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Smit ER, Romijn M, Langerhorst P, van der Zwaan C, van der Staaij H, Rotteveel J, van Kaam AH, Fustolo-Gunnink SF, Hoogendijk AJ, Onland W, Finken MJJ, van den Biggelaar M. Distinct protein patterns related to postnatal development in small for gestational age preterm infants. Pediatr Res 2024:10.1038/s41390-024-03481-0. [PMID: 39152333 DOI: 10.1038/s41390-024-03481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/18/2024] [Accepted: 07/30/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Preterm infants, especially those born small for gestational age (SGA), are at risk of short-term and long-term health complications. Characterization of changes in circulating proteins postnatally in preterm infants may provide valuable fundamental insights into this population. Here, we investigated postnatal developmental patterns in preterm infants and explored protein signatures that deviate between SGA infants and appropriate for gestational age (AGA) infants using a mass spectrometry (MS)-based proteomics workflow. METHODS Longitudinal serum samples obtained at postnatal days 0, 3, 7, 14, and 28 from 67 preterm infants were analyzed using unbiased MS-based proteomics. RESULTS 314 out of 833 quantified serum proteins change postnatally, including previously described age-related changes in immunoglobulins, hemoglobin subunits, and new developmental patterns, e.g. apolipoproteins (APOA4) and terminal complement cascade (C9) proteins. Limited differences between SGA and AGA infants were found at birth while longitudinal monitoring revealed 69 deviating proteins, including insulin-sensitizing hormone adiponectin, platelet proteins, and 24 proteins with an annotated function in the immune response. CONCLUSIONS This study shows the potential of MS-based serum profiling in defining circulating protein trajectories in the preterm infant population and its ability to identify longitudinal alterations in protein levels associated with SGA. IMPACT Postnatal changes of circulating proteins in preterm infants have not fully been elucidated but may contribute to development of health complications. Mass spectrometry-based analysis is an attractive approach to study circulating proteins in preterm infants with limited material. Longitudinal plasma profiling reveals postnatal developmental-related patterns in preterm infants (314/833 proteins) including previously described changes, but also previously unreported proteins. Longitudinal monitoring revealed an immune response signature between SGA and AGA infants. This study highlights the importance of taking postnatal changes into account for translational studies in preterm infants.
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Affiliation(s)
- Eva R Smit
- Department of Molecular Hematology, Sanquin Research, Amsterdam, the Netherlands
| | - Michelle Romijn
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Pediatric Endocrinology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter Langerhorst
- Department of Molecular Hematology, Sanquin Research, Amsterdam, the Netherlands
| | - Carmen van der Zwaan
- Department of Molecular Hematology, Sanquin Research, Amsterdam, the Netherlands
| | - Hilde van der Staaij
- Sanquin Research & Lab Services, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joost Rotteveel
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Pediatric Endocrinology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Suzanne F Fustolo-Gunnink
- Sanquin Research & Lab Services, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Arie J Hoogendijk
- Department of Molecular Hematology, Sanquin Research, Amsterdam, the Netherlands
| | - Wes Onland
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Martijn J J Finken
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Pediatric Endocrinology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Ong WJ, Seng JJB, Yap B, He G, Moochhala NA, Ng CL, Ganguly R, Lee JH, Chong SL. Impact of neonatal sepsis on neurocognitive outcomes: a systematic review and meta-analysis. BMC Pediatr 2024; 24:505. [PMID: 39112966 PMCID: PMC11304789 DOI: 10.1186/s12887-024-04977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/26/2024] [Indexed: 08/11/2024] Open
Abstract
INTRODUCTION Sepsis is associated with neurocognitive impairment among preterm neonates but less is known about term neonates with sepsis. This systematic review and meta-analysis aims to provide an update of neurocognitive outcomes including cognitive delay, visual impairment, auditory impairment, and cerebral palsy, among neonates with sepsis. METHODS We performed a systematic review of PubMed, Embase, CENTRAL and Web of Science for eligible studies published between January 2011 and March 2023. We included case-control, cohort studies and cross-sectional studies. Case reports and articles not in English language were excluded. Using the adjusted estimates, we performed random effects model meta-analysis to evaluate the risk of developing neurocognitive impairment among neonates with sepsis. RESULTS Of 7,909 studies, 24 studies (n = 121,645) were included. Majority of studies were conducted in the United States (n = 7, 29.2%), and all studies were performed among neonates. 17 (70.8%) studies provided follow-up till 30 months. Sepsis was associated with increased risk of cognitive delay [adjusted odds ratio, aOR 1.14 (95% CI: 1.01-1.28)], visual impairment [aOR 2.57 (95%CI: 1.14- 5.82)], hearing impairment [aOR 1.70 (95% CI: 1.02-2.81)] and cerebral palsy [aOR 2.48 (95% CI: 1.03-5.99)]. CONCLUSION Neonates surviving sepsis are at a higher risk of poorer neurodevelopment. Current evidence is limited by significant heterogeneity across studies, lack of data related to long-term neurodevelopmental outcomes and term infants.
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Affiliation(s)
- Wei Jie Ong
- MOH Holdings, Singapore, 1 Maritime Square, Singapore, 099253, Singapore
| | - Jun Jie Benjamin Seng
- MOH Holdings, Singapore, 1 Maritime Square, Singapore, 099253, Singapore.
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore.
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore.
| | - Beijun Yap
- MOH Holdings, Singapore, 1 Maritime Square, Singapore, 099253, Singapore
| | - George He
- Yong Loo Lin School of Medicine, 10 Medical Dr, Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Chen Lin Ng
- MOH Holdings, Singapore, 1 Maritime Square, Singapore, 099253, Singapore
| | - Rehena Ganguly
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, SingHealth Paediatrics Academic Clinical Programme, 100 Bukit Timah Rd, Singapore, 229899, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth Paediatrics Academic Clinical Programme, SingHealth Emergency Medicine Academic Clinical Programme, 100 Bukit Timah Rd, Singapore, 229899, Singapore
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3
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Thompson DK, Cai S, Kelly CE, Alexander B, Matthews LG, Mainzer R, Doyle LW, Cheong JLY, Inder TE, Yang JYM, Anderson PJ. Brain volume and neurodevelopment at 13 years following sepsis in very preterm infants. Pediatr Res 2024:10.1038/s41390-024-03407-w. [PMID: 39003332 DOI: 10.1038/s41390-024-03407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Associations of neonatal infection with brain growth and later neurodevelopmental outcomes in very preterm (VP) infants are unclear. This study aimed to assess associations of neonatal sepsis in VP infants with (1) brain growth from term-equivalent age to 13 years; and (2) 13-year brain volume and neurodevelopmental outcomes. METHODS 224 infants born VP ( < 30 weeks' gestation/<1250 g birthweight) were recruited. Longitudinal brain volumes for 68 cortical and 14 subcortical regions were derived from MRI at term-equivalent, 7 and/or 13 years of age for 216 children (79 with neonatal sepsis and 137 without). 177 children (79%) had neurodevelopmental assessments at age 13. Of these, 63 with neonatal sepsis were compared with 114 without. Brain volumetric growth trajectories across time points were compared between sepsis and no-sepsis groups using mixed effects models. Linear regressions compared brain volume and neurodevelopmental outcome measures at 13 years between sepsis and no sepsis groups. RESULTS Growth trajectories were similar and there was little evidence for differences in brain volumes or neurodevelopmental domains at age 13 years between those with or without sepsis. CONCLUSIONS Neonatal sepsis in children born VP does not appear to disrupt subsequent brain development, or to have functional consequences in early adolescence. IMPACT STATEMENT Neonatal sepsis has been associated with poorer short-term neurodevelopmental outcomes and reduced brain volumes in very preterm infants. This manuscript provides new insights into the long-term brain development and neurodevelopmental outcomes of very preterm-born children who did or did not have neonatal sepsis. We found that regional brain volumes up to 13 years, and neurodevelopmental outcomes at age 13, were similar between those with and without neonatal sepsis. The links between neonatal sepsis and long-term neurodevelopment remain unclear.
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Affiliation(s)
- Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, 3800, Australia.
| | - Shirley Cai
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Melbourne Medicine School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Claire E Kelly
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, 3800, Australia
| | - Bonnie Alexander
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery, Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Lillian G Matthews
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Rheanna Mainzer
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
- Neonatal Services, The Royal Women's Hospital, Parkville, VIC, 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
- Neonatal Services, The Royal Women's Hospital, Parkville, VIC, 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Terrie E Inder
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Center for Neonatal Research, Children's Hospital of Orange County, Orange, CA, 92866, USA
- Department of Pediatrics, University of California, Irvine, CA, 92697, USA
| | - Joseph Y M Yang
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
- Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery, Royal Children's Hospital, Parkville, VIC, 3052, Australia
- Neuroscience Research, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, 3800, Australia
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Mackay CA, Nathan EA, Porter MC, Shrestha D, Kohan R, Strunk T. Epidemiology and Outcomes of Neonatal Sepsis: Experience from a Tertiary Australian NICU. Neonatology 2024:1-12. [PMID: 38889701 DOI: 10.1159/000539174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/27/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Neonatal sepsis is associated with significant mortality and morbidity. Low-middle-income countries are disproportionately affected, but late-onset sepsis (LOS) still occurs in up to 20% of infants <28 weeks in high-income countries. Understanding site-specific data is vital to guide management. METHODS A retrospective cohort study was conducted at King Edward Memorial Hospital (KEMH), Perth. Infants admitted between January 2012 and June 2022 were included. Data were extracted from routine electronic databases. Incidence and aetiology of sepsis were determined and the association of sepsis with neonatal outcomes analysed. RESULTS During the study period, 23,395 newborns were admitted with a median gestation of 37 weeks and birth weight of 2,800 g. There were 370 sepsis episodes in 350 infants; 102 were early-onset sepsis (EOS) (1.6 per 1,000 live births), predominantly Streptococcus agalactiae (35, 34.3%) and Escherichia coli (27, 26.5%); 268 were LOS (0.9 per 1,000 inpatient days), predominantly coagulase-negative staphylococci (CONS) (156, 57.6%) and E. coli (30, 11.1%). The incidence of LOS declined from 2012 to 2022 (p = 0.002). Infants with EOS had increased brain injury (25.7% vs. 4.1%; p = 0.002) and mortality (18.8% vs. 1.6%; p < 0.001). Those with LOS had increased hospital stay (median 95 vs. 15 days; p < 0.001), mortality (15.3% vs. 1.6%; p = 0.018), necrotising enterocolitis (NEC) (7.4% vs. 0.5%; p < 0.001), and chronic lung disease (CLD) (58.1% vs. 5.9%; p = 0.005). Infants <28 weeks with sepsis were at increased risk of neurodevelopmental impairment compared to those without infection (43.2% vs. 30.9%, p = 0.027). CONCLUSIONS While we observed a reduction in LOS incidence, sepsis remains associated with higher mortality, and in survivors with longer hospital stay and increased risk of brain injury, NEC, CLD, and neurodevelopmental impairment.
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Affiliation(s)
- Cheryl Anne Mackay
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Subiaco, Washington, Australia
- School of Medicine, University of Western Australia, Crawley, Washington, Australia
| | - Elizabeth A Nathan
- School of Medicine, University of Western Australia, Crawley, Washington, Australia
| | - Michelle Claire Porter
- Microbiology Department, PathWest Laboratory Services, Nedlands, Perth, Washington, Australia
| | - Damber Shrestha
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Subiaco, Washington, Australia
| | - Rolland Kohan
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Subiaco, Washington, Australia
- School of Medicine, University of Western Australia, Crawley, Washington, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Subiaco, Washington, Australia
- School of Medicine, University of Western Australia, Crawley, Washington, Australia
- Wesfarmers' Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Washington, Australia
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Taneri PE, Devane D, Kirkham J, Molloy E, Daly M, Branagan A, Suguitani D, Wynn JL, Kissoon N, Kawaza K, Simons SHP, Bonnard LN, Giannoni E, Strunk T, Ohaja M, Mugabe K, Quirke F, Bazilio K, Biesty L. Outcomes of interventions in neonatal sepsis: A systematic review of qualitative research. Int J Gynaecol Obstet 2024. [PMID: 38842248 DOI: 10.1002/ijgo.15725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND While a systematic review exists detailing neonatal sepsis outcomes from clinical trials, there remains an absence of a qualitative systematic review capturing the perspectives of key stakeholders. OBJECTIVES Our aim is to identify outcomes from qualitative research on any intervention to prevent or improve the outcomes of neonatal sepsis that are important to parents, other family members, healthcare providers, policymakers, and researchers as a part of the development of a core outcome set (COS) for neonatal sepsis. SEARCH STRATEGY A literature search was carried out using MEDLINE, EMBASE, CINAHL, and PsycInfo databases. SELECTION CRITERIA Publications describing qualitative data relating to neonatal sepsis outcomes were included. DATA COLLECTION AND ANALYSIS Drawing on the concepts of thematic synthesis, texts related to outcomes were coded and grouped. These outcomes were then mapped to the domain headings of an existing model. MAIN RESULTS Out of 6777 records screened, six studies were included. Overall, 19 outcomes were extracted from the included studies. The most frequently reported outcomes were those in the domains related to parents, healthcare workers and individual organ systemas such as gastrointestinal system. The remaining outcomes were classified under the headings of general outcomes, miscellaneous outcomes, survival, and infection. CONCLUSIONS The outcomes identified in this review are different from those reported in neonatal sepsis clinical trials, thus highlighting the importance of incorporating qualitative studies into COS development to encapsulate all relevant stakeholders' perspectives.
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Affiliation(s)
- Petek Eylul Taneri
- HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland
- School of Nursing & Midwifery, University of Galway, Galway, Ireland
| | - Declan Devane
- HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland
- School of Nursing & Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland & Cochrane Ireland, University of Galway, Galway, Ireland
| | - Jamie Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Eleanor Molloy
- Department of Neonatology, Coombe Hospital, Dublin, Ireland
- Department of Paediatrics and Child Health &Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Neonatology, Children's Health Ireland, Dublin, Ireland
| | - Mandy Daly
- Advocacy and Policymaking, Irish Neonatal Health Alliance, Bray, Ireland
| | - Aoife Branagan
- Department of Neonatology, Coombe Hospital, Dublin, Ireland
- Department of Paediatrics and Child Health &Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
| | - Denise Suguitani
- Brazilian Parents of Preemies' Association, Porto Alegre, Brazil
| | - James L Wynn
- Department of Paediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Niranjan Kissoon
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kondwani Kawaza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sinno H P Simons
- Division of Neonatology, Department of Pediatric and Neonatal Intensive Care, Erasmus UMC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service; Wesfarmers' Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Magdalena Ohaja
- School of Nursing & Midwifery, University of Galway, Galway, Ireland
| | - Kenneth Mugabe
- Mbale Regional Referral Hospital, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Fiona Quirke
- HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland
| | | | - Linda Biesty
- School of Nursing & Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland & Cochrane Ireland, University of Galway, Galway, Ireland
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Pavlyshyn H, Sarapuk I, Kozak K. The relationship between neonatal stress in preterm infants and developmental outcomes at the corrected age of 24-30 months. Front Psychol 2024; 15:1415054. [PMID: 38840740 PMCID: PMC11150848 DOI: 10.3389/fpsyg.2024.1415054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
Aim The aim of research was to study the relationship between the stress experienced by preterm infants in the neonatal intensive care unit (NICU) and developmental status in the follow up, and to establish factors, associated with their neurodevelopment. Methods The first stage of research involved measuring stress markers (cortisol, melatonin) in infants (n = 56) during their NICU stay; the second phase assessed the developmental status at the corrected age of 24-30 months. Results The total ASQ-3 score, communication, problem solving, and personal-social skills scores at the corrected age of 24-30 months were positively correlated with melatonin level determined in the neonatal period (r = 0.31, p = 0.026; r = 0.36, p = 0.009; r = 0.30, p = 0.033, and r = 0.32; p = 0.022 respectively). In the same time, ASQ-3 communication and personal-social scores were negatively correlated with cortisol level (r = -0.31, p = 0.043; r = -0.35, p = 0.022). The ROC-curve analysis revealed that a decrease of melatonin below 3.44 ng/mL and 3.71 ng/mL during the neonatal period could predict communication and problem-solving delay, respectively. An increase in cortisol above 0.64 mcg/dl is predictive in personal-social delay. Negative correlation was identified between the NICU and total hospital stay duration and ASQ-3 communication scores in the follow-up (r = -0.27; p = 0.049 and r = -0.41; p = 0.002, respectively). The duration of mechanical ventilation was negatively correlated with gross motor scores (r = -0.46; p = 0.043). Apgar score was positively correlated with ASQ-3 communication (r = 0.29; p = 0.032) and personal-social scores (r = 0.28; p = 0.034); maternal age-with ASQ-3 total (r = 0.29; p = 0.034), communication (r = 0.37; p = 0.006), and personal-social scores (r = 0.29; p = 0.041). Positive correlations were observed between gestational age and communication scores (r = 0.28; p = 0.033). Infants who suffered neonatal sepsis had significantly often delay of communication (p = 0.014) and gross motor skills (p = 0.016). Children who required mechanical ventilation were more likely to have communication delay (p = 0.034). Conclusion Developmental outcomes in preterm infants at the corrected age of 24-30 months were associated with neonatal stress. Correlations between the communication, problem-solving and personal-social development in the follow up and cortisol and melatonin levels determined in the neonatal period supported this evidence. Factors as low gestational age, duration of hospital and NICU stay, mechanical ventilation, and sepsis were associated with more frequent delays in communication, gross motor and problems-solving skills.
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Affiliation(s)
- Halyna Pavlyshyn
- Department of Pediatrics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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7
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de Kroon RR, Frerichs NM, Struys EA, de Boer NK, de Meij TGJ, Niemarkt HJ. The Potential of Fecal Volatile Organic Compound Analysis for the Early Diagnosis of Late-Onset Sepsis in Preterm Infants: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:3162. [PMID: 38794014 PMCID: PMC11124895 DOI: 10.3390/s24103162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
Early diagnosis and treatment of late-onset sepsis (LOS) is crucial for survival, but challenging. Intestinal microbiota and metabolome alterations precede the clinical onset of LOS, and the preterm gut is considered an important source of bacterial pathogens. Fecal volatile organic compounds (VOCs), formed by physiologic and pathophysiologic metabolic processes in the preterm gut, reflect a complex interplay between the human host, the environment, and microbiota. Disease-associated fecal VOCs can be detected with an array of devices with various potential for the development of a point-of-care test (POCT) for preclinical LOS detection. While characteristic VOCs for common LOS pathogens have been described, their VOC profiles often overlap with other pathogens due to similarities in metabolic pathways, hampering the construction of species-specific profiles. Clinical studies have, however, successfully discriminated LOS patients from healthy individuals using fecal VOC analysis with the highest predictive value for Gram-negative pathogens. This review discusses the current advancements in the development of a non-invasive fecal VOC-based POCT for early diagnosis of LOS, which may potentially provide opportunities for early intervention and targeted treatment and could improve clinical neonatal outcomes. Identification of confounding variables impacting VOC synthesis, selection of an optimal detection device, and development of standardized sampling protocols will allow for the development of a novel POCT in the near future.
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Affiliation(s)
- Rimke R. de Kroon
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nina M. Frerichs
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Eduard A. Struys
- Department of Laboratory Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nanne K. de Boer
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Tim G. J. de Meij
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Hendrik J. Niemarkt
- Department of Neonatology, Maxima Medisch Centrum, De Run 4600, 5504 DB Veldhoven, The Netherlands
- Department of Electrical Engineering, TU Eindhoven, Eindhoven University of Technology, Postbus 513, 5600 MB Eindhoven, The Netherlands
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Colaizy TT, Poindexter BB, McDonald SA, Bell EF, Carlo WA, Carlson SJ, DeMauro SB, Kennedy KA, Nelin LD, Sánchez PJ, Vohr BR, Johnson KJ, Herron DE, Das A, Crawford MM, Walsh MC, Higgins RD, Stoll BJ. Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula: A Randomized Clinical Trial. JAMA 2024; 331:582-591. [PMID: 38497706 PMCID: PMC10828950 DOI: 10.1001/jama.2023.27693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/15/2023] [Indexed: 03/19/2024]
Abstract
Importance Maternal milk feeding of extremely preterm infants during the birth hospitalization has been associated with better neurodevelopmental outcomes compared with preterm formula. For infants receiving no or minimal maternal milk, it is unknown whether donor human milk conveys similar neurodevelopmental advantages vs preterm formula. Objective To determine if nutrient-fortified, pasteurized donor human milk improves neurodevelopmental outcomes at 22 to 26 months' corrected age compared with preterm infant formula among extremely preterm infants who received minimal maternal milk. Design, Setting, and Participants Double-blind, randomized clinical trial conducted at 15 US academic medical centers within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants younger than 29 weeks 0 days' gestation or with a birth weight of less than 1000 g were enrolled between September 2012 and March 2019. Intervention Preterm formula or donor human milk feeding from randomization to 120 days of age, death, or hospital discharge. Main Outcomes and Measures The primary outcome was the Bayley Scales of Infant and Toddler Development (BSID) cognitive score measured at 22 to 26 months' corrected age; a score of 54 (score range, 54-155; a score of ≥85 indicates no neurodevelopmental delay) was assigned to infants who died between randomization and 22 to 26 months' corrected age. The 24 secondary outcomes included BSID language and motor scores, in-hospital growth, necrotizing enterocolitis, and death. Results Of 1965 eligible infants, 483 were randomized (239 in the donor milk group and 244 in the preterm formula group); the median gestational age was 26 weeks (IQR, 25-27 weeks), the median birth weight was 840 g (IQR, 676-986 g), and 52% were female. The birthing parent's race was self-reported as Black for 52% (247/478), White for 43% (206/478), and other for 5% (25/478). There were 54 infants who died prior to follow-up; 88% (376/429) of survivors were assessed at 22 to 26 months' corrected age. The adjusted mean BSID cognitive score was 80.7 (SD, 17.4) for the donor milk group vs 81.1 (SD, 16.7) for the preterm formula group (adjusted mean difference, -0.77 [95% CI, -3.93 to 2.39], which was not significant); the adjusted mean BSID language and motor scores also did not differ. Mortality (death prior to follow-up) was 13% (29/231) in the donor milk group vs 11% (25/233) in the preterm formula group (adjusted risk difference, -1% [95% CI, -4% to 2%]). Necrotizing enterocolitis occurred in 4.2% of infants (10/239) in the donor milk group vs 9.0% of infants (22/244) in the preterm formula group (adjusted risk difference, -5% [95% CI, -9% to -2%]). Weight gain was slower in the donor milk group (22.3 g/kg/d [95% CI, 21.3 to 23.3 g/kg/d]) compared with the preterm formula group (24.6 g/kg/d [95% CI, 23.6 to 25.6 g/kg/d]). Conclusions and Relevance Among extremely preterm neonates fed minimal maternal milk, neurodevelopmental outcomes at 22 to 26 months' corrected age did not differ between infants fed donor milk or preterm formula. Trial Registration ClinicalTrials.gov Identifier: NCT01534481.
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Affiliation(s)
- Tarah T. Colaizy
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City
| | - Brenda B. Poindexter
- Department of Pediatrics, Children’s Healthcare of Atlanta, School of Medicine, Emory University, Atlanta, Georgia
| | - Scott A. McDonald
- Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Edward F. Bell
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City
| | - Waldemar A. Carlo
- Division of Neonatology, Heersink School of Medicine, University of Alabama, Birmingham
| | - Susan J. Carlson
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City
| | - Sara B. DeMauro
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kathleen A. Kennedy
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Leif D. Nelin
- Department of Pediatrics, Nationwide Children’s Hospital, College of Medicine, Ohio State University, Columbus
| | - Pablo J. Sánchez
- Department of Pediatrics, Nationwide Children’s Hospital, College of Medicine, Ohio State University, Columbus
| | - Betty R. Vohr
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island
| | - Karen J. Johnson
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City
| | - Dianne E. Herron
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | - Margaret M. Crawford
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | - Michele C. Walsh
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Barbara J. Stoll
- Department of Pediatrics, Children’s Healthcare of Atlanta, School of Medicine, Emory University, Atlanta, Georgia
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston
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9
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Melan N, Pradat P, Godbert I, Pastor-Diez B, Basson E, Picaud JC. Neurodevelopment at 24 months corrected age in extremely preterm infants treated with dexamethasone alternatives during the late postnatal period: a cohort study. Eur J Pediatr 2024; 183:677-687. [PMID: 37955745 PMCID: PMC10912127 DOI: 10.1007/s00431-023-05319-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023]
Abstract
The administration of dexamethasone has been associated with suboptimal neurodevelopment. We aimed to compare the development of extremely premature infants treated or not with alternatives to dexamethasone: betamethasone, hydrocortisone hemisuccinate. This retrospective cohort study included infants born before 29 weeks of gestational age, treated or not with late (day ≥ 7) postnatal steroids (betamethasone, hydrocortisone hemisuccinate). The neurodevelopment outcome was evaluated at 24 months corrected age, after adjustment on comorbidities of extreme prematurity. In order to analyse their overall development, data about growth and respiratory outcomes were collected. Among the 192 infants included, 59 (30.7%) received postnatal steroids. Suboptimal neurodevelopment concerned 37/59 (62.7%) postnatal steroid-treated and 43/133 (38.1%; p = 0.002) untreated infants. However, in multivariable analysis, only severe neonatal morbidity (p = 0.007) and male gender (p = 0.027) were associated with suboptimal neurodevelopment outcome at 24 months. Conclusions: Betamethasone or hydrocortisone hemisuccinate treatment was not an independent risk for suboptimal neurological development, growth and respiratory outcomes assessed at 24 months corrected age in extremely premature infants. Registration number: The study was registered on the ClinicalTrials.gov register: NCT05055193. What is Known: • Late postnatal steroids are used to treat bronchopulmonary dysplasia • Meta-analyses warned against the neurological risk of dexamethasone use during neonatal period. Early or late hydrocortisone hemisuccinate has been evaluated in multiple studies, none of which have reported an adverse effect on neurodevelopment at least to 2 years. Data about the use of betamethasone are scarce. What is New: • The risk of suboptimal neurodevelopment was higher among extremely premature infants who received postnatal steroids when compared to those who did not. • Betamethasone and hydrocortisone hemisuccinate treatment was not an independent risk factor for suboptimal neurodevelopment at 24 months corrected age.
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Affiliation(s)
- Nathalie Melan
- Department of Neonatology, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France
| | - Pierre Pradat
- Centre for Clinical Research, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France
| | - Isabelle Godbert
- Department of Neonatology, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France
| | - Blandine Pastor-Diez
- Department of Neonatology, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France
| | - Eliane Basson
- Department of Neonatology, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France
| | - Jean-Charles Picaud
- Department of Neonatology, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France.
- CarMen Laboratory, INSERM, INRA, Université Claude Bernard Lyon 1, Pierre-Bénite, 69310, Lyon, France.
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10
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Kumar R, Kausch SL, Gummadi AKS, Fairchild KD, Abhyankar MM, Petri WA, Sullivan BA. Inflammatory biomarkers and physiomarkers of late-onset sepsis and necrotizing enterocolitis in premature infants. Front Pediatr 2024; 12:1337849. [PMID: 38312920 PMCID: PMC10834753 DOI: 10.3389/fped.2024.1337849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Background Early diagnosis of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in very low birth weight (VLBW, <1,500 g) infants is challenging due to non-specific clinical signs. Inflammatory biomarkers increase in response to infection, but non-infectious conditions also cause inflammation. Cardiorespiratory data contain physiological biomarkers, or physiomarkers, of sepsis that may be useful in combination with inflammatory hematologic biomarkers for sepsis diagnosis. Objectives To determine whether inflammatory biomarkers measured at the time of LOS or NEC diagnosis differ from times without infection and whether biomarkers correlate with cardiorespiratory sepsis physiomarkers in VLBW infants. Methods Remnant plasma sample collection from VLBW infants occurred with blood draws for routine laboratory testing and suspected sepsis. We analyzed 11 inflammatory biomarkers and a pulse oximetry sepsis warning score (POWS). We compared biomarker levels obtained at the time of gram-negative (GN) bacteremia or NEC, gram-positive (GP) bacteremia, negative blood cultures, and no suspected infection. Results We analyzed 188 samples in 54 VLBW infants. Several biomarkers were increased at the time of GN LOS or NEC diagnosis compared with all other samples. POWS was higher in patients with LOS and correlated with five biomarkers. IL-6 had 78% specificity at 100% sensitivity to detect GN LOS or NEC and added information to POWS. Conclusions Inflammatory plasma biomarkers discriminate sepsis due to GN bacteremia or NEC and correlate with cardiorespiratory physiomarkers.
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Affiliation(s)
- Rupin Kumar
- Department of Pediatrics, Division of Neonatology, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Sherry L. Kausch
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Angela K. S. Gummadi
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Karen D. Fairchild
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Mayuresh M. Abhyankar
- Department of Internal Medicine, Division of Infectious Diseases, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - William A. Petri
- Department of Internal Medicine, Division of Infectious Diseases, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Brynne A. Sullivan
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, United States
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11
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Dammann O, Stansfield BK. Neonatal sepsis as a cause of retinopathy of prematurity: An etiological explanation. Prog Retin Eye Res 2024; 98:101230. [PMID: 37984792 PMCID: PMC10842718 DOI: 10.1016/j.preteyeres.2023.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
Retinopathy of prematurity (ROP) is a complex neonatal disorder with multiple contributing factors. In this paper we have mounted the evidence in support of the proposal that neonatal sepsis meets all requirements for being a cause of ROP (not a condition, mechanism, or even innocent bystander) by means of initiating the early stages of the pathomechanism of ROP occurrence, systemic inflammation. We use the model of etiological explanation, which distinguishes between two overlapping processes in ROP causation. It can be shown that sepsis can initiate the early stages of the pathomechanism via systemic inflammation (causation process) and that systemic inflammation can contribute to growth factor aberrations and the retinal characteristics of ROP (disease process). The combined contribution of these factors with immaturity at birth (as intrinsic risk modifier) and prenatal inflammation (as extrinsic facilitator) seems to provide a cogent functional framework of ROP occurrence. Finally, we apply the Bradford Hill heuristics to the available evidence. Taken together, the above suggests that neonatal sepsis is a causal inducer of ROP.
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Affiliation(s)
- Olaf Dammann
- Dept. of Public Health & Community Medicine, Tufts University School of Medicine, Boston, USA; Dept. of Gynecology & Obstetrics, Hannover Medical School, Hannover, Germany; Dept. of Neuromedicine & Movement Science, Norwegian University of Science & Technology, Trondheim, Norway; Dept. of Philosophy, University of Johannesburg, Johannesburg, South Africa.
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12
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Franklin AD, Freedman A, Wylie K, Mangold KA, Wang V, Price E, Ernst LM. Molecular detection of bacteria, placental inflammation, and neonatal sepsis risk. J Perinatol 2024; 44:46-54. [PMID: 37700009 DOI: 10.1038/s41372-023-01775-5] [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: 06/30/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To identify bacteria in umbilical cord tissue and investigate the association with placental inflammation and neonatal sepsis risk score. STUDY DESIGN Retrospective cohort study from 2017-2019. RNA was extracted from umbilical cord tissue and NanoString nCounter used to identify seven bacteria genera. Sepsis risk score was calculated using the Kaiser sepsis calculator. Placental histopathology was abstracted from medical records. RESULTS Detection of bacterial RNA in the umbilical cord (n = 96/287) was associated with high-stage maternal and fetal acute placental inflammation (maternal 35.4% vs 22.5%, p = 0.03 and fetal 34.4% vs 19.4%, p < 0.01) and maternal vascular malperfusion (36.5% vs 23.0%, p = 0.02). Detection of Ureaplasma spp. was also associated with increased sepsis risk score (1.5/1000 [0.6, 8.6] vs 0.9/1000 [0.2, 2.9], p = 0.04). CONCLUSION Umbilical cord bacterial pathogens are linked to fetal and maternal placental inflammation and maternal vascular malperfusion during gestation and associated with increased sepsis risk score in the neonate.
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Affiliation(s)
- Andrew D Franklin
- Department of Pediatrics, Division of Neonatology, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kristine Wylie
- Department of Pediatrics, Department of Obstetrics and Gynecology, and Department of Molecular Microbiology, Washington University, St. Louis, MO, USA
| | - Kathy A Mangold
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Vivien Wang
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Erica Price
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA.
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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13
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Regazzi M, Berardi A, Picone S, Tzialla C. Pharmacokinetic and Pharmacodynamic Considerations of Antibiotic Use in Neonates. Antibiotics (Basel) 2023; 12:1747. [PMID: 38136781 PMCID: PMC10740758 DOI: 10.3390/antibiotics12121747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
The selection of an appropriate dose of a given antibiotic for a neonate not only requires knowledge of the drug's basic pharmacokinetic (PK) and pharmacodynamic (PD) properties but also the profound effects that organ development might have on the volume of distribution and clearance, both of which may affect the PK/PD of a drug. Interest has grown in alternative antibiotic dosing strategies that are better aligned with the antibiotic's PK and PD properties. These strategies should be used in conjunction with minimum inhibitory concentration measurements and therapeutic drug monitoring to measure their potential success. They can also guide the clinician in tailoring the delivery of antibiotics to suit an individual patient's needs. Model-informed precision dosing, such as Bayesian forecasting dosing software (which incorporates PK/PD population models), may be utilized to optimize antibiotic exposure in neonatal populations. Consequently, optimizing the antibiotic dose and exposure in each newborn requires expertise in different fields. It drives the collaboration of physicians together with lab technicians and quantitative clinical pharmacologists.
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Affiliation(s)
- Mario Regazzi
- S.I.F.E.B, Italian Society of Pharmacokinetics and Biopharmaceutics, 27100 Pavia, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy;
| | - Simonetta Picone
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, 00169 Rome, Italy;
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Ospedale Civile Voghera, ASST Pavia, 27100 Pavia, Italy;
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14
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Balsamo F, Li B, Chusilp S, Lee D, Biouss G, Lee C, Maynes JT, Pierro A. Argon inhalation attenuates systemic inflammation and rescues lung architecture during experimental neonatal sepsis. Pediatr Surg Int 2023; 40:21. [PMID: 38108911 DOI: 10.1007/s00383-023-05596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Neonatal sepsis is a systemic inflammatory infection common in premature infants and a leading cause of mortality. Argon is an emerging interest in the field of noble gas therapy. Neonates with severe sepsis are frequently mechanically ventilated creating an opportunity for inhalation therapy. We aimed to investigate argon inhalation as a novel experimental therapy in neonatal sepsis. METHODS Sepsis was established in C57BL/6 neonatal mice by a lipopolysaccharide intraperitoneal injection on postnatal day 9. Septic pup mice were exposed to room air as well as non-septic controls. In the argon group, septic pup mice were exposed to argon (70% Ar, 30% O2) for 6 h in a temperature-controlled environment. RESULTS At 6 h, survival was significantly enhanced when septic mice received argon compared to septic controls. Serum profiles of cytokine release were significantly attenuated as well as lung architecture restored. CONCLUSIONS Our findings suggest that argon inhalation as a novel treatment for neonatal sepsis, reducing mortality and counteracting the acute systemic inflammatory response in the blood and preserving the architecture of the lung. This research can contribute to a paradigm shift in the treatment and outcome of neonates with sepsis.
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Affiliation(s)
- Felicia Balsamo
- Translational Medicine Program, Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Bo Li
- Translational Medicine Program, Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Sinobol Chusilp
- Translational Medicine Program, Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Dorothy Lee
- Translational Medicine Program, Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - George Biouss
- Translational Medicine Program, Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Carol Lee
- Translational Medicine Program, Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Biochemistry, Faculty of Medicine , University of Toronto, Toronto, Canada
| | - Agostino Pierro
- Translational Medicine Program, Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
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15
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Kurul Ş, Beckers FLM, Vermeulen MJ, Suurland J, Hasbek JE, Ramakers CRB, Simons SHP, Reiss IKM, Taal HR. Inflammation, sepsis severity and neurodevelopmental outcomes of late-onset sepsis in preterm neonates. Pediatr Res 2023; 94:2026-2032. [PMID: 37468719 DOI: 10.1038/s41390-023-02742-8] [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: 11/23/2022] [Revised: 04/15/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association between inflammatory biomarkers (C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6)) and sepsis severity (neonatal-Sequential-Organ-Failure-Assessment (nSOFA)) and neurodevelopmental outcomes at 2 years, among very preterm neonates. METHODS Data on preterm neonates (gestational age <30 weeks) from 2016 until 2020 were reviewed. Outcomes of interest were NDI (no, mild, severe) and the motor and cognitive score on the Dutch-Bayley-Scales-of-Infant-and-Toddler-Development (Bayley-III-NL) assessed at the corrected age of 2 years. Logistic and linear regression analysis were used for categorical and continuous outcomes, respectively. All analyses were adjusted for gestational age, sex and birthweight-for-gestational-age SD-score. RESULTS In total 410 patients were eligible for analysis. Maximum CRP concentrations were associated with lower motor and cognitive scores (effect estimate -0.03 points,(95% CI -0.07; -0.00) and -0.03 points,(95% CI -0.06; -0.004), respectively) and increased risk of severe NDI (odds ratio (OR) 1.01, (95% CI 1.00; 1.01)). High nSOFA scores (≥4) during sepsis episodes were associated with an increased risk of mild NDI (OR 2.01, (95% CI 1.34; 3.03)). There were no consistent associations between IL-6, PCT and the outcomes of interest. CONCLUSION High CRP concentrations and sepsis severity in preterm neonates seem to be associated with neurodevelopmental outcomes in survivors at the age of 2 years. IMPACT STATEMENT The level of inflammation and sepsis severity are associated with neurodevelopmental outcome in preterm neonates at 2 years of corrected age. Sepsis is a major health issue in preterm neonates and can lead to brain damage and impaired neurodevelopment. Biomarkers can be determined to assess the level of inflammation. However, the relation of inflammatory biomarkers with neurodevelopmental outcome is not known. The level of inflammation and sepsis severity are related to neurodevelopmental outcome in preterm neonates. Maximum CRP concentration and high nSOFA scores are associated with an increased risk of neurodevelopmental impairment in survivors at the corrected age of 2 years.
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Affiliation(s)
- Şerife Kurul
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Famke L M Beckers
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marijn J Vermeulen
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jill Suurland
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jasmin E Hasbek
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Sinno H P Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Irwin K M Reiss
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - H Rob Taal
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
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16
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Chen J, Yasrebinia S, Ghaedi A, Khanzadeh M, Quintin S, Dagra A, Peart R, Lucke-Wold B, Khanzadeh S. Meta-analysis of the role of neutrophil to lymphocyte ratio in neonatal sepsis. BMC Infect Dis 2023; 23:837. [PMID: 38012554 PMCID: PMC10683320 DOI: 10.1186/s12879-023-08800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION The neutrophil to lymphocyte ratio (NLR), an inflammatory biomarker, measures innate-adaptive immune system balance. In this systematic review and meta-analysis, we aim to analyze the current literature to evaluate the diagnostic role of NLR in neonatal sepsis. METHODS PubMed, Web of Science, and Scopus were used to conduct a systematic search for relevant publications published before May 14, 2022. RESULTS Thirty studies, including 2328 neonates with sepsis and 1800 neonates in the control group, were included in our meta-analysis. The results indicated that NLR is higher in neonates with sepsis compared to healthy controls (SMD = 1.81, 95% CI = 1.14-2.48, P-value < 0.001) in either prospective (SMD = 2.38, 95% CI = 1.40-3.35, P-value < 0.001) or retrospective studies (SMD = 0.87, 95% CI = 0.63-1.12, P-value < 0.001) with a pooled sensitivity of 79% (95% CI = 62-90%), and a pooled specificity of 91% (95% CI = 73-97%). Also, we found that NLR is higher in neonates with sepsis compared to those who were suspected of sepsis but eventually had negative blood cultures (SMD =1.99, 95% CI = 0.76-3.22, P-value = 0.002) with a pooled sensitivity of 0.79% (95% CI = 0.69-0.86%), and a pooled specificity of 73% (95% CI = 54-85%). In addition, neonates with sepsis had elevated levels of NLR compared to other ICU admitted neonates (SMD = 0.73, 95% CI = 0.63-0.84, P < 0.001). The pooled sensitivity was 0.65 (95% CI, 0.55-0.80), and the pooled specificity was 0.80 (95% CI, 0.68-0.88). CONCLUSION Our findings support NLR as a promising biomarker that can be readily integrated into clinical settings to aid in diagnosing neonatal sepsis. As evidenced by our results, restoring balance to the innate and adaptive immune system may serve as attractive therapeutic targets. Theoretically, a reduction in NLR values could be used to measure therapeutic efficacy, reflecting the restoration of balance within these systems.
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Affiliation(s)
- Jingyang Chen
- The First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | | | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Monireh Khanzadeh
- Geriatric & Gerontology Department, Medical School, Tehran University of Medical and Health Sciences, Tehran, Iran
| | - Stephan Quintin
- Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA
| | - Abeer Dagra
- Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA
| | - Rodeania Peart
- Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA
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17
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Vardar G, Rzayev T, Tezel KG, Ozek E. Can We Estimate Late-Onset Sepsis by Serial Methemoglobin Levels? An Observational Study in Preterm Neonates. Fetal Pediatr Pathol 2023; 42:753-765. [PMID: 37318102 DOI: 10.1080/15513815.2023.2223308] [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: 03/21/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Objective: To assess serial methemoglobin (MetHb) levels in preterm infants as a possible diagnostic method for late-onset sepsis (LOS). Methods: Preterm infants were assigned into two groups: those with culture-proven LOS and controls. Serial MetHb levels were measured. Results: The MetHb values of the LOS group were found to be significantly increased (p < 0.001). The cutoff value for the detection of LOS was calculated as MetHb > 1.75%, optimized for a sensitivity of 81.9% and specificity of 90%. After antimicrobial therapy, MetHb values were found to decrease significantly (p < 0.001). MetHb had an AUC of 0.810 for mortality using the calculated cutoff of >2% (p < 0.005). Conclusions: MetHb levels increase at the onset of LOS and decrease following treatment. MetHb can be added to other sepsis biomarkers as a rapid infectious process indicator for preterm neonates. MetHb > 2% is associated with LOS mortality.
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Affiliation(s)
- Gonca Vardar
- Division of Neonatology, Department of Pediatrics, School of Medicine, Marmara University, Pendik/Istanbul, Turkey
| | - Turkay Rzayev
- Division of Neonatology, Department of Pediatrics, School of Medicine, Marmara University, Pendik/Istanbul, Turkey
| | - Kubra Gokce Tezel
- Division of Neonatology, Department of Pediatrics, School of Medicine, Marmara University, Pendik/Istanbul, Turkey
| | - Eren Ozek
- Division of Neonatology, Department of Pediatrics, School of Medicine, Marmara University, Pendik/Istanbul, Turkey
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18
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Liao Z, Zhu Q, Huang H. Involvement of IL-1β-Mediated Necroptosis in Neurodevelopment Impairment after Neonatal Sepsis in Rats. Int J Mol Sci 2023; 24:14693. [PMID: 37834141 PMCID: PMC10572485 DOI: 10.3390/ijms241914693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
The mechanism of long-term cognitive impairment after neonatal sepsis remains poorly understood, although long-lasting neuroinflammation has been considered the primary contributor. Necroptosis is actively involved in the inflammatory process, and in this study, we aimed to determine whether neonatal sepsis-induced long-term cognitive impairment was associated with activation of necroptosis. Rat pups on postnatal day 3 (P3) received intraperitoneal injections of lipopolysaccharide (LPS, 1 mg/kg) to induce neonatal sepsis. Intracerebroventricular injection of IL-1β-siRNA and necrostatin-1 (NEC1) were performed to block the production of IL-1β and activation of necroptosis in the brain, respectively. The Morris water maze task and fear conditioning test were performed on P28-P32 and P34-P35, respectively. Enzyme-linked immunosorbent assay (ELISA), quantitative real-time PCR (RT-PCR), and Western blotting were used to examine the expression levels of proinflammatory cytokines and necroptosis-associated proteins, such as receptor-interacting protein 1 (RIP1) and receptor-interacting protein 3 (RIP3). Sustained elevation of IL-1β level was observed in the brain after initial neonatal sepsis, which would last for at least 32 days. Sustained necroptosis activation was also observed in the brain. Knockdown of IL-1β expression in the brain alleviated necroptosis and improved long-term cognitive function. Direct inhibition of necroptosis also improved neurodevelopment and cognitive performance. This research indicated that sustained activation of necroptosis via IL-1β contributed to long-term cognitive dysfunction after neonatal sepsis.
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Affiliation(s)
| | | | - Han Huang
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital of Sichuan University, Chengdu 610041, China; (Z.L.); (Q.Z.)
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19
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Camerota M, McGowan EC, Carter BS, Check J, Dansereau LM, DellaGrotta SA, Helderman JB, Hofheimer JA, Neal CR, O'Shea TM, Pastyrnak SL, Smith LM, Lester BM. Maternal Prenatal Risk Phenotypes and Neurobehavioral Outcomes among Infants Born Very Preterm. J Pediatr 2023; 260:113521. [PMID: 37244578 PMCID: PMC10527115 DOI: 10.1016/j.jpeds.2023.113521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess whether prenatal risk phenotypes are associated with neurobehavioral impairment for children born <30 weeks of gestation at discharge from the neonatal intensive care unit (NICU) and at 24-month follow-up. STUDY DESIGN We studied infants from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) study, a multisite investigation of infants born <30 weeks of gestation. There were 704 newborns enrolled in the NOVI study; of these, 679 (96%) had neonatal neurobehavioral data and 556 (79%) had 24-month follow-up data. Maternal prenatal phenotypes (physical and psychological risk groups) were characterized from 24 physical and psychological health risk factors. Neurobehavior was assessed at NICU discharge using the NICU Network Neurobehavioral Scales and at 2-year follow-up using the Bayley Scales of Infant and Toddler Development and the Child Behavior Checklist. RESULTS Children born to mothers in the psychological risk group were at increased risk for dysregulated neonatal neurobehavior (OR, 2.04; 95% CI, 1.08-3.87) at NICU discharge, and for severe motor delay (OR, 3.80; 95% CI, 1.48-9.75), and clinically significant externalizing problems (OR, 2.54; 95% CI, 1.15-5.56) at age 24 months, compared with children born to mothers in the low-risk group. Children born to mothers in the physical risk group were more likely to have severe motor delay (OR, 2.70; 95% CI, 1.07-6.85) compared with the low-risk group. CONCLUSIONS High-risk maternal prenatal phenotypes were associated with neurobehavioral impairment for children born very preterm. This information could identify newborns at risk for adverse neurodevelopmental outcomes.
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Affiliation(s)
- Marie Camerota
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital, Providence, RI.
| | - Elisabeth C McGowan
- Department of Pediatrics, Women and Infants Hospital, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI
| | - Brian S Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, MO
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lynne M Dansereau
- Department of Pediatrics, Women and Infants Hospital, Providence, RI
| | | | | | - Julie A Hofheimer
- Department of Pediatrics, University of North Carolina and Chapel Hill School of Medicine, Chapel Hill, NC
| | - Charles R Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina and Chapel Hill School of Medicine, Chapel Hill, NC
| | - Steven L Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI
| | - Lynne M Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA
| | - Barry M Lester
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI
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20
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Dinleyici EC, Frey G, Kola E, Wippermann U, Bauhofer A, Staus A, Griffiths P, Azharry M, Rohsiswatmo R. Clinical efficacy of IgM-enriched immunoglobulin as adjunctive therapy in neonatal and pediatric sepsis: a systematic review and meta-analysis. Front Pediatr 2023; 11:1239014. [PMID: 37635792 PMCID: PMC10451087 DOI: 10.3389/fped.2023.1239014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Background Sepsis is a major cause of mortality and morbidity globally, with around one-quarter of all sepsis-related deaths occurring in children under the age of 5. We conducted a meta-analysis and systematic review of the literature to evaluate the clinical effectiveness of an IgM-enriched immunoglobulin preparation in pediatrics patients and neonates with sepsis. Methods Systematic searches of PubMed, the Cochrane Library and Embase databases were performed in November 2022, with no date limitations, to identify studies in which IgM-enriched immunoglobulin was used as adjunctive therapy in neonatal and pediatric patients with sepsis. Results In total, 15 studies fulfilled the eligibility criteria, 13 neonatal studies and 2 pediatric studies. Pooled estimates from all studies indicated that mortality rates were significantly lower in patients who received treatment with the IgM-enriched immunoglobulin compared with controls (OR 0.41; 95% CI 0.32-0.55). Further analyses in neonatal studies, alone, showed a significant benefit with longer treatment durations (>3 days) vs. the recommended treatment duration (3 days) (OR 0.32; 95% CI 0.22-0.47) vs. (OR 0.61; 95% CI 0.41-0.92). Treatment with IgM-enriched immunoglobulin was associated with a lower mortality risk compared with controls in prospective studies vs. retrospective analyses (OR 0.37; 95% CI 0.27-0.51) vs. (OR 0.73; 95% CI 0.41-1.30). Conclusions This systematic review suggests that adjunctive treatment with IgM-enriched immunoglobulin may reduce the risk of mortality in neonatal and pediatric populations. However, large randomized controlled trials are required to further substantiate and evaluate these findings.
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Affiliation(s)
- Ener Cagri Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Türkiye
| | - Georg Frey
- Klinik für Neonatologie, Darmstädter Kinderkliniken Prinzessin Margaret, Perinatalzentrum Südhessen, Darmstadt, Germany
| | - Ermira Kola
- Pediatric Intensive Care Unit, University Hospital Center “Mother Teresa”, Tirana, Albania
| | | | - Artur Bauhofer
- Corporate Medical Affairs, Biotest AG, Dreieich, Germany
| | - Alexander Staus
- Corporate Clinical Research & Development, Biotest AG, Dreieich, Germany
| | - Peter Griffiths
- Medical and Scientific Affairs, Biotest UK, Birmingham, United Kingdom
| | - Muhamad Azharry
- Department of Child Health, Neonatology Division, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Rinawati Rohsiswatmo
- Department of Child Health, Neonatology Division, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
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21
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Gibb JJ, MacLeod R, Mahoney L, Elanjikal Z. Modified Seldinger technique for neonatal epicutaneo-caval catheter insertion: A non-randomised retrospective study. J Vasc Access 2023; 24:780-785. [PMID: 34758652 DOI: 10.1177/11297298211054637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Epicutaneo-Caval Catheters (ECCs) are critical for good neonatal care. No previous studies have evaluated which insertion method provides the highest likelihood of success. METHODS This study aimed to compare the success rates and cost of modified Seldinger technique (MST) and split needle technique (SNT). MST was introduced to St Michael's Neonatal Unit, SNT was already in use. Routinely documented data on ECC insertion was retrospectively collected from the clinical notes. Practitioners were able to use their preferred insertion method. A sub-group analysis of success rates in patients born at ⩾35-weeks GA was performed. RESULTS There was a significantly higher first pass (53% vs 26%; p = 0.014) and overall (72% vs 40%; p = 0.0046) successful ECC insertion rate with fewer venipunctures per successful ECC with MST (2.5 vs 6.5; p = 0.002). Logrank test demonstrated a significantly higher successful ECC insertion with MST for patients of all GA (p = 0.003) and for neonates born at ⩾35 weeks (p = 0.015). The cost per successful MST ECC was £156.41 versus £152.51 for SNT. CONCLUSION In this uncontrolled retrospective study, there was a higher chance of successful ECC insertion with MST, with a reduced number of venipunctures and similar costs per successful ECC. Further work in randomised studies is needed to verify this finding and should focus on other clinical outcomes, including rates in central line associated blood stream infections.
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Affiliation(s)
- Jack Jc Gibb
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rachael MacLeod
- Department of Neonatology, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Liam Mahoney
- Department of Neonatology, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ziju Elanjikal
- Department of Neonatology, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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22
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Consales A, Porro M, Gangi S, Pesenti N, Gardon L, Squarza C, Frigerio A, Lezzi I, Vizzari G, Morniroli D, Macchi M, Fontana C, Fumagalli M, Picciolini O, Mosca F, Giannì ML. In-hospital growth and long-term neurodevelopmental outcomes of very low birth weight infants. Front Pediatr 2023; 11:1180068. [PMID: 37252047 PMCID: PMC10211263 DOI: 10.3389/fped.2023.1180068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Background and Objectives Very low birth weight infants (VLBW) are at risk for adverse growth and neurodevelopmental outcomes. We aimed to evaluate the association between growth during Neonatal Intensive Care Unit (NICU) stay and long-term neurodevelopmental outcomes in a cohort of preterm VLBW newborns. Methods We conducted a longitudinal observational study in the Follow-up Service of our Clinic from January 2014 to April 2017. All preterm VLBW infants born at our hospital and enrolled in our follow-up program were considered eligible for the study. The neurodevelopmental assessment was performed using the Griffiths Mental Development Scales at 12 and 24 months corrected age. Results Study population included 172 subjects (47.1% males) with a mean gestational age of 29 weeks and a mean birth weight of 1,117 g. A unitarian Δz-score increase in head circumference from birth to discharge was associated with a 1.6-point increase in General Quotient at 24 months corrected age. An association with subscales C and D was also found. Likewise, an increase in length Δz-score was associated with better 24-month subscale C scores although not reaching statistical significance. No relationship with the outcome at 24 months was found for weight gain. Conclusions Growth during NICU stay appears to be related to a more favorable neurodevelopmental outcome at 24 months corrected age, especially in the hearing and language domain (subscale C). The longitudinal evaluation of auxological parameters during hospitalization can contribute to the identification of subjects at risk for adverse neurodevelopmental outcomes in the first years of life.
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Affiliation(s)
- Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Matteo Porro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Service, Milan, Italy
| | - Silvana Gangi
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Pesenti
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Laura Gardon
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Squarza
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Frigerio
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Lezzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Vizzari
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marta Macchi
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Fontana
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Odoardo Picciolini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Service, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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23
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Sinha A, Bahuguna P, Gupta SS, Kuruba YP, Poluru R, Mathur A, Raja D, Raut AV, Mahajan KS, Sudhakar R, Kulkarni B, Pandey RM, Arora NK, Prinja S. Study protocol for economic evaluation of probiotic intervention for prevention of neonatal sepsis in 0-2-month old low-birth weight infants in India: the ProSPoNS trial. BMJ Open 2023; 13:e068215. [PMID: 36990484 PMCID: PMC10069556 DOI: 10.1136/bmjopen-2022-068215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION The ProSPoNS trial is a multicentre, double-blind, placebo-controlled trial to evaluate the role of probiotics in prevention of neonatal sepsis. The present protocol describes the data and methodology for the cost utility of the probiotic intervention alongside the controlled trial. METHODS AND ANALYSIS A societal perspective will be adopted in the economic evaluation. Direct medical and non-medical costs associated with neonatal sepsis and its treatment would be ascertained in both the intervention and the control arm. Intervention costs will be facilitated through primary data collection and programme budgetary records. Treatment cost for neonatal sepsis and associated conditions will be accessed from Indian national costing database estimating healthcare system costs. A cost-utility design will be employed with outcome as incremental cost per disability-adjusted life year averted. Considering a time-horizon of 6 months, trial estimates will be extrapolated to model the cost and consequences among high-risk neonatal population in India. A discount rate of 3% will be used. Impact of uncertainties present in analysis will be addressed through both deterministic and probabilistic sensitivity analysis. ETHICS AND DISSEMINATION Has been obtained from EC of the six participating sites (MGIMS Wardha, KEM Pune, JIPMER Puducherry, AIPH, Bhubaneswar, LHMC New Delhi, SMC Meerut) as well as from the ERC of LSTM, UK. A peer-reviewed article will be published after completion of the study. Findings will be disseminated to the community of the study sites, with academic bodies and policymakers. REGISTRATION The protocol has been approved by the regulatory authority (Central Drugs Standards Control Organisation; CDSCO) in India (CT-NOC No. CT/NOC/17/2019 dated 1 March 2019). The ProSPoNS trial is registered at the Clinical Trial Registry of India (CTRI). Registered on 16 May 2019. TRIAL REGISTRATION NUMBER CTRI/2019/05/019197; Clinical Trial Registry.
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Affiliation(s)
- Anju Sinha
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, India
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, Scotland's Western Lowlands, UK
| | | | - Yamini Priyanka Kuruba
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Ramesh Poluru
- Research Department, The INCLEN Trust International, New Delhi, India
| | - Apoorva Mathur
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Dilip Raja
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Abhishek V Raut
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Kamaleshwar S Mahajan
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | | | - Bharati Kulkarni
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra K Arora
- Research Department, The INCLEN Trust International, New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, India
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Lodefalk M, Chelslín F, Patriksson Karlsson J, Hansson SR. Placental Changes and Neuropsychological Development in Children-A Systematic Review. Cells 2023; 12:cells12030435. [PMID: 36766778 PMCID: PMC9913696 DOI: 10.3390/cells12030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
Placental dysfunction may increase the offspring's later-life disease risk. The objective of this systematic review was to describe associations between pathological placental changes and neuropsychological outcomes in children after the neonatal period. The inclusion criteria were human studies; original research; direct placental variables; neuropsychological outcomes; and analysis between their associations. The exclusion criterion was the offspring's age-0-28 days or >19 years. The MEDLINE and EMBASE databases were last searched in May 2022. We utilized the ROBINS-I for the risk of bias assessment and performed a narrative synthesis. In total, 3252 studies were identified, out of which 16 were included (i.e., a total of 15,862 participants). Half of the studies were performed on children with neonatal complications, and 75% of the studies reported an association between a placental change and an outcome; however, following the completion of the funnel plots, a risk of publication bias was indicated. The largest study described a small association between placental size and a risk of psychiatric symptoms in boys only. Inconsistency between the studies limited the evidence in this review. In general, no strong evidence was found for an association between pathological placental changes and childhood neuropsychological outcomes after the neonatal period. However, the association between placental size and mental health in boys indicates a placental sexual dimorphism, thereby suggesting an increased vulnerability for male fetuses.
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Affiliation(s)
- Maria Lodefalk
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
- Correspondence:
| | - Felix Chelslín
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Johanna Patriksson Karlsson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Stefan R. Hansson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, 221 00 Lund, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, 214 28 Malmö, Sweden
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25
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Salama B, Tharwat EM. A case control study of maternal and neonatal risk factors associated with neonatal sepsis. J Public Health Res 2023; 12:22799036221150557. [PMID: 36726456 PMCID: PMC9884942 DOI: 10.1177/22799036221150557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/24/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Neonatal Sepsis is a significant leading cause of infant death around the world, particularly in developing nations. The study aimed to identify maternal and neonatal risk factors linked to neonatal sepsis. Methods A hospital-based case-control study was conducted in the ICU. Cases were neonates diagnosed as having sepsis by clinical criteria and laboratory findings. Controls were admitted neonates who were neither suspected nor diagnosed with sepsis. Data on mothers and babies, as well as laboratory findings, were gathered and analyzed. Results A total of 174 cases and 348 controls were included in the study. Maternal age, parity, route of delivery, PROM, prematurity, birth weight, neonatal gender and age were significantly associated with the risk of sepsis (p < 0.05). However, the bivariate logistic model revealed that the most influential predictors of neonatal sepsis were premature rupture of membranes, Gestational age, Neonatal age, birth weight, and mode of delivery. Conclusion Both maternal and neonatal variables were found to have a significant association with the risk of neonatal sepsis; thus, empowering mothers to pursue antenatal care may allow the detection of risk factors for undesirable delivery consequences such as neonatal sepsis, as well as appropriate management to mitigate those risks.
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Affiliation(s)
- Basem Salama
- Community Medicine Department, Damietta
Faculty of Medicine, Al-Azhar University, Egypt,Department of Family and Community
Medicine, Faculty of Medicine, Northern Border University, Saudi Arabia,Basem Salama, Department of Community
Medicine Department, Damietta Faculty of Medicine, Al-Azhar University, New
Damietta, 34325, Egypt.
| | - Elbakry M Tharwat
- Pediatric Department, Damietta Faculty
of Medicine, Al-Azhar University, Egypt
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26
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De Rose DU, Ronchetti MP, Tzialla C, Giuffré M, Auriti C. Editorial: Congenital and perinatal infections: How to prevent sequelaes in neonates and children. Front Pediatr 2023; 11:1142636. [PMID: 36861073 PMCID: PMC9969152 DOI: 10.3389/fped.2023.1142636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
| | | | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Pavia, Italy
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
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Al Gharaibeh FN, Kempton KM, Alder MN. Olfactomedin-4-Positive Neutrophils in Neonates: Link to Systemic Inflammation and Bronchopulmonary Dysplasia. Neonatology 2022; 120:40-48. [PMID: 36549285 PMCID: PMC10010669 DOI: 10.1159/000527902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Little is known about the interplay between neutrophil heterogeneity in neonates in health and disease states. Olfactomedin-4 (OLFM4) marks a subset of neutrophils that have been described in adults and pediatric patients but not neonates, and this subset is thought to play a role in modulating the host inflammatory response. METHODS This is a prospective cohort of neonates who were born between June 2020 and December 2021 at the University of Cincinnati Medical Center NICU. Olfactomedin-4-positive (OLFM4+) neutrophils were identified in the peripheral blood using flow cytometry. RESULTS OLFM4+ neutrophil percentage was not correlated with gestational age or developmental age. Neonates with sepsis had a higher percentage than those without the condition, 66.9% (IQR 24.3-76.9%) versus 21.5% (IQR 10.6-34.7%), respectively, p = 0.0003. At birth, a high percentage of OLFM4+ neutrophils was associated with severe chorioamnionitis at 49.1% (IQR 28.2-61.5%) compared to those without it at 13.7% (IQR 7.7-26.3%), p < 0.0001. Among neonates without sepsis, the percentages of OLFM4+ neutrophils were lower in the BPD/early death group compared to those without BPD, 11.8% (IQR 6.3-29.0%) versus 32.5% (IQR 18.5-46.1%), p = 0.003, and this retained significance in a multiple logistic regression model that included gestational age, birthweight, and race. CONCLUSION This is the first study describing OLFM4+ neutrophils in neonates and it shows that this neutrophil subpopulation is not influenced by gestational age but is elevated in inflammatory conditions such as sepsis and severe chorioamnionitis, and lower percentage at birth is associated with developing bronchopulmonary dysplasia.
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Affiliation(s)
- Faris N Al Gharaibeh
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kristalynn M Kempton
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Matthew N Alder
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Scher MS. A Bio-Social Model during the First 1000 Days Optimizes Healthcare for Children with Developmental Disabilities. Biomedicines 2022; 10:3290. [PMID: 36552046 PMCID: PMC9775202 DOI: 10.3390/biomedicines10123290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Most children with developmental disabilities (DD) live in resource-limited countries (LMIC) or high-income country medical deserts (HICMD). A social contract between healthcare providers and families advocates for accurate diagnoses and effective interventions to treat diseases and toxic stressors. This bio-social model emphasizes reproductive health of women with trimester-specific maternal and pediatric healthcare interactions. Lifelong neuronal connectivity is more likely established across 80% of brain circuitries during the first 1000 days. Maladaptive gene-environment (G x E) interactions begin before conception later presenting as maternal-placental-fetal (MPF) triad, neonatal, or childhood neurologic disorders. Synergy between obstetrical and pediatric healthcare providers can reduce neurologic morbidities. Partnerships between healthcare providers and families should begin during the first 1000 days to address diseases more effectively to moderate maternal and childhood adverse effects. This bio-social model lowers the incidence and lessens the severity of sequalae such as DD. Access to genetic-metabolomic, neurophysiologic and neuroimaging evaluations enhances clinical decision-making for more effective interventions before full expression of neurologic dysfunction. Diagnostic accuracy facilitates developmental interventions for effective preschool planning. A description of a mother-child pair in a HIC emphasizes the time-sensitive importance for early interventions that influenced brain health throughout childhood. Partnership by her parents with healthcare providers and educators provided effective healthcare and lessened adverse effects. Effective educational interventions were later offered through her high school graduation. Healthcare disparities in LMIC and HICMD require that this bio-social model of care begin before the first 1000 days to effectively treat the most vulnerable women and children. Prioritizing family planning followed by prenatal, neonatal and child healthcare improves wellness and brain health. Familiarity with educational neuroscience for teachers applies neurologic diagnoses for effective individual educational plans. Integrating diversity and inclusion into medical and educational services cross socioeconomic, ethnic, racial, and cultural barriers with life-course benefits. Families require knowledge to recognize risks for their children and motivation to sustain relationships with providers and educators for optimal outcomes. The WHO sustainable development goals promote brain health before conception through the first 1000 days. Improved education, employment, and social engagement for all persons will have intergenerational and transgenerational benefits for communities and nations.
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Affiliation(s)
- Mark S. Scher
- Pediatrics and Neurology, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Department of Pediatrics, Division of Pediatric Neurology Fetal/Neonatal Neurology Program, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Al Gharaibeh FN, Mohan S, Santoro MA, Slagle CL, Goldstein SL. Acute kidney injury and early fluid load in a retrospective cohort of neonatal sepsis. Pediatr Nephrol 2022; 38:1971-1977. [PMID: 36525082 DOI: 10.1007/s00467-022-05840-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sepsis and acute kidney injury (AKI) are associated with mortality in the newborn intensive care unit (NICU). There is a paucity of studies that describe AKI and fluid overload in neonatal sepsis and their association with mortality. METHODS Retrospective study of neonates with culture positive sepsis admitted to the NICU between June 2020 and June 2021 was conducted. Primary outcome was in-hospital mortality according to AKI as defined by the neonatal modified Kidney Diseases Improving Outcomes criteria. Secondary outcomes were early fluid overload and vasopressor use. RESULTS Thirty-three percent of neonates had AKI with sepsis, and 57% of cases were severe AKI. AKI was associated with mortality after adjusting for variables that were different between survivors and non-survivors (aOR 5.7 [95% CI 1.1-36], p = 0.04). Early fluid overload occurred in 27% of neonates who were at higher risk of having AKI with sepsis (OR 7.4 [95% CI 1.6-26.0], p = 0.01) and higher risk of mortality (aOR 17.8 [95% CI 2-7545], p = 0.02). CONCLUSIONS AKI and early fluid overload are associated with mortality in sepsis in our retrospective cohort. Mitigating AKI and early fluid overload in sepsis might be a fruitful strategy in reducing mortality with sepsis. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Faris N Al Gharaibeh
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. .,College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Shruthi Mohan
- Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Cara L Slagle
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.,College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Stuart L Goldstein
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Bando N, Fenton TR, Yang J, Ly L, Luu TM, Unger S, O'Connor DL, Shah PS. Association of Postnatal Growth Changes and Neurodevelopmental Outcomes in Preterm Neonates of <29 Weeks' Gestation. J Pediatr 2022; 256:63-69.e2. [PMID: 36509160 DOI: 10.1016/j.jpeds.2022.11.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine associations between weight and head circumference (HC) changes and neurodevelopment in preterm infants. STUDY DESIGN This retrospective cohort study of Canadian Neonatal Network and Canadian Neonatal Follow-Up Network sites included preterm infants born 2010-2018. Logistic regression and model diagnostics evaluated relationships between changes in z score and velocity of weight and HC from birth to discharge from a tertiary neonatal intensive care unit, discharge to 18-24 months corrected age (CA), and birth to 18-24 months CA and significant cognitive/motor impairment at 18-24 months CA classified using a Bayley Scales of Infant and Toddler Development-Third Edition cognitive or motor composite score <70. RESULTS In total, 4530 infants (53.0% male) with a mean (SD) gestational age of 26.3 (1.4) weeks and birth weight of 920 (227) g were included. Weight and HC changes were associated with lower odds of significant cognitive/motor impairment including an OR of 0.87 (95% CI: 0.83, 0.91; P < .001) for a 1-g/d increase in weight from discharge to 18-24 months CA and 0.81 (95% CI: 0.75, 0.88; P < .001) for a 1-unit increase in HC z score from birth to 18-24 months CA. Associations were not statistically significant in morbidity-free neonates. Weight and HC gains poorly discriminated between infants with and without significant cognitive/motor impairment (areas under the receiver operating characteristic curve of <0.64). No growth measure had a clinically useful balance of sensitivity and specificity. CONCLUSIONS Weight and HC changes were associated with significant cognitive/motor impairment but had poor discriminatory capability. Neonatal morbidities may make a larger contribution than postnatal growth to neurodevelopment.
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Affiliation(s)
- Nicole Bando
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tanis R Fenton
- Department of Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Sinai Health, Toronto, ON, Canada
| | - Linh Ly
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
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Xu J, Shin J, McGee M, Unger S, Bando N, Sato J, Vandewouw M, Patel Y, Branson HM, Paus T, Pausova Z, O'Connor DL. Intake of mother's milk by very-low-birth-weight infants and variation in DNA methylation of genes involved in neurodevelopment at 5.5 years of age. Am J Clin Nutr 2022; 116:1038-1048. [PMID: 35977396 PMCID: PMC9535521 DOI: 10.1093/ajcn/nqac221] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Mechanisms responsible for associations between intake of mother's milk in very-low-birth-weight (VLBW, <1500 g) infants and later neurodevelopment are poorly understood. It is proposed that early nutrition may affect neurodevelopmental pathways by altering gene expression through epigenetic modification. Variation in DNA methylation (DNAm) at cytosine-guanine dinucleotides (CpGs) is a commonly studied epigenetic modification. OBJECTIVES We aimed to assess whether early mother's milk intake by VLBW infants is associated with variations in DNAm at 5.5 y, and whether these variations correlate with neurodevelopmental phenotypes. METHODS This cohort study was a 5.5-y follow-up (2016-2018) of VLBW infants born in Ontario, Canada who participated in the Donor Milk for Improved Neurodevelopmental Outcomes trial. We performed an epigenome-wide association study (EWAS) to test whether percentage mother's milk (not including supplemental donor milk) during hospitalization was associated with DNAm in buccal cells during early childhood (n = 143; mean ± SD age: 5.7 ± 0.2 y; birth weight: 1008 ± 517 g). DNAm was assessed with the Illumina Infinium MethylationEPIC array at 814,583 CpGs. In secondary analyses, we tested associations between top-ranked CpGs and measures of early childhood neurodevelopment, e.g., total surface area of the cerebral cortex (n = 41, MRI) and Full-Scale IQ (n = 133, Wechsler Preschool and Primary Scale of Intelligence-IV). RESULTS EWAS analysis demonstrated percentage mother's milk intake by VLBW infants during hospitalization was associated with DNAm at 2 CpGs, cg03744440 [myosin XVB (MYO15B)] and cg00851389 [metallothionein 1A (MT1A)], at 5.5 y (P < 9E-08). Gene set enrichment analysis indicated that top-ranked CpGs (P < 0.001) were annotated to genes enriched in neurodevelopmental biological processes. Corroborating these findings, DNAm at several top identified CpGs from the EWAS was associated with cortical surface area and IQ at 5.5 y (P < 0.05). CONCLUSIONS In-hospital percentage mother's milk intake by VLBW infants was associated with variations in DNAm of neurodevelopmental genes at 5.5 y; some of these DNAm variations are associated with brain structure and IQ.This trial was registered at isrctn.com as ISRCTN35317141 and at clinicaltrials.gov as NCT02759809.
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Affiliation(s)
- Jingxiong Xu
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Jean Shin
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meghan McGee
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Sinai Health, Toronto, Ontario, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Bando
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Julie Sato
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Neuroscience & Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marlee Vandewouw
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neuroscience & Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Yash Patel
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Helen M Branson
- Division of Neuroradiology, Department of Medical Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tomas Paus
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine and CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
- Department of Neuroscience, Faculty of Medicine and CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Zdenka Pausova
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Sinai Health, Toronto, Ontario, Canada
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AbdAllah NB, Al Ageeli E, Shbeer A, Abdulhakim JA, Toraih EA, Salman DO, Fawzy MS, Nassar SS. Long Non-Coding RNAs ANRIL and HOTAIR Upregulation is Associated with Survival in Neonates with Sepsis in a Neonatal Intensive Care Unit. Int J Gen Med 2022; 15:6237-6247. [PMID: 35898301 PMCID: PMC9309290 DOI: 10.2147/ijgm.s373434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Recently, long non-coding RNAs (lncRNAs) have emerged as potential molecular biomarkers for sepsis. We aimed to profile the expression signature of three inflammation-related lncRNAs, MALAT1, ANRIL, and HHOTAIR, in the plasma of neonates with sepsis and correlate these signatures with the phenotype. Patients and Methods This case–control study included 124 neonates with sepsis (88 survivors/36 non-survivors) admitted to the neonatal ICU and 17 healthy neonates. The relative expressions were quantified by real-time PCR and correlated to the clinic-laboratory data. Results The three circulating lncRNAs were upregulated in the cases; the median levels were MALAT1 (median = 1.71, IQR: −0.5 to 3.27), ANRIL (median = 1.09, IQR: 0.89 to 1.30), and HOTAIR (median = 1.83, IQR: 1.44 to 2.41). Co-expression analysis showed that the three studied lncRNAs were directly correlated (all p-values <0.001). Overall and stratification by sex analyses revealed significantly higher levels of the three lncRNAs in non-survivors compared to the survivor group (all p-values <0.001). Principal component analysis showed a clear demarcation between the two study cohorts in males and females. Cohorts with upregulated ANRIL (hazard ratio; HR = 4.21, 95% CI = 1.15–10.4, p=0.030) and HOTAIR (HR = 2.49, 95% CI = 1.02–6.05, p=0.044) were at a higher risk of mortality. Conclusion Circulatory MALAT1, ANRIL, and HOTAIR were upregulated in neonatal sepsis, and the latter two may have the potential as prognostic biomarkers for survival in neonatal sepsis.
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Affiliation(s)
- Nouran B AbdAllah
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Essam Al Ageeli
- Department of Clinical Biochemistry (Medical Genetics), Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Abdullah Shbeer
- Anesthesiology and Intensive Care, Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Jawaher A Abdulhakim
- Medical Laboratory Department, College of Applied Medical Sciences, Taibah University, Yanbu, Saudi Arabia
| | - Eman A Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.,Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Doaa O Salman
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Sanaa S Nassar
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Gan MY, Lee WL, Yap BJ, Seethor STT, Greenberg RG, Pek JH, Tan B, Hornik CPV, Lee JH, Chong SL. Contemporary Trends in Global Mortality of Sepsis Among Young Infants Less Than 90 Days: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:890767. [PMID: 35722477 PMCID: PMC9204066 DOI: 10.3389/fped.2022.890767] [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: 03/06/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Current knowledge on the global burden of infant sepsis is limited to population-level data. We aimed to summarize global case fatality rates (CFRs) of young infants with sepsis, stratified by gross national income (GNI) status and patient-level risk factors. Methods We performed a systematic review and meta-analysis on CFRs among young infants < 90 days with sepsis. We searched PubMed, Cochrane Central, Embase, and Web of Science for studies published between January 2010 and September 2019. We obtained pooled CFRs estimates using the random effects model. We performed a univariate analysis at patient-level and a meta-regression to study the associations of gestational age, birth weight, onset of sepsis, GNI, age group and culture-proven sepsis with CFRs. Results The search yielded 6314 publications, of which 240 studies (N = 437,796 patients) from 77 countries were included. Of 240 studies, 99 were conducted in high-income countries, 44 in upper-middle-income countries, 82 in lower-middle-income countries, 6 in low-income countries and 9 in multiple income-level countries. Overall pooled CFR was 18% (95% CI, 17-19%). The CFR was highest for low-income countries [25% (95% CI, 7-43%)], followed by lower-middle [25% (95% CI, 7-43%)], upper-middle [21% (95% CI, 18-24%)] and lowest for high-income countries [12% (95% CI, 11-13%)]. Factors associated with high CFRs included prematurity, low birth weight, age less than 28 days, early onset sepsis, hospital acquired infections and sepsis in middle- and low-income countries. Study setting in middle-income countries was an independent predictor of high CFRs. We found a widening disparity in CFRs between countries of different GNI over time. Conclusion Young infant sepsis remains a major global health challenge. The widening disparity in young infant sepsis CFRs between GNI groups underscore the need to channel greater resources especially to the lower income regions. Systematic Review Registration [www.crd.york.ac.uk/prospero], identifier [CRD42020164321].
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Affiliation(s)
- Ming Ying Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Li Lee
- Duke-NUS Medical School, Singapore, Singapore
| | - Bei Jun Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rachel G Greenberg
- Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jen Heng Pek
- Emergency Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Bobby Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Christoph Paul Vincent Hornik
- Division of Critical Care Medicine, Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shu-Ling Chong
- Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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Does Neonatal Sepsis Independently Increase Neurodevelopmental Impairment? CHILDREN 2022; 9:children9040568. [PMID: 35455613 PMCID: PMC9027369 DOI: 10.3390/children9040568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
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Thompson DK, Yang JYM, Chen J, Kelly CE, Adamson CL, Alexander B, Gilchrist C, Matthews LG, Lee KJ, Hunt RW, Cheong JLY, Spencer-Smith M, Neil JJ, Seal ML, Inder TE, Doyle LW, Anderson PJ. Brain White Matter Development Over the First 13 Years in Very Preterm and Typically Developing Children Based on the T 1-w/ T 2-w Ratio. Neurology 2022; 98:e924-e937. [PMID: 34937788 PMCID: PMC8901175 DOI: 10.1212/wnl.0000000000013250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate brain regional white matter development in full-term (FT) and very preterm (VP) children at term equivalent and 7 and 13 years of age based on the ratio of T 1- and T 2-weighted MRI (T 1-w/T 2-w), including (1) whether longitudinal changes differ between birth groups or sexes, (2) associations with perinatal risk factors in VP children, and (3) relationships with neurodevelopmental outcomes at 13 years. METHODS Prospective longitudinal cohort study of VP (born <30 weeks' gestation or <1,250 g) and FT infants born between 2001 and 2004 and followed up at term equivalent and 7 and 13 years of age, including MRI studies and neurodevelopmental assessments. T 1-w/T 2-w images were parcellated into 48 white matter regions of interest. RESULTS Of 224 VP participants and 76 FT participants, 197 VP and 55 FT participants had useable T 1-w/T 2-w data from at least one timepoint. T 1-w/T 2-w values increased between term equivalent and 13 years of age, with little evidence that longitudinal changes varied between birth groups or sexes. VP birth, neonatal brain abnormalities, being small for gestational age, and postnatal infection were associated with reduced regional T 1-w/T 2-w values in childhood and adolescence. Increased T 1-w/T 2-w values across the white matter at 13 years were associated with better motor and working memory function for all children. Within the FT group only, larger increases in T 1-w/T 2-w values from term equivalent to 7 years were associated with poorer attention and executive function, and higher T 1-w/T 2-w values at 7 years were associated with poorer mathematics performance. DISCUSSION VP birth and multiple known perinatal risk factors are associated with long-term reductions in the T 1-w/T 2-w ratio in white matter regions in childhood and adolescence, which may relate to alterations in microstructure and myelin content. Increased T 1-w/T 2-w ratio at 13 years appeared to be associated with better motor and working memory function and there appeared to be developmental differences between VP and FT children in the associations for attention, executive functioning, and mathematics performance.
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Affiliation(s)
- Deanne K Thompson
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia.
| | - Joseph Y M Yang
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Jian Chen
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Claire E Kelly
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Christopher L Adamson
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Bonnie Alexander
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Courtney Gilchrist
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Lillian G Matthews
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Katherine J Lee
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Rodney W Hunt
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Jeanie L Y Cheong
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Megan Spencer-Smith
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Jeffrey J Neil
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Marc L Seal
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Terrie E Inder
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Lex W Doyle
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
| | - Peter J Anderson
- From the Victorian Infant Brain Study (VIBeS) (D.T., C.K.), Developmental Imaging (J. Chen, C.L.A., M.S.), and Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute; Department of Neurosurgery (J.Y.-M.Y., B.A.) and Neonatal Medicine (R.H.), The Royal Children's Hospital, Parkville; Neurodevelopment in Health and Disease Program (C.G.), School of Health and Biomedical Sciences, RMIT University, Bundoora; Turner Institute for Brain and Mental Health (L.M., M.S.-S., P.A.), Monash University, Clayton; Neonatal Services (J. Cheong), The Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Pediatric Neurology (J.N.), Washington University School of Medicine, St. Louis, MO; Department of Pediatric Newborn Medicine (T.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Obstetrics and Gynaecology (L.D.), The University of Melbourne, Parkville, Australia
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Ackermann K, Baker J, Festa M, McMullan B, Westbrook J, Li L. Computerized Clinical Decision Support Systems for Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: A Scoping Review (Preprint). JMIR Med Inform 2021; 10:e35061. [PMID: 35522467 PMCID: PMC9123549 DOI: 10.2196/35061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 03/19/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Khalia Ackermann
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Jannah Baker
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Marino Festa
- Kids Critical Care Research, Department of Paediatric Intensive Care, Children's Hospital at Westmead, Sydney, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
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Rohsiswatmo R. Nutritional Management and Recommendation for Preterm Infants: A Narrative Review. AMERTA NUTRITION 2021. [DOI: 10.20473/amnt.v5i1sp.2021.1-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Preterm birth is defined as birth before 37 completed weeks of pregnancy. It is the most important predictor of adverse health and development infant outcomes that extend into the early childhood and beyond. It is also the leading cause of childhood mortality under 5 years of age worldwide and responsible for approximately one million neonatal deaths. It is also a significant contributor to childhood morbidities, with many survivors are facing an increased risk of lifelong disability and poor quality of life. Purpose: In this article, we aimed to describe features of preterm infants, what makes them different from term infants, and what to consider in nutritional management of preterm infants through a traditional narrative literature review. Discussion: Preterm infants are predisposed to more health complications than term infants with higher morbidity and mortality. This morbidity and mortality can be reduced through timely interventions for the mother and the preterm infant. Maternal interventions, such as health education and administration of micronutrient supplementation, are given before or during pregnancy and at delivery, whereas appropriate care for the preterm infants should be initiated immediately after birth, which include early breastfeeding and optimalization of weight gain. Conclusion: Essential care of the preterm infants and early aggressive nutrition should be provided to support rapid growth that is associated with improved neurodevelopmental outcomes. The goal is not only about survival but making sure that these preterm infants grow and develop without any residual morbidity.
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Shim SY, Cho SJ, Park EA. Neurodevelopmental Outcomes at 18-24 Months of Corrected Age in Very Low Birth Weight Infants with Late-onset Sepsis. J Korean Med Sci 2021; 36:e205. [PMID: 34490752 PMCID: PMC8422039 DOI: 10.3346/jkms.2021.36.e205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Preterm infants are prone to sepsis owing to their immature innate immunity and prolonged hospitalization. We aimed to evaluate the association between late-onset sepsis (LOS) during hospitalization and neurodevelopmental delay at 18-24 months of corrected age in very low birth weight infants (VLBWIs), and to ascertain this association when adjusted for perinatal risk factors. METHODS This is a population-based study of VLBWIs born at 23-32 weeks of gestation between January 2014 and December 2017 who were enrolled in the Korean Neonatal Network. Bayley scales of infant development were evaluated at 18-24 months of corrected age in 2,098 infants. To test for LOS as a risk factor for neurodevelopmental delay, multiple logistic regression was used and adjusted for parental education status and clinical variables. RESULTS Blood culture positive LOS was identified in 419 (20.0%) infants. Cognitive and motor delays were found in 392 (18.7%) and 347 (16.5%) infants, respectively. When multivariate analysis was performed, LOS had a significant association with cognitive delay (odds ratio, 1.48; 95% confidence interval, 1.02-2.16), but no association with motor delay in VLBWIs. Both delays were significantly more frequent in cases of intraventricular hemorrhage (IVH) ≥ grade 3, periventricular leukomalacia (PVL), and intrauterine growth restriction (IUGR) and duration of mechanical ventilation. Male sex and necrotizing enterocolitis ≥ grade 2 had an effect on motor delay, whereas paternal college graduation affected cognitive delay. CONCLUSION In VLBWIs with LOS, there is a heightened risk of cognitive delays at 18-24 months of corrected age. Brain injury, such as severe IVH and PVL, duration of mechanical ventilation, and IUGR, were also associated with cognitive and motor delays.
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Affiliation(s)
- So-Yeon Shim
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea.
| | - Su Jin Cho
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Ae Park
- Division of Neonatology, Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
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Deshmukh M, Patole S. Current Status of Probiotics for Preterm Infants. Indian J Pediatr 2021; 88:703-708. [PMID: 33877563 DOI: 10.1007/s12098-021-03736-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Probiotics have been shown to reduce the risk of all-cause mortality, necrotizing enterocolitis (NEC ≥ stage II), late onset sepsis (LOS), and feeding intolerance in preterm infants. Considering the substantial health burden imposed by these conditions, the importance of probiotics in preterm infants cannot be overemphasized. Based on the data from experimental studies, and systematic reviews of randomized controlled trials (RCTs) and non-RCTs, the uptake of this intervention in neonatal medicine has been increasing over the last few years. However, many are still hesitating to adopt this intervention for various reasons, including concerns about probiotic sepsis, product quality, and lack of clarity on optimal strain/s or their combinations. Some question the validity of meta-analyses of studies involving different probiotic strains or their combinations because probiotics effects are considered to be strain-specific. Some of the early concerns about probiotics in preterm infants have been shown to be unjustified. However, the resistance to probiotics continues in many neonatal units around the world. The future of probiotics for preterm infants depends on continued efforts to develop high-quality probiotic products using stringent quality control, improving access to such products, and robust head-to-head comparisons to know the optimal strains or their combinations. Monitoring for adverse effects such as probiotic sepsis and development of antibiotic resistance is crucial. The authors review the current status of probiotics in preterm infants and discuss the scope for further research in this field.
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Affiliation(s)
- Mangesh Deshmukh
- Department of Neonatology, Fiona Stanley Hospital, Perth, Western Australia.,Department of Neonatology, St. John of God Subiaco Hospital, Perth, Western Australia
| | - Sanjay Patole
- Neonatal Directorate, King Edward Memorial Hospital for Women, 374 Bagot Road, Subiaco, Western Australia, 6008. .,School of Medicine, University of Western Australia, Perth, Western Australia.
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Ortgies T, Rullmann M, Ziegelhöfer D, Bläser A, Thome UH. The role of early-onset-sepsis in the neurodevelopment of very low birth weight infants. BMC Pediatr 2021; 21:289. [PMID: 34172028 PMCID: PMC8229301 DOI: 10.1186/s12887-021-02738-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
AIMS The study investigated a putative association between early-onset-sepsis (EOS) and poor neurodevelopmental outcomes at 2 years corrected age in very low birth weight infants. METHODS This was a single-center cohort study on infants weighing less than 1500 g with a gestational age below 35 weeks at birth born between 2008 and 2011. Neurodevelopmental outcomes were assessed at follow-up with the Bayley Scales of Infant Development-II. EOS was defined as either culture-proven EOS or clinical EOS using blood culture, CrP levels, and clinical symptoms and treatment. Neurodevelopmental impairment (NDI) was defined as one or more of the following: Mental Developmental Index (MDI) and/or Psychomotor Developmental Index (PDI) scores lower than 70; presence of cerebral palsy. RESULTS Of 405 eligible newborns in the study period 166 were included. Two had culture-proven and 29 clinical EOS. Median MDI scores in patients with EOS were 96 (IQR: 86-106) and in the control group 94 (84-106, p = 0.77). PDI scores in patients with EOS were 96 (86-106) and in the control group 99,5 (92-103, p = 0.03). Of infected patients 7/31 (24%) showed NDI as defined, whereas only 11/135 (8%) showed NDI in the control group (OR 3.3, p = 0.03). Multiple regression analyses identified chorioamnionitis and poor CRIB-Scores as individual risk factors for MDI or PDI values < 70. CONCLUSION In our study, EOS among VLBW-infants significantly impaired the neurodevelopment at 2 years corrected age. As shown in previous reports infection continues to be a problem and strategies for a reduction need further improvement.
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Affiliation(s)
- Tjark Ortgies
- Division of Neonatology, University Children's Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Michael Rullmann
- Department of Nuclear Medicine, University Hospital Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Dorothée Ziegelhöfer
- Division of Neonatology, University Children's Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Annett Bläser
- Division of Neonatology, University Children's Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Ulrich H Thome
- Division of Neonatology, University Children's Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Diagnosis of Neonatal Late-Onset Infection in Very Preterm Infant: Inter-Observer Agreement and International Classifications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030882. [PMID: 33498557 PMCID: PMC7908350 DOI: 10.3390/ijerph18030882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 02/05/2023]
Abstract
Background: The definition of late-onset bacterial sepsis (LOS) in very preterm infants is not unified. The objective was to assess the concordance of LOS diagnosis between experts in neonatal infection and international classifications and to evaluate the potential impact on heart rate variability and rate of “bronchopulmonary dysplasia or death”. Methods: A retrospective (2017–2020) multicenter study including hospitalized infants born before 31 weeks of gestation with intention to treat at least 5-days with antibiotics was performed. LOS was classified as “certain or probable” or “doubtful” independently by five experts and according to four international classifications with concordance assessed by Fleiss’s kappa test. Results: LOS was suspected at seven days (IQR: 5–11) of life in 48 infants. Following expert classification, 36 of them (75%) were considered as “certain or probable” (kappa = 0.41). Following international classification, this number varied from 13 to 46 (kappa = −0.08). Using the expert classification, “bronchopulmonary dysplasia or death” occurred less frequently in the doubtful group (25% vs. 78%, p < 0.001). Differences existed in HRV changes between the two groups. Conclusion: The definition of LOS is not consensual with a low international and moderate inter-observer agreement. This affects the evaluation of associated organ dysfunction and prognosis.
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CLINICAL AND MICROBIOLOGICAL FEATURES OF EARLY-ONSET NEONATAL SEPSIS IN PRETERM INFANTS. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Early-onset neonatal sepsis (EONS) remains the leading cause of morbidity and mortality, especially among premature infants. Conducting high-quality epidemiological monitoring is an important condition for effective tactics treatment neonatal infections and improving the quality of medical care for this category of newborn.
The aim. Determination of the value of microbiological triggers in the blood in various clinical options for EONS in preterm infants.
Materials and methods. Clinical and microbiological data on 50 prematurely born newborns with EONS were selected. The analysis of the frequency of detected bacteremia, the distribution of pathogenic microorganisms and the clinical characteristics of neonatal sepsis.
Results. In the study, sources of infection were detected in 94 % of cases. Positive blood cultures were obtained in 17 (34 %) newborns with EONS. 61.5 % of all cases of bacteremia were caused by coagulase-negative staphylococcus (CoNS). Gram-negative pathogens were detected in 23.5 % of positive blood cultures, representatives of this group were Escherichia coli and Klebsiella pneumonia. The overall mortality rate from EONS was 30 %.
Conclusions. The incidence of sepsis confirmed by a positive blood culture was 34 %. The most common cause of EONS is CoNS, low incidence of group B Streptococcus sepsis has been established. The most frequent septicopymic sources of infection were the lungs, which is expressed in the high incidence (94 %) of X-ray pneumonia in the structure of the EONS.
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Chawla D. Need of Neonatal Sepsis Surveillance in India. Indian J Pediatr 2020; 87:329-330. [PMID: 32239419 DOI: 10.1007/s12098-020-03280-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, 160 030, India.
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Batta V, Rao S, Wagh D, Tan JKG, Gollow I, Simmer K, Bulsara MK, Patole S. Early neurodevelopmental outcomes of congenital gastrointestinal surgical conditions: a single-centre retrospective study. BMJ Paediatr Open 2020; 4:e000736. [PMID: 32821861 PMCID: PMC7422631 DOI: 10.1136/bmjpo-2020-000736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Evidence is emerging that surgery in the neonatal period is associated with increased risk of suboptimal neurodevelopmental outcomes (SNDO). The aim of this study was to describe neurodevelopmental outcomes (at 1 year) of neonatal surgery for congenital gastrointestinal surgical conditions (CGSC) and to explore risk factors. METHODS Retrospective study (2005-2014) of infants born ≥34 weeks gestation with CGSC and admitted to the surgical neonatal intensive care unit of Perth Children's Hospital, Western Australia. Clinical details and 1-year developmental outcomes based on Griffiths Mental Developmental Assessment Scales were collated from the database and by reviewing the medical records of study infants. SNDO was defined as one or more of the following: a general quotient less than 88 (ie, >1 SD below mean), cerebral palsy, blindness or sensorineural deafness. Univariable and multivariable logistic regression analyses were carried out to explore risk factors for SNDO. A total of 413 infants were included, of which 13 died. Median gestation was 37.6 weeks (IQR: 36.4-39.1). Information on developmental outcomes was available from 262 out of 400 survivors. A total of 43/262 (16.4%) had SNDO. On univariable analysis, lower z scores for birth weight, prolonged duration of antibiotics, increased episodes of general anaesthesia and prolonged duration of hospital stay were associated with SNDO. On multivariable analysis, lower z scores for birth weight and prolonged hospital stay were associated with increased risk of SNDO. CONCLUSIONS Late preterm and term infants undergoing neonatal surgery for CGSC may be at risk for SNDO. Studies with longer duration of follow-up are needed to further evaluate the role of potentially modifiable risk factors on their neurodevelopmental outcomes.
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Affiliation(s)
- Vamsi Batta
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Shripada Rao
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Deepika Wagh
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Jason Khay Ghim Tan
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Ian Gollow
- Paediatric Surgery, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Karen Simmer
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Max K Bulsara
- Biostatistics, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Sanjay Patole
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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