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Davies HG, Thorley EV, Al-Bahadili R, Sutton N, Burt J, Hookham L, Karampatsas K, Lambach P, Muñoz F, Cutland CL, Omer S, Le Doare K. Defining and reporting adverse events of special interest in comparative maternal vaccine studies: a systematic review. Vaccine X 2024; 18:100464. [PMID: 38495929 PMCID: PMC10943481 DOI: 10.1016/j.jvacx.2024.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction The GAIA (Global Alignment on Immunisation Safety Assessment in Pregnancy) consortium was established in 2014 with the aim of creating a standardised, globally coordinated approach to monitoring the safety of vaccines administered in pregnancy. The consortium developed twenty-six standardised definitions for classifying obstetric and infant adverse events. This systematic review sought to evaluate the current state of adverse event reporting in maternal vaccine trials following the publication of the case definitions by GAIA, and the extent to which these case definitions have been adopted in maternal vaccine safety research. Methods A comprehensive search of published literature was undertaken to identify maternal vaccine research studies. PubMed, EMBASE, Web of Science, and Cochrane were searched using a combination of MeSH terms and keyword searches to identify observational or interventional studies that examined vaccine safety in pregnant women with a comparator group. A two-reviewer screening process was undertaken, and a narrative synthesis of the results presented. Results 14,737 titles were identified from database searches, 435 titles were selected as potentially relevant, 256 were excluded, the remaining 116 papers were included. Influenza vaccine was the most studied (25.0%), followed by TDaP (20.7%) and SARS-CoV-2 (12.9%).Ninety-one studies (78.4%) were conducted in high-income settings. Forty-eight (41.4%) utilised electronic health-records. The majority focused on reporting adverse events of special interest (AESI) in pregnancy (65.0%) alone or in addition to reactogenicity (27.6%). The most frequently reported AESI were preterm birth, small for gestational age and hypertensive disorders. Fewer than 10 studies reported use of GAIA definitions. Gestational age assessment was poorly described; of 39 studies reporting stillbirths 30.8% provided no description of the gestational age threshold. Conclusions Low-income settings remain under-represented in comparative maternal vaccine safety research. There has been poor uptake of GAIA case definitions. A lack of harmonisation and standardisation persists limiting comparability of the generated safety data.
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Affiliation(s)
- Hannah G Davies
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
- MRC, UVRI & LSHTM Uganda Research Centre, Entebbe, Uganda
- Makerere University John Hopkins Research Unit, Kampala, Uganda
| | - Emma V Thorley
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Rossul Al-Bahadili
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Natalina Sutton
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Jessica Burt
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Lauren Hookham
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Kostas Karampatsas
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | | | - Flor Muñoz
- Paediatric Infectious Diseases Department, Baylor College of Medicine, Houston, TX, USA
| | - Clare L Cutland
- Wits African Leadership in Vaccinology Expertise (Wits-Alive), School of Pathology, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Saad Omer
- O’Donnell School of Public Health, UT Southwestern Medical Center, Texas, USA
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
- Makerere University John Hopkins Research Unit, Kampala, Uganda
- World Health Organization, Geneva, Switzerland
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Mazuel M, Moulier V, Bourrel AS, Guillier C, Tazi A, Jarreau PH, Chollat C. Systematic culture of central catheters and infections related to catheters in a neonatal intensive care unit: an observational study. Sci Rep 2024; 14:8647. [PMID: 38622221 PMCID: PMC11018835 DOI: 10.1038/s41598-024-59371-2] [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: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
Systematic culture of the tip of central lines is performed in many neonatal intensive care units (NICUs) to guide any subsequent antibiotic therapy. The clinical relevance of this procedure is debated, given the significant bacterial contamination during its removal. We aimed to describe infections related to catheters and assess the usefulness of central catheter systematic cultures for probabilistic antibiotic therapy in cases of suspicion of catheter-related infections in a NICU. A retrospective study in a NICU included all newborn patients hospitalized with a central catheter, between January 2018, and June 2019. The main outcome measures were bacterial catheter colonization, catheter-related infection rate, and simulation-based approach to antibiotic prescription. Three hundred and seventy-five newborns, with 634 central catheters were included. There were 273 (43%) catheters that were colonized by at least one microorganism. There were 183 cases of suspected sepsis, with 31 infections definitively related to the catheter. In our simulation antibiotic prescription approach, there was no significant difference in terms of the efficacy toward the microorganism(s) involved between the probabilistic antibiotic therapies proposed by the experts and those ultimately prescribed. Performing a catheter culture only if catheter-related infection is suspected could be an alternative to routine screening.
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Affiliation(s)
- Marie Mazuel
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, Paris, France
| | - Virginie Moulier
- University Department of Psychiatry, Centre d'Excellence Thérapeutique, Institut de Psychiatrie, Centre hospitalier du Rouvray, Sotteville-lès-Rouen, France
- Unité de Recherche Clinique, Etablissement Publique de Santé de Ville Evrard, 93332, Neuilly-sur-Marne, France
| | - Anne-Sophie Bourrel
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Cyril Guillier
- Paediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Armand Trousseau University Hospital, Sorbonne Université, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpital Cochin, APHP centre - Université Paris Cité, Paris, France
| | - Clément Chollat
- Department of Neonatal Paediatrics, APHP, Service de Néonatologie, Sorbonne Université, Hôpital Armand Trousseau, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, INSERM, NeuroDiderot, 75019, Paris, France.
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Thomas R, Ondongo-Ezhet C, Motsoaledi N, Sharland M, Clements M, Velaphi S. Incidence, pathogens and antimicrobial resistance of blood and cerebrospinal fluid isolates from a tertiary neonatal unit in South Africa: A 10 year retrospective review. PLoS One 2024; 19:e0297371. [PMID: 38241304 PMCID: PMC10798535 DOI: 10.1371/journal.pone.0297371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE To determine trends in incidence, etiology and antimicrobial susceptibility of blood and cerebrospinal fluid (CSF) culture confirmed infections in hospitalized infants in a large tertiary neonatal unit in South Africa. METHODS Single-center, retrospective review of laboratory records of bacteria and fungi, and their susceptibility profiles, isolated from blood and CSF of infants hospitalized in the neonatal unit at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, from 1st January 2010 to 31st December 2019. Laboratory data on isolates and their antimicrobial susceptibilities were collected. Coagulase-negative Staphylococcus, Corynebacteria and Bacillus spp. were excluded. Patient-level clinical and laboratory data were not available. RESULTS There were 8,319 significant isolates, giving an infection rate of 14.3/1000 patient-days. Infection rates increased from 12.0 to 15.7/1000 patient-days (estimated average yearly change 0.6[95%CI, 0.5-0.7];p = <0.001). Gram-negative infection rates increased from 4.3 to 10.8/1000 patient-days (estimated average yearly change 0.7[95%CI,0.6-0.8];p = <0.001). The 2 most commonly isolated Gram-negative organisms were Acinetobacter baumannii (44%) and Klebsiella pneumoniae (39%). Carbapenem resistance was seen in 31% of all Gram-negatives and increased over time (estimated average yearly change 4.8%[95%CI,4.2%-5.3%];p<0.001). Gram-positive infection rates decreased (estimated average yearly change -0.1[95%CI,-0.2- -0.05];p = <0.001). Staphylococcus aureus was the most common Gram-positive isolated. Rates of methicillin-resistant Staphylococcus aureus decreased from 91% to 55%(estimated average yearly change -2.8%[95%CI,-3.5%-2%],p< 0.001). Rates of fungal isolates decreased (estimated average yearly change -0.06[95%CI,-0.1 --0.02]);p = 0.007). Candida parapsilosis (52%) and Candida albicans (35%) were the most common fungi isolated. CONCLUSIONS There has been a marked overall increase in rates of blood and/or CSF infections, with an absolute increase in Gram-negative infections observed, replacing Gram-positive and fungal pathogens. Extended spectrum beta-lactamase Gram-negative isolates are being replaced by carbapenem resistance, with around one third of all significant Gram-negative isolates now carbapenem resistant. Research into hospital based novel treatment and prevention interventions for neonatal sepsis should be urgently prioritized.
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Affiliation(s)
- Reenu Thomas
- Faculty of Health Sciences, Department of Paediatrics, Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Claude Ondongo-Ezhet
- Faculty of Health Sciences, Department of Paediatrics, Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nini Motsoaledi
- Faculty of Health Sciences, Department of Paediatrics, Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Mike Sharland
- St. Georges, University of London, London, United Kingdom
| | | | - Sithembiso Velaphi
- Faculty of Health Sciences, Department of Paediatrics, Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Thomas R, Bijlsma MW, Gonçalves BP, Nakwa FL, Velaphi S, Heath PT. Long-term impact of serious neonatal bacterial infections on neurodevelopment. Clin Microbiol Infect 2024; 30:28-37. [PMID: 37084940 DOI: 10.1016/j.cmi.2023.04.017] [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: 11/29/2022] [Revised: 03/27/2023] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Neonatal bacterial infections have long been recognized as an important cause of acute morbidity and mortality, but long-term neurodevelopmental consequences have not been comprehensively described and discussed. OBJECTIVES We aimed to summarize evidence on the pathogenesis, diagnosis, and epidemiology of long-term sequelae after neonatal bacterial sepsis and meningitis. We also discuss approaches for future studies to quantify the public health impact of neonatal infection-associated neurodevelopmental impairment. SOURCES We identified studies, both research articles and reviews, which provide mechanistic information on the long-term disease, as well as epidemiological studies that describe the frequency of neurodevelopmental impairment in children with and, for comparison, without a history of neonatal bacterial infection. Tools currently used in clinical practice and research settings to assess neurodevelopmental impairment were also reviewed. CONTENT We first enumerate potential direct and indirect mechanisms that can lead to brain injury following neonatal infections. We then discuss summary data, either frequencies or measures of association, from epidemiological studies. Risk factors that predict long-term outcomes are also described. Finally, we describe clinical approaches for identifying children with neurodevelopmental impairment and provide an overview of common diagnostic tools. IMPLICATIONS The limited number of studies that describe the long-term consequences of neonatal infections, often undertaken in high-income settings and using variable designs and diagnostic tools, are not sufficient to inform clinical practice and policy prioritization. Multi-country studies with follow-up into adolescence, standardized diagnostic approaches, and local comparator groups are needed, especially in low and middle-income countries where the incidence of neonatal sepsis is high.
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Affiliation(s)
- Reenu Thomas
- Department of Pediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Pediatrics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Firdose L Nakwa
- Department of Pediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Pediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection, St George's, University of London, London, UK
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Davies HG, Bowman C, Watson G, Dodd C, Jones CE, Munoz FM, Heath PT, Cutland CL, Le Doare K. Standardizing case definitions for monitoring the safety of maternal vaccines globally: GAIA definitions, a review of progress to date. Int J Gynaecol Obstet 2023; 162:29-38. [PMID: 37194339 DOI: 10.1002/ijgo.14843] [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: 08/17/2022] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
In 2014, the Global Alignment on Immunization safety Assessment in pregnancy consortium (GAIA) was formed, with the goal of developing a harmonized, globally-concerted approach to actively monitor the safety of vaccines in pregnancy. A total of 26 standardized definitions for the classification of adverse events have been developed. The aim of this review was to identify and describe studies undertaken to assess the performance of these definitions. A literature search was undertaken to identify published studies assessing the performance of the definitions, and reference lists were snowballed. Data were abstracted by two investigators and a narrative review of the results is presented. Four studies that have evaluated 13 GAIA case definitions (50%) were identified. Five case definitions have been assessed in high-income settings only. Recommendations have been made by the investigators to improve the performance of the definitions. These include ensuring consistency across definitions, removal of the potential for ambiguity or variations in interpretation and ensuring that higher-level criteria are acceptable at lower levels of confidence. Future research should prioritize the key case definitions that have not been assessed in low- and middle-income settings, as well as the 13 that have not undergone any validation.
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Affiliation(s)
- Hannah G Davies
- Centre for Paediatric and Neonatal Infection, Institute of Infection & Immunity, St George's, University of London, London, UK
- Makerere University Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Conor Bowman
- Department of Microbiology, University College London Hospital, London, UK
| | - Gabriella Watson
- Department of Paediatric Infectious Diseases and Immunology, University Hospital Southampton, Southampton, UK
| | - Caitlin Dodd
- Julius Global Health, Universitair Medisch Centrum, Utrecht, the Netherlands
| | - Christine E Jones
- Department of Paediatric Infectious Diseases and Immunology, University Hospital Southampton, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Flor M Munoz
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Paul T Heath
- Centre for Paediatric and Neonatal Infection, Institute of Infection & Immunity, St George's, University of London, London, UK
| | - Clare L Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kirsty Le Doare
- Centre for Paediatric and Neonatal Infection, Institute of Infection & Immunity, St George's, University of London, London, UK
- Makerere University Johns Hopkins University Research Collaboration, Kampala, Uganda
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Ou-Yang MC, Tsai MH, Chu SM, Chen CC, Yang PH, Huang HR, Chang CM, Fu RH, Hsu JF. The Clinical Characteristics, Microbiology and Risk Factors for Adverse Outcomes in Neonates with Gram-Negative Bacillary Meningitis. Antibiotics (Basel) 2023; 12:1131. [PMID: 37508227 PMCID: PMC10376587 DOI: 10.3390/antibiotics12071131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Background: We aimed to describe the clinical features of Gram-negative bacillary (GNB) meningitis in neonates and investigate the risk factors associated with final adverse outcomes of neonatal GNB meningitis. Methods: From 2003 to 2020, all neonates (aged ≤ 90 days old) with bacterial meningitis who were hospitalized in four tertiary-level neonatal intensive care units (NICUs) of two medical centers in Taiwan were enrolled. Neonates with GNB meningitis were compared with those with Streptococcus agalactiae (group B streptococcus, GBS) meningitis. Results: During the study period, a total of 153 neonates with bacterial meningitis were identified and enrolled. GNB and GBS accounted for 40.5% (n = 62) and 35.3% (n = 54) of all neonatal bacterial meningitis, respectively. In neonates with GNB meningitis, the final mortality rate was 6.5% (4 neonates died); 48 (77.4%) had neurological complications, and 26 (44.8%) of 58 survivors had neurological sequelae at discharge. Although the final outcomes were comparable between neonates with GNB meningitis and those with GBS meningitis, neonates with GNB meningitis were more likely to have more severe clinical manifestations initially and have ventriculomegaly at follow-up. After multivariate logistic regression analysis, neonates with seizure at onset, early onset sepsis, and requirement of surgical intervention for neurological complications were independently associated with final adverse outcomes. Conclusions: GNB meningitis was associated with a high risk of neurological complications and sequelae, although it did not significantly increase the final mortality rate. Close monitoring of the occurrence of neurological complications and advanced therapeutic strategies to optimize the outcomes are urgently needed in the future.
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Affiliation(s)
- Mei-Chen Ou-Yang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 63812, Taiwan
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chih-Chen Chen
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Peng-Hong Yang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 33382, Taiwan
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ching-Min Chang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 33382, Taiwan
| | - Ren-Huei Fu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Comparison of adverse pregnancy and birth outcomes using archival medical records before and during the first wave of the COVID-19 pandemic in Kinshasa, Democratic Republic of Congo: a facility-based, retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:31. [PMID: 36647021 PMCID: PMC9841139 DOI: 10.1186/s12884-022-05291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/07/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Little research has been conducted on the impact of the coronavirus disease 2019 (COVID-19) pandemic on either birth outcomes or the ability of archival medical records to accurately capture these outcomes. Our study objective is thus to compare the prevalence of preterm birth, stillbirth, low birth weight (LBW), small for gestational age (SGA), congenital microcephaly, and neonatal bloodstream infection (NBSI) before and during the first wave of the COVID-19 pandemic in Kinshasa, Democratic Republic of Congo (DRC). METHODS We conducted a facility-based retrospective cohort study in which identified cases of birth outcomes were tabulated at initial screening and subcategorized according to level of diagnostic certainty using Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) definitions. Documentation of any birth complications, delivery type, and maternal vaccination history were also evaluated. The prevalence of each birth outcome was compared in the pre-COVID-19 (i.e., July 2019 to February 2020) and intra-COVID-19 (i.e., March to August 2020) periods via two-sample z-test for equality of proportions. RESULTS In total, 14,300 birth records were abstracted. Adverse birth outcomes were identified among 22.0% and 14.3% of pregnancies in the pre-COVID-19 and intra-COVID-19 periods, respectively. For stillbirth, LBW, SGA, microcephaly, and NBSI, prevalence estimates were similar across study periods. However, the prevalence of preterm birth in the intra-COVID-19 period was significantly lower than that reported during the pre-COVID-19 period (8.6% vs. 11.5%, p < 0.0001). Furthermore, the level of diagnostic certainty declined slightly across all outcomes investigated from the pre-COVID-19 to the intra-COVID-19 period. Nonetheless, diagnostic certainty was especially low for certain outcomes (i.e., stillbirth and NBSI) regardless of period; still, other outcomes, such as preterm birth and LBW, had moderate to high levels of diagnostic certainty. Results were mostly consistent when the analysis was focused on the facilities designated for COVID-19 care. CONCLUSION This study succeeded in providing prevalence estimates for key adverse birth outcomes using GAIA criteria during the COVID-19 pandemic in Kinshasa, DRC. Furthermore, our study adds crucial real-world data to the literature surrounding the impact of the COVID-19 pandemic on maternal and neonatal services and outcomes in Africa.
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Golchi S, Willard JJ, Pullenayegum E, Bassani DG, Pell LG, Thorlund K, Roth DE. A Bayesian adaptive design for clinical trials of rare efficacy outcomes with multiple definitions. Clin Trials 2022; 19:613-622. [PMID: 36408565 DOI: 10.1177/17407745221118366] [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: 01/31/2023]
Abstract
INTRODUCTION Bayesian adaptive designs for clinical trials have gained popularity in the recent years due to the flexibility and efficiency that they offer. We consider the scenario where the outcome of interest comprises events with relatively low risk of occurrence and different case definitions resulting in varying control group risk assumptions. This is a scenario that occurs frequently for infectious diseases in global health research. METHODS We propose a Bayesian adaptive design that incorporates different case definitions of the outcome of interest that vary in stringency. A set of stopping rules are proposed where superiority and futility may be concluded with respect to different outcome definitions and therefore maintain a realistic probability of stopping in trials with low event rates. Through a simulation study, a variety of stopping rules and design configurations are compared. RESULTS The simulation results are provided in an interactive web application that allows the user to explore and compare the design operating characteristics for a variety of assumptions and design parameters with respect to different outcome definitions. The results for select simulation scenarios are provided in the article. DISCUSSION Bayesian adaptive designs offer the potential for maximizing the information learned from the data collected through clinical trials. The proposed design enables monitoring and utilizing multiple composite outcomes based on rare events to optimize the trial design operating characteristics.
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Affiliation(s)
- Shirin Golchi
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - James J Willard
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Diego G Bassani
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Lisa G Pell
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Kristian Thorlund
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Daniel E Roth
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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9
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Wright N, Francis L, Bonney D, Wang Z, Francis J. Epidemiology of early and late-onset neonatal sepsis in an Australian regional special care nursery with a high proportion of Aboriginal and Torres Strait Islander births. J Paediatr Child Health 2022; 58:1594-1600. [PMID: 35657077 DOI: 10.1111/jpc.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Abstract
AIM To describe the incidence and aetiology of early and late-onset neonatal sepsis and compare rates in Aboriginal and Torres Strait Islander infants against non-Indigenous infants in the Top End of the Northern Territory. METHODS This was a retrospective case series of infants with positive blood or cerebrospinal fluid cultures at Royal Darwin Hospital between 2012 and 2016. Cultures from infants during initial hospital admission up to 120 days of age were included for analysis. Demographic, clinical, laboratory and treatment data were collected from medical records. Published definitions of sepsis and criteria for organism pathogenicity and were used to determine cases of sepsis. RESULTS There were 52 episodes of sepsis in 45 infants. There were eight cases of early onset sepsis, with an incidence of 0.51 per 1000 live births. The incidence was similar for Aboriginal and non-Indigenous infants. The case fatality rate was 25%. Late-onset sepsis occurred in 44 cases, comprising 1.3% of all infants admitted to the special care nursery. Coagulase-negative Staphylococcus was the most frequently cultured organism. Case fatality rate was 11%. Aboriginal and Torres Strait Islander infants had a five-time higher risk of late-onset sepsis compared with non-Indigenous infants; however, their increased risk was not independent of other sepsis risk factors of low rates and prematurity. CONCLUSIONS The incidence of culture-confirmed early and late-onset sepsis was low, but case fatality was high. Bacteraemia is an important contributor to neonatal and infant mortality in our setting.
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Affiliation(s)
- Natalie Wright
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Laura Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Dennis Bonney
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Zhiqiang Wang
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Davies H, Afrika S, Olema R, Rukundo G, Ouma J, Greenland M, Voysey M, Mboizi R, Sekikubo M, Le Doare K. Protocol for a pregnancy registry of maternal and infant outcomes in Uganda –The PREPARE Study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17809.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Pregnancy is associated with complications which must be differentiated from adverse events associated with the administration of vaccines during pregnancy both in clinical trials and post licensure surveillance. The frequency of pregnancy related complications varies significantly by geographical location and the prevalence of pregnancy and neonatal outcomes are poorly documented in most low-resource settings. In preparation for Group B Streptococcus maternal vaccination trials, we describe a protocol for a pregnancy register at Kawempe National Referral Hospital, Kampala, Uganda to describe pregnancy maternal and infant outcomes. Methods: The study has two components. Firstly, an active, prospective surveillance cohort consisting of pregnant women in their first or second trimester recruited and followed up through their hospital scheduled antenatal visits, delivery and their infants through their extended programme of immunisation visits until 14 weeks of age. Data on obstetric and neonatal outcomes defined by the Brighton Collaboration Global Alliance of Immunisation Safety Assessment in Pregnancy criteria will be collected. Secondly, a passive surveillance cohort collecting data through routine electronic health records on all women and infants attending care at KNRH. Data will be collected on vaccinations and medications including antiretroviral therapy received in antenatal clinic and prior to hospital discharge. Discussion: Conducting vaccine research in resource-limited settings is essential for equity and to answer priority safety questions specific to these settings. It requires improved vaccine safety monitoring, which is especially pertinent in maternal vaccine research. During a trial, understanding the epidemiology and background rates of adverse events in the study population is essential to establish thresholds which indicate a safety signal. These data need to be systematically and reliably collected. This study will describe rates of adverse pregnancy outcomes in a cohort of 4,000 women and infants and any associated medications or vaccines received at a new vaccine trial site in Uganda.
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Dierikx TH, van Kaam AHLC, de Meij TGJ, de Vries R, Onland W, Visser DH. Umbilical cord blood culture in neonatal early-onset sepsis: a systematic review and meta-analysis. Pediatr Res 2022; 92:362-372. [PMID: 34711944 DOI: 10.1038/s41390-021-01792-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/16/2021] [Accepted: 10/05/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peripheral blood culture (PBC) is considered the gold standard for diagnosis of neonatal early-onset sepsis (EOS), but its diagnostic value can be questioned. We aimed to systematically asses the diagnostic test accuracy (DTA) of umbilical cord blood culture (UCBC) for EOS. METHODS A systematic literature search was performed in PubMed, Embase, Web of Science, and the Cochrane Library. Studies performing UCBC for the diagnosis of EOS were included. RESULTS A total of 1908 articles were screened of which 17 were included. Incidences of positive PBC and UCBC were low in all studies. There was a large heterogeneity in the consistency between positive PBC and UCBC outcomes. PBC had a pooled sensitivity of 20.4% (95% CI 0.0-40.9) and specificity of 100.0% (95% CI 100.0-100.0) compared to 42.6% (95% CI 12.7-72.4%) and 97.8% (95% CI 93.1-100.0) of UCBC for clinical EOS, defined as clinical sepsis regardless of PBC outcomes. CONCLUSIONS This systematic review shows that, compared to PBC, UCBC has higher sensitivity and comparable specificity for clinical EOS and might be considered as diagnostic test for EOS. Due to the limited number of studies, low incidences of EOS cases, and the imperfect reference standards for EOS, results should be interpreted cautiously. IMPACT This is the first systematic review and meta-analysis investigating the diagnostic test accuracy of umbilical cord blood culture for neonatal early-onset sepsis. Peripheral blood culture is considered the gold standard for diagnosis of neonatal early-onset sepsis, but its value for this specific diagnosis can be questioned. Umbilical cord blood culture has higher sensitivity and comparable specificity for diagnosis of neonatal early-onset sepsis compared to peripheral blood culture, circumventing the risk for iatrogenic anemia and consequently might be used as a diagnostic tool for early-onset sepsis. Quality of evidence was regarded as low due to imperfect diagnostic methods of neonatal early-onset sepsis.
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Affiliation(s)
- Thomas H Dierikx
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Neonatal Intensive Care Unit, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Anton H L C van Kaam
- Neonatal Intensive Care Unit, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tim G J de Meij
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Wes Onland
- Neonatal Intensive Care Unit, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Douwe H Visser
- Neonatal Intensive Care Unit, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Sharan A, Stuurman AL, Jahagirdar S, Elango V, Riera-Montes M, Kashyap NK, Biccler J, Poluru R, Arora NK, Mathai M, Mangtani P, Devlieger H, Anderson S, Whitaker B, Wong HL, Moran A, Maure CG. Estimating baseline rates of adverse perinatal and neonatal outcomes using a facility-based surveillance approach: A prospective observational study from the WHO Global Vaccine Safety Multi-Country Collaboration on safety in pregnancy. EClinicalMedicine 2022; 50:101506. [PMID: 35770255 PMCID: PMC9234094 DOI: 10.1016/j.eclinm.2022.101506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Most perinatal and neonatal deaths occur in low- and middle-income countries (LMICs), yet, quality data on burden of adverse outcomes of pregnancy is limited in such countries. METHODS A network of 21 maternity units, across seven countries, undertook surveillance for low birthweight, preterm birth, small for gestational age (SGA), stillbirths, congenital microcephaly, in-hospital neonatal deaths, and neonatal infections in a cohort of over 85,000 births from May 2019 - August 2020. For each outcome, site-specific rates per 1,000 livebirths (or per 1,000 total births for stillbirth) and 95% confidence intervals (CI) were calculated. Descriptive sensitivity analysis was conducted to gain insight regarding underreporting of four outcomes at 16 sites. FINDINGS Estimated rates varied across countries and sites, ranging between 43·3-329·5 and 21·4-276·6/1000 livebirths for low birthweight and preterm birth respectively and 11·8-81/1,000 livebirths for SGA. No cases of congenital microcephaly were reported by three sites while the highest estimated rate was 13/1,000 livebirths. Neonatal infection and neonatal death rates varied between 1·8-73 and 0-59·9/1000 livebirths respectively while stillbirth rates ranged between 0-57·1/1000 total births across study sites. Results from the sensitivity analysis confirmed the underreporting of congenital microcephaly and SGA in our study. INTERPRETATION Our study establishes site-specific baseline rates for important adverse perinatal and neonatal outcomes and addresses a critical evidence gap towards improved monitoring of benefits and risks of emerging pregnancy and neonatal interventions. FUNDING The study was sponsored by the World Health Organization with funding from the Bill and Melinda Gates Foundation.
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Affiliation(s)
- Apoorva Sharan
- The INCLEN Trust International, New Delhi, India
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | | | - Jorne Biccler
- P95 Pharmacovigilance and Epidemiology, Leuven, Belgium
| | | | | | - Mathews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Steven Anderson
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Barbee Whitaker
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Hui-Lee Wong
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Allisyn Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Christine Guillard Maure
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
- Corresponding author at: World Health Organization (WHO), Avenue Appia 20, 1202 Geneva, Switzerland.
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Elfarargy MS, Al-Ashmawy G, Abu-Risha S, Khattab H. Zinc Supplementation in Preterm Neonates with Late-Onset Sepsis: Is It Beneficial? Am J Perinatol 2022; 39:1097-1103. [PMID: 33285602 DOI: 10.1055/s-0040-1721659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Neonatal sepsis (NS) is a serious neonatal disease. The aim of this study was to detect the role of zinc (Zn) supplementation in preterm neonates with late-onset sepsis (LOS). STUDY DESIGN A prospective randomized clinical trial study which was done at Tanta University Hospital from August 2016 to March 2018 on 180 preterm neonates with LOS. The studied neonates were divided into two groups: group 1 (90 neonates), which received Zn and antibiotics, and group 2 (90 neonates), which received antibiotics and placebo. In group 1, the neonates received 1.4 mg elemental Zn/kg/d orally for 10 days. Sepsis score, C-reactive protein (CRP), and procalcitonin (PCT) were done for both groups. RESULTS As regards sepsis score, it showed that before beginning the treatment, there were 85 and 84 neonates who had high probable sepsis (HPS) in intervention and control groups, respectively, and this revealed nonstatistically significant difference (non-SSD) between both groups (p-value is 0.756) and after 10 days of treatment, there were 1 and 4 neonates who had HPS in intervention and control group, respectively, and this revealed SSD between both groups (p-value is 0.045*). As regards CRP and PCT, the results showed that before beginning the treatment, the mean ± standard deviation (SD) of CRP and PCT were 39.4 ± 10.1 mg/L and 5.2 + 1.8 ng/mL, respectively, in intervention group, while it was 39.6 + 9.9 mg/L and 5.1 + 1.9 ng/mL, respectively, in control group and this revealed non-SSD between both groups (p-value is 0.893 and 0.717, respectively) and after 10 days of treatment, the mean ± SD of CRP and PCT were 5.3 ± 1.8 mg/L and 0.39 ± 0.13 ng/mL, respectively, in intervention group and 6.1 + 2 mg/L and 0.61 + 0.22 ng/mL, respectively, in control group and this revealed SSD between both groups (p-value is 0.008* and 0.044*, respectively). CONCLUSION Zn supplementation in preterm neonates with LOS is beneficial in improving the clinical and laboratory finding. RECOMMENDATION Zn supplementation for preterm neonates with LOS. KEY POINTS · NS is a serious neonatal disease.. · Preterm neonates are more liable to infections.. · Zn supplementation in preterm neonates with LOS is beneficial in improving the condition..
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Gadoth A, Mukadi Nkamba D, Arena PJ, Hoff NA, Dzogang C, Kampilu D, Beya M, Wong HL, Anderson SA, Kaba D, Rimoin AW. Assessing the feasibility of passive surveillance for maternal immunization safety utilizing archival medical records in Kinshasa, Democratic Republic of the Congo. Vaccine 2022; 40:3605-3613. [PMID: 35570074 DOI: 10.1016/j.vaccine.2022.04.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Since the establishment of the Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) case definitions in 2015, there has been an urgent need for field validation of pharmacovigilance feasibility in low- and middle-income countries. In this study, we assess the availability and quality of archival medical records at ten randomly selected high-traffic maternity wards in Kinshasa province, Democratic Republic of Congo (DRC). METHODS A retrospective cohort of mother-child pairs was established from all recorded births taking place at study sites between July 1, 2019 to February 28, 2020 through digitization of medical records. Adverse birth outcomes and maternal vaccination status, where available and linkable, were defined according to GAIA. Basic demographic information on mothers and newborns was also tabulated; birth outcomes were assessed for both intra-site prevalence and a pooled prevalence. RESULTS A total of 7,697 mother-newborn pair records were extracted, with 37% of infants screening positive as cases of adverse outcomes. Maternal vaccination information was linkable to 67% of those cases. In total, 51% of stillbirths, 98% of preterm births, 100% of low birthweight infants, 90% of small for gestational age infants, 100% of microcephalic infants, and 0% of neonatal bloodstream infections were classifiable according to GAIA standards following initial screening. Forty percent of case mothers had some indication of tetanus vaccination prior to delivery in their medical records, but only 26% of case mothers met some level of GAIA definition for maternal vaccination during the pregnancy of interest. CONCLUSIONS Archival birth records from delivery centers can be feasibly utilized to screen for stillbirth and maternal tetanus vaccination, and to accurately classify preterm birth, low birthweight, small for gestational age, and congenital microcephaly. Assessment of other neonatal outcomes were limited by inconsistent postpartum infant follow-up and records keeping.
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Affiliation(s)
- Adva Gadoth
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Dalau Mukadi Nkamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Patrick J Arena
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Camille Dzogang
- UCLA-DRC Health Research and Training Program, Kinshasa, Democratic Republic of Congo
| | - David Kampilu
- UCLA-DRC Health Research and Training Program, Kinshasa, Democratic Republic of Congo
| | - Michael Beya
- UCLA-DRC Health Research and Training Program, Kinshasa, Democratic Republic of Congo
| | - Hui-Lee Wong
- Office of Biostatistics and Epidemiology, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Steven A Anderson
- Office of Biostatistics and Epidemiology, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Didine Kaba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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Meiring S, Mashau R, Magobo R, Perovic O, Quan V, Cohen C, de Gouveia L, von Gottberg A, Mackay C, Mailula MT, Phayane R, Dramowski A, Govender NP. Study protocol for a population-based observational surveillance study of culture-confirmed neonatal bloodstream infections and meningitis in South Africa: Baby GERMS-SA. BMJ Open 2022; 12:e049070. [PMID: 35135762 PMCID: PMC8830263 DOI: 10.1136/bmjopen-2021-049070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Worldwide, neonatal mortality remains high accounting for 47% of childhood deaths in 2019 and including an estimated 500 000 deaths from neonatal infections. While 42% of global neonatal deaths occur in sub-Saharan Africa, there is limited understanding of population-level burden and aetiology of neonatal infections outside tertiary-level institutions. METHODS AND ANALYSIS We aim to implement the first population-level surveillance for bloodstream infections and meningitis among neonates aged <28 days in South Africa. Tier 1 will include national surveillance of culture-confirmed neonatal infections at all public-sector hospitals describing infection incidence risk, pathogen profile and antimicrobial susceptibility by institution, province and healthcare level (2014-2021). Tier 2 (nested within tier 1) will be conducted at six regional neonatal units over 12 months, will compare the clinical characteristics of neonates with early-onset and late-onset infections and identify potentially modifiable risk factors for mortality. Through tier 2, we will determine the antimicrobial susceptibility of neonatal pathogens, evaluate the appropriateness of empiric antibiotic prescribing and determine the genomic epidemiology of multidrug resistant bacterial and fungal pathogens. ETHICS AND DISSEMINATION Ethics clearance was obtained from the Human Research Ethics Committee of the University of the Witwatersrand (M190320). Funding for the study was obtained through a grant from the Bill and Melinda Gates Foundation (OPP1208882). Baby GERMS-SA aims to impact on national policy, resource allocation and neonatal guidelines by describing the national burden of neonatal infections in South Africa. In addition, end-users in neonatal units will benefit from a facility-level dashboard displaying key indicators of the surveillance findings.
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Affiliation(s)
- Susan Meiring
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Rudzani Mashau
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Rindidzani Magobo
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Olga Perovic
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Vanessa Quan
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Linda de Gouveia
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Cheryl Mackay
- Department of Paediatrics and Child Health, Dora Nginza Hospital, Port Elizabeth, South Africa
| | - Mphekwa Thomas Mailula
- Department of Paediatrics and Child Health, Mankweng Regional Hospital Mankweng, Mankweng, South Africa
| | - Rose Phayane
- Department of Paediatrics and Child Health, Tembisa Provincial Hospital, Johannesburg, South Africa
| | - Angela Dramowski
- Department of Paediactrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nelesh P Govender
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
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Thomas R, Ondongo-Ezhet C, Motsoaledi N, Sharland M, Clements M, Velaphi S. Incidence and All-Cause Mortality Rates in Neonates Infected With Carbapenem Resistant Organisms. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.832011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IntroductionMultidrug-resistant, Gram-negative infections, particularly due to carbapenem resistant organisms (CRO), have increased globally. Few studies have reported on the burden of CRO in neonates from low-middle income countries (LMIC). This study aimed to determine the incidence and mortality rates of culture-confirmed Gram-negative infections, with a special focus on CRO in a neonatal unit from a LMIC.Materials and MethodsPositive bacterial cultures from sterile sites of infants admitted in the neonatal unit from the 1st January 2018 to 31st December 2019, were reviewed retrospectively. Type of organism, susceptibility and outcomes were recorded. Data on Gram-negative isolates, including the CRO, were extracted. Rates and outcomes were analysed.ResultsThere were 2219 neonates with organisms isolated from sterile sites (blood and cerebrospinal fluid), accounting for 30% of all admissions, giving a neonatal sepsis incidence of 17.9/1000 patient-days. There was a total of 1746 positive isolates (excluding coagulase negative Staphyloccocus). Of these, 1706 (98%) were isolated from blood, and 40 (2%) from cerebrospinal fluid. Overall, 1188 (68%) were Gram-negative, 371 (21%) Gram-positive and 187 (10.7%) fungal isolates. The common Gram-negatives were Acinetobacter baumannii (526/1188;44%) and Klebsiella pneumoniae (469/1188;40%). Carbapenem resistance was observed in 359 (68%) of the Acinetobacter baumannii (CRAB) and in 103 (18%) of the Enterobacterales (CRE) isolates, with 98% of CRE being Klebsiella pneumoniae (CR-Klebs). Twenty-four (41%) of Pseudomonas species were carbapenem resistant. Overall, carbapenem resistance was seen in 42% of all Gram-negative organisms. The rate of CRAB and CRE were 2.9 and 0.8/1000 patient-days respectively. The overall, all-cause in-hospital mortality rate in infants with Gram-negative isolates was 22%, with higher mortality rate in those infected with CRO compared to non-CRO (34% vs 13%; OR 3.44; 95% CI 2.58–4.60; p < 0.001). The mortality rate in infants with CRE was higher than those with CRAB (48% vs 33%; OR 1.85; 95% CI 1.18–2.89; p = 0.007).ConclusionWe observed a high incidence of positive cultures from sterile sites. The common organisms isolated were Gram-negatives, and among these carbapenem resistance was high and was associated with high mortality. Mortality was higher in infants with CRE compared to those with CRAB.
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Lozar Krivec J, Lozar Manfreda K, Paro-Panjan D. Clinical Factors Influencing Endogenous Carbon Monoxide Production and Carboxyhemoglobin Levels in Neonates. J Pediatr Hematol Oncol 2022; 44:e84-e90. [PMID: 33735151 DOI: 10.1097/mph.0000000000002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Abstract
Carboxyhemoglobin (COHb) is an index of endogenous carbon monoxide formation during the hem degradation process and could be used to confirm hemolysis in neonates. The influence of other clinical factors on COHb values in neonates has not been fully investigated. We aimed to evaluate the influence of hemolysis, sepsis, respiratory distress, and postnatal age on COHb values. We retrospectively analyzed COHb measurements determined with a carbon monoxide-oximeter in 4 groups of term neonates: A-sepsis, B-respiratory distress, C-hemolysis, and D-healthy neonates. The mean COHb values were 1.41% (SD: 0.26), 1.32% (SD: 0.27), 2.5% (SD: 0.69), and 1.27% (SD: 0.19) (P<0.001) in groups A (n=8), B (n=37), C (n=16), and D (n=76), respectively. COHb in group C was significantly higher than in the other groups. There was a negative correlation between postnatal age and COHb in healthy neonates. A cut-off level of 1.7% had 93% (95% confidence interval [CI]: 89%-97%) sensitivity and 94% (95% CI: 90%-98%) specificity for diagnosis of hemolysis. COHb values were higher during the first days of life. We found that COHb levels in neonates with hemolysis were significantly higher and that the influence of sepsis and respiratory distress on COHb values was insignificant.
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Affiliation(s)
- Jana Lozar Krivec
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Faculty of Medicine
| | | | - Darja Paro-Panjan
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Faculty of Medicine
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Stuurman AL, Sharan A, Jahagirdar S, Elango V, Riera-Montes M, Kashyap N, Biccler J, Poluru R, Arora N, Mathai M, Mangtani P, DeVlieger H, Anderson S, Whitaker B, Wong HL, Cutland C, Guillard Maure C. WHO global vaccine safety multi-country collaboration project on safety in pregnancy: Assessing the level of diagnostic certainty using standardized case definitions for perinatal and neonatal outcomes and maternal immunization. Vaccine X 2021; 9:100123. [PMID: 34825164 PMCID: PMC8605263 DOI: 10.1016/j.jvacx.2021.100123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/31/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Standardized case definitions strengthen post-marketing safety surveillance of new vaccines by improving generated data, interpretation and comparability across surveillance systems. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project developed standardized case definitions for 21 key obstetric and neonatal terms following the Brighton Collaboration (BC) methodology. In this prospective cohort study, we assessed the applicability of GAIA definitions for maternal immunization exposure and for low birth weight (LBW), preterm birth, small for gestational age (SGA), stillbirth, neonatal death, neonatal infection, and congenital microcephaly. We identified the missing data elements that prevented identified cases and exposures from meeting the case definition (level 1-3 of BC diagnostic certainty). Over a one-year period (2019-2020), all births occurring in 21 sites (mostly secondary and tertiary hospitals) in 6 Low Middle Income Countries and 1 High Income Country were recorded and the 7 perinatal and neonatal outcome cases were identified from routine medical records. Up to 100 cases per outcome were recruited sequentially from each site. Most cases recruited for LBW, preterm birth and neonatal death met the GAIA case definitions. Birth weight, a key parameter for all three outcomes, was routinely recorded at all sites. The definitions for SGA, stillbirth, neonatal infection (particularly meningitis and respiratory infection) and congenital microcephaly were found to be less applicable. The main barrier to obtaining higher levels of diagnostic certainty was the lack of sonographic documentation of gestational age in first or second trimester. The definition for maternal immunization exposure was applicable, however, the highest level of diagnostic certainty was only reached at two sites. Improved documentation of maternal immunization will be important for vaccine safety studies. Following the field-testing of these 8 GAIA definitions, several improvements are suggested that may lead to their easier implementation, increased standardization and hence comparison across studies.
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Affiliation(s)
| | - Apoorva Sharan
- INCLEN Trust International, New Delhi, India
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | - Jorne Biccler
- P95 Pharmacovigilance and Epidemiology, Leuven, Belgium
| | | | | | - Matthews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, London School of Tropical Medicine, London, UK
| | | | - Steven Anderson
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Barbee Whitaker
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Hui-Lee Wong
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Clare Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christine Guillard Maure
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Fatmi A, Chabni N, Cernada M, Vento M, González-López M, Aribi M, Pallardó FV, García-Giménez JL. Clinical and immunological aspects of microRNAs in neonatal sepsis. Biomed Pharmacother 2021; 145:112444. [PMID: 34808550 DOI: 10.1016/j.biopha.2021.112444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022] Open
Abstract
Neonatal sepsis constitutes a highly relevant public health challenge and is the most common cause of infant morbidity and mortality worldwide. Recent studies have demonstrated that during infection epigenetic changes may occur leading to reprogramming of gene expression. Post-transcriptional regulation by short non-coding RNAs (e.g., microRNAs) have recently acquired special relevance because of their role in the regulation of the pathophysiology of sepsis and their potential clinical use as biomarkers. ~22-nucleotide of microRNAs are not only involved in regulating multiple relevant cellular and molecular functions, such as immune cell function and inflammatory response, but have also been proposed as good candidates as biomarkers in sepsis. Nevertheless, establishing clinical practice guidelines based on microRNA patterns as biomarkers for diagnosis and prognosis in neonatal sepsis has yet to be achieved. Given their differential expression across tissues in neonates, the release of specific microRNAs to blood and their expression pattern can differ compared to sepsis in adult patients. Further in-depth research is necessary to fully understand the biological relevance of microRNAs and assess their potential use in clinical settings. This review provides a general overview of microRNAs, their structure, function and biogenesis before exploring their potential clinical interest as diagnostic and prognostic biomarkers of neonatal sepsis. An important part of the review is focused on immune and inflammatory aspects of selected microRNAs that may become biomarkers for clinical use and therapeutic intervention.
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Affiliation(s)
- Ahlam Fatmi
- Laboratory of Applied Molecular Biology and Immunology, University of Tlemcen, W0414100, 13000 Tlemcen, Algeria
| | - Nafissa Chabni
- Faculty of Medicine, Tlemcen Medical Centre University, 13000 Tlemcen, Algeria
| | - María Cernada
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain; Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Máximo Vento
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain; Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - María González-López
- Department of Pediatrics. Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mourad Aribi
- Laboratory of Applied Molecular Biology and Immunology, University of Tlemcen, W0414100, 13000 Tlemcen, Algeria; Biotechnology Center of Constantine (CRBt), 25000 Constantine, Algeria
| | - Federico V Pallardó
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Valencia, Spain; INCLIVA Health Research Institute, Mixed Unit for Rare Diseases INCLIVA-CIPF, Valencia, Spain; Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José Luis García-Giménez
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Valencia, Spain; INCLIVA Health Research Institute, Mixed Unit for Rare Diseases INCLIVA-CIPF, Valencia, Spain; Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain.
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Crestani S, Passini E, Spaggiari V, Toffoli C, Boncompagni A, Bedetti L, Spaggiari E, Lucaccioni L, Lugli L, Roversi F, Rossi K, Iughetti L, Berardi A. Lo shock settico nei primi tre mesi di vita. MEDICO E BAMBINO 2021; 40:567-575. [DOI: 10.53126/meb40567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Shock is a generalized tissue hypoperfusion that leads to severe cellular distress and complicates some cases of paediatric and neonatal sepsis. Although a reduction in associated sepsis mortality has been observed in the last decades, it remains one of the most important causes of death or long-term neurodevelopmental disabilities in children. Prompt recognition of this condition is therefore essential to improve survival and long-term outcome. The paediatrician and the neonatologist must therefore be able to promptly recognize the signs and symptoms of sepsis and septic shock to set up an adequate treatment according to the most recent international guidelines. This article provides epidemiological data from Italian and international studies, describes the pathophysiology and clinical manifestations of sepsis and septic shock, as well as the therapeutic indications according to very recent recommendations.
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Affiliation(s)
- Sara Crestani
- Scuola di Specializzazione in Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Erica Passini
- Scuola di Specializzazione in Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - valentina Spaggiari
- Scuola di Specializzazione in Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Carlotta Toffoli
- Scuola di Specializzazione in Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | | | - Luca Bedetti
- Terapia Intensiva Neonatale, AOU Policlinico di Modena
| | | | | | - Licia Lugli
- Terapia Intensiva Neonatale, AOU Policlinico di Modena
| | | | - Katia Rossi
- Terapia Intensiva Neonatale, AOU Policlinico di Modena
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Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes. Microorganisms 2021; 9:microorganisms9102094. [PMID: 34683413 PMCID: PMC8540989 DOI: 10.3390/microorganisms9102094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/13/2021] [Accepted: 10/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Streptococcus agalactiae (also known as group B streptococcus, GBS) is associated with high mortality and morbidity rates in infants, especially those with complicated GBS sepsis, defined as those with meningitis, severe sepsis and/or septic shock. We aimed to characterize the clinical and molecular characteristics and risk factors for adverse outcomes of neonates with invasive GBS diseases. Methods: From 2003 to 2020, all neonates with invasive GBS diseases who were hospitalized in a tertiary-level neonatal intensive care unit (NICU) were enrolled. The GBS isolates underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. We compared cases of complicated GBS sepsis with uncomplicated GBS bacteremia. Results: During the study period, a total of 188 neonates (aged less than 6 months old) with invasive GBS diseases were identified and enrolled. Among them, 119 (63.3%) had uncomplicated GBS bacteremia and 69 (36.7%) neonates had complicated GBS sepsis, including meningitis (25.5%, n = 48) and severe sepsis or septic shock. Among neonates with complicated GBS sepsis, 45 (65.2%) had neurological complications, and 21 (42.0%) of 50 survivors had neurological sequelae at discharge. The overall final mortality rate was 10.1% (19 neonates died). Type III/ST-17 GBS isolates accounted for 56.5% of all complicated GBS sepsis and 68.8% of all GBS meningitis, but this strain was not significantly associated with worse outcomes. The antimicrobial resistance rate among the invasive GBS isolates was obviously increasing in the past two decades. After multivariate logistic regression analysis, neonates with thrombocytopenia and respiratory failure were independently associated with final adverse outcomes. Conclusions: a total of 36.7% of all neonatal invasive GBS diseases were associated with complicated sepsis with/without meningitis. Given the high mortality and morbidity rates in neonates with complicated GBS sepsis, further studies for early identification of specific strains, risk factors or genetic mechanisms that will cause complicated GBS sepsis are urgently needed in the future.
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Preterm birth and severe morbidity in hospitalized neonates who are HIV exposed and uninfected compared with HIV unexposed. AIDS 2021; 35:921-931. [PMID: 33821822 PMCID: PMC8076534 DOI: 10.1097/qad.0000000000002856] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Infants who are HIV exposed but uninfected (HEU) compared with HIV unexposed uninfected (HUU) have an increased risk of adverse birth outcomes, morbidity and hospitalization. In the era of universal maternal antiretroviral treatment, there are few insights into patterns of neonatal morbidity specifically. DESIGN A prospective cohort study. METHODS We compared neonatal hospitalizations among infants who were HEU (n = 463) vs. HUU (n = 466) born between 2017 and 2019 to a cohort of pregnant women from a large antenatal clinic in South Africa. We examined maternal and infant factors associated with hospitalization using logistic regression. RESULTS Hospitalization rates were similar between neonates who were HEU and HUU (13 vs. 16%; P = 0.25). Overall, most hospitalizations occurred directly after birth (87%); infection-related causes were identified in 34%. The most common reason for hospitalization unrelated to infection was respiratory distress (25%). Very preterm birth (<32 weeks) (29 vs. 11%; P = 0.01) as well as very low birthweight (<1500 g) (34 vs. 16%; P = 0.02) occurred more frequently among hospitalized neonates who were HEU. Of those hospitalized, risk of intensive care unit (ICU) admission was higher in neonates who were HEU (53%) than HUU (27%) [risk ratio = 2.1; 95% confidence interval (95% CI) 1.3-3.3]. Adjusted for very preterm birth, the risk of ICU admission remained higher among neonates who were HEU (aRR = 1.8; 95% CI 1.1-2.9). CONCLUSION Neonates who were HEU (vs. HUU) did not have increased all-cause or infection-related hospitalization. However, very preterm birth, very low birthweight and ICU admission were more likely in hospitalized neonates who were HEU, indicating increased severity of neonatal morbidity.
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Ebrahimi ME, Romijn M, Vliegenthart RJS, Visser DH, van Kaam AH, Onland W. The association between clinical and biochemical characteristics of late-onset sepsis and bronchopulmonary dysplasia in preterm infants. Eur J Pediatr 2021; 180:2147-2154. [PMID: 33629121 PMCID: PMC7904512 DOI: 10.1007/s00431-021-03981-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
Studies in preterm infants have shown an association between late-onset sepsis (LOS) and the development of bronchopulmonary dysplasia (BPD). It is unknown whether clinical or biochemical characteristics during sepsis modulate the risk for BPD. This single-center retrospective cohort study included all patients with a gestational age < 30 weeks, born between 2009 and 2015, in whom empiric antimicrobial treatment was initiated > 72 h after birth and continued for at least 5 days, independent on microbiological results. The association between clinical and biochemical characteristics of LOS and the development of BPD in survivors were assessed with multivariate logistic regression analysis adjusted for early-onset sepsis, small for gestational age, and gestational age. Of the 756 admitted infants, 256 infants (mean GA: 27.0 weeks; birthweight: 924 grams) had at least one LOS episode, of whom 79 (30.9%) developed BPD. Analyses showed that only the need for and duration of mechanical ventilation during LOS were independently associated with an increased risk for BPD (adjusted OR 2.62, 95% CI 1.38, 4.96, p value 0.003, and OR 1.004, 95% CI 1.00, 1.007, p value 0.045, respectively).Conclusion: During a LOS, the need for and duration of mechanical ventilation are independently associated with the risk of developing BPD in preterm infants. What is Known: • Premature infants diagnosed with a late-onset sepsis are at higher risk of developing bronchopulmonary dysplasia • This association is mainly shown in infants with a positive blood culture What is New: • This study investigates the clinical and biochemical characteristics of late-onset sepsis and the development of bronchopulmonary dysplasia • The need for mechanical ventilation and duration of mechanical ventilation during late-onset sepsis are associated with an increased risk of developing bronchopulmonary dysplasia.
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Affiliation(s)
- Melania E. Ebrahimi
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michelle Romijn
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Roos J. S. Vliegenthart
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Douwe H. Visser
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anton H. van Kaam
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Comparison of Very Low Birth Weight Preterm Infants with And Without Experienced Target Weight Gain on The Administration of Human Milk Fortifier. JOURNAL OF BIOMEDICINE AND TRANSLATIONAL RESEARCH 2020. [DOI: 10.14710/jbtr.v6i3.9061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Human milk fortifier (HMF) is defined as a supplement added to breastmilk to increase calories, proteins, vitamins, and various nutrition of breastmilk. The purpose of HMF administration is to increase the concentration of breastmilk nutrients to improve the weight of very low birth weight preterm infants. The administration of HMF is insufficient to fulfill protein needs in 20-40% very low birth weight babies, thus the weight gain did not meet the expected target.Objective: To analyze characteristic differences between very low birth weight preterm infants who experienced weight gain according to the target and not according to the target on the administration of HMF.Methods: An analytical study with a case-control approach comparing case and control group, which was observed to determine characteristic differences between both groups. The samples were 52 very low birth weight preterm infants obtained by consecutive sampling. Data analysis includes descriptive analysis and hypothesis testing. Results: Data were obtained from medical records and consisted of 52 participants, including 26 very low birth weight premature infants who experienced weight gain according to the target and 26 who experienced weight gain not according to the target. There was no characteristic difference of cyanosis clinical symptoms (OR 2.3; 95% CI 0.51-10.4), chest retraction (OR 1.0; 95% CI 0.32-3.1), apnea of prematurity comorbid (OR 1.0; 95% CI 0.25-3.9), neonatal infections (OR 0.62; 95% CI 0.21-1.9), starting age of HMF administration (OR 0.62; 95% CI 0.21-1.89), bloating (OR 0.57; 95% CI 0.17-1.9), and vomiting (OR 1.18; 95% CI 0.38-3.7) in both groups.Conclusion: There was no characteristic difference between very low birth weight preterm infants who experienced weight gain according to the target and not according to the target on the administration of HMF.
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Jansen SJ, Lopriore E, Berkhout RJM, van der Hoeven A, Saccoccia B, de Boer JM, Veldkamp KE, van der Beek MT, Bekker V. The Effect of Single-Room Care Versus Open-Bay Care on the Incidence of Bacterial Nosocomial Infections in Pre-Term Neonates: A Retrospective Cohort Study. Infect Dis Ther 2020; 10:1-14. [PMID: 33362985 PMCID: PMC7756131 DOI: 10.1007/s40121-020-00380-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/28/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Nosocomial infections (NIs) are a major source of iatrogenic harm in neonatal intensive care units (NICUs). The influence of the infrastructure of NICUs on NIs is not well documented. This study aims to examine the effect of single-room units (SRU) versus open-bay units (OBU) on the incidence of NIs, including central-line-associated bloodstream infections (CLABSI), in preterm neonates. METHODS All preterm neonates (< 32 weeks gestational age) admitted to our NICU were included. Two study periods were compared: one prior to (May 2015-May 2017) and one following (May 2017-May 2019) transition from OBU to SRU. Incidence density (number of infections per 1000 patient-days) and cumulative incidence (number of infections per 100 neonates) for NIs were calculated. CLABSIs were calculated per 1000 central-line days. U chart analysis was performed to determine special-cause variation in quarterly CLABSI and NI rates. Multivariate competing risk regression was performed to identify independent NI risk factors. RESULTS Of the 712 included infants, 164 (23%) infants acquired ≥ 1 NIs. No differences were found in incidence density (13.68 vs. 12.62, p = 0.62) or cumulative incidence of NI (23.97 vs. 22.02, p = 0.59) between OBU and SRU. CLABSIs showed a similar non-significant reduction after the move (14.00 vs. 10.59, p = 0.51). U chart analysis did not identify unit transition as a potential source of special-cause variation for CLABSI and NI. Competing risks regression analysis revealed longer duration of invasive mechanical ventilation as a significant risk factor for NI (subhazards ratio: 1.03 per day on ventilation, p = 0.01). CONCLUSION Single-rooms are not associated with a significant reduction in NIs in the NICU. This study therefore does not add evidence that could support the transition to SRUs if based only on a large multimodal infection control strategy. Recommendations to build SRUs would require a wider justification, also taking into account other SRU benefits. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40121-020-00380-9.
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Affiliation(s)
- Sophie J. Jansen
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children’s Hospital—Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children’s Hospital—Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Romy J. M. Berkhout
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children’s Hospital—Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Alieke van der Hoeven
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Barbara Saccoccia
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children’s Hospital—Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Jonne M. de Boer
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children’s Hospital—Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Karin E. Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Martha T. van der Beek
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children’s Hospital—Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Li YX, Long DL, Liu J, Qiu D, Wang J, Cheng X, Yang X, Li RM, Wang G. Gestational diabetes mellitus in women increased the risk of neonatal infection via inflammation and autophagy in the placenta. Medicine (Baltimore) 2020; 99:e22152. [PMID: 33019392 PMCID: PMC7535644 DOI: 10.1097/md.0000000000022152] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) produces numerous problems for maternal and fetal outcomes. However, the precise molecular mechanisms of GDM are not clear. METHODS In our study, we randomly assigned 22 pregnant women with fasting glucose concentrations, 1 hour oral glucose tolerance test (1H-OGTT) and 2 hour oral glucose tolerance test (2H-OGTT), different than 28 normal pregnant women from a sample of 107 pregnant women at the First Affiliated Hospital of Jinan University in China. Lipopolysaccharide (LPS), interleukin 1 alpha (IL-1α), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF-α) were measured from blood plasma of pregnant women and umbilical arteries using ultraviolet spectrophotometry. Hematoxylin & Eosin (H&E), Periodic acid-Schiff (PAS) or Masson staining were performed to examine whether diabetes mellitus altered the morphology of placenta. Quantitative PCR (Q-PCR), western blotting and immunofluorescent staining were performed to examine whether diabetes mellitus and autophagy altered the gene expressions of the placental tissue. RESULTS We found that women with GDM exhibited increased placental weight and risk of neonatal infection. The concentrations of IL-6 protein and IL-8 protein in GDM were increased in both maternal and umbilical arterial blood. H&E, Masson and PAS staining results showed an increased number of placental villi and glycogen deposition in patients with GDM, but no placental sclerosis was found. Q-PCR results suggested that the expression levels of HIF-1α and the toll like receptor 4 (TLR4)/ myeloid differential protein-88 (MyD88)/ nuclear factor kappa-B (NF-κB) pathway were increased in the GDM placenta. Through Western Blotting, we found that the expression of NF-kappa-B inhibitor alpha (IKBα) and Nuclear factor-κB p65 (NF-κB p65) in GDM placenta was significantly enhanced. We also showed that the key autophagy-related genes, autophagy-related 7 (ATG7) and microtubule-associated protein 1A/1B-light chain 3 (LC3), were increased in GDM compared with normal pregnant women. CONCLUSIONS Our results suggest that women with GDM exhibit an increased risk of neonatal infection via inflammation and autophagy in the placenta.
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Affiliation(s)
- Yi-xiao Li
- The First Affiliate Hospital of Jinan University
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, Medical College
| | - Deng-lu Long
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, Medical College
| | - Jia Liu
- The First Affiliate Hospital of Jinan University
| | - Di Qiu
- The First Affiliate Hospital of Jinan University
| | - Jingyun Wang
- The First Affiliate Hospital of Jinan University
| | - Xin Cheng
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, Medical College
- Key Laboratory for Regenerative Medicine of the Ministry of Education, Jinan University, Guangzhou, China
| | - Xuesong Yang
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, Medical College
- Key Laboratory for Regenerative Medicine of the Ministry of Education, Jinan University, Guangzhou, China
| | - Rui-man Li
- The First Affiliate Hospital of Jinan University
| | - Guang Wang
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, Medical College
- Key Laboratory for Regenerative Medicine of the Ministry of Education, Jinan University, Guangzhou, China
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Neurodevelopmental Impairment at 1 Year of Age in Infants With Previous Invasive Group B Streptococcal Sepsis and Meningitis. Pediatr Infect Dis J 2020; 39:794-798. [PMID: 32804460 DOI: 10.1097/inf.0000000000002695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Invasive group B streptococcal (GBS) disease causes considerable morbidity and mortality in young infants, and 18% of GBS-meningitis survivors have moderate-to-severe neurodevelopmental impairment. However, there is a paucity of data regarding neurologic impairment following GBS sepsis. METHODS A case-control study was undertaken in infants at 3 secondary-tertiary hospitals in Johannesburg, South Africa. Neurodevelopmental assessments were done at 1 year of age using the Denver II Developmental screening tool. A case was defined as isolation of GBS from blood or cerebrospinal fluid in infants less than 90 days of age. Three healthy controls (range: 1-6) were matched to maternal age, maternal HIV-infection status, gestational age and timing of enrollment. RESULTS Of 122 invasive GBS cases, 78 (63.9%) had sepsis and 44 (36.1%) meningitis. Twenty-two (18%) invasive GBS cases (17 of 78; 21.8% with sepsis and 5 of 44; 11.4% with meningitis) died during the course of hospitalization, and a further 2 (1.6%; 1 sepsis and 1 meningitis case) died by 1 year of age. Five (1.1%) of 449 controls died by 1 year of age. Of the 45 GBS sepsis cases and 141 matched controls followed through to 1 year of age, 11 (24.4%) cases (3 with moderate-to-severe impairment) and 10 (7.1%) controls had an abnormal Denver score with an adjusted (for gender) odds ratio of 3.51; 95% confidence interval (CI): 1.23-10.04; P = 0.019. Four (20%) of the 20 GBS meningitis cases compared with 1 (1.5%) control had neurologic impairment at 1-year of age (aOR: 8.29; 95% CI: 0.88-78.3; P = 0.065) CONCLUSION:: In this setting, invasive GBS disease is associated with a high mortality. Infant survivors of invasive GBS sepsis compared with controls had 3.5-fold greater odds of neurologic impairment by 1 year of age. This corroborates the need for strategies to prevent invasive GBS disease.
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Masanja PP, Kibusi SM, Mkhoi ML. Predictors of Early Onset Neonatal Sepsis among Neonates in Dodoma, Tanzania: A Case Control Study. J Trop Pediatr 2020; 66:257-266. [PMID: 31539064 DOI: 10.1093/tropej/fmz062] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the predictors of early onset neonatal sepsis (EONS) among neonates in Dodoma Tanzania. METHODS A hospital-based case-control study of randomly selected 105 cases and 217 controls in three hospitals in Dodoma region. Cases were neonates diagnosed with neonatal sepsis. Controls were matched to the cases by mother's age and parity at a ratio of 1 case to 2 controls. A semi-structured questionnaire was used to collect data on the potential mother, neonate and interventional predictors of EONS. Both descriptive and inferential statistical analysis were employed to test for independent association. RESULTS Most (92.5%) of neonates were born at term (≥37 weeks) and 84% had normal birth weight of ≥3 kg. After adjusting for confounders, the maternal factors which showed significant association with EONS were maternal history of chorioamnionitis [adjusted odds ratios (AOR) = 1.910, p = 0.042, 95% confidence interval (CI): 1.0223.56], HIV status (AOR = 2.909, p = 0.012, 95% CI: 1.020-8.296), prolonged rupture of membrane (AOR = 2.857, p = 0.014, 95% CI: 1.233-6.619) and multiple digital vaginal examinations during labor (AOR = 5.178, p = 0.026, 95% CI: 1.220-21.986). The neonatal history of perinatal asphyxia was observed to have a significant association with EONS (AOR = 6.781, p = 0.006, 95% CI: 1.725-26.652). CONCLUSION Both maternal and neonatal predictors had significant contribution to EONS. Results shed light on critical factors for consideration to prevent this disease and poor outcomes.
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Affiliation(s)
- Pendo P Masanja
- Department of Clinical Nursing and Midwifery, College of Health Sciences, University of Dodoma, PO Box 359, Dodoma, Tanzania
| | - Stephen M Kibusi
- Department of Clinical Nursing and Midwifery, College of Health Sciences, University of Dodoma, PO Box 359, Dodoma, Tanzania
| | - Mkhoi L Mkhoi
- Department of Clinical Medicine, College of Health Sciences, University of Dodoma, PO Box 395, Dodoma, Tanzania
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Seale AC, Baker CJ, Berkley JA, Madhi SA, Ordi J, Saha SK, Schrag SJ, Sobanjo-Ter Meulen A, Vekemans J. Vaccines for maternal immunization against Group B Streptococcus disease: WHO perspectives on case ascertainment and case definitions. Vaccine 2019; 37:4877-4885. [PMID: 31303524 PMCID: PMC6677922 DOI: 10.1016/j.vaccine.2019.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/18/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023]
Abstract
Group B Streptococcus (GBS) is an important cause of disease in young infants, stillbirths, pregnant and post-partum women. GBS vaccines for maternal immunization are in development aiming to reduce this burden. Standardisation of case definitions and ascertainment methodologies for GBS disease is needed to support future trials of maternal GBS vaccines. Considerations presented here may also serve to promote consistency in observational studies and surveillance, to better establish disease burden. The World Health Organization convened a working group to provide consensus guidance for case ascertainment and case definitions of GBS disease in stillbirths, infants, pregnant and post-partum women, with feedback sought from external stakeholders. In intervention studies, case capture and case ascertainment for GBS disease should be based on antenatal recruitment of women, with active follow-up, systematic clinical assessment, standardised sampling strategies and optimised laboratory methods. Confirmed cases of invasive GBS disease in stillbirths or infants should be included in a primary composite endpoint for vaccine efficacy studies, with GBS cultured from a usually sterile body site (may be post-mortem). For additional endpoints, or observational studies, confirmed cases of GBS sepsis in pregnant and post-partum women should be assessed. Culture independent diagnostic tests (CIDTs) may detect additional presumed cases, however, the use of these diagnostics needs further evaluation. Efficacy of vaccination against maternal and neonatal GBS colonisation, and maternal GBS urinary tract infection could be included as additional, separate, endpoints and/or in observational studies. Whilst the focus here is on specific GBS disease outcomes, intervention studies also present an opportunity to establish the contribution of GBS across adverse perinatal outcomes, including all-cause stillbirth, preterm birth and neonatal encephalopathy.
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Affiliation(s)
- Anna C Seale
- London School of Hygiene & Tropical Medicine, Keppel Street, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Carol J Baker
- Department of Pediatric, University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, & Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Jaume Ordi
- ISGlobal, Barcelona Institute of Global Health, Barcelona, Spain; Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Samir K Saha
- Bangladesh Institute of Child Health, Dhaka, Bangladesh
| | - Stephanie J Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Emerging serotype III sequence type 17 group B streptococcus invasive infection in infants: the clinical characteristics and impacts on outcomes. BMC Infect Dis 2019; 19:538. [PMID: 31216993 PMCID: PMC6585028 DOI: 10.1186/s12879-019-4177-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is an important pathogen that causes high mortality and morbidity in young infants. However, data on clinical manifestations between different GBS serotypes and correlation with molecular epidemiology are largely incomplete. The aim of this study was to determine the serotype distribution, antimicrobial resistance, clinical features and molecular characteristics of invasive GBS isolates recovered from Taiwanese infants. METHODS From 2003 to 2017, 182 non-duplicate GBS isolates that caused invasive disease in infants less than one year of age underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. The clinical features of these infants with GBS disease were also reviewed. RESULTS Of the 182 patients with invasive GBS disease, 41 (22.5%) were early-onset disease, 121 (66.5%) were late-onset disease and 20 (11.0%) were late late-onset disease (> 90 days of age). All these patients were treated with effective antibiotics on time. Among them, 51 (28.0%) had meningitis, 29 (16.0%) had neurological complications, 12 (6.6%) died during hospitalization, and 15 (8.8%) out of 170 patients who survived had long-term neurological sequelae at discharge. Serotype III GBS strains accounted for 64.8%, followed by serotype Ia (18.1%) and Ib (8.2%). MLST analysis revealed 11 different sequence types among the 182 isolates and ST-17 was the most dominant sequence type (56.6%). The correlation between serotype III and ST17 was evident, as ST17 accounted for 87.3% of all serotype III isolates. There was an obvious increasing trend of type III/ST-17 GBS that caused invasive disease in infants. All isolates were susceptible to penicillin, cefotaxime, and vancomycin, while 68.1 and 65.9% were resistant to erythromycin and clindamycin, respectively. CONCLUSIONS Despite timely and appropriate antibiotic treatment, a significant proportion of invasive GBS disease still inevitably causes adverse outcomes. Further study to explore preventive strategies and development of serotype-based vaccines will be necessary in the future.
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Abstract
BACKGROUND Meningitis is a serious disease that occurs more commonly in the neonatal period than in any other age group. Recent data from large national cohorts are needed to determine if the epidemiology of neonatal meningitis (NM) has changed. AIM To assess the rates, causative organisms, risk factors, temporal trends and short-term outcomes of NM in Canadian Neonatal Intensive Care Units (NICUs). METHODS A retrospective review of newborn infants admitted to NICUs participating in the Canadian Neonatal Network between January 2010 and December 2016. Patients with meningitis were reviewed. Outcomes of patients with meningitis were compared with 1:2 matched (for gestation, sex and birth weight) neonates without meningitis. RESULTS Rates of NM ranged between 2.2 and 3.5/1000 NICU admissions during the 7-year study period with the majority of patients (87%) having late-onset meningitis (at >3 days after birth). The most common bacterial organism for both early- and late-onset meningitis was Escherichia coli followed by group B streptococci. Only 31% [95% confidence interval (CI): 24.06-38.63) of neonates with meningitis had simultaneous bacteremia. NM was associated with increased seizures [odds ratio (OR): 8.63; 95% CI: 4.73-15.7], retinopathy of prematurity (OR: 3.23; 95% CI: 1.30-8.02), bronchopulmonary dysplasia (OR: 1.93; 95% CI: 1.11-3.35), days of mechanical ventilation (OR: 1.03; 95% CI: 1.02-1.04) and length of hospital stay (OR: 1.02; 95% CI: 1.01-1.02), but not with mortality before discharge (OR: 1.29; 95% CI: 0.74-2.23). CONCLUSIONS The rate of NM remains largely unchanged in Canadian NICUs. NM was associated with increased major morbidities and longer hospital stay but not with mortality before discharge.
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Stark JH, Wool E, Tran L, Robinson E, Chemelski M, Weibel D, Huang WT, Kochhar S, Hardy JR, Bailey S, Galiwango E, Kajungu D. Assessing feasibility of resources at health facilities in Uganda to diagnose pregnancy and neonatal outcomes. Int Health 2019; 11:128-135. [PMID: 30252056 DOI: 10.1093/inthealth/ihy066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/27/2018] [Accepted: 09/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Standardized case definitions for obstetric and neonatal outcomes were developed by the Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project. These definitions can facilitate comparable assessment of maternal immunization safety surveillance and research. This study assessed the capabilities of health centers (HC) in Uganda to implement these definitions in a low income country, which has not been explored. METHODS Healthcare practitioners at 15 government-accredited health centers and one government-funded district hospital in the Iganga-Mayuge Health and Demographic Surveillance Site (IMHDSS) in Uganda were interviewed about the facility's clinical diagnostic and laboratory capabilities. Five obstetric and five neonatal case definitions were evaluated. Definitions with the highest diagnostic certainty were designated as level 1, while definitions that decreased in certainty were designated as level 2 or 4. HCs were evaluated on diagnostic and laboratory capabilities to apply the GAIA definitions. RESULTS Higher-level facilities in the IMHDSS demonstrated the ability to diagnose more specific levels of the GAIA obstetric and neonatal outcomes than lower-level facilities. Furthermore, for the neonatal outcome assessment, there was an increased ability to diagnose outcomes moving from GAIA level 1 to level 3. CONCLUSIONS The ability of health centers to implement globally standardized definitions is promising for implementation of standardized data collection methods for global vaccine safety surveillance and research.
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Affiliation(s)
- James H Stark
- Worldwide Safety and Regulatory, Pfizer, New York, NY, USA.,College of Global Public Health, New York University, New York, NY, USA
| | - Eve Wool
- College of Global Public Health, New York University, New York, NY, USA.,Northwell Health Solutions, Population Health Management, Manhasset, NY, USA
| | - Lena Tran
- College of Global Public Health, New York University, New York, NY, USA.,Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, CA, USA
| | - Elizabeth Robinson
- College of Global Public Health, New York University, New York, NY, USA.,New York University, School of Medicine, New York, NY, USA
| | - Meaghan Chemelski
- College of Global Public Health, New York University, New York, NY, USA.,Maine Medical Center Research Institute, Clinical Trials Office, Scarborough, ME, USA
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wan-Ting Huang
- Office of Preventive Medicine, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Sonali Kochhar
- Global Healthcare Consulting; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Janet R Hardy
- ECC Population Health Group and University of South Florida, Tampa, FL, USA
| | - Steven Bailey
- Worldwide Safety and Regulatory, Pfizer, New York, NY, USA
| | - Edward Galiwango
- Makerere University Centre for Health and Population Research, Iganga Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
| | - Dan Kajungu
- Makerere University Centre for Health and Population Research, Iganga Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
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Abstract
BACKGROUND Little is known about early-onset neonatal bacterial infections (EONBI) in Madagascar. Our aim was to determine their epidemiology to improve their management. METHODS Inborn neonates at risk for EONBI and admitted in the neonatal unit of 2 tertiary hospitals in Antananarivo, Madagascar, were included in a prospective study from April 2012 to March 2013. Using a clinical algorithm, blood culture, gastric fluid culture and C-reactive protein dosage were performed in newborns at high risk of infection, that is, peri partum fever, prematurity <35 weeks' gestation or birth weight <2000 g, or presenting with clinical signs of infection. EONBI was defined as a bacteremia occurring within the first week of life. RESULTS Among 307 neonates, 75 (24.4%) had an EONBI caused by 1 (n = 59) or 2 (n = 16) bacteria (91 isolates). Gram-negative bacteria were predominant (n = 62, 82.7%), including Enterobacter cloacae (n = 26), Klebsiella pneumoniae (n = 14), Escherichia coli (n = 7) and Proteus mirabilis (n = 2). Group B Streptococcus, Acinetobacter baumanii and Enterococcus sp. represented 3.6%, 8.2% and 12.1% of the isolates, respectively. All E. cloacae and 12/14 (85.7%) K. pneumoniae were extended-spectrum β-lactamase producers. At all, 41/91 (45.1%) bacteria were multidrug-resistant (MDR) and 34/75 (45.3%) newborns had an EONBI caused by an MDR bacteria. Neonatal asphyxia was the only factor associated with multidrug resistance (odds ratio: 4.52; CI: 1.20-16.94; P = 0.025). The EONBI-related mortality (n = 20/75, 26.7%) rose up to 38.2% (n = 13/34) in case of MDR bacteria. CONCLUSIONS The epidemiology of EONBIs in Madagascar is comparable to that found in many low-income countries. Prevention, including improvement of hygiene during resuscitation for neonatal asphyxia, is likely to be more effective in reducing EONBI-related morbidity and mortality than using new antibiotics to counter resistance.
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Costeloe K, Turner MA, Padula MA, Shah PS, Modi N, Soll R, Haumont D, Kusuda S, Göpel W, Chang YS, Smith PB, Lui K, Davis JM, Hudson LD. Sharing Data to Accelerate Medicine Development and Improve Neonatal Care: Data Standards and Harmonized Definitions. J Pediatr 2018; 203:437-441.e1. [PMID: 30293637 DOI: 10.1016/j.jpeds.2018.07.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Kate Costeloe
- Paediatric Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
| | - Michael A Padula
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Prakesh S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Lunenfeld Tannebaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Neena Modi
- Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | - Roger Soll
- Vermont Oxford Network, Neonatology, University of Vermont College of Medicine, Burlington, VT
| | - Dominique Haumont
- Department of Neonatology, Saint-Pierre University Hospital, Brussels, Belgium
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Wolfgang Göpel
- Neonatology and Paediatric Intensive Care, University of Lübeck, Department of Paediatrics, Lübeck, Germany
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Kei Lui
- Discipline of Paediatrics, School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Jonathan M Davis
- Department of Paediatrics, Floating Hospital for Children, Tufts Medical Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
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Giannoni E, Agyeman PKA, Stocker M, Posfay-Barbe KM, Heininger U, Spycher BD, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Donas A, Leone A, Hasters P, Relly C, Riedel T, Kuehni C, Aebi C, Berger C, Schlapbach LJ. Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study. J Pediatr 2018; 201:106-114.e4. [PMID: 30054165 DOI: 10.1016/j.jpeds.2018.05.048] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/09/2018] [Accepted: 05/30/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS). STUDY DESIGN All newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015 were included in the study. We defined EOS as infection occurring <3 days after birth, and LOS as infection ≥3 days after birth. Infants with LOS were classified as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission. Incidence was estimated based on the number of livebirths in Switzerland and adjusted for the proportion of admissions at centers participating in the study. RESULTS We identified 444 episodes of blood culture-proven sepsis in 429 infants; 20% of cases were EOS, 62% hospital-acquired LOS, and 18% community-acquired LOS. The estimated national incidence of EOS, hospital-acquired LOS, and community-acquired LOS was 0.28 (95% CI 0.23-0.35), 0.86 (0.76-0.97), and 0.28 (0.23-0.34) per 1000 livebirths. Compared with EOS, hospital-acquired LOS occurred in infants of lower gestational age and was more frequently associated with comorbidities. Community-acquired LOS was more common in term infants and in male infants. Mortality was 18%, 12%, and 0% in EOS, hospital-acquired LOS, and community-acquired LOS, and was higher in preterm infants, in infants with septic shock, and in those requiring mechanical ventilation. CONCLUSIONS We report a high burden of sepsis in neonates with considerable mortality and morbidity. EOS, hospital-acquired LOS, and community-acquired LOS affect specific patient subgroups and have distinct clinical presentation, pathogens and outcomes.
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Affiliation(s)
- Eric Giannoni
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland; Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | | | - Alex Donas
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Antonio Leone
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Claudia Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Luregn J Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Faculty of Medicine, The University of Queensland, Brisbane, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Australia
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36
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Stuurman AL, Riera M, Lamprianou S, Perez-Vilar S, Anderson SA, Mangtani P, Devlieger H, Verstraeten T, Zuber PL, Guillard Maure C. Vaccine safety surveillance in pregnancy in low- and middle-income countries using GAIA case definitions: A feasibility assessment. Vaccine 2018; 36:6736-6743. [DOI: 10.1016/j.vaccine.2018.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022]
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Whittaker E, Goldblatt D, McIntyre P, Levy O. Neonatal Immunization: Rationale, Current State, and Future Prospects. Front Immunol 2018; 9:532. [PMID: 29670610 PMCID: PMC5893894 DOI: 10.3389/fimmu.2018.00532] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/28/2018] [Indexed: 12/11/2022] Open
Abstract
Infections take their greatest toll in early life necessitating robust approaches to protect the very young. Here, we review the rationale, current state, and future research directions for one such approach: neonatal immunization. Challenges to neonatal immunization include natural concern about safety as well as a distinct neonatal immune system that is generally polarized against Th1 responses to many stimuli such that some vaccines that are effective in adults are not in newborns. Nevertheless, neonatal immunization could result in high-population penetration as birth is a reliable point of healthcare contact, and offers an opportunity for early protection of the young, including preterm newborns who are deficient in maternal antibodies. Despite distinct immunity and reduced responses to some vaccines, several vaccines have proven safe and effective at birth. While some vaccines such as polysaccharide vaccines have little effectiveness at birth, hepatitis B vaccine can prime at birth and requires multiple doses to achieve protection, whereas the live-attenuated Bacille Calmette-Guérin (BCG), may offer single shot protection, potentially in part via heterologous ("non-specific") beneficial effects. Additional vaccines have been studied at birth including those directed against pertussis, pneumococcus, Haemophilus influenza type B and rotavirus providing important lessons. Current areas of research in neonatal vaccinology include characterization of early life immune ontogeny, heterogeneity in and heterologous effects of BCG vaccine formulations, applying systems biology and systems serology, in vitro platforms that model age-specific human immunity and discovery and development of novel age-specific adjuvantation systems. These approaches may inform, de-risk, and accelerate development of novel vaccines for use in early life. Key stakeholders, including the general public, should be engaged in assessing the opportunities and challenges inherent to neonatal immunization.
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Affiliation(s)
- Elizabeth Whittaker
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, United Kingdom
| | - David Goldblatt
- Immunobiology Section, UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children’s Hospital Network and University of Sydney, Sydney, NSW, Australia
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Vergnano S, Seale AC, Fitchett EJA, Sharland M, Heath PT. Serious bacterial infections in neonates: improving reporting and case definitions. Int Health 2017; 9:148-155. [PMID: 28582556 DOI: 10.1093/inthealth/ihx011] [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: 11/11/2016] [Accepted: 04/21/2017] [Indexed: 12/31/2022] Open
Abstract
Neonatal infections affect about 7 million neonates causing over 600 000 deaths every year. Estimating the burden is challenging as there are multiple reporting criteria and definitions for serious bacterial infections in neonates. Essential criteria for reporting serious neonatal bacterial infections have recently been published as the STROBE-NI checklist and, in the context of maternal vaccination, definitions have been published by the Brighton Collaboration Global Alignment of Immunization safety Assessment in pregnancy (GAIA) project. Standardisation of reporting criteria is essential to allow data comparability. This an important step in providing a clearer picture of the burden of serious bacterial infections in neonates and a welcome progress for guiding new investments in interventions.
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Affiliation(s)
- Stefania Vergnano
- Paediatric Infectious Disease Research Group, Department of Infection and Immunity, St George's University of London, Jenner wing, London, UK
| | - Anna C Seale
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.,The Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Mike Sharland
- Paediatric Infectious Disease Research Group, Department of Infection and Immunity, St George's University of London, Jenner wing, London, UK
| | - Paul T Heath
- Paediatric Infectious Disease Research Group, Department of Infection and Immunity, St George's University of London, Jenner wing, London, UK
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Abstract
Neonatal pneumonia may occur in isolation or as one component of a larger infectious process. Bacteria, viruses, fungi, and parasites are all potential causes of neonatal pneumonia, and may be transmitted vertically from the mother or acquired from the postnatal environment. The patient's age at the time of disease onset may help narrow the differential diagnosis, as different pathogens are associated with congenital, early-onset, and late-onset pneumonia. Supportive care and rationally selected antimicrobial therapy are the mainstays of treatment for neonatal pneumonia. The challenges involved in microbiological testing of the lower airways may prevent definitive identification of a causative organism. In this case, secondary data must guide selection of empiric therapy, and the response to treatment must be closely monitored.
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Affiliation(s)
| | - Richard A. Polin
- Corresponding author. Babies Hospital Central, 115, New York, NY, USA.
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Bonhoeffer J, Kochhar S, Hirschfeld S, Heath PT, Jones CE, Bauwens J, Honrado Á, Heininger U, Muñoz FM, Eckert L, Steinhoff M, Black S, Padula M, Sturkenboom M, Buttery J, Pless R, Zuber P. Global alignment of immunization safety assessment in pregnancy - The GAIA project. Vaccine 2016; 34:5993-5997. [PMID: 27751641 DOI: 10.1016/j.vaccine.2016.07.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/06/2016] [Indexed: 01/06/2023]
Abstract
Immunization in pregnancy provides a promising contribution to globally reducing neonatal and under-five childhood mortality and morbidity. Thorough assessment of benefits and risks for the primarily healthy pregnant women and their unborn babies is required. The GAIA project was formed in response to the call of the World Health Organization for a globally concerted approach to actively monitor the safety of vaccines and immunization in pregnancy programs. GAIA aims to improve the quality of outcome data from clinical vaccine trials in pregnant women with a specific focus on the needs and requirements for safety monitoring in LMIC. In the first year of the project, a large and functional network of experts was created. The first outputs include a guidance document for clinical trials of immunization in pregnancy, a basic data collection guide, ten case definitions of key obstetric and neonatal health outcomes, an ontology of key terms and a map of pertinent disease codes. The GAIA Network is designed as an open and growing forum for professionals sharing the GAIA vision and aim. Based on the initial achievements, tools and services are developed to support investigators and strengthen immunization in pregnancy programs with specific focus on LMIC.
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Affiliation(s)
- Jan Bonhoeffer
- Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland.
| | | | - Steven Hirschfeld
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | | | | | | | - Ángel Honrado
- Synapse Research Management Partners, Barcelona, Spain
| | | | | | | | | | - Steven Black
- Cincinnati Children's Hospital Medical Center, USA
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Englund JA, Chu HY. Vaccines Against Respiratory Syncytial Virus: The Time Has Come. J Infect Dis 2016; 215:4-7. [PMID: 27694634 DOI: 10.1093/infdis/jiw455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
- Janet A Englund
- Pediatric Infectious Diseases, Seattle Children's Research Institute.,Department of Medicine, University of Washington, Seattle
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle
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