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Kurul Ş, Reijnierse JJ, Koppens HJ, Onland W, Simons SHP, Reiss IKM, Taal HR, Visser DH. Assessing neonatal Sequential Organ Failure (nSOFA) scores in suspected late-onset neonatal sepsis among preterm infants: implications for morbidity and mortality. BMJ Paediatr Open 2024; 8:e002884. [PMID: 39734076 DOI: 10.1136/bmjpo-2024-002884] [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: 07/11/2024] [Accepted: 11/15/2024] [Indexed: 12/31/2024] Open
Abstract
BACKGROUND The neonatal Sequential Organ Failure Assessment (nSOFA) score is an organ dysfunction score developed for predicting mortality risk in preterm neonates with proven late-onset neonatal sepsis (LONS) and necrotising enterocolitis. However, the utility of the nSOFA score in determining the risk of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) or mortality in patients with suspected LONS is unknown. METHODS We performed a dual-centre retrospective cohort study of preterm (gestational age <32 weeks) neonates suspected of LONS, from 2016 to 2020 at two neonatal intensive care units. The nSOFA scores (range 0-15) were calculated for each suspected LONS episode at various time points around the sepsis evaluation. A nSOFA burden score was calculated, by counting each time point the nSOFA score was ≥4 during all sepsis episodes (in the time period -6 to 48 hours). The association with 10-day sepsis-related mortality and severe ROP and BPD was assessed. RESULTS A total of 1157 episodes of suspected LONS in 706 neonates occurred. The nSOFA was significantly associated with 10-day mortality at various time points. The nSOFA score 6 hours after drawing a blood culture (T6) was associated with 10-day sepsis-related mortality (adjusted OR (aOR) 1.31; 95% CI (1.22 to 1.40; p<0.001)), in a model corrected for gestational age, sex, age at evaluation and gestational age-adjusted birth weight. The nSOFA burden scores were positively associated with the risk for ROP (aOR 1.24; 95% CI 1.09 to 1.41; p=0.001) and BPD (aOR 1.30; 95% CI 1.13 to 1.50; p<0.001). CONCLUSION Our findings show that the nSOFA score in preterm neonates suspected of LONS is associated with subsequent mortality, ROP and BPD. Incorporating nSOFA scores may help to identify sepsis survivors at the highest risk of adverse outcomes, who may require more intensive monitoring and adapted therapy.
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Affiliation(s)
- Şerife Kurul
- Department of Pediatrics, Division Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Joyce J Reijnierse
- Department of Pediatrics, Division Neonatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Hugo J Koppens
- Department of Pediatrics, Division Neonatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Wes Onland
- Department of Pediatrics, Division Neonatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Sinno H P Simons
- Department of Pediatrics, Division Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - H Rob Taal
- Department of Pediatrics, Division Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Douwe H Visser
- Department of Pediatrics, Division Neonatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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Zhao Y, Zhang L, Zhang M, Li S, Sun X, Sun X, Yao G, Li C, Li M, Song C, He H, Jia Y, Jv B, Yu Y, Zhu Y, Wang L. Impact of early caffeine administration on respiratory outcomes in very preterm infants initially receiving invasive mechanical ventilation. BMJ Open Respir Res 2024; 11:e002285. [PMID: 39209350 PMCID: PMC11367330 DOI: 10.1136/bmjresp-2023-002285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE The guidelines recommend early caffeine administration for preterm infants requiring non-invasive mechanical ventilation since earlier treatment is associated with better outcomes. The objective was to evaluate the impact of early caffeine therapy (within 24 hours after birth) on respiratory outcomes in very preterm infants who were initially receiving invasive mechanical ventilation. METHODS This was an observation cohort study from 1 January 2018 to 31 December 2022 based on a database that was prospectively collected and maintained. Infants who initially received invasive mechanical ventilation were divided into two groups based on the timing of caffeine initiation: within the first 24 hours after birth (early) and within 48 hours of birth or later (late). Generalised linear mixed models with a random effect model for the centre were used to assess the impact of different caffeine initiation times on neonatal outcomes. RESULTS Among the cohort of 9880 infants born at <32 weeks gestation, 2381 were eligible for this study (early initiation: 1758 (73.8%) and late initiation: 623 (26.2%)). For infants born at more than 28 weeks of gestation, the adjusted generalised linear mixed model showed that the duration of invasive mechanical ventilation was 1.34 (95% CI -2.40 to -0.27) days shorter and the incidence of moderate-to-severe bronchopulmonary dysplasia (BPD) was lower (adjusted OR 0.63; 95% CI 0.41 to 0.96) in the early caffeine group compared with the late caffeine group. CONCLUSION In very preterm infants who initially receive invasive mechanical ventilation, early administration of caffeine within 24 hours after birth can shorten the duration of invasive mechanical ventilation, reduce the incidence of moderate-to-severe BPD and improve respiratory outcomes. The very early initiation of caffeine treatment does not appear to be associated with any adverse outcomes. TRIAL REGISTRATION NUMBER ChiCTR1900025234.
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Affiliation(s)
- Yarui Zhao
- Party Committee Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lidan Zhang
- The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Mingtao Zhang
- Department of Neonatology, Hebei PetroChina Central Hospital, Langfang, China
| | - Shuai Li
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Xuemei Sun
- Department of Neonatology, Linyi People's Government, Linyi, Shandong, China
| | - Xiaolin Sun
- Department of Neonatology, Women and Children’s Healthcare Hospital of Linyi, Linyi, China
| | - Guo Yao
- Department of Neonatology, The Affiliated Taian City Central Hospital of Qingdao University, Taian, China
| | - Cong Li
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng City, China
| | - Minmin Li
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chunyu Song
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haiying He
- Department of Neonatology, The Third Hospital of Bao Gang Group, Baotou, China
| | - Yongfeng Jia
- Department of Neonatology, Shangluo Central Hospital, Shangluo, China
| | - Bing Jv
- Blood Center of Shangdong Province, Jinan, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yun Zhu
- Party Committee Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Li Wang
- The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
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Xu H, Ca D, Zhou L. Diagnostic and prognostic value of PCT and RDW in premature infants with septicemia. Medicine (Baltimore) 2024; 103:e35725. [PMID: 38363932 PMCID: PMC10869038 DOI: 10.1097/md.0000000000035725] [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: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 02/18/2024] Open
Abstract
It aims to study the diagnostic effect of procalcitonin (PCT) and red blood cell distribution width (RDW) in premature septicemia (PS), and to analyze the prognostic evaluation value of PCT and RDW in PS. Ninety eight septicemia premature infants (SPI) who visited the neonatal intensive care unit of our hospital from June 2019 to July 2021 were selected and met the criteria. Based on the patient's condition and the neonatal shock score, they were separated into a severe group (SG) and a mild group (MG). There were 43 children and 55 children in the 2 groups, respectively. According to the survival status of SPI after 3 days of treatment, they were divided into a death group and a SG. It detected and analyzed the peripheral venous blood of SPI before treatment (BT) and after treatment (AT), and observed the changes of PCT and RDW. The comparison of general data between severe and mild SPI and their mothers did not have statistical significance (P > .05). The PCT of the SG was higher than that of the MG BT, on the 1st day and the 3rd day AT; The PCT BT and AT in both groups ranged from high to low on the 1st day and the 3rd day AT and BT (P < .05). The RDW in the SG were higher than those in the MG, and the RDW BT and AT in both groups were the highest on the 1st day AT; The RDW BT in the MG was higher than on the 3rd day AT, while the RDW BT in the SG was lower than on the 3rd day AT (P < .05). The optimal cutoff values for PCT on the 1st and 3rd day AT were 40.594ng/ml and 64.854ng/ml, respectively, with sensitivity of 100.0% and 100.0%, and specificity of 73.2% and 87.1% (P < .05). The optimal cutoff values for RDW on the 1st and 3rd day AT were 16.649% and 18.449%, respectively, with sensitivity of 100.0% and 100.0%, and specificity of 68.5% and 91.8% (P < .05). Monitoring the changes in PCT and RDW can promote the early diagnosis of PS and their prognosis evaluation.
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Affiliation(s)
- Huafen Xu
- Department of Neonatology, Hainan Provincial People’s Hospital, Haikou, Hainan, China
| | - Dong Ca
- Department of Neonatology, Hainan Provincial People’s Hospital, Haikou, Hainan, China
| | - Lixia Zhou
- Department of Neonatology, Hainan Provincial People’s Hospital, Haikou, Hainan, China
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Yu Z, Wang L, Wang Y, Zhang M, Xu Y, Liu A. Development and Validation of a Risk Scoring Tool for Bronchopulmonary Dysplasia in Preterm Infants Based on a Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11050778. [PMID: 36900783 PMCID: PMC10000930 DOI: 10.3390/healthcare11050778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Background: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in preterm infants with high disability and mortality rates. Early identification and treatment of BPD is critical. Objective: This study aimed to develop and validate a risk scoring tool for early identification of preterm infants that are at high-risk for developing BPD. Methods: The derivation cohort was derived from a systematic review and meta-analysis of risk factors for BPD. The statistically significant risk factors with their corresponding odds ratios were utilized to construct a logistic regression risk prediction model. By scoring the weights of each risk factor, a risk scoring tool was established and the risk stratification was divided. External verification was carried out by a validation cohort from China. Results: Approximately 83,034 preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g were screened in this meta-analysis, and the cumulative incidence of BPD was about 30.37%. The nine predictors of this model were Chorioamnionitis, Gestational age, Birth weight, Sex, Small for gestational age, 5 min Apgar score, Delivery room intubation, and Surfactant and Respiratory distress syndrome. Based on the weight of each risk factor, we translated it into a simple clinical scoring tool with a total score ranging from 0 to 64. External validation showed that the tool had good discrimination, the area under the curve was 0.907, and that the Hosmer-Lemeshow test showed a good fit (p = 0.3572). In addition, the results of the calibration curve and decision curve analysis suggested that the tool showed significant conformity and net benefit. When the optimal cut-off value was 25.5, the sensitivity and specificity were 0.897 and 0.873, respectively. The resulting risk scoring tool classified the population of preterm infants into low-risk, low-intermediate, high-intermediate, and high-risk groups. This BPD risk scoring tool is suitable for preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g. Conclusions: An effective risk prediction scoring tool based on a systematic review and meta-analysis was developed and validated. This simple tool may play an important role in establishing a screening strategy for BPD in preterm infants and potentially guide early intervention.
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Affiliation(s)
- Zhumei Yu
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- School of Nursing, Anhui Medical University, Hefei 230032, China
| | - Lili Wang
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yang Wang
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Min Zhang
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yanqin Xu
- Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Annuo Liu
- School of Nursing, Anhui Medical University, Hefei 230032, China
- Correspondence:
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A predictive model for prognosis in very low birth weight infants with late-onset sepsis. Pediatr Res 2023:10.1038/s41390-023-02480-x. [PMID: 36725910 DOI: 10.1038/s41390-023-02480-x] [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: 08/10/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aims to develop a predictive model to assess the probability of poor prognosis in very low birth weight infants (VLBWI) with late-onset sepsis (LOS). METHODS A total of 309 eligible VLBWI with LOS were included in the study. Logistic regression was used to determine prognostic factors for VLBWI with LOS. A nomogram incorporating these factors was created to predict the probability of poor prognosis. Poor prognosis includes death and survival with severe complications. RESULTS In the developmental cohort, the incidence of poor prognosis was 59.5% (147/247). Forward stepwise logistic regression analysis showed that HCO3, albumin (ALB), ionized calcium (iCa), blood urea nitrogen (BUN), gestational age (GA), and birth weight (BW) were independent predictors of poor prognosis in VLBWI with LOS. The predictive model showed good discrimination and calibration. In the developmental cohort, the prediction model had a sensitivity of 83.7%, a specificity of 74.0%, and a C-index of 0.845 (95% confidence interval: 0.795-0.894). CONCLUSION Our study identified independent predictors of poor prognosis in VLBWI with LOS and used them to construct a predictive model. This model can help clinicians to identify high-risk groups with poor prognosis early and provide important clinical reference information. IMPACT This article highlights the development of a predictive model to assess the probability of poor prognosis in very low birth weight infants with late-onset sepsis (LOS). The model constructed in this manuscript was the first model to predict the poor prognosis of VLBWI with LOS. We mean a poor prognosis that includes death and some severe complications that may lead to long-term disability. Clinicians can use the model's scoring results to assess a patient's condition and accurately identify the occurrence of poor prognosis.
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6
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Alonso-Ojembarrena A, Méndez-Abad P, Alonso-Quintela P, Zafra-Rodríguez P, Oulego-Erroz I, Lubián-López SP. Lung ultrasound score has better diagnostic ability than NT-proBNP to predict moderate-severe bronchopulmonary dysplasia. Eur J Pediatr 2022; 181:3013-3021. [PMID: 35648231 DOI: 10.1007/s00431-022-04491-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED The N-terminal end of B-type natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) score have been proven to be adequate early biomarkers of bronchopulmonary dysplasia (BPD) in preterm infants. Our aim was to study if the predictive capacity of each one is increased by analyzing them together. We included infants born before 32 weeks with NT-proBNP and LUS scores on the first day of life (DOL) and on the 3rd, 7th, and 14th DOL and compared the diagnostic ability for moderate-severe BPD (msBPD) of each biomarker and in combination. We also compared them with a multivariate model of msBPD using only clinical variables. The sample size was 133 patients, and twenty-seven (20%) developed msBPD. The LUS score on the 7th DOL had better performance than NT-proBNP at the same moment: area under the receiver operating characteristic curve (AUC) 0.83 (0.75-0.89) versus 0.66 (0.56-0.75), p = 0.003, without differences in the rest of the times studied. These values did not increase when using the combination of both. A multivariate regression model that included only clinical variables (birth weight and invasive mechanical ventilation (IMV) at the 7th DOL) predicted msBPD with the same AUC as after the addition of any of these biomarkers, neither together. CONCLUSION The LUS score is a better predictor of msBPD on the 7th DOL than NT-proBNP in preterm infants born before 32 weeks, although they have similar diagnostic accuracy on the 1st, 3rd, and 14th DOL. Neither of them, nor together, have a better AUC for msBPD than a clinical model with birthweight and the need for IMV at the 7th DOL. WHAT IS KNOWN • NT-proBNP and LUS score are early predictors of moderate-severe bronchopulmonary dysplasia (msBPD). WHAT IS NEW • The combination of both NT-proBNP and LUS score does not increase the predictive ability of each separately.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar Universitary Hospital, Avenida Ana de Viya 11, 11010, Cádiz, Spain. .,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.
| | - Paula Méndez-Abad
- Neonatal Intensive Care Unit, Puerta del Mar Universitary Hospital, Avenida Ana de Viya 11, 11010, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Paula Alonso-Quintela
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain.,Biomedicine Institute of León (IBIOMED), University of León, León, Spain
| | - Pamela Zafra-Rodríguez
- Neonatal Intensive Care Unit, Puerta del Mar Universitary Hospital, Avenida Ana de Viya 11, 11010, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Ignacio Oulego-Erroz
- Biomedicine Institute of León (IBIOMED), University of León, León, Spain.,Pediatric Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain.,Working Group On Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care (SECIP), Madrid, Spain
| | - Simón P Lubián-López
- Neonatal Intensive Care Unit, Puerta del Mar Universitary Hospital, Avenida Ana de Viya 11, 11010, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Maternal and Child Health and Radiology, School of Medicine, University of Cádiz, Cádiz, Spain
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Zheng X, Li Y, Cheng Q, Wang L. Predictive Value of Ionized Calcium for Prognosis of Sepsis in Very Low Birth Weight Infants. J Inflamm Res 2022; 15:3749-3760. [PMID: 35799618 PMCID: PMC9255904 DOI: 10.2147/jir.s369431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Previous studies have shown that ionized calcium (iCa) is strongly correlated with critical illnesses, including sepsis. However, there are few studies on the association of iCa levels and sepsis in very low birth weight infants (VLBWI). Therefore, the aim of this study was to investigate the role of iCa in assessing the severity of sepsis and in predicting the prognosis of sepsis in VLBWI. Patients and Methods 249 eligible VLBWI with sepsis were included in the present study and were divided into good and poor prognosis groups according to prognosis. We collected complete laboratory and clinical data. The lowest iCa measured during the first 24h from sepsis onset was recorded, and the Pediatric Risk of Mortality (PRISM III) score was calculated for each newborn. Results Neonatal mortality was higher in the hypocalcemia group (32.80% vs 12.80%, P < 0.001), and iCa levels were negatively correlated with PRISM III scores (r= −0.819, P < 0.001). The result of multiple logistic regression analysis showed that iCa was an independent predictor of poor prognosis (odds ratio [OR]= 0.558, 95% confidence interval [CI], 0.406–0.768, P < 0.001). Furthermore, our data demonstrated that iCa was also an independent predictor for the occurrence of death in VLBWI with sepsis who have a poor prognosis (OR= 0.659, 95% CI, 0.445–0.977, P =0.038). ROC curve analysis showed that iCa had good discriminatory power in predicting the poor prognosis (AUC=0.739, 95% CI, 0.664–0.813, P <0.001) in VLBWI with sepsis. Conclusion iCa levels correlate with the severity of sepsis and can be an independent predictor of poor prognosis in VLBWI with sepsis.
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Affiliation(s)
- Xuejie Zheng
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Yuanzhi Li
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Qiyuan Cheng
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Lili Wang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Correspondence: Lili Wang, Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Tel +86 13075578390, Email
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Implementation of a Vancomycin Dose-Optimization Protocol in Neonates: Impact on Vancomycin Exposure, Biological Parameters, and Clinical Outcomes. Antimicrob Agents Chemother 2022; 66:e0219121. [PMID: 35465728 DOI: 10.1128/aac.02191-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Vancomycin dosing used in neonates results frequently in insufficient concentrations. A vancomycin dose-optimization protocol consisting of an individualization of loading and maintenance doses (administered during continuous infusion) through a previously validated pharmacokinetic model was implemented in our center. This monocenter retrospective study aimed to compare vancomycin average concentration (Cavg) in the therapeutic range (15 to 25 mg/L) and biological and clinical parameters before and after implementation of this protocol. A total of 60 and 59 courses of vancomycin treatment in 45 and 49 patients were analyzed in groups before and after implementation, respectively. Initial vancomycin Cavg were more frequently in the therapeutic range in the group after implementation (74.6% versus 28.3%, P < 0.001), with 1.6-fold higher Cavg (20.3 [17.0-22.2] mg/L versus 12.9 [11.3-17.0] mg/L, P < 0.001). Considering all Cavg during longitudinal therapeutic drug monitoring (TDM), the frequency of therapeutic Cavg was higher in the group after implementation (74.8% [n = 103] versus 31% [n = 116], P < 0.001). The dose optimization protocol was also associated with a reduced time to obtain a negative blood culture (P < 0.001) and fewer antibiotic switches (P = 0.025), without increasing the frequency of nephrotoxicity. Clinical outcomes also appeared to be improved, with less periventricular leukomalacia (P = 0.021), trended toward less respiratory instability (P = 0.15) and a shorter duration of vasoactive drug use (P = 0.18) for neonates receiving personalized doses of vancomycin. This personalized vancomycin dose protocol improves vancomycin exposure in neonates, with good safety, and suggests an improvement in biological and clinical outcomes.
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Shim SY, Cho SJ, Park EA. Neurodevelopmental Outcomes at 18-24 Months of Corrected Age in Very Low Birth Weight Infants with Late-onset Sepsis. J Korean Med Sci 2021; 36:e205. [PMID: 34490752 PMCID: PMC8422039 DOI: 10.3346/jkms.2021.36.e205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Preterm infants are prone to sepsis owing to their immature innate immunity and prolonged hospitalization. We aimed to evaluate the association between late-onset sepsis (LOS) during hospitalization and neurodevelopmental delay at 18-24 months of corrected age in very low birth weight infants (VLBWIs), and to ascertain this association when adjusted for perinatal risk factors. METHODS This is a population-based study of VLBWIs born at 23-32 weeks of gestation between January 2014 and December 2017 who were enrolled in the Korean Neonatal Network. Bayley scales of infant development were evaluated at 18-24 months of corrected age in 2,098 infants. To test for LOS as a risk factor for neurodevelopmental delay, multiple logistic regression was used and adjusted for parental education status and clinical variables. RESULTS Blood culture positive LOS was identified in 419 (20.0%) infants. Cognitive and motor delays were found in 392 (18.7%) and 347 (16.5%) infants, respectively. When multivariate analysis was performed, LOS had a significant association with cognitive delay (odds ratio, 1.48; 95% confidence interval, 1.02-2.16), but no association with motor delay in VLBWIs. Both delays were significantly more frequent in cases of intraventricular hemorrhage (IVH) ≥ grade 3, periventricular leukomalacia (PVL), and intrauterine growth restriction (IUGR) and duration of mechanical ventilation. Male sex and necrotizing enterocolitis ≥ grade 2 had an effect on motor delay, whereas paternal college graduation affected cognitive delay. CONCLUSION In VLBWIs with LOS, there is a heightened risk of cognitive delays at 18-24 months of corrected age. Brain injury, such as severe IVH and PVL, duration of mechanical ventilation, and IUGR, were also associated with cognitive and motor delays.
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Affiliation(s)
- So-Yeon Shim
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea.
| | - Su Jin Cho
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Ae Park
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
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