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Mezgebu T, Ossabo G, Zekiwos A, Mohammed H, Demisse Z. Neonatal sepsis and its associated factors among neonates admitted to the neonatal intensive care unit in Wachemo University Comprehensive Specialized Hospital, Southern Ethiopia, 2022. Front Pediatr 2023; 11:1184205. [PMID: 37465417 PMCID: PMC10350534 DOI: 10.3389/fped.2023.1184205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/22/2023] [Indexed: 07/20/2023] Open
Abstract
Background Neonatal sepsis is a major public health problem worldwide. It is one of the leading causes of neonatal mortality and morbidity worldwide. The neonatal mortality rate is higher in developing countries, where the extent and causes of neonatal sepsis are not yet known. Neonatal sepsis is a leading cause of neonatal mortality in Ethiopia. As a result, this study aimed to assess the proportion and identify maternal and neonatal risk factors for neonatal sepsis among neonates admitted to the neonatal intensive care unit. Methods An institutional-based cross-sectional study was conducted from May 2022 to July 2022 at the Wachemo University Comprehensive Specialized Teaching Hospital, Neonatal Intensive Care Unit, southern Ethiopia. A total of 205 neonates with indexed mothers participated in the study. Using a consecutive sampling technique, a structured, pretested questionnaire was used to collect data from the study subjects. Data were entered into EpiData Manager version 3.1 for Windows and then exported to SPSS version 22 for further data cleaning and analysis. Descriptive analyses were performed by using frequency, percentage, and summary statistics to describe the key variables. A multivariate regression model was used to identify factors associated with neonatal sepsis. Finally, statistical significance was declared at a p-value of less than 0.05, and an adjusted odds ratio (AOR) with a 95% confidence level was used to declare the variable's association with the outcome variable. Result The overall prevalence rate of neonatal sepsis was 39.5% (95% CI: 33.7-45.9). Multivariable analysis was performed by taking a variable that is statistically significant in bivariate logistic regression as a candidate variable. Multivariable model analysis showed that unmarried status AOR = 18.37 (95% CI: 1.56-216.14), maternal fever during delivery AOR = 4.74 (95% CI: 1.63-13.8), and premature rupture of membrane AOR = 7.53 (95% CI: 2.19-25.6) were variables that increased the odds of developing neonatal sepsis. Conclusion The study's findings indicate that neonatal sepsis is highly prevalent. Unmarried maternal status, maternal fever during delivery, and premature rupture of the membrane were predictors of neonatal sepsis. Therefore, providing training for health workers and close monitoring and evaluation during obstetric and neonatal care are crucial to halt the occurrence of neonatal sepsis.
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Affiliation(s)
- Taye Mezgebu
- Department of Comprehensive Nursing, Schools of Nursing, College of Health Science and Medicine, Wachemo University, Hosanna, Ethiopia
| | - Getachew Ossabo
- Department of Comprehensive Nursing, Schools of Nursing, College of Health Science and Medicine, Wachemo University, Hosanna, Ethiopia
| | - Asnakech Zekiwos
- Department of Comprehensive Nursing, Schools of Nursing, College of Health Science and Medicine, Wachemo University, Hosanna, Ethiopia
| | - Hamdino Mohammed
- Department of Comprehensive Nursing, Schools of Nursing, College of Health Science and Medicine, Wachemo University, Hosanna, Ethiopia
| | - Zerihun Demisse
- Department of Pediatrics and Child Health Nursing, Schools of Nursing, College of Health Science and Medicine, Wachemo University, Hosanna, Ethiopia
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Yu Z, Yan C, Qiu D, Zhang X, Wen C, Dong S. Accumulation and ecotoxicological effects induced by combined exposure of different sized polyethylene microplastics and oxytetracycline in zebrafish. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 319:120977. [PMID: 36586558 DOI: 10.1016/j.envpol.2022.120977] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Microplastics have been widely reported as carriers of antibiotics, yet studies investigating the combined ecotoxicology of microplastics and antibiotics on organisms is limited. In this study, different sized polystyrene plastics and oxytetracycline (OTC) were used to carry out a 30-day single and binary-combined exposure experiment of zebrafish, and the microplastics and OTC accumulation, liver histological alteration, biomarkers and transcriptomic response of zebrafish were evaluated. Our results indicated that 300 nm and 50 nm plastic particles increased the OTC accumulation in liver by 33.8% and 44.5%, respectively. Microplastics and OTC induced severe liver histological damage, and the damage is size-dependent, increasing with the decrease of microplastics sizes. The liver biomarkers indicated a different response pattern in single microplastics exposure and combined with OTC, single or co-exposure of 50 nm nano-plastics and OTC induced intense responses of integrated biomarker response values. The 50 nm nano-plastics, OTC and their combined exposure induced 1330, 2693 and 3965 significantly differentially expressed genes, respectively, in which the steroid biosynthesis pathway was significantly affected by all the three treatments. This study elucidated the size-dependent effects of microplastics and provided detailed data from histopathology to transcriptome profile, enhancing our understanding of the ecotoxicity of microplastics and OTC.
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Affiliation(s)
- Ziyue Yu
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, 361021, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Changzhou Yan
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, 361021, China.
| | - Donghua Qiu
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, 361021, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xin Zhang
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, 361021, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Ce Wen
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, 361021, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Sijun Dong
- College of Life Sciences, Institute of Life Sciences and Green Development, Hebei University, Baoding 071002, China
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Akalu TY, Aynalem YA, Shiferaw WS, Desta M, Amha H, Getaneh D, Asmare B, Alamneh YM. Prevalence and determinants of early onset neonatal sepsis at two selected public referral hospitals in the Northwest Ethiopia: a cross-sectional study. BMC Pediatr 2023; 23:10. [PMID: 36600219 DOI: 10.1186/s12887-022-03824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Globally, neonatal mortality is decreasing, and road maps such as the Early Newborn Action Plan set ambitious targets for 2030. Despite this, deaths in the first weeks of life continue to rise as a percentage of total child mortality. Neonatal sepsis with early onset continues to be a significant cause of death and illness. The majority of sepsis-related deaths occur in developing nations, where the prevalence and causes of newborn sepsis are yet unknown. As a result, the goal of this study was to determine the prevalence of early-onset sepsis and identify determinant factors. METHODS A cross-sectional study was conducted on 368 study participants in referral hospitals of East and West Gojjam Zones from March 1st to April 30th, 2019. Study participants were selected at random using lottery method. Face-to-face interviews with index mothers for maternal variables and neonatal record review for neonatal variables were used to collect data using a structured pretested questionnaire. Data were entered into Epidata 3.1 and then exported to STATA/SE software version 14. Finally, the logistic regression model was used for analysis. Statistical significance was declared at P < 0.05 after multivariable logistic regression. RESULTS A total of 368 newborns and their index mothers took part in this study. The mean age of the newborns was 4.69 days (± 1.93SD). Early-onset neonatal sepsis was seen in 34% of the babies. Nulliparity (AOR: 3.3, 95% CI: 1.1-9.5), duration of labor > 18 h after rupture of membranes (AOR: 11.3, 95% CI: 3.0-41.8), gestational age of 32-37 weeks (AOR: 3.2, 95% CI: 1.2-8.5), and neonates who require resuscitation at birth (AOR: 4, 95% CI: 1.4 -11.8) were all found to be significantly associated with early-onset neonatal sepsis. CONCLUSION AND RECOMMENDATION Early-onset neonatal sepsis was found to be high in this study. Early-onset neonatal sepsis was found to be associated with maternal, obstetric, and neonatal variables. Comprehensive prevention strategies that target the identified risk factors should be implemented right away.
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Affiliation(s)
- Tadesse Yirga Akalu
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | | | | | - Melaku Desta
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Haile Amha
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Dejen Getaneh
- College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bayachew Asmare
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Rodrigues Wilde MO, Mezadri T, Gouveia PB, Grillo LP, Valete C. Prediction of early-onset neonatal sepsis in umbilical cord blood analysis: an integrative review. J Matern Fetal Neonatal Med 2022; 35:10187-10198. [PMID: 36100266 DOI: 10.1080/14767058.2022.2122798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this study was to describe the inflammatory markers studied in umbilical cord blood and to analyze the performance of the three markers most frequently studied for the prediction of early-onset neonatal sepsis. DATA SOURCES An integrative review from 1995 to 2021 was performed, with a search in the MEDLINE, Embase, Cochrane Library, SciELO, and gray literature databases, using the terms "neonates," "newborns," "neonatal sepsis," "early-onset neonatal sepsis," "neonatal infection," "inflammatory markers," "biomarkers," "cord blood," "fetal blood." STUDY SELECTION AND DATA EXTRACTIONS Study evaluation was limited to primary studies, prospective, observational or intervention, descriptive or analytical, that assessed the diagnosis of early-onset neonatal sepsis using inflammatory markers in umbilical cord blood, in Portuguese, English, or Spanish. Qualitative studies, reports, review studies, and case series were excluded. Only studies with a punctuation ≥ 6 in the Newcastle-Ottawa scale were included. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Sixteen studies were included in the qualitative synthesis. Procalcitonin, C-reactive protein, and interleukin-6 were the most frequently studied markers. The best performance for C-reactive protein was observed at a 0.2 mg/L cutoff, with a sensitivity of 82% and a negative predictive value of 99%. Procalcitonin presented the best performance at a 0.5 ng/mL cutoff with 87.5% sensitivity and 98.7% negative predictive value. Interleukin-6 presented the best performance at a 108.5 ng/mL cutoff, with 95% sensitivity and 97.4% negative predictive value. CONCLUSION The evaluation of markers in the umbilical cord for the diagnosis of early-onset neonatal sepsis, could contribute to a more assertive therapy for the neonate and anticipate sepsis screening. Since the cost is less and technically easier, C-reactive protein is recommended for routine use.
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Affiliation(s)
| | - Tatiana Mezadri
- Professional Master's Program in Health and Work Management, University of the Vale do Itajaí, Itajai, Brazil
| | | | - Luciane Peter Grillo
- Professional Master's Program in Health and Work Management, University of the Vale do Itajaí, Itajai, Brazil
| | - Cristina Valete
- Department of Medicine, Universidade Federal de São Carlos, Sao Carlos, Brazil
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Sherbiny HS, Mostafa HAEF, Sherief LM, Kamal NM, El-Shal AS, Abdel-El Halm MM, Khan HY, Ali ASA. Validity of serum and urinary hepcidin as biomarkers for late-onset sepsis in premature infants. Ther Adv Chronic Dis 2022; 13:20406223221122527. [PMID: 36093263 PMCID: PMC9459492 DOI: 10.1177/20406223221122527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 07/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Sepsis remains one of the leading causes of neonatal morbidity and mortality,
particularly among premature infants. Blood culture is the ‘gold standard’
for the diagnosis of neonatal sepsis but is associated with several
pitfalls. Aim of the work: We aim to evaluate the validity of measuring serum (S.Hep) and urinary
hepcidin (U.Hep) concentrations as diagnostic biomarkers for late-onset
sepsis (LOS) in preterm infants. Patients and Methods: The current case-control study included 73 cases of clinically and laboratory
confirmed late-onset sepsis as the ‘case group’ and 50 nonseptic premature
infants of comparable age and sex as the ‘control group’. S.Hep and U.Hep
concentrations were evaluated at enrollment (acute sample) and after 1 week
of treatment (convalescent sample). Results: Patients had a statistically significant higher concentration of both S.Hep
and U.Hep as compared with nonseptic controls (p = 0.0001).
Similarly, a significant reduction of both S.Hep and U.Hep was detected
after 1 week of treatment (p = 0.001). A cut-off value
of ⩾ 94.8 ng/ml of S.Hep and ⩾ 264 ng/mg of U.Hep/urinary creatinine showed
high sensitivity, specificity, and positive predictive value in the
diagnosis of neonatal LOS. Conclusions: Both S.Hep and U.Hep can function as promising accurate and rapid surrogate
tests for the diagnosis of LOS. U.Hep measurement has the advantage of being
noninvasive, with no hazards of phlebotomy, and is less variable throughout
the day.
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Affiliation(s)
- Hanan Sakr Sherbiny
- Pediatric Department, Zagazig University, Zagazig, Egypt, Pediatric Department, College of Medicine, Bisha University, Bisha, Saudi Arabia
| | | | | | - Naglaa M Kamal
- Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal Saeed El-Shal
- Zagazig University, Zagazig, Egypt, Armed Forces College of Medicine (AFCM), Cairo, Egypt
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Antimicrobial Peptides in Early-Life Host Defense, Perinatal Infections, and Necrotizing Enterocolitis—An Update. J Clin Med 2022; 11:jcm11175074. [PMID: 36079001 PMCID: PMC9457252 DOI: 10.3390/jcm11175074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Host defense against early-life infections such as chorioamnionitis, neonatal sepsis, or necrotizing enterocolitis (NEC) relies primarily on innate immunity, in which antimicrobial peptides (AMPs) play a major role. AMPs that are important for the fetus and neonate include α and β defensins, cathelicidin LL-37, antiproteases (elafin, SLPI), and hepcidin. They can be produced by the fetus or neonate, the placenta, chorioamniotic membranes, recruited neutrophils, and milk-protein ingestion or proteolysis. They possess antimicrobial, immunomodulating, inflammation-regulating, and tissue-repairing properties. AMPs are expressed as early as the 13th week and increase progressively through gestation. Limited studies are available on AMP expression and levels in the fetus and neonate. Nevertheless, existing evidence supports the role of AMPs in pathogenesis of chorioamnionitis, neonatal sepsis, and NEC, and their association with disease severity. This suggests a potential role of AMPs in diagnosis, prevention, prognosis, and treatment of sepsis and NEC. Herein, we present an overview of the antimicrobial and immunomodulating properties of human AMPs, their sources in the intrauterine environment, fetus, and neonate, and their changes during pre- and post-natal infections and NEC. We also discuss emerging data regarding the potential utility of AMPs in early-life infections, as diagnostic or predictive biomarkers and as therapeutic alternatives or adjuncts to antibiotic therapy considering the increase of antibiotic resistance in neonatal intensive care units.
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Magnitude and associated factors of neonatal sepsis among neonates admitted to neonatal intensive care unit of Northern oromia hospitals, Ethiopia: A multicenter cross-sectional study. Ann Med Surg (Lond) 2022; 78:103782. [PMID: 35620038 PMCID: PMC9127159 DOI: 10.1016/j.amsu.2022.103782] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Globally sepsis is the most cause of neonatal death. Neonatal sepsis is the major newborn killer in Ethiopia, which accounts for more than one-third of neonatal deaths. Therefore, the study was aimed to assess the prevalence and associated factors of neonatal sepsis. Methods An institutional based cross-sectional study was employed on a total of 378 neonates admitted to the NICU of selected four hospitals. It was conducted from January 2021 to March 2021. Multivariate logistic regression analysis was used to determine the prevalence of neonatal sepsis. Results Among neonates who enrolled in this study 188(50.1%) of them were females and 283 (75.5%) of them were in the age group of early neonatal period. The overall magnitude of neonatal sepsis in this study was 196(52.27%). From this 159(81.12%) and 37(18.88%) of neonates developed early onset neonatal sepsis and late onset neonatal sepsis, respectively. Factors such as age of neonates[AOR = 2.351, 95% CI (1.131, 4.888)], birth weight of neonate less than 2.5 kg[AOR = 2.546, 95% CI (1.875, 3.643)], multiple per digital vaginal examination[AOR =0.278, 95% CI (0.148,0.522)], history of urinary tract infection[AOR = 3.709, 95% CI (1.828–7.301)], Meconium stained amniotic fluid (MSAF)[AOR = 0.384, 95% CI (0.152, 0.968)] and intrapartum high fever[AOR = 2.203, 95% CI (1.034, 4.692)] were the independent determinants of neonatal sepsis. Conclusion This study indicated that the magnitude of neonatal sepsis was found to be high. In general, this study has found that both maternal and neonatal factors had contributed to the risk of neonatal sepsis. Based on these results we recommend the healthcare providers to focus on the prevention of risk factors rather than treating the disease after it occurs. Globally, sepsis is one of the major causes of morbidity and mortality. Neonatal sepsis is categorized as early onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS) . In a developing countries accurate diagnosis of neonatal sepsis is not satisfactory.
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Katz BZ, Benisty D, Kay S, Herzlich J, Raskind C, Marom R. Comprehensive Morphological Assessment of Cord Blood: Normal Values and the Prevalence of Morphologically Aberrant Leukocytes. Acta Haematol 2021; 145:184-192. [PMID: 34727546 DOI: 10.1159/000520638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cord blood (CB) is becoming a valuable source for stem cells utilized in a variety of cell therapy applications, as well as for newborn diagnostics. Some parameters of the CB cellular components can be provided by automated analyzers, while others, such as immature or aberrant cells, require blood film morphological assessment. The objectives of the study were to establish normal CB morphology and to determine the prevalence of morphologically aberrant leukocytes in CB. METHODS We performed a comprehensive morphological analysis of 100 CB samples taken from healthy term and appropriate-for-gestational-age neonates born to healthy mothers, preterm neonates, neonates of diabetic mothers, and small-for-gestational-age neonates. Blood counts were assessed, and manual morphological analyses were performed by laboratory specialists. RESULTS The manual differential count of normal CB samples established the following values: 47.8 ± 10.7% neutrophils, 31.2 ± 9.8% lymphocytes, 10.0 ± 4.0% monocytes, and 3.0 ± 2.5% eosinophils, with no significant sex-related differences. Blasts were observed in 44/100 samples with an average of 0.5 ± 0.7% per sample, and only a minor left shift was observed. There were significant populations of large granular lymphocytes (19.1 ± 10.6% of the total lymphocytes) and morphologically aberrant lymphocytes (12.4 ± 5.4% of the total lymphocytes) in the samples, irrespective of neonatal status. The differentials of preterm CB samples differ significantly from normal term CB samples, including the reverse of neutrophils/lymphocytes ratio, and the lack of basophils. CONCLUSIONS Normal values and unique morphological features in the CB of neonates are described. The abundant morphologically aberrant lymphocytes in CB may represent an immature state of the immune system at birth.
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Affiliation(s)
- Ben-Zion Katz
- Division of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Benisty
- Division of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sigi Kay
- Division of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacky Herzlich
- Department of Neonatology, Dana Dwek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Craig Raskind
- Department of Neonatology, Dana Dwek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ronella Marom
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatology, Dana Dwek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Bayih WA, Ayalew MY, Chanie ES, Abate BB, Alemayehu SA, Belay DM, Aynalem YA, Sewyew DA, Kebede SD, Demis A, Yitbarek GY, Tassew MA, Birhan BM, Alemu AY. The burden of neonatal sepsis and its association with antenatal urinary tract infection and intra-partum fever among admitted neonates in Ethiopia: A systematic review and meta-analysis. Heliyon 2021; 7:e06121. [PMID: 33644445 PMCID: PMC7887389 DOI: 10.1016/j.heliyon.2021.e06121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/24/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND More than one-third of the neonatal death in Ethiopia has been attributed to neonatal sepsis. However, there is no recent national evidence about the burden of neonatal sepsis and its association with antenatal urinary tract infection and intra-partum fever, which are commonly reported maternal morbidities in Ethiopia. Therefore, the aim of this systematic review and meta-analysis was to assess the pooled burden of neonatal sepsis and its association with antenatal urinary tract infection as well as intra-partum fever in the country. METHODS Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size, reported prevalence of neonatal sepsis, antenatal urinary tract infection and intrapartum fever on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the random inverse varience-effects model due to significant heterogeneity between studies (I2= 99.2%). Subgroup analysis was performed for evidence of heterogeneity. Sensitivity analyses were performed. Absence of publication bias was declared from symmetry of funnel plot and Egger's test (p = 0.244). RESULTS In this systematic review and meta-analysis, a total of 36,016 admitted neonates were included from 27 studies. Of these 27 studies, 23 employed cross-sectional design whereas 3 studies had case control type and only one study had cohort design. The prevalence of neonatal sepsis among admitted Ethiopian neonates at different regions of the country ranged from 11.7%-77.9%. However, the pooled prevalence of neonatal sepsis was 40.25% [95% CI: 34.00%, 46.50%; I2 = 99.2%]. From regional subgroup analysis, the highest prevalence was observed in the Oromiya region. Neonates born to mothers who had antenatal urinary tract infection were at 3.55 times (95% CI: 2.04, 5.06) higher risk of developing neonatal sepsis as compared to those neonates born to mothers who didn't have antenatal urinary tract infection. Moreover, neonates born to mothers having intra-partum fever were 3.63 times (95% CI: 1.64, 5.62) more likely to develop neonatal sepsis as compared to those born to mothers who were nonfebrile during intrapartum. CONCLUSION Neonatal sepsis has remained a problem of public health importance in Ethiopia. Both antenatal urinary tract infection and intra-partum fever were positively associated with neonatal sepsis. Therefore, preventing maternal urinary tract infection during pregnancy and optimizing the intra-partum care are recommended to mitigate the burden of neonatal sepsis in Ethiopia.
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Affiliation(s)
- Wubet Alebachew Bayih
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | | | - Ermias Sisay Chanie
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | | | - Sintayehu Asnakew Alemayehu
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | | | - Dagne Addisu Sewyew
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Solomon Demis Kebede
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | | | - Getachew Yideg Yitbarek
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Misganaw Abie Tassew
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Binyam Minuye Birhan
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Abebaw Yeshambel Alemu
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
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Hagag AA, El Frargy MS, Yonis RL, Al-Ashmawy GM. Diagnostic Value of Assessment of Serum Cortisol, Hepcidin and Thyroid Hormones Levels in Neonates with Late-Onset Sepsis. Infect Disord Drug Targets 2021; 21:248-256. [PMID: 32216741 DOI: 10.2174/1871526520666200327185244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
Neonatal sepsis is a clinical syndrome characterized by symptoms and signs of infection in the first twenty-eight days of life. Serum thyroid, cortisol and hepcidin are affected by neonatal sepsis. ; Aim of the Work: The aim of this study was to assess the diagnostic value of serum thyroid hormones including free triiodothyronine (free TT3) and free tetraiodothyronine (free TT4), serum cortisol and hepcidin levels through comparison of their concentrations between normal neonates and neonates with high probable late-onset sepsis. ; Patients and Methods: This case-control study was carried out on 40 neonates with suspected high probable late-onset neonatal sepsis based on clinical and laboratory finding who were admitted to NICU of Pediatric Department, Tanta University, Egypt in the period from April 2017 to May 2019 (group I) and 40 healthy neonates matched in age and sex as a control group (group II). For patients and controls, blood culture, highly sensitive C-reactive protein (H-s CRP), serum hepcidin, serum cortisol and thyroid hormones levels including free TT3 and free TT4 were assessed. ; Results: There were no significant differences between studied groups regarding weight, gestational age, sex and mode of delivery. H-s CRP, serum cortisol and hepcidin were significantly higher in group I than group II while serum-free TT3 and free TT4 were significantly lower in group I compared with controls (group II). There was significantly lower H-s CRP, serum hepcidin and cortisol and significantly higher serum-free TT3 and free TT4 in group I after antibiotic therapy compared to the same group before treatment while there were no significant differences between group I after antibiotic therapy and control group (group II) regarding the same parameters. There was a significant positive correlation between H-s CRP and serum hepcidin and cortisol in group I while there was a significant negative correlation between H-s CRP and free TT3 and free TT4. ROC curve of specificity and sensitivity of H-s CRP, serum hepcidin, cortisol, free TT3 and free TT4 in the prediction of neonatal sepsis shows that serum hepcidin had the highest sensitivity and specificity with 95% and 90% respectively followed by serum cortisol, H-s CRP, free TT3 and lastly free TT4. ; Conclusion and Recommendations: Neonates with high probable sepsis had significantly higher serum cortisol and hepcidin and significantly lower free TT3 and free TT4 compared with healthy neonates. These findings may draw our attention about the use of these markers in the diagnosis of neonatal sepsis which can help in early treatment and subsequently better prognosis.
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Affiliation(s)
- Adel A Hagag
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed S El Frargy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Reham L Yonis
- Department of Physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ghada M Al-Ashmawy
- Department of Biochemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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11
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Abate BB, Kasie AM, Reta MA, Kassaw MW. Neonatal sepsis and its associated factors in East Africa: a systematic review and meta-analysis. Int J Public Health 2020; 65:1623-1633. [PMID: 32997150 DOI: 10.1007/s00038-020-01489-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to reveal the magnitude of neonatal sepsis and its associated factors in East Africa. METHODS Using PRISMA guideline, we reviewed and meta-analyzed studies from Google Scholar, Cochrane library, and PubMed; last search date: October 15, 2019. Heterogeneity across the studies was estimated. The subgroup analysis was done. Publication bias was also assessed. RESULTS A total of 26 studies with 11,239 participants are included. The pooled prevalence of neonatal sepsis in East Africa was 29.765% (95% CI 23.36-35.94). Home delivery (AOR = 2.67; 95% CI 1.15-4.00), maternal history of urinary tract infection (UTI) (AOR = 2.083; 95% CI 0.24-3.93), gestational age/(preterm) (AOR = 1.56; 95% CI 1.04-2.08), prolonged labor (AOR = 3.23; 95% CI 0.04-6.51) and PROM (AOR = 1.95; 95% CI 0.53-3.37) were identified associated factors of neonatal sepsis. CONCLUSIONS The prevalence of neonatal sepsis in East Africa remains high. The relevant stockholders should give attention for neonates delivered from women with intranatal fever to prevent neonatal sepsis. Pregnant women should be screened for UTI. Appropriate interventions should be put in place to manage PROM to decrease the chance of ascending microorganisms.
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Affiliation(s)
- Biruk Beletew Abate
- College of Health Sciences, Department of Nursing, Woldia University, P. O. Box 400, Woldia, Ethiopia.
| | - Ayelign Mengesha Kasie
- College of Health Sciences, Department of Nursing, Woldia University, P. O. Box 400, Woldia, Ethiopia
| | - Melese Abate Reta
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, P. O. Box 400, Woldia, Ethiopia.,Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mesfin Wudu Kassaw
- College of Health Sciences, Department of Nursing, Woldia University, P. O. Box 400, Woldia, Ethiopia
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12
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Cross JH, Prentice AM, Cerami C. Hepcidin, Serum Iron, and Transferrin Saturation in Full-Term and Premature Infants during the First Month of Life: A State-of-the-Art Review of Existing Evidence in Humans. Curr Dev Nutr 2020; 4:nzaa104. [PMID: 32793848 PMCID: PMC7413980 DOI: 10.1093/cdn/nzaa104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
Neonates regulate iron at birth and in early postnatal life. We reviewed literature from PubMed and Ovid Medline containing data on umbilical cord and venous blood concentrations of hepcidin and iron, and transferrin saturation (TSAT), in human neonates from 0 to 1 mo of age. Data from 59 studies were used to create reference ranges for hepcidin, iron, and TSAT for full-term-birth (FTB) neonates over the first month of life. In FTB neonates, venous hepcidin increases 100% over the first month of life (to reach 61.1 ng/mL; 95% CI: 20.1, 102.0 ng/mL) compared with umbilical cord blood (29.7 ng/mL; 95% CI: 21.1, 38.3 ng/mL). Cord blood has a high concentration of serum iron (28.4 μmol/L; 95% CI: 26.0, 31.1 μmol/L) and levels of TSAT (51.7%; 95% CI: 46.5%, 56.9%). After a short-lived immediate postnatal hypoferremia, iron and TSAT rebounded to approximately half the levels in the cord by the end of the first month. There were insufficient data to formulate reference ranges for preterm neonates.
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Affiliation(s)
- James H Cross
- Epidemiology and Population Health, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Banjul, The Gambia
| | - Andrew M Prentice
- Epidemiology and Population Health, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Banjul, The Gambia
| | - Carla Cerami
- Epidemiology and Population Health, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Banjul, The Gambia
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13
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Singh P, Chaudhari V. Association of Early-Onset Sepsis and Vitamin D Deficiency in Term Neonates. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1757-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Hashemi SH, Esna-Ashari F, Nemat Gorgani F, Tayebinia H, Mamani M. Increased serum levels of hepcidin and C-reactive protein in patients with brucellosis. Trans R Soc Trop Med Hyg 2019; 112:509-512. [PMID: 30137576 DOI: 10.1093/trstmh/try092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/11/2018] [Indexed: 12/17/2022] Open
Abstract
Background Increased serum level of C-reactive protein (CRP) as a classic acute phase protein has commonly been reported in acute brucellosis. Hepcidin is also an acute phase protein and has a critical role in host defense. The aim of this study was to compare the level of hepcidin and CRP in patients with brucellosis. Methods All patients with brucellosis referred to Sina Hospital during a 10-month period were included. Serum samples were checked for hepcidin levels in patients and also in the control group. Information on demographic and clinical characteristics was determined through completion of a questionnaire. Results A total of 42 patients with brucellosis and 42 healthy controls were enrolled. The most common symptoms of brucellosis were fever (76%) and arthralgia (69%). The mean serum level of hepcidin in patients (42.6±11.7 pg/mL) was significantly higher than in the controls (17.3±4.2 pg/mL) (p<0.001). The mean serum levels of CRP in patients and controls were 12.6±12.2 and 3.1±2.4 mg/L, respectively (p=0.001). Conclusions Increased serum levels of hepcidin in brucellosis can be considered a diagnostic biomarker of inflammation and active disease. Further studies are needed to identify the role of hepcidin as a host defense mechanism in brucellosis.
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Affiliation(s)
- Seyyed Hamid Hashemi
- Brucellosis Research Center, Department of Infectious Diseases, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzaneh Esna-Ashari
- Department of Community Medicine, Hamadan University of Medical Sciences, Fahmideh Street, Hamadan, Iran
| | - Farnaz Nemat Gorgani
- Brucellosis Research Center, Department of Infectious Diseases, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Heydar Tayebinia
- Brucellosis Research Center, Department of Clinical Biochemistry, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Mojgan Mamani
- Brucellosis Research Center, Department of Infectious Diseases, Hamadan University of Medical Sciences, Hamadan, Iran
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15
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Tabbah SM, Buhimschi CS, Rodewald-Millen K, Pierson CR, Bhandari V, Samuels P, Buhimschi IA. Hepcidin, an Iron Regulatory Hormone of Innate Immunity, is Differentially Expressed in Premature Fetuses with Early-Onset Neonatal Sepsis. Am J Perinatol 2018; 35. [PMID: 29532452 PMCID: PMC7412256 DOI: 10.1055/s-0038-1626711] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Hepcidin, a mediator of innate immunity, binds the iron exporter ferroportin, leading to functional hypoferremia through intracellular iron sequestration. We explored hepcidin-ferroportin interactions in neonates clinically diagnosed with early-onset neonatal sepsis (EONS). STUDY DESIGN Hepcidin and interleukin (IL)-6 were quantified by enzyme-linked immunosorbent assay (ELISA) in 92 paired cord blood-maternal blood samples in the following groups: "Yes" EONS (n = 41, gestational age [GA] 29 ± 1 weeks) and "No" EONS (n = 51, GA 26 ± 1 weeks). Placental hepcidin and ferroportin expression were evaluated by immunohistochemistry and real-time-polymerase chain reaction (RT-PCR). Liver hepcidin and ferroportin expression patterns were ascertained in autopsy specimens of neonates (n = 8) who died secondary to culture-proven sepsis. RESULTS Cord blood hepcidin was significantly elevated (GA corrected, p = 0.018) and was positively correlated with IL-6 (r = 0.379, p = 0.001) in EONS. Hepcidin localized at syncytiotrophoblast and fetal vascular endothelium. Placental ferroportin, but not hepcidin mRNA correlated with cord blood hepcidin levels (r = 0.46, p = 0.039) and funisitis severity (r = 0.50, p = 0.018). Newborns who died from sepsis (n = 4) had higher hepatic hepcidin and iron sequestration, but lower ferroportin staining than those who died of nonsepsis causes (n = 4). CONCLUSION Premature fetuses with EONS have elevated circulating hepcidin, likely related to lower placenta and liver ferroportin expression. Fetal hepcidin-ferroportin interaction appears to play a role in EONS pathophysiology independent of maternal response to intrauterine inflammation.
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Affiliation(s)
- Sammy M. Tabbah
- Department of Obstetrics & Gynecology, The Ohio State
University College of Medicine, Columbus, OH 43210
| | - Catalin S. Buhimschi
- Department of Obstetrics & Gynecology, The Ohio State
University College of Medicine, Columbus, OH 43210
| | - Katherine Rodewald-Millen
- Department of Obstetrics & Gynecology, The Ohio State
University College of Medicine, Columbus, OH 43210
| | - Christopher R. Pierson
- Department of Pathology and Laboratory Medicine, Nationwide
Children’s Hospital, Columbus, OH 43205, Departments of Pathology and
Biomedical Education & Anatomy, The Ohio State University College of Medicine
Columbus, OH 43210
| | - Vineet Bhandari
- Department of Pediatrics, Drexel University College of
Medicine, Philadelphia, PA 19134
| | - Philip Samuels
- Department of Obstetrics & Gynecology, The Ohio State
University College of Medicine, Columbus, OH 43210
| | - Irina A. Buhimschi
- Center for Perinatal Research, The Research Institute at
Nationwide Children’s Hospital, Columbus, OH 43215,Department of Pediatrics, The Ohio State University College
of Medicine, Columbus, OH 43210
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16
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Pathological Role and Diagnostic Value of Endogenous Host Defense Peptides in Adult and Neonatal Sepsis: A Systematic Review. Shock 2018; 47:673-679. [PMID: 27941592 DOI: 10.1097/shk.0000000000000815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sepsis is a systemic host response to an infection leading to organ failure. This is associated with dynamic expression of endogenous host defense peptides. Dysregulation of these peptides is associated with septic morbidity and mortality. METHODS We performed a systematic search of articles indexed in PubMed, ISI Web of Knowledge, EmBase, and Scopus database from inception to October 2016. Both preclinical and clinical studies investigating the role of host defense peptides in pathogenesis and as biomarkers for sepsis were included. RESULTS Of the available literature, cathelicidin, defensin, and hepcidin are among the best-characterized peptides. These regulate immune response, and crosstalk with pyroptosis and coagulation cascades. The applicability of these peptides as septic biomarkers has been investigated in vitro and in vivo studies. However, numerous studies were based on endotoxemia without an infection, jeopardizing interpretation of the outcomes. Cathelicidin and defensin were frequently reported in adult sepsis while hepcidin in neonatal sepsis. The expression level of these peptides is significantly associated with septic condition. Most of the studies employed a cross-sectional design, precluding the establishment of a temporal relationship between candidate peptide biomarkers and sepsis. CONCLUSIONS Innate defense peptides have been insufficiently evaluated as either diagnostic or prognostic biomarkers. In the future, evaluation of host defense peptides as septic biomarkers may employ a longitudinal design and consider a panel of multiple peptides.
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17
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Lu X, Xue L, Sun W, Ye J, Zhu Z, Mei H. Identification of key pathogenic genes of sepsis based on the Gene Expression Omnibus database. Mol Med Rep 2017; 17:3042-3054. [PMID: 29257295 PMCID: PMC5783525 DOI: 10.3892/mmr.2017.8258] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/10/2017] [Indexed: 12/20/2022] Open
Abstract
Sepsis is a life-threatening condition in which an uncontrolled inflammatory host response is triggered. The exact pathogenesis of sepsis remains unclear. The aim of the present study was to identify key genes that may aid in the diagnosis and treatment of sepsis. mRNA expression data from blood samples taken from patients with sepsis and healthy individuals was downloaded from the Gene Expression Omnibus database and differentially expressed genes (DEGs) between the two groups were identified. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and protein-protein interaction (PPI) network construction, was performed to investigate the function of the identified DEGs. Furthermore, for validation of these results, the expression levels of several DEGs were analyzed by reverse transcription quantitative-polymerase chain reaction (RT-qPCR) in three patients with sepsis and three healthy blood samples to support the results obtained from the bioinformatics analysis. Receiver operating characteristic analyses were also used to analyze the diagnostic ability of the identified DEGs for sepsis. The results demonstrated that a total of 4,402 DEGs, including 1,960 upregulated and 2,442 downregulated genes, were identified between patients with sepsis and healthy individuals. KEGG pathway analysis revealed that 39 DEGs were significantly enriched in toll-like receptor signaling pathways. The top 20 upregulated and downregulated DEGs were used to construct the PPI network. Hub genes with high degrees, including interleukin 1 receptor-associated kinase 3 (IRAK3), S100 calcium-binding protein (S100)A8, angiotensin II receptor-associated protein (AGTRAP) and S100A9, were demonstrated to be associated sepsis. Furthermore, RT-qPCR results demonstrated that IRAK3, adrenomedullin (ADM), arachidonate 5-lipoxygenase (ALOX5), matrix metallopeptidase 9 (MMP9) and S100A8 were significantly upregulated, while ectonucleoside triphosphate diphosphohydrolase 1 (ENTPD1) was upregulated but not significantly, in blood samples from patients with sepsis compared with healthy individuals, which was consistent with bioinformatics analysis results. Therefore, AGTRAP, IRAK3, ADM, ALOX5, MMP9, S100A8 and ENTPD1 were identified to have potential diagnostic value in sepsis. In conclusion, dysregulated levels of the AGTRAP, IRAK3, ADM, ALOX5, MMP9, S100A8 and ENTPD1 genes may be involved in sepsis pathophysiology and may be utilized as potential diagnostic biomarkers or therapeutic targets.
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Affiliation(s)
- Xinxing Lu
- Department of Intensive Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Lu Xue
- Department of Intensive Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Wenbin Sun
- Department of Intensive Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Jilu Ye
- Department of Intensive Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Zhiyun Zhu
- Department of Intensive Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Haifeng Mei
- Department of Intensive Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
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18
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Kaiser M, Schroeckenfuchs M, Castellani C, Warncke G, Till H, Singer G. The diagnostic value of hepcidin to predict the presence and severity of appendicitis in children. J Surg Res 2017; 222:102-107. [PMID: 29273360 DOI: 10.1016/j.jss.2017.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/26/2017] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to determine the diagnostic capacity of hepcidin in pediatric acute appendicitis and its accuracy as a predictor of the severity of appendicitis. MATERIALS AND METHODS In children with appendicitis (n = 39), leukocytes, platelet count, and the serum levels of C-reactive protein (CRP) and hepcidin were compared to a control group (n = 25) of patients with unspecific abdominal pain. Additionally, parameters were compared between children with simple (n = 17) and complicated appendicitis (n = 22). Receiver operation characteristic analyses of the different parameters were performed and the areas under the curve (AUCs) calculated. RESULTS Leukocytes and serum hepcidin levels were significantly higher in children with acute appendicitis versus control group (13.7 ± 5.7 versus 9.8 ± 3.9 G/L, P = 0.005 and 31.3 ± 21.7 versus 20.4 ± 14 ng/mL, P = 0.039). AUCs for hepcidin, leukocytes, and CRP were 0.654, 0.711, and 0.619, respectively. Complicated appendicitis was associated with significantly higher hepcidin concentrations compared to simple appendicitis (38.5 ± 17.6 ng/mL versus 21.6 ± 23.4 ng/mL, P < 0.001). A combination of leukocytes, CRP, and hepcidin had the highest AUC (0.914) to predict complicated appendicitis. CONCLUSIONS Increased serum levels of hepcidin were found in children with appendicitis compared to controls. While hepcidin was useful to identify patients with complicated appendicitis as it does not seem appropriate to distinguish between simple appendicitis and other causes for acute abdominal pain.
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Affiliation(s)
- Margarita Kaiser
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | | | - Christoph Castellani
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
| | - Gert Warncke
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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19
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Say B, Uras N, Sahin S, Degirmencioglu H, Oguz SS, Canpolat FE. Effects of cord blood vitamin D levels on the risk of neonatal sepsis in premature infants. KOREAN JOURNAL OF PEDIATRICS 2017; 60:248-253. [PMID: 29042866 PMCID: PMC5638722 DOI: 10.3345/kjp.2017.60.8.248] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/17/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Abstract
Purpose Vitamin D plays a key role in immune function. Vitamin D deficiency may play a role in the pathogenesis of infections, and low levels of circulating vitamin D are strongly associated with infectious diseases. In this study, we aimed to evaluate the effects of low vitamin D levels in cord blood on neonatal sepsis in preterm infants. Methods One hundred seventeen premature infants with gestational age of <37 weeks were enrolled. In the present study, severe vitamin D deficiency (group 1) was defined as a 25-hydroxyvitamin D (25(OH)D) concentration <5 ng/mL; vitamin D insufficiency (group 2), 25(OH)D concentration ≥5 ng/mL and <15 ng/mL; and vitamin D sufficiency (group 3), 25(OH)D concentration ≥15 ng/mL. Results Sixty-three percent of the infants had deficient levels of cord blood vitamin D (group 1), 24% had insufficient levels (group 2), and 13% were found to have sufficient levels (group 3). The rate of neonatal sepsis was higher in group 2 than in groups 1 and 3. Conclusion There was no significant relationship between the cord blood vitamin D levels and the risk of neonatal sepsis in premature infants.
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Affiliation(s)
- Birgul Say
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Nurdan Uras
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Suzan Sahin
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Halil Degirmencioglu
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Serife Suna Oguz
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Fuat Emre Canpolat
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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20
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Gamal TS, Madiha AAS, Hanan MK, Abdel-Azeem MEM, Marian GS. Neonatal and Maternal 25-OH Vitamin D Serum Levels in Neonates with Early-Onset Sepsis. CHILDREN-BASEL 2017; 4:children4050037. [PMID: 28486434 PMCID: PMC5447995 DOI: 10.3390/children4050037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/22/2017] [Accepted: 05/02/2017] [Indexed: 12/14/2022]
Abstract
Vitamin D is a fat-soluble vitamin that is important for calcium metabolism and plays an important role in the immune functions. The aim of this study was to measure neonatal and maternal 25-OH vitamin D serum levels in neonates with early onset sepsis. The study included fifty neonates with early onset sepsis (25 full-term and 25 preterm infants) and thirty age and sex matched healthy neonates as controls. After history taking and clinical examination, complete blood count, C-reactive protein and 25-OH vitamin D serum levels (neonatal and maternal) were measured for all neonates. The mean gestational age for neonates with sepsis was (37.5 ± 0.98 for full term and 34.1 ± 1.26 for preterm neonates). Neonatal and maternal 25-OH vitamin D serum levels were significantly lower in patients (6.4 ± 1.8 and 24.6 ± 2.2 nmol/L) than controls (42.5 ± 20.7 and 50.4 ± 21.4 nmol/L). Significant negative correlations between neonatal and maternal 25-OH vitamin D serum levels and all sepsis markers and significant positive correlations between neonatal and maternal 25-OH vitamin D levels were present. At cut-off values <20 nmol/L for neonatal and <42 nmol/L for maternal 25-OH vitamin D for detection of neonatal sepsis, the sensitivity, specificity, positive predicted value (PPV) and negative predicted value (NPV) were 84%, 79%, 94.7% and 82.3% for neonatal and 82%, 77%, 91.4% and 80.6% for maternal 25-OH vitamin D, respectively. Positive correlations between neonatal and maternal 25-OH Vitamin D serum levels are present and they are negatively correlated with all sepsis markers. They can be sensitive early predictors for early onset sepsis in neonates.
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Affiliation(s)
| | | | | | | | - Gamil S Marian
- Pediatric Department, El-Minya University, Minya, 11432, Egypt.
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21
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Gilfillan M, Bhandari V. Biomarkers for the diagnosis of neonatal sepsis and necrotizing enterocolitis: Clinical practice guidelines. Early Hum Dev 2017; 105:25-33. [PMID: 28131458 DOI: 10.1016/j.earlhumdev.2016.12.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sepsis and necrotizing enterocolitis are major contributors to morbidity and mortality in neonates, especially in those born preterm. While therapeutic interventions are available for both (for e.g. antibiotics), a major dilemma is early diagnosis so that these interventions can be done in a timely manner. As clinical evaluation alone is unreliable in identifying infants in the early stages of neonatal sepsis or necrotizing enterocolitis, there is a need to find specific biomarkers associated with these conditions to improve diagnostic capabilities. Optimal use of biomarkers in the identification and management of affected neonates requires an understanding of the properties of each marker within the timeline of the inflammatory response. We propose that early- and mid-phase markers such as neutrophil CD64 and procalcitonin should be combined with the late-phase biomarker C-reactive protein for maximal diagnostic benefit. Appropriately powered trials evaluating the serial measurements of these markers in decisions related to antibiotic stewardship in the neonatal population are indicated, in addition to more studies investigating other potentially useful biomarkers.
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Affiliation(s)
- Margaret Gilfillan
- Section of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Vineet Bhandari
- Section of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
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22
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Erkilic EE, Erdogan HM, Ogun M, Kirmizigul AH, Gokce E, Kuru M, Kukurt A. Relationship between hepcidin and oxidant/antioxidant status in calves with suspected neonatal septicemia. Vet World 2016; 9:1238-1241. [PMID: 27956775 PMCID: PMC5146304 DOI: 10.14202/vetworld.2016.1238-1241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022] Open
Abstract
AIM This study has been conducted for the purpose of determining serum hepcidin, total antioxidant status (TAS), total oxidant status (TOS), and Fe levels in calves with suspected neonatal septicemia before and after treatment and the clinical significance of hepcidin in calves with suspected neonatal septicemia. MATERIALS AND METHODS The study material consisted of 15 calves of different ages and sexes brought to the Training, Research and Application Center at the Kafkas University Faculty of Veterinary Medicine with suspected neonatal septicemia. 8.5 mL of blood was drawn from the jugular vein of each animal into coagulant tubes before and after treatment for one-off biochemical analyses and centrifuged. After this, the serum was separated. Hepcidin, TAS, TOS, and Fe levels in the serum were measured. RESULTS While pre-treatment hepcidin levels were 58.42±3.46 ng/mL, post-treatment levels were 46.87±2.98 ng/mL (p<0.05). Pre-treatment Fe levels were 60.13±7.27 µg/dl, while post-treatment levels were 83.1±8.09 µg/dl (p<0.05). The changes in the TAS and TOS levels were also found to be statistically significant. CONCLUSION In light of the fact that hepcidin plays a role function in the regulation of Fe as well as the fact that Fe is a significant nutritional source for many microorganisms, it was concluded that hepcidin may play a significant role in nutritional immunity and the pathogenesis of diseases.
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Affiliation(s)
- E. E. Erkilic
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Kafkas, 36100, Kars, Turkey
| | - H. M. Erdogan
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Kafkas, 36100, Kars, Turkey
| | - M. Ogun
- Department of Biochemistry, Faculty of Veterinary Medicine, University of Kafkas, 36100, Kars, Turkey
| | - A. H. Kirmizigul
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Kafkas, 36100, Kars, Turkey
| | - E. Gokce
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Kafkas, 36100, Kars, Turkey
| | - M. Kuru
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, University of Kafkas, 36100, Kars, Turkey
| | - A. Kukurt
- Department of Biochemistry, Faculty of Veterinary Medicine, University of Kafkas, 36100, Kars, Turkey
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Gunes T, Yildirim S, Ozdemir A, Gokahmetoglu S, Korkut S, Ozturk MA, Kurtoglu S. Maternal and cord blood hepcidin levels based on gestational weeks in term and preterm infants. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Dosch NC, Guslits EF, Weber MB, Murray SE, Ha B, Coe CL, Auger AP, Kling PJ. Maternal Obesity Affects Inflammatory and Iron Indices in Umbilical Cord Blood. J Pediatr 2016; 172:20-8. [PMID: 26970931 PMCID: PMC5808508 DOI: 10.1016/j.jpeds.2016.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/23/2015] [Accepted: 02/05/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the impact of maternal obesity and gestational weight gain across pregnancy on fetal indices of inflammation and iron status. STUDY DESIGN Eighty-five healthy term newborns delivered via elective cesarean were categorized by 2 maternal body mass index (BMI) thresholds; above or below 30 kg/m(2) or above or below 35 kg/m(2). Umbilical cord plasma levels of C-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF)-α, ferritin, and hepcidin were assayed. Cytokines released by phytohemagglutinin-stimulated umbilical cord mononuclear cells (MNCs) were assayed. RESULTS Maternal class II obesity, defined as BMI of 35 kg/m(2) and above, predicted higher C-reactive protein and TNF-α in umbilical cord plasma (P < .05 for both), and also proinflammatory cytokines (IL-1β, IL-6, and TNF-α) from stimulated MNC (P < .05 for all). The rise in plasma TNF-α and MNC TNF-α was not linear but occurred when the threshold of BMI 35 kg/m(2) was reached (P < .005, P < .06). Poorer umbilical cord iron indices were associated with maternal obesity. When ferritin was low, IL-6 was higher (P < .04), but this relationship was present primarily when maternal BMI exceeded 35 kg/m(2) (P < .03). Ferritin was correlated with hepcidin (P < .0001), but hepcidin was unrelated to either maternal BMI or inflammatory indices. CONCLUSIONS Class II obesity and above during pregnancy is associated with fetal inflammation in a threshold fashion. Although maternal BMI negatively impacted fetal iron status, hepcidin, related to obesity in adults, was related to iron status and not obesity in fetuses. Pediatricians should be aware of these relationships.
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Affiliation(s)
| | | | - Morgan B. Weber
- Department of Pediatrics, School of Medicine and Public Health
| | | | - Barbara Ha
- Department of Pediatrics, School of Medicine and Public Health
| | - Christopher L. Coe
- Harlow Center for Biological Psychology and,Department of Psychology, University of Wisconsin, Madison, WI
| | | | - Pamela J. Kling
- Department of Pediatrics, School of Medicine and Public Health
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Similarly Lethal Strains of Extraintestinal Pathogenic Escherichia coli Trigger Markedly Diverse Host Responses in a Zebrafish Model of Sepsis. mSphere 2016; 1:mSphere00062-16. [PMID: 27303721 PMCID: PMC4894679 DOI: 10.1128/msphere.00062-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/29/2016] [Indexed: 02/06/2023] Open
Abstract
In individuals with sepsis, the infecting microbes are commonly viewed as generic inducers of inflammation while the host background is considered the primary variable affecting disease progression and outcome. To study the effects of bacterial strain differences on the maladaptive immune responses that are induced during sepsis, we employed a novel zebrafish embryo infection model using extraintestinal pathogenic Escherichia coli (ExPEC) isolates. These genetically diverse pathogens are a leading cause of sepsis and are becoming increasingly dangerous because of the rise of multidrug-resistant strains. Zebrafish infected with ExPEC isolates exhibit many of the pathophysiological features seen in septic human patients, including dysregulated inflammatory responses (cytokine storms), tachycardia, endothelial leakage, and progressive edema. However, only a limited subset of ExPEC isolates can trigger a sepsis-like state and death of the host when introduced into the bloodstream. Mirroring the situation in human patients, antibiotic therapy reduced ExPEC titers and improved host survival rates but was only effective within limited time frames that varied, depending on the infecting pathogen. Intriguingly, we find that phylogenetically distant but similarly lethal ExPEC isolates can stimulate markedly different host transcriptional responses, including disparate levels of inflammatory mediators. These differences correlate with the amounts of bacterial flagellin expression during infection, as well as differential activation of Toll-like receptor 5 by discrete flagellar serotypes. Altogether, this work establishes zebrafish as a relevant model of key aspects of human sepsis and highlights the ability of genetically distinct ExPEC isolates to induce divergent host responses independently of baseline host attributes. IMPORTANCE Sepsis is a life-threatening systemic inflammatory condition that is initiated by the presence of microorganisms in the bloodstream. In the United States, sepsis due to ExPEC and other pathogens kills well over a quarter of a million people each year and is associated with tremendous health care costs. A high degree of heterogeneity in the signs and symptomology of sepsis makes this disease notoriously difficult to effectively diagnose and manage. Here, using a zebrafish model of sepsis, we find that similarly lethal but genetically distinct ExPEC isolates can elicit notably disparate host responses. These variances are in part due to differences in the levels and types of flagellin that are expressed by the infecting ExPEC strains. A better understanding of the variable impact that bacterial factors like flagellin have on host responses during sepsis could lead to improved diagnostic and therapeutic approaches to these often deadly infections. Podcast: A podcast concerning this article is available.
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Inflammation and Inflammatory Diseases, Markers, and Mediators: Role of CRP in Some Inflammatory Diseases. BIOLOGY OF C REACTIVE PROTEIN IN HEALTH AND DISEASE 2016. [PMCID: PMC7122703 DOI: 10.1007/978-81-322-2680-2_4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Delanghe JR, Speeckaert MM. Translational research and biomarkers in neonatal sepsis. Clin Chim Acta 2015; 451:46-64. [DOI: 10.1016/j.cca.2015.01.031] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/24/2015] [Accepted: 01/24/2015] [Indexed: 01/22/2023]
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Cizmeci MN, Kanburoglu MK, Akelma AZ, Ayyildiz A, Kutukoglu I, Malli DD, Tatli MM. Cord-blood 25-hydroxyvitamin D levels and risk of early-onset neonatal sepsis: a case-control study from a tertiary care center in Turkey. Eur J Pediatr 2015; 174:809-15. [PMID: 25504199 DOI: 10.1007/s00431-014-2469-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 12/14/2022]
Abstract
UNLABELLED Vitamin D has been linked with immunity, and the immunomodulatory role of this molecule in regulating key elements of the immune system has become an area of intense scientific investigation. We designed a case-control study to investigate whether neonates with early-onset neonatal sepsis (EONS) had lower levels of vitamin D. The primary exposure for the analysis in the study was the cord-blood level of 25-hydroxyvitamin D (25(OH)D). Of the 2571 live births occurring during the 18-month study period, 53 infants were admitted to the neonatal intensive care unit with suspected EONS. After clinical and laboratory confirmation, 40 newborns with EONS and 43 controls were analyzed. Cord-blood 25(OH)D levels of infants in the study group were significantly lower than that of the control group (median 12.6 ng/mL (3.1-78.9) vs. 21 (5-118); p = 0.038, respectively). In multivariate models, a low cord-blood 25(OH)D level (<30 ng/ml) was associated with an increased risk of EONS (OR = 5.6; 95% CI = 1.3-23.5). CONCLUSION Cord-blood 25(OH)D levels of neonates with EONS were significantly lower than that of the healthy controls, and a low level of cord-blood vitamin D was found to be associated with an increased risk of EONS. Further studies are warranted to confirm this association.
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Affiliation(s)
- Mehmet Nevzat Cizmeci
- Division of Neonatology, Department of Pediatrics, Fatih University Medical School, Alparslan Turkes Cd., Emek, 06510, Ankara, Turkey,
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Kali A, Charles MVP, Seetharam RSK. Hepcidin - A novel biomarker with changing trends. Pharmacogn Rev 2015; 9:35-40. [PMID: 26009691 PMCID: PMC4441160 DOI: 10.4103/0973-7847.156333] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 05/23/2014] [Accepted: 05/05/2015] [Indexed: 12/11/2022] Open
Abstract
Hepcidin is a novel peptide hormone of hepatic origin. It has a crucial role in iron metabolism. The causative association of this peptide in anemia and iron overloading states has been well established. Current research has expanded the diagnostic implications of hepcidin in other medical conditions. Increased serum hepcidin has been reported in neoplastic diseases, inflammation, and sepsis. However, the clinical use of hepcidin as a biomarker is limited owing to nonavailability of an appropriate diagnostic test. Assays for serum and urine hepcidin estimation have been developed recently, which are likely to facilitate the use of hepcidin in research as well as in patient care in the near future.
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Affiliation(s)
- Arunava Kali
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
| | - Marie Victor Pravin Charles
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
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Kleber A, Kubulus D, Rössler D, Wolf B, Volk T, Speer T, Fink T. Melatonin modifies cellular stress in the liver of septic mice by reducing reactive oxygen species and increasing the unfolded protein response. Exp Mol Pathol 2014; 97:565-71. [DOI: 10.1016/j.yexmp.2014.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/28/2014] [Indexed: 01/10/2023]
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Aydin I, Agilli M, Nuri Aydin F. Cord blood and serum hepcidin levels in neonatal sepsis: A biochemical evaluation. Med Hypotheses 2014; 83:633. [DOI: 10.1016/j.mehy.2014.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/14/2014] [Indexed: 12/01/2022]
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