Platelet mass index and prediction of severity of transient tachypnea of the newborn

Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children

Platelet mass index (PMI) as a prognostic indicator in pediatric sepsis has not been previously reported. In this retrospective observational study, we evaluated PMI's performance as a prognostic indicator in children aged younger than 18 years with sepsis and septic shock in relationship with survival. Over 5 years, we collected data from 122 children admitted to our pediatric intensive care unit (PICU). PMI accuracy was assessed with sensitivity and specificity and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Median PMI values on days 1 and 3 of PICU admission were lower among nonsurvivors. On day 1 of PICU admission, a cutoff PMI value of 1,450 fL/nL resulted in a sensitivity of 72% and a specificity of 69%, and the AUC was 0.70 (95% confidence interval [CI]: 0.55-0.86). Similarly, on day 3, a cutoff of 900 fL/nL resulted in a sensitivity of 71% and a specificity of 70%, and the AUC was 0.76 (95% CI: 0.59-0.92). Our exploratory study suggests that low PMI in children with septic shock is associated with increased mortality. Considering the PMI's fair performance, further studies should be performed to assess its clinical value.

Simple Hematological Markers in Predicting the Severity of Transient Tachypnea of Newborn: New Wine in Old Bottles

OBJECTIVES

To evaluate the validity of red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet mass index (PMI) of patients with transient tachypnea of the newborn (TTN), and to find out their roles in predicting severity of TTN.

PATIENTS AND METHODS

In this prospective study, hematological parameters (RDW, PMI) and ratios (NLR, PLR) of 147 patients with TTN and 147 full-term healthy controls were evaluated and compared at birth and at 72nd h of life.

PATIENT

s with TTN and 147 full-term healthy controls were evaluated and compared at birth and at 72nd hours of life.

RESULTS

RDW and NLR were not only significantly higher in patients with TTN at birth (p = 0.001) and at 72nd hours of life (p: 0.001), but also were correlated with days of nasal continuous positive airway pressure therapy, duration of O2 therapy, TTN clinical scores, hospitalization and TTN duration. At a cut-off value of 2.40, NLR had a sensitivity of 82.5% and specificity of 77.5% to predict TTN, the most striking parameter at 72nd hours of life. RDW of 17.75 was also determined as the predictive cutoff value of TTN (sensitivity 72.5%; specificity 67.5%; area under the receiver-operating characteristic curve 0.80; p = 0.001). Multivariate analysis model adjusted for delivery, gestational age, male gender revealed that RDW and NLR were significantly and independently associated with TTN.

CONCLUSION

RDW and NLR both at birth and at 72nd hours of life can be used as biomarkers to distinguish TTN patients from healthy newborns and to predict the severity of TTN.

The use of immature granulocyte and other complete blood count parameters in the diagnosis of transient tachypnea of the newborn

Background

Although Transient tachypnea of the newborn (TTN) is one of the most common causes of respiratory distress in the newborn period, there is no laboratory parameter used to diagnose it. Immatur granulocyte (IG) measurement is accepted as a useful indicator that can be used in early detection of many infectious conditions, especially neonatal sepsis. In this study, it was aimed to determine if IG and other complete blood count (CBC) parameters could be used as laboratory findings supporting TTN diagnosis.

Materials and methods

This study, which was retrospectively planned, was conducted in the neonatal intensive care unit (NICU) a public hospital between January 1, 2019 and January 31, 2021. Randomly selected 50 infants, hospitalized with the diagnosis of TTN, constituted the patient group of the study. 50 infants hospitalized with the diagnosis of hyperbilirubinemia and did not have any additional problems accepted as the control group. IG and other CBC parameters of infants in the patient and control groups were compared in the study.

Results

There was no significant difference between the patient and control groups in terms of demographic data and types of delivery (p > 0.05). The rate of delivery by elective cesarean section (C/S) was significantly higher than the rate of normal spontaneous vaginal (NSV) delivery in the patient group (p < 0.001). The IG number and percentage, WBC (white blood cell) count, RDW (red cell distribution width), number and percentage of NRBC (nucleated red blood cell), neutrophil and lymphocyte ratio, count and percentage of basophil and PLR (platelet/lymphocyte ratio) of the patient group was significantly higher than the control group (p < 0.05).

Conclusion

According to the findings obtained in the study, it was concluded that IG and other CBC parameters may be used to support clinical and imaging findings to diagnose transient tachypnea of the newborn.

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There was no significant difference between the patient and control groups in terms of demographic data and types of delivery.

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The rate of elective cesarean section (C/S) was significantly higher than normal spontaneous vaginal (NSV) delivery in the patient group.

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The IG number and percentage, WBC count, RDW, number and percentage of NRBC, neutrophil and lymphocyte ratio, count and percentage of basophil and PLR of the patient group was significantly higher than the control group.

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IG and other CBC parameters can be useful to support clinical and imaging findings to diagnose TTN.

Carbapenem-Resistant Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit: Risk Factors for Mortality

AIM

The aim of our study was to determine the factors associated with mortality in neonates with carbapenem-resistant Klebsiella pneumoniae (CRKP).

MATERIAL AND METHODS

This retrospective, single-center study was conducted in the Neonatal Intensive Care Unit of Harran University Faculty of Medicine between January 2017 and July 2018 who had CRKP growth in their blood, urine or cerebrospinal fluid cultures. The discharged group was designated as the control group (Group 1), whereas the group that faced mortality was classified as the case group (Group 2). The demographic data, clinical findings and laboratory and microbiological results of the two groups were compared to identify risk factors.

RESULTS

A total of 58 patients (36 in Group 1 and 22 in Group 2) exhibited CRKP growth during the study period. Low birth weight (p = 0.039), previous antifungal (p = 0.002) or amikacin use (p = 0.040), congenital anomalies (p = 0.002), total parenteral nutrition (TPN) administration (p = 0.002), surgery (p = 0.035), thrombocytopenia (p = 0.007), low platelet mass index (p = 0.011), elevated C-reactive protein (p = 0.004), high carbapenem minimum inhibitory concentration (MIC) (p = 0.029) and high amikacin MIC (p = 0.019) were associated with mortality. In a multivariate regression analysis, previous antifungal use (p = 0.028), congenital anomalies (p = 0.032) and TPN use (p = 0.013) were independent factors in predicting mortality.

CONCLUSION

Previous antifungal use, congenital anomalies and TPN use were found to be independent risk factors for mortality in neonates with CRKP infection.