DIAGNOSTIC MARKERS IN NEONATAL SEPSIS

2007 ◽  
Vol 18 (1) ◽  
pp. 53-65
Author(s):  
HUGH S. LAM ◽  
PAK C NG
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Bacterial Infections ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Significant Proportion ◽  
Control Measures ◽  
Exogenous Surfactant ◽  
Vlbw Infants

Breakthroughs in the management of sick newborns, including exogenous surfactant therapy, advance ventilation techniques, inhaled nitric oxide, and use of antenatal corticosteroids have led to substantial improvements in the survival of vulnerable preterm infants. Neonatal clinicians now have access to an ever increasing armament of antimicrobial agents to help combat infections. However, even with the support of such advanced therapeutic modalities, strict infection control measures and low thresholds for use of broad-spectrum antibiotics, the threat of bacterial infections especially in the most susceptible group of preterm, very low birth weight (VLBW) infants have persisted. A recent survey suggests that a significant proportion of VLBW infants (21%) have at least one episode of late-onset culture proven sepsis during their stay in the neonatal unit. Infected infants require longer hospital stay and have higher risk of developing complications, such as bronchopulmonary dysplasia and adverse long-term neurodevelopment. Neonates with infection often present with subtle and non-specific signs of sepsis. Some may be asymptomatic at the initial stages of infection. Even those infants with signs may not be clinically distinguishable from patients suffering from transient tachypnoea of the newborn, respiratory distress syndrome, apnoea of prematurity or acute exacerbation of bronchopulmonary dysplasia, during early phases of the disease. Such presentations can lead to both delayed treatment of genuinely infected infants and indiscriminate use of antibiotics in non-infected cases, resulting in acceleration of emergence of bacterial resistance, alteration of patterns of bacterial infection, and inefficient treatment of septicaemia. Both early and late-onset infections are important causes of neonatal morbidity and mortality. Methods to assist neonatal clinicians diagnose infants in the early stages of infection are, therefore, highly desirable.

scholarly journals Oropharyngeal Administration of Colostrum Increases Salivary Secretory IgA Levels in Very Low-Birth-Weight Infants

2017 ◽  
Vol 34 (14) ◽  
pp. 1389-1395 ◽  
Author(s):  
Coleen Greecher ◽  
Kim Doheny ◽  
Kristen Glass
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Multicenter Trial ◽  
Secretory Iga ◽  
Control Group ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Late Onset Sepsis

Aim Oropharyngeal administration of colostrum (OAC) has been proposed to provide mother's early milk to very low-birth-weight (VLBW) infants in the first few days of life. The aim of this study was to test the hypothesis that OAC would increase salivary secretory IgA (SsIgA). Patients and Methods Overall, 30 VLBW infants randomized to receive OAC or sterile water had salivary sampling for SsIgA on the day of life (DOL) 2, 7, and 14. The incidence of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) was determined prospectively. Within and between-group comparisons were made by paired and independent samples t-tests. Results Baseline characteristics were similar between groups. SsIgA was higher in OAC versus the control group (p < 0.05) on DOL 7, but not subsequently on DOL 14. There was no difference in LOS or NEC. Conclusion OAC increased SsIgA at DOL 7. A large, multicenter trial is needed to determine if OAC decreases LOS or NEC in VLBW infants.

scholarly journals Incidence of bronchopulmonary dysplasia and mortality of very low birth weight infants in Vojvodina

2020 ◽  
Vol 148 (1-2) ◽  
pp. 52-57
Author(s):  
Gordana Vilotijevic-Dautovic ◽  
Aleksandra Doronjski ◽  
Gordana Vijatov-Djuric ◽  
Milena Bjelica
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Bronchopulmonary Dysplasia ◽  
Very Low Birth Weight ◽  
Developed Countries ◽  
Supplemental Oxygen ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Original Definition ◽  
Overall Mortality

Introduction/Objective. The incidence of bronchopulmonary dysplasia (BPD) varies depending on the prematurity rate, definition, and therapy that are applied at a certain center. The average incidence of BPD for very low birth weight infants (VLBW) in developed countries ranges 4?53%. The mortality of VLBW infants is high and represents 50% of the total neonatal and infant mortality. In recent years, the survival limits are shifted towards lower gestations. The aim of our study was to determine the incidence and severity of BPD in VLBW infants in Vojvodina and the overall mortality. Methods. This retrospective study was conducted from January 2006 to December 2011 and included 504 infants with birth weight < 1,500 g. Results. In the total premature infants? population, 82.3% survived by the gestational age of 36 weeks. According to the original definition of BPD, as supplemental oxygen use at 28 days of life, BPD had 45.4% of infants. According to the severity based definition 19.4% had mild BPD, 19.8% moderate BPD and 6.5% severe BPD. If BPD is observed as supplemental oxygen use at 36 weeks postmenstrual age, BPD had 26% of infants. Conclusion. The overall mortality and incidence of BPD in our study are comparable to those in some developed countries and lower compared to underdeveloped countries.

scholarly journals Polymeric Nanomaterials for Efficient Delivery of Antimicrobial Agents

Pharmaceutics ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2108
Author(s):  
Yin Wang ◽  
Hui Sun
Keyword(s):  
Biomedical Applications ◽  
Bacterial Infections ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
Silver Ions ◽  
Delivery Systems ◽  
Human Beings ◽  
Antimicrobial Substances ◽  
Efficient Delivery ◽  
Healing Tissue

Bacterial infections have threatened the lives of human beings for thousands of years either as major diseases or complications. The elimination of bacterial infections has always occupied a pivotal position in our history. For a long period of time, people were devoted to finding natural antimicrobial agents such as antimicrobial peptides (AMPs), antibiotics and silver ions or synthetic active antimicrobial substances including antimicrobial peptoids, metal oxides and polymers to combat bacterial infections. However, with the emergence of multidrug resistance (MDR), bacterial infection has become one of the most urgent problems worldwide. The efficient delivery of antimicrobial agents to the site of infection precisely is a promising strategy for reducing bacterial resistance. Polymeric nanomaterials have been widely studied as carriers for constructing antimicrobial agent delivery systems and have shown advantages including high biocompatibility, sustained release, targeting and improved bioavailability. In this review, we will highlight recent advances in highly efficient delivery of antimicrobial agents by polymeric nanomaterials such as micelles, vesicles, dendrimers, nanogels, nanofibers and so forth. The biomedical applications of polymeric nanomaterial-based delivery systems in combating MDR bacteria, anti-biofilms, wound healing, tissue engineering and anticancer are demonstrated. Moreover, conclusions and future perspectives are also proposed.

Neurodevelopmental Outcomes of Very Low Birth Weight Infants at 18–24 Months, Corrected Gestational Age in a Tertiary Health Centre: A Prospective Cohort Study

2019 ◽  
Vol 65 (6) ◽  
pp. 552-560
Author(s):  
Samuel P Oommen ◽  
Sridhar Santhanam ◽  
Hima John ◽  
Reeba Roshan ◽  
T O Swathi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Health Centre ◽  
Significant Proportion ◽  
Neurodevelopmental Outcome ◽  
Developmental Outcome ◽  
Neurodevelopmental Outcomes ◽  
Vlbw Infants ◽  
Neonatal Complications

Abstract Objective To determine the prevalence and risk factors for poor neurodevelopmental outcome in a cohort of very low birth weight (VLBW) infants. Subjects and methods Four hundred and twenty-two infants of a total of 643 VLBW survivors from a teaching hospital in South India were followed up to assess their neurodevelopmental outcomes. Results Among the 422 children who completed the assessment, results of 359 children whose assessments were done between 18 and 24 months were analysed. Thirty-seven children (10.31%) had poor neurodevelopmental outcome, six children [1.67%] had cerebral palsy, one child had visual impairment and another had hearing impairment. Poor post-natal growth was independently associated with poor neurodevelopmental outcomes in the multivariate analysis (p = 0.045). Neonatal complications were not associated with the developmental outcome. Conclusion Despite lower rates of neonatal complications compared with Western cohorts, significant proportion of VLBW infants had poor neurodevelopmental outcomes. Poor post-natal growth was an important determinant of the developmental outcome

scholarly journals Late Onset Neutropenia in Very Low Birth Weight (VLBW) Infants

1999 ◽  
Vol 45 (4, Part 2 of 2) ◽  
pp. 217A-217A
Author(s):  
Said Omar ◽  
Alaa Salhadar ◽  
Diane Wooliever ◽  
Patricia Alsgaard
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Vlbw Infants

Sepsis and Mortality Prediction in Very Low Birth Weight Infants: Analysis of HeRO and nSOFA

2021 ◽  
Author(s):  
Angela C. Zeigler ◽  
John E. Ainsworth ◽  
Karen D. Fairchild ◽  
James L. Wynn ◽  
Brynne A. Sullivan
Keyword(s):  
Birth Weight ◽  
Blood Culture ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Mortality Prediction ◽  
Blood Cultures ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Prediction Of Mortality

Objective Scores to predict sepsis or define sepsis severity could improve care for very low birth weight (VLBW) infants. The heart rate characteristics (HRC) index (HeRO score) was developed as an early warning system for late-onset sepsis (LOS), and also rises before necrotizing enterocolitis (NEC). The neonatal sequential organ failure assessment (nSOFA) was developed to predict sepsis-associated mortality using respiratory, hemodynamic, and hematologic data. The aim of this study was to analyze the HRC index and nSOFA near blood cultures in VLBW infants relative to diagnosis and sepsis-associated mortality. Study Design Retrospective, single-center study of VLBW infants from 2011 to 2019. We analyzed HRC index and nSOFA around blood cultures diagnosed as LOS/NEC. In a subgroup of the cohort, we analyzed HRC and nSOFA near the first sepsis-like illness (SLI) or sepsis ruled-out (SRO) compared with LOS/NEC. We compared scores by diagnosis and mortality during treatment. Results We analyzed 179 LOS/NEC, 93 SLI, and 96 SRO blood culture events. In LOS/NEC, the HRC index increased before the blood culture, while nSOFA increased at the time of culture. Both scores were higher in nonsurvivors compared with survivors and in LOS/NEC compared with SRO. The nSOFA 12 hours after the time of blood culture predicted mortality during treatment better than any other time point analyzed (area under the curve 0.91). Conclusion The HRC index provides earlier warning of imminent sepsis, whereas nSOFA after blood culture provides better prediction of mortality. Key Points

Principles of antibiotic therapy

2019 ◽  
Vol 98 (4) ◽  
pp. 137-144
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Prophylaxis ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
Bacterial Pathogens ◽  
Comprehensive Approach ◽  
Contemporary Medicine ◽  
Selection Of

The paper describes the basic sources and principles of antibiotic therapy in contemporary medicine in which the ability to treat bacterial infections may be lost. The main reason for that is the increasing resistance of bacterial pathogens to antibiotics. A possible solution is to implement a comprehensive program of antibiotic stewardship incorporating adequate consideration of indication and selection of antimicrobial agents including appropriate duration and way of administration. Another important component of the comprehensive approach to bacterial resistance and antibiotic therapy is adequately applied antibiotic prophylaxis in surgery.

scholarly journals Early Pulse Oximetry Data Improves Prediction of Death and Adverse Outcomes in a Two-Center Cohort of Very Low Birth Weight Infants

2018 ◽  
Vol 35 (13) ◽  
pp. 1331-1338 ◽  
Author(s):  
A. Wallman-Stokes ◽  
J. Isler ◽  
R. Sahni ◽  
J. Moorman ◽  
K. Fairchild ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pulse Oximetry ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Adverse Outcomes ◽  
Predictive Score ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Net Reclassification Improvement

Background We previously showed, in a single-center study, that early heart rate (HR) characteristics predicted later adverse outcomes in very low birth weight (VLBW) infants. We sought to improve predictive models by adding oxygenation data and testing in a second neonatal intensive care unit (NICU). Methods HR and oxygen saturation (SpO2) from the first 12 hours and first 7 days after birth were analyzed for 778 VLBW infants at two NICUs. Using multivariate logistic regression, clinical predictive scores were developed for death, severe intraventricular hemorrhage (sIVH), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity (tROP), late-onset septicemia (LOS), and necrotizing enterocolitis (NEC). Ten HR-SpO2 measures were analyzed, with first 12 hours data used for predicting death or sIVH and first 7 days for the other outcomes. HR-SpO2 models were combined with clinical models to develop a pulse oximetry predictive score (POPS). Net reclassification improvement (NRI) compared performance of POPS with the clinical predictive score. Results Models using clinical or pulse oximetry variables alone performed well for each outcome. POPS performed better than clinical variables for predicting death, sIVH, and BPD (NRI > 0.5, p < 0.01), but not tROP, LOS, or NEC. Conclusion Analysis of early HR-SpO2 characteristics adds to clinical risk factors to predict later adverse outcomes in VLBW infants.

Neonatal Bacteremia: Patterns of Antibiotic Resistance

2001 ◽  
Vol 22 (12) ◽  
pp. 767-770 ◽  
Author(s):  
Ruben Bromiker ◽  
Ilan Arad ◽  
Ofra Peleg ◽  
Aviya Preminger ◽  
Dan Engelhard
Keyword(s):  
Antibiotic Resistance ◽  
Early Onset ◽  
Bacterial Infections ◽  
Bacterial Resistance ◽  
Late Onset ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Negative ◽  
Live Births ◽  
Gram Negative Organisms

AbstractObjective:To determine the incidence and evaluate the antimicrobial-susceptibility patterns of bacterial infections in our neonatal units.Design:Retrospective surveillance study.Setting:The neonatal units of the Hadassah University Hospitals, Jerusalem, Israel.Patients:All newborns admitted from January 1994 through February 1999.Methods:The records of all patients with positive blood and cerebrospinal fluid cultures were reviewed. Bacteremia was considered early-onset (vertical) when occurring within the first 72 hours of life and late-onset (nosocomial) when occurring later. The prevalence and antibiotic-resistance patterns of vertically transmitted and nosocomially acquired strains were compared and studied over time.Results:219 of 35,691 newborn infants had at least one episode of bacteremia (6.13/1,000 live births). There were 305 identified organisms, of which 21% (1.29/1,000 live births) were considered vertically transmitted and 79% nosocomially acquired. The most common organism causing early-onset disease (29.2%) was group B streptococcus (0.38/1,000 live births), whereas coagulase-negative staphylococci (51%) were the most prevalent in late-onset disease. All gram-positive bacteria were susceptible to vancomycin. Most gram-positive organisms other than staphylococci were susceptible to ampicillin. Gram-negative organisms represented 31% of all isolates. Generally, there was a trend of increasing resistance to commonly used antibiotics among nosocomially acquired gram-negative organisms, compared to those vertically transmitted, with statistically significant differences for ampicillin and mezlocillin (P<.05 andP<.01, respectively). Over the years, a trend toward an increasing resistance to antibiotics was observed among gram-negative organisms.Conclusions:The trend of increasing bacterial resistance to commonly used antibiotics necessitates the implementation of a rational empirical treatment strategy, based on local susceptibility data, reserving certain agents for emerging resistant pathogens.

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