387 Anemia and Elevated C-Reactive Protein in Premature Low Birth Weight Infants as Predictors of Positive Blood Cultures

Abstract Background: The relationship between low birth weight and increased risk for metabolic syndrome (MetS) in later life has been frequently described, but mechanisms underlying this association remain unknown. Methods: In 280 young adults of the PROGRAM study, aged 18–24 yr, we investigated associations of birth weight, gain in weight for length during early life, and adult IGF-I sd score (SDS), with number of MetS components (ordinal regression analyses), prevalence of MetS components and MetS (logistic regression analyses), and other metabolic parameters (linear regression analyses). Revised criteria of the National Cholesterol Educational Program (Adult Treatment Panel III) were used to determine components of MetS. The other metabolic parameters were C-reactive protein, insulin sensitivity, trunk fat mass, total cholesterol, and low-density lipoprotein cholesterol. Results: More gain in weight for length SDS in the first 3 months of life was significantly associated with an increased number of MetS components [odds ratio (OR) = 1.34], prevalence of low high-density lipoprotein cholesterol (OR = 1.49), prevalence of MetS (OR = 2.51), increased C-reactive protein levels, and lower insulin sensitivity (P = 0.007) at the age of 21 yr. Low birth weight SDS was associated with lower insulin sensitivity (P = 0.036), but low birth weight SDS and adult IGF-I SDS were not significantly associated with any of the MetS components or MetS prevalence at 21 yr. Conclusion: Our study demonstrates that higher gain in weight for length in the first 3 months of life is associated with a higher prevalence of MetS at 21 yr, whereas low birth weight and low adult IGF-I are not.

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Use of a Computerized C-Reactive Protein (CRP) Based Sepsis Evaluation in Very Low Birth Weight (VLBW) Infants: A Five-Year Experience

PLoS ONE ◽

10.1371/journal.pone.0078602 ◽

2013 ◽

Vol 8 (11) ◽

pp. e78602 ◽

Cited By ~ 12

Author(s):

Sarah A. Coggins ◽

James L. Wynn ◽

Melissa L. Hill ◽

James C. Slaughter ◽

Asli Ozdas-Weitkamp ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

C Reactive Protein ◽

Vlbw Infants ◽

Reactive Protein

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Persistent Bacteremia Due to Coagulase-Negative Staphylococci in Low Birth Weight Neonates

PEDIATRICS ◽

10.1542/peds.84.6.977 ◽

1989 ◽

Vol 84 (6) ◽

pp. 977-985

Author(s):

Christian C. Patrick ◽

Sheldon L. Kaplan ◽

Carol J. Baker ◽

Joseph T. Parisi ◽

Edward O. Mason

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Polyacrylamide Gel Electrophoresis ◽

Sodium Dodecyl ◽

Clinical Manifestations ◽

Blood Cultures ◽

Coagulase Negative Staphylococci ◽

Low Birth Weight Infants ◽

Persistent Bacteremia ◽

Intravascular Catheters

During a 6-month period in 1987, 13 low birth weight neonates without indwelling central intravascular catheters had persistent (positive blood cultures for ≥6 days) coagulase-negative staphylococcal bacteremia despite adequate antibiotic therapy. Daily blood cultures remained persistently positive for a mean of 13 days (range 6 to 25 days). This group of infants was compared with other low birth weight infants with similar birth weights and nonpersistent coagulase-negative staphylococcal bacteremia, defined as two or more positive blood cultures accompanied by supporting clinical manifestations of sepsis. During this period, coagulase-negative staphylococcal represented 29% of all bacteremias, and 33% of coagulase-negative staphylococcal bacteremias were persistent. Other than soft tissue abscesses, none of the infants with persistent coagulase-negative staphylococcal bacteremia had a defined focus of infection. Abdominal distention (P= .001) and thrombocytopenia (P<.03) occurred significantly more frequently in the patients with persistent coagulase-negative staphylococcal bacteremia than in those with nonpersistent bacteremia. Of the 13 patients with persistent coagulase-negative staphylococcal bacteremia, 2 received methicillin and 11 received vancomycin. No antibiotic tolerance to either antibiotic could be demonstrated. Serum concentrations of vancomycin far exceeded the minimum bactericidal concentration in all cases in which vancomycin was prescribed. No in vitro differences could be demonstrated between persistent and nonpersistent coagulase-negative staphylococcal strains for slime production, biotype, proteins from modified whole cell lysates developed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and opsonophagocytosis by adult neutrophils in the presence of pooled human sera. Additionally, plasmid profile analysis and phage typing revealed no common strain causing the persistent bacteremia. The pathogenesis of persistent coagulase-negative staphylococcal bacteremia in low birth weight neonates without intravascular catheters remains obscure.

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

American Journal of Perinatology ◽

10.1055/s-0041-1728829 ◽

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

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