scholarly journals Certain clinical and paraclinical markers of sepsis-induced myocardial dysfunction in newborn

2021 ◽  
pp. 41-48
Author(s):  
О.К. Koloskova ◽  
◽  
N.M. Kretsu ◽  
T.M. Bilous ◽  
◽  
...  
Keyword(s):  
Neonatal Sepsis ◽  
Inflammatory Process ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Preterm Neonates ◽  
Screening Methods ◽  
Term Infants ◽  
Lactate Dehydrogenase Activity ◽  
Group I ◽  
Minute Apgar Score

The problem of neonatal sepsis continues to be one of the leading places in neonatal practice. The issues of early diagnostics of cardiovascular disorders in neonates with sepsis by means of up-to-date methods of examination remain relevant. They can be used as screening methods with the purpose to verify possible development of cardiovascular dysfunction. Purpose — to study the meaning of certain clinical and paraclinical markers of myocardial dysfunction in neonates with sepsis. Materials and methods. In order to realize the objective we have observed 69 neonates with signs of generalized infectious-inflammatory process. Group I (32 patients — 46,4%) included neonates with the term of gestation 37–42 weeks, group II included 37 preterm neonates (53,6%) with the term of gestation under 36 week inclusive. Results. It was found that in mothers who gave birth prematurely, compared to mothers of newborns of group I, premature rupture of membranes occurred more often, but 1.5 times less often — indications of infectious diseases of the genitourinary system of the pregnant woman. Generalized infectious-inflammatory process during the neonatal period of term infants is accompanied by electrocardiographic signs of left ventricular overload associated with female sex (r=0,30), delivery by cesarean section (r=0,27), and assessment of neonatal condition by a 5=minute Apgar score (r=-0,33). Conclusions. Increased values of lactate dehydrogenase activity in the blood serum of both term and preterm neonates are associated with left ventricular over-load in the term ones, and right ventricular overload in the preterm infants. Changes found in electrophysiological heart activity promote the necessity of a routine use of electrocardiography in neonates with signs of septic process. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: neonatal sepsis; myocardial dysfunction.

scholarly journals CLINICAL-ANAMNESTIC AND ECHOCARDIOGRAPHIC MARKERS OF NEONATAL SEPSIS AT DIFFERENT GESTATION AGE OF NEWBORN

2021 ◽  
Vol 127 (4) ◽  
pp. 107-115
Author(s):  
Natalia Kretsu ◽  
Olena Koloskova ◽  
Tetiana Bilous
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
General Condition ◽  
Neonatal Sepsis ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Sepsis Group ◽  
Group I ◽  
Echocardiographic Parameters ◽  
Group Ii

neonatal sepsis remains one of the leading causes of morbidity and mortality in the neonatal age. The involvement of the myocardium in sepsis remains insufficiently studied, in particular in neonatology, where issues of myocardial dysfunction in neonatal generalized infection seem even more controversial, especially in neonatal sepsis at different gestational terms. Objective. To study specific clinical and anamnestic and echocardiographic parameters in infants depending on gestational age for optimization of the prognosis in neonatal sepsis. Material and research methods. To achieve this goal, we observed 57 newborns with a verified diagnosis of "Neonatal sepsis". Group I (23 patients – 40.3%) included newborns with a gestational age of 37-42 weeks, Group II – 34 premature infants (59.7%) with a gestation of up to 36 weeks. The latter group, depending on the gestational age, was divided into IIA subgroup, which was formed by 21 prematurely born patients with NS with a gestational age of 32-36 weeks, and the IIB subgroup – 13 newborns born before 32 weeks of gestation. Research results. The analysis showed that the severity of the impairment in the general condition of the examined newborns general condition was assessed as severe in 47.8% of newborns of group I, in 88.2% of cases in group II (PI: II <0.05), in 85.7% of representatives of subgroup IIA (PI: IIA <0.05) and in 92.3% of children of subgroup IIB (PI: IIB <0.001). It is shown that every third child (30.4%) of group I, 67.6% of newborns of group II (PI: II <0.05), half (52.4%) of the representatives of subgroup IIA (PII: IIA <0.01) and all seriously ill patients (92.3%) of subgroup IIB (PI: IIB, IIA: IIB <0.05) required cardiopulmonary resuscitation in the delivery room. Thus, in relation to full-term patients, the risk of this significant postnatal factor of emergency is likely to increase: for group II: OR - 4.77 (95% CI 2.63-8.68), RR - 2.17 (95% CI 1.57-3.0), AR = 0.37; and for premature babies with a gestational age of less than 32 weeks (IIB subgroup), respectively: OR – 27.44 (95% CI 11.73-64.19), RR – 7.55 (95% CI 5.58-10.21 ), AR – 0.65. The correlation analysis showed that in premature infants suffering from NS, the increase in the functional capacity of the left ventricular myocardium was associated with the female sex (for EF r = 0.94, P = 0.0001, for FS - r = 0, 94, P = 0.0001) and the number of days of inotropic support (for EF r = 0.68, P = 0.043, for FS - r = 0.71, P = 0.03). Conclusions. The analysis of echocardiographic parameters in the group of premature infants revealed a direct correlation between the ejection fraction and cardiovascular resuscitation immediately after birth (r = 0.64) and the duration of inotropic drugs (r = 0.68).

Pre-Clinical Evaluation of a Novel, Pneumatic, Ventricular Assist Device (Medos® HIA-VAD®) under Pathophysiological Conditions

1997 ◽  
Vol 20 (7) ◽  
pp. 389-396 ◽  
Author(s):  
F.R. Waldenberger ◽  
B. Meyns ◽  
H. Reul ◽  
R. Eilers ◽  
W. Flameng
Keyword(s):  
Coronary Artery ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Assisted Circulation ◽  
Wall Thickening ◽  
Base Line ◽  
Assist Device ◽  
Circumflex Artery ◽  
Group I ◽  
Group Ii

To evaluate a new cardiac assist system, the Medos® HIA-VAD®, we studied the effects of mechanical unloading on regional and global myocardial dysfunction. As a model for the regional temporary contractile dysfunction we chose an anesthetized, open chest preparation in sheep. We occluded the diagonal coronary artery for 15 minutes and reperfused for 90 minutes. Hemodynamic parameters and wall thickening were monitored. Unloading with the 60-ml Medos® HIA-VAD® was performed either during ischemia (group II) or during reperfusion (group III). The recovery of non-uniformity indicated by post-ejection wall thickening was significantly faster (p<0.05) in both groups if compared to the non-assisted group (group I) (all groups n=4). Recovery of systolic wall thickening in the postischemic region in group I was only 76±12%, while it was 103±11% and 92±11% in groups II and III, respectively (p<0.05). In a canine model of global left ventricular failure, we occluded the left anterior descending coronary artery for 20 min, and after 5 minutes of reperfusion, the circumflex artery for 45 min (group I, n=5). After 5 min of CX occlusion in group II we performed assisted circulation for 90 min with the 10-ml (n=5) and the 25-ml (n=5) Medos® HIA-VAD®. In group I, no dog survided, in group II, all survided 4 hours of reperfusion (n=10). Lactate at the end of the experiment was 1.1±0.9 mmol/L (10-ml) and 1.1±0.2 mmol/L (25-ml) (p>0.05 vs. base line). We conclude that the Medos® HIA-VAD® is a reliable assist device that enhances myocardial recovery and allows sufficient peripheral circulation in the case of cardiogenic shock.

scholarly journals Targeting the eCIRP/TREM-1 Interaction with a Small Molecule Inhibitor Improves Cardiac Dysfunction in Neonatal Sepsis

2020 ◽  
Author(s):  
Naomi-Liza Denning ◽  
Monowar Aziz ◽  
Li Diao ◽  
Jose M Prince ◽  
Ping Wang
Keyword(s):  
Membrane Potential ◽  
Cardiac Dysfunction ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Rna Binding ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Neonatal Cardiomyocytes ◽  
Cardiac Strain ◽  
Stimulation Of

Abstract Background: Neonatal sepsis and the associated myocardial dysfunction remain a leading cause of infant mortality. Extracellular cold-inducible RNA-binding protein (eCIRP) acts as a ligand of triggering receptor expressed on myeloid cells-1 (TREM-1). M3 is a small CIRP-derived peptide that inhibits the eCIRP/TREM-1 interaction. We hypothesize that the eCIRP/TREM-1 interaction in cardiomyocytes contributes to sepsis-induced cardiac dysfunction in neonatal sepsis, while M3 is cardioprotective. Methods: Serum was collected from neonates in the Neonatal Intensive Care Unit (NICU). 5-7-day old C57BL/6 mouse pups were used in this study. Primary murine neonatal cardiomyocytes were stimulated with recombinant murine (rm) CIRP with M3. TREM-1 mRNA and supernatant cytokine levels were assayed. Mitochondrial oxidative stress, ROS, and membrane potential were assayed. Neonatal mice were injected with rmCIRP and speckle-tracking echocardiography was conducted to measure cardiac strain. Sepsis was induced by i.p. cecal slurry. Mouse pups were treated with M3 or vehicle. After 16 h, echocardiography was performed followed by euthanasia for tissue analysis. A 7-day survival study was conducted. Results: Serum CIRP levels were elevated in septic human neonates. rmCIRP stimulation of cardiomyocytes increased TREM-1 gene expression. Stimulation of cardiomyocytes with rmCIRP upregulated TNF-α and IL-6 in the supernatants, while this upregulation was inhibited by M3. Stimulation of cardiomyocytes with rmCIRP resulted in a reduction in mitochondrial membrane potential (MMP) while M3 treatment returned MMP to near baseline. rmCIRP caused mitochondrial calcium overload; this was inhibited by M3. rmCIRP injection impaired longitudinal and radial cardiac strain. Sepsis resulted in cardiac dysfunction with a reduction in cardiac output and left ventricular end diastolic diameter. Both were improved by M3 treatment. Treatment with M3 attenuated serum, cardiac, and pulmonary levels of pro-inflammatory cytokines compared to vehicle-treated septic neonates. M3 dramatically increased sepsis survival. Conclusions: Inhibition of eCIRP/TREM-1 interaction with M3 is cardioprotective, decreases inflammation, and improves survival in neonatal sepsis. Trial registration: Retrospectively registered.

Brain Type Natriuretic Peptide

2008 ◽  
Vol 27 (5) ◽  
pp. 343-346 ◽  
Author(s):  
Patricia Nash
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Transplant Rejection ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Preterm Neonates ◽  
Term Infants ◽  
End Diastolic Volume ◽  
Ventricular Diastolic Dysfunction ◽  
Near Term

BRAIN TYPE NATRIURETIC PEPTIDE, also called B-type natriuretic peptide (BNP), has emerged as a valuable diagnostic and prognostic marker in the assessment of heart failure in adults.1–7 Serum BNP levels have also been shown to differentiate pulmonary from cardiac causes of dyspnea and to be useful as a screening tool for ventricular hypertrophy, ventricular diastolic dysfunction, transplant rejection, and risk for sudden death in adult patients with congestive heart failure (CHF).3,7,8 In pediatric patients, BNP levels have been found to increase with a hemodynamically significant ventricular septal defect and to correlate with the volume of the shunt and the left ventricular end diastolic volume.7 Recently, BNP levels have been investigated for use in determining the hemodynamic significance of a patent ductus arteriosus (PDA) in preterm neonates.3,7,9–11 They have also been studied for use in the diagnosis and management of persistent pulmonary hypertension in term and near-term infants.6 This article reviews BNP terminology, structure, physiology, measurement, and potential utility in the NICU.

scholarly journals Targeting the eCIRP/TREM-1 interaction with a small molecule inhibitor improves cardiac dysfunction in neonatal sepsis

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Naomi-Liza Denning ◽  
Monowar Aziz ◽  
Li Diao ◽  
Jose M. Prince ◽  
Ping Wang
Keyword(s):  
Membrane Potential ◽  
Cardiac Dysfunction ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Rna Binding ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Neonatal Cardiomyocytes ◽  
Cardiac Strain ◽  
Stimulation Of

Abstract Background Neonatal sepsis and the associated myocardial dysfunction remain a leading cause of infant mortality. Extracellular cold-inducible RNA-binding protein (eCIRP) acts as a ligand of triggering receptor expressed on myeloid cells-1 (TREM-1). M3 is a small CIRP-derived peptide that inhibits the eCIRP/TREM-1 interaction. We hypothesize that the eCIRP/TREM-1 interaction in cardiomyocytes contributes to sepsis-induced cardiac dysfunction in neonatal sepsis, while M3 is cardioprotective. Methods Serum was collected from neonates in the Neonatal Intensive Care Unit (NICU). 5–7-day old C57BL/6 mouse pups were used in this study. Primary murine neonatal cardiomyocytes were stimulated with recombinant murine (rm) CIRP with M3. TREM-1 mRNA and supernatant cytokine levels were assayed. Mitochondrial oxidative stress, ROS, and membrane potential were assayed. Neonatal mice were injected with rmCIRP and speckle-tracking echocardiography was conducted to measure cardiac strain. Sepsis was induced by i.p. cecal slurry. Mouse pups were treated with M3 or vehicle. After 16 h, echocardiography was performed followed by euthanasia for tissue analysis. A 7-day survival study was conducted. Results Serum eCIRP levels were elevated in septic human neonates. rmCIRP stimulation of cardiomyocytes increased TREM-1 gene expression. Stimulation of cardiomyocytes with rmCIRP upregulated TNF-α and IL-6 in the supernatants, while this upregulation was inhibited by M3. Stimulation of cardiomyocytes with rmCIRP resulted in a reduction in mitochondrial membrane potential (MMP) while M3 treatment returned MMP to near baseline. rmCIRP caused mitochondrial calcium overload; this was inhibited by M3. rmCIRP injection impaired longitudinal and radial cardiac strain. Sepsis resulted in cardiac dysfunction with a reduction in cardiac output and left ventricular end diastolic diameter. Both were improved by M3 treatment. Treatment with M3 attenuated serum, cardiac, and pulmonary levels of pro-inflammatory cytokines compared to vehicle-treated septic neonates. M3 dramatically increased sepsis survival. Conclusions Inhibition of eCIRP/TREM-1 interaction with M3 is cardioprotective, decreases inflammation, and improves survival in neonatal sepsis. Trial registration Retrospectively registered.

Apgar Score and Risk of Cerebral Palsy in Preterm Infants: A Population-Based Cohort Study

2021 ◽  
Author(s):  
Damjan Osredkar ◽  
Ivan Verdenik ◽  
Anja Troha Gergeli ◽  
Ksenija Gersak ◽  
Miha Lucovnik
Keyword(s):  
Cerebral Palsy ◽  
Preterm Infants ◽  
Apgar Score ◽  
Preterm Neonates ◽  
Adjusted Relative Risk ◽  
Term Infants ◽  
Apgar Scores ◽  
Risk Of Death ◽  
Increased Risk ◽  
Minute Apgar Score

AbstractA low Apgar score is associated with increased risk of cerebral palsy (CP) in term infants, while such association remains controversial in preterm neonates. The objective of this study was to assess association between 5-minute Apgar scores and CP in different subcategories of preterm birth based on gestational age. The Slovenian National Perinatal Information System was used to identify singleton children without congenital malformations live-born at 22 to 37 weeks of gestation between 2002 and 2010. Data were linked to the Slovenian Registry of Cerebral Palsy in children born between 2002 and 2010. CP was diagnosed at a minimum of 5 years of age. Of 11,924 children included, 241 (2.0%) died before discharge and 153 (1.3%) were diagnosed with CP. Five-minute Apgar scores <7 were significantly associated with higher risk of death or CP (compared with scores ≥9) at all preterm gestations. CP alone was associated with Apgar scores <7 only at moderately or late preterm gestation (32–36 weeks) (adjusted relative risk [aRR]: 8.27; 95% confidence interval [CI]: 1.87–36.64 for scores 0–4 and aRR: 4.96; 95% CI 1.89–13.06 for scores 5–6). In conclusion, a low 5-minute Apgar score was associated with combined outcome of neonatal death or CP in all preterm births, while in surviving preterm infants at >32 weeks a low 5-minute Apgar score was associated with CP.

Elevated cardiac biomarkers and echocardiographic left ventricular dysfunction at admission in patients with dengue fever: report from a tertiary care center in Northwest India

2018 ◽  
Vol 48 (4) ◽  
pp. 261-265 ◽  
Author(s):  
Arjun Lakshman ◽  
Prasanth Balasubramanian ◽  
Ram V Nampoothiri ◽  
Rajesh Vijayvergiya ◽  
Ashish Bhalla ◽  
...  
Keyword(s):  
Dengue Fever ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Myocardial Dysfunction ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Screening Methods ◽  
Cardiac Symptoms

Cardiac involvement is not an uncommon manifestation in dengue fever and diagnosing it has always been a challenge to physicians owing to its constellation of clinical features and lack of standard screening methods. We studied the prevalence of cardiac involvement among fifty sequential adult patients of dengue fever admitted in our emergency department, PGIMER, Chandigarh, India, who were assessed clinically and classified based on the severity. They were studied for possible cardiac involvement by means of point-of-care testing for serum cardiac biomarkers (quantitative troponin-I, creatinine kinase - MB Isoform and cardiac myoglobin) and two-dimensional transthoracic echocardiogram (2D-echo). Evidence of myocardial involvement was present in 16% and 30% patients based on 2D-echo and biomarker testing respectively. On univariate analysis, the presence of cardiac symptoms (p = 0.009) and of shock (p = 0.003) showed statistically significant association with biomarker elevation. However, this and evidence of myocardial dysfunction by 2-D echo showed poor inter-correlation.

Effects of Rest and Exercise on Cardiac Blood Volume Determinations

1997 ◽  
Vol 36 (08) ◽  
pp. 259-264
Author(s):  
N. Topuzović
Keyword(s):  
Radionuclide Ventriculography ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Volume Determination ◽  
Group I ◽  
Lv Volumes ◽  
Group Ii ◽  
Lv Volume

Summary Aim: The purpose of this study was to investigate the changes in blood activity during rest, exercise and recovery, and to assess its influence on left ventricular (LV) volume determination using the count-based method requiring blood sampling. Methods: Forty-four patients underwent rest-stress radionuclide ventriculography; Tc-99m-human serum albumin was used in 13 patients (Group I), red blood cells was labeled using Tc-99m in 17 patients (Group II) in vivo, and in 14 patients (Group III) by modified in vivo/in vitro method. LV volumes were determined by a count-based method using corrected count rate in blood samples obtained during rest, peak exercise and after recovery. Results: In group I at stress, the blood activity decreased by 12.6 ± 5.4%, p <0.05, as compared to the rest level, and increased by 25.1 ± 6.4%, p <0.001, and 12.8 ± 4.5%, p <0.05, above the resting level in group II and III, respectively. This had profound effects on LV volume determinations if only one rest blood aliquot was used: during exercise, the LV volumes significantly decreased by 22.1 ± 9.6%, p <0.05, in group I, whereas in groups II and III it was significantly overestimated by 32.1 ± 10.3%, p <0.001, and 10.7 ± 6.4%, p <0.05, respectively. The changes in blood activity between stress and recovery were not significantly different for any of the groups. Conclusion: The use of only a single blood sample as volume aliquot at rest in rest-stress studies leads to erroneous estimation of cardiac volumes due to significant changes in blood radioactivity during exercise and recovery.

Diagnostic value of assessment of Serum Cortisol, Hepcidin and Thyroid Hormone Levels in Neonates with Late Onset Sepsis

2020 ◽  
Vol 20 ◽  
Author(s):  
Adel Hagag ◽  
Mohamed S Elfarargy ◽  
Reham Lyonis ◽  
Ghada M Al-Ashmawy
Keyword(s):  
Thyroid Hormones ◽  
Antibiotic Therapy ◽  
Neonatal Sepsis ◽  
Late Onset ◽  
Serum Cortisol ◽  
Control Group ◽  
Serum Free ◽  
Group I ◽  
Late Onset Sepsis ◽  
Serum Hepcidin

Background: Neonatal sepsis is a clinical syndrome characterized by symptoms and signs of infection in the first twenty eight days of life. Serum thyroid, cortisol and hepcidin are affected by neonatal sepsis. Aim of the work: The aim of this study was to assess the predictive value of serum thyroid hormones including free triiodothyronine (free TT3) and free tetraiodothyronine (free TT4), serum cortisol and hepcidin levels through comparison of their concentrations between normal neonates and neonates with high probable late onset sepsis. Patients and Methods: This case control study was carried out on 40 neonates with suspected high probable late onset neonatal sepsis based on clinical and laboratory finding who were admitted to NICU of Pediatric Department, Tanta University, Egypt in the period from April 2017 to May 2019 (group I) and 40 healthy neonates matched in age and sex as a control group (group II). For patients and controls; blood culture, highly sensitive C‑reactive protein (H-s CRP), serum hepcidin, serum cortisol and thyroid hormones levels including free TT3 and free TT4 were assessed. Results: There were no significant differences between studied groups as regard weight, gestational age, sex and mode of delivery. H-s CRP, serum cortisol and hepcidin were significantly higher in group I than group II while serum free TT3 and free TT4 were significantly lower in group I compared with controls. There was significantly lower H-s CRP, serum hepcidin and cortisol and significantly higher serum free TT3 and free TT4 in group I after antibiotic therapy compared to the same group before treatment while there were no significant differences between group I after antibiotic therapy and control group as regard the same parameters. There were significant positive correlation between H-s CRP and serum hepcidin and cortisol in group I while there was significant negative correlation between H-s CRP and free TT3 and free TT4. ROC curve of specificity and sensitivity of H-s CRP, serum hepcidin, cortisol, free TT3 and free TT4 in prediction of neonatal sepsis shows that serum hepcidin had the highest sensitivity and specificity with 95% and 90% respectively followed by serum cortisol, H-s CRP, free TT3 and lastly free TT4. Conclusion and recommendations: Neonates with high probable sepsis had significantly higher serum cortisol and hepcidin and significantly lower free TT3 and free TT4 compared with healthy neonates. These findings may arouse our attention about the use of these markers in diagnosis of in neonatal sepsis which can lead to early treatment and subsequently better prognosis.

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