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Mulatie Z, Aynalem M, Getawa S. Hematological profiles of newborns of mothers with hypertensive disorders of pregnancy delivered at the University of Gondar comprehensive specialized hospital: a comparative cross-sectional study. BMC Pediatr 2024; 24:17. [PMID: 38183053 PMCID: PMC10768143 DOI: 10.1186/s12887-023-04491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/17/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy can cause prenatal placental perfusion with insufficient blood supply to the fetus, resulting in fetal exposure to hypoxia and leading to disturbance of neonatal hematopoietic stem cells. This study aimed to compare the hematological profiles of newborns from mothers with hypertensive disorders and normotensive delivered at the University of Gondar comprehensive specialized hospital. METHODS A comparative cross-sectional study was conducted from March to May 2022 among 308 newborns from hypertensive and normotensive mothers in equal proportions. A systematic random sampling technique was used to select study participants. Three milliliters of cord blood were collected to perform a complete blood count by Beckman coulter. The results were presented using tables and graphs. Independent t-test and Mann-Whitney U test were done to compare the hematological profiles of the two groups. P-value < 0.05were considered statistically significant. RESULTS The majority of hypertensive and normotensive mothers' ages were between 20 and 34 years (83.77% and 90.91%, respectively). The hematocrit levels were significantly higher in neonates of hypertensive mothers than the neonates of normotensive mothers (49.10 ± 5.19% and 46.09 ± 7.63% respectively) (P < 0.001) while neutrophil counts were significantly lower in neonates of hypertensive mothers than the neonates of normotensive mothers (6.62 ± 3.30 and 7.55 ± 3.31 × 103 /ul respectively) (P = 0.007). Also, platelets counts were significantly lower in neonates of hypertensive mothers than neonates of normotensive mothers (221.25 ± 83.56 and 260.24 ± 83.01 × 103/ul respectively) (P < 0.001). The platelet and nucleated red blood cell count showed a statistically significant difference among newborns from mothers with superimposed preeclampsia and gestational hypertension. CONCLUSION Newborns delivered from hypertensive disorders of pregnancy had low white blood cell parameters, low platelet count and high red blood cell parameters compared to controls. As result, newborns may develop leukopenia, thrombocytopenia and polycythemia, respectively. Therefore, newborns should be monitored for early detection and follow-up of hematological abnormalities before complications occurred.
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Affiliation(s)
- Zewudu Mulatie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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2
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Yasa B, Memur S, Ozturk DY, Bagci O, Uslu SI, Cetinkaya M. Neonatal Outcomes of Premature Infants Born to Women with the Novel Coronavirus (SARS-CoV-2) Infection: A Case Control Study. Am J Perinatol 2023; 40:1715-1724. [PMID: 34839474 DOI: 10.1055/s-0041-1740177] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Novel coronavirus disease 2019 (COVID-19) is a disease associated with atypical pneumonia caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The first cases of COVID-19 were reported in Wuhan at the end of 2019. Transmission usually occurs via infected droplets and close personal contact; the possibility of vertical transmission is still under debate. This retrospective study aimed to analyze clinical characteristics of premature infants born to mothers with symptomatic COVID-19 disease. STUDY DESIGN This case control study compared the clinical and laboratory data of 20 premature infants born to mothers infected with SARS-CoV-2 with sex and gestational age-matched historical controls. RESULTS The median gestational age and birth weight in both groups were similar. Respiratory distress developed in 11 (55.5%) infants in study group and 19 (47.5%) infants in control group. Mechanical ventilation and endotracheal surfactant administration rates were similar. Median duration of hospitalization was 8.5 (2-76) days in study group and 12 days in historical controls. Real-time reverse-transcription polymerase chain reaction tests (RT-PCR) of nasopharyngeal swab samples for SARS-CoV-2 were found to be negative twice, in the first 24 hours and later at 24 to 48 hours of life. No neutropenia or thrombocytopenia was detected in the study group. Patent ductus arteriosus, bronchopulmonary dysplasia, and necrotizing enterocolitis rates were similar between groups. No mortality was observed in both groups. CONCLUSION To the best of our knowledge, this is one of the few studies evaluating the clinical outcomes of premature infants born to SARS-CoV-2 infected mothers. There was no evidence of vertical transmission of SARS-CoV-2 from symptomatic SARS-CoV-2-infected women to the neonate in our cohort. The neonatal outcomes also seem to be favorable with no mortality in preterm infants. KEY POINTS · SARS-CoV-2 pandemic is a challenge for pregnant women.. · Neonatal outcomes of premature infants born to mothers infected with SARS-CoV-2 not well defined.. · SARS-CoV-2 infection seems to have no adverse effect on mortality and morbidity in premature infants..
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Affiliation(s)
- Beril Yasa
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Seyma Memur
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Dilek Y Ozturk
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Onur Bagci
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Sait I Uslu
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Merih Cetinkaya
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
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3
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Sousa P, Sousa B, Calheiros-Trigo F, Martins M, Paz-Dias C. Acinetobacter baumannii Early-Onset Sepsis After Home Delivery Into Toilet Water. Cureus 2023; 15:e45951. [PMID: 37885560 PMCID: PMC10599798 DOI: 10.7759/cureus.45951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Early-onset sepsis (EOS) is an important cause of morbidity and mortality in newborns, usually caused by pathogens acquired intrapartum. We present the case of a term neonate born by home delivery in the toilet, after an unsupervised pregnancy. He developed a culture-proven early-onset sepsis caused by Acinetobacter baumannii. This was the first case of neonatal sepsis by this pathogen in our unit. The microorganism was susceptible to all antibiotics tested. The neonate was treated empirically with ampicillin and cefotaxime and completed 21 days of directed therapy with meropenem, as meningitis could not be excluded. During the clinical course, the newborn developed severe and persistent thrombocytopenia and neutropenia. In this report, we discuss the etiology behind this clinical presentation. We intend to raise awareness for the consideration of Acinetobacter baumannii as a potential pathogen in EOS, particularly in the presence of adverse birth circumstances.
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Affiliation(s)
- Patrícia Sousa
- Department of Pediatrics, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Beatriz Sousa
- Department of Neonatology, Hospital Senhora da Oliveira, Guimarães, PRT
| | | | - Mariana Martins
- Department of Neonatology, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Clara Paz-Dias
- Department of Neonatology, Hospital Senhora da Oliveira, Guimarães, PRT
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4
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Lucas C, Panko L. Failure to Thrive: A Modern Recipe for Success. Clin Pediatr (Phila) 2023; 62:655-657. [PMID: 36419218 DOI: 10.1177/00099228221139539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Christy Lucas
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Laura Panko
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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5
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Riedy M, Zhang JF, Huang T, Swayampakula AK. Infantile-onset Pompe disease with neutropenia: Treatment decisions in the face of a unique phenotype. JIMD Rep 2023; 64:17-22. [PMID: 36636589 PMCID: PMC9830011 DOI: 10.1002/jmd2.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023] Open
Abstract
Infantile-onset Pompe disease manifests with early signs of cardiomyopathy during the first few days to weeks of life. We present the case of a newborn born via emergency cesarean section with atrial flutter and moderate biventricular hypertrophy who was diagnosed with Pompe disease on New York State newborn screen. Diagnosis was confirmed with repeat leukocyte acid alpha-glucosidase (GAA) enzyme activity, GAA gene sequencing, urine Hex4, and evaluation of Cross-Reactive Immunological Material (CRIM) status. The patient was also found to be persistently neutropenic which to our knowledge has not been previously reported in the literature in association with Pompe disease. This report highlights the impact that newborn screening had on time to diagnosis and initiation of treatment with enzyme replacement therapy. We also discuss how our patient's concurrent neutropenia impacted decision making related to immune tolerance induction prior to starting enzyme replacement therapy.
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Affiliation(s)
- Mary Riedy
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - Jeff F. Zhang
- Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - Taosheng Huang
- Division of Genetics, Department of PediatricsUniversity at BuffaloBuffaloNew YorkUSA
| | - Anil Kumar Swayampakula
- Division of Critical Care Medicine, Department of Pediatrics, John R. Oishei Children's HospitalUniversity at BuffaloBuffaloNew YorkUSA
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6
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Shah J, Balasubramaniam T, Yang J, Shah PS. Leukopenia and Neutropenia at Birth and Sepsis in Preterm Neonates of <32 Weeks' Gestation. Am J Perinatol 2022; 39:965-972. [PMID: 33231269 DOI: 10.1055/s-0040-1721133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to evaluate associations between leukopenia or neutropenia at birth and risk of sepsis in very preterm neonates. STUDY DESIGN We conducted a retrospective unmatched cohort study of neonates of <32 weeks' gestation. Those with leukopenia (≤5,000/µL) were compared with a unmatched cohort without leukopenia. Comparisons were also made for patients with neutropenia and without neutropenia. The outcomes were early-onset sepsis, late-onset sepsis, and mortality. RESULTS We identified 271 neonates with leukopenia at birth and 271 without. Multivariable analyses identified higher odds of early-onset sepsis (adjusted odds ratio [AOR] = 4.85, 95% confidence interval [CI]: 1.29-18.20) in leukopenic neonates. Of neonates with leukopenia, 183 had both leukopenia and neutropenia and were associated with the highest odds of early-onset sepsis (AOR = 6.94, 95% CI: 1.77-27.15) compared with those with neither or with either alone. CONCLUSION Leukopenia, neutropenia, and both leukopenia and neutropenia at birth were associated with early-onset sepsis in very preterm neonates. KEY POINTS · Leukopenia and neutropenia combined at birth was associated with highest odds of early-onset sepsis.. · Leukopenia or neutropenia were associated with sepsis in preterm neonates.. · The risk of infection persist throughout neonatal stay in NICU..
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Affiliation(s)
- Jyotsna Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Jie Yang
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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7
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Rosa F, Yelvington B, Terry N, Tripp P, Pittman HE, Fay BL, Ross TJ, Sikes JD, Flowers JB, Bar-Yoseph F, Yeruva L. Evaluation of the Safety of a Plant-Based Infant Formula Containing Almonds and Buckwheat in a Neonatal Piglet Model. Nutrients 2022; 14:1499. [PMID: 35406111 PMCID: PMC9002815 DOI: 10.3390/nu14071499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
A randomized neonatal piglet trial was conducted to evaluate the safety and the effects of a plant-based formula containing almonds and buckwheat as the main ingredients on growth and plasma parameters. From postnatal day (PND) 2 to 21, the piglets were fed a dairy-based milk formula (Similac Advance) or a plant-based formula (Else Nutrition) and all piglets were euthanized at day 21. No diarrhea was observed after PND 8 and all the piglets completed the trial. Body growth, kcal intake, the complete plasma count parameters and hematological parameters were within the reference range in both groups. Organ growth and development was similar between the two groups. Plasma glucose was higher in the dairy-based-fed piglets relative to the plant-based at 2 weeks of age. Liver function biomarkers levels were greater in the plasma of the plant-based compared to the dairy-based fed group. In addition, calcium levels were higher in the plant-based fed piglets at 1 week of age. Thus, the plant-based formula tested in this study was well tolerated by the piglets and supported similar growth compared to dairy-based milk formula. Therefore, the results support the safety of the tested plant-based infant formula during the neonatal period in comparison to the dairy-based formula fed group.
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Affiliation(s)
- Fernanda Rosa
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79415, USA
| | - Brooke Yelvington
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
| | - Nathan Terry
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
| | - Patricia Tripp
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
| | - Hoy E. Pittman
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
| | - Bobby L. Fay
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
| | - Taylor J. Ross
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
| | - James D. Sikes
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
| | | | | | - Laxmi Yeruva
- United States Department of Agriculture-Agriculture Resaarch Service, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA; (F.R.); (B.Y.); (N.T.); (P.T.); (H.E.P.III); (B.L.F.); (T.J.R.); (J.D.S.)
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8
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Silva M, Carvalho V, Raposo F, Lima M, Costa M. A case of neonatal alloimmune neutropenia with an uncommon presentation. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Blom M, Bredius RGM, van der Burg M. Future Perspectives of Newborn Screening for Inborn Errors of Immunity. Int J Neonatal Screen 2021; 7:ijns7040074. [PMID: 34842618 PMCID: PMC8628921 DOI: 10.3390/ijns7040074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
Newborn screening (NBS) programs continue to expand due to innovations in both test methods and treatment options. Since the introduction of the T-cell receptor excision circle (TREC) assay 15 years ago, many countries have adopted screening for severe combined immunodeficiency (SCID) in their NBS program. SCID became the first inborn error of immunity (IEI) in population-based screening and at the same time the TREC assay became the first high-throughput DNA-based test in NBS laboratories. In addition to SCID, there are many other IEI that could benefit from early diagnosis and intervention by preventing severe infections, immune dysregulation, and autoimmunity, if a suitable NBS test was available. Advances in technologies such as KREC analysis, epigenetic immune cell counting, protein profiling, and genomic techniques such as next-generation sequencing (NGS) and whole-genome sequencing (WGS) could allow early detection of various IEI shortly after birth. In the next years, the role of these technical advances as well as ethical, social, and legal implications, logistics and cost will have to be carefully examined before different IEI can be considered as suitable candidates for inclusion in NBS programs.
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Affiliation(s)
- Maartje Blom
- Laboratory for Pediatric Immunology, Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
- Correspondence:
| | - Robbert G. M. Bredius
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Mirjam van der Burg
- Laboratory for Pediatric Immunology, Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
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10
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Rustogi D, Soraisham AS, Murguia-Favela L, Leaker M, Shah RM, Lodha A. Agranulocytosis and lymphopenia in neonate: A neonatal emergency. J Paediatr Child Health 2021; 57:1096-1098. [PMID: 32767802 DOI: 10.1111/jpc.15109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 07/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Deepika Rustogi
- Section of Neonatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amuchou S Soraisham
- Section of Neonatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Luis Murguia-Favela
- Section of Hematology/Immunology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Leaker
- Section of Hematology/Immunology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ravi M Shah
- Pediatric Oncology, and Bone Marrow Transplant, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Abhay Lodha
- Section of Neonatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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11
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Brook B, Harbeson DJ, Shannon CP, Cai B, He D, Ben-Othman R, Francis F, Huang J, Varankovich N, Liu A, Bao W, Bjerregaard-Andersen M, Schaltz-Buchholzer F, Sanca L, Golding CN, Larsen KL, Levy O, Kampmann B, Tan R, Charles A, Wynn JL, Shann F, Aaby P, Benn CS, Tebbutt SJ, Kollmann TR, Amenyogbe N. BCG vaccination-induced emergency granulopoiesis provides rapid protection from neonatal sepsis. Sci Transl Med 2021; 12:12/542/eaax4517. [PMID: 32376769 DOI: 10.1126/scitranslmed.aax4517] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 03/13/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Abstract
Death from sepsis in the neonatal period remains a serious threat for millions. Within 3 days of administration, bacille Calmette-Guérin (BCG) vaccination can reduce mortality from neonatal sepsis in human newborns, but the underlying mechanism for this rapid protection is unknown. We found that BCG was also protective in a mouse model of neonatal polymicrobial sepsis, where it induced granulocyte colony-stimulating factor (G-CSF) within hours of administration. This was necessary and sufficient to drive emergency granulopoiesis (EG), resulting in a marked increase in neutrophils. This increase in neutrophils was directly and quantitatively responsible for protection from sepsis. Rapid induction of EG after BCG administration also occurred in three independent cohorts of human neonates.
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Affiliation(s)
- Byron Brook
- Department of Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC V5Z 1M9, Canada
| | - Danny J Harbeson
- Department of Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC V5Z 1M9, Canada
| | - Casey P Shannon
- PROOF Centre of Excellence, British Columbia, 10th floor, 1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada.,UBC Centre for Heart Lung Innovation, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Bing Cai
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Daniel He
- Department of Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC V5Z 1M9, Canada.,PROOF Centre of Excellence, British Columbia, 10th floor, 1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada.,UBC Centre for Heart Lung Innovation, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rym Ben-Othman
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Freddy Francis
- Department of Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC V5Z 1M9, Canada
| | - Joe Huang
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Natallia Varankovich
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Aaron Liu
- Department of Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC V5Z 1M9, Canada
| | - Winnie Bao
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut (SSI), Artillerivej 5, 2300 Copenhagen S, Denmark.,Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
| | - Frederik Schaltz-Buchholzer
- Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut (SSI), Artillerivej 5, 2300 Copenhagen S, Denmark.,OPEN, Institute of Clinical Research and Danish Institute for Advanced Science, University of Southern Denmark, and Odense University Hospital, J.B. Winsløws Vej, 5000 Odense C, Denmark
| | - Lilica Sanca
- Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau, Guinea-Bissau
| | - Christian N Golding
- Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut (SSI), Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Kristina Lindberg Larsen
- Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut (SSI), Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Ofer Levy
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA 02115, USA.,Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, P.O. Box 273, Banjul, The Gambia.,Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Rusung Tan
- Department of Pathology, Sidra Medicine and Weill Cornell Medicine, Doha, Qatar
| | - Adrian Charles
- Department of Pathology, Sidra Medicine and Weill Cornell Medicine, Doha, Qatar
| | - James L Wynn
- Department of Paediatrics and Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, P.O. Box 100296, Gainesville, FL 32610-0296, USA
| | - Frank Shann
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau, Guinea-Bissau
| | - Christine S Benn
- Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut (SSI), Artillerivej 5, 2300 Copenhagen S, Denmark.,OPEN, Institute of Clinical Research and Danish Institute for Advanced Science, University of Southern Denmark, and Odense University Hospital, J.B. Winsløws Vej, 5000 Odense C, Denmark
| | - Scott J Tebbutt
- PROOF Centre of Excellence, British Columbia, 10th floor, 1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada.,UBC Centre for Heart Lung Innovation, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.,Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Tobias R Kollmann
- Department of Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC V5Z 1M9, Canada. .,Department of Pediatrics, University of British Columbia, and BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.,Telethon Kids Institute, 100 Roberts Road, Subiaco, Western Australia 6008, Australia
| | - Nelly Amenyogbe
- Department of Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC V5Z 1M9, Canada. .,Telethon Kids Institute, 100 Roberts Road, Subiaco, Western Australia 6008, Australia
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李 丽, 杨 波, 高 翔, 任 漪, 苏 敏, 杨 春, 黄 迪, 王 惠. [Risk factors for neutropenia of late newborns]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:375-380. [PMID: 33840410 PMCID: PMC8050555 DOI: 10.7499/j.issn.1008-8830.2012026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the risk factors and treatment for neutropenia of late newborns (NLN). METHODS Related clinical data were collected from the preterm infants and critically ill neonates who were admitted to the neonatal intensive care unit from July 2019 to January 2020. A total of 46 newborns with a blood absolute neutrophil count (ANC) of < 1.5×109/L for two consecutive times at weeks 2-4 after birth were enrolled as the NLN group. A total of 92 late newborns with a blood ANC of ≥ 1.5×109/L, matched at a ratio of 1:2, were enrolled as the control group. Possible risk factors associated with NLN and the treatment process were recorded. A logistic regression analysis was performed to identify the risk factors for NLN. RESULTS Among the 46 neonates in the NLN group, 29 had a gestational age of < 32 weeks, 14 had a gestational age of 32-37 weeks, and 3 had a gestational age of > 37 weeks. There was no significant difference between the two groups in the incidence rates of gestational hypertension, premature rupture of membranes > 18 hours and intrauterine distress, 5-minute Apgar score, the duration of positive pressure ventilation, the incidence rate of early-onset sepsis, and the type of initially used antibiotics (P > 0.05). Compared with the control group, the NLN group had a higher incidence rate of late-onset sepsis and a longer duration of antibiotic use (P < 0.05). Late-onset sepsis and prolonged duration of antibiotic use were independent risk factors for NLN (P < 0.05). With the presence of late-onset sepsis, the risk of NLN was increased by 1.537 times in neonates, and the risk of NLN was increased by 76.9% for every 3-day increase in the duration of antibiotic use. The mean age at the diagnosis of NLN was (21±6) days for the 46 neonates in the NLN group. Thirteen neonates with NLN were administered with recombinant human granulocyte colony-stimulating factor (G-CSF, 10 μg/kg) once or twice. O the 13 neonates, 6 had an ANC of < 0.5×109/L and 7 had a gestational age of < 32 weeks or severe disease conditions. After treatment the ANC returned to > 1.0×109/L in the 13 neonates. No drug-related adverse reactions were found. After the diagnosis of NLN, 2 neonates developed sepsis, and the remaining 44 neonates did not develop any common purulent infections. CONCLUSIONS The risk of NLN increases with the presence of late-onset sepsis and the increase in the duration of antibiotic use. NLN is generally a benign process. G-CSF appears to be safe and effective for NLN with severe disease conditions or severe reduction in ANC.
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Affiliation(s)
- 丽 李
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 波 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 翔羽 高
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 漪 任
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 敏 苏
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 春艳 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 迪 黄
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 惠颖 王
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
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13
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李 丽, 杨 波, 高 翔, 任 漪, 苏 敏, 杨 春, 黄 迪, 王 惠. [Risk factors for neutropenia of late newborns]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:375-380. [PMID: 33840410 PMCID: PMC8050555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/03/2021] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To study the risk factors and treatment for neutropenia of late newborns (NLN). METHODS Related clinical data were collected from the preterm infants and critically ill neonates who were admitted to the neonatal intensive care unit from July 2019 to January 2020. A total of 46 newborns with a blood absolute neutrophil count (ANC) of < 1.5×109/L for two consecutive times at weeks 2-4 after birth were enrolled as the NLN group. A total of 92 late newborns with a blood ANC of ≥ 1.5×109/L, matched at a ratio of 1:2, were enrolled as the control group. Possible risk factors associated with NLN and the treatment process were recorded. A logistic regression analysis was performed to identify the risk factors for NLN. RESULTS Among the 46 neonates in the NLN group, 29 had a gestational age of < 32 weeks, 14 had a gestational age of 32-37 weeks, and 3 had a gestational age of > 37 weeks. There was no significant difference between the two groups in the incidence rates of gestational hypertension, premature rupture of membranes > 18 hours and intrauterine distress, 5-minute Apgar score, the duration of positive pressure ventilation, the incidence rate of early-onset sepsis, and the type of initially used antibiotics (P > 0.05). Compared with the control group, the NLN group had a higher incidence rate of late-onset sepsis and a longer duration of antibiotic use (P < 0.05). Late-onset sepsis and prolonged duration of antibiotic use were independent risk factors for NLN (P < 0.05). With the presence of late-onset sepsis, the risk of NLN was increased by 1.537 times in neonates, and the risk of NLN was increased by 76.9% for every 3-day increase in the duration of antibiotic use. The mean age at the diagnosis of NLN was (21±6) days for the 46 neonates in the NLN group. Thirteen neonates with NLN were administered with recombinant human granulocyte colony-stimulating factor (G-CSF, 10 μg/kg) once or twice. O the 13 neonates, 6 had an ANC of < 0.5×109/L and 7 had a gestational age of < 32 weeks or severe disease conditions. After treatment the ANC returned to > 1.0×109/L in the 13 neonates. No drug-related adverse reactions were found. After the diagnosis of NLN, 2 neonates developed sepsis, and the remaining 44 neonates did not develop any common purulent infections. CONCLUSIONS The risk of NLN increases with the presence of late-onset sepsis and the increase in the duration of antibiotic use. NLN is generally a benign process. G-CSF appears to be safe and effective for NLN with severe disease conditions or severe reduction in ANC.
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Affiliation(s)
- 丽 李
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 波 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 翔羽 高
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 漪 任
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 敏 苏
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 春艳 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 迪 黄
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 惠颖 王
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
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Berends C, Maggen C, Lok CAR, van Gerwen M, Boere IA, Wolters VERA, Van Calsteren K, Segers H, van den Heuvel-Eibrink MM, Painter RC, Gziri MM, Amant F. Maternal and Neonatal Outcome after the Use of G-CSF for Cancer Treatment during Pregnancy. Cancers (Basel) 2021; 13:cancers13061214. [PMID: 33802196 PMCID: PMC8001066 DOI: 10.3390/cancers13061214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Treatment of pregnant cancer patients should adhere as much as possible to standard treatment protocols in order to safeguard maternal prognosis. The use of Granulocyte colony-stimulating factor (G-CSF) can be indicated for dose dense chemotherapy in high risk breast cancer patients or for the treatment or prevention of neutropenic fever, which can be an important threat for maternal and fetal survival. However, as evidence is still scarce, physicians are still reluctant to the use of G-CSF during pregnancy. In this series, the International Network of Cancer, Infertility and Pregnancy (INCIP) reports on 42 pregnant patients who received G-CSF during oncological treatment. Reported maternal and neonatal complications are acceptable; however, a continuous evaluation of clinical practice is necessary as the limited data in numbers and follow-up do not allow robust conclusions. Abstract Data on the use of Granulocyte colony-stimulating factor (G-CSF) in pregnant cancer patients are scarce. The International Network of Cancer, Infertility and Pregnancy (INCIP) reviewed data of pregnant patients treated with chemotherapy and G-CSF, and their offspring. Among 2083 registered patients, 42 pregnant patients received G-CSF for the following indications: recent chemotherapy induced febrile neutropenia (5; 12%), dose dense chemotherapy (28, 67%), poly chemotherapy (7, 17%), or prevention of neutropenia at delivery (2; 5%). Among 24 women receiving dose dense chemotherapy, three (13%) patients recovered from asymptomatic neutropenia within 5 days. One patient developed pancytopenia following polychemotherapy after which the pregnancy was complicated by chorioamnionitis and intrauterine death. Nineteen singleton livebirths (49%) were born preterm. Sixteen neonates (41%) were admitted to the Neonatal Intensive care Unit (NICU). No neonatal neutropenia occurred. Two neonates had congenital malformations. Out of 21 children in follow-up, there were four children with a motor development delay and two premature infants had a delay in cognitive development. In conclusion, the rate of maternal and neonatal complications are similar to those described in (pregnant) women treated with chemotherapy. Due to small numbers and limited follow-up, rare or delayed effects among offspring exposed to G-CSF in utero cannot be ruled out yet.
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Affiliation(s)
- Claudia Berends
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek—Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.B.); (C.A.R.L.); (M.v.G.); (V.E.R.A.W.)
| | - Charlotte Maggen
- Department of Oncology, KU Leuven, 3000 Leuven, Belgium;
- Department of Obstetrics and Prenatal Medicine, Vrije Universiteit Brussel (VUB), University Hospital of Brussels, 1090 Brussels, Belgium
| | - Christianne A. R. Lok
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek—Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.B.); (C.A.R.L.); (M.v.G.); (V.E.R.A.W.)
| | - Mathilde van Gerwen
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek—Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.B.); (C.A.R.L.); (M.v.G.); (V.E.R.A.W.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Ingrid A. Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands;
| | - Vera E. R. A. Wolters
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek—Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.B.); (C.A.R.L.); (M.v.G.); (V.E.R.A.W.)
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Development and Regeneration—Unit Woman and Child, KU Leuven, 3000 Leuven, Belgium
| | - Heidi Segers
- Department of Pediatric Hemato-Oncology, UZ Leuven, 3000 Leuven, Belgium;
| | | | - Rebecca C. Painter
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam Reproduction and Development, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, 1200 Sint-Lambrechts-Woluwe, Belgium;
| | - Frédéric Amant
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek—Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.B.); (C.A.R.L.); (M.v.G.); (V.E.R.A.W.)
- Department of Oncology, KU Leuven, 3000 Leuven, Belgium;
- Center for Gynecological Oncology Amsterdam, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-512-29-75
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15
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Non-specific effects of BCG vaccination on neutrophil and lymphocyte counts of healthy neonates from a developed country. Vaccine 2021; 39:1887-1891. [PMID: 33750591 DOI: 10.1016/j.vaccine.2021.02.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 01/07/2023]
Abstract
BCG vaccination is known to reduce neonatal mortality from infections in a pathogen-agnostic manner. In this observational study we report on whether an emergency granulopoietic response is elicited in term babies from a developed country following BCG vaccination. We studied a cohort of neonates re-admitted to the hospital from home for feeding support separated into 2 groups dependent on whether they had received BCG vaccination. Clinical data including gender, weight, gestational age, method of feeding and full blood count results were retrieved retrospectively. While lymphocyte counts increase following BCG vaccination irrespective of gender and in proportion with the time elapsed after vaccination, the increase in neutrophil counts, is only observed in boys. This increase appears to be temporary. Our results confirm the presence of emergency granulopoiesis following BCG vaccination in a neonatal cohort from a developed country. However, this effect appears to be gender-specific and is present only in boys.
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Frater JL. How I investigate neutropenia. Int J Lab Hematol 2021; 42 Suppl 1:121-132. [PMID: 32543073 DOI: 10.1111/ijlh.13210] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 01/24/2023]
Abstract
Neutropenia is a common laboratory finding in adults and children. Its underlying causes are extremely heterogeneous and include benign conditions, autoimmune disorders, infections, and malignancies. The clinical laboratory plays a central role in the diagnosis of these disorders, including data derived from hematology, microbiology, molecular biology/cytogenetics, and clinical chemistry. The purpose of this review is to (a) highlight the clinical, hematologic, and molecular genetic features of the major entities resulting in neutropenia and (b) outline an algorithm-based approach to permit the classification of neutropenias.
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Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA
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17
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Arneth B. Neonatal Immune Incompatibilities between Newborn and Mother. J Clin Med 2020; 9:E1470. [PMID: 32422924 PMCID: PMC7291300 DOI: 10.3390/jcm9051470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Incompatibilities between the mother and unborn baby can cause complications that must be identified early to initiate the appropriate treatment. For example, neonatal alloimmune thrombocytopenia (NAIT), neonatal alloimmune neutropenia (NAIN), and morbus hemolyticus neonatorum affect children worldwide. Aim: This literature review aims to depict the similarities and differences between these three disorders from a clinical and mechanistic point of view. Material and Methods: The current literature review entailed conducting a systematic search to locate articles on the three conditions. Different electronic databases, including PsycINFO, PubMed, Web of Science, and CINAHL, were searched using the search terms "neonatal alloimmune thrombocytopenia", "neonatal alloimmune neutropenia", "morbus hemolyticus neonatorum", "NAIT", "FNAIT", "fetal", "NAIN", and "hemolytic disease of the newborn". Results: This review shows that these three diseases are caused by incompatibilities between the maternal and fetal immune systems. Furthermore, these conditions can lead to severe complications that hinder fetal development and cause death if not well managed. Discussion: The current literature review shows that NAIT, NAIN, and morbus hemolyticus neonatorum are rare conditions that occur when the mother produces antibodies against the fetal immune system. Thus, there is a need for the early detection of these conditions to initiate appropriate treatment before the child experiences adverse effects. Conclusion: The development of NAIT, NAIN, and morbus hemolyticus neonatorum is linked to the production of antibodies against the fetal immune system and fetal antigens. Further studies are required to determine potential interventions to reduce the risk of developing these three conditions.
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Affiliation(s)
- Borros Arneth
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Hospital of the Universities of Giessen and Marburg, Justus Liebig University, 35339 Giessen, Germany;
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Hospital of the Universities of Giessen and Marburg, Philipps University Marburg, Baldingerstraße 1, 35033 Marburg, Germany
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18
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Doan J, Kottayam R, Krishnamurthy MB, Malhotra A. Neonatal alloimmune neutropaenia: Experience from an Australian paediatric health service. J Paediatr Child Health 2020; 56:757-763. [PMID: 31858675 DOI: 10.1111/jpc.14735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/28/2019] [Accepted: 12/01/2019] [Indexed: 01/04/2023]
Abstract
AIM To describe the presenting features and investigation findings in infants diagnosed with neonatal alloimmune neutropaenia (NAIN) within an Australian paediatric health network. The secondary aim was to describe the management and resolution of neutropaenia in infants with NAIN. METHODS A retrospective cohort study was conducted at Monash Children's Hospital, Melbourne, Australia. Infants referred to the Victorian Transplantation and Immunogenetics Service for evaluation of NAIN were identified and medical records were reviewed. Descriptive statistical analysis of infants' clinical outcomes, investigation findings and management was performed. RESULTS Nine infants were diagnosed with NAIN between December 2004 and June 2017. Overall incidence of NAIN was around 1 per 10 000 births. Median gestational age was 38 (range 35-40) weeks and birthweight was 2920 (2300-4445) g. Median age at NAIN work-up was 7 (2-33) days. Prior to investigation for NAIN, median absolute neutrophil count was 0.2 (0.01-0.6) × 109 cells/L. The post-natal ward was the source of presentation in most infants (78%). All except one infant were admitted to a neonatal unit and commenced on intravenous antibiotics (89%). Six infants were asymptomatic but received antibiotics for risk of infection (75%). Granulocyte-colony stimulating factor was administered to 44% of infants due to neutropaenia with presumed or confirmed infection. NAIN resolved at median age of 32 (6-200) days. CONCLUSIONS Infants with NAIN frequently presented with severe, unexpected neutropaenia without major infection. Intravenous antibiotic therapy and granulocyte-colony stimulating factor use was common in this cohort.
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Affiliation(s)
- John Doan
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
| | | | | | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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19
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Silvinato A, Bernardo WM, Floriano I, Soledade GNB. Neonatal sepsis with neutropenia: granulocyte-colony stimulating factor (G-CSF). Rev Assoc Med Bras (1992) 2020; 66:3-10. [PMID: 32130373 DOI: 10.1590/1806-9282.66.1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 01/22/2023] Open
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20
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Rodríguez-Benítez MV, Gámez-Belmonte R, Gil-Campos M, Hernández-Chirlaque C, Bouzas PR, Sánchez de Medina F, Martínez-Augustin O. Premature Birth Infants Present Elevated Inflammatory Markers in the Meconium. Front Pediatr 2020; 8:627475. [PMID: 33537270 PMCID: PMC7848191 DOI: 10.3389/fped.2020.627475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Prematurity, a well-established risk factor for various intestinal diseases in newborns, results in increased morbidity and mortality. However, the intestinal inflammatory status of preterm (PT) infants has been poorly characterized. Here we have broadly described the intestinal and systemic inflammatory status of PT children. Materials and Methods: Meconium and plasma from 39 PT and 32 full term (T) newborns were studied. Fecal calprotectin, polymorphonuclear leukocyte elastase (PMN-E), TNF, IL-17A, IL-8, IP-10, MCP-1, MIP-1, IL-1β, IL-1α, and E-selectin and the enzymatic activities of myeloperoxidase (MPO) and alkaline phosphatase (AP) in meconium were measured. Plasma levels of AP, hepatocyte growth factor, nerve growth factor (NGF), proinflammatory cytokines, leptin, adiponectin, PAI-1, and resistin were also determined. Correlations with gestational age (GA) and birth weight (BW) were studied. Results: Neutrophil derived PMN-E, MPO and calprotectin were increased in the meconium of PT compared to T newborns, while AP was decreased. No significant differences were found in other inflammatory parameters. Considering data from all children, GA and BW showed inverse correlation with neutrophil markers, while AP directly correlated with BW. Plasma levels of IL-1β and NGF were enhanced in PT infants, and were also negatively correlated with BW. PT children additionally showed neutropenia and decreased adiponectin, leptin, haematocrit, and haemoglobin. These parameters (neutrophils, adiponectin, and so forth) were positively correlated with GA and BW, while IL-8, MCP-1, PAI-1, and plasma AP were negatively correlated. PT children showing postnatal morbidity exhibited increased meconium MPO and MIP-1α. Conclusion: PT neonates present a significant elevation of intestinal inflammatory parameters, characterized by the presence of neutrophil markers, associated with mild systemic inflammation.
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Affiliation(s)
| | - Reyes Gámez-Belmonte
- Department of Pharmacology, CIBERehd, School of Pharmacy, Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, Granada, Spain
| | - Mercedes Gil-Campos
- Unit of Pediatrics Metabolism, Reina Sofia University Hospital, University of Córdoba, IMIBIC, CIBEROBN, Córdoba, Spain
| | - Cristina Hernández-Chirlaque
- Department of Biochemistry and Molecular Biology II, CIBERehd, School of Pharmacy, Instituto de Investigación Biosanitaria ibs.GRANADA, Instituto de Ciencia y Tecnología de los Alimentos José Mataix, University of Granada, Granada, Spain
| | - Paula R Bouzas
- Department of Statistics, University of Granada, Granada, Spain
| | - Fermín Sánchez de Medina
- Department of Pharmacology, CIBERehd, School of Pharmacy, Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, Granada, Spain
| | - Olga Martínez-Augustin
- Department of Biochemistry and Molecular Biology II, CIBERehd, School of Pharmacy, Instituto de Investigación Biosanitaria ibs.GRANADA, Instituto de Ciencia y Tecnología de los Alimentos José Mataix, University of Granada, Granada, Spain
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Singh S, Singh VK, Rai G. Identification of Differentially Expressed Hematopoiesis-associated Genes in Term Low Birth Weight Newborns by Systems Genomics Approach. Curr Genomics 2020; 20:469-482. [PMID: 32655286 PMCID: PMC7327969 DOI: 10.2174/1389202920666191203123025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 11/22/2022] Open
Abstract
Background Low Birth Weight (LBW) (birth weight <2.5 Kg) newborns are associated with a high risk of infection, morbidity and mortality during their perinatal period. Compromised innate immune responses and inefficient hematopoietic differentiation in term LBW newborns led us to evaluate the gene expression status of hematopoiesis. Materials and Methods In this study, we compared our microarray datasets of LBW-Normal Birth Weight (NBW) newborns with two reference datasets to identify hematopoietic stem cells genes, and their differential expression in the LBW newborns, by hierarchical clustering algorithm using gplots and RcolorBrewer package in R. Results Comparative analysis revealed 108 differentially expressed hematopoiesis genes (DEHGs), of which 79 genes were up-regulated, and 29 genes were down-regulated in LBW newborns compared to their NBW counterparts. Moreover, protein-protein interactions, functional annotation and pathway analysis demonstrated that the up-regulated genes were mainly involved in cell proliferation and differentiation, MAPK signaling and Rho GTPases signaling, and the down-regulated genes were engaged in cell proliferation and regulation, immune system regulation, hematopoietic cell lineage and JAK-STAT pathway. The binding of down-regulated genes (LYZ and GBP1) with growth factor GM-CSF using docking and MD simulation techniques, indicated that GM-CSF has the potential to alleviate the repressed hematopoiesis in the term LBW newborns. Conclusion Our study revealed that DEHGs belonged to erythroid and myeloid-specific lineages and may serve as potential targets for improving hematopoiesis in term LBW newborns to help build up their weak immune defense against life-threatening infections.
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Affiliation(s)
- Sakshi Singh
- 1Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India; 2Centre for Bioinformatics, School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Vinay K Singh
- 1Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India; 2Centre for Bioinformatics, School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Geeta Rai
- 1Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India; 2Centre for Bioinformatics, School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi, India
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Incidence of Neonatal Neutropenia and Leukopenia After In Utero Exposure to Chemotherapy for Maternal Cancer. Am J Clin Oncol 2019; 42:351-354. [DOI: 10.1097/coc.0000000000000527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Das A, Ray S, Chattopadhyay A, Hazra A, Mondal R. Gestation-wise Reference Ranges of Neutrophil Counts in Indian Newborns. Oman Med J 2019; 34:131-136. [PMID: 30918607 PMCID: PMC6425059 DOI: 10.5001/omj.2019.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives Blood counts are commonly performed tests in neonatal intensive care units with the results having various clinical ramifications. Interpreting blood counts as normal or abnormal requires reference ranges as per gestation. Studies on reference ranges for neonatal neutrophil counts are already scarce, and data is lacking in the Asian context. We sought to formulate gestation-wise reference ranges of neutrophil counts in an Indian setting. Methods Healthy, newborn babies of either gender, aged between 30 to 41 weeks gestation were included in the study. Gestational age was corroborated through first trimester dating scan and postnatally by the New Ballard Score. Single venous blood samples were drawn on day three and day five for estimation of total leukocyte count, differential count (neutrophils, lymphocytes), and peripheral blood smear examination. Results We evaluated the data of 420 newborns. The normative values were compiled week-wise for gestational ages of 30 to 41 weeks at birth. We observed a clustering of neutrophil count values below 8000 cells/μL on day three and below 5000 cells/μL on day five. No gender-based differences in counts were observed. We were able to generate reference range curves for neutrophil counts as per gestational age. Conclusions The absolute neutrophil counts of term and preterm Indian newborns are higher than the values depicted in the standard reference chart used currently. This indicates that a different standard chart as per gestation should be used in Indo-Asian countries to differentiate ‘normal’ from ‘abnormal’.
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Affiliation(s)
- Arijita Das
- Department of Pediatric Medicine, Medical College, Kolkata, India
| | - Somosri Ray
- Department of Neonatology, Medical College, Kolkata, India
| | - Arnab Chattopadhyay
- Department of Hematology and Transfusion Medicine, Medical College, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Rakesh Mondal
- Department of Pediatric Medicine, Medical College, Kolkata, India
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Seguier J, Barlogis V, Croisille L, Audrain M, Ebbo M, Beaupain B, Meunier B, Vallentin B, Jean R, Harle JR, Donadieu J, Schleinitz N. Severe Transitory Neonatal Neutropenia Associated with Maternal Autoimmune or Idiopathic Neutropenia. J Clin Immunol 2019; 39:200-206. [PMID: 30900095 DOI: 10.1007/s10875-019-00608-5] [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: 10/23/2018] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Neonatal immune neutropenia is observed in rare cases in newborns from mothers with idiopathic or autoimmune neutropenia, secondary to passive transfer of maternal granulocyte auto-antibodies. METHODS We performed a literature review and report four supplementary cases from the French registry of neutropenia. RESULTS Only 14 cases (11 mothers, 14 newborns) have been reported. Granulocyte aggregation (GAT) and granulocyte indirect immunofluorescence test (GIFT) are the recommended laboratory procedures for antibody detection. Monoclonal antibody-specific immobilization of granulocyte antigens (MAIGA)-confirmed antibody specificity. Antibody detection in newborns is not generally possible owing to extreme neutropenia. In half of the cases autoantibodies against neutrophils (AAN) were positive in maternal sera (7 out of 11). In some newborns tested, IgG+ AAN were also positive, with disappearance in parallel of spontaneous neutrophil count improvement. No correlation between maternal type of AAN and titer and neonatal neutropenia can be established. Neutropenia resolved spontaneously between 2 weeks and 4 months. Infections in newborns were observed in 43% of cases, with no deaths reported. Granulocyte colony-stimulating factor (G-CSF) was administered to some newborns (5 out of 14) in the case of infections. Low-dose G-CSF administered to childbearing women during pregnancy could be proposed to prevent neutropenia in newborns. CONCLUSIONS From the few cases reported so far it is impossible to draw any conclusions regarding frequency, risk factors, and outcome, but the overall prognosis for newborns seems good. Because it can be associated with potentially severe neonatal infections, autoimmune neutropenia in childbearing mothers should be closely monitored in collaboration with gynecologists and pediatricians.
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Affiliation(s)
- Julie Seguier
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France.
| | - Vincent Barlogis
- Aix-Marseille University, APHM, Pédiatrie et hématologie pédiatrique Hôpital de la Timone, Marseille, France
| | | | - Marie Audrain
- Laboratoire d'immunologie, Institut de biologie, CHU de Nantes, Nantes, France
| | - Mikael Ebbo
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France
| | - Blandine Beaupain
- Service d'hématologie pédiatrique, Hôpital Trousseau, APHP, Paris, France
| | - Benoit Meunier
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France
| | - Blandine Vallentin
- Aix-Marseille University, APHM, Pédiatrie et hématologie pédiatrique Hôpital de la Timone, Marseille, France
| | - Rodolphe Jean
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Conception, Marseille, France
| | - Jean-Robert Harle
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France
| | - Jean Donadieu
- Service d'hématologie pédiatrique, Hôpital Trousseau, APHP, Paris, France
| | - Nicolas Schleinitz
- Aix-Marseille University, APHM, Médecine Interne Hôpital de la Timone, 264 rue Saint Pierre, 13385 cedex 5, Marseille, France
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McMahon KE, Habeeb O, Bautista GM, Levin S, DeChristopher PJ, Glynn LA, Jeske W, Muraskas JK. The association between AB blood group and neonatal disease. J Neonatal Perinatal Med 2019; 12:81-86. [PMID: 30347622 DOI: 10.3233/npm-17115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Numerous studies have examined the association between ABO blood groups and adult disease states, but very few have studied the neonatal population. The objective of this study was to determine the relationship between AB blood group and the occurrence of common neonatal disorders such as neutropenia at birth, sepsis, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and patent ductus arteriosus (PDA) compared to all other blood groups. METHODS We performed a retrospective review on 3,981 infants born at 22 0/7 to 42 6/7 weeks' gestational age and compared the relative risk of neonatal diseases in infants with AB blood group to that of infants with all other blood groups (A, B, and O). RESULTS When compared to all other blood groups, AB infants demonstrated an increased risk for developing negative clinical outcomes. AB blood group was significantly associated with a 14-89% increased risk of neutropenia at birth, sepsis, RDS, and ROP. Risks for IVH and PDA were not significant. CONCLUSION We hypothesize that the phenotypic expression of A and B antigens, rather than the antigens themselves, in the AB group may reveal an enhanced susceptibility to injury at the endothelial level resulting in an increased risk for disease development.
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Affiliation(s)
- K E McMahon
- Loyola University Medical Center, Maywood, IL, USA
| | - O Habeeb
- New York University Langone Medical Center, New York, NY, USA
| | - G M Bautista
- Loyola University Medical Center, Maywood, IL, USA
| | - S Levin
- Loyola University Medical Center, Maywood, IL, USA
| | | | - L A Glynn
- Mercy Health Rockford, University of Illinois, Rockford, IL, USA
| | - W Jeske
- Loyola University Medical Center, Maywood, IL, USA
| | - J K Muraskas
- Loyola University Medical Center, Maywood, IL, USA
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26
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van den Broek L, van der Werff-Ten Bosch J, Cortoos PJ, van Steijn S, van den Akker M. Severe neutropenia in a breastfed infant: a case report and discussion of the differential diagnosis. Int Med Case Rep J 2018; 11:333-337. [PMID: 30532602 PMCID: PMC6245346 DOI: 10.2147/imcrj.s173826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neonatal neutropenia is regularly seen with variable etiology. We describe a breastfed infant with maternal medication use as a probable cause of neonatal neutropenia. An 8 days old exclusively breastfed female infant of Arab-Berber descent was referred to our hospital because of an infection of the umbilicus. Complete blood count showed a picture of severe isolated neutropenia. After initiating intravenous antibiotic treatment, the infection quickly resolved, but the isolated neutropenia persisted. Bone marrow aspiration indicated severe congenital neutropenia. The mother was known to have Crohn’s disease, treated with methylprednisolone and adalimumab up to 3 months before delivery, and latent tuberculosis, for which she used isoniazid postnatally. Breast-feeding was terminated and filgrastim was started, with an increase of the neutrophilic count. After several weeks, filgrastim could be terminated. Bone marrow and complete blood count were repeated and were completely normal. This case report describes a very young breastfed female infant with severe neutropenia, causing an infection, in which maternal adalimumab use could not be excluded as a possible cause. Maternal isoniazid use is highly unlikely.
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Affiliation(s)
| | | | | | - Susanne van Steijn
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium,
| | - Machiel van den Akker
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium, .,Department of Pediatric Hematology Oncology, UZ Brussel, Brussels, Belgium,
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27
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Porcelijn L, de Haas M. Neonatal Alloimmune Neutropenia. Transfus Med Hemother 2018; 45:311-316. [PMID: 31049048 DOI: 10.1159/000492949] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/16/2018] [Indexed: 12/17/2022] Open
Abstract
Neonatal alloimmune neutropenia (NAIN, NAIN or NIN) is a neutrophil blood group antagonism, analogous to hemolytic disease of the fetus and newborn (HDFN) and fetal/neonatal alloimmune thrombocytopenia (FNAIT). A limited number of prospective screening studies showed that granulocyte-specific antibodies were detectable in 0.35-1.1% of random postnatal maternal samples and that the incidence of NAIN was below 0.1%. Symptoms vary from none to mild skin infections, omphalitis or more severe infections like pneumonia, sepsis, and meningitis. Treatment of neonatal infection with antibiotics and granulocyte-colony stimulating factor is advised.
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Affiliation(s)
- Leendert Porcelijn
- Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Masja de Haas
- Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, the Netherlands.,Department of Immuno-Hematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
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28
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Abdelhamid R, Yusuf K, Lodha A, Al Awad EH. Severe congenital autoimmune neutropenia in preterm monozygotic twins: case series and literature review. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2018-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The presence of high levels of neutrophil associated immunoglobulins (NAIG) in the serum of newborns with neutropenia and their mothers is usually associated with the diagnosis of allo-immune neonatal neutropenia (AINN). We describe a set of otherwise healthy late preterm monozygotic twins who presented with an isolated severe neonatal neutropenia on the first day of life. Flow cytometry for neutrophil antibody screen for both twins detected elevated levels of NAIG with normal serum levels of allo anti-neutrophil antibody (allo-NAB). Maternal serum did not contain either NAIG or allo-NAB. Also, the NAIG immunoglobulin M (IgM) levels were markedly increased in both twins if compared to the increase in the NAIG immunoglobulin G (IgG). Both twins showed very good response to a short course treatment with granulocyte colony stimulating factor (G-CSF), they remained clinically well until 12 months of age. We suggest that this case may be an early presentation of autoimmune neutropenia of infancy. This case study is the earliest report of autoimmune neutropenia of infancy in preterm monozygotic twins.
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Affiliation(s)
- Rehab Abdelhamid
- Section of Neonatology, Peter Lougheed Centre , University of Calgary , Calgary , Canada
| | - Kamran Yusuf
- Section of Neonatology, Peter Lougheed Centre , University of Calgary , Calgary , Canada
| | - Abhay Lodha
- Section of Neonatology, Peter Lougheed Centre , University of Calgary , Calgary , Canada
| | - Essa Hamadan Al Awad
- Clinical Associate Professor, University of Calgary, Section of Neonatology , Peter Lougheed Centre 3500, 26th Ave, NE , Calgary, AB T1Y6J4 , Canada , Tel.: +1(403)943-4892; Fax: +1(403)943-2565
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29
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Leroy S, Caumette E, Waddington C, Hébert A, Brant R, Lavoie PM. A Time-Based Analysis of Inflammation in Infants at Risk of Bronchopulmonary Dysplasia. J Pediatr 2018; 192:60-65.e1. [PMID: 29092751 DOI: 10.1016/j.jpeds.2017.09.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/28/2017] [Accepted: 09/07/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To precisely delineate the timing and contribution of inflammation to bronchopulmonary dysplasia (BPD) in preterm infants during the neonatal period. STUDY DESIGN Longitudinal study of blood inflammatory biomarkers (interleukin [IL]-6, IL-8, and granulocyte colony-stimulating factor) measured between birth and 42 days of age, at high temporal (daily) resolution, in infants born at or below 30 weeks of gestation. Cytokine predictors of BPD at 36 weeks postmenstrual age were adjusted for infant-specific and time-dependent factors, using hierarchical mixed effects regressions models. RESULTS A total of 1518 data points were obtained in 62 infants (mean gestational age of 27 weeks). Infants who developed BPD later on presented increased inflammation after birth compared with infants without BPD. Inflammation was sustained, with gradual attenuation over 2 weeks (IL-8: OR: 6.5 [95% CI: 1.8-24]; granulocyte colony-stimulating factor: 3.3 [1.5-7.6]) and was higher in boys and in infants of lower birth weight. This inflammation preceded the clinical increased requirement in supplemental oxygen characteristic of BPD, and preceded the peak occurrence of neonatal sepsis or necrotizing enterocolitis. CONCLUSIONS Systemic inflammation occurs early in the neonatal period and precedes clinical symptoms in infants with BPD. These data provide a discrete vulnerability window period, supporting a role for targeted intensive care interventions during the early phase of BPD.
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Affiliation(s)
- Sandrine Leroy
- EA2415, Montpellier University, Montpellier, France; Mobile Pediatrics Intensive Care Unit, Avicenne hospital, AP-HP, Paris, France
| | | | - Chandra Waddington
- Neonatal Program, Children's and Women's Hospitals of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Audrey Hébert
- Neonatal Program, Children's and Women's Hospitals of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rollin Brant
- Neonatal Program, Children's and Women's Hospitals of British Columbia, Vancouver, British Columbia, Canada; Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascal M Lavoie
- Neonatal Program, Children's and Women's Hospitals of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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30
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Hoenig M, Pannicke U, Gaspar HB, Schwarz K. Recent advances in understanding the pathogenesis and management of reticular dysgenesis. Br J Haematol 2017; 180:644-653. [PMID: 29270983 DOI: 10.1111/bjh.15045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Reticular Dysgenesis is a rare immunodeficiency which is clinically characterized by the combination of Severe Combined Immunodeficiency (SCID) with agranulocytosis and sensorineural deafness. Mutations in the gene encoding adenylate kinase 2 (AK2) were identified to cause this phenotype. In this review, we will demonstrate important clinical differences between reticular dysgenesis and other SCID entities and summarize recent concepts in the understanding of the pathophysiology of the disease and the management strategies for this difficult condition.
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Affiliation(s)
- Manfred Hoenig
- Department of Paediatrics, University Medical Centre Ulm, Ulm, Germany
| | - Ulrich Pannicke
- Institute for Transfusion Medicine, University of Ulm, Ulm, Germany.,Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Wuerttemberg, Hessen, Germany
| | - Hubert B Gaspar
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Klaus Schwarz
- Institute for Transfusion Medicine, University of Ulm, Ulm, Germany.,Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Wuerttemberg, Hessen, Germany
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Abstract
Bacteremia and sepsis are conditions associated with high mortality and are of great impact to health care operations. Among the top causes of mortality in the United States, these conditions cause over 600 fatalities each day. Empiric, broad-spectrum treatment is a common but often a costly approach that may fail to effectively target the correct microbe, may inadvertently harm patients via antimicrobial toxicity or downstream antimicrobial resistance. To meet the diagnostic challenges of bacteremia and sepsis, laboratories must understand the complexity of diagnosing and treating septic patients, in order to focus on creating algorithms that can help direct a more targeted approach to antimicrobial therapy and synergize with existing clinical practices defined in new Surviving Sepsis Guidelines. Significant advances have been made in improving blood culture media; as yet no molecular or antigen-based method has proven superior for the detection of bacteremia in terms of limit of detection. Several methods for rapid molecular identification of pathogens from blood cultures bottles are available and many more are on the diagnostic horizon. Ultimately, early intervention by molecular detection of bacteria and fungi directly from whole blood could provide the most patient benefit and contribute to tailored antibiotic coverage of the patient early on in the course of the disease. Although blood cultures remain as the best means of diagnosing bacteremia and candidemia, complementary testing with antigen tests, microbiologic investigations from other body sites, and histopathology can often aid in the diagnosis of disseminated disease, and application of emerging nucleic acid test methods and other new technology may greatly impact our ability to bacteremic and septic patients, particularly those who are immunocompromised.
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Wynn JL, Kelly MS, Benjamin DK, Clark RH, Greenberg R, Benjamin DK, Smith PB. Timing of Multiorgan Dysfunction among Hospitalized Infants with Fatal Fulminant Sepsis. Am J Perinatol 2017; 34:633-639. [PMID: 27923248 PMCID: PMC5604435 DOI: 10.1055/s-0036-1597130] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Identify the progression of specific signs of multiorgan dysfunction among infants with fatal sepsis. Study Design Cohort study of 679 infants who died within 3 days of the start of a late-onset sepsis (LOS) episode in neonatal intensive care units from 1997 to 2012. We extracted clinical and laboratory data on the day of death (day 0) and the preceding 5 days (days -5 to -1). Results Median (25th percentile-75th percentile) gestational age was 25 (24-28) weeks. Compared with day -1, day 0 was characterized by an increased requirement for mechanical ventilation and higher mean fraction of inspired oxygen. Measures of cardiorespiratory support and the proportion of infants with neutropenia began to rise on day -2. Conclusion Hospitalized infants with fatal LOS manifest respiratory, cardiovascular, renal, immune, and hematologic dysfunction. Knowledge of these factors and their timing may be important for the development and testing of novel therapeutics to reduce sepsis mortality.
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Affiliation(s)
- James L. Wynn
- Departments of Pediatrics and Pathology, Immunology, and Experimental Medicine, University of Florida, Gainesville, Florida
| | - Matthew S. Kelly
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | | | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida
| | - Rachel Greenberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Abstract
Neutropenia, usually defined as a blood neutrophil count <1·5 × 109 /l, is a common medical problem for children and adults. There are many causes for neutropenia, and at each stage in life the clinical pattern of causes and consequences differs significantly. I recommend utilizing the age of the child and clinical observations for the preliminary diagnosis and primary management. In premature infants, neutropenia is quite common and contributes to the risk of sepsis with necrotizing enterocolitis. At birth and for the first few months of life, neutropenia is often attributable to isoimmune or alloimmune mechanisms and predisposes to the risk of severe bacterial infections. Thereafter when a child is discovered to have neutropenia, often associated with relatively minor symptoms, it is usually attributed to autoimmune disorder or viral infection. The congenital neutropenia syndromes are usually recognized when there are recurrent infections, the neutropenia is severe and there are congenital anomalies suggesting a genetic disorder. This review focuses on the key clinical finding and laboratory tests for diagnosis with commentaries on treatment, particularly the use of granulocyte colony-stimulating factor to treat childhood neutropenia.
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Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
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34
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Kleiboer B, Gass D. A One-Day-Old Girl With Neutropenia. Clin Pediatr (Phila) 2017; 56:201-203. [PMID: 27215975 DOI: 10.1177/0009922816642742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - David Gass
- 1 Levine Children's Hospital, Charlotte, NC, USA
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35
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Abstract
PURPOSE OF REVIEW Neutropenia lasting for at least for 3 months and not attributable to drugs or a specific genetic, infectious, inflammatory, autoimmune or malignant cause is called chronic idiopathic neutropenia (CIN). CIN and autoimmune neutropenia (AIN) are very similar and overlapping conditions. The clinical consequences depend upon the severity of neutropenia, but it is not considered a premalignant condition. RECENT FINDINGS Long-term observational studies in children indicate that the disease often lasts for 3-5 years in children, then spontaneously remits, but it rarely remits in adult cases. The value of antineutrophil antibody testing in both children and adults is uncertain. Most recent data suggest that CIN and AIN are immune-mediated diseases, but there are no new clinical or genetic tests to aid in diagnosis. Treatment with granulocyte colony stimulating factor (G-CSF) is effective to increase blood neutrophils in almost all cases; this treatment is reserved, however, for patients with both neutropenia and evidence of recurrent fevers, inflammatory symptoms and infections. There is little or no evidence to indicate that G-CSF treatment predisposes to myeloid malignancies in this population. SUMMARY It is important to recognize CIN and AIN, the most common causes of chronic neutropenia in both children and adults. If the neutropenia is not severe, that is more than 0.5 × 10/l, most patients can be observed and not treated prophylactically with antibiotics or a growth factor. When neutropenia is severe, treatment with G-CSF is often beneficial.
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Affiliation(s)
- David C. Dale
- University of Washington, Department of Medicine, Seattle, WA
| | - Audrey Anna Bolyard
- Severe Chronic Neutropenia International Registry, University of Washington, Department of Medicine, Seattle, WA
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Newburger PE. Autoimmune and other acquired neutropenias. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:38-42. [PMID: 27913460 PMCID: PMC5380382 DOI: 10.1182/asheducation-2016.1.38] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This educational review addresses the diagnostic evaluation of patients for autoimmune and other forms of acquired neutropenia, including the futility of deconstructing the overlap of chronic "autoimmune," "benign," and "idiopathic" categories. Isolated neutropenias caused by infection, drugs, and immunologic disorders are also addressed. Discussion of management options emphasizes a conservative approach, with largely supportive care for these mostly benign and self-limited disorders.
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Affiliation(s)
- Peter E Newburger
- Departments of Pediatrics and Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, MA
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Treatment of Congenital Toxoplasmosis: Safety of the Sulfadoxine-Pyrimethamine Combination in Children Based on a Method of Causality Assessment. Pediatr Infect Dis J 2016; 35:634-8. [PMID: 26906163 DOI: 10.1097/inf.0000000000001120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The treatment of newborns and infants with congenital toxoplasmosis is standard practice. Some observational studies have examined safety in newborns, but most of these failed to provide sufficient details for a provisional assessment of causality. The aim of this study was to evaluate the clinical and biological adverse effects of the combination of sulfadoxine-pyrimethamine. METHODS Sixty-five children treated for 1 year with a combination of sulfadoxine-pyrimethamine (1 dose every 10 days) for congenital toxoplasmosis were followed up to evaluate abnormal hematological values and potential adverse events using a standardized method of causality assessment. RESULTS Nine patients (13.8%) presented at least 1 adverse clinical event that was nonspecific, such as diarrhea on the day of drug administration, vomiting and agitation. In 1 patient, erythema appeared at the end of the treatment and resolved within 10 days. None of these events was attributed to the treatment. Six patients (9.2%) developed an adverse hematological event (neutropenia, n = 3; eosinophilia, n = 2 and both anemia and eosinophilia, n = 1) that was considered to be possibly related to the sulfadoxine-pyrimethamine combination. Four treatments were temporarily interrupted, and toxicity was observed after readministration of treatment in 1 case only. However, none of these adverse events was life threatening. CONCLUSIONS According to our results and previously published data, the combination of sulfadoxine-pyrimethamine seems to be well tolerated. However, the sample size of our study was too small to rule out the risk of less frequent, but nevertheless severe, reactions and, in particular, of hypersensitivity reactions.
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Méndez-Domínguez N, Achach-Asaf JA, Basso-García LM, Quiñones-Pacheco YB, Gómez-Carro S. [Septic shock secondary to non-congenital chikungunya fever in a young infant: A clinical case]. ACTA ACUST UNITED AC 2016; 87:143-7. [PMID: 27032486 DOI: 10.1016/j.rchipe.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/20/2016] [Accepted: 02/25/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION A chikungunya outbreak took place in the State of Yucatan starting in the second half of 2015 OBJECTIVE: To analyse the clinical course of a case of chikungunya in a previously healthy infant, providing practical evidence to guide future diagnoses and treatment during outbreak seasons in endemic areas CASE REPORT Clinical manifestation started with a sudden onset of fever and a diffuse macular-papillary erythema, originally treated in the community with non-steroidal anti-inflammatory drugs. Two days later, the fever relapsed with hypoactivity, severe thrombocytopenia and neutropenia (without lymphopenia), respiratory distress, liver dysfunction, sepsis, followed by septic shock with a fatal outcome. IgM test was positive to chikungunya, while her mother tested negative. Pseudomonas aeruginosa was isolated from the blood culture possible due to contamination, without ruling out the possibility of a mixed origin sepsis. CONCLUSIONS Chikungunya is a disease in which the manifestations in neonates and young infants can be severe, and even fatal. It is important to suspect it in this age group at risk of vector contact, in the presence of fever without apparent source of infection and cutaneous manifestations. It is important to use the antipyretics cautiously, considering the possibility of aggravating the underlying infection, and the potential hepatic and haematological damage.
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Affiliation(s)
- Nina Méndez-Domínguez
- Centro de Investigación y de Estudios Avanzados del IPN, Departamento de Ecología Humana, Mérida, Yucatán, México.
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Kumar SKM, Bhat BV. Distinct mechanisms of the newborn innate immunity. Immunol Lett 2016; 173:42-54. [PMID: 26994839 DOI: 10.1016/j.imlet.2016.03.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 12/23/2022]
Abstract
The ontogeny of immunity during early life is of high importance as it shapes the immune system for the entire course of life. The microbiome and the environment contribute to the development of immunity in newborns. As immune responses in newborns are predominantly less experienced they are increasingly susceptible to infections. Though the immune cells in newborns are in 'naïve' state, they have been shown to mount adult-like responses in several circumstances. The innate immunity plays a vital role in providing protection during the neonatal period. Various stimulants have been shown to enhance the potential and functioning of the innate immune cells in newborns. They are biased against the production of pro-inflammatory cytokines and this makes them susceptible to wide variety of intracellular pathogens. The adaptive immunity requires prior antigenic experience which is very limited in newborns. This review discusses in detail the characteristics of innate immunity in newborns and the underlying developmental and functional mechanisms involved in the immune response. A better understanding of the immunological milieu in newborns could help the medical fraternity to find novel methods for prevention and treatment of infection in newborns.
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Affiliation(s)
- S Kingsley Manoj Kumar
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| | - B Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India.
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Abstract
This article reviews and updates the state of the art on the hematologic aspects related to neonatal sepsis in preterm neonates in the neonatal intensive care unit and overviews all hematologic changes occurring during neonatal infections and their implications both as diagnostic and prognostic parameters to guide clinicians at the patients' bedside.
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Affiliation(s)
- Paolo Manzoni
- Division of Neonatology and NICU, Sant'Anna Hospital, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino 10126, Italy.
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Shaver AK, Walkovich K, Connelly JA. Recurrence of Neonatal Lupus Post-Cord Blood Transplant for Severe Congenital Neutropenia. Pediatrics 2015. [PMID: 26195545 DOI: 10.1542/peds.2014-3448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neonatal lupus erythematosus (NLE) is a rare autoimmune disorder associated with transplacental migration of maternal autoantibodies against SS-A (Ro) or SS-B (La) antigens that results in cardiac, hepatic, cutaneous, and hematologic manifestations. Although NLE-associated neutropenia is considered transient and benign, neutropenia caused by severe congenital neutropenia (SCN) is life-threatening. Diagnosing a complicated picture of neonatal neutropenia can be challenging because there are many overlapping features between the acquired and inherited etiologies. This article highlights this diagnostic challenge with a case of delayed diagnosis of SCN due to an initial diagnosis of concurrent NLE. Secondary to SCN refractory to granulocyte colony-stimulating factor, our patient underwent a matched sibling cord blood transplant. Posttransplant, the patient developed recurrence of NLE symptoms, representing the first case of maternally transferred autoantibodies causing symptoms in a cord blood recipient. This novel finding prompted a review of the standards for collecting, processing, and storing of cord blood donations. This article also discusses the importance of physician familiarity with the differences and similarities between publicly and privately banked cord blood donations to adequately counsel expectant parents.
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Affiliation(s)
- Ashley K Shaver
- University of Michigan Medical School, Ann Arbor, Michigan; and
| | - Kelly Walkovich
- University of Michigan Medical School, Ann Arbor, Michigan; and Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Connelly
- University of Michigan Medical School, Ann Arbor, Michigan; and Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
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van den Tooren-de Groot R, Ottink M, Huiskes E, van Rossum A, van der Voorn B, Slomp J, de Haas M, Porcelijn L. Management and outcome of 35 cases with foetal/neonatal alloimmune neutropenia. Acta Paediatr 2014; 103:e467-74. [PMID: 25039288 DOI: 10.1111/apa.12741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/10/2013] [Accepted: 07/08/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to provide an overview of foetal/neonatal alloimmune neutropenia (FNAIN), together with advice on the clinical management. METHODS Neutrophil serology in the Netherlands is centralised at Sanquin Diagnostic Services. We examined FNAIN cases between January 1, 1991, and July 1, 2013, to determine the number of cases diagnosed, the relationship with human neutrophil antigen (HNA) antibody, the clinical presentation and therapeutic interventions. RESULTS We identified 35 FNAIN cases. The detected HNA antibodies were as follows: anti-HNA-1a (n = 7), anti-HNA-1b (n = 12), anti-HNA-1c (n = 2), anti-HNA-2 (n = 8), anti-HNA-3a (n = 1), anti-HNA-5a (n = 1) and anti-FcγRIIIb (n = 4). No infections were diagnosed in 14 neonates, and the other 21 neonates suffered from omphalitis (n = 6), urinary tract infection (n = 1), candida mucositis (n = 1), fever of unknown origin (n = 6) and sepsis (n = 7, 20%). Parity, gestational age, birthweight, neutrophil counts and antibody specificity were not significantly different for cases with, and without, infections. All the infected children were treated with antibiotics. No children died. CONCLUSION More than half (21) of the 35 cases of FNAIN presented with infections and most implicated were HNA-1a, HNA-1b and HNA-2. Treatment with antibiotics seemed adequate. A neonatal neutropenia workflow model for use in neonatal intensive care units is presented.
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Affiliation(s)
| | - Mark Ottink
- Department of Pediatrics Medisch Spectrum Twente; Enschede The Netherlands
| | - Elly Huiskes
- Department of Immunohematology Diagnostics; Sanquin Diagnostic Services; Amsterdam The Netherlands
| | - André van Rossum
- Department of Clinical Chemistry; Bronovo hospital; Den Haag The Netherlands
| | | | - Jennichjen Slomp
- Department of Clinical Chemistry; MEDLON; Enschede The Netherlands
- Department of Clinical Chemistry; Medisch Spectrum Twente; Enschede The Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics; Sanquin Diagnostic Services; Amsterdam The Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics; Sanquin Diagnostic Services; Amsterdam The Netherlands
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