scholarly journals Ductal ligation timing and neonatal outcomes: a 12-year bicentric comparison

2021 ◽  
Author(s):  
Silvia Martini ◽  
Silvia Galletti ◽  
Wilf Kelsall ◽  
Emanuela Angeli ◽  
Marta Agulli ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cardiac Surgery ◽  
Late Onset ◽  
Postoperative Mortality ◽  
Cost Benefit ◽  
Neonatal Outcomes ◽  
Late Onset Sepsis ◽  
Extremely Preterm ◽  
Pda Ligation ◽  
The Impact

AbstractPatent ductus arteriosus (PDA) is common among extremely preterm infants. In selected cases, surgical PDA ligation may be required. The timing for PDA ligation may depend upon a variety of factors, with potential clinical implications. We aimed to investigate the impact of different surgical PDA managements on ligation timing and neonatal outcomes. Inborn infants < 32 weeks of gestation and < 1500 g admitted at two tertiary Neonatal Intensive Care Units that underwent PDA ligation between 2007 and 2018 were enrolled in this retrospective cohort study and split into the following groups based on their surgical management: on-site bedside PDA ligation (ONS) vs. referral to an off-site pediatric cardiac surgery (OFS). Neonatal characteristics, surgical timing, and clinical outcomes of the enrolled infants were compared between the groups. Multivariate analysis was performed to evaluate the impact of PDA ligation timing on significantly different outcomes. Seventy-eight neonates (ONS, n = 39; OFS, n = 39) were included. Infants in the ONS group underwent PDA ligation significantly earlier than those in the OFS group (median age 12 vs. 36 days, p < 0.001) with no increase in postoperative mortality and complications. The multivariate analysis revealed a significant association between PDA ligation timing, late-onset sepsis prevalence (OR 1.045, 0.032), and oxygen need at discharge (OR 1.037, p = 0.025).Conclusions: Compared with off-site surgery, on-site bedside ligation allows an earlier surgical closure of PDA, with no apparent increase in mortality or complications. Earlier PDA ligation may contribute to reduced rates of late-onset sepsis and post-discharge home oxygen therapy, with possible cost-benefit implications. What is known:• Ineffective or contraindicated pharmacological closure of a hemodynamically significant PDA may require a surgical ligation.• Available literature comparing the effect of early vs. late PDA ligation on the main neonatal morbidities has yield contrasting results. What is new:• The availability of a cardiac surgery service performing bedside PDA ligation allows an earlier intervention compared to patient referral to an off-site center, with no difference in postoperative mortality and complications compared to off-site surgery.• Earlier PDA ligation was associated with a lower prevalence of late-onset sepsis and of oxygen need at discharge, with possible cost-benefit implications.

scholarly journals Neonatal Outcomes Following Culture-negative Late-onset Sepsis Among Preterm Infants

2020 ◽  
Vol 39 (3) ◽  
pp. 232-238
Author(s):  
Siyuan Jiang ◽  
Zuming Yang ◽  
Ruobing Shan ◽  
Yi Zhang ◽  
Weili Yan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Late Onset ◽  
Neonatal Outcomes ◽  
Late Onset Sepsis ◽  
Culture Negative

scholarly journals The Impact of Patent Ductus Arteriosus in Neonates with Late Onset Sepsis: A Retrospective Matched-Case Control Study

2012 ◽  
Vol 53 (5) ◽  
pp. 309-314 ◽  
Author(s):  
Pei-Jung Chiang ◽  
Jen-Fu Hsu ◽  
Ming-Horng Tsai ◽  
Reyin Lien ◽  
Ming-Chou Chiang ◽  
...  
Keyword(s):  
Case Control Study ◽  
Late Onset ◽  
Ductus Arteriosus ◽  
Case Control ◽  
Late Onset Sepsis ◽  
Matched Case ◽  
The Impact ◽  
Matched Case Control Study ◽  
Control Study ◽  
Patent Ductus

scholarly journals Late-Onset Sepsis as a Risk Factor for Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants: A Nationwide Cohort Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Euiseok Jung ◽  
Byong Sop Lee
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Bronchopulmonary Dysplasia ◽  
Late Onset ◽  
Extremely Low Birth Weight ◽  
Late Onset Sepsis ◽  
The Impact ◽  
Multiple Episodes

Abstract This study aimed to determine the effect of late-onset sepsis (LOS) on the development of bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants. A prospective cohort study was performed using data collected from 64 centres registered in the Korean national registry. LOS was defined as a positive blood culture and antibiotics treatment after 72 hours of life and prior to 36 weeks postmenstrual age (PMA). Data on the causative organisms were collected and analysed for respiratory outcomes. Among the 1,434 ELBW infants who survived to 36 weeks PMA, 481 (34%) developed LOS caused by bacteria (n = 405), fungi (n = 28), or both (n = 48). The incidence of BPD was significantly associated with LOS in both the entire cohort and the propensity score-matched cohort. Two or more LOS episodes were a risk factor for BPD. The impact of multiple episodes of LOS on BPD was prominent in infants who received mechanical ventilation for two weeks or less. The estimated odds ratios for BPD and severe BPD were greater with fungal LOS than with bacterial LOS. In conclusion, LOS, particularly complicated by multiple episodes and/or fungi, was a risk factor for BPD in ELBW infants.

scholarly journals The Impact of Environmental and Genetic Factors on Neonatal Late-Onset Sepsis

2011 ◽  
Vol 158 (2) ◽  
pp. 234-238.e1 ◽  
Author(s):  
Matthew J. Bizzarro ◽  
Yuan Jiang ◽  
Naveed Hussain ◽  
Jeffrey R. Gruen ◽  
Vineet Bhandari ◽  
...  
Keyword(s):  
Genetic Factors ◽  
Late Onset ◽  
Late Onset Sepsis ◽  
The Impact

scholarly journals Prognostic factors in locally advanced colon cancer treated by extended resection

2004 ◽  
Vol 59 (6) ◽  
pp. 361-368 ◽  
Author(s):  
René A.C. Vieira ◽  
Ademar Lopes ◽  
Paulo A.C. Almeida ◽  
Benedito M. Rossi ◽  
Wilson T. Nakagawa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Colon Carcinoma ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Locally Advanced ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
The Impact ◽  
Overall Survival Rates

The impact of clinical, pathologic, and surgical variables on the postoperative morbidity, mortality, and survival of patients undergoing extended resections of colon carcinoma were evaluated. METHODS: The medical records of 95 patients who underwent extended resections for colon carcinoma between 1953 and 1996 were reviewed. In all cases, in addition to colectomy, 1 or more organs and/or structures were resected en bloc due to a macroscopically based suspicion of tumor invasion. The clinical, pathologic, and surgical parameters were analyzed. Overall survival rates were analyzed according to the method of Kaplan and Meier. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Eighty-six patients were treated by curative surgeries and the remaining by palliative resections. Invasion of the organs and/or adjacent structures and regional lymph nodes was found microscopically in 48 and 31 patients, respectively. The median follow-up without postoperative mortality was 47.7 months. The 5-year overall survival rates was 52.6%. The 5-year overall survival rates for patients undergoing curative and palliative surgeries was 58.3% and 0%, respectively. The mean survival time in the palliative surgery group was 3.1 months. Multivariate analysis showed that Karnofsky performance status was strongly related to the risk of postoperative complications (P = .01), and postoperative deaths were associated with the type of surgery and Karnofsky performance status at the time of admission (P = .001). CONCLUSIONS: Some patients with locally advanced colon adenocarcinomas undergoing extended resections have a 5-year overall survival rates of 58.3%. Patients could benefit from palliative-intent procedures, but these measures should cautiously be indicated and avoided in patients with low Karnofsky performance status due to high rates of postoperative mortality and poor survival.

scholarly journals Comparison of Neonatal Outcomes With the Use Cefotaxime Versus Ceftazidime in a Neonatal Intensive Care Unit

2020 ◽  
Vol 25 (2) ◽  
pp. 117-123
Author(s):  
Payal D. Patel ◽  
Palak Bhagat ◽  
Allison H. Bartlett ◽  
Deborah S. Bondi
Keyword(s):  
Neonatal Intensive Care ◽  
Late Onset ◽  
Multidrug Resistant ◽  
Neonatal Outcomes ◽  
Stage Ii ◽  
Drug Shortage ◽  
Late Onset Sepsis ◽  
National Drug ◽  
Increased Risk ◽  
Culture Positive

OBJECTIVES There is a national drug shortage of cefotaxime, and ceftazidime is recommended as an alternative to cefotaxime for neonates. This study evaluated culture-positive late-onset sepsis (LOS), multidrug resistant organisms (MDROs), and other neonatal outcomes with the use of ceftazidime compared with cefotaxime in neonates. METHODS This was a single-center, retrospective cohort study of neonatal subjects who received at least 24 hours of ceftazidime or cefotaxime between April 1, 2015, and August 1, 2017. Subjects were excluded if they received the alternate antibiotic for more than 24 hours. RESULTS A total of 101 subjects were included (ceftazidime, n = 58; cefotaxime, n = 43). Median gestational ages were significantly different between groups (28.1 [IQR, 25.0–36.6] weeks versus 32.3 [IQR, 26.9–37.4] in the ceftazidime and cefotaxime groups, respectively, p &lt; 0.05). Results showed a non-statistically significant increased incidence of culture-positive LOS (17.2% versus 2.3%, respectively, adjusted OR 6.51 [95% CI, 0.78–55.23], p = 0.09) and MDRO infections (5.2% versus 0%, respectively, p = 0.26) with the use of ceftazidime compared with cefotaxime. There was a statistically significant increased risk of stage II to III necrotizing enterocolitis (NEC) with the use of ceftazidime (22.4% versus 2.3%, respectively, adjusted OR 9.68 [95% CI, 1.18–79.45], p = 0.04). CONCLUSIONS This study found a statistically significant increase in stage II to III NEC with the use of ceftazidime compared with cefotaxime. There was a higher rate of culture-positive LOS and MDRO infections with ceftazidime, but this was not significant. Further research is warranted to assess the implications ceftazidime use in neonates.

scholarly journals Lactoferrin impact on gut microbiota in preterm infants with late-onset sepsis or necrotising enterocolitis: the MAGPIE mechanisms of action study

2021 ◽  
Vol 8 (14) ◽  
pp. 1-88
Author(s):  
Nicholas Embleton ◽  
Janet Berrington ◽  
Stephen Cummings ◽  
Jon Dorling ◽  
Andrew Ewer ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Liquid Chromatography ◽  
Preterm Infants ◽  
Late Onset ◽  
Disease Onset ◽  
Necrotising Enterocolitis ◽  
Liquid Chromatography Mass Spectrometry ◽  
Chromatography Mass Spectrometry ◽  
Late Onset Sepsis ◽  
The Impact

Background Preterm infants have high rates of morbidity, especially from late-onset sepsis and necrotising enterocolitis. Lactoferrin is an anti-infective milk protein that may act through effects on gut bacteria, metabolites and epithelial cell function. The impact of supplemental lactoferrin in reducing late-onset sepsis was explored in the Enteral LactoFerrin In Neonates (ELFIN) trial. Objectives The Mechanisms Affecting the Gut of Preterm Infants in Enteral feeding (MAGPIE) study was nested within the ELFIN trial and aimed to determine the impact of lactoferrin on gut microbiota and bacterial function, and changes preceding disease onset. We aimed to explore impacts on the stool bacteria and faecal/urinary metabolome using gas and liquid chromatography–mass spectrometry, and explore immunohistological pathways in resected tissue. Methods Preterm infants from 12 NHS hospitals were enrolled in the study, and daily stool and urine samples were collected. Local sample collection data were combined with ELFIN trial data from the National Perinatal Epidemiology Unit, Oxford. The longitudinal impact of lactoferrin in healthy infants was determined, and samples that were collected before disease onset were matched with samples from healthy control infants. Established, quality-controlled 16S ribonucleic acid, gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry analyses were conducted. Validated databases and standardised workflows were used to identify bacteria and metabolites. Tissue samples from infants undergoing surgery and matched controls were analysed. Results We recruited 479 preterm infants (mean gestation of 28.4 ± 2.3 weeks) and collected > 33,000 usable samples from 467 infants. 16S ribonucleic acid bacterial analysis was conducted on samples from 201 infants, of whom 20 had necrotising enterocolitis and 51 had late-onset sepsis, along with samples from healthy matched controls to explore longitudinal changes. The greatest change in relative bacterial abundance over time was observed in Staphylococcus, which decreased from 42% at aged 7–9 days to only 2% at aged 30–60 days (p < 0.001). Small but significant differences in community composition were observed between samples in each ELFIN trial group (R 2 = 0.005; p = 0.04). Staphylococcus (p < 0.01), Haemophilus (p < 0.01) and Lactobacillus (p = 0.01) showed greater mean relative abundance in the placebo group than in the lactoferrin group. Gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry analyses showed that lactoferrin had limited impact on the metabolome. Liquid chromatography–mass spectrometry showed significant metabolite differences between necrotising enterocolitis or late-onset sepsis infants and healthy controls. The resected gut tissue analysis revealed 82 differentially expressed genes between healthy and necrotic tissue. Limitations Although we recruited a large number of infants, collecting daily samples from every infant is challenging, especially in the few days immediately preceding disease onset. Conclusion We conducted a large mechanistic study across multiple hospital sites and showed that, although lactoferrin significantly decreased the level of Staphylococcus and other key pathogens, the impact was smaller than those of other clinical variables. Immunohistochemistry identified multiple inflammatory pathways leading to necrotising enterocolitis and showed that the use of NHS pathology archive tissue is feasible in the context of a randomised controlled trial. Future work We observed significant changes in the stool and urinary metabolome in cases preceding late-onset sepsis or necrotising enterocolitis, which provide metabolic targets for a future mechanistic and biomarker study. Trial registration Current Controlled Trials ISRCTN12554594. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.

Sex Differences in Myocardial Injury After Non-Cardiac Surgery and Postoperative Mortality

2020 ◽  
Author(s):  
Jihye Kwon ◽  
Jungchan Park ◽  
Seunghwa Lee ◽  
Cheol Won Hyun ◽  
Jihoon Kim ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Troponin ◽  
Survival Benefit ◽  
Myocardial Injury ◽  
Multivariable Analysis ◽  
Postoperative Mortality ◽  
Short And Long Term ◽  
The Impact

Abstract BackgroundMyocardial injury after non-cardiac surgery (MINS) has recently been accepted as a predictor of mortality. However, the impact of sex difference on the incidence and survival following MINS has not been fully understood. This study aimed to compare the incidence of MINS and mortality in male and female patients during the short and long term periods.MethodsFrom January 2010 to June 2019, consecutive patients with cardiac troponin (cTn) within 30 days after non-cardiac surgery were grouped according to sex. The incidence of MINS and the mortality of the patients with MINS were compared.ResultsOf the total of 33,311 patients, 18,546 (55.7%) patients were male and 14,765 (44.3%) were female. In multivariable analysis, females showed significantly lower incidence of MINS (17.9% vs. 14.2%; odds ratio, 0.76; 95% confidence interval [CI], 0.71-0.81; p < 0.001). In patients with MINS, propensity score-matched analysis showed that 30-day mortality did not differ according to sex, but the mortality in females was significantly lower during the overall follow-up (33.0% vs. 25.7%; hazard ratio, 0.75; 95% CI, 0.66-0.84; p < 0.001).ConclusionThe incidence of MINS appeared to be lower in female than male. In patients with MINS, female may be associated with survival benefit. A further study is needed to confirm this finding.

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