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Abda A, Panetta L, Blackburn J, Chevalier I, Lachance C, Ovetchkine P, Sicard M. Urinary tract infections in very premature neonates: the definition dilemma. J Perinatol 2024; 44:731-738. [PMID: 38553603 DOI: 10.1038/s41372-024-01951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Data on urinary tract infections (UTIs) in very preterm neonates (VPTNs) are scarce. We aimed to (i) describe the characteristics of UTIs in VPTNs and (ii) compare the diagnostic practices of neonatal clinicians to established pediatric guidelines. METHODS All VPTNs (<29 weeks GA) with a suspected UTI at the CHU Sainte-Justine neonatal intensive care unit from January 1, 2014, and December 31, 2019, were included and divided into two definition categories: Possible UTI, and Definite UTI. RESULTS Most episodes were Possible UTI (87%). Symptoms of UTIs and pathogens varied based on the definition category. A positive urinalysis was obtained in 25%. Possible UTI episodes grew 2 organisms in 62% of cases and <50,000 CFU/mL in 62% of cases. CONCLUSION Characteristics of UTIs in VPTNs vary based on the definition category and case definitions used by clinicians differ from that of established pediatric guidelines.
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Affiliation(s)
- Assil Abda
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
| | - Luc Panetta
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Pediatric Emergency Department, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - Julie Blackburn
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Research center, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC, Canada
| | - Isabelle Chevalier
- Department of Pediatrics, Division of General Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Christian Lachance
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Research center, CHU Sainte-Justine, Montreal, QC, Canada
| | - Philippe Ovetchkine
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Research center, CHU Sainte-Justine, Montreal, QC, Canada
| | - Melanie Sicard
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Research center, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC, Canada
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2
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Kumar RS, Otero NA, Abubakar MO, Elliott MR, Wiggins JY, Sharif MM, Sullivan BA, Fairchild KD. Framework for Considering Abnormal Heart Rate Characteristics and Other Signs of Sepsis in Very Low Birth Weight Infants. Am J Perinatol 2024; 41:706-712. [PMID: 34875699 DOI: 10.1055/a-1715-3727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE A heart rate characteristics index (HeRO score), incorporating low variability and superimposed decelerations, was developed as a sepsis risk indicator for preterm infants in the neonatal intensive care unit (NICU). A rise in the risk score should prompt consideration of other clinical changes that may be signs of sepsis to decide whether a workup and antibiotics are needed. We aimed to develop a framework to systematically consider signs potentially indicating sepsis in very low birth weight (VLBW) infants. STUDY DESIGN We developed easy-recall acronyms for 10 signs of sepsis in VLBW infants. Over 12 months in a level IV NICU, neonatology fellows completed a brief survey after each shift to document changes prompting sepsis workups. We analyzed associations between survey data, hourly heart rate characteristic data, and the diagnosis of the workup, grouped as culture-positive sepsis (CXSEP, positive blood or urine culture), clinical sepsis (CLINSEP, negative cultures treated with antibiotics ≥5 days), or sepsis ruled out (SRO, negative cultures and <3 days antibiotics). RESULTS We analyzed 93 sepsis workups in 48 VLBW infants (35 CXSEP, 20 CLINSEP, and 38 SRO). The most frequently cited changes prompting the workups were heart rate patterns and respiratory deterioration, which were common in all three categories. Low blood pressure and poor perfusion were uncommonly cited but were more likely to be associated with CXSEP than the other signs. A rise in the HeRO score ≥1 from 0 to 12 hours before compared with 12to 72 hours prior the blood culture occurred in 31% of workups diagnosed as CXSEP, 16% CLINSEP, and 31% SRO. CONCLUSION The HeRO score can alert clinicians to VLBW infants at high or increasing risk of a sepsis-like illness, but heart rate characteristic patterns are highly variable in individual babies. The easy-recall NeoSEP-10 framework can assist clinicians in considering other clinical changes when making decisions about sepsis workups and the duration of antibiotics. KEY POINTS · Abnormal heart rate characteristics can indicate sepsis or other pathologies in preterm infants.. · We developed a simple bedside tool to consider clinical signs potentially associated with sepsis.. · Considering vital sign trends together with clinical changes is a key to right-timing antibiotics..
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Affiliation(s)
- Rupin S Kumar
- Department of Pediatrics, University of Kentucky, Lexington, Kentucky
| | | | - Maryam O Abubakar
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Megan R Elliott
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Jaclyn Y Wiggins
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Misky M Sharif
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Brynne A Sullivan
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Karen D Fairchild
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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3
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Speier RL, Cotten CM, Benjamin DK, Lewis K, Keeler K, Kidimbu G, Roberts W, Clark RH, Zimmerman KO, Stark A, Greenberg RG. Late-Onset Sepsis Evaluation and Empiric Therapy in Extremely Low Gestational Age Newborns. J Pediatric Infect Dis Soc 2023; 12:S37-S43. [PMID: 38146858 DOI: 10.1093/jpids/piad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/12/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Little is known about late-onset sepsis (LOS) evaluations in extremely low gestational age newborns (ELGANs). We describe frequencies of LOS evaluation in ELGANs, infant characteristics, and empiric therapy choices during evaluations. METHODS Cohort study of infants 22-28 weeks gestational age (GA) discharged from 243 centers from 2009 to 2018, excluding infants with congenital anomalies, discharged or deceased prior to postnatal day (PND) 2, or admitted after PND 2. A new LOS evaluation was defined as the first blood culture obtained between PND 3 and 90, or one obtained ≥1 day following a negative culture and ≥10 days from prior positive cultures. We determined numbers of evaluations and percentage positive by GA, center, and over time. We described characteristics associated with positive evaluations, infants with LOS, and empiric antimicrobials. We calculated descriptive and comparative statistics using Wilcoxon rank sum, Fisher's exact, or Pearson chi-square tests, as appropriate. RESULTS Of 47,187 included infants, 67% had ≥1 LOS evaluation and 21% of evaluated infants had ≥1 LOS (culture positive) episode; 1.6 evaluations occurred per infant and 10% were positive. The percentage of infants evaluated and positive for LOS was higher at earlier GA. LOS was associated with inotrope support (15% vs. 9%; p < .001) and invasive mechanical ventilation (66% vs. 51%; p < .001). Infants with positive cultures were more likely than infants with negative cultures to receive empiric antimicrobials during the LOS evaluation (95% vs. 73%; p < .001). CONCLUSIONS Among ELGANs, earlier GA and postnatal age were associated with LOS evaluation and positive cultures. Most infants undergoing evaluation were started on empiric antimicrobials.
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Affiliation(s)
| | | | - Daniel K Benjamin
- Department of Medicine, Duke University School of Medicine
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kelsey Lewis
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
| | - Kanecia O Zimmerman
- Department of Medicine, Duke University School of Medicine
- Duke Clinical Research Institute, Durham, NC, USA
| | - Ashley Stark
- Department of Medicine, Duke University School of Medicine
| | - Rachel G Greenberg
- Department of Medicine, Duke University School of Medicine
- Duke Clinical Research Institute, Durham, NC, USA
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4
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Gatseva P, Blazhev A, Yordanov Z, Atanasova V. Early Diagnostic Markers of Late-Onset Neonatal Sepsis. Pediatr Rep 2023; 15:548-559. [PMID: 37755410 PMCID: PMC10535522 DOI: 10.3390/pediatric15030050] [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: 08/16/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE Early diagnosis of nosocomial infections in newborns is a great challenge, because in the initial phase of systemic infection, clinical symptoms are often non-specific, and routinely used hematological markers are not sufficiently informative. The aim of this study was to determine the potential of early inflammatory markers to diagnose late-onset neonatal sepsis-procalcitonin (PCT), interleukin 6 (IL-6), interleukin 8 (IL-8) and endocan (ESM-1). MATERIAL AND METHODS A prospective clinical-epidemiological study was conducted in a third-level NICU in Pleven, Bulgaria. Patients with suspected late-onset sepsis and healthy controls were tested. A sandwich ELISA method was used to measure the serum concentrations of biomarkers. RESULTS Sixty newborns were included, of which 35% symptomatic and infected, 33.3% symptomatic but uninfected and 31.7% asymptomatic controls. The mean values of PCT, IL-6, I/T index and PLT differ significantly in the three groups. For ESM-1, IL-8 and CRP, the difference was statistically insignificant. The best sensitivity (78%) and negative predictive value (84%) was found for IL-6. The combinations of PCT + IL-6 and PCT + IL-6+ I/T+ PLT showed very good diagnostic potential. CONCLUSION The introduction into the routine practice of indicators such as PCT and IL-6 may provide an opportunity to promptly optimize the diagnostic and therapeutic approach to LOS.
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Affiliation(s)
- Preslava Gatseva
- Department of Pediatrics, Medical University Pleven, 5800 Pleven, Bulgaria;
- Dr. Georgi Stranski University Hospital, 5800 Pleven, Bulgaria
| | - Alexander Blazhev
- Department of Anatomy, Histology, Cytology and Biology, Medical University Pleven, 5800 Pleven, Bulgaria;
| | - Zarko Yordanov
- Department of Anaesthesiology and Resuscitation, Medical University Pleven, 5800 Pleven, Bulgaria;
| | - Victoria Atanasova
- Department of Pediatrics, Medical University Pleven, 5800 Pleven, Bulgaria;
- Dr. Georgi Stranski University Hospital, 5800 Pleven, Bulgaria
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5
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Lloyd LG, van Weissenbruch MM, Dramowski A, Gleeson B, Ferreyra C, Bekker A. Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case-control study. BMJ Paediatr Open 2023; 7:e002056. [PMID: 37550083 PMCID: PMC10407408 DOI: 10.1136/bmjpo-2023-002056] [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: 05/03/2023] [Accepted: 06/08/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early diagnosis of neonatal infection is essential to prevent serious complications and to avoid unnecessary use of antibiotics. The prevalence of healthcare-associated infections (HAIs) among very low birthweight (VLBW; <1500 g) infants is 20%; and the mortality in low-resource settings can be as high as 70%. This study aimed to develop an Infection Prediction Score to diagnose bacterial HAIs. METHODS A retrospective cohort of VLBW infants investigated for HAI was randomised into two unmatched cohorts. The first cohort was used for development of the score, and the second cohort was used for the internal validation thereof. Potential predictors included risk factors, clinical features, interventions, and laboratory data. The model was developed based on logistic regression analysis. RESULTS The study population of 655 VLBW infants with 1116 episodes of clinically suspected HAIs was used to develop the model. The model had five significant variables: capillary refill time >3 s, lethargy, abdominal distention, presence of a central venous catheter in the previous 48 hours and a C reactive protein ≥10 mg/L. The area below the receiver operating characteristic curve was 0.868. A score of ≥2 had a sensitivity of 54.2% and a specificity of 96.4%. CONCLUSION A novel Infection Prediction Score for HAIs among VLBW infants may be an important tool for healthcare providers working in low-resource settings but external validation needs to be performed before widespread use can be recommended.
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Affiliation(s)
- Lizel G Lloyd
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Mirjam Maria van Weissenbruch
- Division IC Neonatology (NICU), Department of Pediatrics, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Angela Dramowski
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | | | - Adrie Bekker
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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6
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Pons S, Trouillet-Assant S, Subtil F, Abbas-Chorfa F, Cornaton E, Berthiot A, Galletti S, Plat A, Rapin S, Trapes L, Generenaz L, Brengel-Pesce K, Callies A, Plaisant F, Claris O, Portefaix A, Flamant C, Butin M. Performance of 11 Host Biomarkers Alone or in Combination in the Diagnosis of Late-Onset Sepsis in Hospitalized Neonates: The Prospective EMERAUDE Study. Biomedicines 2023; 11:1703. [PMID: 37371798 DOI: 10.3390/biomedicines11061703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the high prevalence of late-onset sepsis (LOS) in neonatal intensive care units, a reliable diagnosis remains difficult. This prospective, multicenter cohort study aimed to identify biomarkers early to rule out the diagnosis of LOS in 230 neonates ≥7 days of life with signs of suspected LOS. Blood levels of eleven protein biomarkers (PCT, IL-10, IL-6, NGAL, IP-10, PTX3, CD14, LBP, IL-27, gelsolin, and calprotectin) were measured. Patients received standard of care blinded to biomarker results, and an independent adjudication committee blinded to biomarker results assigned each patient to either infected, not infected, or unclassified groups. Performances of biomarkers were assessed considering a sensitivity of at least 0.898. The adjudication committee classified 22% of patients as infected and all of these received antibiotics. A total of 27% of the not infected group also received antibiotics. The best biomarkers alone were IL-6, IL-10, and NGAL with an area under the curve (95% confidence interval) of 0.864 (0.798-0.929), 0.845 (0.777-0.914), and 0.829 (0.760-0.898), respectively. The best combinations of up to four biomarkers were PCT/IL-10, PTX3/NGAL, and PTX3/NGAL/gelsolin. The best models of biomarkers could have identified not infected patients early on and avoided up to 64% of unjustified antibiotics. At the onset of clinical suspicion of LOS, additional biomarkers could help the clinician in identifying non-infected patients.
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Affiliation(s)
- Sylvie Pons
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Sophie Trouillet-Assant
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
- Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, INSERM U1111, CNRS UMR5308, ENS Lyon, 69364 Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, 69003 Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Université Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Fatima Abbas-Chorfa
- Service de Biostatistique, Hospices Civils de Lyon, 69003 Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Université Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Elise Cornaton
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Amélie Berthiot
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Sonia Galletti
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Aurélie Plat
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Stephanie Rapin
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Laurene Trapes
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Laurence Generenaz
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Karen Brengel-Pesce
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Arnaud Callies
- Department of Neonatology, Hôpital Mère-Enfant, University Hospital of Nantes, 44093 Nantes, France
| | - Franck Plaisant
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Croix Rousse, 69002 Lyon, France
- Research Unit EA 4129, University Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Aurelie Portefaix
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Cyril Flamant
- Department of Neonatology, Hôpital Mère-Enfant, University Hospital of Nantes, 44093 Nantes, France
| | - Marine Butin
- Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, INSERM U1111, CNRS UMR5308, ENS Lyon, 69364 Lyon, France
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
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7
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Baltogianni M, Giapros V, Kosmeri C. Antibiotic Resistance and Biofilm Infections in the NICUs and Methods to Combat It. Antibiotics (Basel) 2023; 12:antibiotics12020352. [PMID: 36830264 PMCID: PMC9951928 DOI: 10.3390/antibiotics12020352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Neonatal sepsis is an important cause of neonatal morbidity and mortality. A significant proportion of bacteria causing neonatal sepsis is resistant to multiple antibiotics, not only to the usual empirical first-line regimens, but also to second- and third-line antibiotics in many neonatal intensive care units (NICUs). NICUs have unique antimicrobial stewardship goals. Apart from antimicrobial resistance, NICUs have to deal with another problem, namely biofilm infections, since neonates often have central and peripheral lines, tracheal tubes and other foreign bodies for a prolonged duration. The aim of this review is to describe traditional and novel ways to fight antibiotic-resistant bacteria and biofilm infections in NICUs. The topics discussed will include prevention and control of the spread of infection in NICUs, as well as the wise use of antimicrobial therapy and ways to fight biofilm infections.
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Affiliation(s)
- Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
- Correspondence: ; Tel.: +30-26-5100-7546
| | - Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece
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8
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Ren Z, Yang S, Han J, Nie C, Wang C, Wang J, Zheng X, Yang H, Zhang Q, Pei J, Xu F, Yang J. Reduction of antibiotic use and multi-drug resistance bacteria infection in neonates after improvement of antibiotics use strategy in a level 4 neonatal intensive care unit in southern China. Eur J Clin Microbiol Infect Dis 2023; 42:87-98. [PMID: 36409375 DOI: 10.1007/s10096-022-04522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
The investigation on antibiotic stewardship in neonatal intensive care unit in China is scarce. This study aimed to analyze the effect of a comprehensive 2-year antibiotic stewardship in a level 4 NICU. During this baseline period from October 1st 2017 to October 1st 2019, continuation of empirical antibiotic therapy for ruled-out sepsis courses was beyond 72 h and for pneumonia was more than 7 days. Meropenem or vancomycin was used even if they were not the only bacterial sensitive antibiotics. The intervention period was from October 2nd 2019 to August 23rd 2021. Three areas for quality improvement were targeted in our center: discontinuation of antibiotic use in ruled-out sepsis within 72 h, treatment duration for culture-negative pneumonia less than 7 days, and vancomycin or meropenem was not used unless the cultured bacteria was only susceptible to them. The total antibiotic consumption decreased from 791.1 to 466.3 days of therapy per 1000 patient days from baseline to intervention period. Antibiotics were stopped within 72 h for 47.48% patients with rule-out sepsis and within 7 days for 75.70% patients with pneumonia compared with 11.56% and 37.69% during the baseline period respectively. The prevalence of multi-drug resistance bacteria decreased from 67.20 to 48.90%. The total use rate of meropenem or vancomycin decreased from 7.6 to 1.8%. Our quality improvement approach on antibiotic strategy significantly reduced antibiotic use and prevalence of multi-drug resistance bacteria in our NICU.
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Affiliation(s)
- Zhuxiao Ren
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shumei Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jiangxue Han
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Chuan Nie
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Cuicui Wang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianlan Wang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xuaner Zheng
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Haoming Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Qi Zhang
- Department of Clinical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jingjun Pei
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fang Xu
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China. .,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China.
| | - Jie Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China. .,Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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9
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From computer to bedside, involving neonatologists in artificial intelligence models for neonatal medicine. Pediatr Res 2023; 93:437-439. [PMID: 36526854 DOI: 10.1038/s41390-022-02413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/08/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
In recent years, data have become the main driver of medical innovation. With increased availability and decreased price of storage and computing power, the potential for improvement in care is enormous. Many data-driven explorations have started. However, the actual implementation of artificial intelligence in healthcare remains scarce. We describe essential elements during a computer-to-bedside process in a data science project that support the crucial role of the neonatologist. IMPACT: There is a great potential for data science in neonatal medicine. Multidisciplinary teams form the foundation of a data science project. Domain experts will need to play a pivotal role. We need an open learning environment.
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10
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Peng Z, van de Sande D, Lorato I, Long X, Liang RH, Andriessen P, Cottaar W, Stuijk S, van Pul C. A Comparison of Video-based Methods for Neonatal Body Motion Detection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3047-3050. [PMID: 36086375 DOI: 10.1109/embc48229.2022.9871700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Preterm infants in a neonatal intensive care unit (NICU) are continuously monitored for their vital signs, such as heart rate and oxygen saturation. Body motion patterns are documented intermittently by clinical observations. Changing motion patterns in preterm infants are associated with maturation and clinical events such as late-onset sepsis and seizures. However, continuous motion monitoring in the NICU setting is not yet performed. Video-based motion monitoring is a promising method due to its non-contact nature and therefore unobtrusiveness. This study aims to determine the feasibility of simple video-based methods for infant body motion detection. We investigated and compared four methods to detect the motion in videos of infants, using two datasets acquired with different types of cameras. The thermal dataset contains 32 hours of annotated videos from 13 infants in open beds. The RGB dataset contains 9 hours of annotated videos from 5 infants in incubators. The compared methods include background substruction (BS), sparse optical flow (SOF), dense optical flow (DOF), and oriented FAST and rotated BRIEF (ORB). The detection performance and computation time were evaluated by the area under receiver operating curves (AUC) and run time. We conducted experiments to detect motion and gross motion respectively. In the thermal dataset, the best performance of both experiments is achieved by BS with mean (standard deviation) AUCs of 0.86 (0.03) and 0.93 (0.03). In the RGB dataset, SOF outperforms the other methods in both experiments with AUCs of 0.82 (0.10) and 0.91 (0.05). All methods are efficient to be integrated into a camera system when using low-resolution thermal cameras.
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Lloyd LG, Dramowski A, Bekker A, Malou N, Ferreyra C, Van Weissenbruch MM. Performance Comparison of Infection Prediction Scores in a South African Neonatal Unit: A Retrospective Case-Control Study. Front Pediatr 2022; 10:830510. [PMID: 35359896 PMCID: PMC8963199 DOI: 10.3389/fped.2022.830510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Infection prediction scores are useful ancillary tests in determining the likelihood of neonatal hospital-acquired infection (HAI), particularly in very low birth weight (VLBW; <1,500 g) infants who are most vulnerable to HAI and have high antibiotic utilization rates. None of the existing infection prediction scores were developed for or evaluated in South African VLBW neonates. METHODS We identified existing infection prediction scores through literature searches and assessed each score for suitability and feasibility of use in resource-limited settings. Performance of suitable scores were compared using a retrospective dataset of VLBW infants (2016-2017) from a tertiary hospital neonatal unit in Cape Town, South Africa. Sensitivity, specificity, predictive values, and likelihood ratios were calculated for each score. RESULTS Eleven infection prediction scores were identified, but only five were suitable for use in resource-limited settings (NOSEP1, Singh, Rosenberg, and Bekhof scores). The five selected scores were evaluated using data from 841 episodes of HAI in 659 VLBW infants. The sensitivity for the scores ranged between 3% (NOSEP1 ≥14; proven and presumed infection), to a maximum of 74% (Singh score ≥1; proven infection). The specificity of these scores ranged from 31% (Singh score ≥1; proven and presumed infection) to 100% (NOSEP1 ≥11 and ≥14, NOSEP-NEW-1 ≥11; proven and presumed infection). CONCLUSION Existing infection prediction scores did not achieve comparable predictive performance in South African VLBW infants and should therefore only be used as an adjunct to clinical judgment in antimicrobial decision making. Future studies should develop infection prediction scores that have high diagnostic accuracy and are feasible to implement in resource-limited neonatal units.
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Affiliation(s)
- Lizel Georgi Lloyd
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nada Malou
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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12
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Ackermann K, Baker J, Festa M, McMullan B, Westbrook J, Li L. Computerized Clinical Decision Support Systems for Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: A Scoping Review (Preprint). JMIR Med Inform 2021; 10:e35061. [PMID: 35522467 PMCID: PMC9123549 DOI: 10.2196/35061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 03/19/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Khalia Ackermann
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Jannah Baker
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Marino Festa
- Kids Critical Care Research, Department of Paediatric Intensive Care, Children's Hospital at Westmead, Sydney, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
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13
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Gorantiwar S, de Waal K. Progression from sepsis to septic shock and time to treatments in preterm infants with late-onset sepsis. J Paediatr Child Health 2021; 57:1905-1911. [PMID: 34085340 DOI: 10.1111/jpc.15606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
AIM Late-onset sepsis (LOS) in preterm infants can progress rapidly from minimal clinical signs and symptoms to septic shock which is associated with high mortality. The aim of this study was to describe the progression from sepsis to septic shock and evaluate our management performance with emphasis on time to treatments. METHODS This was a retrospective observational study including preterm infants ≤32 weeks gestation with LOS and septic shock defined as the requirement of fluids and vasopressors. Physiological changes and time to first diagnostics and treatments were determined from the point of first appearance of clinical signs and symptoms of sepsis (TONSET ). RESULTS During the 10-year observational period, 279 infants developed LOS and 25 (8.9%) progressed to septic shock. The median (interquartile range) time from TONSET to blood culture, administering antibiotics, fluid bolus and vasopressors was 8.4 (4.8-12.2), 9.2 (5.6-12.4), 14.6 (9.5-34.5) and 22.0 (14.6-44.7) h, respectively. Hypotension and raised lactate were prominent physiological changes in the progression to septic shock. Fluid bolus and vasopressors were administered when blood pressure was 20 and 41% below to what was normal before the infant became unwell. Vasopressors significantly increased blood pressure and heart rate. Mortality rate was 40% with no difference in time to treatments between survivors and non-survivors. CONCLUSION Clinical recognition of the onset of sepsis in preterm infants remains difficult and contributes to delay of treatment. Once recognised, early administration of antibiotics, fluid bolus and vasopressors should be prioritised.
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Affiliation(s)
- Sujit Gorantiwar
- Department of Neonatology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
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14
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Msanga DR, Parpia F, Konje ET, Hokororo A, Mshana SE. High Mortality among Premature Neonates with Positive Blood Culture Neonatal Sepsis in a Tertiary Hospital, Tanzania: A Call for Action. CHILDREN 2021; 8:children8111037. [PMID: 34828750 PMCID: PMC8622475 DOI: 10.3390/children8111037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/25/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Abstract
Well-documented vital signs are key in the prediction of sepsis in low- and middle-income countries. We determined prevalence, associated factors, and outcomes of positive blood culture sepsis in premature neonates at Bugando Medical Centre Mwanza, Tanzania. Temperature, oxygen saturation, heart rate, respiratory rate, and random blood glucose were repeatedly recorded at admission, 8 h, and 24 h in all 250 neonates enrolled. Clinical and microbiological data were collected from patient records followed by descriptive data analysis. The mean age of the neonates was 3 ± 5.2 days, with the majority (90%) aged <10 days. The prevalence of positive blood culture sepsis was 21.2% (95% CI: 16.1–26.2). The fluctuation of the random blood glucose (RBG) (aOR = 1.34, 95% CI: (1.07–1.67), p = 0.010), low oxygen saturation (aOR = 0.94, 95% CI: (0.88–0.99), p = 0.031), premature rupture of membrane aOR = 4.28, 95% CI: (1.71–10.71), p = 0.002), gestational age < 34 weeks (aOR = 2.73, 95% CI: (1.20–6.24), p = 0.017), and home delivery (aOR = 3.90, 95% CI: (1.07–14.19), p = 0.039) independently predicted positive blood culture. Significantly more deaths were recorded in neonates with a positive blood culture than those with a negative blood culture (32.1% vs. 5.1%, p < 0.001). In limited-resource settings, clinicians should use the vital signs and clinical information to initiate timely sepsis treatment among preterm neonates to prevent deaths and other morbidities.
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Affiliation(s)
- Delfina R. Msanga
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania; (F.P.); (A.H.)
- Correspondence:
| | - Fatema Parpia
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania; (F.P.); (A.H.)
| | - Eveline T. Konje
- Department of Public Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania;
| | - Adolfine Hokororo
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania; (F.P.); (A.H.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania;
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15
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Berka I, Korček P, Straňák Z. C-Reactive Protein, Interleukin-6, and Procalcitonin in Diagnosis of Late-Onset Bloodstream Infection in Very Preterm Infants. J Pediatric Infect Dis Soc 2021:piab071. [PMID: 34343328 DOI: 10.1093/jpids/piab071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/13/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Late-onset bloodstream infection (LOBSI) is common in very preterm infants. Early and accurate diagnosis is crucial for prognosis and outcome. We aimed to analyze the accuracy of routinely used inflammatory biomarkers in the diagnosis of LOBSI as compared to uninfected controls. METHODS In this single-center, retrospective case-control study, interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) were routinely measured, when infection was clinically suspected. The definition of LOBSI was based on positive blood culture, clinical signs of infection, and onset more than 72 hours after birth. RESULTS Among 285 enrolled infants, 66 developed LOBSI. IL-6 was superior to other markers, and levels greater than 100 ng/L had a sensitivity of 94% and a specificity of 99% for the presence of LOBSI. Receiver operating characteristic curve of IL-6 had area under the curve of 0.988 (95% CI = 0.975-1.00, P < .001). The negative predictive value of IL-6, CRP, and PCT for optimal cutoff values was 99%, 95%, and 93%, respectively. The logistic regression model of IL-6 > 100 ng/L or CRP > 10 mg/L were successfully predicted LOBSI in 97.9% of cases. CONCLUSIONS The combination of IL-6 and CRP seems to have great potential in routine rapid diagnosis of LOBSI development. High negative predictive value of all tested markers could encourage the early discontinuation of antibiotic treatment.
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Affiliation(s)
- Ivan Berka
- Department of Neonatology, Institute for the Care of Mother and Child-Neonatology, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Korček
- Department of Neonatology, Institute for the Care of Mother and Child-Neonatology, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zbyněk Straňák
- Department of Neonatology, Institute for the Care of Mother and Child-Neonatology, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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16
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Near-infrared spectroscopy as a diagnostic tool for necrotizing enterocolitis in preterm infants. Pediatr Res 2021; 90:148-155. [PMID: 33036017 DOI: 10.1038/s41390-020-01186-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/11/2020] [Accepted: 09/12/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND We aimed to investigate whether splanchnic tissue oxygen saturation (rsSO2) measured by near-infrared spectroscopy (NIRS) could contribute to the early diagnosis of necrotizing enterocolitis (NEC). METHODS We retrospectively included infants with suspected NEC, gestational age <32 weeks and/or birth weight <1200 g in the first 3 weeks after birth. We calculated mean rsSO2, cerebral tissue oxygen saturation (rcSO2), variability of rsSO2 (coefficients of variation [rsCoVAR] = SD/mean), and splanchnic-cerebral oxygenation ratio ([SCOR] = rsSO2/rcSO2) in the period around the abdominal radiograph to confirm or reject NEC. RESULTS Of the 75 infants, 21 (28%) had NEC (Bell's stage ≥2). Characteristics of infants with and without NEC differed only on mechanical ventilation and nil-per-os status. RsSO2 tended to be higher and rcSO2 lower in infants with NEC. RsCoVAR (median [range]) was lower (0.11 [0.03-0.34]) vs. 0.20 [0.01-0.52], P = 0.002) and SCOR higher (0.64 [0.37-1.36]) vs. 0.47 [0.16-1.09], P = 0.004) in NEC infants. Adjusted for postnatal age, mechanical ventilation, and nil-per-os status, a 0.1 higher rsCoVAR decreased the likelihood of NEC diagnosis with likelihood ratio (LR) 0.38 (95% CI 0.18-0.78) and a 0.1 higher SCOR increased it with LR 1.28 (1.02-1.61). CONCLUSIONS Using NIRS, high SCOR may confirm NEC and high variability of rsSO2 may rule out NEC, when suspicion arises. IMPACT Near-infrared spectroscopy may contribute to the diagnosis of necrotizing enterocolitis. When clinical signs are present a high splanchnic-cerebral oxygenation may indicate necrotizing enterocolitis. A low splanchnic-cerebral oxygenation ratio and high variability of splanchnic tissue oxygen saturation may rule out necrotizing enterocolitis. Whether a bedside real-time availability of the splanchnic-cerebral oxygenation ratio and variability of splanchnic tissue oxygen saturation improves NEC diagnosis needs to be further investigated.
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17
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Calor AK, Yumani DF, van Weissenbruch MM. Early Nutrition during Hospitalization in Relation to Bone Health in Preterm Infants at Term Age and Six Months Corrected Age. Nutrients 2021; 13:nu13041192. [PMID: 33916331 PMCID: PMC8065483 DOI: 10.3390/nu13041192] [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: 01/28/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Aim: to evaluate the potential association of macronutrient intake in the first postnatal weeks on bone mineral content (BMC) and bone mineral density (BMD) in extremely and very preterm infants. Methods: fifty-eight extremely and very preterm infants were included. Daily macronutrient intake was calculated in g kg−1 day−1 from birth up to 36 weeks postmenstrual age. A dual-energy X-ray absorptiometry whole body scan was used to assess BMC and BMD in preterm infants at term corrected age (TCA) and six months corrected age (CA). Results: fat intake (g kg−1 day−1) in the first four postnatal weeks was positively associated with BMC and BMD at TCA. At six months CA, protein and fat intake (g kg−1 day−1) in the first weeks of life were both individual predictors for BMD. Fat intake (g kg−1 day−1) in the first four postnatal weeks was significantly associated with BMC at six months CA. Conclusion: the association of macronutrient intake in the first postnatal weeks on BMC or BMD, at TCA and six months CA, suggest that early nutritional intervention immediately after birth and during early infancy is important for bone health in the first months of life.
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18
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Kasmire KE, Vega C, Bennett NJ, Laurich VM. Hypothermia: A Sign of Sepsis in Young Infants in the Emergency Department? Pediatr Emerg Care 2021; 37:e124-e128. [PMID: 30113435 DOI: 10.1097/pec.0000000000001539] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Diagnosis of sepsis in young infants can be challenging due to the nonspecific signs, which can include hypothermia. Whether the presence of hypothermia in young infants should prompt evaluation for serious infection is unclear. The objectives were to measure the prevalence of serious infection among infants ≤60 days of age with hypothermia in the emergency department (ED) and determine other clinical features of hypothermic infants who have serious infection. METHODS This is a retrospective analysis of all infants ≤60 days seen in a children's hospital ED from April 2014 to February 2017. Primary outcome was presence of serious infection, defined as urinary tract infection, bacteremia, meningitis, pneumonia, or herpes virus infection. Hypothermia was defined as a rectal temperature of 36.0°C or less. RESULTS Of 4797 infants ≤60 days of age seen in the ED, 116 had hypothermia. The prevalence of serious infection was 2.6% (3/116) in hypothermic infants compared with 15.2% (61/401) in febrile infants (P < 0.01). Hypothermic infants with serious infections were more likely to have a history of prematurity, apnea, poor feeding, lethargy, ill-appearance, and respiratory signs than hypothermic infants without serious infection. All 3 hypothermic infants with serious infection had other concerning features. CONCLUSIONS The prevalence of serious infection in hypothermic young infants in the ED is low. Serious infection is unlikely in infants with isolated hypothermia.
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Affiliation(s)
| | - Carolina Vega
- From the Connecticut Children's Medical Center, Hartford, CT
| | | | - V Matt Laurich
- From the Connecticut Children's Medical Center, Hartford, CT
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19
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Cabon S, Porée F, Cuffel G, Rosec O, Geslin F, Pladys P, Simon A, Carrault G. Voxyvi: A system for long-term audio and video acquisitions in neonatal intensive care units. Early Hum Dev 2021; 153:105303. [PMID: 33453631 DOI: 10.1016/j.earlhumdev.2020.105303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/04/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the European Union, 300,000 newborn babies are born prematurely every year. Their care is ensured in Neonatal Intensive Care Units (NICU) where vital signs are constantly monitored. In addition, other descriptors such as motion, facial and vocal activities have been shown to be essential to assess neurobehavioral development. AIM In the scope of the European project Digi-NewB, we aimed to develop and evaluate a new audio-video device designed to non-invasively acquire multi-modal data (audio, video and thermal images), while fitting the wide variety of bedding environment in NICU. METHODS Firstly, a multimodal system and associated software and guidelines to collect data in neonatal intensive care unit were proposed. Secondly, methods for post-evaluation of the acquisition phase were developed, including the study of clinician feedback and a qualitative analysis of the data. RESULTS The deployment of 19 acquisition devices in six French hospitals allowed to record more than 500 newborns of different gestational and postmenstrual ages. After the acquisition phase, clinical feedback was mostly positive. In addition, quality of more than 300 recordings was inspected and showed that 77% of the data is exploitable. In depth, the percentage of sole presence of the newborn was estimated at 62% within recordings. CONCLUSIONS This study demonstrates that audio-video acquisitions are feasible on a large scale in real life in NICU. The experience also allowed us to make a clear observation of the requirements and challenges that will have to be overcome in order to set up audio-video monitoring methods.
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Affiliation(s)
- S Cabon
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000, France.
| | - F Porée
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000, France
| | - G Cuffel
- Voxygen, Pleumeur-Bodou F-22560, France
| | - O Rosec
- Voxygen, Pleumeur-Bodou F-22560, France
| | - F Geslin
- CHU Rennes, Rennes F-35000, France
| | - P Pladys
- CHU Rennes, Rennes F-35000, France
| | - A Simon
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000, France
| | - G Carrault
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000, France
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20
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Diagnosis of Neonatal Late-Onset Infection in Very Preterm Infant: Inter-Observer Agreement and International Classifications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030882. [PMID: 33498557 PMCID: PMC7908350 DOI: 10.3390/ijerph18030882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 02/05/2023]
Abstract
Background: The definition of late-onset bacterial sepsis (LOS) in very preterm infants is not unified. The objective was to assess the concordance of LOS diagnosis between experts in neonatal infection and international classifications and to evaluate the potential impact on heart rate variability and rate of “bronchopulmonary dysplasia or death”. Methods: A retrospective (2017–2020) multicenter study including hospitalized infants born before 31 weeks of gestation with intention to treat at least 5-days with antibiotics was performed. LOS was classified as “certain or probable” or “doubtful” independently by five experts and according to four international classifications with concordance assessed by Fleiss’s kappa test. Results: LOS was suspected at seven days (IQR: 5–11) of life in 48 infants. Following expert classification, 36 of them (75%) were considered as “certain or probable” (kappa = 0.41). Following international classification, this number varied from 13 to 46 (kappa = −0.08). Using the expert classification, “bronchopulmonary dysplasia or death” occurred less frequently in the doubtful group (25% vs. 78%, p < 0.001). Differences existed in HRV changes between the two groups. Conclusion: The definition of LOS is not consensual with a low international and moderate inter-observer agreement. This affects the evaluation of associated organ dysfunction and prognosis.
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21
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Dogan P, Ozkan H, Koksal N, Oral HB, Celebi S, Bagci O, Guney Varal I. Mannose-Binding Lectin Levels in Late-Onset Sepsis in Preterm Infants: Results from a Prospective Study in a Tertiary Care Center. Fetal Pediatr Pathol 2020; 39:363-372. [PMID: 31411530 DOI: 10.1080/15513815.2019.1652374] [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] [Indexed: 10/26/2022]
Abstract
Introduction: This study aimed to determine the association between serum mannose-binding lectin (MBL) levels, gene polymorphisms and late-onset sepsis (LOS) in preterm infants. Methods: Infants with <37 gestational weeks were categorized into two groups according to the presence of LOS during their hospitalization. An MBL level <700 ng/ml was defined as deficiency, <400 ng/ml as severe deficiency. Codon 54 and 57 polymorphisms of MBL2 gene were analyzed. Results: Overall, 153 preterm infants were included. MBL deficiency was found to be more common in the LOS group (p = 0.02). The rate of Gram-negative sepsis was higher in MBL2 variant-type (p = 0.01). In the logistic regression analysis, MBL levels <700 ng/ml were found to have a significant effect on LOS development (odds ratio: 2.692, 95% confidence interval 1.196-5.8, p = 0.02). Conclusions: MBL deficiency is an important risk factor for the development of LOS. Furthermore, there is an association between MBL2 gene polymorphism and Gram-negative sepsis.
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Affiliation(s)
- Pelin Dogan
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Hilal Ozkan
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Nilgun Koksal
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Haluk Barbaros Oral
- Uludag University, Faculty of Medicine, Department of Immunology, Bursa, Turkey
| | - Solmaz Celebi
- Uludag University, Faculty of Medicine, Department of Pediatrics, Division of Infectious Diseases, Bursa, Turkey
| | - Onur Bagci
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Ipek Guney Varal
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
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Sola A, Mir R, Lemus L, Fariña D, Ortiz J, Golombek S. Suspected Neonatal Sepsis: Tenth Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN). Neoreviews 2020; 21:e505-e534. [PMID: 32737171 DOI: 10.1542/neo.21-8-e505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Suspected neonatal sepsis is one of the most common diagnoses made in newborns (NBs), but very few NBs actually have sepsis. There is no international consensus to clearly define suspected neonatal sepsis, but each time that this suspected diagnosis is assumed, blood samples are taken, venous accesses are used to administer antibiotics, and the mother-child pair is separated, with prolonged hospital stays. X-rays, urine samples, and a lumbar puncture are sometimes taken. This is of concern, as generally <10% and no more than 25%-30% of the NBs in whom sepsis is suspected have proven neonatal sepsis. It seems easy to start antibiotics with suspicion of sepsis, but stopping them is difficult, although there is little or no support to maintain them. Unfortunately, the abuse of antibiotics in inpatient and outpatient NBs is foolish. Its negative impact on neonatal health and the economy is a public health problem of epidemiological and even epidemic proportions. This manuscript is a shortened version of the 10th Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN) on suspected neonatal sepsis at the end of 2018, updated with publications from its completion to February 2020. This manuscript describes useful strategies for everyday neonatal practice when neonatal sepsis is suspected, along with important aspects about the indisputable value of clinical evaluation of the NB and about obtaining and interpreting blood cultures, urine cultures, and other cultures. Likewise, the low value of laboratory tests in suspected neonatal sepsis is demonstrated with evidence and clinical recommendations are made on the appropriate use of antibiotics.
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Affiliation(s)
- Augusto Sola
- Medical Director, Ibero-American Society of Neonatology, Wellington, FL
| | - Ramón Mir
- Neonatology Department Chief in Hospital de Clìnicas Universidad Nacional de Asunciòn, Paraguay
| | - Lourdes Lemus
- Departamento de Neonatología, Hospital de Pediatría UMAE, Instituto Mexicano del Seguro Social, Guadalajara Jalisco, México
| | - Diana Fariña
- Director of the Neonatal Intensive Care Unit, Hospital de Pediatría, Buenos Aires, Argentina
| | - Javier Ortiz
- Ángeles del Pedregal Hospital, Mexico City, Mexico
| | - Sergio Golombek
- Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, NJ
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Song W, Jung SY, Baek H, Choi CW, Jung YH, Yoo S. A Predictive Model Based on Machine Learning for the Early Detection of Late-Onset Neonatal Sepsis: Development and Observational Study. JMIR Med Inform 2020; 8:e15965. [PMID: 32735230 PMCID: PMC7428919 DOI: 10.2196/15965] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/27/2020] [Accepted: 06/07/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Neonatal sepsis is associated with most cases of mortalities and morbidities in the neonatal intensive care unit (NICU). Many studies have developed prediction models for the early diagnosis of bloodstream infections in newborns, but there are limitations to data collection and management because these models are based on high-resolution waveform data. OBJECTIVE The aim of this study was to examine the feasibility of a prediction model by using noninvasive vital sign data and machine learning technology. METHODS We used electronic medical record data in intensive care units published in the Medical Information Mart for Intensive Care III clinical database. The late-onset neonatal sepsis (LONS) prediction algorithm using our proposed forward feature selection technique was based on NICU inpatient data and was designed to detect clinical sepsis 48 hours before occurrence. The performance of this prediction model was evaluated using various feature selection algorithms and machine learning models. RESULTS The performance of the LONS prediction model was found to be comparable to that of the prediction models that use invasive data such as high-resolution vital sign data, blood gas estimations, blood cell counts, and pH levels. The area under the receiver operating characteristic curve of the 48-hour prediction model was 0.861 and that of the onset detection model was 0.868. The main features that could be vital candidate markers for clinical neonatal sepsis were blood pressure, oxygen saturation, and body temperature. Feature generation using kurtosis and skewness of the features showed the highest performance. CONCLUSIONS The findings of our study confirmed that the LONS prediction model based on machine learning can be developed using vital sign data that are regularly measured in clinical settings. Future studies should conduct external validation by using different types of data sets and actual clinical verification of the developed model.
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Affiliation(s)
- Wongeun Song
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Se Young Jung
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyunyoung Baek
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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The Course Of IGF-1 Levels and Nutrient Intake in Extremely and Very Preterm Infants During Hospitalisation. Nutrients 2020; 12:nu12030675. [PMID: 32131447 PMCID: PMC7146384 DOI: 10.3390/nu12030675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Insulin-like growth factor 1 (IGF-1) plays an important role in the complex association between nutrition, growth, and maturation in extremely and very preterm infants. Nevertheless, in this population, research on associations between IGF-1 and nutrition is limited. Therefore this study aimed to evaluate the possible associations between the course of IGF-1 levels and nutrient intake between preterm birth and 36 weeks postmenstrual age (PMA). METHODS 87 infants born between 24 and 32 weeks gestational age were followed up to 36 weeks PMA. Actual daily macronutrient intake was calculated, and growth was assessed weekly. IGF-1 was sampled from umbilical cord blood at birth and every other week thereafter. RESULTS There was an inverse relationship between the amount of parenteral nutrition in the second week of life and IGF-1. Total protein, fat, and carbohydrate intake, as well as total energy intake, primarily showed a positive association with IGF-1 levels, particularly between 30 and 33 weeks PMA. Gestational age, bronchopulmonary dysplasia (BPD), and weight were significant confounders in the association between nutrient intake and IGF-1 levels. CONCLUSION Parenteral nutrition was found to be a negative predictor of IGF-1 levels, and there could potentially be a time frame in which macronutrient intake is unable to impact IGF-1 levels. Future research should aim to narrow down this time frame and to gain more insight into factors enhancing or decreasing the response of IGF-1 to nutrition, e.g., age and inflammatory state, to align nutritional interventions accordingly.
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Abstract
BACKGROUND Culture-negative late-onset sepsis (LOS) is commonly diagnosed in neonatal intensive care units, while the outcomes of neonatal culture-negative LOS are not reported for large cohorts. This study aimed to examine the incidence and neonatal outcomes for culture-negative LOS in a contemporary multicenter cohort of preterm infants. METHODS We performed a retrospective analysis of data from a cluster-randomized controlled study. Infants <34 weeks of gestation and admitted to 25 neonatal intensive care units between May 1, 2015, and April 30, 2018, were included. Culture-negative LOS was diagnosed if infants had abnormal manifestations and laboratory tests but negative blood cultures. The primary outcome was a composite of mortality or morbidities including periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) ≥ stage 3 or bronchopulmonary dysplasia (BPD). RESULTS Of 22,346 eligible infants, 1505 (6.7%) infants had culture-negative and 761 (3.4%) infants had culture-positive LOS. Compared with infants without LOS, infants with culture-negative LOS had higher rates of composite outcome (24.1% vs. 9.6%), death (3.8% vs. 1.8%), PVL (4.8% vs. 2.2%), severe ROP (3.3% vs. 1.1%) and BPD (18.1% vs. 7.0%). After adjustment, culture-negative LOS was independently associated with increased risk of composite outcome {adjusted odds ratio [aOR]: 1.8 [95% confidence interval (CI): 1.5-2.1]}, PVL [aOR: 2.0 (95% CI: 1.4-2.8)] and BPD [aOR: 1.8 (95% CI: 1.5-2.2)] relative to the absence of LOS. CONCLUSION Culture-negative LOS was frequently diagnosed in preterm infants and was associated with increased risks of adverse outcomes. There is an emerging need for more precise diagnosis and treatment strategies for culture-negative LOS.
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26
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Dogan P, Guney Varal I. Red cell distribution width as a predictor of late-onset Gram-negative sepsis. Pediatr Int 2020; 62:341-346. [PMID: 31880020 DOI: 10.1111/ped.14123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/15/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Late-onset sepsis (LOS) remains an important cause of morbidity and mortality in preterm infants. In this study, our aim was to investigate the red-cell distribution width (RDW) levels during a LOS episode, and its association with the type of growing microorganism and mortality. METHODS Preterm infants with culture-proven sepsis during their neonatal intensive care unit stay were enrolled. Red-cell distribution width levels were obtained in the first 4 h of postnatal life and at the onset of the LOS episode, and compared for these time frames. The study cohort was divided into two groups according to the type of the growing microorganism. The RDW levels were then assessed in intra- and inter-group analyses. RESULTS Eighty-six infants were included in the final analysis. RDW levels were increased in the study cohort after a LOS attack (P < 0.001). Infants with Gram-negative sepsis showed a significant increase in their RDW levels, but they remained unchanged in infants with Gram-positive sepsis (P < 0.001 and P = 0.4, respectively). An RDW cut-off of >19.50% was related with a sensitivity of 87% and a specificity of 81% for predicting late-onset Gram-negative sepsis (P < 0.001). Logistic regression analysis showed a positive association of RDW with mortality when adjusted for covariants (adjusted odds ratio: 1.40; 95% confidence interval: 1.02-1.80; P = 0.03). CONCLUSIONS Our findings show that RDW levels increased during a LOS episode in preterm infants, which was especially evident in Gram-negative infections. We believe that these findings may be of importance in the early diagnosis and prognosis of LOS in preterm infants.
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Affiliation(s)
- Pelin Dogan
- Division of Neonatology, Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, University of Health Sciences, Bursa, Turkey
| | - Ipek Guney Varal
- Division of Neonatology, Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, University of Health Sciences, Bursa, Turkey
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27
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Every Minute Counts: The Urgency of Identifying Infants with Sepsis. J Pediatr 2020; 217:10-12. [PMID: 31668480 DOI: 10.1016/j.jpeds.2019.09.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022]
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28
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Wang B, Li G, Jin F, Weng J, Peng Y, Dong S, Liu J, Luo J, Wu H, Shen Y, Meng Y, Wang X, Hei M. Effect of Weekly Antibiotic Round on Antibiotic Use in the Neonatal Intensive Care Unit as Antibiotic Stewardship Strategy. Front Pediatr 2020; 8:604244. [PMID: 33384975 PMCID: PMC7769868 DOI: 10.3389/fped.2020.604244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Antibiotics are commonly used in the neonatal intensive care unit (NICU). The objective was to observe the effect of weekly antibiotic round in NICU (WARN) to the antibiotic use in NICU. Methods: A retrospective observational study was performed. Departmental-level diagnosis categories and the parameters of antibiotic usage in NICU for the period of 2016-2017 (Phase 1) and 2018-2019 (Phase 2) were collected. WARN in NICU was started since January 2018. A time series forecasting was used to predict the quarterly antibiotic use in Phase 2, based on data from Phase 1. The actual antibiotic use of each quarter in Phase 2 was compared with the predicted values. Results: Totally 9297 neonates were included (4743 in Phase 1, 4488 in Phase 2). The composition of the disease spectrum between Phase 1 and Phase 2 was not different (P > 0.05). In Phase 1 and Phase 2, the overall antibiotic rate was 94.4 and 74.2%, the average accumulative defined daily dose per month was 199.00 ± 55.77 and 66.80 ± 45.64, the median antibiotic use density per month was 10.31 (9.00-13.27) and 2.48 (1.92-4.66), the median accumulative defined daily dose per case per month was 0.10 (0.09-0.13) and 0.03 (0.02-0.47), the number of patients who received any kind of antibiotic per 1000 hospital days per month was 103.45 (99.30-107.48) and 78.66 (74.62-82.77), rate of culture investigation before antibiotics was 64 to 92%, respectively, and all were better than the predicted values (P < 0.01). Conclusion: The implementation of periodical antibiotic rounds was effective in reducing the antibiotics use in the NICU.
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Affiliation(s)
- Bo Wang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Geng Li
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
| | - Fei Jin
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
| | - Jingwen Weng
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
| | - Yaguang Peng
- Neonatal Center, National Center for Child Health, Beijing, China.,Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shixiao Dong
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
| | - Jingyuan Liu
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
| | - Jie Luo
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
| | - Hailan Wu
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
| | - Yanhua Shen
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
| | - Yao Meng
- Neonatal Center, National Center for Child Health, Beijing, China.,Department of Clinical Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaoling Wang
- Neonatal Center, National Center for Child Health, Beijing, China.,Department of Clinical Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Neonatal Center, National Center for Child Health, Beijing, China
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29
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Brower LH, Wilson PM, Murtagh Kurowski E, Haslam D, Courter J, Goyal N, Durling M, Shah SS, Schondelmeyer A. Using Quality Improvement to Implement a Standardized Approach to Neonatal Herpes Simplex Virus. Pediatrics 2019; 144:peds.2018-0262. [PMID: 31345997 DOI: 10.1542/peds.2018-0262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Neonatal herpes simplex virus (HSV) infections are associated with high mortality and long-term morbidity. However, incidence is low and acyclovir, the treatment of choice, carries risk of toxicity. We aimed to increase the percentage of patients 0 to 60 days of age who are tested and treated for HSV in accordance with local guideline recommendations from 40% to 80%. METHODS This quality improvement project took place at 1 freestanding children's hospital. Multiple plan-do-study-act cycles were focused on interventions aimed at key drivers including provider buy-in, guideline availability, and accurate identification of high-risk patients. A run chart was used to track the effect of interventions on the percentage managed per guideline recommendations over time by using established rules for determining special cause. Pre- and postimplementation acyclovir use was compared by using a χ2 test. In HSV-positive cases, delayed acyclovir initiation, defined as >1 day from presentation, was tracked as a balancing measure. RESULTS The median percentage of patients managed according to guideline recommendations increased from 40% to 80% within 8 months. Acyclovir use decreased from 26% to 7.9% (P < .001) in non-high-risk patients but did not change significantly in high-risk patients (73%-83%; P = .15). There were no cases of delayed acyclovir initiation in HSV-positive cases. CONCLUSIONS Point-of-care availability of an evidence-based guideline and interventions targeted at provider engagement improved adherence to a new guideline for neonatal HSV management and decreased acyclovir use in non-high-risk infants. Further study is necessary to confirm the safety of these recommendations in other settings.
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Affiliation(s)
- Laura H Brower
- Divisions of Hospital Medicine.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Paria M Wilson
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Pediatric Emergency Medicine.,Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eileen Murtagh Kurowski
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Pediatric Emergency Medicine.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Haslam
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Infectious Diseases, and
| | - Joshua Courter
- Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Neera Goyal
- Divisions of Hospital Medicine.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of External Primary Care, Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | - Samir S Shah
- Divisions of Hospital Medicine.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Infectious Diseases, and
| | - Amanda Schondelmeyer
- Divisions of Hospital Medicine.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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30
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Walker SAN, Cormier M, Elligsen M, Choudhury J, Rolnitsky A, Findlater C, Iaboni D. Development, evaluation and validation of a screening tool for late onset bacteremia in neonates - a pilot study. BMC Pediatr 2019; 19:253. [PMID: 31340780 PMCID: PMC6651932 DOI: 10.1186/s12887-019-1633-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022] Open
Abstract
Background Clinical and laboratory parameters can aid in the early identification of neonates at risk for bacteremia before clinical deterioration occurs. However, current prediction models have poor diagnostic capabilities. The objective of this study was to develop, evaluate and validate a screening tool for late onset (> 72 h post admission) neonatal bacteremia using common laboratory and clinical parameters; and determine its predictive value in the identification of bacteremia. Methods A retrospective chart review of neonates admitted to a neonatal intensive care unit (NICU) between March 1, 2012 and January 14, 2015 and a prospective evaluation of all neonates admitted between January 15, 2015 and March 30, 2015 were completed. Neonates with late-onset bacteremia (> 72 h after NICU admission) were eligible for inclusion in the bacteremic cohort. Bacteremic patients were matched to non-infected controls on several demographic parameters. A Pearson’s Correlation matrix was completed to identify independent variables significantly associated with infection (p < 0.05, univariate analysis). Significant parameters were analyzed using iterative binary logistic regression to identify the simplest significant model (p < 0.05). The predictive value of the model was assessed and the optimal probability cut-off for bacteremia was determined using a Receiver Operating Characteristic curve. Results Maximum blood glucose, heart rate, neutrophils and bands were identified as the best predictors of bacteremia in a significant binary logistic regression model. The model’s sensitivity, specificity and accuracy were 90, 80 and 85%, respectively, with a false positive rate of 20% and a false negative rate of 9.7%. At the study bacteremia prevalence rate of 51%, the positive predictive value, negative predictive value and negative post-test probability were 82, 89 and 11%, respectively. Conclusion The model developed in the current study is superior to currently published neonatal bacteremia screening tools. Validation of the tool in a historic data set of neonates from our institution will be completed. Electronic supplementary material The online version of this article (10.1186/s12887-019-1633-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra A N Walker
- Department of Pharmacy E-302, Sunnybrook Health Sciences Centre (SHSC), 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Melanie Cormier
- Department of Pharmacy E-302, Sunnybrook Health Sciences Centre (SHSC), 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Marion Elligsen
- Department of Pharmacy E-302, Sunnybrook Health Sciences Centre (SHSC), 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | | | | | | | - Dolores Iaboni
- SHSC, Women and Babies Program, Toronto, Ontario, Canada
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31
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Palatnik A, Liu LY, Lee A, Yee LM. Predictors of early-onset neonatal sepsis or death among newborns born at <32 weeks of gestation. J Perinatol 2019; 39:949-955. [PMID: 31089257 DOI: 10.1038/s41372-019-0395-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To develop a predictive model for early-onset neonatal sepsis or death among infants born at less than 32 weeks of gestation. STUDY DESIGN This was a case-control study of all deliveries <32 weeks between 2011 and 2015 in a single tertiary care center. Cases were defined as neonates diagnosed with early-onset sepsis based on a blood or cerebrospinal fluid culture or neonates who expired during the first week of life. Controls consisted of neonates without these outcomes. Variables previously identified to be associated with neonatal sepsis or death were abstracted from the medical record. Bivariable analyses and multivariable logistic regression were used to determine independent risk factors for early-onset neonatal sepsis or death. An ROC curve was created and AUC calculated to estimate the predictive capacity of these associations. RESULTS Of 779 eligible neonates, early-onset neonatal sepsis or death occurred in 73 (9.4%). In bivariable analyses, mothers whose neonates were diagnosed with early-onset sepsis or death were more likely to be obese, have an intrapartum fever, and have meconium-stained amniotic fluid, and were less likely to have received betamethasone or antepartum/intrapartum antibiotics. Gestational age at delivery and birth weight was significantly lower among neonates diagnosed with neonatal sepsis or death. In multivariable analyses, factors remaining independently associated with neonatal sepsis or death were earlier gestational age at the time of delivery (specifically <28 weeks), intrapartum fever, presence of meconium-stained amniotic fluid, and lower birth weight. The AUC for this regression was 0.81 (95% confidence interval 0.77-0.83). CONCLUSION Earlier gestational age at the time of delivery, intrapartum fever, meconium, and lower birth weight are independently associated with early-onset neonatal sepsis or death among deliveries occurring at <32 weeks of gestation; these factors can be used to create a model with fair predictive capability.
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Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Lilly Y Liu
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andy Lee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Kitano T, Takagi K, Arai I, Yasuhara H, Ebisu R, Ohgitani A, Kitagawa D, Oka M, Masuo K, Minowa H. A simple and feasible antimicrobial stewardship program in a neonatal intensive care unit of a Japanese community hospital. J Infect Chemother 2019; 25:860-865. [PMID: 31109751 DOI: 10.1016/j.jiac.2019.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/30/2019] [Accepted: 04/16/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although tertiary hospitals have successfully introduced ASPs by antimicrobial stewardship teams, lots of community hospitals without pediatric infectious disease specialists have difficulty implementing ASP. We present a successful implementation of simple and feasible NICU antimicrobial stewardship program in a Japanese community hospital. METHOD We developed a protocol of antimicrobial treatment in our NICU department and have implemented the protocol from September 2017. The protocol consists of start and stop of criteria antimicrobial treatment, weekend report of blood culture result from microbiology department and stopping ordering antimicrobials beforehand for the next day. We compared days of therapy (DOT) during the post-implementation period (September 2017 to August 2018) with that of pre-implementation period (March 2013 to August 2017). RESULT In pre- and post-ASP implementation periods, 913 and 194 patients were analyzed. DOT was 175.1 and 41.6/1000 patient-days, respectively (p < 0.001) with 76.2% reduction. The percentage of neonates who had any antimicrobials and the percentage of prolonged antimicrobial treatments among neonates who had any antimicrobials decreased significantly (55.3% vs 20.6%, p < 0.001 and 65.0% vs 32.5%, p < 0.001). The protocol compliance rates were also significantly different (55.4% vs 95.4%; p < 0.001). The methicillin-resistant rate of S.aureus rates were significantly reduced in post-ASP period (31.1% vs 12.9%; p = 0.002). CONCLUSION This ASP program was easily implemented in a NICU department of a community hospital and significantly reduced antimicrobial prescription. This kind of simple protocol may be successfully scaled-up in resource limited community hospitals without no pediatric infectious disease specialists or antimicrobial stewardship team.
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Affiliation(s)
- Taito Kitano
- Department of Pediatrics, Nara Medical University Hospital, 840 Shijo, Kashihara, Nara, 6348521, Japan; Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Kumiko Takagi
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Ikuyo Arai
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Hajime Yasuhara
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Reiko Ebisu
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Ayako Ohgitani
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Daisuke Kitagawa
- Department of Microbiology, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Miyako Oka
- Department of Microbiology, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Kazue Masuo
- Department of Microbiology, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Hideki Minowa
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
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Cantey JB, Pyle AK, Wozniak PS, Hynan LS, Sánchez PJ. Early Antibiotic Exposure and Adverse Outcomes in Preterm, Very Low Birth Weight Infants. J Pediatr 2018; 203:62-67. [PMID: 30172430 DOI: 10.1016/j.jpeds.2018.07.036] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/28/2018] [Accepted: 07/11/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine whether antibiotic use in the first 14 postnatal days in preterm, very low birth weight (birth weight of ≤1500 g) infants is associated with risk after 14 days of age for late-onset sepsis, necrotizing enterocolitis (NEC), or death after controlling for severity of illness using the Clinical Risk Index in Babies II score, and determine whether duration of antibiotic exposure was associated with risk of adverse outcomes. STUDY DESIGN This retrospective cohort study included very low birth weight infants born at ≤326/7 weeks of gestation admitted to the neonatal intensive care unit from September 2010 to June 2014. Infants were excluded if they had major congenital anomalies or culture-proven sepsis, NEC, or death during the first 14 days of life. Antibiotic exposure was recorded as days of therapy and length of therapy in days. RESULTS Of 374 infants, 70 (19%) had late-onset sepsis, NEC, or death after 14 days of age. The median number of antibiotic days of therapy and length of therapy were 5.5 and 3.0, respectively. In multivariate analysis after controlling for severity of illness, each antibiotic day of therapy was associated with a 1.24 times increased risk of sepsis, NEC, or death (OR, 1.24; 95% CI, 1.17-1.31). Risk was similar when length of therapy was used (OR, 1.47; 95% CI, 1.32-1.64). CONCLUSIONS After controlling for severity of illness, each day of antibiotic therapy provided to preterm, very low birth weight infants in the first 2 weeks of age is associated with an increased risk of late-onset sepsis, NEC, or death.
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Affiliation(s)
- Joseph B Cantey
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Division of Neonatal-Perinatal Medicine and Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX; University of Texas Health Science Center San Antonio, San Antonio, TX.
| | - Alaina K Pyle
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Division of Neonatal-Perinatal Medicine and Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX; Division of Neonatology, Yale School of Medicine, New Haven, CT
| | - Phillip S Wozniak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Division of Neonatology and Pediatric Infectious Diseases, Center for Perinatal Research, Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, OH
| | - Linda S Hynan
- Clinical Sciences and Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Pablo J Sánchez
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Division of Neonatal-Perinatal Medicine and Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX; Division of Neonatology and Pediatric Infectious Diseases, Center for Perinatal Research, Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, OH
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Blood culture indications in critically ill neonates: a multicenter prospective cohort study. Eur J Pediatr 2018; 177:1565-1572. [PMID: 30051146 DOI: 10.1007/s00431-018-3203-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 12/29/2022]
Abstract
UNLABELLED Due to potential lethality of healthcare-associated sepsis (HAS), a low threshold for blood culturing and antimicrobial therapy (ABT) initiation is accepted. We assessed variability in the trigger for blood culturing between three neonatal intensive care units. A multicenter prospective cohort study was conducted. In newborns with suspicion of HAS, 10 predefined clinical signs, nosocomial sepsis (NOSEP) score, C-reactive protein, ABT initiation, and risk factors were registered at time of culturing. Outcome was lab-confirmed HAS, defined according to the NeoKISS-criteria. Two hundred ninety-nine suspected HAS episodes were considered in 212 infants, of which 118 had birth-weight ≤ 1500 g; proportion of lab-confirmed HAS per suspected episode was 30/192 (center 1), 28/60 (center 2), and 8/47 (center 3) (p < 0.001). Median C-reactive protein and number of clinical signs at time of culturing differed between centers 1, 2, and 3 (respectively 11 vs. 5 vs. 3 mg/L, p = 0.001; 1 sign [IQR 0-2, center 1] vs. 3 signs [IQR 2-4, centers 2 and 3], p < 0.001). Median NOSEP score at time of culturing was 5 (IQR 3-8, center 1), 5 (IQR 3-9, center 2), and 8 (IQR 5-11, center 3) (p = 0.016). Difference in ABT initiation was noticed (82 vs. 93 vs. 74%, p = 0.05). CONCLUSION Center heterogeneity in sampling practice is substantial. Optimizing sampling practice can be recommended. What is Known: • Blood culture test is a common diagnostic procedure in critically-ill newborns. • A low threshold for sampling and antimicrobial therapy initiation is accepted. What is New: • Variability in blood culture practice was assessed between 3 neonatal intensive care units by the registration of sampling frequencies, clinical indications, and antimicrobial therapy initiation.
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McPherson C, Liviskie C, Zeller B, Nelson MP, Newland JG. Antimicrobial Stewardship in Neonates: Challenges and Opportunities. Neonatal Netw 2018; 37:116-123. [PMID: 29615159 DOI: 10.1891/0730-0832.37.2.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neonatal infections result in significant morbidity and mortality. Antibiotics are vital for the treatment of infections but disrupt the neonatal microbiome, put the infant at risk for an adverse drug reaction, and may lead to the development of antibiotic resistance. Immediately after birth, clinicians must determine which infants require empiric antibiotics. Online risk stratification tools may provide a superior approach to decision trees. In infants who require empiric therapy for early-onset sepsis, ampicillin and an aminoglycoside with dosing based on recent pharmacokinetic studies represents the most appropriate first-line agents; third-generation cephalosporins should be reserved for patients with a high likelihood of Gram-negative meningitis. An antistaphylococcal penicillin and gentamicin should be utilized for suspected late-onset sepsis. Vancomycin and other broad-spectrum agents are reserved for patients with a history of resistant organisms. Antibiotic duration should be guided by understanding the clinical indications and obtaining the necessary cultures appropriately (i.e., adequate volume blood cultures). In the absence of a positive culture, antibiotic duration should often be limited. Individual institutions should leverage a multidisciplinary, interprofessional team to identify opportunities for antimicrobial stewardship. A collaborative, transparent system is required to change unit culture and generate a sustained impact on antibiotic utilization with optimal patient outcomes.
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Goldberg Y, Pollak M, Mitelpunkt A, Orlovsky M, Weiss-Meilik A, Gorfine M. Change-point detection for infinite horizon dynamic treatment regimes. Stat Methods Med Res 2017; 26:1590-1604. [DOI: 10.1177/0962280217708655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A dynamic treatment regime is a set of decision rules for how to treat a patient at multiple time points. At each time point, a treatment decision is made depending on the patient’s medical history up to that point. We consider the infinite-horizon setting in which the number of decision points is very large. Specifically, we consider long trajectories of patients’ measurements recorded over time. At each time point, the decision whether to intervene or not is conditional on whether or not there was a change in the patient’s trajectory. We present change-point detection tools and show how to use them in defining dynamic treatment regimes. The performance of these regimes is assessed using an extensive simulation study. We demonstrate the utility of the proposed change-point detection approach using two case studies: detection of sepsis in preterm infants in the intensive care unit and detection of a change in glucose levels of a diabetic patient.
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Affiliation(s)
| | - Moshe Pollak
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexis Mitelpunkt
- Tel-Aviv University, Tel-Aviv, Israel
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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37
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Cantey JB, Wozniak PS, Pruszynski JE, Sánchez PJ. Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study. THE LANCET. INFECTIOUS DISEASES 2016; 16:1178-1184. [DOI: 10.1016/s1473-3099(16)30205-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Bulkowstein S, Ben-Shimol S, Givon-Lavi N, Melamed R, Shany E, Greenberg D. Comparison of early onset sepsis and community-acquired late onset sepsis in infants less than 3 months of age. BMC Pediatr 2016; 16:82. [PMID: 27387449 PMCID: PMC4936327 DOI: 10.1186/s12887-016-0618-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 06/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background We compared demographic and clinical characteristics of early-onset sepsis (EOS) and community-acquired late onset sepsis (CA-LOS) in infants. Methods Our medical center is the sole hospital in southern-Israel, enabling incidence calculations. EOS (<7 days) and CA-LOS (7–90 days) episodes recorded between 2007 and 2013 were reviewed. Univariate and multivariate analyses were performed. Results 70 EOS and 114 CA-LOS episodes were recorded. The respective mean ± SD annual rates per 1,000 live-births were 0.66 ± 0.16 and 1.03 ± 0.23. Prematurity (42.9 % vs. 17.0 %), premature rupture of membranes (PROM; 22.9 % vs. 1.9 %), leukopenia (29.0 % vs. 11.6 %), thrombocytopenia (44.9 % vs. 14.3 %) and Streptococcus agalactiae infections (22.7 % vs. 8.1 %) were more common in EOS. Fever (25.4 % vs. 79.1 %) and Streptococcus pneumoniae infections (1.3 % vs. 12.9 %) were less common in EOS. In both groups, Gram-negative bacteria predominated (~60 %). Longer hospitalization duration (23.3 ± 25.1 vs. 10.3 ± 8.6 days) and higher case fatality rate (20.0 % vs. 5.3 %) were noted in EOS. Antibiotic resistance rates to empiric EOS and CA-LOS treatments were 0.0 % and 1.2 %, respectively. In multivariate analysis, adjusting for prematurity and ethnicity, PROM, central line, low Apgar-score, low birth-weight, ventilation support and non-vaginal delivery were risk factors for EOS. Normal temperature, thrombocytopenia and leukopenia characterized EOS. Conclusion EOS and CA-LOS rates were low in Jewish compared with Bedouin infants. EOS was characterized by higher rates of perinatal risk factors, S. agalactiae infections, normal temperature, thrombocytopenia, leukopenia and mortality, while fever and S. pneumoniae infections were common in CA-LOS. Current initial antibiotic regimens seem adequate, considering the susceptibility patterns of the isolated pathogens Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0618-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shlomi Bulkowstein
- Pediatric Infectious Disease Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva, 84101, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shalom Ben-Shimol
- Pediatric Infectious Disease Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva, 84101, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Noga Givon-Lavi
- Pediatric Infectious Disease Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva, 84101, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Rimma Melamed
- Pediatric Infectious Disease Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva, 84101, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eilon Shany
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Neonatology Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva, 84101, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Abstract
Antibiotics are invaluable in the management of neonatal infections. However, overuse or misuse of antibiotics in neonates has been associated with adverse outcomes, including increased risk for future infection, necrotizing enterocolitis, and mortality. Strategies to optimize the use of antibiotics in the neonatal intensive care unit include practicing effective infection prevention, improving the diagnostic evaluation and empiric therapy for suspected infections, timely adjustment of therapy as additional information becomes available, and treating proven infections with an effective, narrow-spectrum agent for the minimum effective duration. Antibiotic stewardship programs provide support for these strategies but require the participation and input of neonatologists as stakeholders to be most effective.
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Affiliation(s)
- Joseph B Cantey
- Division of Neonatal/Perinatal Medicine, Division of Infectious Diseases, Texas A&M Health Science Center College of Medicine, Baylor Scott & White Health, Temple, TX, USA.
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Wortham JM, Hansen NI, Schrag SJ, Hale E, Van Meurs K, Sánchez PJ, Cantey JB, Faix R, Poindexter B, Goldberg R, Bizzarro M, Frantz I, Das A, Benitz WE, Shane AL, Higgins R, Stoll BJ. Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections. Pediatrics 2016; 137:peds.2015-2323. [PMID: 26719293 PMCID: PMC4702021 DOI: 10.1542/peds.2015-2323] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Current guidelines for prevention of neonatal group B streptococcal disease recommend diagnostic evaluations and empirical antibiotic therapy for well-appearing, chorioamnionitis-exposed newborns. Some clinicians question these recommendations, citing the decline in early-onset group B streptococcal disease rates since widespread intrapartum antibiotic prophylaxis implementation and potential antibiotic risks. We aimed to determine whether chorioamnionitis-exposed newborns with culture-confirmed, early-onset infections can be asymptomatic at birth. METHODS Multicenter, prospective surveillance for early-onset neonatal infections was conducted during 2006-2009. Early-onset infection was defined as isolation of a pathogen from blood or cerebrospinal fluid collected ≤ 72 hours after birth. Maternal chorioamnionitis was defined by clinical diagnosis in the medical record or by histologic diagnosis by placental pathology. Hospital records of newborns with early-onset infections born to mothers with chorioamnionitis were reviewed retrospectively to determine symptom onset. RESULTS Early-onset infections were diagnosed in 389 of 396,586 live births, including 232 (60%) chorioamnionitis-exposed newborns. Records for 229 were reviewed; 29 (13%) had no documented symptoms within 6 hours of birth, including 21 (9%) who remained asymptomatic at 72 hours. Intrapartum antibiotic prophylaxis exposure did not differ significantly between asymptomatic and symptomatic infants (76% vs 69%; P = .52). Assuming complete guideline implementation, we estimated that 60 to 1400 newborns would receive diagnostic evaluations and antibiotics for each infected asymptomatic newborn, depending on chorioamnionitis prevalence. CONCLUSIONS Some infants born to mothers with chorioamnionitis may have no signs of sepsis at birth despite having culture-confirmed infections. Implementation of current clinical guidelines may result in early diagnosis, but large numbers of uninfected asymptomatic infants would be treated.
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Affiliation(s)
- Jonathan M. Wortham
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nellie I. Hansen
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Stephanie J. Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ellen Hale
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia;,Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Krisa Van Meurs
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Pablo J. Sánchez
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph B. Cantey
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roger Faix
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Brenda Poindexter
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ronald Goldberg
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Matthew Bizzarro
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Ivan Frantz
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; and
| | - Abhik Das
- Social, Statistical, and Environmental Sciences, RTI International, Rockville, Maryland
| | - William E. Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Andi L. Shane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia;,Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Rosemary Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia;,Children’s Healthcare of Atlanta, Atlanta, Georgia
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Ussat M, Vogtmann C, Gebauer C, Pulzer F, Thome U, Knüpfer M. The role of elevated central-peripheral temperature difference in early detection of late-onset sepsis in preterm infants. Early Hum Dev 2015; 91:677-81. [PMID: 26513628 DOI: 10.1016/j.earlhumdev.2015.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/31/2015] [Accepted: 09/15/2015] [Indexed: 12/21/2022]
Abstract
AIMS The study investigated the association between clinical symptoms and late-onset sepsis (LOS) in preterm infants with the aim of identifying a non-invasive tool for the early detection of LOS. METHODS This was a prospective study of 83 episodes of suspected LOS in 67 preterm infants. At the time LOS was suspected, we recorded a standardized set of clinical symptoms. A diagnosis of "clinical LOS" (Clin-LOS), "culture-proven LOS" (Prov-LOS) or "LOS not present" (No-LOS) was made on the basis of C-reactive protein (CrP) and blood culture results where Clin-LOS was defined as CrP>10mg/l, Prov-LOS was defined as CrP>10mg/l AND positive blood cultures, or it was established that there was no sepsis present (No-LOS). We examined univariable associations between clinical signs and LOS using odds ratio (OR) analysis and then adjusted the odds ratio (adOR) through binary regression analysis. RESULTS Clin-LOS was diagnosed in 20/83 episodes, 19 cases were found to have Prov-LOS. Clinical signs which had a significant association with Clin-LOS were capillary refill time >2s (OR 2.9) and decreased responsiveness (OR 5.2), whereas there was a negative association between gastric residuals and LOS (OR 0.35). However, the most marked association was found for a greater central-peripheral temperature difference (cpTD) >2°C (OR 9). In Prov-LOS an increased heart rate (OR 3.1), prolonged capillary refill time (OR 3.3) and again an increased cpTD (OR 16) had a significant association with LOS, whereas gastric residuals were negatively associated (OR 0.29). Regression analysis showed that cpTD was the most striking clinical sign associated with both Clin- (adOR 6.3) and Prov-LOS (adOR 10.5). CONCLUSIONS Prolonged capillary refill time and - more impressive - elevated cpTD were the most useful clinical symptoms for detection of LOS in preterm infants. We especially suggest using cpTD as a predictor of LOS. It is a cheap, non-invasive and readily available tool for daily routines.
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Affiliation(s)
- M Ussat
- Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - C Vogtmann
- Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - C Gebauer
- Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - F Pulzer
- Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - U Thome
- Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - M Knüpfer
- Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
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Bekhof J, Kollen BJ, Kok JH, Van Straaten HLM. Glucosuria as an early marker of late-onset sepsis in preterms: a prospective cohort study. BMC Pediatr 2015; 15:125. [PMID: 26383242 PMCID: PMC4573674 DOI: 10.1186/s12887-015-0425-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/19/2015] [Indexed: 11/13/2022] Open
Abstract
Background Early and accurate diagnosis of late-onset sepsis (LONS) in preterm infants is difficult since presenting signs are subtle and non-specific. Because neonatal sepsis may be accompanied by glucose intolerance and glucosuria, we hypothesized that glucosuria may be associated with LONS in preterms, in an early stage. We aim to evaluate the association of glucosuria and late-onset neonatal sepsis (LONS) in preterm infants, in an attempt to improve early and accurate diagnosis of LONS. Methods We performed a prospective observational cohort study in 316 preterms (<34 weeks). We daily measured glucosuria and followed patients for occurrence of LONS, defined as clinical and blood culture-proven sepsis occurring after 72 h. Attending physicians were blinded to glucosuria results. We assessed the diagnostic value of glucosuria for clinical and blood culture-proven LONS using logistic regression analysis. Results Glucosuria was found in 65.8 % of 316 preterm patients, and sepsis was suspected 157 times in 123 patients. LONS was found in 47.1 % of 157 suspected episodes. The presence of glucosuria was associated with LONS (OR 2.59, 95 % CI 1.24–5.43, p = 0.012) with sensitivity 69.0 % and specificity 53.8 % (Likelihoodratio 1.49). After adjustment for gestational age, birth weight, and postnatal age, this association weakened and was no longer significant (adjusted OR 2.16; 95 % CI 0.99–1.85, p = 0.055). An increase in glucosuria 48–24 h before onset of symptoms was not associated with LONS. Conclusion In preterms glucosuria is associated with LONS within 24 h, however this association is too weak to be of diagnostic value.
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Affiliation(s)
- Jolita Bekhof
- Princess Amalia Children's Clinic, Isala, Dr van Heesweg 2, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
| | - Boudewijn J Kollen
- Department of General Practice, University MedicalCenter Groningen, University of Groningen, Groningen, The Netherlands.
| | - Joke H Kok
- Department of Neonatology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Henrica L M Van Straaten
- Princess Amalia Children's Clinic, Isala, Dr van Heesweg 2, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
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Kipfmueller F, Schneider J, Prusseit J, Dimitriou I, Zur B, Franz AR, Bartmann P, Mueller A. Role of Neutrophil CD64 Index as a Screening Marker for Late-Onset Sepsis in Very Low Birth Weight Infants. PLoS One 2015; 10:e0124634. [PMID: 25894336 PMCID: PMC4404048 DOI: 10.1371/journal.pone.0124634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/17/2015] [Indexed: 01/30/2023] Open
Abstract
Introduction The role of CD64 in late onset sepsis (LOS) in preterm infants has been described in several studies. Aim of this study was to investigate whether CD64 expression is increased in the days before clinical manifestation of LOS. Methods Patients with birth weight below 1,500g were eligible for study participation. During routine blood sampling CD64 index was determined between day of life 4 and 28. Patients were allocated to one of four groups: (1) blood-culture positive sepsis, (2) clinical sepsis, (3) symptoms of infection without biochemical evidence of infection, or (4) patients without suspected infection. Kinetics of CD64 expression were compared during a period before and after the day of infection in the respective groups. Results 50 infants were prospectively enrolled and allocated to each group as follows: group (1) n = 7; group (2) n = 10; group (3) n = 8; and group (4) n = 25. CD64 index was elevated in 57% of patients in group (1) at least two days before infection. In contrast only 20% in the clinical sepsis group and 0% in group (3) had an elevated CD64 index in the days before infection. 10 of the 25 patients in the control group (4) presented increased CD64 index values during the study period. Conclusions The CD64 index might be a promising marker to detect LOS before infants demonstrate signs or symptoms of infection. However, larger prospective studies are needed to define optimal cut-off values and to investigate the role of non-infectious inflammation in this patient group.
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Affiliation(s)
- Florian Kipfmueller
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Jessica Schneider
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Julia Prusseit
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Ioanna Dimitriou
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Berndt Zur
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Axel R. Franz
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
- Current affiliation: Department of Neonatology, University Children’s Hospital Tuebingen, Tuebingen, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
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Verstraete EH, Blot K, Mahieu L, Vogelaers D, Blot S. Prediction models for neonatal health care-associated sepsis: a meta-analysis. Pediatrics 2015; 135:e1002-14. [PMID: 25755236 DOI: 10.1542/peds.2014-3226] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Blood culture is the gold standard to diagnose bloodstream infection but is usually time-consuming. Prediction models aim to facilitate early preliminary diagnosis and treatment. We systematically reviewed prediction models for health care-associated bloodstream infection (HABSI) in neonates, identified superior models, and pooled clinical predictors. DATA SOURCES LibHub, PubMed, and Web of Science. METHODS The studies included designed prediction models for laboratory-confirmed HABSI or sepsis. The target population was a consecutive series of neonates with suspicion of sepsis hospitalized for ≥ 48 hours. Clinical predictors had to be recorded at time of or before culturing. Methodologic quality of the studies was assessed. Data extracted included population characteristics, total suspected and laboratory-confirmed episodes and definition, clinical parameter definitions and odds ratios, and diagnostic accuracy parameters. RESULTS The systematic search revealed 9 articles with 12 prediction models representing 1295 suspected and 434 laboratory-confirmed sepsis episodes. Models exhibit moderate-good methodologic quality, large pretest probability range, and insufficient diagnostic accuracy. Random effects meta-analysis showed that lethargy, pallor/mottling, total parenteral nutrition, lipid infusion, and postnatal corticosteroids were predictive for HABSI. Post hoc analysis with low-gestational-age neonates demonstrated that apnea/bradycardia, lethargy, pallor/mottling, and poor peripheral perfusion were predictive for HABSI. Limitations include clinical and statistical heterogeneity. CONCLUSIONS Prediction models should be considered as guidance rather than an absolute indicator because they all have limited diagnostic accuracy. Lethargy and pallor and/or mottling for all neonates as well as apnea and/or bradycardia and poor peripheral perfusion for very low birth weight neonates are the most powerful clinical signs. However, the clinical context of the neonate should always be considered.
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Affiliation(s)
| | - Koen Blot
- Ghent University, Belgium, Ghent, Belgium
| | - Ludo Mahieu
- University of Antwerp, Belgium, Antwerp, Belgium; Antwerp University Hospital, Antwerp, Belgium
| | - Dirk Vogelaers
- Ghent University, Belgium, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium; and
| | - Stijn Blot
- Ghent University, Belgium, Ghent, Belgium; Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
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Prospective surveillance of antibiotic use in the neonatal intensive care unit: results from the SCOUT study. Pediatr Infect Dis J 2015; 34:267-72. [PMID: 25191849 DOI: 10.1097/inf.0000000000000542] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prolonged or unnecessary antibiotic use is associated with adverse outcomes in neonates. Our objectives were to quantify all antibiotic use in a Level-III neonatal intensive care unit and to identify scenarios where their use could be reduced. METHODS Surveillance and evaluation of all antibiotic use provided to every infant admitted to a Level-III neonatal intensive care unit from 10/3/11 to 11/30/12 was performed. Types of antibiotics, reasons for their initiation, discontinuation and duration, as well as clinical, laboratory and outcome data were recorded. Antibiotic use was quantified by days of therapy (DOT) per 1000 patient-days (PD). RESULTS A total of 1607 infants were included. The total antibiotic use was 9165 DOT (343.2 DOT/1000 PD; 5.7 DOT/infant). Seventy-two percent of infants received 1 (43%) or more (29%) courses of antibiotics. Gentamicin (46%), ampicillin (39%) and oxacillin (8%) were the most frequently used agents. Ninety-four percent of antibiotic use (323 DOT/1000 PD) was empiric therapy for suspected infection. Sixty-three percent (216.2 DOT/1000 PD) was discontinued at approximately 48 hours when cultures were sterile (68%>48 hours, 32%≤48 hours). Twenty-six percent of all antibiotic use (89.4 DOT/1000 PD) was therapy for ≥5 days despite sterile cultures; pneumonia (16%) and "culture-negative" sepsis (8%) were the major contributors. Five percent (17.4 DOT/1000 PD) of antibiotic use was for culture-proven sepsis, 5% (16.6 DOT/1000 PD) was penicillin prophylaxis for group B Streptococcus and 1% (3.5 DOT/1000 PD) was preprocedural prophylaxis. CONCLUSIONS Narrow-spectrum therapy accounted for >92% of antibiotic use and would not be monitored by most stewardship programs. Only 5% of antibiotic usage was due to culture-proven infection. Pneumonia and "culture-negative" sepsis were frequent reasons for prolonged therapy; further study of these conditions may allow reduction in treatment duration.
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Abstract
There are unique challenges to antimicrobial stewardship in neonatal intensive care units (NICUs). Diagnosis of infection is difficult as neonates can have nonspecific signs and symptoms. Between and within NICUs, significant variation exists in the treatment duration of suspected sepsis and pneumonia. Development of multidisciplinary teams and meaningful metrics are essential for sustainable antibiotic stewardship. Potential stewardship interventions include optimizing culturing techniques, guiding empiric therapy by NICU-specific antibiograms, using ancillary laboratory tests, and promptly discontinuing therapy once infection is no longer suspected. Use of large neonatal databases can be used to benchmark antibiotic use and conduct comparative effectiveness research.
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Affiliation(s)
- Joseph B Cantey
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Division of Neonatal/Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Sameer J Patel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 20, Chicago, Illinois 60611-2605, USA
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Preterm Premature Rupture of Membranes and the Rate of Neonatal Sepsis After Two Courses of Antenatal Corticosteroids. Obstet Gynecol 2014; 124:999-1003. [DOI: 10.1097/aog.0000000000000460] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current management of late onset neonatal bacterial sepsis in five European countries. Eur J Pediatr 2014; 173:997-1004. [PMID: 24522326 DOI: 10.1007/s00431-014-2279-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/22/2014] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Late onset neonatal sepsis (LOS) has a high mortality and the optimal management is poorly defined. We aimed to evaluate new expert panel-derived criteria to define LOS and characterize the current management and antibiotic susceptibility of LOS-causing organisms in Europe. A prospective observational study enrolled infants aged 4 to 90 days in five European countries. Clinical and laboratory findings as well as empiric treatment were recorded and patients were followed until the end of antibiotic therapy. Failure was defined as a change of primary antibiotic, no resolution of clinical signs, appearance of new signs/pathogens or death. Antibiotic therapy was considered appropriate if the organism was susceptible to at least one empiric antibiotic. 113 infants (median age 14 days, 62 % ≤1500 g) were recruited; 61 % were culture proven cases (28 CoNS, 24 Enterobacteriaceae, 11 other Gram-positives and 6 Gram-negative non-fermentative organisms). The predictive value of the expert-panel criteria to identify patients with a culture proven LOS was 61 % (95 % CI 52 % to 70 %). Around one third of Enterobacteriaceae were resistant to ampicillin + or cefotaxime + gentamicin but only 10 % to meropenem. Empiric treatment contained a total of 43 different antibiotic regimens. All-cause mortality was 8 % with an additional 45 % classified as failure of empiric therapy, mainly due to change of primary antibiotics (42/60). CONCLUSIONS The expert panel-derived diagnostic criteria performed well identifying a high rate of culture proven sepsis. Current management of LOS in Europe is extremely variable suggesting an urgent need of evidence-based guidelines.
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Farhadi R, Yaghobian M, Saravi BM. Clinical findings leading to the diagnosis of sepsis in neonates hospitalized in Imam Khomeini and Bu Ali hospitals, Sari, Iran: 2011-2012. Glob J Health Sci 2014; 6:298-303. [PMID: 24999128 PMCID: PMC4825260 DOI: 10.5539/gjhs.v6n4p298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/25/2014] [Accepted: 02/06/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND One of the important diseases in neonatal period is sepsis. Clinical sign and symptoms in addition to lab tests are the most important way to accurate diagnosis and prevention of mortality. This study was conducted with the aim of determining the most clinical sign and symptoms which leading to diagnosis of sepsis. MATERIALS & METHODS This is a descriptive cross-sectional study. The medical records of patients hospitalized in hospitals of Mazandaran University of Medical Sciences during 2011-2012 were reviewed. Variables were age, sex, birth and admission weight, clinical sign and symptoms, methods of delivery, admission and discharge condition, discharge status, the time elapsed between showing the symptom and admission to hospital, gestational age and the result of cultures. The data were recorded in a checklist and analyzed with SPSS and descriptive statistics. RESULTS finding showed that 120 patients discharged during period of study with diagnosis of sepsis. Discharged status of 27 (%22/5) were expired. Median age was 1 day with 8 hours SD, length of stay were 12±1 days, gestational age was34±3 weeks and median birth weight was 2477±977 grams. The median time elapsed between showing the symptom and admission to hospital was 38±31 hours. Blood culture in 10 (%8/3) and urine culture in 8 (%7/6) patients were positive. None of patients have positive lumbar puncture culture. The frequent sign and symptpms in patients were respiratory distress, poor feeding and lethargy. CONCLUSION Early diagnosis of neonatal sepsis is not possible only by specific laboratory exams. Clinical sign and symptoms can help us to prediction and diagnosis of neonatal sepsis. Results of this research revealed that it is not clear which one of manifestations was started first or the second because of medical history sheets don't show this process.
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Affiliation(s)
| | - Mahbobeh Yaghobian
- Mazandaran University of Medical Sciences, Sari, Iran Traditional and complementary medicine research centre,Mazandaran University of Medical Sciences, Sari, Iran.
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Abstract
Neonatal sepsis continues to be a common and significant health care burden, especially in very-low-birth-weight infants (VLBW <1500 g). Though intrapartum antibiotic prophylaxis has decreased the incidence of early-onset group B streptococcal infection dramatically, it still remains a major cause of neonatal sepsis. Moreover, some studies among VLBW preterm infants have shown an increase in early-onset sepsis caused by Escherichia coli. As the signs and symptoms of neonatal sepsis are nonspecific, early diagnosis and prompt treatment remains a challenge. There have been a myriad of studies on various diagnostic markers like hematological indices, acute phase reactants, C-reactive protein, procalcitonin, cytokines, and cell surface markers among others. Nonetheless, further research is needed to identify a biomarker with high diagnostic accuracy and validity. Some of the newer markers like inter α inhibitor proteins have shown promising results thereby potentially aiding in early detection of neonates with sepsis. In order to decrease the widespread, prolonged use of unnecessary antibiotics and improve the outcome of the infants with sepsis, reliable identification of sepsis at an earlier stage is paramount.
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Affiliation(s)
- Birju A Shah
- Instructor of Pediatrics; Neonatal-Perinatal Medicine; Warren Alpert Medical School of Brown University; Women & Infants Hospital of Rhode Island; Providence, RI USA
| | - James F Padbury
- Pediatrician-in-Chief, Professor of Pediatrics; Warren Alpert Medical School of Brown University; Women & Infants Hospital of Rhode Island; Providence, RI USA
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