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Montaner Ramón A, Castilla Fernández Y, Frick MA, Camba Longueira F, Céspedes Domínguez MC, Ribes Bautista C, Castillo Salinas F. How to assess early-onset neonatal sepsis? Comparison of three detection strategies. An Pediatr (Barc) 2023; 98:92-98. [PMID: 36710085 DOI: 10.1016/j.anpede.2022.10.009] [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: 05/24/2022] [Accepted: 10/19/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Early-onset neonatal sepsis (EONS) can cause significant morbidity and mortality, especially if it is not detected early. Given the decrease in its incidence in the past few decades, it is important to find a balance between reducing the use of diagnostic tests and continuing to detect affected patients. We compared 3 detection strategies in patients with risk factors (RFs) for infection: laboratory screening (S1), the Neonatal Sepsis Risk Calculator (S2) and clinical observation (S3). PATIENTS AND METHODS Retrospective observational study in neonates born at 34 weeks of gestation or later and with RFs or symptoms compatible with EONS. We analysed outcomes in our unit with the use of laboratory screening (S1) and compared them with the other two strategies (S2 and S3) to contemplate whether to modify our protocol. RESULTS The study included 754 patients, and the most frequent RFs were prolonged rupture of membranes (35.5%) and maternal colonization by Streptococcus agalactiae (38.5%). Strategies S2 and S3 would decrease the performance of laboratory tests (S1, 56.8% of patients; S2, 9.9%; S3, 22.4%; P < 0.01), hospital admissions (S1, 11%; S2, 6.9%; S3, 7.9%; P < 0.01) and the use of antibiotherapy (S1, 8.6%; S2, 6.7%; S3, 6.4%; P < 0.01). Sepsis was diagnosed in 13 patients, and it would have been detected with S2 and S3 except in 1 patient who had asymptomatic bacteriemia by Enterococcus faecalis. No patient with mild and self-limited symptoms in whom antibiotherapy was not started received a diagnosis of sepsis later on. CONCLUSION Close clinical observation seems to be a safe option and could reduce the use of diagnostic tests, hospital admission and unnecessary antibiotherapy. The watchful waiting approach in patients with mild and self-limiting symptoms in the first hours post birth does not appear to be associated with failure to identify sepsis.
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Affiliation(s)
| | | | - María Antoinette Frick
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitari Vall D'hebron, Barcelona, Spain
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Sánchez-Luna M, Fernández Colomer B, de Alba Romero C, Alarcón Allen A, Baña Souto A, Camba Longueira F, Cernada Badía M, Galve Pradell Z, González López M, López Herrera MC, Ribes Bautista C, Sánchez García L, Zamora Flores E. Neonates Born to Mothers With COVID-19: Data From the Spanish Society of Neonatology Registry. Pediatrics 2021; 147:peds.2020-015065. [PMID: 33479162 DOI: 10.1542/peds.2020-015065] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe neonatal and maternal characteristics of the largest prospective cohort of newborns from mothers with coronavirus disease 2019 (COVID-19), the data of which were prospectively collected from the nationwide registry of the Spanish Society of Neonatology. METHODS Between March 8, 2020, and May 26, 2020, the data of 503 neonates born to 497 mothers diagnosed with COVID-19 during pregnancy or at the time of delivery were collected by 79 hospitals throughout Spain. RESULTS Maternal symptoms were similar to that of the general population, with 5% of severe forms. In 45.8% of asymptomatic women at the time of delivery, severe acute respiratory syndrome coronavirus 2 infection was detected because of recommendations established in Spain to perform COVID-19 screening in all women admitted to the hospital for labor. The rate of preterm deliveries was 15.7% and of cesarean deliveries, 33%. The most common diagnostic test was detection of viral RNA by polymerase chain reaction of nasopharyngeal swabs at a median age of 3 hours after delivery (1-12 hours). Almost one-half of neonates were left skin-to-skin after delivery, and delayed clamping of umbilical cords was performed in 43% of neonates. Also, 62.3% of asymptomatic neonates were managed with rooming-in. Maternal milk was received by 76.5% of neonates, 204 of them as exclusive breastfeeding. CONCLUSIONS The current study indicates that there is no need for separation of mothers from neonates, allowing delayed cord clamping and skin-to-skin contact along with maintenance of breastfeeding in a high percentage of newborns from mothers with COVID-19.
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Affiliation(s)
- Manuel Sánchez-Luna
- Department of Neonatology, Hospital General Universitario Gregorio Marañón and Complutense University of Madrid, Madrid, Spain;
| | - Belén Fernández Colomer
- Neonatology Service, Department of Pediatrics, Hospital Central Universitario de Asturias, Oviedo, Spain
| | | | - Ana Alarcón Allen
- Department of Neonatology, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Ana Baña Souto
- Neonatology Service, Department of Pediatrics, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Fátima Camba Longueira
- Department of Neonatology, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Cernada Badía
- Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - María González López
- Department of Neonatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Carmen Ribes Bautista
- Department of Neonatology, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Elena Zamora Flores
- Department of Neonatology, Hospital General Universitario Gregorio Marañón and Complutense University of Madrid, Madrid, Spain
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Fernández Colomer B, Sánchez-Luna M, de Alba Romero C, Alarcón A, Baña Souto A, Camba Longueira F, Cernada M, Galve Pradell Z, González López M, López Herrera MC, Ribes Bautista C, Sánchez García L, Zamora Flores E, Pellicer A, Alonso Díaz C, Herraiz Perea C, Romero Ramírez DS, de Las Cuevas Terán I, Pescador Chamorro I, Fernández Trisac JL, Arruza Gómez L, Cardo Fernández LM, García García MJ, Nicolás López M, Hortelano López M, Riaza Gómez M, Hernández González N, González Sánchez R, Zambudio Sert S, Larrosa Capacés S, Matías Del Pozo V. Neonatal Infection Due to SARS-CoV-2: An Epidemiological Study in Spain. Front Pediatr 2020; 8:580584. [PMID: 33194912 PMCID: PMC7644848 DOI: 10.3389/fped.2020.580584] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: Coronavirus disease 2019 (COVID-19) cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to increase worldwide. Although some data from pediatric series are available, more evidence is required, especially in neonates, a group with specific characteristics that deserve special attention. This study aimed to describe general and clinical characteristics, management, and treatment of postnatal-acquired (community and nosocomial/hospital-acquired) COVID-19 neonatal cases in Spain. Methods: This was a national prospective epidemiological study that included cases from a National Registry supported by the Spanish Society of Neonatology. Neonates with postnatal SARS-CoV-2 infection were included in this study. General data and infection-related information (mode and source of transmission, age at diagnosis, clinical manifestations, need for hospitalization, admission unit, treatment administered, and complementary studies performed, hospital stay associated with the infection) were collected. Results: A total of 40 cases, 26 community-acquired and 14 nosocomial were registered. Ten were preterm newborns (2 community-acquired and 8 nosocomial COVID-19 cases). Mothers (in both groups) and healthcare workers (in nosocomial cases) were the main source of infection. Hospital admission was required in 22 community-acquired cases [18 admitted to the neonatal intermediate care unit (NIMCU) and 4 to the neonatal intensive care unit (NICU)]. Among nosocomial COVID-19 cases (n = 14), previously admitted for other reasons, 4 were admitted to the NIMCU and 10 to the NICU. Ten asymptomatic patients were registered (5 in each group). In the remaining cases, clinical manifestations were generally mild in both groups, including upper respiratory airways infection, febrile syndrome or acute gastroenteritis with good overall health. In both groups, most severe cases occurred in preterm neonates or neonates with concomitant pathologies. Most of the cases did not require respiratory support. Hydroxychloroquine was administered to 4 patients in the community-acquired group and to 2 patients in the nosocomial group. Follow-up after hospital discharge was performed in most patients. Conclusions: This is the largest series of COVID-19 neonatal cases in Spain published to date. Although clinical manifestations were generally mild, prevention, treatment, and management in this group are essential.
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Affiliation(s)
| | - Manuel Sánchez-Luna
- Neonatology Department, Complutense University, Madrid, Spain.,Division of Neonatology, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Ana Alarcón
- Department of Neonatology, Sant Joan de Déu University Hospital, Barcelona, Spain
| | - Ana Baña Souto
- Department of Neonatology, Clinical Hospital de Santiago, Santiago de Compostela, Spain
| | | | - María Cernada
- Division of Neonatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - María González López
- Department of Neonatology, Regional de Málaga University Hospital, Málaga, Spain
| | | | | | | | - Elena Zamora Flores
- Division of Neonatology, Gregorio Marañón University Hospital, Madrid, Spain
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Clara Alonso Díaz
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | | | | | - Luis Arruza Gómez
- Department of Neonatology, Clinical Hospital San Carlos, Madrid, Spain
| | | | | | - Marta Nicolás López
- Department of Neonatology, Germans Trias i Pujol University Hospital, Badalona, Spain
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Ruiz-Navarrete MA, Arriaga C, Bautista CR, Morilla A. Fasciola hepatica: characterization of somatic and excretory-secretory antigens of adult flukes recognized by infected sheep. Rev Latinoam Microbiol 1993; 35:301-7. [PMID: 8047733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The immune response of sheep to somatic components and excretory/secretory products of adult Fasciola hepatica, was studied during an experimental infection. Antibodies against adult fluke somatic and excretory/secretory antigens were detected by thin layer immunoassay from the second week post infection. Similarly, the results of Western blot analysis showed specific recognition of several components as early as two weeks after infection. However, an increase in the number and intensity of bands with time of infection was observed in the patterns of antigenic recognition. Most notorious was the strong reactivity of all infected sheep sera towards components of 20-23 kDa in the somatic preparation and components of 23-27 kDa in the excretory/secretory products of adult F. hepatica, specially noticeable after the sixth week post-infection. Since these polypeptides were recognized by all infected animals, they could play an important role in the diagnosis of sheep fascioliasis.
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Affiliation(s)
- M A Ruiz-Navarrete
- CENID Microbiología, Instituto Nacional de Investigaciones Forestales y Agropecuarias, SARH, México, D. F., Mexico
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