Diagnosis of Neonatal Late-Onset Infection in Very Preterm Infant: Inter-Observer Agreement and International Classifications

Background: The definition of late-onset bacterial sepsis (LOS) in very preterm infants is not unified. The objective was to assess the concordance of LOS diagnosis between experts in neonatal infection and international classifications and to evaluate the potential impact on heart rate variability and rate of “bronchopulmonary dysplasia or death”. Methods: A retrospective (2017–2020) multicenter study including hospitalized infants born before 31 weeks of gestation with intention to treat at least 5-days with antibiotics was performed. LOS was classified as “certain or probable” or “doubtful” independently by five experts and according to four international classifications with concordance assessed by Fleiss’s kappa test. Results: LOS was suspected at seven days (IQR: 5–11) of life in 48 infants. Following expert classification, 36 of them (75%) were considered as “certain or probable” (kappa = 0.41). Following international classification, this number varied from 13 to 46 (kappa = −0.08). Using the expert classification, “bronchopulmonary dysplasia or death” occurred less frequently in the doubtful group (25% vs. 78%, p < 0.001). Differences existed in HRV changes between the two groups. Conclusion: The definition of LOS is not consensual with a low international and moderate inter-observer agreement. This affects the evaluation of associated organ dysfunction and prognosis.

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Faculty Opinions recommendation of Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718213334.793488807 ◽

2013 ◽

Author(s):

Mari-Paule Thiet

Keyword(s):

Randomized Controlled Trial ◽

Intraventricular Hemorrhage ◽

Late Onset ◽

Controlled Trial ◽

Delayed Cord Clamping ◽

Very Preterm Infants ◽

Very Preterm ◽

Randomized Controlled ◽

Cord Clamping ◽

Late Onset Sepsis

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Neighborhood Disadvantage and Early Respiratory Outcomes in Very Preterm Infants with Bronchopulmonary Dysplasia.

The Journal of Pediatrics ◽

10.1016/j.jpeds.2021.06.061 ◽

2021 ◽

Author(s):

Juliette Deschamps ◽

Mohamed Boucekine ◽

Laurence Fayol ◽

Jean Christophe Dubus ◽

Steve Nauleau ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Neighborhood Disadvantage ◽

Very Preterm Infants ◽

Very Preterm ◽

Respiratory Outcomes

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Cause of preterm birth and late-onset sepsis in very preterm infants: the EPIPAGE-2 cohort study

Pediatric Research ◽

10.1038/s41390-021-01411-y ◽

2021 ◽

Author(s):

Mathilde Letouzey ◽

◽

Laurence Foix-L’Hélias ◽

Héloïse Torchin ◽

Ayoub Mitha ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Preterm Infants ◽

Late Onset ◽

Very Preterm Infants ◽

Very Preterm ◽

Late Onset Sepsis

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67 Are NICUs too busy?

Paediatrics & Child Health ◽

10.1093/pch/pxab061.052 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e47-e48

Author(s):

Marc Beltempo ◽

Robert Platt ◽

Anne-Sophie Julien ◽

Regis Blais ◽

Bertelle Valerie ◽

...

Keyword(s):

Preterm Infants ◽

Patient Outcomes ◽

Gestational Age ◽

Late Onset ◽

Mode Of Delivery ◽

Random Effect ◽

Organizational Factors ◽

Neurological Injury ◽

Very Preterm Infants ◽

Very Preterm

Abstract Primary Subject area Neonatal-Perinatal Medicine Background In a health care system with limited resources, hospital organizational factors such as unit occupancy and nurse-to-patient ratios may contribute to patient outcomes. Objectives We aimed to assess the association of NICU occupancy and nurse staffing with outcomes of very preterm infants born < 33 weeks gestational age (GA). Design/Methods This was a multicenter retrospective cohort study of infants born 23-32 weeks GA without major congenital anomaly, admitted within 2 days after birth to one of four Level 3 NICUs in Quebec, Canada (2015-2018). For each 8 h shift, data on unit occupancy were obtained from a central provincial database (SiteNeo) and linked to the hospital nursing hours database (Logibec). Unit occupancy rates and nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) were pooled for the first shift, 24 h, and 7 days of admission for each infant. Patient data were obtained from the Canadian Neonatal Network database. Primary outcome was mortality and/or morbidity (severe neurological injury, bronchopulmonary dysplasia, necrotizing enterocolitis, and late-onset sepsis, severe retinopathy of prematurity). Adjusted odds ratios (AOR) for association of exposure with outcomes were estimated using generalized linear mixed models with a random effect for center, while adjusting for confounders (gestational age, small for gestational age, sex, outborn, Score for Neonatal Acute Physiology version 2, mode of delivery, and the other organizational variables). Results Among 1870 infants included in analyses, 796 (43%) had mortality/morbidity. Median occupancy was 89% (IQR 82-94) and median nursing provision was 1.13 (IQR 0.97-1.37). Overall higher NICU occupancy on shift of admission, first 24 h, and 7 days were associated with higher odds of mortality/morbidity (Figure 1) but nursing provision was not (Figure 2). Subgroup analysis by GA (< 29 and 29-32 weeks) yielded similar results (not shown). Generalized linear mixed model analyses showed that a 5% reduction in occupancy in the first 24 h of admission was associated with a 6% reduction in mortality/morbidity. Conclusion NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes.

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Severity of Bronchopulmonary Dysplasia Among Very Preterm Infants in the United States

PEDIATRICS ◽

10.1542/peds.2020-030007 ◽

2021 ◽

pp. e2020030007

Author(s):

Erik A. Jensen ◽

Erika M. Edwards ◽

Lucy T. Greenberg ◽

Roger F. Soll ◽

Danielle E.Y. Ehret ◽

...

Keyword(s):

United States ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

The United States ◽

Very Preterm Infants ◽

Very Preterm

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Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

Neonatology ◽

10.1159/000517585 ◽

2021 ◽

pp. 1-9

Author(s):

Victoria Aldecoa-Bilbao ◽

Mar Velilla ◽

Marta Teresa-Palacio ◽

Carla Balcells Esponera ◽

Ana Herranz Barbero ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Lung Ultrasound ◽

Respiratory Support ◽

Very Preterm Infants ◽

Very Preterm ◽

Pleural Line ◽

Respiratory Management ◽

Postmenstrual Age ◽

Severity Of The Disease

Introduction: Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. Methods: Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. Results: Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (p < 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted NICHD 2001-BPD with R2 = 0.522; AUC = 0.87 (0.79–0.94), p < 0.001, and Jensen 2019-BPD with R2 = 0.315 (AUC = 0.80 [0.70–0.90], p < 0.001). A model including mechanical ventilation >5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (R2 = 0.655, p < 0.001) with an AUC = 0.90 (0.84–0.97), p < 0.001. Conclusion: LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

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Response to bronchodilators in very preterm infants with evolving bronchopulmonary dysplasia

Research and Reports in Neonatology ◽

10.2147/rrn.s96961 ◽

2015 ◽

pp. 113 ◽

Cited By ~ 2

Author(s):

Daniel K Morrow ◽

Diane Schilling ◽

Cynthia McEvoy

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Very Preterm Infants ◽

Very Preterm

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Individualising care in severe bronchopulmonary dysplasia: a series of N-of-1 trials comparing transpyloric and gastric feeding

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-317148 ◽

2019 ◽

Vol 105 (4) ◽

pp. 399-404 ◽

Cited By ~ 1

Author(s):

Erik A Jensen ◽

Huayan Zhang ◽

Rui Feng ◽

Kevin Dysart ◽

Kathleen Nilan ◽

...

Keyword(s):

Bronchopulmonary Dysplasia ◽

Random Order ◽

Supplemental Oxygen ◽

Very Preterm Infants ◽

Intention To Treat ◽

Postmenstrual Age ◽

Registration Number ◽

Adjusted Incidence Rate ◽

Fraction Of Inspired Oxygen ◽

Gastric Feeding

ObjectiveCompare rates of hypoxaemia during transpyloric and gastric feedings in very preterm infants with severe bronchopulmonary dysplasia.DesignN-of-1 multiple crossover trials with individual patient and pooled data analyses.SettingLevel IV intensive care nursery.PatientsInfants receiving positive airway pressure between 36 and 55 weeks postmenstrual age were enrolled between December 2014–July 2016.InterventionN-of-1 trial consisting of two blocks, each with a 4-day gastric and 4-day transpyloric feeding period assigned in random order.Main outcome measuresThe primary outcome was the frequency of daily intermittent hypoxaemic events (SpO2 ≤80% lasting 10–180 s). Secondary outcomes included the daily proportion of time with an SpO2 ≤80% and mean daily fraction of inspired oxygen.ResultsOf 15 infants, 13 completed the trial and 2 stopped early for transient worsening in respiratory status during gastric feedings. In the intention-to-treat analyses, transpyloric feedings resulted in increased rates of intermittent hypoxaemia in five infants, greater time per day in hypoxaemia in three infants and more supplemental oxygen use in three infants. One infant received more supplemental oxygen during gastric feedings. The remaining study outcomes were similar between the feeding routes in all other infants. Pooling all data, transpyloric feedings resulted in a higher frequency of intermittent hypoxaemic events (median 7.5/day (IQR 1–23.5) vs 3/day (1–11); adjusted incidence rate ratio 1.8, 95% CI 1.3 to 2.5) and a greater proportion of daily hypoxaemia time (median 0.8% (IQR 0.1–2.3) vs 0.4% (0.07–1.8); adjusted mean difference 1.6, 95% CI 1.1 to 2.5).ConclusionsTranspyloric compared with gastric feedings modestly increased rates of hypoxaemia among study participants.Trial registration numberNCT02142621

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Whole blood transcriptional responses of very preterm infants during late-onset sepsis

PLoS ONE ◽

10.1371/journal.pone.0233841 ◽

2020 ◽

Vol 15 (6) ◽

pp. e0233841 ◽

Cited By ~ 2

Author(s):

Sherrianne Ng ◽

Tobias Strunk ◽

Amy H. Lee ◽

Erin E. Gill ◽

Reza Falsafi ◽

...

Keyword(s):

Preterm Infants ◽

Whole Blood ◽

Late Onset ◽

Transcriptional Responses ◽

Very Preterm Infants ◽

Very Preterm ◽

Late Onset Sepsis

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Availability of Donor Milk for Very Preterm Infants Decreased the Risk of Necrotizing Enterocolitis without Adversely Impacting Growth or Rates of Breastfeeding

Nutrients ◽

10.3390/nu11081895 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1895 ◽

Cited By ~ 8

Author(s):

Débora Cañizo Vázquez ◽

Sandra Salas García ◽

Montserrat Izquierdo Renau ◽

Isabel Iglesias-Platas

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Neonatal Intensive Care ◽

Late Onset ◽

Donor Milk ◽

Very Preterm Infants ◽

Very Preterm ◽

Breastfeeding Rates ◽

Group 2 ◽

Group 1

Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mother’s milk (OMM) is not enough. Our aim was to compare the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in very preterm infants (VPI) after the introduction of DM. Growth and breastfeeding rates were examined as secondary outcomes. Single center, observational and retrospective cohort study comparing 227 VPI admitted to our neonatal unit before (Group 1, n = 99) and after (Group 2, n = 128) DM introduction. Enteral nutrition was started earlier after DM availability (2.6 ± 1.1 vs. 2.1 ± 1 days, p = 0.001). Incidence of NEC decreased in group 2 (9.1% vs. 3.4%, p = 0.055), especially in those born between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044). Surgical NEC was also less frequent. Suffering NEC was 4 times more likely in group 1 (multivariate analysis). Availability of DM did not impact breastfeeding rates or preterm growth. Our findings support the protective role of DM against NEC, particularly in non-extreme VPI, a group less frequently included in clinical guidelines and research studies on the use of DM.

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