Shock and dyselectrolytemia in a neonate with late-onset COVID-19 infection

Most reports of COVID-19 in neonates suggest that they are infected postnatally and present with gastrointestinal or respiratory symptoms. We describe a neonate who had community-acquired COVID-19, and presented with late-onset sepsis and developed dyselectrolytemia. The 26-day-old male baby had fever, feed refusal and shock. Rapid antigen test for SARS-CoV-2 by nasopharyngeal swab was positive and levels of circulating inflammatory markers were high. The baby was supported with antibiotics, and inotropic and vasopressor drugs. He had seizures and bradycardia due to dyselectrolytemia on day 2 of admission. On day 3, he had respiratory distress, with non-specific chest radiographic findings, and was managed with non-invasive support for 24 hours. The baby was discharged after 8 days. On serial follow-up, he was breastfeeding well and gaining weight appropriately with no morbidity. Our report highlights a unique presentation of COVID-19, with late-onset infection and shock-like features along with dyselectrolytemia and seizures.

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Neurodevelopmental outcomes following neonatal late-onset sepsis and blood culture-negative conditions

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320664 ◽

2021 ◽

pp. fetalneonatal-2020-320664

Author(s):

Sagori Mukhopadhyay ◽

Karen M Puopolo ◽

Nellie I Hansen ◽

Scott A Lorch ◽

Sara B DeMauro ◽

...

Keyword(s):

Blood Culture ◽

Late Onset ◽

Antibiotic Administration ◽

Adjusted Relative Risk ◽

Neurodevelopmental Outcomes ◽

Risk Of Death ◽

Late Onset Sepsis ◽

Early Onset Sepsis ◽

Culture Negative

ObjectiveDetermine risk of death or neurodevelopmental impairment (NDI) in infants with late-onset sepsis (LOS) versus late-onset, antibiotic-treated, blood culture-negative conditions (LOCNC).DesignRetrospective cohort study.Setting24 neonatal centres.PatientsInfants born 1/1/2006–31/12/2014, at 22–26 weeks gestation, with birth weight 401–1000 g and surviving >7 days were included. Infants with early-onset sepsis, necrotising enterocolitis, intestinal perforation or both LOS and LOCNC were excluded.ExposuresLOS and LOCNC were defined as antibiotic administration for ≥5 days with and without a positive blood/cerebrospinal fluid culture, respectively. Infants with these diagnoses were also compared with infants with neither condition.OutcomesDeath or NDI was assessed at 18–26 months corrected age follow-up. Modified Poisson regression models were used to estimate relative risks adjusting for covariates occurring ≤7 days of age.ResultsOf 7354 eligible infants, 3940 met inclusion criteria: 786 (20%) with LOS, 1601 (41%) with LOCNC and 1553 (39%) with neither. Infants with LOS had higher adjusted relative risk (95% CI) for death/NDI (1.14 (1.05 to 1.25)) and death before follow-up (1.71 (1.44 to 2.03)) than those with LOCNC. Among survivors, risk for NDI did not differ between the two groups (0.99 (0.86 to 1.13)) but was higher for LOCNC infants (1.17 (1.04 to 1.31)) compared with unaffected infants.ConclusionsInfants with LOS had higher risk of death, but not NDI, compared with infants with LOCNC. Surviving infants with LOCNC had higher risk of NDI compared with unaffected infants. Improving outcomes for infants with LOCNC requires study of the underlying conditions and the potential impact of antibiotic exposure.

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Tocopherol Efficacy and Safety for Preventing Retinopathy of Prematurity: A Randomized, Controlled, Double-Masked Trial

PEDIATRICS ◽

10.1542/peds.79.4.489 ◽

1987 ◽

Vol 79 (4) ◽

pp. 489-500 ◽

Cited By ~ 1

Author(s):

Dale L. Phelps ◽

Arthur L. Rosenbaum ◽

Sherwin J. lsenberg ◽

Rosemary D. Leake ◽

Frederick J. Dorey

Keyword(s):

Premature Infants ◽

Retinopathy Of Prematurity ◽

Plasma Levels ◽

Late Onset ◽

Retinal Hemorrhage ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Late Onset Sepsis ◽

Prospective Monitoring

To test the efficacy and safety of vitamin E in preventing retinopathy of prematurity, 287 infants with birth weights of less than 1.5 kg or gestational ages of less than 33 weeks were enrolled within 24 hours of birth in a randomized, double-masked trial of IV, followed by oral, placebo v tocopherol (adjusted to plasma levels of 3 to 3.5 mg/dL). In the 196 infants completing ophthalmic follow-up, tocopherol did not prevent retinopathy of prematurity of any stage (28% placebo treated v 26% tocopherol treated) or moderately severe retinopathy of prematurity (8% placebo treated v 11% tocopherol treated). Cicatricial sequelae were not significantly different (1/97 placebo treated v 3/99 tocopherol treated), with one placebo-treated infant and one tocopherol-treated infant having retinal detachments. Among all 232 infants examined, those treated with tocopherol had more retinal hemorrhage than placebo-treated infants (8/121 placebo treated v 16/111 tocopherol treated), and retinal hemorrhage correlated positively (P < .01) with plasma levels of tocopherol after the first 2 weeks of age. Prospective monitoring of morbidity including late-onset sepsis, necrotizing enterocolitis, etc revealed no differences between groups except that grades 3 and 4 intraventricular hemorrhage occurred more frequently in infants weighing less than 1 kg at birth who had received tocopherol (14/42, 33%) v those who had received placebo (4/43, 9%) (P < .02). Our data do not support the use of tocopherol for prophylaxis against retinopathy of prematurity in premature infants and suggest that IV tocopherol treatment starting on day 1 may increase the incidence of hemorrhagic complications of prematurity, particularly in infants with birth weights of less than 1 kg.

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Serum Amyloid A, Procalcitonin, Tumor Necrosis Factor-α, and Interleukin-1βLevels in Neonatal Late-Onset Sepsis

Mediators of Inflammation ◽

10.1155/2008/737141 ◽

2008 ◽

Vol 2008 ◽

pp. 1-7 ◽

Cited By ~ 22

Author(s):

Birsen Ucar ◽

Bilal Yildiz ◽

M. Arif Aksit ◽

Coskun Yarar ◽

Omer Colak ◽

...

Keyword(s):

Serum Amyloid A ◽

Late Onset ◽

Serum Amyloid ◽

Amyloid A ◽

Late Onset Sepsis ◽

Sepsis Score ◽

Reliable Marker ◽

Factor Α ◽

Necrosis Factor

Background. Sepsis is an important cause of mortality in newborns. However, a single reliable marker is not available for the diagnosis of neonatal late-onset sepsis (NLS). The aim of this study is to evaluate the value of serum amyloid A (SAA) and procalcitonin (PCT) in the diagnosis and follow-up of NLS.Methods. 36 septic and healthy newborns were included in the study. However, SAA, PCT, TNF-α, IL-1β, and CRP were serially measured on days 0, 4, and 8 in the patients and once in the controls. Töllner's sepsis score (TSS) was calculated for each patient.Results. CRP, PCT, and TNF-αlevels in septic neonates at each study day were significantly higher than in the controls (P=.001). SAA and IL-1βlevels did not differ from healthy neonates. The sensitivity and specificity were 86.8% and 97.2% for PCT, 83.3% and 80.6% for TNF-α, 75% and 44.4% for SAA on day 0.Conclusion. Present study suggests that CRP seems to be the most helpful indicator and PCT and TNF-αmay be useful markers for the early diagnosis of NLS. However, SAA, IL-1β, and TSS are not reliable markers for the diagnosis and follow-up of NLS.

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Unusual presentation of late-onset disseminated staphylococcal sepsis in a preterm infant

BMJ Case Reports ◽

10.1136/bcr-2018-226325 ◽

2019 ◽

Vol 12 (3) ◽

pp. e226325 ◽

Cited By ~ 1

Author(s):

Shahzad Gul Khattak ◽

Ian Dady ◽

Devdeep Mukherjee

Keyword(s):

Late Onset ◽

Whole Body ◽

Whole Body Mri ◽

Left Hand ◽

Non Invasive ◽

Male Baby ◽

Left Elbow ◽

The Right ◽

Panton Valentine Leukocidin ◽

Rule Out

An ex-30-week gestation, preterm male baby was admitted to a tertiary neonatal unit and noted to have increased ventilator requirements and diagnosed with sepsis. The baby also developed an abscess over the left elbow and over the xiphisternum along with a decrease in movement of the left hand and the right leg. Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (SA) was isolated from the blood culture. A whole body MRI showed disseminated abscess with multiple foci in the lung, left elbow and over the xiphisternum. Disseminated sepsis with multiple septic foci has not been previously reported in neonates. We would like to highlight the fact that sepsis due to PVL toxin-producing SA can cause significant morbidity and mortality in neonates. Proper screening should be done to rule out septic foci in neonates. MRI is a good non-invasive investigation to document septic foci in a neonate and rule out multiorgan involvement.

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Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2

American Journal of Perinatology ◽

10.1055/s-0040-1710541 ◽

2020 ◽

Vol 37 (08) ◽

pp. 869-872 ◽

Cited By ~ 48

Author(s):

Simonetta Costa ◽

Danilo Buonsenso ◽

Maurizio Sanguinetti ◽

Paola Cattani ◽

Brunella Posteraro ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Observational Study ◽

Late Onset ◽

Early Period ◽

Key Points ◽

Long Term Consequences ◽

Late Onset Infection ◽

In Pregnancy

Objective To date, no information on late-onset infection in newborns to mother with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contracted in pregnancy are available. This study aimed to evaluate postdischarge SARS-CoV-2 status of newborns to mothers with COVID-19 in pregnancy that, at birth, were negative to SARS-CoV-2. Study Design This is an observational study of neonates born to mothers with coronavirus disease 2019 (COVID-19). Results Seven pregnant women with documented SARS-CoV-2 infection have been evaluated in our institution. One woman had a spontaneous abortion at 8 weeks of gestational age, four women recovered and are still in follow-up, and two women delivered. Two newborns were enrolled in the study. At birth and 3 days of life, newborns were negative to SARS-CoV-2. At 2-week follow-up, one newborn tested positive although asymptomatic. Conclusion Our findings highlight the importance of follow-up of newborns to mothers with COVID-19 in pregnancy, since they remain at risk of contracting the infection in the early period of life and long-term consequences are still unknown. Key Points

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Fecal Volatile Organic Compound Profiles are Not Influenced by Gestational Age and Mode of Delivery: A Longitudinal Multicenter Cohort Study

Biosensors ◽

10.3390/bios10050050 ◽

2020 ◽

Vol 10 (5) ◽

pp. 50 ◽

Cited By ~ 1

Author(s):

Nancy Deianova ◽

Sofia el Manouni el Hassani ◽

Hendrik J. Niemarkt ◽

Veerle Cossey ◽

Anton H. van Kaam ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Late Onset ◽

Mode Of Delivery ◽

Delivery Mode ◽

Multicenter Cohort Study ◽

Diagnostic Biomarkers ◽

Non Invasive ◽

Late Onset Sepsis ◽

Volatile Organic

Fecal volatile organic compounds (VOC) reflect human and gut microbiota metabolic pathways and their interaction. VOC behold potential as non-invasive preclinical diagnostic biomarkers in various diseases, e.g., necrotizing enterocolitis and late onset sepsis. There is a need for standardization and assessment of the influence of clinical and environmental factors on the VOC outcome before this technique can be applied in clinical practice. The aim of this study was to investigate the influence of gestational age (GA) and mode of delivery on the fecal VOC pattern in preterm infants born below 30 weeks of gestation. Longitudinal fecal samples, collected on days 7, 14, and 21 postnatally, were analyzed by an electronic nose device (Cyranose 320®). In total, 58 preterm infants were included (29 infants born at GA 24–26 weeks vs. 29 at 27–29 completed weeks, 24 vaginally born vs. 34 via C-section). No differences were identified at any predefined time point in terms of GA and delivery mode (p > 0.05). We, therefore, concluded that correction for these factors in this population is not warranted when performing fecal VOC analysis in the first three weeks of life.

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SARS-COV-2 comorbidity network and outcome in hospitalized patients in Crema, Italy

PLoS ONE ◽

10.1371/journal.pone.0248498 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248498 ◽

Cited By ~ 1

Author(s):

Tommaso Gili ◽

Giampaolo Benelli ◽

Elisabetta Buscarini ◽

Ciro Canetta ◽

Giuseppe La Piana ◽

...

Keyword(s):

Interstitial Pneumonia ◽

Ace Inhibitors ◽

Chest Ct ◽

Respiratory Support ◽

Nasopharyngeal Swab ◽

Angiotensin Ii Receptor ◽

Entire Study ◽

Icu Admission ◽

Non Invasive

We report onset, course, correlations with comorbidities, and diagnostic accuracy of nasopharyngeal swab in 539 individuals suspected to carry SARS-COV-2 admitted to the hospital of Crema, Italy. All individuals underwent clinical and laboratory exams, SARS-COV-2 reverse transcriptase-polymerase chain reaction on nasopharyngeal swab, and chest X-ray and/or computed tomography (CT). Data on onset, course, comorbidities, number of drugs including angiotensin converting enzyme (ACE) inhibitors and angiotensin-II-receptor antagonists (sartans), follow-up swab, pharmacological treatments, non-invasive respiratory support, ICU admission, and deaths were recorded. Among 411 SARS-COV-2 patients (67.7% males) median age was 70.8 years (range 5–99). Chest CT was performed in 317 (77.2%) and showed interstitial pneumonia in 304 (96%). Fatality rate was 17.5% (74% males), with 6.6% in 60–69 years old, 21.1% in 70–79 years old, 38.8% in 80–89 years old, and 83.3% above 90 years. No death occurred below 60 years. Non-invasive respiratory support rate was 27.2% and ICU admission 6.8%. Charlson comorbidity index and high C-reactive protein at admission were significantly associated with death. Use of ACE inhibitors or sartans was not associated with outcomes. Among 128 swab negative patients at admission (63.3% males) median age was 67.7 years (range 1–98). Chest CT was performed in 87 (68%) and showed interstitial pneumonia in 76 (87.3%). Follow-up swab turned positive in 13 of 32 patients. Using chest CT at admission as gold standard on the entire study population of 539 patients, nasopharyngeal swab had 80% accuracy. Comorbidity network analysis revealed a more homogenous distribution 60–40 aged SARS-COV-2 patients across diseases and a crucial different interplay of diseases in the networks of deceased and survived patients. SARS-CoV-2 caused high mortality among patients older than 60 years and correlated with pre-existing multiorgan impairment.

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6 Neurodevelopmental Outcomes of Extremely Preterm Infants with Late-Onset Bacterial Sepsis According to Type of Bacteria

Paediatrics & Child Health ◽

10.1093/pch/pxab061.002 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e2-e4

Author(s):

Smita Roychoudhury ◽

Abhay Lodha ◽

Anne Synnes ◽

Joseph Ting ◽

Sajit Augustine ◽

...

Keyword(s):

Gestational Age ◽

Late Onset ◽

Gram Negative Bacteria ◽

Bacterial Sepsis ◽

Gram Positive ◽

Gram Negative ◽

Late Onset Sepsis ◽

Extremely Preterm ◽

Extremely Preterm Infants

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Late-onset sepsis (LOS) is associated with adverse neonatal outcome. There is limited data on the long-term neurodevelopmental (ND) outcomes of infants based on type of bacteria causing LOS. We hypothesize that the type of bacterial pathogen causing late-onset sepsis influences the developmental outcome in extremely preterm infants. Objectives To compare the neurodevelopmental (ND) outcomes at 18-24 months corrected age (CA) of infants born < 29 weeks who had late-onset sepsis (LOS) caused by: (1) gram-positive bacteria; (2) gram-negative bacteria; (3) mixed (both gram-positive and gram-negative bacteria); and (4) those with no sepsis (that is, no sepsis or culture-negative sepsis). Design/Methods In this retrospective multicentre cohort study, we studied infants born at <29 weeks’ gestational age (GA) between January 2010 and December 2017 and evaluated for neurodevelopmental assessment at 18–24 months’ CA at nine Canadian Neonatal Follow-up Network centers. Infants with early-onset sepsis, major congenital anomalies, those who received palliative care at birth, those who died before 2 days of age, those with non-bacterial infections, and those lost to follow up were excluded. Exposure is late-onset sepsis (LOS) which is defined as the presence of a pathogenic organism in the blood or cerebrospinal fluid culture obtained from a neonate suspected of having sepsis after 2 days of age. The primary outcome was a composite of death or ND impairment (NDI) defined as the presence of any one of the following: cerebral palsy, Bayley-III score of <85 on any one of the components (Cognitive, Language, Motor composite score), hearing loss, and visual impairment. Demographic factors and ND outcomes were compared among the four groups using univariate and multivariate analysis. Results Of the 3640 infants included, 823 (22.6%) had late-onset sepsis (LOS). Of the 823 infants with LOS, 569 (69.1%) infants had gram-positive sepsis, 172 (20.9%) had gram-negative sepsis, and 82 (10%) had mixed sepsis. Maternal and neonatal characteristics and outcome are reported in Table 1. Outcome data after adjustment for gestational age (GA), sex, antenatal steroids, SNAP-II score, small for gestational age (SGA), maternal age, and caesarian delivery are presented in Table 2. Conclusion Late-onset bacterial sepsis, especially gram-negative sepsis and mixed infections, were associated with increased risk of composite outcome of death or neurodevelopmental impairment (NDI), or NDI alone, at 18-24 months corrected age (CA) in infants <29 weeks’ gestational age (GA).

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Validity of Serum And Urinary Hepcidin As Biomarkers of Late-Onset Sepsis of Premature Infants

10.21203/rs.3.rs-1053179/v1 ◽

2021 ◽

Author(s):

Hanan Sakr Sherbiny ◽

Hanaa Mostafa ◽

Mahmoud Abdel-el Halm ◽

Amal El Shal ◽

Naglaa Kamal ◽

...

Keyword(s):

Blood Culture ◽

Premature Infants ◽

Late Onset ◽

Control Group ◽

Total Leucocyte Count ◽

Case Group ◽

Non Invasive ◽

Late Onset Sepsis ◽

Serum Hepcidin ◽

Serum And Urine

Abstract Background: Sepsis remains one of the leading causes of neonatal morbidity and mortality particularly among premature infants. Blood culture is the “gold standard” for diagnosis of neonatal sepsis but is associated with several pitfalls. Adjunctive diagnostic tests, including biological markers should be used to aid in antibiotic -starting decision in presumed septic preemies until culture results are availableAim of the work: We aim to evaluate the validity of measuring serum hepcidin concentration as diagnostic biomarker for late-onset sepsis in preemies and to quantify its cut-off value that differentiate truly septic from non-septic symptomatic premature infants. In addition, to examine the correlation between serum hepcidin (Hep-S) and urinary hepcidin (Hep-U) and to find out if measuring Hep-U can be used as an alternative safe, non-invasive biomarker for late-onset sepsis diagnosis, without exposure to frequent phlebotomy and its risks.Patients and Methods: The current case-control study included seventy-three (73) cases of clinically and laboratory confirmed late-onset sepsis as "case group" and fifty (50) non-septic premature infants of comparable age and gender as "control group". All participants were evaluated as per unit protocol to rule out sepsis by complete blood count, CRP, blood, urine, CSF and other cultures as indicated, plus different radiologic modalities as needed. Acute serum and urinary hepcidin concentration were evaluated by ELISA for all participants at enrollment "acute sample". After one week of treatment, convalescent samples for serum and urine hepcidin were collected and compared with the acute samples.Results: Statistically significant higher concentration of both serum and urinary hepcidin were recorded among cases as compared with non-septic peers (t=44.2&p=0.0001, t=23.8 &p=0.0001 for serum and urine hepcidin respectively). Similarly, Significant reduction of hepcidin at different body fluids was recoded after one week of treatment as compared with acute samples (paired t =18.1&p=0.001, paired t =14.1&p=0.001 for serum and urine hepcidin respectively). Significant direct correlations were reported between acute serum hepcidin levels and CRP, urinary hepcidin, and total leucocyte count. While significant negative correlation was recorded with platelets count. AUC of serum hepcidin ROC is 0.93, A cut off value of ≥94.8ng/ml of S. hepcidin showed sensitivity (88%), specificity (94%), PPV (95%) and NPV (84%) respectively with accurately diagnosing 90.2% of presenting cases as septic or not. While urinary hepcidin showed slightly less discriminating ability with AUC of 0.87. At cut-off value of ≥ 264 ng/mg of urinary hepcidin/urinary creatinine showed sensitivity (85%), specificity (90%), PPV (92.5%) and NPV (81%) respectively with accurately diagnosing 84.5% of presenting cases as septic or not.Conclusions: Hepcidin concentration in different body fluid can function as promising accurate and rapid surrogate test, with blood culture, that guide empiric antibiotics –starting decision or withholding it safely until the culture results is ready in symptomatic presumed septic preemies. Urinary hepcidin has advantages over serum hepcidin as; it is non-invasive, no hazards of phlebotomy, and less variable throughout the day.

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SARS-COV-2 comorbidity network and outcome in hospitalized patients in Crema, Italy

10.1101/2020.04.14.20053090 ◽

2020 ◽

Cited By ~ 10

Author(s):

Gianpaolo Benelli ◽

Elisabetta Buscarini ◽

Ciro Canetta ◽

Giuseppe La Piana ◽

Guido Merli ◽

...

Keyword(s):

Interstitial Pneumonia ◽

Ace Inhibitors ◽

Chest Ct ◽

Respiratory Support ◽

Nasopharyngeal Swab ◽

X Ray ◽

Icu Admission ◽

Non Invasive ◽

Arterial Blood

AbstractNo systematic data on hospitalized SARS-COV-2 patients from Western countries are available. We report onset, course, correlations with comorbidities, and diagnostic accuracy of nasopharyngeal swab in 539 individuals suspected to carry SARS-COV-2 admitted to the hospital of Crema, Italy. All individuals underwent clinical and laboratory exams, SARS-COV-2 reverse transcriptase-polymerase chain reaction on nasopharyngeal swab, and chest X-ray and/or computed tomography (CT). Data on onset, course, comorbidities, number of drugs including angiotensin converting enzyme (ACE) inhibitors and angiotensin-II-receptor antagonists (sartans), follow-up swab, pharmacological treatments, non-invasive respiratory support, ICU admission, and deaths were recorded. Among 411 SARS-COV-2 patients (66.6% males) median age was 70.5 years (range 1-99). Chest CT was performed in 317 (77.2%) and showed interstitial pneumonia in 304 (96%). Fatality rate was 17.5% (74% males), with 6.6% in 60-69 years old, 21.1% in 70-79 years old, 38.8% in 80-89 years old, and 83.3% above 90 years. No death occurred below 60 years. Non-invasive respiratory support rate was 27.2% and ICU admission 6.8%. Older age, cough and dyspnea at onset, hypertension, cardiovascular diseases, diabetes, renal insufficiency, >7 drugs intake and positive X-ray, low lymphocyte count, high C-reactive protein, aspartate aminotransferase and lactate dehydrogenase values, and low PO2 partial pressure with high lactate at arterial blood gas analysis at admission were significantly associated with death. Use of ACE inhibitors or sartans was not associated with outcomes. Comorbidity network analysis revealed homogenous distribution of deceased and 60-80 aged SARS-COV-2 patients across diseases. Among 128 swab negative patients at admission (63.3% males) median age was 67.7 years (range 1-98). Chest CT was performed in 87 (68%) and showed interstitial pneumonia in 76 (87.3%). Follow-up swab turned positive in 13 of 32 patients. Using chest CT at admission as gold standard on the entire study population of 539 patients, nasopharyngeal swab had 80% sensitivity. SARS-CoV-2 caused high mortality among patients older than 60 years and correlated with pre- existing multiorgan impairment. ACE inhibitors and sartans did not influence patients’ outcome.

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