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Kasirer Y, Shchors I, Hammerman C, Bin-Nun A. Platelet Indices: Universally Available Clinical Adjunct for Diagnosing Necrotizing Enterocolitis. Am J Perinatol 2024; 41:e1575-e1580. [PMID: 36918160 DOI: 10.1055/a-2053-7759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Platelet function parameters can be predictive of several adult diseases and their severity. However, few studies report on the association between platelet indices and neonatal diseases, specifically necrotizing enterocolitis (NEC). The objective of this study is to investigate whether platelet indices are associated with NEC diagnosis and NEC-related mortality. STUDY DESIGN We retrospectively examined records from infants admitted to the neonatal intensive care unit with a diagnosis of NEC, verified by the presence of pneumatosis on X-ray or pathology at surgery. We compared them with an age-matched group of prematures without NEC. We investigated platelet count, mean platelet volume (MPV), platelet distribution width and red cell distribution width to platelet ratio (RPR) and delta platelets from birth to the time of NEC diagnosis or day of life 14 in the control group. RESULTS Sixty-nine infants with NEC and 78 control infants were studied. Basic sociodemographic data were similar in both groups. All platelet parameters measured-except for MPV-were significantly associated with NEC diagnosis. Although MPV was not associated with the diagnosis of NEC (p = 0.800), it was significantly associated with NEC-related mortality (p < 0.001). Only total platelet count and RPR were significantly associated with both NEC diagnosis (p < 0.0001) and mortality (p = 0.04 and 0.01, respectively). On multivariable analysis only the change in platelet count from birth to time of diagnosis remained significant. CONCLUSION While not definitive, this study demonstrates that these routinely available, inexpensive, and easily calculated platelet indices can provide a clinical adjunct in the often-elusive attempts to definitively diagnose NEC in preterm neonates. KEY POINTS · Platelet indices were associated with NEC diagnosis.. · MPV was predictive of NEC-related mortality.. · Delta platelet count from birth was significantly related to NEC diagnosis..
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Affiliation(s)
- Yair Kasirer
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Irina Shchors
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Department of Pediatrics, The Hebrew University, Jerusalem, Israel
| | - Alona Bin-Nun
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Department of Pediatrics, The Hebrew University, Jerusalem, Israel
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Shafique MA, Abbas SQ, Habiba U, Mughal A, Fadlalla Ahmad TK, Munir Chaudhary A. Transfusion strategies for neonates: current perspectives. Ann Med Surg (Lond) 2024; 86:1550-1562. [PMID: 38463073 PMCID: PMC10923393 DOI: 10.1097/ms9.0000000000001751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Blood transfusion intervention has been proven to be a crucial therapeutic aid for preterm infants with serious morbidities such as sepsis, intraventricular hemorrhage, and cardiopulmonary insufficiencies. However, blood transfusion practices have also been shown to cause significant adverse outcomes, which may negate the therapeutic effect of the intervention. To address the varying policies regarding the administration of blood products, healthcare professionals have adopted a consensus-based approach. The absence of a standard protocol has resulted in conflicting outcomes in previous clinical studies. Objective This study aimed to evaluate the effectiveness of blood transfusion practices in preterm infants by analyzing past clinical research and identifying the current trends that have emerged as a result of recent trials. Results Recent trials have demonstrated comparable trends in mortality rates and other primary outcomes, including retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia, and brain injury, following transfusion of blood products in both groups. Nevertheless, employing restrictive thresholds rather than adopting a liberal approach can reduce these outcomes. Conclusion The current literature does not provide clear support for either technique as opposing and contradictory results are evident. However, there is a slight inclination toward the restrictive transfusion threshold due to recent trials, which warrants further in-depth investigation into this issue.
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Affiliation(s)
| | - Syeda Q. Abbas
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Ume Habiba
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Aira Mughal
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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O'Reilly D, Murphy CA, Moore CM, Ní Áinle F, Gormley IC, Morrell CN, Curley A, Mc Callion N, Maguire P. Markers of platelet activation foR identification of late onset sEpsis in infaNTs: PARENT study protocol. Pediatr Res 2024; 95:852-856. [PMID: 37758864 DOI: 10.1038/s41390-023-02812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Newborns are at high risk of sepsis. At present there is no definitive "rule in" blood test for sepsis at the point of clinical concern. A positive blood culture remains the gold standard test for neonatal sepsis, however laboratory markers that correlate prospectively with culture positive sepsis could aid clinicians in making decisions regarding administration of empiric antibiotic therapies. METHODS This multi-site, prospective observational study will take place in two neonatal intensive care units (National Maternity Hospital and Rotunda Hospital, Dublin). Neonates born at less than 34 weeks will be enroled and informed consent obtained prior to late onset sepsis work up. If at any point subsequently during their neonatal intensive care stay they develop signs and symptoms of possible sepsis requiring blood culture, an additional sodium citrate sample will be obtained. Infants will be categorised into three groups as follows: (i) culture positive sepsis, (ii) culture negative sepsis where an infant receives 5 days of antibiotics (iii) non sepsis. Our primary outcome is to establish if differential platelet/endothelial activation can prospectively identify neonatal culture positive late onset sepsis. TRIAL REGISTRATION NUMBER NCT05530330 IMPACT: Preterm infants are a high risk group for the development of sepsis which is a major cause of mortality in this population. Platelets have been associated with host response to invasive bacterial infections both in animal models and translational work. A positive blood culture is the gold standard test for neonatal sepsis but can be unreliable due to limited blood sampling in the very low birth weight population. This study hopes to establish if platelet/endothelial associated plasma proteins can prospectively identify late onset neonatal sepsis.
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Affiliation(s)
- Daniel O'Reilly
- School of Biomolecular and Biomedical Science, University College Dublin, Dublin, 4, Ireland.
- Department of Neonatology, Rotunda Hospital, Dublin, 1, Ireland.
- Department of Neonatology, National Maternity Hospital, Dublin, 2, Ireland.
| | - Claire Anne Murphy
- Department of Neonatology, National Maternity Hospital, Dublin, 2, Ireland
| | - Carmel Maria Moore
- Department of Neonatology, National Maternity Hospital, Dublin, 2, Ireland
- School of Medicine, University College Dublin, Dublin, 4, Ireland
| | - Fionnuala Ní Áinle
- School of Biomolecular and Biomedical Science, University College Dublin, Dublin, 4, Ireland
- Department of Haematology, Rotunda Hospital, Dublin, 1, Ireland
- Department of Haematology, Mater Hospital, Dublin, 7, Ireland
| | | | | | - Anna Curley
- Department of Neonatology, National Maternity Hospital, Dublin, 2, Ireland
| | - Naomi Mc Callion
- Department of Neonatology, Rotunda Hospital, Dublin, 1, Ireland
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, 2, Ireland
| | - Patricia Maguire
- School of Biomolecular and Biomedical Science, University College Dublin, Dublin, 4, Ireland
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Jiang J, Mao Y, Zhou Q, Wu J. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are early predictors of bronchopulmonary dysplasia. Medicine (Baltimore) 2023; 102:e34987. [PMID: 37657037 PMCID: PMC10476759 DOI: 10.1097/md.0000000000034987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023] Open
Abstract
To determine whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are correlated with bronchopulmonary dysplasia (BPD) on the first day of prematurity and to help with early warning, identification, and intervention in the development of BPD. From January 2017 to June 2022, newborns who were diagnosed with BPD conducted a retrospective cohort study. Complete blood cells were measured within the first 24 hours of life in preterm neonates of 32 gestational weeks with BPD as the observation group and non-BPD infants as the control group. In all groups, the NLR and PLR levels were measured. Both univariate and multivariate logistic regression analyses were used to evaluate the data. In this research 76 cases of non-BPD and 48 cases of BPD were used as controls. Compared with the non-BPD group, the NLR and PLR levels were considerably higher in the BPD group. Logistic regression analysis suggested that NLR and PLR were independent risk factors for BPD (OR [odds ratio]: 3.786; 95% CI [confidence interval]: 1.75-8.16; P < .05; OR: 3.391; 95% CI: 1.85-28.78; P < .05). The findings may demonstrate that higher NLR and PLR are independently and significantly associated with the development of BPD.
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Affiliation(s)
- Junsheng Jiang
- Department of Pediatrics, Linping Branch, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yueyan Mao
- Department of Pediatrics, Linping Branch, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Qian Zhou
- Department of Emergency, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jiabo Wu
- Department of Pediatrics, Linping Branch, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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An R, Ou Y, Pang L, Yuan Y, Li Q, Xu H, Sheng B. Epidemiology and Risk Factors of Community-Associated Bloodstream Infections in Zhejiang Province, China, 2017–2020. Infect Drug Resist 2023; 16:1579-1590. [PMID: 36969944 PMCID: PMC10032239 DOI: 10.2147/idr.s400108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose Community-associated bloodstream infection (CA-BSI) is increasing in many community settings. However, the clinical significance and epidemiology of CA-BSI present in hospital admissions in China are not well established. In this work, we identified the risk factors in outpatients presenting with CA-BSI, and investigate the role of procalcitonin (PCT) and hypersensitive C-reactive protein (CRP) in diagnosing different types of the pathogen in patients with acute CA-BSI. Methods A retrospective study enrolling 219 outpatients with CA-BSI from The Zhejiang People's Hospital from January 2017 to December 2020 was performed. Susceptibility of the isolates obtained from these patients was examined. Subjecting receiver operating characteristic curves (ROC) were constructed to analyze the specificity and sensitivity of PCT, CRP, and WBC in determining infections caused by different bacterial genera. Risk factors for CA-BSI in the emergency setting were analyzed using essential information and simple identification of other pathogenic bacterial species through rapidly tested biomarkers. Results A total of 219 patients were included in the selection criteria, of which 103 were infected with Gram-positive bacteria (G+) and 116 with Gram-negative bacteria (G-). The PCT was significantly higher in the GN-BSI group than in the GP-BSI group, while no significant difference was observed between the two groups for CRP. Subjecting ROC curves were constructed to analyze WBC, CRP, and PCT, and the area under the curve (AUC) of the PCT in this model was 0.6661, with sensitivity = 0.798 and specificity = 0.489. Conclusion The PCT between the GP-BSI group and the GN-BSI group was significantly different. By combining the knowledge of clinicians and the clinical signs of patients, PCT should be utilized as a supplementary approach to initially determine pathogens and direct medication in the early stages of clinical practice.
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Affiliation(s)
- Rongcheng An
- Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Yingwei Ou
- Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Lingxiao Pang
- Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Yongsheng Yuan
- Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Qian Li
- Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Hao Xu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Bin Sheng
- Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
- Correspondence: Bin Sheng, Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China, Tel +86 571 85893793, Email
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Worku M, Aynalem M, Biset S, Woldu B, Adane T, Tigabu A. Role of complete blood cell count parameters in the diagnosis of neonatal sepsis. BMC Pediatr 2022; 22:411. [PMID: 35831816 PMCID: PMC9277845 DOI: 10.1186/s12887-022-03471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal sepsis is one of the leading causes of neonatal morbidity and mortality in developing countries like Ethiopia. The investigation of neonatal sepsis needs the application of inclusive diagnostic tools. Therefore, this study aimed to assess the role of CBC parameters in diagnosing neonatal sepsis. METHODS A comparative cross-sectional study was conducted from September 2020 to November 2021 at the University of Gondar Comprehensive Specialized Hospital. A total of 250 neonates were included using a convenient sampling technique. A structured questionnaire and a data collection sheet were used to obtain the socio-demographic and clinical characteristics of the study participants. A venous blood sample was collected for CBC and blood culture tests. Epi-Info Version 7 and SPSS Version 25 were used for data entry and analysis, respectively. The data distribution was checked by the Shapiro-Wilk test. Then, an independent t-test was conducted to compare CBC parameters, and the significant parameters were recruited for the ROC curves analysis. The Younden index test was used to determine the cutoff point for the sensitivity and specificity. A p-value of <0.05 was considered statistically significant. RESULTS Out of 250 study participants, 144 (57.6%) were males, with a median age of 6 days (IQR = 4 days). Early-onset and late-onset sepsis were developed in about 29.6% (37/250) and 70.4% (88/250) of the neonates, respectively. The TLC and ANC parameters were significantly lower in cases than in control groups. The TLC, Hgb, lymphocyte count, and ANC parameters have a sensitivity of 64.8, 68, 33.6, and 49.6%, respectively. Their specificity in the diagnosis of neonatal sepsis was 64.8, 53.6, 83.2, and 90.4%, respectively. CONCLUSION Total leucocyte count, ANC, and platelet count all showed significant associations with neonatal sepsis. Besides, the TLC, ANC, and platelet counts had good sensitivity and specificity in diagnosing neonatal sepsis. Therefore, these parameters can be used as a diagnostic tool for neonatal sepsis in resource-limited areas.
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Affiliation(s)
- Minichil Worku
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, 196, Gondar, Ethiopia.
| | - Sirak Biset
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanu Woldu
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, 196, Gondar, Ethiopia
| | - Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, 196, Gondar, Ethiopia
| | - Abiye Tigabu
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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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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Arabdin M, Khan A, Zia S, Khan S, Khan GS, Shahid M. Frequency and Severity of Thrombocytopenia in Neonatal Sepsis. Cureus 2022; 14:e22665. [PMID: 35386168 PMCID: PMC8967110 DOI: 10.7759/cureus.22665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Neonatal sepsis includes numerous systemic illnesses such as septicemia, meningitis, urinary tract infections, and pneumonia. In developing countries, the major reason for neonatal mortality is septicemia, which accounts for almost 50% of overall deaths. Thrombocytopenia is one of the most common hematological problems during the neonatal period, affecting the majority of sufferers admitted to the neonatal intensive care unit (NICU). The aim of our study was to find the frequency of thrombocytopenia and its severity in neonates with sepsis. Methods The study was conducted at the Department of Hematology at Khyber Medical University, Peshawar, Pakistan. A total of 170 neonates with an age of fewer than 28 days, both genders, and positive blood cultures were included in the study using a non-probability consecutive sampling technique. Data was recorded in predesigned questionnaires after taking informed consent. Data were recorded and analyzed using SPSS version 26 (IBM Corporation, Armonk, NY, USA). Results Of the 170 neonates, 104 (61.2%) were males, with a mean age of 12.12±8.88 days. The majority of the babies 73 (42.9%) were in the age group of 0-7 days. Most of the neonates 72 (42.4%) were born via normal vaginal delivery (NVD). Of the neonates, 117 (68.82%) presented with fever, and 105 (61.76%) were reluctant to feed. Furthermore, 65.29% of the neonates had thrombocytopenia, of which 34 (20%) had mild, 43 (25.3%) had moderate, and 34 (20%) had severe thrombocytopenia. In neonates with positive blood culture, the platelet level was low (p<0.001). In the case of gram-negative organisms, the level of platelets was lower as compared to gram-positive organisms (p<0.001). Conclusion Sepsis is still a common cause of newborn thrombocytopenia. The fact that it is present in more than half of all culture-positive sepsis episodes indicates the severity of the condition. This condition is further defined by higher percentages of early-onset gram-negative septicemia compared to gram-positive sepsis.
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Kurt A, Tosun MS, Altuntaş N. Diagnostic accuracy of complete blood cell count and neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios for neonatal infection. ASIAN BIOMED 2022; 16:43-52. [PMID: 37551395 PMCID: PMC10321158 DOI: 10.2478/abm-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Complete blood cell (CBC) counts and neutrophil-to-lymphocyte (NLR), lymphocyte-to-monocyte (LMR), and platelet-to-lymphocyte ratios (PLR) are simple measurements that are conducted as part of routine diagnostic procedures. Objective To determine the diagnostic importance, specificity, and sensitivity of these measurements for the diagnosis of neonatal infections and in discriminating between neonatal sepsis and various other infections. Methods We conducted a retrospective study of data from a consecutive series of 232 neonatal patients admitted to Yildirim Beyazit University Yenimahalle Training and Research Hospital in Ankara for 2 years from 2016 to 2018. We included patients with a diagnosis of or clinically suspected infection, and healthy neonates were included as controls. Data included CBC counts, and bacterial culture results, considered the criterion standard for the diagnosis of neonatal sepsis. NLR, LMR, and PLR were calculated. We compared data using independent Student t and Mann-Whitney U tests and determined the sensitivity, specificity, and likelihood ratio (LHOR) of the characteristics for neonatal sepsis using receiver operating characteristic curve analyses. Results We included data from 155 neonatal patients with a diagnosis or suspicion of infection and 77 healthy neonates. NLR was significantly higher in neonates with sepsis or fever due to dehydration (P < 0.001) than in neonates with other infections or healthy neonates. LMR was significantly higher in neonates with sepsis or viral infection than in those with other infections or healthy controls (P = 0.003). In neonates with early-onset sepsis (EOS), we found cut-off values of ≥4.79 [area under curve (AUC) 0.845, 95% confidence interval (CI) 0.76-0.93, LHOR 11.6, specificity 98.7%, sensitivity 15%] for NLR, ≥1.24 (AUC 0.295; CI 0.18-0.41, LHOR 1.02, specificity 2.6%, sensitivity 100%) for LMR, and ≥37.72 (AUC 0.268; CI 0.15-0.39, LHOR 0.86, specificity 7.8%, sensitivity 80%) for PLR. We found cut-off values of ≥4.94 (AUC 0.667; CI 0.56-0.77, LHOR 4.16, specificity 98.7%, sensitivity 5.4%) for NLR and ≥10.92 (AUC 0.384; CI 0.26-0.51, LHOR 6.24, specificity 98.7%, sensitivity 8.1%) for LMR in those with late-onset sepsis (LOS). Conclusions CBCs, NLR, LMR, and PLR may be useful for the differential diagnosis of EOS and LOS, and neonates with sepsis from those with other infection. NLR may be a useful diagnostic test to identify neonatal patients with septicemia more quickly than other commonly used diagnostic tests such as blood cultures. NLR has high specificity and LHOR, but low sensitivity.
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Affiliation(s)
- Abdullah Kurt
- Department of Pediatrics, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara06370, Turkey
| | - Merve Sezen Tosun
- Department of Pediatrics, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara06370, Turkey
| | - Nilgün Altuntaş
- Department of Pediatrics, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara06370, Turkey
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Goh GL, Lim CSE, Sultana R, De La Puerta R, Rajadurai VS, Yeo KT. Risk Factors for Mortality From Late-Onset Sepsis Among Preterm Very-Low-Birthweight Infants: A Single-Center Cohort Study From Singapore. Front Pediatr 2022; 9:801955. [PMID: 35174116 PMCID: PMC8841856 DOI: 10.3389/fped.2021.801955] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the risk factors for mortality associated with late onset sepsis (LOS) among preterm very-low-birthweight (VLBW) infants. STUDY DESIGN We performed a retrospective cohort study of infants born <32 weeks gestation and <1,500 gm admitted to a Singaporean tertiary-level neonatal intensive care unit. We determined the clinical, microbial, and laboratory risk factors associated with mortality due to culture-positive LOS in this cohort. RESULTS A total of 1,740 infants were admitted, of which 169 (9.7%) developed LOS and 27 (16%) died. Compared to survivors, those who died had lower birth gestational age (median 24 vs. 25 weeks, p = 0.02) and earlier LOS occurrence (median 10 vs. 17 days, p = 0.007). There was no difference in the incidence of meningitis (11.1 vs. 16.9%, p = 0.3), NEC (18.5 vs. 14.8%, p = 0.6), or intestinal surgery (18.5 vs. 23.3%, p = 0.6) among infants who died compared to survivors. Gram-negative bacteria accounted for 21/27 (77.8%) LOS-associated deaths and almost all (13/14, 93%) fulminant episodes. The presence of multiorgan failure, as evidenced by the need for mechanical ventilation (100 vs. 79.0%, p = 0.008), elevated lactate (12.4 vs. 2.1 mmol/L, p < 0.001), and inotropic support (92.6 vs. 37.5%, p < 0.001), was significantly associated with mortality. Infants who died had significantly lower white blood cell (WBC) counts (median 4.2 × 109/L vs. 9.9 × 109/L, p = 0.001), lower platelet count (median 40 × 109/L vs. 62 × 109/L, p = 0.01), and higher immature to total neutrophil (I: T) ratio (0.2 vs. 0.1, p = 0.002). Inotrope requirement [AOR 22.4 (95%CI 2.9, 103.7)], WBC <4 × 109/L [AOR 4.7 (1.7, 13.2)], and I: T ratio >0.3 [AOR 3.6 (1.3, 9.7)] were independently associated with LOS mortality. CONCLUSIONS In a setting with predominantly Gram-negative bacterial infections, the need for inotropic support, leukopenia, and elevated I: T ratio were significantly associated with LOS mortality among preterm VLBW infants.
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Affiliation(s)
- Guan Lin Goh
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Charis Shu En Lim
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Rowena De La Puerta
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
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11
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Clinical and Laboratory Findings of Nosocomial Sepsis in Extremely Low Birth Weight Infants According to Causative Organisms. J Clin Med 2022; 11:jcm11010260. [PMID: 35012001 PMCID: PMC8745858 DOI: 10.3390/jcm11010260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND nosocomial sepsis remains a significant source of morbidity and mortality in extremely low birth weight (ELBW) infants. Early and accurate diagnosis is very important, but it is difficult due to the similarities in clinical manifestation between the causative microorganisms. We tried to identify the differences between causative microorganisms in clinical and laboratory findings and to help choose antibiotics, when sepsis was suspected in ELBW infants. METHODS a retrospective study was conducted on preterm infants, born at less than 28 weeks of gestation, with a birth weight of less than 1000 g between January 2009 and December 2019. Clinical and laboratory findings of suspected sepsis, after the first 72 h of life, were assessed. We classified them into four groups according to blood culture results (gram positive, gram negative, fungal, and negative culture groups) and compared them. RESULTS a total of 158 patients were included after using the exclusion criteria, with 45 (29%) in the gram positive group, 35 (22%) in the gram negative group, 27 (17%) in the fungal group, and 51 (32%) in the negative culture group. There were no significant differences in mean gestational age, birth weight, and neonatal morbidities, except for the age of onset, which was earlier in the fungal group than other groups. White blood cell (WBC) counts were the highest in the gram negative group and the lowest in the fungal group. The mean platelet counts were the lowest in the fungal group. C-reactive protein (CRP) levels were the highest in the gram negative group, while glucose was the highest in the fungal group. CONCLUSIONS in conclusion, we showed that there are some differences in laboratory findings, according to causative microorganisms in the nosocomial sepsis of ELBW infants. Increased WBC and CRP were associated with gram negative infection, while decreased platelet and glucose level were associated with fungal infection. These data may be helpful for choosing empirical antibiotics when sepsis is suspected.
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12
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O’Reilly D, Murphy CA, Drew R, El-Khuffash A, Maguire PB, Ainle FN, Mc Callion N. Platelets in pediatric and neonatal sepsis: novel mediators of the inflammatory cascade. Pediatr Res 2022; 91:359-367. [PMID: 34711945 PMCID: PMC8816726 DOI: 10.1038/s41390-021-01715-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/14/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023]
Abstract
Sepsis, a dysregulated host response to infection, has been difficult to accurately define in children. Despite a higher incidence, especially in neonates, a non-specific clinical presentation alongside a lack of verified biomarkers has prevented a common understanding of this condition. Platelets, traditionally regarded as mediators of haemostasis and thrombosis, are increasingly associated with functions in the immune system with involvement across the spectrum of innate and adaptive immunity. The large number of circulating platelets (approx. 150,000 cells per microlitre) mean they outnumber traditional immune cells and are often the first to encounter a pathogen at a site of injury. There are also well-described physiological differences between platelets in children and adults. The purpose of this review is to place into context the platelet and its role in immunology and examine the evidence where available for its role as an immune cell in childhood sepsis. It will examine how the platelet interacts with both humoral and cellular components of the immune system and finally discuss the role the platelet proteome, releasate and extracellular vesicles may play in childhood sepsis. This review also examines how platelet transfusions may interfere with the complex relationships between immune cells in infection. IMPACT: Platelets are increasingly being recognised as important "first responders" to immune threats. Differences in adult and paediatric platelets may contribute to differing immune response to infections. Adult platelet transfusions may affect infant immune responses to inflammatory/infectious stimuli.
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Affiliation(s)
- Daniel O’Reilly
- grid.416068.d0000 0004 0617 7587Department of Neonatology, Rotunda Hospital, Dublin, Ireland ,grid.7886.10000 0001 0768 2743Conway-SPHERE Research Group, Conway Institute, University College Dublin, Dublin, Ireland
| | - Claire A. Murphy
- grid.416068.d0000 0004 0617 7587Department of Neonatology, Rotunda Hospital, Dublin, Ireland ,grid.7886.10000 0001 0768 2743Conway-SPHERE Research Group, Conway Institute, University College Dublin, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Department of Paediatrics, Royal College of Surgeons in Ireland, Dubin, Ireland
| | - Richard Drew
- grid.416068.d0000 0004 0617 7587Clinical Innovation Unit, Rotunda Hospital, Dublin, Ireland ,Irish Meningitis and Sepsis Reference Laboratory, Children’s Health Ireland at Temple Street, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Afif El-Khuffash
- grid.416068.d0000 0004 0617 7587Department of Neonatology, Rotunda Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Department of Paediatrics, Royal College of Surgeons in Ireland, Dubin, Ireland
| | - Patricia B. Maguire
- grid.7886.10000 0001 0768 2743Conway-SPHERE Research Group, Conway Institute, University College Dublin, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Biomolecular & Biomedical Science, University College Dublin, Dublin, Ireland
| | - Fionnuala Ni Ainle
- grid.7886.10000 0001 0768 2743Conway-SPHERE Research Group, Conway Institute, University College Dublin, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Biomolecular & Biomedical Science, University College Dublin, Dublin, Ireland ,grid.411596.e0000 0004 0488 8430Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland ,grid.416068.d0000 0004 0617 7587Department of Haematology, Rotunda Hospital, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, Dublin, Ireland
| | - Naomi Mc Callion
- grid.416068.d0000 0004 0617 7587Department of Neonatology, Rotunda Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Department of Paediatrics, Royal College of Surgeons in Ireland, Dubin, Ireland
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13
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Akter S, Chaudhury IJ, Jahan MA, Sah S, Mannan A. Pathogens and Antibiogram of Blood Stream Isolates in Neonatal Sepsis: Findings from a Tertiary Care Hospital, Bangladesh. INTEGRATIVE JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.15342/ijms.2022.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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14
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Invasive fungal infections in neonates: a review. Pediatr Res 2022; 91:404-412. [PMID: 34880444 DOI: 10.1038/s41390-021-01842-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
Invasive fungal infections remain the leading causes of morbidity and mortality in neonates, especially preterm and very low birth weight infants. Most invasive fungal infections are due to Candida or Aspergillus species, and other fungi are increasingly reported and described. Appropriate identification and treatment are required to augment activity and reduce the toxicity of antifungal drugs. Successful use of antifungals in the vulnerable neonatal population is important for both prevention and treatment of infection. Strategies for prevention, including prophylactic antifungal therapy as well as reducing exposure to modifiable risk factors, like limiting antibiotic exposure, discontinuation of central catheters, and hand hygiene are key techniques to prevent and decrease rates of invasive fungal infections. In conclusion, this is a review of the most common causes, prevention strategies, prophylaxis, and treatment of invasive fungal infections in neonates.
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15
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Gao Q, Li Z, Mo X, Wu Y, Zhou H, Peng J. Combined procalcitonin and hemogram parameters contribute to early differential diagnosis of Gram-negative/Gram-positive bloodstream infections. J Clin Lab Anal 2021; 35:e23927. [PMID: 34363413 PMCID: PMC8418508 DOI: 10.1002/jcla.23927] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background Hemogram parameters and procalcitonin (PCT) play auxiliary roles in the diagnosis and outcome of sepsis. However, it is not clear whether these indicators can quickly distinguish bacterial classification or guide the choice of empirical antibiotics. Methods We retrospectively enrolled 381 patients with bloodstream infections (BSI), divided into Gram‐positive bloodstream infections (GP‐BSI) and Gram‐negative bloodstream infections (GN‐BSI). Demographic parameters, hemogram parameters, and PCT were recorded and compared between the two groups. Results The mean platelet volume (MPV), platelet distribution width (PDW), and PCT in the GN‐BSI group were significantly higher than those in the GP‐BSI group, while the platelet count (PLT), plateletcrit, platelet count‐to‐white blood cell count ratio (PWR), platelet count‐to‐neutrophil count ratio (PNR), platelet count‐to‐PCT ratio (PLT/PCT), and mean platelet volume‐to‐PCT ratio (MPV/PCT) were significantly lower in the GN‐BSI group. Multivariate stepwise logistic regression analysis revealed that the independent predictors of GN‐BSI were MPV, PWR, and PCT. The areas under the curve (AUC) for this prediction model was 0.79, with sensitivity =0.75 and specificity =0.71. Conclusions There were significant differences in terms of PCT, platelet parameters, and platelet‐related index‐PCT ratio between GN‐BSI and GP‐BSI. Combined PCT and hemogram parameters are more conducive to the early differential diagnosis of bacterial classification of BSI.
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Affiliation(s)
- Qiqing Gao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhuohong Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xichao Mo
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yihua Wu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Zhou
- Department of Hospital Infection Management of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
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16
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Hornik CD, Bondi DS, Greene NM, Cober MP, John B. Review of Fluconazole Treatment and Prophylaxis for Invasive Candidiasis in Neonates. J Pediatr Pharmacol Ther 2021; 26:115-122. [PMID: 33603574 PMCID: PMC7887891 DOI: 10.5863/1551-6776-26.2.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/17/2020] [Indexed: 01/29/2023]
Abstract
Invasive candidiasis accounts for approximately 10% of nosocomial infections in preterm infants, with an incidence of 1% to 4% among neonatal intensive care unit (NICU) admissions and a mortality as high as 20% to 30%. These outcomes warrant improved treatment and prevention strategies for infants at highest risk. The Infectious Diseases Society of America provides guidelines on antifungal medications for the prophylaxis and treatment of candidiasis in NICUs; however, there are still variations in practice on the use of fluconazole for prophylaxis and treatment of invasive candidiasis. This review provides specific information regarding fluconazole activity, pharmacokinetics, and a literature evaluation of dosing strategies and comparisons to other treatments in the neonatal population.
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17
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Majumdar A, Biswas S, Jana A. Platelet indices as an earlier and economical marker of neonatal sepsis. IRAQI JOURNAL OF HEMATOLOGY 2021. [DOI: 10.4103/ijh.ijh_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Luo P, Zhang K, Chen Y, Geng X, Wu T, Li L, Zhou P, Jiang PP, Ma L. Antenatal Antibiotic Exposure Affects Enteral Feeding, Body Growth, and Neonatal Infection in Preterm Infants: A Retrospective Study. Front Pediatr 2021; 9:750058. [PMID: 35004538 PMCID: PMC8727690 DOI: 10.3389/fped.2021.750058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Antibiotics are widely prescribed by obstetricians, which exposes a large number of infants to antenatal antibiotics (AAB). The effect of AAB on various aspects of neonatal development of preterm infants remains unclear. Methods: In this retrospective study, infants born with gestational age (GA) between 22 +0 and 36 +6 weeks at our unit from 2017 to 2019 were included. Multivariable analysis was adopted to examine the associations between AAB exposure and various outcomes related to enteral feeding process, body growth, and neonatal infection after adjusting for potential confounders. Further subanalysis on the exposure level of AAB and stratified analysis by GA (<34 vs. ≥34 weeks) were also conducted. Results: In this cohort comprising 2,543 preterm infants, AAB was associated with decreased risks of feeding intolerance (odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.48-0.82) and neonatal infection (OR: 0.63, 95% CI: 0.41-0.94). Higher AAB exposure level was associated with higher Z scores of birth weight (β = 0.37, 95% CI: 0.27-0.47), but lower Δbodyweight Z-scores (β = -0.20, 95% CI: -0.27 to -0.13). AAB was positively associated with the parameters related to body growth in infants with GA <34 weeks but negatively associated in those with GA ≥34 weeks. Conclusions: AAB exposure affects the enteral feeding process and neonatal infection. The effects on body growth vary by the exposure level of AAB and GA of infants. A well-designed prospective and preferably multi-centre study with predefined parameters is required to confirm our findings.
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Affiliation(s)
- Ping Luo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kun Zhang
- Department of Obstetrics, 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
| | - Xiuwen Geng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Tong Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- 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
| | - Ping-Ping Jiang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Liya Ma
- Department of Children Healthcare, Bao'an Women and Children's Hospital, Jinan University, Shenzhen, China
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19
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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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20
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Abstract
INTRODUCTION Thrombocytopaenia is one of the most common haemostatic abnormalities among neonates. It affects approximately one-quarter of neonates admitted into neonatal intensive care units and may lead to a high risk of bleeding and mortality, which are substantial causes for concern by neonatologists. Platelet transfusion (PT) is a specific treatment for thrombocytopaenia. To date, PT thresholds are diverse since the associations between low platelet count and negative outcomes are not clear. We propose this protocol for a systematic review to collect and assess evidence concerning the best PT threshold to reduce mortality, bleeding and major morbidity among neonates with thrombocytopaenia. METHODS AND ANALYSIS The systematic review will be performed according to the Cochrane Handbook for Systematic Review of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the Grading of Recommendations Assessment, Development and Evaluation system. Two independent researchers will perform the study selection, data extraction/coding, quality assessment and further analyses of the included studies, with disagreements being resolved by a third researcher. A systematic search of the literature will be conducted in the PubMed, Cochrane Library and Embase databases from database inception through 13 October 2020. All randomised controlled trials, cohort studies and case-control studies will be included without any restrictions regarding publication date or language. The primary outcomes will comprise in-hospital mortality and bleeding episodes. Endnote X9 and Review Manager V.5.3 software will be used to manage the selection process and statistical analysis, respectively. If the included studies are sufficient and homogeneous for any of the outcomes, a quantitative synthesis (meta-analysis) may be performed. Otherwise, we will conduct a narrative systematic review of the results. ETHICS AND DISSEMINATION Ethical approval is not required for this study because the data will be obtained from published studies and will not include individual patient data. The results of this study are anticipated to be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020169262.
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Affiliation(s)
- Dengjun Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Jinlin Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Yan Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
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21
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Bæk O, Brunse A, Nguyen DN, Moodley A, Thymann T, Sangild PT. Diet Modulates the High Sensitivity to Systemic Infection in Newborn Preterm Pigs. Front Immunol 2020; 11:1019. [PMID: 32536925 PMCID: PMC7267211 DOI: 10.3389/fimmu.2020.01019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Preterm infants are born with an immature immune system, limited passive immunity, and are at risk of developing bacteremia and sepsis in the postnatal period. We hypothesized that enteral feeding, with or without added immunoglobulins, improves the clinical response to systemic infection by coagulase negative staphylococci. Methods: Using preterm cesarean delivered pigs as models for preterm infants, we infused live Staphylococcus epidermidis (SE, 5 × 109 colony forming units per kg) systemically 0–3 days after birth across five different experiments. SE infection responses were assessed following different gestational age at birth (preterm vs. term), enteral milk diets (bovine colostrum, infant formula with or without added porcine plasma) and with/without systemic immunoglobulins. Pigs infected with SE were assessed 12–48 h for clinical variables, blood bacteriology, chemistry, hematology, and gut dysfunction (intestinal permeability, necrotizing enterocolitis lesions). Results: Adverse clinical responses and increased mortality were observed in preterm vs. term pigs, when infected with SE just after birth. Feeding bovine colostrum just after birth improved blood SE clearance and clinical status (improved physical activity and intestinal structure, fewer bone marrow bacteria), relative to pigs fed infant formula. A few days later, clinical responses to SE bacteremia (hematology, neutrophil phagocytic capacity, T cell subsets) were less severe, and less affected by different milk diets, with or without added immunoglobulins. Conclusion: Prematurity increases the sensitivity of newborn pigs to SE bacteremia, potentially causing sepsis. Sensitivity to systemic SE infection decreases rapidly in the days after preterm birth. Both age and diet (parenteral nutrition, colostrum, milk, formula) may influence gut inflammation, bacterial translocation and systemic immune development in the days after birth in preterm newborns.
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Affiliation(s)
- Ole Bæk
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Brunse
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Duc Ninh Nguyen
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arshnee Moodley
- Veterinary Clinical Microbiology, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Thymann
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.,Department of Pediatrics, Odense University Hospital, Odense, Denmark
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22
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Abstract
BACKGROUND Despite the absence of adequate safety or efficacy data, clindamycin is widely prescribed in the neonatal intensive care unit. We evaluated the association between clindamycin exposure and adverse events, as well as antibiotic effectiveness in infants. METHODS This was a retrospective cohort study of infants receiving clindamycin before postnatal day 121 who were discharged from a Pediatrix Medical Group neonatal intensive care unit (1997-2015). Using a previously developed pharmacokinetic model, we performed simulations to predict clindamycin exposure based on available dosing data. We used multivariable logistic regression to evaluate the association between clindamycin exposure and safety outcomes during and after clindamycin therapy. We reported the proportion of infants with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and clearance of MRSA bacteremia. RESULTS A total of 4089 infants received clindamycin at a median (25th-75th percentile) dose of 15 mg/kg/d (12-16). Clearance increased with older gestational age. Infants with the highest total clindamycin exposure had marginally increased odds of necrotizing enterocolitis within 7 days (adjusted odds ratio = 1.95 [1.04-3.63]), but exposure was not associated with death, sepsis, seizures, intestinal perforation or intestinal strictures. Of 25 infants who had MRSA bacteremia, 19 (76%) cleared the infection by the end of the clindamycin course. CONCLUSIONS Higher clindamycin exposure was not associated with increased odds of death or nonlaboratory adverse events. The use of pharmacokinetic models combined with available electronic health record data offers a valuable, cost-effective approach to analyzing the safety and effectiveness of drugs in infants when large-scale trials are not feasible.
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Thom CS, Devine M, Kleinman S, Jensen EA, Lambert MP, Padula MA. Neonatal platelet count trends during inhaled nitric oxide therapy. Br J Haematol 2020; 188:e28-e30. [PMID: 31840227 PMCID: PMC6982552 DOI: 10.1111/bjh.16301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
MESH Headings
- Administration, Inhalation
- Female
- Hernias, Diaphragmatic, Congenital/blood
- Hernias, Diaphragmatic, Congenital/drug therapy
- Humans
- Hypertension, Pulmonary/blood
- Hypertension, Pulmonary/congenital
- Hypertension, Pulmonary/drug therapy
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/drug therapy
- Male
- Nitric Oxide/administration & dosage
- Platelet Count
- Retrospective Studies
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Affiliation(s)
- Christopher S Thom
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Devine
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stacey Kleinman
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erik A Jensen
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michele P Lambert
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael A Padula
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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24
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Vardon-Bounes F, Gratacap MP, Groyer S, Ruiz S, Georges B, Seguin T, Garcia C, Payrastre B, Conil JM, Minville V. Kinetics of mean platelet volume predicts mortality in patients with septic shock. PLoS One 2019; 14:e0223553. [PMID: 31622365 PMCID: PMC6797099 DOI: 10.1371/journal.pone.0223553] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/05/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Thrombocytopenia is well recognized as a poor prognosis sign associated with increased mortality and prolonged Intensive Care Unit (ICU) stay, particularly in septic patients. Mean platelet volume (MPV) could represent a relevant predictive marker of mortality. Here we investigated whether MPV kinetics during the first 15 days after hospital admission has a potential prognostic value for clinical outcome in septic shock. Methods We performed a retrospectively analysis of a cohort of 301 septic patients admitted in ICU. Three-month mortality was the primary endpoint. The prognostic value of the covariates of interest was ascertained by multidimensional analysis. We proposed a classification and regression trees analysis to predict survival probability. Results MPV kinetics was significantly different between 90-day survivors and non-survivors when followed during 15 days (except on day 3). 10-day MPV >11.6fL was an independent predictive factor of 90-day mortality (Hazard Ratio (HR) 3.796, 95% Confidence Interval (CI) [1.96–7.35], p = 0.0001) in multivariate analysis. Base excess on day 4 <1.9mmol/L was also a predictive factor of mortality (HR 2.972, 95%CI [1.38–6.40], p = 0.0054. Conclusion MPV increase during the first 15 days after ICU admission in non-survivors was observed during septic shock and 10-day MPV >11.6fL was an independent predictive factor of 90-day mortality. This could be explained by the emergent response to acute platelet loss during septic shock, leading to megakaryocyte rupture to produce new but potentially immature platelets in the circulation. Therefore, continuous monitoring of MPV may be a useful parameter to stratify mortality risk in septic shock.
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Affiliation(s)
- Fanny Vardon-Bounes
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
- * E-mail:
| | - Marie-Pierre Gratacap
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
| | - Samuel Groyer
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Ruiz
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
| | - Bernard Georges
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
| | - Thierry Seguin
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
| | - Cédric Garcia
- Hematology laboratory, Toulouse University Hospital, Toulouse, France
| | - Bernard Payrastre
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
- Hematology laboratory, Toulouse University Hospital, Toulouse, France
| | - Jean-Marie Conil
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
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PREDICTORS OF CANDIDEMIA IN PEDIATRIC PATIENTS (0–12 YEARS) ADMITTED IN A TERTIARY CARE HOSPITAL OF NORTHERN INDIA. ACTA ACUST UNITED AC 2019. [DOI: 10.32677/ijch.2019.v06.i09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Patients with suppressed immunity are at the highest risk for hospital-acquired infections. Among these, invasive candidiasis is the most prevalent systemic fungal nosocomial infection. Over recent decades, the combined prevalence of non-albicans Candida species outranked Candida albicans infections in several geographical regions worldwide, highlighting the need to understand their pathobiology in order to develop effective treatment and to prevent future outbreaks. Candida parapsilosis is the second or third most frequently isolated Candida species from patients. Besides being highly prevalent, its biology differs markedly from that of C. albicans, which may be associated with C. parapsilosis' increased incidence. Differences in virulence, regulatory and antifungal drug resistance mechanisms, and the patient groups at risk indicate that conclusions drawn from C. albicans pathobiology cannot be simply extrapolated to C. parapsilosis Such species-specific characteristics may also influence their recognition and elimination by the host and the efficacy of antifungal drugs. Due to the availability of high-throughput, state-of-the-art experimental tools and molecular genetic methods adapted to C. parapsilosis, genome and transcriptome studies are now available that greatly contribute to our understanding of what makes this species a threat. In this review, we summarize 10 years of findings on C. parapsilosis pathogenesis, including the species' genetic properties, transcriptome studies, host responses, and molecular mechanisms of virulence. Antifungal susceptibility studies and clinician perspectives are discussed. We also present regional incidence reports in order to provide an updated worldwide epidemiology summary.
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Dong Y, Glaser K, Speer CP. Late-onset sepsis caused by Gram-negative bacteria in very low birth weight infants: a systematic review. Expert Rev Anti Infect Ther 2019; 17:177-188. [PMID: 30640556 DOI: 10.1080/14787210.2019.1568871] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Very low birth weight (VLBW) infants are highly susceptible to late-onset sepsis (LOS). Compared to Gram-positive bacteria, Gram-negative bacteria are less common to cause LOS, but are associated with a more severe clinical manifestation, higher mortality, and increased risk of neonatal morbidity. So far, the clinical picture of late-onset Gram-negative sepsis (LOGNS) in VLBW infants has not been elucidated. An up-to-date and thorough understanding of the clinical picture of LOGNS in VLBW infants is important to optimize current anti-sepsis protocols. Areas covered: Literature published in the last three decades was searched for data on the epidemiology, pathogen profile, risk factors, clinical manifestations, laboratory parameters, mortality, and short-term and long-term morbidity of LOGNS in VLBW infants. Expert opinion: Gram-negative bacteria are major contributors of neonatal morbidity and mortality in VLBW infants with LOS, potentially posing a significant disease burden. Unravelling the pathogen-specific clinical picture of LOGNS and the underlying mechanisms is of particular interest. VLBW infants may differ from more mature neonates in terms of disease burden and clinical course of LOGNS. Epidemiologic studies aided by advanced molecular techniques may help to develop anti-sepsis protocols specialized for VLBW infants, with strategies targeting Gram-negative bacteria.
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Affiliation(s)
- Ying Dong
- a University Children's Hospital , University of Wuerzburg , Wuerzburg , Germany.,b Department of Neonatology , Children's Hospital of Fudan University , Shanghai , China
| | - Kirsten Glaser
- a University Children's Hospital , University of Wuerzburg , Wuerzburg , Germany
| | - Christian P Speer
- a University Children's Hospital , University of Wuerzburg , Wuerzburg , Germany
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Cakir B, Liegl R, Hellgren G, Lundgren P, Sun Y, Klevebro S, Löfqvist C, Mannheimer C, Cho S, Poblete A, Duran R, Hallberg B, Canas J, Lorenz V, Liu ZJ, Sola-Visner MC, Smith LE, Hellström A. Thrombocytopenia is associated with severe retinopathy of prematurity. JCI Insight 2018; 3:99448. [PMID: 30282834 DOI: 10.1172/jci.insight.99448] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 08/23/2018] [Indexed: 12/25/2022] Open
Abstract
Retinopathy of prematurity (ROP) is characterized by abnormal retinal neovascularization in response to vessel loss. Platelets regulate angiogenesis and may influence ROP progression. In preterm infants, we assessed ROP and correlated with longitudinal postnatal platelet counts (n = 202). Any episode of thrombocytopenia (<100 × 109/l) at ≥30 weeks postmenstrual age (at onset of ROP) was independently associated with severe ROP, requiring treatment. Infants with severe ROP also had a lower weekly median platelet count compared with infants with less severe ROP. In a mouse oxygen-induced retinopathy model of ROP, platelet counts were lower at P17 (peak neovascularization) versus controls. Platelet transfusions at P15 and P16 suppressed neovascularization, and platelet depletion increased neovascularization. Platelet transfusion decreased retinal of vascular endothelial growth factor A (VEGFA) mRNA and protein expression; platelet depletion increased retinal VEGFA mRNA and protein expression. Resting platelets with intact granules reduced neovascularization, while thrombin-activated degranulated platelets did not. These data suggest that platelet releasate has a local antiangiogenic effect on endothelial cells to exert a downstream suppression of VEGFA in neural retina. Low platelet counts during the neovascularization phase in ROP is significantly associated with the development of severe ROP in preterm infants. In a murine model of retinopathy, platelet transfusion during the period of neovascularization suppressed retinopathy.
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Affiliation(s)
- Bertan Cakir
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Raffael Liegl
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Gunnel Hellgren
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pia Lundgren
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ye Sun
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanna Klevebro
- Department of Neonatology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Chatarina Löfqvist
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clara Mannheimer
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Steve Cho
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Poblete
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rubi Duran
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Boubou Hallberg
- Department of Neonatology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Jorge Canas
- Department of Pediatrics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Viola Lorenz
- Department of Pediatrics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhi-Jian Liu
- Department of Pediatrics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha C Sola-Visner
- Department of Pediatrics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lois Eh Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
Neonatal sepsis (NS) continues to be a diagnostic challenge and a prime cause of mortality. Forage for a lucid, cost-effective yet highly sensitive and specific marker in diagnosing this entity is an incessant task. This study aimed to evaluate the predictive value of mean platelet volume (MPV) in diagnosing NS. Neonates diagnosed with sepsis from January 2016 to March 2016 were included in the study. The subjects were stratified into the following: (i) culture-proven sepsis (group I); (ii) culture-negative clinical sepsis (group II); and (iii) control group (group III). Several hematologic markers such as hemoglobin, total leukocyte count, platelet count, MPV, plateletcrit, platelet distribution width, immature-to-mature neutrophil ratio, toxic change, serum urea, bilirubin, and C-reactive protein were analyzed. The results were compared among the groups, and their efficacy in diagnosing NS was appraised. The study involved 210 neonates, of which, groups I, II, and III constituted 64, 75, and 71 cases, respectively. The mean MPV among groups I, II, and III was 9.56, 8.86, and 8.58 fL, respectively (P<0.05). Strikingly higher values of platelet count, immature-to-mature neutrophil ratio, MPV, plateletcrit, and C-reactive protein were found in group I in contrast to those in groups II and III (P<0.05). The baseline MPV of patients with culture-proven sepsis was comparatively higher than controls and was found to be statistically significant. Hence, MPV can be a simple, economical, and specific predictor of NS.
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Aydemir C, Aydemir H, Kokturk F, Kulah C, Mungan AG. The cut-off levels of procalcitonin and C-reactive protein and the kinetics of mean platelet volume in preterm neonates with sepsis. BMC Pediatr 2018; 18:253. [PMID: 30068303 PMCID: PMC6090766 DOI: 10.1186/s12887-018-1236-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Sepsis is a leading cause of morbidity and mortality among newborns. C-reactive protein (CRP) and procalcitonin (PCT) have some limitations in the diagnosis of preterm neonatal sepsis. In this study, the cut-offs of PCT and CRP, and the efficacy of mean platelet volume (MPV) were investigated. Methods We identified key demographic details and compared laboratory values between preterm infants with early onset and late onset neonatal sepsis (EONS/LONS) retrospectively. Blood samples were collected within the first few hours of the onset of clinical sepsis (CRP 1, PCT 1, MPV 1) and were repeated after 24 h (CRP 2, PCT 2, MPV 2). The optimal cut-offs for CRP, PCT and MPV were determined using receiver operating characteristic (ROC) analysis. Furthermore, pairwise comparisons of ROC curves were made to evaluate the performances of these tests. Results In EONS, the cut-off of CRP 1 was 2.6 mg/L, the sensitivity, specificity, PPV and NPV were 80.6, 83.0, 67.5 and 90.7%, respectively (p < 0.001). At a PCT 1 cut-off of 1.1 ng/mL, the sensitivity, specificity, PPV and NPV were 78.6, 81.2, 64.7 and 89.6%, respectively (p < 0.001). The sensitivity, specificity, PPV, and NPV of the CRP 1 cut-off of 3.6 mg/L for LONS were 78.3, 87.4, 74.8, and 89.4%, respectively. At a PCT 1 cut-off of 5.2 ng/mL, the sensitivity, specificity, PPV and NPV were 58.5, 95.5, 86.1, and 82.9% respectively. For proven sepsis, the cut-off of CRP 1 was 7.0 mg/L with a 76.5% sensitivity, 98.2% specificity, 94.9% PPV and 90.5% NPV (p < 0.001). At a PCT 1 cut-off of 1.36 ng/mL, the sensitivity, specificity, PPV and NPV were 90.8, 83.4, 70.6 and 94.4%, respectively (p < 0.001). In each subgroup, other than EONS, the performances of CRP 1 and PCT 1 measurements were found to be statistically higher than MPV 1. CRP 2 cut-off levels of LONS group and proven sepsis group were found to be lower than the initial values. Conclusions Optimal cut-off levels of CRP 1 and PCT 1 may differ in preterm sepsis subgroups. The diagnostic performances of CRP 1 and PCT 1 didn’t differ however, they were more efficacious than MPV.
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Affiliation(s)
- C Aydemir
- Department of Pediatrics, Medical Faculty, Division of Neonatology, Bülent Ecevit University, Zonguldak, Turkey
| | - H Aydemir
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bulent Ecevit University, 67600, Zonguldak, Turkey.
| | - F Kokturk
- Department of Biostatistics, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
| | - C Kulah
- Department of Microbiology, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
| | - A G Mungan
- Department of Biochemistry, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
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Shaaban HA, Safwat N. Mean platelet volume in preterm: a predictor of early onset neonatal sepsis. J Matern Fetal Neonatal Med 2018; 33:206-211. [PMID: 29886794 DOI: 10.1080/14767058.2018.1488161] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Early onset sepsis (EOS) is potentially life-threatening problem especially in preterm. EOS diagnosis is challenging due to its non-specific signs and laboratory tests. Mean platelet volume (MPV) has been used as predictor of many inflammatory diseases.Objectives: To assess the correlation between serial MPV measurement and EOS occurrence in preterm infants and to determine MPV effectiveness in combination with C reactive protein (CRP) to diagnose EOS and mortality prediction.Methods: The study was carried out on 95 preterm infants with antenatal risk factor for EOS. Blood samples were taken for complete blood count (CBC) including MPV evaluated at birth (cord blood) and at 72 h of life. CRP analyzed on days 1 and 3, subsequently patients were identified in two groups: sepsis (n = 28) and no-sepsis (n = 67).Results: MPV was significantly higher on both day 1 (10.23 ± 0.92) fl and day 3 (10.77 ± 1.16) fL in the sepsis group compared with no-sepsis (8.11 ± 0.29) fl and (8.53 ± 0.42) fl, respectively. MPV of 8.6 fL was identified as cut off value in patients probably resulting in sepsis with a sensitivity of 97.14% and a specificity of 100%. MPV of 10.4 fl was determined as cut off value in patients possibly resulting in death with a sensitivity of 70% and a specificity of 82.5%. The combination of both MPV and CRP on day 1 resulted in improving performance of MPV with higher negative predictive value (93.1%) and higher sensitivity (80%).Conclusion: High cord blood and day 3 MPV can be used as surrogate marker for prediction of EOS and associated mortality in preterm neonates.
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Affiliation(s)
- Hebatallah A Shaaban
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nesma Safwat
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Qi L, Fan W, Xia X, Yao L, Liu L, Zhao H, Kong X, Liu J. Nosocomial outbreak of Candida parapsilosis sensu stricto fungaemia in a neonatal intensive care unit in China. J Hosp Infect 2018; 100:e246-e252. [PMID: 29928941 DOI: 10.1016/j.jhin.2018.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Candida parapsilosis is a common agent of fungaemia, but few outbreaks of Candida parapsilosis infection have been reported in China. AIM To elaborate an outbreak of nosocomial Candida parapsilosis sensu stricto fungaemia in a neonatal intensive care unit (NICU) of a comprehensive hospital in China from July to October 2017. METHODS Epidemics and characteristics of fungaemia cases were investigated. Surveillance samples were collected. Vitek 2 Compact System, internal transcribed spacer sequencing, and random amplified polymorphic DNA (RAPD) typing were conducted to identify the isolates. Antifungal susceptibility test was performed for all bloodstream isolates. FINDINGS Sixteen neonates were diagnosed as Candida parapsilosis sensu stricto fungaemia during this period. Presenting symptoms included leucopenia, thrombocytopenia, and respiratory crackles. Fifteen cases were cured whereas one case who suffered from severe concomitant diseases died. The isolates were susceptible to fluconazole, amphotericin B, itraconazole, voriconazole, and 5-fluorocytosine. A total of 313 surveillance samples were collected, and Candida parapsilosis sensu stricto was identified from 16 environmental samples and one sample from an ultrasonographer's hand. The colonized locations included wiping cloths, faucets, sinks, operating table, puddles in the bathroom, a ventilator, and an ultrasonic probe. The RAPD patterns of all the Candida parapsilosis sensu stricto isolates from bloodstream and surveillance samples were identical. The outbreak was controlled after a series of infection control measures. CONCLUSION Contaminated environment was associated with this outbreak. Close attention to immunocompromised patients, thorough environmental disinfection and hand hygiene should be strengthened in NICU.
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Affiliation(s)
- L Qi
- Department of Laboratory, Army General Hospital, PLA, Beijing, China
| | - W Fan
- Department of Laboratory, Army General Hospital, PLA, Beijing, China
| | - X Xia
- Department of Infection Control, Army General Hospital, PLA, Beijing, China
| | - L Yao
- Department of Laboratory, Army General Hospital, PLA, Beijing, China
| | - L Liu
- Department of Laboratory, Army General Hospital, PLA, Beijing, China
| | - H Zhao
- Department of Laboratory, Army General Hospital, PLA, Beijing, China
| | - X Kong
- Department of Extremely Preterm Neonatal Intensive Care Unit, Army General Hospital, PLA, Beijing, China
| | - J Liu
- Department of Laboratory, Army General Hospital, PLA, Beijing, China.
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Abstract
Thrombocytopenia is common in patients with invasive bacterial infections. Bacteria can activate platelets, but it is unclear if this affects platelet count. The aim of this study was to examine whether bacteraemia with Staphylococcus aureus, which readily activate human platelets, was more likely to be complicated by thrombocytopenia than bacteraemia with Escherichia coli or Streptococcus pneumoniae with different abilities to activate platelets.We compared information from 600 adult patients with community-acquired bacteraemia with S. aureus (n = 140), E. coli (n = 420) and S. pneumoniae (n = 40) in Southern Sweden, 2012, linking information on positive blood cultures from microbiological databases and medical charts. The proportion of patients with thrombocytopenia (platelet count <150 × 109/ml) was calculated. Logistic regression was used to estimate the odds ratios (OR) for thrombocytopenia according to bacterial species adjusted for confounders.The proportion of thrombocytopenia was 29% in S. aureus, 28% in E. coli and 20% in S. pneumonia bacteraemia (P = 0.50), corresponding to an OR of 1.2 (95% confidence interval 0.7-1.9) for thrombocytopenia for S. aureus as compared with E. coli or S. pneumoniae, adjusted for confounders.This study indicates that platelet activation by bacteria is not a major causative mechanism in sepsis-associated thrombocytopenia.
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Prevalence and Severity of Thrombocytopenia in Blood Culture Proven Neonatal Sepsis: A Prospective Study. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.12471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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Platelet Distribution Width to Platelet Count Ratio as an Index of Severity of Illness. Indian J Pediatr 2018; 85:10-14. [PMID: 28842812 DOI: 10.1007/s12098-017-2432-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To prospectively validate association between the ratio of platelet distribution width (PDW)/platelet count (PCT) and pediatric intensive care unit (PICU) mortality. METHODS The study was done in the pediatric intensive care unit (PICU). Platelet indices in the first sample taken after admission were used. In this case control analysis, cases were the patients who died in PICU and the survivors served as controls. Consecutive 209 eligible patients over a period of 15 mo from January 2014 through March 2015 were included. Exposure was PDW/PC above 0.07. Of them 174 survived and 35 died. RESULTS The mean PDW for survivors was 16.77 (±0.92) and for those who died it was 17.33 (±1.03) (p 0.0015). Mean platelet count (PC) for survivors was 3,46,000 (±1,64,700) and for those who died it was 1,75,800 (±1,61,500) (p < 0.001). PDW/PC for survivors was 0.12 (±0.46) and for those who died it was 0.336 (±0.53) (p 0.0014). Using the cut-off of 0.07 for PDW/PC described by Golwala et al., 77.14% above the cut-off died, compared to 22.85% below that cut-off. The odds ratio (OR) for death was 10.6 (95% CI: 4.48 to 25.12). The area under the receiver operating curve (ROC) curve for PDW/PC ratio was 0.81. CONCLUSIONS The ratio of PDW/PC, higher than 0.07 in the first sample after admission can be considered as an independent predictor of mortality with sensitivity and specificity of 77.1% and 77.5%, respectively. It may be a useful component for inclusion in composite scores for predicting mortality.
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Hu YX, Xu XX, Shao Y, Yuan GL, Mei F, Zhou Q, Cheng Y, Wang J, Wu XR. The prognostic value of lymphocyte-to-monocyte ratio in retinopathy of prematurity. Int J Ophthalmol 2017; 10:1716-1721. [PMID: 29181316 DOI: 10.18240/ijo.2017.11.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 06/01/2017] [Indexed: 12/12/2022] Open
Abstract
AIM To evaluate the associations between development of retinopathy of prematurity (ROP) and serum lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). METHODS A retrospective cohort study was performed, involving infants who were screened for ROP from January 2015 to December 2015. Preterm newborns of ≤32 gestational weeks with ROP were enrolled as the observation group, and non-ROP infants were enrolled as the control group, whose complete blood cell were measured within the first 24h of life. The levels of NLR, LMR and PLR were determined in all groups. The data obtained were analyzed using univariate and multivariate logistic regression analysis. RESULTS In this study, 40 cases of ROP were enrolled and 40 cases of non-ROP as controls. The LMR levels were significantly higher (P<0.001) in ROP group (3.96±1.16) compared to non-ROP group (2.85±0.79). The NLR levels were significantly lower (P=0.035) in ROP group {median [interquartile range (IQR)], 0.88 (0.67-1.46)} compared to non-ROP group [median (IQR), 1.20 (0.85-1.89)]. The median PLR values were 61.99 (IQR, 50.23-75.98) in ROP group and 69.24 (IQR, 55.52-88.12) in non-ROP group (P=0.104). Logistic regression analysis suggested that LMR was an independent risk factor for ROP (OR: 0.275; 95% CI: 0.134-0.564; P=0.001). CONCLUSION The findings demonstrate that higher LMR is independently and significantly associated with the development of ROP, and the LMR may be invoked as a predictive tool for identifying risk for ROP.
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Affiliation(s)
- Yu-Xiang Hu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Xuan Xu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yi Shao
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Gao-Le Yuan
- Department of Pediatrics, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Feng Mei
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Quan Zhou
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yi Cheng
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jun Wang
- Second Department of Respiratory Disease, Jiangxi Provincial People's Hospital, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Rong Wu
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Ree IMC, Fustolo-Gunnink SF, Bekker V, Fijnvandraat KJ, Steggerda SJ, Lopriore E. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One 2017; 12:e0185581. [PMID: 28977011 PMCID: PMC5627935 DOI: 10.1371/journal.pone.0185581] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 09/15/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives Thrombocytopenia is a frequent problem in neonatal sepsis and is among the most predictive, independent risk factors for sepsis-associated mortality. This study aims to clarify the occurrence, severity and duration of thrombocytopenia in neonatal sepsis. Study design A cohort study was carried out among all neonates with proven culture positive sepsis that were admitted to a tertiary NICU between 2006 and 2015 (n = 460). The occurrence, severity and duration of thrombocytopenia were recorded, as well as major bleedings and potential risk factors for mortality in neonatal sepsis. Results Sepsis was diagnosed in 460 of 6551 neonates (7%). Severe thrombocytopenia (platelets ≤50*109/L) occurred in 20% (92/460) of septic neonates. The median time for platelets to rise >100*109 was 6.0 days (interquartile range 4.0–7.0). On multivariate analysis, maternal hypertension, intravascular thrombosis and Gram negative (as opposed to Gram positive) sepsis were independently associated with thrombocytopenia in neonatal sepsis. In severe thrombocytopenia, 10% (9/92) suffered a severe IVH, compared to 5% (20/356) in neonates with platelets >50*109/L (p = 0.125). 10% (9/92) suffered a pulmonary hemorrhage, compared to 2% (9/368) in neonates with platelets >50*109/L (p = 0.001). On multivariate analysis, thrombocytopenia and Gram negative (as opposed to Gram positive) sepsis were independently associated with neonatal mortality. Conclusions Thrombocytopenia is independently associated with maternal hypertension, intravascular thrombosis and Gram negative sepsis. Thrombocytopenia in neonatal sepsis increases the risk of mortality nearly four-fold, with another six-fold increase in mortality in case of Gram negative sepsis.
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Affiliation(s)
- Isabelle M. C. Ree
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
| | - Suzanne F. Fustolo-Gunnink
- Department of Pediatric Hematology, Academic Medical Center, Amsterdam, The Netherlands
- Sanquin Blood Supply, Department of Clinical Transfusion Research, Leiden, The Netherlands
| | - Vincent Bekker
- Division of Hematology/Immunology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Karin J. Fijnvandraat
- Department of Pediatric Hematology, Academic Medical Center, Amsterdam, The Netherlands
- Sanquin Blood Supply, Department of Plasma Proteins, Amsterdam, the Netherlands
| | - Sylke J. Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
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King J, Pana ZD, Lehrnbecher T, Steinbach WJ, Warris A. Recognition and Clinical Presentation of Invasive Fungal Disease in Neonates and Children. J Pediatric Infect Dis Soc 2017; 6:S12-S21. [PMID: 28927201 PMCID: PMC5907856 DOI: 10.1093/jpids/pix053] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive fungal diseases (IFDs) are devastating opportunistic infections that result in significant morbidity and death in a broad range of pediatric patients, particularly those with a compromised immune system. Recognizing them can be difficult, because nonspecific clinical signs and symptoms or isolated fever are frequently the only presenting features. Therefore, a high index of clinical suspicion is necessary in patients at increased risk of IFD, which requires knowledge of the pediatric patient population at risk, additional predisposing factors within this population, and the clinical signs and symptoms of IFD. With this review, we aim to summarize current knowledge regarding the recognition and clinical presentation of IFD in neonates and children.
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Affiliation(s)
- Jill King
- Aberdeen Fungal Group, Medical Research Council Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, and the Royal Aberdeen Children’s Hospital, United Kingdom
| | - Zoi-Dorothea Pana
- Hospital Epidemiology and Infection Control, Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; and
| | - William J Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, and Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina
| | - Adilia Warris
- Aberdeen Fungal Group, Medical Research Council Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, and the Royal Aberdeen Children’s Hospital, United Kingdom
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Yang YC, Mao J. Value of platelet count in the early diagnosis of nosocomial invasive fungal infections in premature infants. Platelets 2017; 29:65-70. [PMID: 28374642 DOI: 10.1080/09537104.2017.1293810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to investigate the value of a platelet count (PLT) in the early diagnosis of nosocomial invasive fungal infections in premature infants. Based on clinical diagnosis combined with blood culture results, 72 premature infants of 5354 pediatric patients who were hospitalized in the neonatal ward of our hospital between September 2009 and February 2013 were diagnosed with nosocomial invasive fungal infections (fungal infection group). There were 58 premature infants diagnosed with bacterial infections during the same period (bacterial infection group). The control group included 74 premature infants without nosocomial infections who were hospitalized during the same period. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity, specificity, and diagnostic efficacy of the PLT and white blood cell (WBC) counts and C-reactive protein (CRP) level in the diagnosis of fungal infections in premature infants. The risk factors for invasive fungal infections included birth weight < 2000 g, gestational age < 32 weeks, peripherally inserted central catheter (PICC), oxygen inhalation therapy, intravenous nutrition, and administration of antibiotics (p < 0.05). Compared with the control group, the WBC and PLT counts in the fungal infection group decreased in the early and acute stages of infection (p < 0.01), while the CRP level increased (p < 0.01). The PLT count in the bacterial infection group decreased in the early and acute stages of infection (p < 0.01) and the CRP level increased (p < 0.05). Moreover, the decrease in the PLT count in the fungal infection group was more significant than the bacterial infection group (p < 0.01) and the CRP level increased more in the fungal infection group in the early stage of infection (p < 0.01); however, there were no significant differences in the PLT count and CRP level between the fungal and bacterial infection groups in the acute stage of infection (p > 0.05). ROC curve analysis of the WBC and PLT counts and the CRP level in the early diagnosis of fungal infections showed that the area under the curve of the PLT count was 0.912 (95% confidence interval:0.863-0.961), thus indicating a high accuracy with a cutoff PLT count of 157.0 × 109/L. The corresponding sensitivity and specificity were 77.8% and 94.6%, respectively. We conclude that the PLT count is a convenient, economical, and effective predictor of invasive fungal infections in premature infants and has potential in the early diagnosis of fungal infections.
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Affiliation(s)
- Yu-Chen Yang
- a Department of Pediatrics , Shengjing Hospital of China Medical University , Shenyang , China
| | - Jian Mao
- a Department of Pediatrics , Shengjing Hospital of China Medical University , Shenyang , China
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Potential biomarkers for effective screening of neonatal sepsis infections: An overview. Microb Pathog 2017; 107:234-242. [PMID: 28377234 DOI: 10.1016/j.micpath.2017.03.042] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/17/2022]
Abstract
Neonatal sepsis, a clinical disorder developed by bacterial blood stream infections (BSI) in neonates, is one of the serious global public health problems that must be addressed. More than one million of the estimated global newborn deaths per year are occurred due to severe infections. The genesis of the infection is divided into early-onset sepsis (EOS) and late-onset sepsis (LOS) of the disease. The clinical complications of neonatal sepsis may be associated with bronchopulmonary dysplasia, ductus arteriosus and necrotizing enterocolitis. The clinical diagnosis and treatment of neonatal sepsis is highly complicated. Over the past few years distinct biomarkers have been identified. Most widely used biomarkers are C-reactive protein, Procalcitonin (PCT) and Serum amyloid A (SAA). Until recently, many potential biomarkers including Cell Surface antigens and Bacterial surface antigens and genetic biomarkers are being investigated. Protein biomarkers, cytokines and chemokines are getting much interest for identification of neonatal sepsis infection.
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Bhat Y R. Platelet indices in neonatal sepsis: A review. World J Clin Infect Dis 2017; 7:6-10. [DOI: 10.5495/wjcid.v7.i1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/20/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Thrombocytopenia is a common hematological abnormality in neonates with sepsis. The autoanalyzers now-a-days readily provide platelet indices along with platelet counts without any additional cost. However these indices are not given proper weightage often. The important platelet indices available for clinical utility include mean platelet volume (MPV), platelet distribution width and plateletcrit that are related to morphology and proliferation kinetics of platelets. Studies in adult patients reported their role in the diagnosis of severe sepsis and prognosis of adverse clinical outcomes including mortality. Abnormal MPV can aid diagnosing the cause of thrombocytopenia. Low MPV associated with thrombocytopenia has been found to result in clinical bleeding. Other indices, however, are less studied. The studies addressing the importance of these platelet indices in neonatal sepsis are limited. The current review gives an overview of potential utility of important platelet indices in neonatal sepsis.
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Lundgren P, Lundberg L, Hellgren G, Holmström G, Hård AL, Smith LE, Wallin A, Hallberg B, Hellström A. Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia. Neonatology 2016; 111:79-85. [PMID: 27631399 PMCID: PMC5159260 DOI: 10.1159/000448161] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The most severe form of rapidly progressing retinopathy of prematurity (ROP) is termed aggressive posterior ROP (APROP). APROP frequently causes severe visual impairment in affected preterm infants despite timely and appropriate laser treatment. OBJECTIVES We investigated the postnatal characteristics associated with APROP development in a national Swedish cohort. METHODS This retrospective, 1:1 matched case-control study included all infants that developed APROP in zone 1 (n = 9) between 2008 and 2012. Control infants, matched for gestational age and birth weight, developed ROP no worse than stage 2 (n = 9). We retrieved data from medical records on infant birth characteristics, postnatal morbidities, and blood analyses from birth to the first ROP treatment. Infectious episodes included sepsis, C-reactive protein ≥10 mg/l, and other clinical signs of infection that required antibiotic treatment. A platelet count <100 × 109/l was considered to be thrombocytopenia. RESULTS All APROP cases postnatally developed at least two infectious episodes, one in the first month and one around the time of ROP diagnosis. All APROP cases exhibited thrombocytopenia in the first month, and 6/9 exhibited thrombocytopenia around the time of ROP diagnosis. Compared to the controls, APROP cases more frequently developed necrotizing enterocolitis (8/9 vs. 1/9; p < 0.01) and sepsis (9/9 vs. 3/9; p < 0.01), and they had significantly lower median platelet counts (90 × 109/l, range 4-459, vs. 158 × 109/l, range 20-500; p < 0.001). CONCLUSION Multiple infectious episodes and thrombocytopenia, particularly around the time of ROP diagnosis, were associated with APROP development.
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Affiliation(s)
- Pia Lundgren
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linnea Lundberg
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hellgren
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Holmström
- Department of Neuroscience, Ophthalmology, University Hospital, Uppsala
| | - Anna-Lena Hård
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lois E Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Boubou Hallberg
- Department of Neonatology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Golwala ZM, Shah H, Gupta N, Sreenivas V, Puliyel JM. Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study. Afr Health Sci 2016; 16:356-62. [PMID: 27605950 DOI: 10.4314/ahs.v16i2.3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Thrombocytopenia has been shown to predict mortality. We hypothesize that platelet indices may be more useful prognostic indicators. Our study subjects were children one month to 14 years old admitted to our hospital. AIM To determine whether platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) and their ratios can predict mortality in hospitalised children. METHODS Children who died during hospital stay were the cases. Controls were age matched children admitted contemporaneously. The first blood sample after admission was used for analysis. Receiver operating characteristic (ROC) curve was used to identify the best threshold for measured variables and the ratios studied. Multiple regression analysis was done to identify independent predictors of mortality. RESULTS Forty cases and forty controls were studied. Platelet count, PCT and the ratios of MPV/Platelet count, MPV/PCT, PDW/Platelet count, PDW/PCT and MPV × PDW/Platelet count × PCT were significantly different among children who survived compared to those who died. On multiple regression analysis the ratio of MPV/PCT, PDW/Platelet count and MPV/Platelet count were risk factors for mortality with an odds ratio of 4.31(95% CI, 1.69-10.99), 3.86 (95% CI, 1.53-9.75), 3.45 (95% CI, 1.38-8.64) respectively. In 67% of the patients who died MPV/PCT ratio was above 41.8 and PDW/Platelet count was above 3.86. In 65% of patients who died MPV/Platelet count was above 3.45. CONCLUSION The MPV/PCT, PDW/Platelet count and MPV/Platelet count, in the first sample after admission in this case control study were predictors of mortality and could predict 65% to 67% of deaths accurately.
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Affiliation(s)
| | - Hardik Shah
- Department of Pediatrics and Neonatology, St. Stephens Hospital, New Delhi
| | - Neeraj Gupta
- Department of Pediatrics and Neonatology, St. Stephens Hospital, New Delhi
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi
| | - Jacob M Puliyel
- Department of Pediatrics and Neonatology, St. Stephens Hospital, New Delhi
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Şentürk M, Azgın İ, Övet G, Alataş N, Ağırgöl B, Yılmaz E. The role of the mean platelet volume and neutrophil-to-lymphocyte ratio in peritonsillar abscesses. Braz J Otorhinolaryngol 2016; 82:662-667. [PMID: 27068888 PMCID: PMC9444737 DOI: 10.1016/j.bjorl.2015.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/28/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Peritonsillar abscess is a serious infectious disease of the tonsillar tissue. Treatment generally requires both medical and surgical approaches to relieve the symptoms. Recently, in addition to clinical follow-up, some inflammatory markers, such as the mean platelet volume and neutrophil-to-lymphocyte ratio, have been considered to be additional inflammatory monitoring markers in inflammatory diseases. Objective The aim of this study was to describe the role of mean platelet volume and neutrophil-to-lymphocyte ratio in patients with peritonsillar abscess. Methods A retrospective study was conducted in 88 patients with peritonsillar abscess and 88 healthy individuals. We analyzed the white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, mean platelet volume and neutrophil-to-lymphocyte ratio values and compared them among the patient and control groups. Results The mean platelet volume levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess posttreatment group and the control group. A mean platelet volume value of 8.7 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 75%, 65.9%, 68% and 72%, respectively. The neutrophil-to-lymphocyte ratio levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess post-treatment group and the control group. A neutrophil-to-lymphocyte ratio value of 3.08 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 90.9%, 90.9%, 90.9% and 90.9%, respectively. While the white blood cell count, neutrophil count, lymphocyte count and C-reactive protein values were significantly different among the patient and control groups (p < 0.05), the platelet count was not significantly different among the patient and control groups (p > 0.05). Conclusion The mean platelet volume and neutrophil-to-lymphocyte ratio values made us think that these parameters were quick, inexpensive and reliable inflammatory follow-up parameters and could be easily integrated into daily practice for peritonsillar abscess treatment except platelet count.
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Affiliation(s)
- Mehmet Şentürk
- Konya Education and Research Hospital, Department of Otolaryngology Head and Neck Surgery, Konya, Turkey.
| | - İsa Azgın
- Konya Education and Research Hospital, Department of Otolaryngology Head and Neck Surgery, Konya, Turkey
| | - Gültekin Övet
- Konya Education and Research Hospital, Department of Otolaryngology Head and Neck Surgery, Konya, Turkey
| | - Necat Alataş
- Konya Education and Research Hospital, Department of Otolaryngology Head and Neck Surgery, Konya, Turkey
| | - Betül Ağırgöl
- Konya Education and Research Hospital, Department of Otolaryngology Head and Neck Surgery, Konya, Turkey
| | - Esra Yılmaz
- Konya Education and Research Hospital, Department of Otolaryngology Head and Neck Surgery, Konya, Turkey
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Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, Algert CS, Thornton JG, Crowther CA. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet 2016; 387:444-52. [PMID: 26564381 DOI: 10.1016/s0140-6736(15)00724-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm pre-labour ruptured membranes close to term is associated with increased risk of neonatal infection, but immediate delivery is associated with risks of prematurity. The balance of risks is unclear. We aimed to establish whether immediate birth in singleton pregnancies with ruptured membranes close to term reduces neonatal infection without increasing other morbidity. METHODS The PPROMT trial was a multicentre randomised controlled trial done at 65 centres across 11 countries. Women aged over 16 years with singleton pregnancies and ruptured membranes before the onset of labour between 34 weeks and 36 weeks and 6 days weeks who had no signs of infection were included. Women were randomly assigned (1:1) by a computer-generated randomisation schedule with variable block sizes, stratified by centre, to immediate delivery or expectant management. The primary outcome was the incidence of neonatal sepsis. Secondary infant outcomes included a composite neonatal morbidity and mortality indicator (ie, sepsis, mechanical ventilation ≥24 h, stillbirth, or neonatal death); respiratory distress syndrome; any mechanical ventilation; and duration of stay in a neonatal intensive or special care unit. Secondary maternal outcomes included antepartum or intrapartum haemorrhage, intrapartum fever, postpartum treatment with antibiotics, and mode of delivery. Women and caregivers could not be masked, but those adjudicating on the primary outcome were masked to group allocation. Analyses were by intention to treat. This trial is registered with the International Clinical Trials Registry, number ISRCTN44485060. FINDINGS Between May 28, 2004, and June 30, 2013, 1839 women were recruited and randomly assigned: 924 to the immediate birth group and 915 to the expectant management group. One woman in the immediate birth group and three in the expectant group were excluded from the primary analyses. Neonatal sepsis occurred in 23 (2%) of 923 neonates whose mothers were assigned to immediate birth and 29 (3%) of 912 neonates of mothers assigned to expectant management (relative risk [RR] 0·8, 95% CI 0·5-1·3; p=0·37). The composite secondary outcome of neonatal morbidity and mortality occurred in 73 (8%) of 923 neonates of mothers assigned to immediate delivery and 61 (7%) of 911 neonates of mothers assigned to expectant management (RR 1·2, 95% CI 0·9-1·6; p=0·32). However, neonates born to mothers in the immediate delivery group had increased rates of respiratory distress (76 [8%] of 919 vs 47 [5%] of 910, RR 1·6, 95% CI 1·1-2·30; p=0·008) and any mechanical ventilation (114 [12%] of 923 vs 83 [9%] of 912, RR 1·4, 95% CI 1·0-1·8; p=0·02) and spent more time in intensive care (median 4·0 days [IQR 0·0-10·0] vs 2·0 days [0·0-7·0]; p<0·0001) compared with neonates born to mothers in the expectant management group. Compared with women assigned to the immediate delivery group, those assigned to the expectant management group had higher risks of antepartum or intrapartum haemorrhage (RR 0·6, 95% CI 0·4-0·9), intrapartum fever (0·4, 0·2-0·9), and use of postpartum antibiotics (0·8, 0·7-1·0), and longer hospital stay (p<0·0001), but a lower risk of caesarean delivery (RR 1·4, 95% CI 1·2-1·7). INTERPRETATION In the absence of overt signs of infection or fetal compromise, a policy of expectant management with appropriate surveillance of maternal and fetal wellbeing should be followed in pregnant women who present with ruptured membranes close to term. FUNDING Australian National Health and Medical Research Council, the Women's and Children's Hospital Foundation, and The University of Sydney.
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Affiliation(s)
- Jonathan M Morris
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia.
| | - Christine L Roberts
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Jennifer R Bowen
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia; Department of Neonatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jillian A Patterson
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Diana M Bond
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Charles S Algert
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Jim G Thornton
- School of Clinical Sciences, Division of Obstetrics and Gynaecology, City Hospital, University of Nottingham, Nottingham, UK
| | - Caroline A Crowther
- The Robinson Institute, Women's and Children's Hospital, Adelaide, SA, Australia; Liggins Institute, The University of Auckland, Grafton, Auckland, New Zealand
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Mean platelet volume in young children with urinary tract infection. Sci Rep 2015; 5:18072. [PMID: 26666588 PMCID: PMC4678298 DOI: 10.1038/srep18072] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/10/2015] [Indexed: 12/20/2022] Open
Abstract
Mean platelet volume (MPV) has not yet been well-established in urinary tract infection (UTI). The purpose of this study was to evaluate the role of MPV as an acute phase reactant in children with UTI. Data from 118 young children (<2 years) with UTI between 2012 and 2013 were grouped as acute pyelonephritis (APN) and lower UTI according to the dimercaptosuccinic acid (DMSA) scan abnormalities. MPV, platelet distribution width (PDW) platelet count, and other infection markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]) were measured. WBC (P = 0.001), ESR (P = 0.005), CRP (P < 0.001) and MPV levels (P = 0.011) were significantly higher in the APN group than those in the lower UTI group. MPV positively correlated with PDW, CRP and negatively with platelet count. Multiple logistic regression analyses showed that CRP and MPV were independent predictive factors for APN patients. However, the area under the Receiver Operating Characteristic (ROC) curve analysis for MPV was lower than CRP. Our results suggest that MPV can be an inflammatory marker in UTI, but the predictive value of MPV was not superior to CRP in the diagnosis of APN.
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Effect of Severe Maternal Iron Deficiency Anemia on Neonatal Platelet Indices. Indian J Pediatr 2015; 82:1091-6. [PMID: 25980502 DOI: 10.1007/s12098-015-1775-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the effect of maternal iron deficiency anemia (IDA) on fetal thrombopoiesis. METHODS In this prospective observational study, maternal and cord blood iron status parameters (serum iron, serum ferritin, total iron-binding capacity, and transferrin saturation), and platelet indices, such as, absolute platelet count (APC), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit, were estimated in a convenient sample of 142 mothers with IDA (hemoglobin <11 g/dl and serum ferritin <12 ng/ml) and an equal number of healthy non-anemic (hemoglobin ≥11 g/dl) mothers, who delivered singleton live neonates at term gestation. Mothers with antenatal thrombocytopenia, infections, inflammatory conditions, pregnancy-induced hypertension and neonates with perinatal asphyxia, sepsis and congenital malformations were excluded. RESULTS For statistical analysis, the IDA group was further subdivided into mild-to-moderate (hemoglobin 7-10.9 g/dl) and severe (hemoglobin <7 g/dl) anemia. Cord blood APC and PDW were comparable between non-anemic and mild-to-moderate anemic mothers (242,550 ± 54,320/μL vs. 235,260 ± 34,620/μL for APC and 16.2 ± 1.4 vs. 16.4 ± 1.8 fl for PDW, respectively), but in severe IDA group, cord blood APC and PDW were significantly lower (74,520 ± 12,380/μL and 17.8 ± 2.1 fl, respectively, p < 0.001). MPV and plateletcrit were comparable. None of the study neonates had a platelet count <30,000/μL or showed any evidence of clinical bleeding. CONCLUSIONS Neonates born to mothers with severe IDA had moderate thrombocytopenia with increased PDW, though no change was observed in MPV and plateletcrit. Further studies should be carried out to identify the cause and consequences of this observation.
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