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Butzer SK, Faust K, Oberthuer A, Kleindiek C, Kuehne B, Haertel C, Mehler K. Wide use of broad-spectrum antibiotics in very low birth weight infants with spontaneous focal intestinal perforation-is it really justified? Infection 2024:10.1007/s15010-024-02257-2. [PMID: 38634989 DOI: 10.1007/s15010-024-02257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Very low birth weight (VLBW) infants are at a risk of spontaneous focal intestinal perforation (FIP). Treatment includes supportive care, antibiotics, and drainage with/without surgery. Broad-spectrum antibiotic agents like carbapenems are applied frequently, although their use is not well-supported by the limited evidence of causal pathogens. We hypothesize that the use of carbapenems may not be necessary in VLBW infants with FIP. Our primary objective was to evaluate the antimicrobial use in VLBW infants with FIP in a cohort of the German Neonatal Network (GNN). The secondary objective was to characterize a subset in detail as a benchmark for future targets of stewardship. METHODS Data on VLBW infants with FIP was collected prospectively within the GNN, a collaboration of 68 neonatal intensive care units (NICU). With regards to the primary objective, patient characteristics and antimicrobial treatment were extracted from the predefined GNN database. To address our secondary objective, an additional on-site assessment of laboratory and microbiological culture results were performed. RESULTS In the GNN cohort, 613/21,646 enrolled infants (2.8%) developed FIP requiring surgery. They were frequently treated with carbapenems (500/613 (81.6%)) and vancomycin (497/613 (81.1%)). In a subset of 124 VLBW infants, 77 (72.6%) had proof of gram-positive bacteria in the abdominal cavity, coagulase-negative staphylococci (CoNS) predominantly. Despite the low prevalence of gram-negative bacteria (n = 6 (4.8%)), the combination of meropenem and vancomycin was prescribed most frequently (n = 96 (78.0%)). CONCLUSION The use of carbapenems as broad-spectrum antimicrobials agents might not be justified in most VLBW infants with FIP. Knowledge on the development of the neonatal gut microbiota, local resistance patterns and individual microbiological findings should be taken into consideration when implementing antimicrobial stewardship programs (ASPs).
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Affiliation(s)
- Sarina K Butzer
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Kirstin Faust
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - André Oberthuer
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | | | - Benjamin Kuehne
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Christoph Haertel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
- German Neonatal Network (GNN), Lübeck, Germany
| | - Katrin Mehler
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
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Stutz R, Meyer C, Kaiser E, Goedicke-Fritz S, Schroeder HW, Bals R, Haertel C, Rogosch T, Kerzel S, Zemlin M. Attenuated asthma phenotype in mice with a fetal-like antigen receptor repertoire. Sci Rep 2021; 11:14199. [PMID: 34244568 PMCID: PMC8270943 DOI: 10.1038/s41598-021-93553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/21/2021] [Indexed: 11/09/2022] Open
Abstract
We hypothesized that the scarcity of N-nucleotides might contribute to the inability of the neonate to mount a robust allergic immune response. To test this, we used terminal deoxyribunucleotidyl Transferase deficient (TdT-/-) mice, which express "fetal-like" T cell receptor and immunoglobulin repertoires with largely germline-encoded CDR3 regions. Intraperitoneal sensitization was followed by aerosol provocation with either PBS or the allergen OVA in both TdT-/- mice and wild-type mice to develop allergic respiratory inflammation. The effects of this procedure were investigated by lung function test, immunological analysis of serum and brochoalveolar lavage. The local TH2 cytokine milieu was significantly attenuated in TdT-/- mice. Within this group, the induction of total IgE levels was also significantly reduced after sensitization. TdT-/- mice showed a tendency toward reduced eosinophilic inflow into the bronchial tubes, which was associated with the elimination of respiratory hyperreactivity. In conclusion, in a murine model of allergic airway inflammation, the expression of fetal-like antigen receptors was associated with potent indications of a reduced ability to mount an asthma phenotype. This underlines the importance of somatically-generated antigen-receptor repertoire diversity in type one allergic immune responses and suggests that the fetus may be protected from allergic responses, at least in part, by controlling N addition.
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Affiliation(s)
- Regine Stutz
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Christopher Meyer
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Elisabeth Kaiser
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Sybelle Goedicke-Fritz
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany.,Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
| | - Harry W Schroeder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Bals
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, Saarland University Medical School, Homburg, Germany
| | - Christoph Haertel
- Department of Pediatrics, Würzburg University Medical Center, Würzburg, Germany
| | - Tobias Rogosch
- Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
| | - Sebastian Kerzel
- Department of Pediatrics, Philipps-University Marburg, Marburg, Germany.,Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, Campus St. Hedwig, Regensburg, Germany
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany. .,Department of Pediatrics, Philipps-University Marburg, Marburg, Germany.
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Albrecht M, Pagenkemper M, Wiessner C, Spohn M, Lütgehetmann M, Jacobsen H, Gabriel G, Zazara DE, Haertel C, Hecher K, Diemert A, Arck PC. Infant immunity against viral infections is advanced by the placenta-dependent vertical transfer of maternal antibodies. Vaccine 2021; 40:1563-1571. [PMID: 33431223 DOI: 10.1016/j.vaccine.2020.12.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/12/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022]
Abstract
Neonatal passive immunity, derived from transplacental transfer of IgG antibodies from mother to fetus during pregnancy, can mitigate the risk for severe infections in the early postnatal period. Understanding the placenta as the gateway organ in this process, we aimed to evaluate the influence of specific factors modulating the transplacental IgG transfer rate (TPTR) in 141 mother/neonate pairs. We further evaluated the potential health advantage elicited by maternal IgG with regard to respiratory tract infections during infancy and early childhood. Data and biological samples collected within the prospective longitudinal pregnancy cohort study PRINCE (Prenatal Identification of Children's Health) were used for these analyses. We tested IgG antibody levels against seven pathogens (measles, mumps, rubella, tetanus, diphtheria, pertussis and influenza A) by ELISA and detected seropositivity in 72.6-100% of pregnant women and in 76.3-100% of their neonates, respectively. Cord blood IgG levels reached 137-160% of levels detected in maternal blood. Strikingly, assessment of TPTR for all seven antigens highlighted that TPTR strongly depends on individual placental function. Subsequent in-depth analysis of anti-influenza A IgG revealed a link between cord blood levels and uterine perfusion, measured by uterine artery pulsatility index. Moreover, higher cord blood anti-influenza A IgG levels were associated with a significantly reduced risk for respiratory tract infections during the first six months of life, indicating a high degree of cross-reactivity and possible pathogen-agnostic effects of anti-influenza A antibodies. Taken together, our data suggest that early life immunity is modulated by maternal IgG levels and individual placental features such as perfusion. Vaccination of pregnant women, i.e. against influenza, can increase neonatal antibody levels and hereby protect against early life respiratory infections. Consequently, specific guidelines should evolve in order to safeguard neonates born from pregnancies with poorer placental capacity for vertical transfer of protective antibodies.
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Affiliation(s)
- Marie Albrecht
- Division for Experimental Feto-Maternal Medicine, Department of Obstetrics and Prenatal Medicine, University Medical Center of Hamburg-Eppendorf, Germany
| | - Mirja Pagenkemper
- Department of Obstetrics and Prenatal Medicine, University Medical Center of Hamburg-Eppendorf, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center of Hamburg-Eppendorf, Germany
| | - Michael Spohn
- Bioinformatics Facility, University Medical Center of Hamburg-Eppendorf, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany
| | - Henning Jacobsen
- Viral Zoonoses - One Health, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Gülsah Gabriel
- Viral Zoonoses - One Health, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany; Institute of Virology, University of Veterinary Medicine, Hannover, Germany
| | - Dimitra E Zazara
- Division for Experimental Feto-Maternal Medicine, Department of Obstetrics and Prenatal Medicine, University Medical Center of Hamburg-Eppendorf, Germany; Department of Pediatrics, University Medical Center of Hamburg-Eppendorf, Germany
| | - Christoph Haertel
- University Children's Hospital, University of Würzburg, Wuerzburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Prenatal Medicine, University Medical Center of Hamburg-Eppendorf, Germany
| | - Anke Diemert
- Department of Obstetrics and Prenatal Medicine, University Medical Center of Hamburg-Eppendorf, Germany
| | - Petra Clara Arck
- Division for Experimental Feto-Maternal Medicine, Department of Obstetrics and Prenatal Medicine, University Medical Center of Hamburg-Eppendorf, Germany.
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Dzietko M, Schulz S, Preuss M, Haertel C, Stein A, Felderhoff-Mueser U, Goepel W. Apolipoprotein E gene polymorphisms and intraventricular haemorrhage in infants born preterm: a large prospective multicentre cohort study. Dev Med Child Neurol 2019; 61:337-342. [PMID: 30084487 DOI: 10.1111/dmcn.13987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
AIM Infants born preterm are at risk of intraventricular haemorrhage (IVH) but individual susceptibility related to genes is not well defined in this vulnerable population. Apolipoprotein genotypes APOE2 and APOE4 increase the hazard of cerebral haemorrhages in adults. We investigated whether APOE is associated with prevalence of IVH and is likely to have a particular genotype. METHOD In this prospective study, 5075 infants born preterm with genotype APOE3 were compared to 965 (APOE2) and 1912 (APOE4) individuals, to analyse the association between APOE genotype and grade III and IV IVH. We used a logistic regression model including gestational age, antenatal steroid treatment, 5-minute Apgar scores less than 3, intubation, pneumothorax, small for gestational age, multiple birth, sex, and maternal descent as independent factors. RESULTS The APOE2 (20.1%) and APOE4 (19.8%) genotypes were significantly more prevalent in infants with IVH than in those with the APOE3 haplotype (17.4%) (APOE2: odds ratio [OR] 1.33, 95% confidence interval [CI] 1.00-1.76; APOE4: OR 1.39, 95% CI 1.12-1.74). Infants with two polymorphisms had the highest risk of IVH (8.7%; OR 1.63, 95% CI 1.09-2.45). INTERPRETATION APOE2 and APOE4 genotypes are relevant risk factors for IVH in infants born preterm. Our findings improve our understanding of the genetic contributions to IVH.
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Affiliation(s)
- Mark Dzietko
- Department of Pediatrics I, University Duisburg-Essen, Essen, Germany
| | - Soeren Schulz
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Michael Preuss
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | | | - Anja Stein
- Department of Pediatrics I, University Duisburg-Essen, Essen, Germany
| | | | - Wolfgang Goepel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
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Bossung V, Haertel C, Rody A. Zweizeitige Entbindung bei dichorialer, diamnioter Zwillingsschwangerschaft und PPROM des ersten Geminus – zwei Fallberichte. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- V Bossung
- Klinik für Frauenheilkunde und Geburtshilfe, UKSH Campus Lübeck
| | - C Haertel
- Klinik für Kinder- und Jugendmedizin, UKSH Campus Lübeck
| | - A Rody
- Klinik für Frauenheilkunde und Geburtshilfe, UKSH Campus Lübeck
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Hoellen F, Hornemann A, Haertel C, Reh A, Rody A, Schneider S, Tuschy B, Bohlmann MK. Does maternal underweight prior to conception influence pregnancy risks and outcome? In Vivo 2014; 28:1165-1170. [PMID: 25398817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Data analyzing risks during pregnancy and neonatal outcome in Caucasian women with pre-conceptional underweight are scarce. PATIENTS AND METHODS We conducted a retrospective cohort study in Northern Germany comparing pregnancy risks and neonatal outcomes in nulliparous women with either pre-conceptional underweight or normal weight. RESULTS The data of 3,854 nulliparous women with either underweight (n = 243; BMI ≤ 18.5 kg/m(2)) or normal weight (n = 3611; BMI 18.5-24.9 kg/m(2)) were screened. The risks for preterm birth (23.3 vs. 18.6%; p = 0.004) and neonatal underweight were significantly higher in women with underweight prior to conception (p < 0.0001). The risk for secondary caesarean sections was significantly lower in underweight patients. CONCLUSION To our knowledge, the present retrospective cohort study constitutes the largest sub-group analysis on delivery and maternal and neonatal outcome in pre-conceptionally underweight mothers. There are significantly more preterm deliveries in underweight mothers, while maternal outcome and birth-associated trauma (lacerations, caesarean section) is not disadvantageously influenced by maternal underweight. Further investigations are required in order to specify nutritional deficits in underweight pregnant women and to optimize medication in cases where nutritional balance cannot be achieved in order to improve the neonatal status at birth.
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Affiliation(s)
- Friederike Hoellen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Amadeus Hornemann
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Haertel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Annette Reh
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Sven Schneider
- Institute of Public Health, University Medical Centre Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael K Bohlmann
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Rank N, Michel C, Haertel C, Lenhart A, Welte M, Meier-Hellmann A, Spies C. N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients: results of a prospective, randomized, double-blind study. Crit Care Med 2000; 28:3799-807. [PMID: 11153617 DOI: 10.1097/00003246-200012000-00006] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In septic shock, decreased splanchnic blood flow is reported, despite adequate systemic hemodynamics. Aacetylcysteine (NAC) was found to increase hepatosplanchnic blood flow in experimental settings. In septic shock patients, NAC improved the clearance of indocyanine green and the relationship of systemic oxygen consumption to oxygen demand. We investigated the influence of NAC on liver blood flow, hepatosplanchnic oxygen transport-related variables, and liver function during early septic shock. DESIGN Prospective, randomized, double-blind study. SETTING Septic shock patients admitted to an interdisciplinary surgical intensive care unit. PATIENTS We examined 60 septic shock patients within 24 hrs after onset of sepsis. They were conventionally resuscitated with volume and inotropes and were in stable condition. A gastric tonometer was inserted into the stomach and a catheter into the hepatic vein. Microsomal liver function was assessed by using the plasma appearance of monoethylglycinexylidide (MEGX). INTERVENTIONS Subjects randomly received either a bolus of 150 mg/kg iv NAC over 15 mins and a subsequent continuous infusion of 12.5 mg/kg/hr NAC over 90 mins (n = 30) or placebo (n = 30). MEASUREMENTS AND MAIN RESULTS Measurements were performed before (baseline) and 60 mins after beginning the infusion (infusion). After NAC, a significant increase in absolute liver blood flow index (2.7 vs. 3.3 L/min/m2; p = .01) and cardiac index (5.0 vs. 5.7 L/min/m2; p = .02) was observed. Fractional liver blood flow index (cardiac index-related liver blood flow index) did not change. The difference between arterial and gastric mucosal carbon dioxide tension decreased (p = .05) and MEGX increased (p = .04). Liver blood flow index and MEGX correlated significantly (r(s) = .57; p < or = .01). CONCLUSIONS After NAC treatment, hepatosplanchnic flow and function improved and may, therefore, suggest enhanced nutritive blood flow. The increase of liver blood flow index was not caused by redistribution to the hepatosplanchnic area, but by an increase of cardiac index. Because of its correlation with liver blood flow index, MEGX may be helpful in identifying patients who benefit from NAC treatment in early septic shock.
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Affiliation(s)
- N Rank
- Department of Anesthesiology and Operative Intensive Care Medicine, University Hospital Benjamin Franklin, Freie Universität Berlin, Germany
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