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Huang R, Lu TL, Liu RH. Comparison of the accuracy of hematological parameters in the diagnosis of neonatal sepsis: a network meta-analysis. Infection 2024:10.1007/s15010-024-02354-2. [PMID: 39095667 DOI: 10.1007/s15010-024-02354-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/14/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Currently, there are hundreds of hematological parameters used for rapid diagnosis of neonatal sepsis, but there is no network meta-analysis to compare the diagnostic efficacy of these parameters. METHODS We searched for literature on the diagnostic neonatal sepsis and selected 20 of the most common parameters to compare their diagnostic efficacy. We used Bayesian network meta-analysis, Frequentist network meta-analysis, and individual traditional diagnostic meta-analysis to analyze the data and verify the stability of the results. Based on the above analysis, we ranked the diagnostic efficacy of 20 parameters and searched for the optimal indicator. We also conducted subgroup analysis based on different designs. GRADE was used to evaluate the quality of evidence. RESULTS 311 articles were included in the analysis, of which 206 articles were included in the network meta-analysis. Bayesian models fond the top three of the advantage index were P-SEP, SAA, and CD64. In Individual model, P-SEP, SAA, and CD64 had the best sensitivity; ABC, SAA, and P-SEP had the best specificity. Frequentist model showed that CD64, P-SEP, and IL-10 ranked in the top three for sensitivity, while P-SEP, ABC, and I/M in specificity. Overall, P-SEP, SAA, CD64, and PCT have good sensitivity and specificity among all the three methods. The results of subgroup analysis were consistent with the overall analysis. All evidence was mostly of moderate or low quality. CONCLUSIONS P-SEP, SAA, CD64, and PCT have good diagnostic efficacy for neonatal sepsis. However, further studies are required to confirm these findings.
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Affiliation(s)
- Rong Huang
- Department of Laboratory, Panyu Hexian Memorial Hospital of Guangzhou, Guangzhou, 511400, China
| | - Tai-Liang Lu
- Department of Gastrointestinal Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Ri-Hui Liu
- Medical Insurance Office, Human Resources and Social Security Bureau of Guangzhou's Nansha District, Guangzhou, 511466, China.
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Huncikova Z, Stensvold HJ, Øymar KAA, Vatne A, Lang AM, Støen R, Brigtsen AK, Moster D, Eriksen BH, Selberg T, Rønnestad A, Klingenberg C. Variation in antibiotic consumption in very preterm infants-a 10 year population-based study. J Antimicrob Chemother 2024; 79:143-150. [PMID: 37986613 PMCID: PMC10761275 DOI: 10.1093/jac/dkad358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES Wide variations in antibiotic use in very preterm infants have been reported across centres despite similar rates of infection. We describe 10 year trends in use of antibiotics and regional variations among very preterm infants in Norway. PATIENTS AND METHODS All live-born very preterm infants (<32 weeks gestation) admitted to any neonatal unit in Norway during 2009-18 were included. Main outcomes were antibiotic consumption expressed as days of antibiotic therapy (DOT) per 1000 patient days (PD), regional variations in use across four health regions, rates of sepsis and sepsis-attributable mortality and trends of antibiotic use during the study period. RESULTS We included 5296 infants: 3646 (69%) were born at 28-31 weeks and 1650 (31%) were born before 28 weeks gestation with similar background characteristics across the four health regions. Overall, 80% of the very preterm infants received antibiotic therapy. The most commonly prescribed antibiotics were the combination of narrow-spectrum β-lactams and aminoglycosides, but between 2009 and 2018 we observed a marked reduction in their use from 100 to 40 DOT per 1000 PD (P < 0.001). In contrast, consumption of broad-spectrum β-lactams remained unchanged (P = 0.308). There were large variations in consumption of vancomycin, broad-spectrum β-lactams and first-generation cephalosporins, but no differences in sepsis-attributable mortality across regions. CONCLUSIONS The overall antibiotic consumption was reduced during the study period. Marked regional variations remained in consumption of broad-spectrum β-lactams and vancomycin, without association to sepsis-attributable mortality. Our results highlight the need for antibiotic stewardship strategies to reduce consumption of antibiotics that may enhance antibiotic resistance development.
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Affiliation(s)
- Zuzana Huncikova
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Asbjørn Alexander Øymar
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anlaug Vatne
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
| | - Astri Maria Lang
- Paediatric Department, Akershus University Hospital, Lørenskog, Norway
| | - Ragnhild Støen
- Department of Paediatrics, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Karin Brigtsen
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Dag Moster
- Department of Paediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Beate Horsberg Eriksen
- Department of Paediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje Selberg
- Department of Paediatric and Adolescent Medicine, Ostfold County Hospital, Gralum, Norway
| | - Arild Rønnestad
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Ostfold County Hospital, Gralum, Norway
- Medical Faculty, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claus Klingenberg
- Department of Paediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
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Modrzejewska M, Bosy-Gąsior W, Grzesiak W. Association of Positive Bacterial Cultures Obtained from the Throat, Anus, Ear, Bronchi and Blood in Very-Low-Birth-Weight Premature Infants with Severe Retinopathy of Prematurity-Own Observations. J Clin Med 2023; 12:6374. [PMID: 37835018 PMCID: PMC10573982 DOI: 10.3390/jcm12196374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The causative factors responsible for the development of Retinopathy of Prematurity (ROP) are still unexplored. Therefore, one of the most important factors can be perinatal inflammation. METHODS This retrospective study included 114 premature infants (228 eyes) meeting a birth criteria of ≤ 32 weeks gestational age (GA) and a birth weight (BW) ≤ 1710. Examined Group (EG) n = 51 of BW 852.7 ± 255.7; GA 26.3 ± 2.0 with severe ROP treated by diode laser or anti-VEGF intravitreal injection. Control Group (CG) n = 63 of BW 1313.9 ± 284.5; GA 28.8 ± 1.6 without ROP. Microbiological bacterial and fungal cultures of the ear, anus, bronchial throat and blood were taken. Medical data and laboratory tests in correlation to 3 ROP and A-ROP were analysed. RESULTS Positive bacterial tests dominated in EG, 47% vs. CG, 23%. Significant correlations between positive cultures obtained from natural cavities: anus (p < 0.001), throat (p = 0.002), as well as from blood (p = 0.001) and severe ROP which requires diode laser and anti-VEGF treatment were noted. Significant inflammation markers which correlate with the development of severe ROP are Klebsiella pneumoniae (KP) (p = 0.002) and Coagulase-negative Staphylococci (CoNS) (p < 0.001). CoNS, p < 0.001; KP, p = 0.002; the remaining Maltophilia stenotrophomonas (MS); Staphylococcus aureus (SA), p = 0.005; and Enterobacter cloacae (EC), p = 0.02 were the most frequent bacteria in severe ROP. High levels of white blood cells (WBC), C-reactive protein (CRP), lymphocytes (LYM) and low thrombocytes (PLT) correlated sequentially with (Odds Ratio, OR) CoNS (2.3); MS (5.9); KP (3.1); and all positive cultures (APC) (9.5). An important correlation between the BPD-EC (4.3); intrauterine inflammation-KP (3.4); PDA-EC (3.9); and asphyxia-CoNS (3.0) was identified. CONCLUSIONS It cannot be ruled out that positive microbiological results of blood, anal and pharyngeal cultures may become prognostic markers for the early development of ROP, which would enable early initiation of ophthalmological treatment in premature infants from the VLBW group.
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Affiliation(s)
- Monika Modrzejewska
- Scientific Association of Students, II Department of Ophthalmology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Wiktoria Bosy-Gąsior
- Scientific Association of Students, II Department of Ophthalmology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Wilhelm Grzesiak
- Faculty of Biotechnology and Animal Hysbandry, West-Pomeranian Technological University, Al. Piastów 48, 70-311 Szczecin, Poland;
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Tucker MH, Yeh HW, Oh D, Shaw N, Kumar N, Sampath V. Preterm sepsis is associated with acute lung injury as measured by pulmonary severity score. Pediatr Res 2023; 93:1050-1056. [PMID: 35906303 DOI: 10.1038/s41390-022-02218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sepsis related acute lung injury (ALI) is established in adults but has not been investigated in premature infants. Herein, we used pulmonary severity score (PSS) trajectories and C-reactive protein (CRP) to examine the relation between sepsis and ALI in premature infants. METHODS This retrospective study identified 211 sepsis and 123 rule out (RO) events in 443 infants born <31 weeks and <1500 grams. The PSS was calculated prior to, at the time of, and up to 1 week after each event. Initial and peak CRP values were collected for each event. RESULTS PSS significantly increased at 0 h from baseline (-72h) and remained increased at all subsequent time points (all p < 0.002) in sepsis events. Mean PSS in sepsis episodes were also higher compared to RO events at +24 h, +48 h, +72 h, and +168 h (all p < 0.004). A positive correlation was noted between peak CRP values in sepsis events and PSS at 0 h, +24 h, +48 h, and +72 h. CONCLUSIONS The temporal PSS trends and correlation with CRP levels observed in sepsis but not in RO events supports the hypothesis that neonatal sepsis is associated with ALI and contributes to the accumulating evidence that neonatal ARDS occurs. IMPACT To evaluate pulmonary severity scores and c-reactive protein values over time to establish an association between preterm neonatal sepsis and acute lung injury (ALI). Though sepsis is well established as the most common indirect cause of ALI leading to acute respiratory distress syndrome (ARDS) in adults and pediatrics, this phenomenon remains undefined in neonates. This study validates the proposal by the Neonatal ARDS Project that ARDS also occurs in neonates by demonstrating acute and sustained changes in markers of pulmonary injury temporally related to a diagnosis of neonatal sepsis in preterm infants.
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Affiliation(s)
- Megan Hudson Tucker
- Division of Neonatology, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Hung-Wen Yeh
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Daniel Oh
- University of Missouri at Kansas City School of Medicine, Kansas City, MO, USA
| | - Nicole Shaw
- Division of Neonatology, Hurley Children's Hospital, Flint, MI, USA
| | - Navin Kumar
- Division of Neonatology, Hurley Children's Hospital, Flint, MI, USA
| | - Venkatesh Sampath
- Division of Neonatology, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA
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Elias C, Nogueira PJ, Sousa P. Preterm birth characteristics and outcomes in Portugal, between 2010 and 2018-A cross-sectional sequential study. Health Sci Rep 2023; 6:e1054. [PMID: 36846533 PMCID: PMC9945543 DOI: 10.1002/hsr2.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/23/2022] [Accepted: 12/29/2022] [Indexed: 02/25/2023] Open
Abstract
Introduction According to the World Health Organization, 11% of all children are born prematurely, representing 15 million births annually. An extensive analysis on preterm birth, from extreme to late prematurity and associated deaths, has not been published. The authors characterize premature births in Portugal, between 2010 and 2018, according to gestational age, geographic distribution, month, multiple gestations, comorbidities, and outcomes. Methods A sequential, cross-sectional, observational epidemiologic study was conducted, and data were collected from the Hospital Morbidity Database, an anonymous administrative database containing information on all hospitalizations in National Health Service hospitals in Portugal, and coded according to the ICD-9-CM (International Classification of Diseases), until 2016, and ICD-10 subsequently. Data from the National Institute of Statistics was utilized to compare the Portuguese population. Data were analyzed using R software. Results In this 9-year study, 51.316 births were preterm, representing an overall prematurity rate of 7.7%. Under 29 weeks, birth rates varied between 5.5% and 7.6%, while births between 33 and 36 weeks varied between 76.9% and 81.0%. Urban districts presented the highest preterm rates. Multiple births were 8× more likely preterm and accounted for 37%-42% of all preterm births. Preterm birth rates slightly increased in February, July, August, and October. Overall, respiratory distress syndrome (RDS), sepsis, and intraventricular hemorrhage were the most common morbidities. Preterm mortality rates varied significantly with gestational age. Conclusion In Portugal, 1 in 13 babies was born prematurely. Prematurity was more common in predominantly urban districts, a surprise finding that warrants further studies. Seasonal preterm variation rates also require further analysis and modelling to factor in heat waves and low temperatures. A decrease in the case rate of RDS and sepsis was observed. Compared with previously published results, preterm mortality per gestational age decreased; however, further improvements are attainable in comparison with other countries.
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Affiliation(s)
- Cecília Elias
- Unidade de Saúde Publica Francisco GeorgeACES Lisboa Norte, ARSLVTLisboaPortugal,EPI Task‐Force FMUL, Faculdade de MedicinaUniversidade de LisboaLisboaPortugal
| | - Paulo Jorge Nogueira
- EPI Task‐Force FMUL, Faculdade de MedicinaUniversidade de LisboaLisboaPortugal,NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRCNOVA University LisbonLisbonPortugal,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de MedicinaUniversidade de LisboaLisboaPortugal,Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de MedicinaUniversidade de LisboaLisboaPortugal,Instituto de Saúde Ambiental, Faculdade de MedicinaUniversidade de LisboaLisboaPortugal
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRCNOVA University LisbonLisbonPortugal
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Green EA, Garrick SP, Peterson B, Berger PJ, Galinsky R, Hunt RW, Cho SX, Bourke JE, Nold MF, Nold-Petry CA. The Role of the Interleukin-1 Family in Complications of Prematurity. Int J Mol Sci 2023; 24:2795. [PMID: 36769133 PMCID: PMC9918069 DOI: 10.3390/ijms24032795] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023] Open
Abstract
Preterm birth is a major contributor to neonatal morbidity and mortality. Complications of prematurity such as bronchopulmonary dysplasia (BPD, affecting the lung), pulmonary hypertension associated with BPD (BPD-PH, heart), white matter injury (WMI, brain), retinopathy of prematurity (ROP, eyes), necrotizing enterocolitis (NEC, gut) and sepsis are among the major causes of long-term morbidity in infants born prematurely. Though the origins are multifactorial, inflammation and in particular the imbalance of pro- and anti-inflammatory mediators is now recognized as a key driver of the pathophysiology underlying these illnesses. Here, we review the involvement of the interleukin (IL)-1 family in perinatal inflammation and its clinical implications, with a focus on the potential of these cytokines as therapeutic targets for the development of safe and effective treatments for early life inflammatory diseases.
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Affiliation(s)
- Elys A. Green
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Steven P. Garrick
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Briana Peterson
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Philip J. Berger
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Robert Galinsky
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC 3168, Australia
| | - Rod W. Hunt
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Steven X. Cho
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Jane E. Bourke
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3168, Australia
| | - Marcel F. Nold
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Claudia A. Nold-Petry
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
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Hallmaier-Wacker LK, Andrews A, Nsonwu O, Demirjian A, Hope RJ, Lamagni T, Collin SM. Incidence and aetiology of infant Gram-negative bacteraemia and meningitis: systematic review and meta-analysis. Arch Dis Child 2022; 107:988-994. [PMID: 35710719 PMCID: PMC9606543 DOI: 10.1136/archdischild-2022-324047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND One in six infant deaths worldwide are caused by invasive bacterial infections, of which a substantial but unquantified proportion are caused by Gram-negative bacteria. METHODS We conducted a systematic review of studies published from 31 May 2010 to 1 June 2020 indexed in MEDLINE, Embase and Global Health databases. We performed meta-analyses of the incidence of Gram-negative bacteraemia and of individual Gram-negative species as proportions of all infant bacteraemia, stratified by onset (early vs late) and country income (low/middle vs high). RESULTS 152 studies from 54 countries were included, 60 in high-income countries (HIC) and 92 in low-income/middle-income countries (LMIC). Gram-negatives represented a higher proportion (53%, 95% CI 49% to 57%) of all infant bacteraemia in LMIC compared with HIC (28%, 95% CI 25% to 32%). Incidence of infant Gram-negative bacteraemia was 2.01 (95% CI 1.15 to 3.51) per 1000 live births; it was five times higher in LMIC (4.35, 95% CI 2.94 to 6.43) compared with HIC (0.73, 95% CI 0.39 to 7.5). In HIC, Escherichia coli was the leading Gram-negative pathogen, representing 19.2% (95% CI 15.6% to 23.4%) of early and 7.3% (95% CI 5.3% to 10.1%) of all late-onset bacteraemia; Klebsiella spp were the next most common cause (5.3%) of late-onset bacteraemia. In LMIC, Klebsiella spp caused 16.4% (95% CI 11.5% to 22.7%) of early and 15.0% (95% CI 10.1% to 21.8%) of late-onset bacteraemia, followed by E. coli (early-onset 7.50%, 95% CI 4.98% to 11.1%; late-onset 6.53%, 95% CI 4.50% to 9.39%) and Pseudomonas spp (early-onset 3.93%, 95% CI 2.04% to 7.44%; late-onset 2.81%, 95% CI 1.99% to 3.95%). CONCLUSION E. coli, Klebsiella and Pseudomonas spp cause 20%-28% of early-onset infant bacteraemia and 14% cases of infant meningitis worldwide. Implementation of preventive measures could reduce the high incidence of Gram-negative bacteraemia in LMIC. PROSPERO REGISTRATION NUMBER CRD42020191618.
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Affiliation(s)
- Luisa K Hallmaier-Wacker
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Amelia Andrews
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Olisaeloka Nsonwu
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Alicia Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
- Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Russell J Hope
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Theresa Lamagni
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Simon M Collin
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
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8
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Oumer M, Abebaw D, Tazebew A. Time to recovery of neonatal sepsis and determinant factors among neonates admitted in Public Hospitals of Central Gondar Zone, Northwest Ethiopia, 2021. PLoS One 2022; 17:e0271997. [PMID: 35900981 PMCID: PMC9374017 DOI: 10.1371/journal.pone.0271997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal sepsis is a leading cause of neonatal morbidity and mortality,
particularly in developing countries. Time to recovery is an indicator of
the severity of sepsis, and risk factors varied significantly according to
study population and settings. Moreover, published literature regarding the
time to recovery of neonatal sepsis is scarce. Objective The aim of this study was to assess the time to recovery of neonatal sepsis
and determinant factors among neonates admitted in the Public Hospitals of
Central Gondar Zone, Northwest Ethiopia. Methods An institution-based prospective follow-up study design was conducted among
631 neonates with sepsis. A structured, pre-tested, interviewer-administered
questionnaire was used. The median time to recovery, life-table, the Kaplan
Meier curve, and the log-rank test were computed. Both bi-variable and
multivariable Cox regression models were applied to analyze the data. Results Of all septic neonates, 511 successfully recovered. They were followed for a
total of 4,740-neonate day’s observation and the median time to recovery was
7 days (IQR = 5–10 days). After adjusting for covariates, intrapartum fever
(AHR = 0.69, 95%CI: 0.49, 0.99), induced onset of labor (AHR = 0.68, 95%CI:
0.49, 0.94), chest indrawing (AHR = 0.67, 95%CI: 0.46, 0.99), late onset
sepsis (AHR = 0.55, 95%CI: 0.40, 0.75), non-oral enteral feeding (AHR =
0.38, 95%CI: 0.29, 0.50), assisted with bag and mask (AHR = 0.72, 95%CI:
0.56, 0.93), normal birth weight (AHR = 1.42, 95%CI: 1.03, 1.94),
gestational age of 37–42 weeks (AHR = 1.93, 95%CI: 1.32, 2.84), septic shock
(AHR = 0.08, 95%CI: 0.02, 0.39), infectious complications (AHR = 0.42,
95%CI: 0.29, 0.61), being in critical conditions (AHR = 0.68, 95%CI: 0.52,
0.89), and early recognition of illness (AHR = 1.83, 95%CI: 1.27, 2.63) were
independently associated with the time to recovery of neonatal sepsis. Conclusions and recommendations The time to recovery of this study was moderately acceptable as compared to
the previous studies. The above-mentioned factors could be used for the
early identification of neonates with sepsis at risk for protracted illness
and it could guide prompt referral to higher centers in primary health
sectors. This also will provide prognostic information to clinicians and
families as longer recovery time has economic and social implications in our
country.
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Affiliation(s)
- Mohammed Oumer
- Department of Human Anatomy, School of Medicine, College of Medicine and
Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Dessie Abebaw
- Department of Epidemiology and Biostatistics, Institute of Public Health,
College of Medicine and Health Sciences, University of Gondar, Gondar,
Ethiopia
| | - Ashenafi Tazebew
- Department of Pediatrics and Child Health, School of Medicine, College of
Medicine and Health Sciences, University of Gondar, Gondar,
Ethiopia
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Implementation of a Vancomycin Dose-Optimization Protocol in Neonates: Impact on Vancomycin Exposure, Biological Parameters, and Clinical Outcomes. Antimicrob Agents Chemother 2022; 66:e0219121. [PMID: 35465728 DOI: 10.1128/aac.02191-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Vancomycin dosing used in neonates results frequently in insufficient concentrations. A vancomycin dose-optimization protocol consisting of an individualization of loading and maintenance doses (administered during continuous infusion) through a previously validated pharmacokinetic model was implemented in our center. This monocenter retrospective study aimed to compare vancomycin average concentration (Cavg) in the therapeutic range (15 to 25 mg/L) and biological and clinical parameters before and after implementation of this protocol. A total of 60 and 59 courses of vancomycin treatment in 45 and 49 patients were analyzed in groups before and after implementation, respectively. Initial vancomycin Cavg were more frequently in the therapeutic range in the group after implementation (74.6% versus 28.3%, P < 0.001), with 1.6-fold higher Cavg (20.3 [17.0-22.2] mg/L versus 12.9 [11.3-17.0] mg/L, P < 0.001). Considering all Cavg during longitudinal therapeutic drug monitoring (TDM), the frequency of therapeutic Cavg was higher in the group after implementation (74.8% [n = 103] versus 31% [n = 116], P < 0.001). The dose optimization protocol was also associated with a reduced time to obtain a negative blood culture (P < 0.001) and fewer antibiotic switches (P = 0.025), without increasing the frequency of nephrotoxicity. Clinical outcomes also appeared to be improved, with less periventricular leukomalacia (P = 0.021), trended toward less respiratory instability (P = 0.15) and a shorter duration of vasoactive drug use (P = 0.18) for neonates receiving personalized doses of vancomycin. This personalized vancomycin dose protocol improves vancomycin exposure in neonates, with good safety, and suggests an improvement in biological and clinical outcomes.
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Usuda H, Carter S, Takahashi T, Newnham JP, Fee EL, Jobe AH, Kemp MW. Perinatal care for the extremely preterm infant. Semin Fetal Neonatal Med 2022; 27:101334. [PMID: 35577715 DOI: 10.1016/j.siny.2022.101334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Being born preterm (prior to 37 weeks of completed gestation) is a leading cause of childhood death up to five years of age, and is responsible for the demise of around one million preterm infants each year. Rates of prematurity, which range from approximately 5 to 18% of births, are increasing in most countries. Babies born extremely preterm (less than 28 weeks' gestation) and in particular, in the periviable (200/7-256/7 weeks) period, are at the highest risk of death, or the development of long-term disabilities. The perinatal care of extremely preterm infants and their mothers raises a number of clinical, technical, and ethical challenges. Focusing on 'micropremmies', or those born in the periviable period, this paper provides an update regarding the aetiology and impacts of periviable preterm birth, advances in the antenatal, intrapartum, and acute post-natal management of these infants, and a review of counselling/support approaches for engaging with the infant's family. It concludes with an overview of emerging technology that may assist in improving outcomes for this at-risk population.
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Affiliation(s)
- Haruo Usuda
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan
| | - Sean Carter
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore
| | - Tsukasa Takahashi
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan
| | - John P Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Erin L Fee
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Alan H Jobe
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Perinatal Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH, 45229, USA
| | - Matthew W Kemp
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore; School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, 6150, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan.
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11
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Untargeted 1H-NMR Urine Metabolomic Analysis of Preterm Infants with Neonatal Sepsis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12041932] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
One of the most critical medical conditions occurring after preterm birth is neonatal sepsis, a systemic infection with high rates of morbidity and mortality, chiefly amongst neonates hospitalized in Neonatal Intensive Care Units (NICU). Neonatal sepsis is categorized as early-onset sepsis (EOS) and late-onset sepsis (LOS) regarding the time of the disease onset. The accurate early diagnosis or prognosis have hurdles to overcome, since there are not specific clinical signs or laboratory tests. Herein, a need for biomarkers presents, with the goals of aiding accurate medical treatment, reducing the clinical severity of symptoms and the hospitalization time. Through nuclear magnetic resonance (NMR) based metabolomics, we aim to investigate the urine metabolomic profile of septic neonates and reveal those metabolites which could be indicative for an initial discrimination between the diseased and the healthy ones. Multivariate and univariate statistical analysis between NMR spectroscopic data of urine samples from neonates that developed EOS, LOS, and a healthy control group revealed a discriminate metabolic profile of septic newborns. Gluconate, myo-inositol, betaine, taurine, lactose, glucose, creatinine and hippurate were the metabolites highlighted as significant in most comparisons.
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12
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de Sousa JCS, de Carvalho AVD, Monte de Prada LDC, Marinho AP, de Lima KF, Macedo SKDO, Santos CDP, da Câmara SMA, Barreto ACDNG, Pereira SA. Nutritional Factors Associated with Late-Onset Sepsis in Very Low Birth Weight Newborns. Nutrients 2021; 14:196. [PMID: 35011069 PMCID: PMC8747100 DOI: 10.3390/nu14010196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Delayed onset of minimal enteral nutrition compromises the immune response of preterm infants, increasing the risk of colonization and clinical complications (e.g., late-onset sepsis). This study aimed to analyze associations between late-onset sepsis in very low birth weight infants (<1500 g) and days of parenteral nutrition, days to reach full enteral nutrition, and maternal and nutritional factors. METHODS A cross-sectional study was carried out with very low birth weight infants admitted to a neonatal intensive care unit (NICU) of a reference maternity hospital of high-risk deliveries. Data regarding days of parenteral nutrition, days to reach full enteral nutrition, fasting days, extrauterine growth restriction, and NICU length of stay were extracted from online medical records. Late-onset sepsis was diagnosed (clinical or laboratory) after 48 h of life. Chi-squared, Mann-Whitney tests, and binary logistic regression were applied. RESULTS A total of 97 preterm infants were included. Of those, 75 presented late-onset sepsis with clinical (n = 40) or laboratory (n = 35) diagnosis. Maternal urinary tract infection, prolonged parenteral nutrition (>14 days), and extrauterine growth restriction presented 4.24-fold, 4.86-fold, and 4.90-fold higher chance of late-onset sepsis, respectively. CONCLUSION Very low birth weight infants with late-onset sepsis had prolonged parenteral nutrition and took longer to reach full enteral nutrition. They also presented a higher prevalence of extrauterine growth restriction than infants without late-onset sepsis.
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Affiliation(s)
- Juliany Caroline Silva de Sousa
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Ana Verônica Dantas de Carvalho
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Lorena de Carvalho Monte de Prada
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Arthur Pedro Marinho
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Kerolaynne Fonseca de Lima
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Suianny Karla de Oliveira Macedo
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Camila Dayze Pereira Santos
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | | | - Anna Christina do Nascimento Granjeiro Barreto
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Silvana Alves Pereira
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal 59075-000, Brazil;
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Salimi U, Dummula K, Tucker MH, Dela Cruz CS, Sampath V. Postnatal Sepsis and Bronchopulmonary Dysplasia in Premature Infants: Mechanistic Insights into "New BPD". Am J Respir Cell Mol Biol 2021; 66:137-145. [PMID: 34644520 DOI: 10.1165/rcmb.2021-0353ps] [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] [Indexed: 11/24/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a debilitating disease in premature infants resulting from lung injury that disrupts alveolar and pulmonary vascular development. Despite the use of lung-protective ventilation and targeted oxygen therapy, BPD rates have not significantly changed over the last decade. Recent evidence suggests that sepsis and conditions initiating the systemic inflammatory response syndrome in preterm infants are key risk factors for BPD. However, the mechanisms by which sepsis-associated systemic inflammation and microbial dissemination program aberrant lung development are not fully understood. Progress has been made within the last 5 years with the inception of animal models allowing mechanistic investigations into neonatal acute lung injury and alveolar remodeling due to endotoxemia and NEC. These recent studies begin to unravel the pathophysiology of early endothelial immune activation via pattern recognition receptors such as Toll Like Receptor 4 and disruption of critical lung developmental processes such as angiogenesis, extracellular matrix deposition, and ultimately alveologenesis. Here we review scientific evidence from preclinical models of neonatal sepsis-induced lung injury to new data emerging from clinical literature.
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Affiliation(s)
- Umar Salimi
- Yale University, 5755, Pediatrics, New Haven, Connecticut, United States
| | - Krishna Dummula
- Children's Mercy, 4204, Pediatrics, Kansas City, Missouri, United States
| | - Megan H Tucker
- Children's Mercy, 4204, Pediatrics, Kansas City, Missouri, United States
| | - Charles S Dela Cruz
- Yale University, Pulmonary and Critical Care Medicine, New Haven, Connecticut, United States
| | - Venkatesh Sampath
- Children\'s Mercy Hospitals and Clinics, 4204, Pediatrics, Kansas City, Missouri, United States;
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Shim SY, Cho SJ, Park EA. Neurodevelopmental Outcomes at 18-24 Months of Corrected Age in Very Low Birth Weight Infants with Late-onset Sepsis. J Korean Med Sci 2021; 36:e205. [PMID: 34490752 PMCID: PMC8422039 DOI: 10.3346/jkms.2021.36.e205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Preterm infants are prone to sepsis owing to their immature innate immunity and prolonged hospitalization. We aimed to evaluate the association between late-onset sepsis (LOS) during hospitalization and neurodevelopmental delay at 18-24 months of corrected age in very low birth weight infants (VLBWIs), and to ascertain this association when adjusted for perinatal risk factors. METHODS This is a population-based study of VLBWIs born at 23-32 weeks of gestation between January 2014 and December 2017 who were enrolled in the Korean Neonatal Network. Bayley scales of infant development were evaluated at 18-24 months of corrected age in 2,098 infants. To test for LOS as a risk factor for neurodevelopmental delay, multiple logistic regression was used and adjusted for parental education status and clinical variables. RESULTS Blood culture positive LOS was identified in 419 (20.0%) infants. Cognitive and motor delays were found in 392 (18.7%) and 347 (16.5%) infants, respectively. When multivariate analysis was performed, LOS had a significant association with cognitive delay (odds ratio, 1.48; 95% confidence interval, 1.02-2.16), but no association with motor delay in VLBWIs. Both delays were significantly more frequent in cases of intraventricular hemorrhage (IVH) ≥ grade 3, periventricular leukomalacia (PVL), and intrauterine growth restriction (IUGR) and duration of mechanical ventilation. Male sex and necrotizing enterocolitis ≥ grade 2 had an effect on motor delay, whereas paternal college graduation affected cognitive delay. CONCLUSION In VLBWIs with LOS, there is a heightened risk of cognitive delays at 18-24 months of corrected age. Brain injury, such as severe IVH and PVL, duration of mechanical ventilation, and IUGR, were also associated with cognitive and motor delays.
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Affiliation(s)
- So-Yeon Shim
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea.
| | - Su Jin Cho
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Ae Park
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
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Al-Matary A, Huseynova R, Qaraqe M, Aldandan F. The predictive factors for poor outcomes in preterm infants with coagulase-negative staphylococci infection. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_105_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Nitkin CR, Xia S, Menden H, Yu W, Xiong M, Heruth DP, Ye SQ, Sampath V. FOSL1 is a novel mediator of endotoxin/lipopolysaccharide-induced pulmonary angiogenic signaling. Sci Rep 2020; 10:13143. [PMID: 32753701 PMCID: PMC7403357 DOI: 10.1038/s41598-020-69735-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/16/2020] [Indexed: 01/03/2023] Open
Abstract
Systemic sepsis is a known risk factor for bronchopulmonary dysplasia (BPD) in premature infants, a disease characterized by dysregulated angiogenesis and impaired vascular and alveolar development. We have previoulsy reported that systemic endotoxin dysregulates pulmonary angiogenesis resulting in alveolar simplification mimicking BPD in neonatal mice, but the underlying mechanisms remain unclear. We undertook an unbiased discovery approach to identify novel signaling pathways programming sepsis-induced deviant lung angiogenesis. Pulmonary endothelial cells (EC) were isolated for RNA-Seq from newborn C57BL/6 mice treated with intraperitoneal lipopolysaccharide (LPS) to mimic systemic sepsis. LPS significantly differentially-regulated 269 genes after 6 h, and 1,934 genes after 24 h. Using bioinformatics, we linked 6 h genes previously unknown to be modulated by LPS to 24 h genes known to regulate angiogenesis/vasculogenesis to identify pathways programming deviant angiogenesis. An immortalized primary human lung EC (HPMEC-im) line was generated by SV40 transduction to facilitate mechanistic studies. RT-PCR and transcription factor binding analysis identified FOSL1 (FOS like 1) as a transcriptional regulator of LPS-induced downstream angiogenic or vasculogenic genes. Over-expression and silencing studies of FOSL1 in immortalized and primary HPMEC demonstrated that baseline and LPS-induced expression of ADAM8, CXCR2, HPX, LRG1, PROK2, and RNF213 was regulated by FOSL1. FOSL1 silencing impaired LPS-induced in vitro HPMEC angiogenesis. In conclusion, we identified FOSL1 as a novel regulator of sepsis-induced deviant angiogenic signaling in mouse lung EC and human fetal HPMEC.
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Affiliation(s)
- Christopher R Nitkin
- Division of Neonatology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Sheng Xia
- Division of Neonatology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Heather Menden
- Division of Neonatology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Wei Yu
- Division of Neonatology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Min Xiong
- Division of Experimental and Translational Genetics, Children's Mercy Kansas City, Kansas City, MO, 64108, USA.,Unaffiliated, Kansas City, USA
| | - Daniel P Heruth
- Division of Experimental and Translational Genetics, Children's Mercy Kansas City, Kansas City, MO, 64108, USA
| | - Shui Qing Ye
- Division of Neonatology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Venkatesh Sampath
- Division of Neonatology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
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CLINICAL AND MICROBIOLOGICAL FEATURES OF EARLY-ONSET NEONATAL SEPSIS IN PRETERM INFANTS. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Early-onset neonatal sepsis (EONS) remains the leading cause of morbidity and mortality, especially among premature infants. Conducting high-quality epidemiological monitoring is an important condition for effective tactics treatment neonatal infections and improving the quality of medical care for this category of newborn.
The aim. Determination of the value of microbiological triggers in the blood in various clinical options for EONS in preterm infants.
Materials and methods. Clinical and microbiological data on 50 prematurely born newborns with EONS were selected. The analysis of the frequency of detected bacteremia, the distribution of pathogenic microorganisms and the clinical characteristics of neonatal sepsis.
Results. In the study, sources of infection were detected in 94 % of cases. Positive blood cultures were obtained in 17 (34 %) newborns with EONS. 61.5 % of all cases of bacteremia were caused by coagulase-negative staphylococcus (CoNS). Gram-negative pathogens were detected in 23.5 % of positive blood cultures, representatives of this group were Escherichia coli and Klebsiella pneumonia. The overall mortality rate from EONS was 30 %.
Conclusions. The incidence of sepsis confirmed by a positive blood culture was 34 %. The most common cause of EONS is CoNS, low incidence of group B Streptococcus sepsis has been established. The most frequent septicopymic sources of infection were the lungs, which is expressed in the high incidence (94 %) of X-ray pneumonia in the structure of the EONS.
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The Influence of the Variation in Sepsis Rate between Neonatal Intensive Care Units on Neonatal Outcomes in Very-Low-Birth-Weight Infants. Sci Rep 2020; 10:6687. [PMID: 32317733 PMCID: PMC7174287 DOI: 10.1038/s41598-020-63762-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/06/2020] [Indexed: 12/02/2022] Open
Abstract
Sepsis is commonly known to affect neonatal outcomes. We assessed how much center-to-center variability of the sepsis rate affects the outcomes of very-low-birth-weight infants (VLBWIs). 7,493 VLBWIs registered in the Korean Neonatal Network from 2013 to 2016 were classified into three groups according to the sepsis rate: low sepsis group (LS) < 25th percentile versus intermediate sepsis group (IS) 25th–75th versus high sepsis group (HS) ≥ 75th. The incidence density of sepsis for the LS, IS, and HS groups were 1.17, 3.17, and 8.88 cases/1,000 person-days. After propensity score matching was done for multiple antenatal and perinatal factors, the odds ratio of death, moderate to severe bronchopulmonary dysplasia and/or death, periventricular leukomalacia, and survival without major morbidities for the HS group were 2.0 (95% confidence interval 1.4–2.8), 1.9 (1.5–2.4), 1.5 (1.1–2.3) and 0.7 (0.5–0.8) when compared with the IS group, and 2.2 (1.6–3.2), 2.3 (1.8–2.9), 2.0 (1.3–2.9), and 0.7 (0.6–0.9) when compared with the LS group. There were no significant differences in those outcomes between the LS and IS groups. Hence, nationwide quality improvements to control the sepsis rate especially in units with a high sepsis rate will be helpful to improve the outcomes of VLBWIs.
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Wójkowska-Mach J, Chmielarczyk A, Strus M, Lauterbach R, Heczko P. Neonate Bloodstream Infections in Organization for Economic Cooperation and Development Countries: An Update on Epidemiology and Prevention. J Clin Med 2019; 8:E1750. [PMID: 31640253 PMCID: PMC6832148 DOI: 10.3390/jcm8101750] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
The term neonatal sepsis is used to describe a generalized bloodstream infection of bacterial, viral, or fungal origin which is associated with hemodynamic changes and other clinical symptoms and signs, however, there is no unified definition. There are no basic criteria regarding differentiation of early-onset sepsis (EOS) versus late-onset sepsis (LOS). Stratification used in studies on neonatal sepsis also rarely includes the general condition of the newborn according to unambiguous assessment at birth, which hampers the establishment of a clear, uniform epidemiological description of neonatal sepsis. We aim to review the published data about the epidemiology and microbiology of sepsis in Organization for Economic Cooperation and Development (OECD) countries. Data was also collected on sepsis prevention programs that can be implemented in neonatal units. The outcomes of interest were incidence or incidence density of EOS and LOS, microbiology of EOS and LOS, and data on the methodology of the research, in particular the criteria for inclusion and exclusion of newborns from the study. Pubmed, EMBASE, LILACS Embase, Scopus, and Google Scholar were used. For the preselection step, inclusion criteria included: "bloodstream infection" or "neonatal sepsis" (MesH), "very low birth weight", and "country" full-text studies, human, and English language. Exclusion criteria included: studies published in languages other than English and studies available only as an abstracts. For proper selection, inclusion criteria included: information about epidemiology or microbiology bloodstream infection (BSI), study population and case definitions, exclusion criteria, narrative reviews, commentaries, case studies, pilot studies, study protocols, pediatric studies, and only clinical data (without microbiology or epidemiology) or studies with only one etiological factor analysis. The data review indicated the lack of an unequivocal, unified definition and no unambiguous basic criteria with regard to differentiation of EOS versus LOS. Among infants <1500 g, studies reported an EOS rate from 7% to 2%. For studies using other definitions (mostly all inborn babies), the rate of EOS ranged from 1% to 3%. The LOS incidences were much more varied among countries; the highest rates were in the multicenter studies focused on very low birth weight (VLBW) infants. The main pathogens in EOS are GBS and Gram-negative bacteria in LOS. Our review data shows that LOS microbiology is very diverse and that Gram-positive cocci, especially staphylococci, predominate versus Gram-negative rods. Unfortunately, the lack of uniform, international prevention programs results in high newborn morbidity and insufficient postnatal prevention of late-onset infections.
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Affiliation(s)
- Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
| | - Agnieszka Chmielarczyk
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
| | - Magdalena Strus
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
| | - Ryszard Lauterbach
- Neonatology Clinic, University Hospital, Jagiellonian University Medical College, 31-121 Kraków, Poland.
| | - Piotr Heczko
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
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Huang J, Tang Y, Zhu T, Li Y, Chun H, Qu Y, Mu D. Cumulative evidence for association of sepsis and retinopathy of prematurity. Medicine (Baltimore) 2019; 98:e17512. [PMID: 31626109 PMCID: PMC6824763 DOI: 10.1097/md.0000000000017512] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease affected by multiple factors such as infection and preterm birth. The role of sepsis in the development of ROP remains controversial. This systematic review and meta-analysis aimed to identify the impact of sepsis on ROP. METHODS The PubMed, Embase, and Cochrane Library databases were searched using terms related to sepsis and ROP. Cohort or case-control studies that reported the association of sepsis and ROP were eligible. The odds ratios (ORs) together with the 95% confidence interval (CI) were extracted from the studies or computed by authors if not provided. RESULTS Thirty-four studies were ultimately included in this meta-analysis. The pooled results showed that sepsis increased the risk for the development of any stage ROP (OR = 2.16; 95% CI: 1.65-2.82). Both early onset (OR = 2.50; 95% CI: 1.97-3.18) and late-onset (OR = 1.37; 95% CI: 1.22-1.55) sepsis were associated with severe ROP. Furthermore, both bacterial sepsis (OR = 1.74; 95% CI: 1.21-2.50) and fungal sepsis (OR = 2.96; 95% CI: 2.05-4.28) were also found to be associated with severe ROP. CONCLUSION Sepsis increased the risk of any stage ROP, especially for the severe ROP. Further high-quality clinical studies are needed to eliminate heterogeneity and publication bias to validate these findings.
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Affiliation(s)
- Jichong Huang
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education
| | - Ying Tang
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Tingting Zhu
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education
| | - Yafei Li
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education
| | - Hua Chun
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education
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Kachikis A, Walker CL, McAdams RM, Gyamfi-Bannerman C, Adams Waldorf KM. Phenotypic overlap in neonatal respiratory morbidity following preterm premature rupture of membranes versus spontaneous preterm labor. J Matern Fetal Neonatal Med 2019; 34:1941-1948. [PMID: 31402735 DOI: 10.1080/14767058.2019.1651280] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD), a major source of morbidity in premature neonates, has been associated with intrauterine infection and preterm birth. Both preterm premature rupture of membranes (PPROM) and spontaneous preterm labor (sPTL) are linked with intrauterine inflammation. Whether PPROM and sPTL, as two phenotypic categories of preterm birth, are associated with exposure to different degrees and durations of inflammation that might impact fetal lung development is unknown. PPROM may be associated with longer latency until delivery, which is beneficial for neonatal mortality, but may impart greater injury risk to the developing fetal lungs. It is unknown if PPROM is associated with a greater risk of adverse neonatal respiratory outcomes than sPTL. OBJECTIVE The objective of this study was to determine if PPROM imparts a differentially greater risk for neonatal BPD than sPTL. A secondary objective was to determine if PPROM was associated with a greater risk of adverse neonatal respiratory outcomes other than BPD and whether gestational latency following PPROM or sPTL diagnosis constitutes a risk factor for fetal lung injury. STUDY DESIGN We conducted a retrospective secondary analysis of a large cohort of women at risk for spontaneous preterm birth, who were originally enrolled in a randomized controlled trial of magnesium sulfate versus placebo examining neuroprotection. For our study, we included women with a singleton pregnancy complicated by PPROM or sPTL and delivery between 24 and 34 weeks gestational age. Cases with multiple gestation, congenital anomalies, maternal seropositivity for human immunodeficiency virus, or hypertensive diseases of pregnancy (including preeclampsia) were excluded. The primary outcome was BPD. Secondary outcomes were respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), requirement for mechanical ventilation, pneumonia, neonatal sepsis, fetal or neonatal death, and a composite of adverse neonatal respiratory outcomes including (BPD, pneumonia, RDS, and TTN). Statistical analyses included chi-square, Student's t-test and logistic and multiple regression. RESULTS A total of 1729 women were included in this analysis including 1554 with PPROM and 175 with sPTL. Women in the PPROM group were more likely to be older, not of Hispanic race, married, more educated, have smoked during pregnancy and have a greater body mass index. The BPD rate was not significantly different following PPROM versus sPTL. Neonates in the PPROM group experienced a lower rate of pneumonia (p = .001), neonatal sepsis (p = .009) and patent ductus arterious (PDA) requiring either medical or surgical therapy (p < .001) than neonates in the sPTL group. Chorioamnionitis was more common in the PPROM group (p = .008) than the sPTL group. After multivariable logistic regression with BPD or composite of adverse neonatal respiratory outcomes as the dependent outcomes, and controlling for gestational age at delivery, maternal smoking history, duration of mechanical ventilation and RDS, there was no significant difference between PPROM and sPTL. CONCLUSIONS BPD rates were not significantly different in neonates born to women following PPROM versus sPTL. However, PPROM was associated with lower rates of pneumonia, neonatal sepsis, and PDA requiring therapy in the univariate analysis, but not the multivariate analysis. Neonatal respiratory outcomes may have a similar phenotypic overlap regardless of whether preterm birth follows PPROM or sPTL.
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Affiliation(s)
- Alisa Kachikis
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Christie L Walker
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Ryan M McAdams
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | | | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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22
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Siffel C, Kistler KD, Lewis JFM, Sarda SP. Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review. J Matern Fetal Neonatal Med 2019; 34:1721-1731. [PMID: 31397199 DOI: 10.1080/14767058.2019.1646240] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infants born extremely preterm (<28 weeks gestational age (GA)) face a high risk of neonatal mortality. Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity. OBJECTIVE To evaluate the global incidence of BPD among infants born extremely preterm. DESIGN A systematic review of the literature was conducted in Embase and MEDLINE (via PubMed) using a prespecified search strategy for BPD and prematurity. Observational studies published in English between 16 May 2006 and 16 October 2017 reporting on the occurrence of BPD in infants born <28 weeks GA were included. RESULTS Literature searches yielded 103 eligible studies encompassing 37 publications from Europe, 38 publications from North America, two publications from Europe and North America, 19 publications from Asia, one publication from Asia and North America, six publications from Oceania, and zero publications from Africa or South America. The reported global incidence range of BPD was 10-89% (10-73% in Europe, 18-89% in North America, 18-82% in Asia, and 30-62% in Oceania). When only population-based observational studies that defined BPD as requiring supplemental oxygen at 36 weeks postmenstrual age were included, the global incidence range of BPD was 17-75%. The wide range of incidences reflected interstudy differences in GA (which was inversely related to BPD incidence), birthweight, and survival rates across populations and institutions. CONCLUSIONS BPD is a common health morbidity occurring with extremely preterm birth. Further study of factors that impact incidence, aside from low GA, may help to elucidate modifiable risks.
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Affiliation(s)
- Csaba Siffel
- Takeda, Lexington, MA, USA.,College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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23
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Suffolk R, Agertoft L, Johansen M, Zachariassen G. Late-onset group B streptococcus infections and severe bronchopulmonary dysplasia in an extremely preterm born infant. BMJ Case Rep 2019; 12:12/7/e229255. [DOI: 10.1136/bcr-2019-229255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.
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Adams M, Bassler D. Practice variations and rates of late onset sepsis and necrotizing enterocolitis in very preterm born infants, a review. Transl Pediatr 2019; 8:212-226. [PMID: 31413955 PMCID: PMC6675686 DOI: 10.21037/tp.2019.07.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/08/2019] [Indexed: 01/01/2023] Open
Abstract
The burden of late onset sepsis (LOS) and necrotizing enterocolitis (NEC) remains high for newborns in low- and high-income countries. Very preterm born infants born below 32 weeks gestation are at highest risk because their immune system is not yet adapted to ex-utero life, providing intensive care frequently compromises their skin or mucosa and they require a long duration of hospital stay. An epidemiological overview is difficult to provide because there is no mutually accepted definition available for either LOS or NEC. LOS incidence proportions are generally reported based on identified blood culture pathogens. However, discordance in minimum day of onset and whether coagulase negative staphylococci or fungi should be included into the reported proportions lead to variation in reported incidences. Complicating the comparison are the absence of biomarkers, ancillary lab tests or prediction models with sufficiently high positive and/or negative predictive values. The only high negative predictive values result from negative blood culture results with negative lab results allowing to discontinue antibiotic treatment. Similar difficulties exist in reporting and diagnosing NEC. Although most publications base their proportions on a modified version of Bell's stage 2 or 3, comparisons are made difficult by the multifactorial nature of the disease reflecting several pathways to intestinal necrosis, the absence of a reliable biomarker and the unclear differentiation from spontaneous intestinal perforations. Comparable reports in very low birthweight infants range between 5% and 30% for LOS and 1.6% to 7.1% for NEC. Evidence based guidelines to support treatment are missing. Treatment for LOS remains largely empirical and focused mainly on antibiotics. In the absence of a clear diagnosis, even unspecific early warning signals need to be met with antibiotic treatment. Cessation after negative blood culture is difficult unless the child was asymptomatic from the beginning. As a result, antibiotics are the most commonly prescribed medications, but unnecessary exposure may result in increased risk for mortality, NEC, further infections and childhood obesity or asthma. Finding ways to limit antibiotic use are thus important and have shown a large potential for improvement of care and limitation of cost. Over recent decades, none of the attempts to establish novel therapies have succeeded. LOS and NEC proportions remained mostly stable. During the past 10 years however, publications emerged reporting a reduction, sometimes by almost 50%. Most concern units participating in a surveillance system using quality improvement strategies to prevent LOS or NEC (e.g., hand hygiene, evidence based "bundles", feeding onset, providing own mother's milk). We conclude that these approaches display a potential for wider spread reduction of LOS and NEC and for a subsequently more successful development of novel therapies as these often address the same pathways as the prevention strategies.
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Affiliation(s)
- Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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25
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Nugud AA, Nugud S, Nugud A, Nugud AA, Kathamuthu R, Jalal M. Perinatal risk factors for development of retinopathy of prematurity in a tertiary neonatal intensive care unit. J Taibah Univ Med Sci 2019; 14:306-311. [PMID: 31435422 PMCID: PMC6694889 DOI: 10.1016/j.jtumed.2019.05.001] [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] [Received: 01/28/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Retinopathy of prematurity (ROP) is a vasoproliferative disorder that is one of the main preventable causes of blindness among preterm neonates. This study aimed to determine the incidence of ROP and investigate the relationship between perinatal risk factors and ROP development. METHODS This retrospective, non-interventional, non-comparative, hospital-based study was conducted at a tertiary-level neonatal intensive care unit. A total of 163 consecutive patients who met the inclusion criteria were recruited in this study. RESULTS ROP prevalence was 0.01. During the study period, 44 patients developed ROP (27%), and 119 (73%) did not. Stage I ROP was detected in 8 patients (4.9%); stage II ROP without plus-disease in 26 patients (16%); stage II disease with comorbidities in 1 patient (0.6%); and stage III disease in 9 patients (5.5%). None of the patients showed stage IV and V disease. The mean gestational age was 27.7 ± 2.08 weeks in babies who had ROP and 29.59 ± 1.80 weeks in the other group. Neonates with ROP required more frequent blood transfusion (average, 4.89 ± 3.164 transfusions) compared to their counterparts who received an average of 1.19 ± 1.733 transfusions. Intracranial haemorrhage was identified in 55 (33.7%) patients, of whom 14.1% had ROP. Moreover, neonatal seizures occurred in 23 (14.11%) babies and were more common among babies who had ROP (n = 14). CONCLUSION This study identified key factors associated with ROP, such as intracranial haemorrhage with or without neonatal seizures and a high frequency of blood transfusions.
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Affiliation(s)
- Alaa A. Nugud
- Latifa Women and Children Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Shomous Nugud
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ahmed Nugud
- Aljalila Children's Specialty Hospital, Dubai Health Care City, Dubai, United Arab Emirates
| | - Assmaa A. Nugud
- Ras Al Khaimah Medical and Health Sciences University, RAK, United Arab Emirates
| | - Raja Kathamuthu
- Dubai Hospital Quality & Development Office, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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26
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Cantey JB, Anderson KR, Kalagiri RR, Mallett LH. Morbidity and mortality of coagulase-negative staphylococcal sepsis in very-low-birth-weight infants. World J Pediatr 2018. [PMID: 29536341 DOI: 10.1007/s12519-018-0145-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in the neonatal intensive care unit (NICU) and usually require vancomycin treatment. Our objective was to determine whether CoNS are associated with neonatal morbidity and mortality. METHODS This was a retrospective cohort study of very-low-birth-weight (VLBW, ≤ 1500 g) infants from 1989 to 2015. Exclusion criteria were major congenital anomaly or death within 72 h. CoNS was considered a pathogen if recovered from ≥ 2 cultures, or 1 culture if treated for ≥ 5 days and signs of sepsis were present. Logistic regression was used to examine factors associated with morbidity and mortality. RESULTS Of 2242 VLBW infants, 285 (12.7%) had late-onset sepsis. CoNS (125, 44%), Staphylococcus aureus (52, 18%), and Escherichia coli (36, 13%) were the most commonly recovered organisms. In multivariate analysis, CoNS sepsis was not associated with mortality [OR 0.6 (95% CI 0.2-2.6)), but sepsis with other organisms was [OR 4.5 (95% CI 2.6-8.0)]. CoNS sepsis was associated with longer hospitalization but not risk for bronchopulmonary dysplasia, intraventricular hemorrhage, or retinopathy of prematurity. CONCLUSION CoNS sepsis was not associated with mortality or morbidities other than length of stay. These findings support vancomycin-reduction strategies in the NICU.
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Affiliation(s)
- Joseph B Cantey
- Department of Pediatrics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | | | - Ram R Kalagiri
- Texas A&M Health Science Center, Baylor/Scott & White Health, Temple, TX, USA
| | - Lea H Mallett
- Texas A&M Health Science Center, Baylor/Scott & White Health, Temple, TX, USA
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27
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Shin HB, Yu NL, Lee NM, Yi DY, Yun SW, Chae SA, Lim IS. Predictive Factors for Severe Thrombocytopenia and Classification of Causes of Thrombocytopenia in Premature Infants. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hoon Bum Shin
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Na Li Yu
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Na Mi Lee
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Ahn Chae
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Seok Lim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
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28
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Chorioamnionitis and subsequent bronchopulmonary dysplasia in very-low-birth weight infants: a 25-year cohort. J Perinatol 2016; 36:1045-1048. [PMID: 27583395 DOI: 10.1038/jp.2016.138] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/26/2016] [Accepted: 08/01/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether chorioamnionitis (CA) or sepsis were associated with bronchopulmonary dysplasia (BPD) in a 25-year cohort of very-low-birth weight (VLBW) infants. STUDY DESIGN VLBW infants ⩽32 weeks gestation admitted to the neonatal intensive care unit between 1989 and 2014 were reviewed. BPD was defined using the National Institutes of Health consensus definition. CA was defined clinically. Logistic regression models were used for BPD prediction. RESULTS One thousand six hundred and eighty-seven infants were included; 44% (n=740) had moderate or severe BPD. In multivariable analysis, lower gestational age (odds ratio (OR) 1.12 per week (95% confidence interval (CI) 1.11, 1.14)), sepsis (OR 2.03 (95% CI 1.49, 2.77)) and birth year ⩾1995 (OR 1.49 (95% CI 1.09, 2.04)) were significant predictors of BPD. CA was not associated with BPD (OR 1.18 (95% CI 0.66, 2.11)). CONCLUSION Sepsis, but not CA, is associated with the development of moderate or severe BPD in VLBW infants after controlling for gestational age.
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29
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Tarr PI, Warner BB. Gut bacteria and late-onset neonatal bloodstream infections in preterm infants. Semin Fetal Neonatal Med 2016; 21:388-393. [PMID: 27345372 DOI: 10.1016/j.siny.2016.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Late-onset neonatal bloodstream infections remain challenges in neonatology. Hand hygiene, line care, and judicious use of indwelling lines are welcome interventions, but might not reduce the incidence of late-onset neonatal bloodstream infections from bacteria originating in the gut. Accumulating data suggest that many pathogens causing late-onset neonatal bloodstream infections are of gut origin, including Gram-positive cocci. In addition to the host-canonical paradigm (i.e., all bacteria have equal risk of invasion and bloodstream infections are functions of variable infant susceptibility), we should now consider bacteria-canonical paradigms, whereby late-onset neonatal bloodstream infection is a function of colonization with a specific subset of bacteria with exceptional invasive potential. In either event, we can no longer be content to reactively approach late-onset neonatal bloodstream infections; instead we need to reduce the occurrences of these infections by broadening our scope of effort beyond line care, and determine the pre-invasive habitat of these pathogens.
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Affiliation(s)
- Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Pathobiology Research Unit, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
| | - Barbara B Warner
- Fetal Center, Division of Newborn Medicine, Washington University School of Medicine, St Louis, MO, USA
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30
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Bird SD. Artificial placenta: Analysis of recent progress. Eur J Obstet Gynecol Reprod Biol 2016; 208:61-70. [PMID: 27894031 DOI: 10.1016/j.ejogrb.2016.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/18/2016] [Accepted: 11/10/2016] [Indexed: 12/18/2022]
Abstract
The artificial placenta (AP) has for many decades captured the imagination of scientists and authors with popular fiction including The Matrix and Aldous Huxley's "Brave New World", depicting a human surviving ex-utero in an artificial uterine environment (AUE). For scientists this has fascinated as a way forward for extremely preterm infants (EPIs) born less than 28 weeks of gestation. Early successes with mechanical ventilation (MV) for infants born above 28 weeks of gestation meant that AP research lost momentum. More recently, the gestational age limit for survival now borders on 23 weeks and corresponds to the biological milestone of lung development marked by the early canalicular stage of lung morphogenesis. The so called greyzone of 23-25 weeks represents a steep increase in mortality with decreasing gestational age and current options in neonatal care are on the fringes of efficacy for this population. A shift in thinking recognizes the vitality of EPIs as a fetus rather than a 37-40 week neonate and this has reinvigorated the concept of the AP. This review will discuss the scale of extreme preterm birth with special reference to previable infants born in the greyzone. Recent AP studies using sheep models are compared, technical obstacles discussed and future research themes identified.
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Affiliation(s)
- Stephen D Bird
- Department of Obstetrics and Gynaecology, The University of Melbourne, Australia.
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31
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Turan M, Ekin S, Ucler R, Arısoy A, Bayram Y, Yalınkılıç A, Bozan N, Garca MF, Çankaya H. Effect of inhaled steroids on laryngeal microflora. Acta Otolaryngol 2016; 136:699-702. [PMID: 26901427 DOI: 10.3109/00016489.2016.1146409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Conclusions As is known, this study is the first study to evaluate the effect of inhaled steroids on laryngeal microflora. The data support that ICS usage causes changes in the larynx microflora. Purpose The aim of this study was to determine the alteration in larynx microbial flora of the patients treated with ICS comparing the culture results of a control group. In addition, laryngeal microflora was compared to the smears obtained from the vallecula and pharynx. Materials and methods The study included 39 patients (mean age = 45.56 ± 12.76 years) who had been using a corticosteroid inhaler and control group consisting of 27 persons (mean age = 43.07 ± 13.23 years). Culture samples were obtained from the pharynx, larynx, and vallecula in the patient and control groups, and they were evaluated in the microbiology laboratory. Obtained culture results were named by the same microbiologist according to the basic microorganism classification method. Results Coagulase-negative staphylococci (CNS), Streptococcus viridians (VGS) and candida albicans were detected to grow significantly more in the patient group in all three anatomic localizations compared to the control group. Neisseria spp, basillus spp, and Non-viridans alpha-hemolytic streptococcus were detected to grow significantly more in the control group in all three anatomic localizations compared to the patient group.
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Affiliation(s)
- Mahfuz Turan
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Selami Ekin
- b Department of Chest Disease , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Rıfkı Ucler
- c Department of Endocrinology and Metabolism , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Ahmet Arısoy
- b Department of Chest Disease , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Yasemin Bayram
- d Department of Medical Microbiology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Abdulaziz Yalınkılıç
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Nazım Bozan
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Mehmet Fatih Garca
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Hakan Çankaya
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
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Sathiyamurthy S, Banerjee J, Godambe SV. Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review. World J Clin Pediatr 2016; 5:159-171. [PMID: 27170926 PMCID: PMC4857229 DOI: 10.5409/wjcp.v5.i2.159] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/24/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
Infants in the neonatal intensive care unit are highly susceptible to healthcare associated infections (HAI), with a substantial impact on mortality, morbidity and healthcare costs. Effective skin disinfection with topical antiseptic agents is an important intervention in the prevention or reduction of HAI. A wide array of antiseptic preparations in varying concentrations and combinations has been used in neonatal units worldwide. In this article we have reviewed the current evidence of a preferred antiseptic of choice over other agents for topical skin disinfection in neonates. Chlorhexidine (CHG) appears to be a promising antiseptic agent; however there exists a significant concern regarding the safety of all agents used including CHG especially in preterm and very low birth weight infants. There is substantial evidence to support the use of CHG for umbilical cord cleansing and some evidence to support the use of topical emollients in reducing the mortality in infants born in developing countries. Well-designed large multicentre randomized clinical trials are urgently needed to guide us on the most appropriate and safe antiseptic to use in neonates undergoing intensive care, especially preterm infants.
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Samardzic J, Allegaert K, Wilbaux M, Pfister M, van den Anker JN. Quantitative clinical pharmacology practice for optimal use of antibiotics during the neonatal period. Expert Opin Drug Metab Toxicol 2016; 12:367-75. [PMID: 26817821 DOI: 10.1517/17425255.2016.1147559] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION For safe and effective neonatal antibiotic therapy, knowledge of the pharmacokinetic parameters of antibacterial agents in neonates is a prerequisite. Fast maturational changes during the neonatal period influence pharmacokinetic and pharmacodynamic parameters and their variability. Consequently, the need for applying quantitative clinical pharmacology and determining optimal drug dosing regimens in neonates has become increasingly recognized. AREAS COVERED Modern quantitative approaches, such as pharmacometrics, are increasingly utilized to characterize, understand and predict the pharmacokinetics of a drug and its effect, and to quantify the variability in the neonatal population. Individual factors, called covariates in modeling, are integrated in such approaches to explain inter-individual pharmacokinetic variability. Pharmacometrics has been shown to be a relevant tool to evaluate, optimize and individualize drug dosing regimens. EXPERT OPINION Challenges for optimal use of antibiotics in neonates can largely be overcome with quantitative clinical pharmacology practice. Clinicians should be aware that there is a next step to support the clinical decision-making based on clinical characteristics and therapeutic drug monitoring, through Bayesian-based modeling and simulation methods. Pharmacometric modeling and simulation approaches permit us to characterize population average, inter-subject and intra-subject variability of pharmacokinetic parameters such as clearance and volume of distribution, and to identify and quantify key factors that influence the pharmacokinetic behavior of antibiotics during the neonatal period.
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Affiliation(s)
- Janko Samardzic
- a Institute of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty , University of Belgrade , Belgrade , Serbia.,b Division of Paediatric Pharmacology and Pharmacometrics , University of Basel Children's Hospital , Basel , Switzerland
| | - Karel Allegaert
- c Department of Development and Regeneration , KU Leuven , Leuven , Belgium.,d Intensive Care and Department of Pediatric Surgery , Erasmus MC Sophia Children's Hospital , Rotterdam , the Netherlands
| | - Mélanie Wilbaux
- b Division of Paediatric Pharmacology and Pharmacometrics , University of Basel Children's Hospital , Basel , Switzerland
| | - Marc Pfister
- b Division of Paediatric Pharmacology and Pharmacometrics , University of Basel Children's Hospital , Basel , Switzerland
| | - John N van den Anker
- b Division of Paediatric Pharmacology and Pharmacometrics , University of Basel Children's Hospital , Basel , Switzerland.,d Intensive Care and Department of Pediatric Surgery , Erasmus MC Sophia Children's Hospital , Rotterdam , the Netherlands.,e Division of Pediatric Clinical Pharmacology , Children's National Medical Center , Washington , DC , USA
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Participative Facility Planning for Obstetrical and Neonatal Care Processes: Beginning of Life Process. JOURNAL OF HEALTHCARE ENGINEERING 2016; 2016:7836493. [PMID: 29062469 PMCID: PMC5168447 DOI: 10.1155/2016/7836493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/03/2016] [Accepted: 11/14/2016] [Indexed: 11/17/2022]
Abstract
Introduction. Old hospitals may promote inefficient patient care processes and safety. A new, functionally planned hospital presents a chance to create an environment that supports streamlined, patient-centered healthcare processes and adapts to users' needs. This study depicts the phases of a facility planning project for pregnant women and newborn care processes (beginning of life process) at Turku University Hospital. Materials and Methods. Project design reports and meeting documents were utilized to assess the beginning of life process as well as the work processes of the Women's and Children's Hospital. Results. The main elements of the facility design (FD) project included rigorous preparation for the FD phase, functional planning throughout the FD process, and setting key values: (1) family-centered care, (2) Lean thinking and Lean tools as the framework for the FD process, (3) safety, and (4) cooperation. Conclusions. A well-prepared FD project with sufficient insight into functional planning, Lean thinking, and user-centricity seemed to facilitate the actual FD process. Although challenges occurred, the key values were not forgone and were successfully incorporated into the new hospital building.
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