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Li W, Zhang C, Li W, Qin F, Gao X, Xu F. Nomogram for predicting fulminant necrotizing enterocolitis. Pediatr Surg Int 2023; 39:154. [PMID: 36939896 PMCID: PMC10027821 DOI: 10.1007/s00383-023-05435-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Fulminant necrotizing enterocolitis (FNEC) is the most serious subtype of NEC and has a high mortality rate and a high incidence of sequelae. Onset prediction can help in the establishment of a customized treatment strategy. This study aimed to develop and evaluate a predictive nomogram for FNEC. METHODS We conducted a retrospective observation to study the clinical data of neonates diagnosed with NEC (Bell stage ≥ IIB). Neonates were divided into the FNEC and NEC groups. A multivariate logistic regression model was used to construct the nomogram model. The performance of the nomogram was assessed using area under the curve, calibration analysis, and decision curve analysis. RESULTS A total of 206 neonate cases were included, among which 40 (19.4%) fulfilled the definition of FNEC. The identified predictors were assisted ventilation after NEC onset; shock at NEC onset; feeding volumes before NEC onset; neutrophil counts on the day of NEC onset; and neutrophil, lymphocyte, and monocyte counts on day 1 after NEC onset. The nomogram exhibited good discrimination, with an area under the receiver operating characteristic curve of 0.884 (95% CI 0.825-0.943). The predictive model was well calibrated. Decision curve analysis confirmed the clinical usefulness of this nomogram. CONCLUSION A nomogram with a potentially effective application was developed to facilitate the individualized prediction of FNEC, with the hope of providing further direction for the early diagnosis of FNEC and timing of intervention.
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Affiliation(s)
- Weibo Li
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Branch Center of the Third Affiliated Hospital of Advanced Medical Research Center of Zhengzhou University, Zhengzhou, Henan, China
| | - Chen Zhang
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Branch Center of the Third Affiliated Hospital of Advanced Medical Research Center of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenli Li
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Branch Center of the Third Affiliated Hospital of Advanced Medical Research Center of Zhengzhou University, Zhengzhou, Henan, China
| | - Fanyue Qin
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Branch Center of the Third Affiliated Hospital of Advanced Medical Research Center of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiang Gao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Falin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- Branch Center of the Third Affiliated Hospital of Advanced Medical Research Center of Zhengzhou University, Zhengzhou, Henan, China.
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Qin F, Yuan M, Zhang C, Zhu C, Dong H, Xu F. Association of neutropenia at disease onset with severe surgical necrotizing enterocolitis and higher mortality: A retrospective study. Front Surg 2022; 9:971898. [PMID: 36303851 PMCID: PMC9592859 DOI: 10.3389/fsurg.2022.971898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Neutrophils are among the earliest immune cells recruited to the site of an intestinal injury, but their predictive role in the progression of necrotizing enterocolitis (NEC) has not been fully elucidated. This study aimed to evaluate if a reduction in neutrophils at the onset of NEC is associated with severe surgical NEC and/or NEC-associated deaths. Methods This is a retrospective cohort study in which neonates underwent surgery due to NEC during 2015-2020. The data on absolute neutrophil count (ANC), before and at the onset of NEC, were collected from the complete blood count results. The primary exposure was the difference in absolute neutrophil count (ΔANC) at NEC onset. The primary outcome was severe surgical NEC, defined as the residual small bowel length after intestinal resection of <30 cm. Results A total of 157 neonates were included in this study, of which 53 were diagnosed with severe surgical NEC. A decrease in ANC at the onset of NEC was associated with an increased probability of severe surgical NEC (crude odds ratio [OR] 1.248, 95% CI 1.107-1.407; P = 0.000). ΔANC (area under the curve [AUC] 0.729, 95% CI 0.653-0.797; P < 0.001] was a good predictor for severe surgical NEC. The addition of platelets to ΔANC at NEC onset (AUC 0.738, 95% CI 0.662-0.808; P < 0.001) resulted in a higher AUC and specificity for severe surgical NEC prediction than ΔANC alone. A reduction in the neutrophil count at NEC onset (ΔANC > 0) was associated with adverse outcomes (hazard ratio [HR] 3.48, 95% CI 1.64-7.36) and a lower survival probability (χ2 10.63; P < 0.001). Conclusion A reduction in the ANC at the onset of NEC was associated with severe surgical NEC and higher mortality. The addition of platelets to ΔANC at NEC onset resulted in a higher predictive value of severe surgical NEC. This study may provide a new insight into the bedside evaluation of NEC by analyzing data from the day of NEC onset.
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Affiliation(s)
- Fanyue Qin
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjie Yuan
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chen Zhang
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chu Zhu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huifang Dong
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Advanced Medical Research Center of Zhengzhou University, Zhengzhou, China
| | - Falin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Advanced Medical Research Center of Zhengzhou University, Zhengzhou, China,Correspondence: Falin Xu
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Jiang PP, Peng SS, Pankratova S, Luo P, Zhou P, Chen Y. Proteins Involved in Synaptic Plasticity Are Downregulated in the Cerebrospinal Fluid of Infants With Clinical Sepsis Complicated by Neuroinflammation. Front Cell Neurosci 2022; 16:887212. [PMID: 35634471 PMCID: PMC9130476 DOI: 10.3389/fncel.2022.887212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Newborn infants are prone to sepsis and related inflammation of different organs. Neuroinflammation has been associated with long-term adverse neuronal (neuropsychiatric/neurodegenerative) outcomes, including attention deficit hyperactivity disorder (ADHD) or even Alzheimer's disease. Despite a vast number of findings on sepsis-induced inflammatory responses in the central nervous system (CNS), how neuroinflammation affects brain development remains largely elusive. In this study, neonates with clinical sepsis and screened for meningitis were included and classified by the neuroinflammation status based on cerebrospinal fluid (CSF) parameters (INF vs. NOINF). CSF samples collected from clinical screening were subjected to proteomics analysis. Proteins with differential abundance were subjected to enrichment analysis to reveal affected biological pathways. INF and NOINF infants had similar demographic data and hematological and biochemical parameters in blood and CSF. The CSF proteomes were essentially different between the two groups. All 65 proteins with differential abundance showed lower abundance in the INF group and functionally covered pivotal developmental processes, including axonal and synaptic function and extracellular homeostasis. CSF proteins, PTPRZ1 and IGFBP4, were correlated with C-reactive protein (CRP) and ratios of immature/total neutrophils in blood. In general, a substantial change in the CSF protein profile was found under neuroinflammation, and these changes are related to systemic conditions. The results suggest that changes in CSF proteins may be involved in sepsis-affected neurodevelopment, such as disturbances in circuit formation, which has the potential to predispose neonates to long-term adverse outcomes.
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Affiliation(s)
- Ping-Ping Jiang
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shan-Shan Peng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Stanislava Pankratova
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ping Luo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ping Zhou
- Department of Neonatology, Bao'an Women and Children's Hospital, Jinan University, Shenzhen, China
| | - You Chen
- Department of Neonatology, Bao'an Women and Children's Hospital, Jinan University, Shenzhen, China
- *Correspondence: You Chen
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Alkhaldy HY, A. Awan Z, Abouzaid AA, Elbahaie HM, Al Amoudi SM, Andarawi M, F Shehata S. The Prevalence of Isolated Neutropenia at High Altitude in Southern Saudi Arabia: Does Altitude Affect Leucocyte Count? Int J Gen Med 2020; 13:1373-1379. [PMID: 33299343 PMCID: PMC7721288 DOI: 10.2147/ijgm.s284133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Isolated neutropenia is a common problem in hematology practice. Benign ethnic neutropenia (BEN) is the common form of neutropenia worldwide and it affects mainly African and Middle Eastern ethnicities. Most cases of isolated mild and moderate neutropenia are benign and associated with no clinical significance. The aim of this study was to estimate the prevalence of isolated neutropenia at high-altitude southern Saudi Arabia. METHODS A large dataset of complete blood counts (CBCs) was analyzed for walk-in patients of both genders, of age ranges from 12 to 60 years doing blood tests at a commercial lab for high altitude - 2,270 meters above sea level - (HA) group, and from sea level SL group. Abnormal biochemical or CBC results were excluded before analysis. RESULTS For HA group, 3123 CBCs were analyzed and for SL group 18,427 CBCs were analyzed. The prevalence of mild neutropenia, defined as absolute neutrophil count (ANC) in the range of 1.0-.5× 109/L, was 12.4% (n=399) versus 5.6% (n=1025), while moderate neutropenia, defined as ANC of 0.5-1 × 109/L, was present 6% (n=191) versus 1.45% (n=269) in the high altitude and sea level groups, respectively. Severe neutropenia, defined as neutrophil count less than 0.5-1 × 109/L, was rare in both groups. CONCLUSION Isolated neutropenia is common in Saudis living at high altitude. While benign ethnic neutropenia (BEN) is thought to be the major contributing factor to this high prevalence, other factors including environmental factors and altitude are possible contributing factors along with underlying ethnic neutropenia.
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Affiliation(s)
- Husain Y Alkhaldy
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Research Center for Advanced Materials Science, King Khalid University, Abha, Saudi Arabia
| | - Zuhier A. Awan
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
| | - Ahmed A Abouzaid
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
- Department of Medical Biochemistry, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hossameldin M Elbahaie
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
- Clinical Pathology Department, Suez Canal University, Ismailia, Egypt
| | - Saeed M Al Amoudi
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
| | - Mohamed Andarawi
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Shehata F Shehata
- Department of Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Hao YX, Yu JL. [Cut-off value of white blood cell count in the diagnosis of early-onset sepsis in neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1159-1163. [PMID: 33172548 PMCID: PMC7666395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/03/2020] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To study the clinical significance and cut-off value of white blood cell (WBC) count in the diagnosis of early-onset sepsis (EOS) in neonates. METHODS A retrospective analysis was performed on 306 neonates with EOS who were admitted from January 2019 to March 2020. A total of 580 children without infection who were admitted during the same period of time were enrolled as the control group. General status and WBC count were compared between the two groups. The diagnostic value of WBC count was analyzed based on the diagnostic and therapeutic protocol of neonatal sepsis in 2003 (referred to as the 2003 diagnostic and therapeutic protocol) and the expert consensus on the diagnosis and treatment of neonatal sepsis (2019 edition) (referred to as the 2019 expert consensus). RESULTS According to the two different diagnosis and treatment protocols, the statistical analysis showed that WBC count had a relatively positive rate (51.3% and 32.0% respectively) but a relatively high specificity (93.3% and 98.6% respectively). The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of WBC count in the 2003 diagnostic and therapeutic protocol was larger than that in the 2019 expert consensus (P<0.05). CONCLUSIONS The cut-off value of WBC ≥25×109/L in the 2003 diagnostic and therapeutic protocol is more reasonable in the diagnosis of EOS.
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Affiliation(s)
- Ying-Xia Hao
- Department of Neonatology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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Hao YX, Yu JL. [Cut-off value of white blood cell count in the diagnosis of early-onset sepsis in neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1159-1163. [PMID: 33172548 PMCID: PMC7666395 DOI: 10.7499/j.issn.1008-8830.2005143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the clinical significance and cut-off value of white blood cell (WBC) count in the diagnosis of early-onset sepsis (EOS) in neonates. METHODS A retrospective analysis was performed on 306 neonates with EOS who were admitted from January 2019 to March 2020. A total of 580 children without infection who were admitted during the same period of time were enrolled as the control group. General status and WBC count were compared between the two groups. The diagnostic value of WBC count was analyzed based on the diagnostic and therapeutic protocol of neonatal sepsis in 2003 (referred to as the 2003 diagnostic and therapeutic protocol) and the expert consensus on the diagnosis and treatment of neonatal sepsis (2019 edition) (referred to as the 2019 expert consensus). RESULTS According to the two different diagnosis and treatment protocols, the statistical analysis showed that WBC count had a relatively positive rate (51.3% and 32.0% respectively) but a relatively high specificity (93.3% and 98.6% respectively). The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of WBC count in the 2003 diagnostic and therapeutic protocol was larger than that in the 2019 expert consensus (P<0.05). CONCLUSIONS The cut-off value of WBC ≥25×109/L in the 2003 diagnostic and therapeutic protocol is more reasonable in the diagnosis of EOS.
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Affiliation(s)
- Ying-Xia Hao
- Department of Neonatology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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