scholarly journals Look Who’s Talking: Host and Pathogen Drivers of Staphylococcus epidermidis Virulence in Neonatal Sepsis

2022 ◽  
Vol 23 (2) ◽  
pp. 860
Author(s):  
Isabella A. Joubert ◽  
Michael Otto ◽  
Tobias Strunk ◽  
Andrew J. Currie
Keyword(s):  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Bacterial Infections ◽  
Late Onset ◽  
Neonatal Morbidity ◽  
Invasive Disease ◽  
Bacterial Invasion ◽  
High Resource ◽  
Increased Risk ◽  
Neonatal Icu

Preterm infants are at increased risk for invasive neonatal bacterial infections. S. epidermidis, a ubiquitous skin commensal, is a major cause of late-onset neonatal sepsis, particularly in high-resource settings. The vulnerability of preterm infants to serious bacterial infections is commonly attributed to their distinct and developing immune system. While developmentally immature immune defences play a large role in facilitating bacterial invasion, this fails to explain why only a subset of infants develop infections with low-virulence organisms when exposed to similar risk factors in the neonatal ICU. Experimental research has explored potential virulence mechanisms contributing to the pathogenic shift of commensal S. epidermidis strains. Furthermore, comparative genomics studies have yielded insights into the emergence and spread of nosocomial S. epidermidis strains, and their genetic and functional characteristics implicated in invasive disease in neonates. These studies have highlighted the multifactorial nature of S. epidermidis traits relating to pathogenicity and commensalism. In this review, we discuss the known host and pathogen drivers of S. epidermidis virulence in neonatal sepsis and provide future perspectives to close the gap in our understanding of S. epidermidis as a cause of neonatal morbidity and mortality.

scholarly journals Procalcitonin is a Prognosis Biomarker in Late Onset Neonatal Sepsis: A Pilot Study

2021 ◽  
Author(s):  
Valerie Ruetsch ◽  
Simon Barreault ◽  
Nolwenn Le Sache ◽  
Pierre Tissieres
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Area Under The Curve ◽  
Neonatal Morbidity ◽  
Good Prognosis ◽  
Operating Characteristics ◽  
Sepsis Diagnosis

Abstract Background. Neonatal sepsis contributes substantially to neonatal morbidity and mortality. Procalcitonin (PCT) is a recognized biomarker for the diagnosis of late-onset neonatal sepsis (LONS), however, little is known about the prognosis value of PCT in LONS. This study aims at assessing PCT value as a prognosis biomarker in preterm infants with LONS. Methods. Retrospective single center observational cohort. All premature infants (less than 32 weeks of gestational age) with LONS admitted in a tertiary neonatal intensive care unit.Discussion. Among the 59 preterm infants included in the analysis, 48 survived (81.4%, 48/59). Deceased patients had a significantly lower gestational age (p=0,025) and weight (p= 0,016) at the time of LONS diagnosis. Although PCT values were not different between both groups at the time of LONS diagnosis, it was more elevated during the first 24 hours in deceased patients (p=0,041). Accuracy of PCT for LONS prognosis ranged from 0.70 to 0.82 of area under the curve on reciever operating characteristics curves. Optimal PCT cut-off values at LONS diagnosis was 8,92 µg/L (Youden’s J index 0.53), 15.75 µg/L for PCT values during the first 24 hours (J index 0.56), and 6.74 µg/L between 24 and 48 hours after diagnosis (J index 0.54). The estimated survival probability at day 60 was above 95% for patient with a PCT value at sepsis diagnosis under 8,9 µg/L and less than 45% if higher (p<0.0001). Conclusion. A PCT value > 8.92 µg/L obtained at LONS diagnosis suspicion seems to be a good prognosis biomarker.

scholarly journals Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia

2020 ◽  
Vol 4 (1) ◽  
pp. e000740
Author(s):  
Netsanet Workneh Gidi ◽  
Robert L Goldenberg ◽  
Assaye K Nigussie ◽  
Elizabeth McClure ◽  
Amha Mekasha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Late Onset ◽  
Early Recognition ◽  
Neonatal Outcomes ◽  
P Value ◽  
Prolonged Hospitalisation ◽  
Increased Risk ◽  
Appropriate For Gestational Age

PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study ‘Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)’. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32–36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.

scholarly journals cfDNA and DNases: New Biomarkers of Sepsis in Preterm Neonates—A Pilot Study

Cells ◽  
2022 ◽  
Vol 11 (2) ◽  
pp. 192
Author(s):  
Moritz Lenz ◽  
Thomas Maiberger ◽  
Lina Armbrust ◽  
Antonia Kiwit ◽  
Axel Von der Wense ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Dnase I ◽  
Sepsis Group ◽  
Preterm Neonates ◽  
Control Group ◽  
Suspected Sepsis ◽  
Epidemiological Characteristics

Introduction: An early and accurate diagnosis of early onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS) is essential to improve the outcome of this devastating conditions. Especially, preterm infants are at risk. Reliable biomarkers are rare, clinical decision-making depends on clinical appearance and multiple laboratory findings. Markers of NET formation and NET turnover might improve diagnostic precision. Aim of this study was to evaluate the diagnostic value of NETs in sepsis diagnosis in neonatal preterm infants. Methods: Plasma samples of neonatal preterm infants with suspected sepsis were collected. Blood samples were assayed for markers of NET formation and NET turnover: cfDNA, DNase1, nucleosome, NE, and H3Cit. All clinical findings, values of laboratory markers, and epidemiological characteristics were collected retrospectively. Two subpopulations were created to divide EONS from LONS. EMA sepsis criteria for neonatal sepsis were used to generate a sepsis group (EMA positive) and a control group (EMA negative). Results: A total of 31 preterm neonates with suspected sepsis were included. Out of these, nine patients met the criteria for sepsis according to EMA. Regarding early onset neonatal sepsis (3 EONS vs. 10 controls), cfDNA, DNase I, nucleosome, and CRP were elevated significantly. H3Cit and NE did not show any significant elevations. In the late onset sepsis collective (6 LONS vs. 12 controls), cfDNA, DNase I, and CRP differed significantly compared to control group.

scholarly journals Fatal, Fulminant and Invasive Non-Typeable Haemophilus influenzae Infection in a Preterm Infant: A Re-Emerging Cause of Neonatal Sepsis

2020 ◽  
Vol 5 (1) ◽  
pp. 30 ◽  
Author(s):  
Sudipta Roy Chowdhury ◽  
Srabani Bharadwaj ◽  
Suresh Chandran
Keyword(s):  
Haemophilus Influenzae ◽  
Preterm Infant ◽  
Neonatal Sepsis ◽  
Group B Streptococcus ◽  
Invasive Disease ◽  
Preventative Measures ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Serotype B ◽  
Group B

Early-onset neonatal sepsis (EOS) is a major cause of neonatal death and long-term neurodevelopmental disabilities among survivors. The common pathogens causing EOS are group B streptococcus (GBS) and Escherichia coli. Haemophilus influenzae (H. influenzae) is a Gram-negative coccobacillus that can cause severe invasive disease and can be divided into either typeable or non-typeable strains. H. influenzae serotype b (Hib) is the most virulent and the major cause of bacterial meningitis in young children prior to routine immunization against Hib. Hib infection rates have dramatically reduced since then. However, a number of studies have reported an increasing incidence of non-typeable H. influenzae (NTHi) sepsis in neonates worldwide and concluded that pregnant women may have an increased risk to invasive NTHi disease with poor pregnancy outcomes. We present a case of fulminant neonatal sepsis caused by NTHi in an extremely preterm infant and discuss potential preventative measures to reduce its re-emergence.

Serum Pentraxin 3 Concentration in Neonatal Sepsis

2019 ◽  
Vol 14 (05) ◽  
pp. 219-222
Author(s):  
Fatih Battal ◽  
Özgül Emel Bulut ◽  
Şule Yıldırım ◽  
Hakan Aylanç ◽  
Nazan Kaymaz ◽  
...  
Keyword(s):  
Neonatal Sepsis ◽  
Bacterial Infections ◽  
Clinical Signs ◽  
Neonatal Morbidity ◽  
Gene Organization ◽  
Control Group ◽  
Case Group ◽  
Pentraxin 3 ◽  
Suspected Sepsis ◽  
Reactive Protein

Objective Neonatal sepsis is one of the most important causes of neonatal morbidity and mortality. Symptoms and signs of neonatal sepsis can be silent; therefore, laboratory investigation is necessary in cases of doubt or if there are risk factors. Early diagnosis is important for early intervention and treatment. The most valuable method for diagnosis is blood culture; however, false positivity due to contamination or false negativity despite ongoing fatal bacterial infections can be seen. Pentraxin 3 is a prototype of the long pentraxin family. It has some differences from C-reactive protein (CRP) in terms of gene organization and localization and production site. It is effective in the early phase of inflammation and it is detected as an early marker of sepsis in adults. The aim of this study was to investigate whether pentraxin 3 can be used as a marker in neonatal sepsis. Materials and Methods Thirty newborns with suspected sepsis with antenatal history or the presence of clinical signs of sepsis, such as hypo/hyperthermia, feed intolerance, lethargy, hypotonia, irregular cardiac rhythms, bradycardia, cyanosis, apnea, respiratory distress, or metabolic acidosis, were enrolled in the study as a case group, and 28 healthy newborns were included as a control group. Serum pentraxin 3, procalcitonin, CRP, and hemogram in the study group and serum procalcitonin and pentraxin in the control group were examined. Results Serum pentraxin 3 (pg/mL) and serum procalcitonin (ng/mL) levels were 2,273.82 ± 1,260.75 and 0.86 ± 0.52 in the case group and 957.41 ± 268.00 and 0.19 ± 0.18 in the control group (p < 0.001 for both), respectively. Conclusion The present study showed that serum pentraxin 3 levels may be a useful marker in the diagnosis of neonatal sepsis.

Drug Therapy in Neonatal Sepsis

1989 ◽  
Vol 2 (1) ◽  
pp. 28-35
Author(s):  
Susan Phillips ◽  
Glenn Kaplan
Keyword(s):  
Neonatal Sepsis ◽  
Bacterial Infections ◽  
Neonatal Intensive Care ◽  
Clinical Status ◽  
Clinical Manifestations ◽  
Neonatal Morbidity ◽  
Treatment Modalities ◽  
Isolation And Identification ◽  
Technological Advances ◽  
High Risk Infants

Despite the remarkable technological advances in neonatal intensive care, bacterial infections continue to be a significant cause of neonatal morbidity and mortality. The clinical manifestations of sepsis are frequently subtle and nonspecific. Progression of the disease is rapid and mortality continues to be high. Antimicrobial therapy must be instituted as soon as possible after symptomatic and high risk infants are identified. Empiric broad spectrum antibiotic therapy is initiated to cover the most likely pathogens that are etiologic in neonatal sepsis. Pathogen specific therapy is guided by the isolation and identification of the infecting organism and its susceptibility patterns. The clinical status of the infant must be closely monitored, and basic supportive care provided to optimize the infants chance of survival. The emergence of drug resistance and adverse drug reaction profiles may further dictale which antimicrobial regimen is the safest and most effective. Unconventional therapies should be reserved for the most critically ill infants after conventional treatment has failed. Controlled trials of pharmacologic and nonpharmacologic treatment modalities for neonatal sepsis are needed to optimize the management of these infants.

scholarly journals Neonatal Sepsis: Clinical Considerations

2017 ◽  
Vol 07 (01) ◽  
pp. e54-e59 ◽  
Author(s):  
S. Blatt ◽  
M. Schroth
Keyword(s):  
Neonatal Sepsis ◽  
Late Onset ◽  
Rapid Development ◽  
Group B Streptococcus ◽  
Neonatal Morbidity ◽  
Screening Tests ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Clinical Considerations ◽  
Group B

AbstractUnspecific symptoms and rapid development of sepsis up to septic shock from systemic inflammatory response syndrome (SIRS) are well-known, important issues in neonatology. A common cause is the infection by Streptococcus agalactiae (Group B Streptococcus [GBS]) or Escherichia coli, which contributes significantly to neonatal morbidity and mortality. Whereas early-onset sepsis is normally derived from mother during birth, late-onset sepsis can be transmitted by the environment. Management of neonatal sepsis includes the maintenance of cardiovascular and pulmonary function besides antibiotic therapy. Due to the fact that until today, there are no reliable screening tests for detecting early sepsis, clinical assessment is considered to be of utmost importance.

scholarly journals Perinatal Ureaplasma Exposure Is Associated With Increased Risk of Late Onset Sepsis and Imbalanced Inflammation in Preterm Infants and May Add to Lung Injury

2019 ◽  
Vol 9 ◽  
Author(s):  
Kirsten Glaser ◽  
Anna Gradzka-Luczewska ◽  
Marta Szymankiewicz-Breborowicz ◽  
Natalia Kawczynska-Leda ◽  
Birgit Henrich ◽  
...  
Keyword(s):  
Lung Injury ◽  
Preterm Infants ◽  
Late Onset ◽  
Late Onset Sepsis ◽  
Increased Risk

Role of presepsin in the diagnosis of late-onset neonatal sepsis in preterm infants

2015 ◽  
pp. 1-6 ◽  
Author(s):  
Sevilay Topcuoglu ◽  
Cansev Arslanbuga ◽  
Tugba Gursoy ◽  
Alev Aktas ◽  
Guner Karatekin ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Late Onset

scholarly journals Reintubation rates after extubation to different non-invasive ventilation modes in preterm infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alaa Masry ◽  
Nuha A. M. A. Nimeri ◽  
Olfa Koobar ◽  
Samer Hammoudeh ◽  
Prem Chandra ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Neonatal Morbidity ◽  
Intermittent Positive Pressure Ventilation ◽  
Nasal Cannula ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Increased Risk

Abstract Introduction Respiratory Distress Syndrome (RDS) is a common cause of neonatal morbidity and mortality in premature newborns. In this study, we aim to compare the reintubation rate in preterm babies with RDS who were extubated to Nasal Continuous Positive Airway Pressure (NCPAP) versus those extubated to Nasal Intermittent Positive Pressure Ventilation (NIPPV). Methods This is a retrospective study conducted in the Neonatal Intensive Care Unit (NICU) of Women’s Wellness and Research Center (WWRC), Doha, Qatar. The medical files (n = 220) of ventilated preterm infants with gestational age ranging between 28 weeks 0 days and 36 weeks + 6 days gestation and extubated to non-invasive respiratory support (whether NCPAP, NIPPV, or Nasal Cannula) during the period from January 2016 to December 2017 were reviewed. Results From the study group of 220 babies, n = 97 (44%) babies were extubated to CPAP, n = 77 (35%) were extubated to NIPPV, and n = 46 (21%) babies were extubated to Nasal Cannula (NC). Out of the n = 220 babies, 18 (8.2%) were reintubated within 1 week after extubation. 14 of the 18 (77.8%) were reintubated within 48 h of extubation. Eleven babies needed reintubation after being extubated to NCPAP (11.2%) and seven were reintubated after extubation to NIPPV (9.2%), none of those who were extubated to NC required reintubation (P = 0.203). The reintubation rate was not affected by extubation to any form of non-invasive ventilation (P = 0.625). The mode of ventilation before extubation does not affect the reintubation rate (P = 0.877). The presence of PDA and NEC was strongly associated with reintubation which increased by two and four-folds respectively in those morbidities. There is an increased risk of reintubation with babies suffering from NEC and BPD and this was associated with an increased risk of hospital stay with a P-value ranging (from 0.02–0.003). Using multivariate logistic regression, NEC the NEC (OR = 5.52, 95% CI 1.26, 24.11, P = 0.023) and the vaginal delivery (OR = 0.23, 95% CI 0.07, 0.78, P = 0.018) remained significantly associated with reintubation. Conclusion Reintubation rates were less with NIPPV when compared with NCPAP, however, this difference was not statistically significant. This study highlights the need for further research studies with a larger number of neonates in different gestational ages birth weight categories. Ascertaining this information will provide valuable data for the factors that contribute to re-intubation rates and influence the decision-making and management of RDS patients in the future.

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