life-threatening infection. This study was designed to test the hypotheses that a diagnostic algorithm that includes measurements of interleukin 8 (IL-8) and C-reactive protein (CRP) 1) reduces antibiotic therapy and 2) does not result in more initially missed infections compared with standard management that does not include an IL-8 measurement. METHODS Term and preterm infants who were <72 hours of age and had clinical signs or obstetric risk factors suggesting neonatal bacterial infection but stable enough to wait for results of diagnostic tests were enrolled into the study. A total of 1291 infants were randomly assigned to receive antibiotic therapy according to the guidelines of each center (standard group) or to receive antibiotic therapy when IL-8 was >70 pg/mL and/or CRP was >10 mg/L (IL-8 group). The primary outcome variables were 1) the number of infants treated with antibiotics and 2) the number of infants with infections missed at the initial evaluation. RESULTS In the IL-8 group, fewer infants received antibiotic therapy than in the standard group (36.1% [237 of 656] vs 49.6% [315 of 635]). In the IL-8 group, 24 (14.5%) of 165 infants with infection were not detected at the initial evaluation, compared with 28 (17.3%) of 162 in the standard group. CONCLUSIONS The number of newborn infants who received postnatal antibiotic therapy can be reduced with a diagnostic algorithm that includes measurements of IL-8 and CRP. This diagnostic strategy seemed to be safe.
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Affiliation(s)
- Axel R Franz
- Department of Pediatrics, Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany.
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Clark R, Powers R, White R, Bloom B, Sanchez P, Benjamin DK. Nosocomial infection in the NICU: a medical complication or unavoidable problem? J Perinatol 2004; 24:382-8. [PMID: 15116140 DOI: 10.1038/sj.jp.7211120] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nosocomial sepsis is a serious problem for neonates who are admitted for intensive care. As it is associated with increases in mortality, morbidity, and prolonged length of hospital stay, both the human and fiscal costs of these infections are high. Although the rate of nosocomial sepsis increases with the degree of both prematurity and low birth weight, no specific lab test has been shown to be very useful in improving our ability to predict who has a "real" blood-stream infection and, therefore, who needs to be treated with a full course of antibiotics. As a result, antibiotic use is double the rate of "proven" sepsis and we are facilitating the growth of resistant organisms in the neonatal intensive care unit. The purpose of this article is to review the topic of nosocomial infections in neonates.
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Affiliation(s)
- Reese Clark
- Pediatrix Medical Group, Inc., 1301 Concord Terrace, Sunrise, FL 33323-2825, USA
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49
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Franz AR, Sieber S, Pohlandt F, Kron M, Steinbach G. Whole blood interleukin 8 and plasma interleukin 8 levels in newborn infants with suspected bacterial infection. Acta Paediatr 2004; 93:648-53. [PMID: 15174789 DOI: 10.1111/j.1651-2227.2004.tb02991.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To evaluate a new micro-method technique for measurement of interleukin 8 in detergent-lysed whole blood (whole blood IL-8) applicable to capillary blood sampling as a test for bacterial infections in neonates. METHODS Whole blood IL-8 was measured at the first suspicion of infection along with IL-8 determined in plasma (plasma IL-8), C-reactive protein and blood cultures in 154 consecutive newborn infants with clinical signs of bacterial infection. Only 20 microl of whole blood were required for the new assay. RESULTS Blood culture-proven infections were diagnosed in six infants and clinical infection (defined as a combination of clinical and laboratory signs) in 20 infants. 1000 pg/ml was determined as the suitable threshold for whole blood IL-8 by ROC-curve analysis. At that threshold, whole blood IL-8 detected blood culture-proven infections with a sensitivity of 83% and a specificity of 67%. The areas under the ROC curves were similar for whole blood IL-8 and plasma IL-8. CONCLUSIONS Compared with plasma IL-8, whole blood IL-8 offers the advantages that measurements of whole blood IL-8 require a smaller blood sample volume and are not altered by haemolysis. The diagnostic accuracy of whole blood IL-8 remains to be studied in more detail in the future.
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Affiliation(s)
- A R Franz
- Department of Paediatrics, Division of Neonatology and Paediatric Critical Care, University of Ulm, 89070 Ulm, Germany.
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Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L. Diagnosis of neonatal sepsis: a clinical and laboratory challenge. Clin Chem 2004; 50:279-87. [PMID: 14752012 DOI: 10.1373/clinchem.2003.025171] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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