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Papagianis PC, Noble PB, Ahmadi-Noorbakhsh S, Savigni D, Moss TJM, Pillow JJ. Postnatal steroids as lung protective and anti-inflammatory in preterm lambs exposed to antenatal inflammation. Pediatr Res 2024; 95:931-940. [PMID: 38066248 DOI: 10.1038/s41390-023-02911-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Lung inflammation and impaired alveolarization precede bronchopulmonary dysplasia (BPD). Glucocorticoids are anti-inflammatory and reduce ventilator requirements in preterm infants. However, high-dose glucocorticoids inhibit alveolarization. The effect of glucocorticoids on lung function and structure in preterm newborns exposed to antenatal inflammation is unknown. We hypothesise that postnatal low-dose dexamethasone reduces ventilator requirements, prevents inflammation and BPD-like lung pathology, following antenatal inflammation. METHODS Pregnant ewes received intra-amniotic LPS (E.coli, 4 mg/mL) or saline at 126 days gestation; preterm lambs were delivered 48 h later. Lambs were randomised to receive either tapered intravenous dexamethasone (LPS/Dex, n = 9) or saline (LPS/Sal, n = 10; Sal/Sal, n = 9) commencing <3 h after birth. Respiratory support was gradually de-escalated, using a standardised protocol aimed at weaning from ventilation towards unassisted respiration. Tissues were collected at day 7. RESULTS Lung morphology and mRNA levels for inflammatory mediators were measured. Respiratory support requirements were not different between groups. Histological analyses revealed higher tissue content and unchanged alveolarization in LPS/Sal compared to other groups. LPS/Dex lambs exhibited decreased markers of pulmonary inflammation compared to LPS/Sal. CONCLUSION Tapered low-dose dexamethasone reduces the impact of antenatal LPS on ventilation requirements throughout the first week of life and reduces inflammation and pathological thickening of the preterm lung IMPACT: We are the first to investigate the combination of antenatal inflammation and postnatal dexamethasone therapy in a pragmatic study design, akin to contemporary neonatal care. We show that antenatal inflammation with postnatal dexamethasone therapy does not reduce ventilator requirements, but has beneficial maturational impacts on the lungs of preterm lambs at 7 days of life. Appropriate tapered postnatal dexamethasone dosing should be explored for extuabtion of oxygen-dependant neonates.
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Affiliation(s)
- Paris C Papagianis
- Department of Pharmacology, School of Medicine, Nursing and Health Sciences, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.
| | - Peter B Noble
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
| | | | - Donna Savigni
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Timothy J M Moss
- Department of Obstetrics and Gynaecology, School of Clinical Health Sciences, Monash University, Clayton, VIC, Australia
| | - J Jane Pillow
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
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2
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Cupido DT, de Beer C. Screening for viral pathogens in the gastrointestinal tract from cases of sudden unexpected death in infancy at the Tygerberg Medico-legal Mortuary. Virol J 2023; 20:281. [PMID: 38031160 PMCID: PMC10688011 DOI: 10.1186/s12985-023-02249-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
Sudden and unexpected death in infancy (SUDI) may be triggered by an external risk or exposure. Intestinal infections with enteric viruses may disrupt the gut and enhance bacterial toxins present in SUDI cases. While diarrhoeal disease deaths have decreased worldwide, approximately half a million deaths still occur in children in Sub- Saharan Africa and South Asia. Furthermore, the role of viral enteropathogens in SUDI cases have not been investigated. The aim of this study was to describe specific viral pathogens in stool samples collected from SUDI cases and age-matched, apparently healthy infants in Cape Town, South Africa. Stool samples were collected from 176 SUDI cases between June 2017 and May 2018. In addition, stool samples were collected from the nappies of 30 age-matched, apparently healthy infants as a control group. Real-time polymerase chain reaction was performed on the stool samples for viral detection. A total of 111 SUDI cases were positive for viruses, with rotavirus (38.6%; 68/176) and norovirus GI and GII (30.0%; 53/176) were prevalent in SUDI cases. Adenovirus Type F was present in only 15.9% (28/176), astrovirus in 9.7% (17/176), and sapovirus in 0.6% (1/176) of cases. In the control samples, norovirus GII was detected most frequently (36.7%; 11/30), followed by rotavirus (33.3%; 10/30), and sapovirus in 6.7% (2/30). While there was no significant association between SUDI cases and enteric viruses, the majority of viruses were significantly associated with the seasons. The study confirms the importance of rotavirus vaccination and describes the significance of norovirus infection in children, post rotavirus vaccine introduction.
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Affiliation(s)
- Danielle T Cupido
- Division of Medical Virology, Department of Pathology, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - Corena de Beer
- Division of Medical Virology, Department of Pathology, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
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3
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Vincent A, Chu NT, Shah A, Avanthika C, Jhaveri S, Singh K, Limaye OM, Boddu H. Sudden Infant Death Syndrome: Risk Factors and Newer Risk Reduction Strategies. Cureus 2023; 15:e40572. [PMID: 37465778 PMCID: PMC10351748 DOI: 10.7759/cureus.40572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
Sudden infant death syndrome (SIDS) continues to be one of the top causes of infant death in the U.S. Despite significant public health initiatives focused on high-risk populations to enhance sleep environments and techniques. The SIDS rate has remained stable in recent years. Risk factors and newer risk reduction strategies for SIDS are the focus of this review article. We conducted a comprehensive literature search on Medline, Cochrane, Embase, and Google Scholar until July 2022. The following search strings and Medical Subject Heading (MeSH) terms were used: "SIDS," "Sudden Infant Death" and "SUID". We explored the literature on SIDS for its epidemiology, pathophysiology, the role of various etiologies and their influence, associated complications leading to SIDS, and preventive and treatment modalities. Despite a more than 50% drop-in rates since the start of the "Back to Sleep" campaign in 1994, sudden infant death syndrome (SIDS) continues to be the top cause of post-neonatal mortality in the United States, despite continued educational initiatives that support safe sleep and other risk reduction strategies. The new American Academy of Pediatrics guidelines for lowering the risk of SIDS include a lot of emphasis on sleeping habits, bedding, and environment but also include elements that are frequently ignored (i.e., prenatal care, smoking, alcohol and drug use, and childhood vaccinations). This study highlights these less-frequently discussed aspects and identifies treatments that have produced beneficial behavioral shifts that benefit newborns as well as their mothers' health and wellbeing.
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Affiliation(s)
- Anita Vincent
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Ngan Thy Chu
- Paediatrics, City Children's Hospital, Ho Chi Minh city, VNM
| | - Aashka Shah
- Paediatrics and Child Health, Pramukhswami Medical College, Karamsad, Anand, IND
| | - Chaithanya Avanthika
- Pediatrics, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Sharan Jhaveri
- Medicine and Surgery, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College (NHLMMC), Ahmedabad, IND
| | - Kunika Singh
- Paediatrics, Xinjiang Medical University, Xinjiang, CHN
| | - Om M Limaye
- Paediatrics, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, IND
| | - Himasaila Boddu
- Paediatrics, Dr. Pinnamaneni Siddartha Institute of Medical Sciences and Research Foundation, Krishna, IND
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4
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Pulmonary immune profiling of SIDS: impaired immune maturation and age-related cytokine imbalance. Pediatr Res 2022; 93:1239-1249. [PMID: 35986144 PMCID: PMC10132963 DOI: 10.1038/s41390-022-02203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/26/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND For sudden infant death syndrome (SIDS), an impaired immunocompetence has been discussed for a long time. Cytokines and chemokines are soluble immune mediators (SIM) whose balance is essential for the immune status. We hypothesized that an imbalanced immune response might contribute to the etiology of SIDS. METHODS We investigated 27 cytokines, chemokines, and growth factors in protein lysates of lungs derived from 29 SIDS cases and 15 control children deceased for other reasons. RESULTS Except for the CCL5, no significant differences were detected in the lungs between SIDS cases with and without mild upper respiratory tract infections. In contrast, IL-1RA, IL-7, IL-13, and G-CSF were decreased in the merged SIDS cases compared to control cases without evidence of infection. Plotting SIM concentrations against infant age resulted in increasing concentrations in control but not in SIDS lungs, indicating a disturbed immune maturation. Moreover, an age-dependent shift towards a Th2-related pattern was observed in SIDS. CONCLUSIONS Our findings suggest that an impaired maturation of the immune system, an insufficient response to respiratory pathogens, and an immune response modulated by Th1/Th2 imbalance might play a possible role in triggering SIDS. These findings might in part be explained by chronic stress. IMPACT Maturation of the cytokine and chemokine network may be impaired in SIDS. An imbalance between Th1- and Th2-related cytokines, which may reflect a state of chronic stress causing a more Th2 shift. An impaired immune maturation, an insufficient response to respiratory pathogens, and an immune response modulated by Th1/Th2 imbalance might play a possible role in SIDS.
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5
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Iregbu K, Dramowski A, Milton R, Nsutebu E, Howie SRC, Chakraborty M, Lavoie PM, Costelloe CE, Ghazal P. Global health systems' data science approach for precision diagnosis of sepsis in early life. THE LANCET. INFECTIOUS DISEASES 2022; 22:e143-e152. [PMID: 34914924 DOI: 10.1016/s1473-3099(21)00645-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/29/2022]
Abstract
Neonates and children in low-income and middle-income countries (LMICs) contribute to the highest number of sepsis-associated deaths globally. Interventions to prevent sepsis mortality are hampered by a lack of comprehensive epidemiological data and pathophysiological understanding of biological pathways. In this review, we discuss the challenges faced by LMICs in diagnosing sepsis in these age groups. We highlight a role for multi-omics and health care data to improve diagnostic accuracy of clinical algorithms, arguing that health-care systems urgently need precision medicine to avoid the pitfalls of missed diagnoses, misdiagnoses, and overdiagnoses, and associated antimicrobial resistance. We discuss ethical, regulatory, and systemic barriers related to the collection and use of big data in LMICs. Technologies such as cloud computing, artificial intelligence, and medical tricorders might help, but they require collaboration with local communities. Co-partnering (joint equal development of technology between producer and end-users) could facilitate integration of these technologies as part of future care-delivery systems, offering a chance to transform the global management and prevention of sepsis for neonates and children.
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Affiliation(s)
- Kenneth Iregbu
- Department of Medical Microbiology, National Hospital Abuja, Nigeria
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Emmanuel Nsutebu
- Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Stephen R C Howie
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | | | - Pascal M Lavoie
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Ceire E Costelloe
- Global Digital Health Unit, School of Public Health, Imperial College London, London, UK
| | - Peter Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK.
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6
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Goldwater PN. The Science (or Nonscience) of Research Into Sudden Infant Death Syndrome (SIDS). Front Pediatr 2022; 10:865051. [PMID: 35498810 PMCID: PMC9051368 DOI: 10.3389/fped.2022.865051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED This Viewpoint paper presents a timely and constructive critique of mainstream SIDS research. It is concerning that twenty-first century medical science has not provided an answer to the tragic enigma of SIDS. The paper helps explain why this is so and illustrates possible shortcomings in the investigation of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID) by mainstream researchers. Mainstream findings are often based on questionable and dogmatic assumptions that return to founding notions such as the Triple Risk Hypothesis and the contention that the mechanisms underlying SIDS/SUID are heterogeneous in nature. The paper illustrates how the pathological findings in SIDS have been under-investigated (or ignored) and that key epidemiological risk factors have slipped from memory. This apparent amnesia has resulted in failure to use these established SIDS facts to substantiate the significance of various neuropathological, neurochemical, or other research findings. These unsupported findings and their derivative hypotheses are therefore ill-founded and lack scientific rigor. CONCLUSION The deficits of SIDS "science" revealed in this paper explain why the SIDS enigma has not yet been solved. To make progress in understanding SIDS, it is important that researchers, as scientists, uphold standards of research. Encouragement for new directions of research is offered.
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Affiliation(s)
- Paul Nathan Goldwater
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Is There a Role for the Microbiome and Sudden Death? A Systematic Review. Life (Basel) 2021; 11:life11121345. [PMID: 34947876 PMCID: PMC8706612 DOI: 10.3390/life11121345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background. Sudden unexpected death (SUD) is one of the most important and worthy investigation case profiles in emergency medicine and forensic pathology. Sudden unexpected deaths in adults (SUDA) are frequently caused by cardiac events, while infections usually cause those in infants younger than one year (SUDI), and to a lesser extent, in children older than one year (SUDC). However, in some instances of children under the age of one dying (SIDS), a cause is not discovered despite a thorough investigation that includes a review of clinical history, examination of the death scene, and a complete autopsy. Several studies demonstrate that the microbiome influences host immunity, alters susceptibility to viral respiratory infections, and has a vital role in various health, disease, and death outcomes. The main objective of this systematic review was to compile and offer a complete vision of the main lines of research on microbiome and sudden death that have emerged in recent years and their relationship with forensic sciences, as well as the possible contributions or limitations in the field of forensic sciences. Methods. Following PRISMA principles, a systematic evaluation of the microbiome and sudden death in forensic science was conducted. In this review, our study classified the sudden deaths as SUDA, SUDI, and SIDS. Results. The role of microbiome research in sudden death is discussed in this review. Various studies have linked the detection of different bacteria or viruses as a probable cause of sudden death. Bacteria analysed differ between studies that used autopsy specimens from deaths classified as SUDA, SUDI, and SIDS, or, except in the case of Staphylococcus aureus and Escherichia coli, which have been analysed in both SUDI and SIDS autopsies. In the case of viruses, only Cytomegalovirus has been analysed in both SIDS and SUDI cases. However, all the viruses studied are respiratory viruses found in samples of nasopharyngeal or lung fluid. Conclusions. Although the application of the microbiome in sudden death and other fields of forensic science is still in its early stages, a role of the microbiome in sudden deaths cannot be ruled out, but we cannot conclude that it is a significant factor either.
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8
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Goldwater PN. A mouse zoonotic virus (LCMV): A possible candidate in the causation of SIDS. Med Hypotheses 2021; 158:110735. [PMID: 34801792 DOI: 10.1016/j.mehy.2021.110735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/06/2021] [Accepted: 11/03/2021] [Indexed: 12/26/2022]
Abstract
Lymphocytic choriomeningitis virus (LCMV) is a ubiquitous virus carried by rodents. It causes human disease through contact with infectious mouse faeces, urine or secretions. The virus initially infects the human respiratory tract and lungs and produces typical viral symptoms and signs. The infection is usually self-limiting and recovery is the norm. A small proportion of individuals may develop aseptic meningitis. It is hypothesised that in infancy the virus may cause respiratory tract infection through contact with mouse excreta. The infection could activate production of staphylococcal enterotoxin in babies who are colonised by Staphylococcus aureus. Indeed, a mouse animal model has shown that the combination of LCMV infection and introduction of enterotoxin B produces fatal haematogenous shock. Neither agent alone is lethal. Pathological (and physiological) evidence indicates shock could be the underlying terminal event in SIDS (the observed tissue damage seen in the heart and diaphragmatic muscles, and apoptosis observed in the brain and brainstem of SIDS cases). These features are consistent with a haematogenous shock event. The epidemiology of SIDS is entirely consistent with a mouse-related viral zoonosis. Moreover, rural cases of SIDS tend to feature more often than urban cases and their occurrence would be consistent with the dynamics of mouse populations. Low socioeconomic living conditions (a major risk factor for SIDS) is consistent with prevalence of mouse populations and poor hygienic conditions, with overcrowding. Prone sleeping would facilitate aspiration or ingestion of infectious material from contaminated surfaces. and poor hygienic conditions, with overcrowding, and prone sleeping would facilitate aspiration or ingestion of infectious material from contaminated surfaces. The epidemiology and pathology of SIDS and the dynamics and ubiquity of mouse populations together with human serological data would support the hypothesis that LCMV is a potential candidate as a key factor in the causation of SIDS.
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Affiliation(s)
- Paul N Goldwater
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia.
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9
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Vitaliti G, Falsaperla R. Chorioamnionitis, Inflammation and Neonatal Apnea: Effects on Preterm Neonatal Brainstem and on Peripheral Airways: Chorioamnionitis and Neonatal Respiratory Functions. CHILDREN-BASEL 2021; 8:children8100917. [PMID: 34682182 PMCID: PMC8534519 DOI: 10.3390/children8100917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
Background: The present manuscript aims to be a narrative review evaluating the association between inflammation in chorioamnionitis and damage on respiratory centers, peripheral airways, and lungs, explaining the pathways responsible for apnea in preterm babies born by delivery after chorioamnionitis. Methods: A combination of keywords and MESH words was used, including: "inflammation", "chorioamnionitis", "brainstem", "cytokines storm", "preterm birth", "neonatal apnea", and "apnea physiopathology". All identified papers were screened for title and abstracts by the two authors to verify whether they met the proper criteria to write the topic. Results: Chorioamnionitis is usually associated with Fetal Inflammatory Response Syndrome (FIRS), resulting in injury of brain and lungs. Literature data have shown that infections causing chorioamnionitis are mostly associated with inflammation and consequent hypoxia-mediated brain injury. Moreover, inflammation and infection induce apneic episodes in neonates, as well as in animal samples. Chorioamnionitis-induced inflammation favors the systemic secretion of pro-inflammatory cytokines that are involved in abnormal development of the respiratory centers in the brainstem and in alterations of peripheral airways and lungs. Conclusions: Preterm birth shows a suboptimal development of the brainstem and abnormalities and altered development of peripheral airways and lungs. These alterations are responsible for reduced respiratory control and apnea. To date, mostly animal studies have been published. Therefore, more clinical studies on the role of chorioamninitis-induced inflammation on prematurity and neonatal apnea are necessary.
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Affiliation(s)
- Giovanna Vitaliti
- Unit of Pediatrics, Department of Medical Sciences, Section of Pediatrics, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-34-0471-0614
| | - Raffaele Falsaperla
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico G.Rodolico-San Marco, San Marco Hospital, University of Catania, 95124 Catania, Italy;
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Policlinico G.Rodolico-San Marco, San Marco Hospital, San Marco Hospital, University of Catania, 95124 Catania, Italy
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10
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Booth J, Margetts B, Bryant W, Issitt R, Hutchinson C, Martin N, Sebire NJ. Machine Learning Approaches to Determine Feature Importance for Predicting Infant Autopsy Outcome. Pediatr Dev Pathol 2021; 24:351-360. [PMID: 33781121 DOI: 10.1177/10935266211001644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Sudden unexpected death in infancy (SUDI) represents the commonest presentation of postneonatal death. We explored whether machine learning could be used to derive data driven insights for prediction of infant autopsy outcome. METHODS A paediatric autopsy database containing >7,000 cases, with >300 variables, was analysed by examination stage and autopsy outcome classified as 'explained (medical cause of death identified)' or 'unexplained'. Decision tree, random forest, and gradient boosting models were iteratively trained and evaluated. RESULTS Data from 3,100 infant and young child (<2 years) autopsies were included. Naïve decision tree using external examination data had performance of 68% for predicting an explained death. Core data items were identified using model feature importance. The most effective model was XG Boost, with overall predictive performance of 80%, demonstrating age at death, and cardiovascular and respiratory histological findings as the most important variables associated with determining medical cause of death. CONCLUSION This study demonstrates feasibility of using machine-learning to evaluate component importance of complex medical procedures (paediatric autopsy) and highlights value of collecting routine clinical data according to defined standards. This approach can be applied to a range of clinical and operational healthcare scenarios.
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Affiliation(s)
- John Booth
- Great Ormond Street Hospital, Great Ormond Street Hospital Institute of Child Health and NIHR GOSH BRC, London, UK
| | - Ben Margetts
- Great Ormond Street Hospital, Great Ormond Street Hospital Institute of Child Health and NIHR GOSH BRC, London, UK
| | - Will Bryant
- Great Ormond Street Hospital, Great Ormond Street Hospital Institute of Child Health and NIHR GOSH BRC, London, UK
| | - Richard Issitt
- Great Ormond Street Hospital, Great Ormond Street Hospital Institute of Child Health and NIHR GOSH BRC, London, UK
| | - Ciaran Hutchinson
- Great Ormond Street Hospital, Great Ormond Street Hospital Institute of Child Health and NIHR GOSH BRC, London, UK
| | - Nigel Martin
- Department of Computer Science and Information Systems, Birkbeck University of London, London, UK
| | - Neil J Sebire
- Great Ormond Street Hospital, Great Ormond Street Hospital Institute of Child Health and NIHR GOSH BRC, London, UK
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11
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Gates L, Klein NJ, Sebire NJ, Alber DG. Characterising Post-mortem Bacterial Translocation Under Clinical Conditions Using 16S rRNA Gene Sequencing in Two Animal Models. Front Microbiol 2021; 12:649312. [PMID: 34135873 PMCID: PMC8200633 DOI: 10.3389/fmicb.2021.649312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
Sudden unexpected death in infancy (SUDI) is the sudden and unexpected death of an apparently healthy infant occurring within the first year of life where the cause is not immediately obvious. It is believed that a proportion of unexplained infant deaths are due to an infection that remains undiagnosed. The interpretation of post-mortem microbiology results is difficult due to the potential false-positives, a source of which is post-mortem bacterial translocation. Post-mortem bacterial translocation is the spread of viable bacteria from highly colonised sites to extra-intestinal tissues. We hypothesise that although post-mortem bacterial translocation occurs, when carcasses are kept under controlled routine clinical conditions it is not extensive and can be defined using 16S rRNA gene sequencing. With this knowledge, implementation of the 16S rRNA gene sequencing technique into routine clinical diagnostics would allow a more reliable retrospective diagnosis of ante-mortem infection. Therefore, the aim of this study was to establish the extent of post-mortem bacterial translocation in two animal models to establish a baseline sequencing signal for the post-mortem process. To do this we used 16S rRNA gene sequencing in two animal models over a 2 week period to investigate (1) the bacterial community succession in regions of high bacterial colonisation, and (2) the bacterial presence in visceral tissues routinely sampled during autopsy for microbiological investigation. We found no evidence for significant and consistent post-mortem bacterial translocation in the mouse model. Although bacteria were detected in tissues in the piglet model, we did not find significant and consistent evidence for post-mortem bacterial translocation from the gastrointestinal tract or nasal cavity. These data do not support the concept of significant post-mortem translocation as part of the normal post-mortem process.
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Affiliation(s)
- Lily Gates
- Department of Infection, Immunity and Inflammation, University College London Institute of Child Health, London, United Kingdom
| | - Nigel J Klein
- Department of Infection, Immunity and Inflammation, University College London Institute of Child Health, London, United Kingdom
| | - Neil J Sebire
- Histopathology, Great Ormond Street Hospital, London, United Kingdom
| | - Dagmar G Alber
- Department of Infection, Immunity and Inflammation, University College London Institute of Child Health, London, United Kingdom
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12
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Saegeman V, Cohen MC, Burton JL, Martinez MJ, Rakislova N, Offiah AC, Fernandez-Rodriguez A. Microbiology in minimally invasive autopsy: best techniques to detect infection. ESGFOR (ESCMID study group of forensic and post-mortem microbiology) guidelines. Forensic Sci Med Pathol 2021; 17:87-100. [PMID: 33464531 PMCID: PMC7814172 DOI: 10.1007/s12024-020-00337-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/20/2022]
Abstract
This manuscript aims to: 1) provide specific guidelines on PMM techniques in the setting of minimally invasive autopsy (MIA), both for pathologists collecting samples and for microbiologists advising pathologists and interpreting the results and 2) introduce standardization in PMM sampling at MIA. Post-mortem microbiology (PMM) is crucial to identify the causative organism in deaths due to infection. MIA including the use of post-mortem (PM) computed tomography (CT) and PM magnetic resonance imaging (MRI), is increasingly carried out as a complement or replacement for the traditional PM. In this setting, mirroring the traditional autopsy, PMM aims to: detect infectious organisms causing sudden unexpected deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical diagnostic errors. Meaningful interpretation of PMM results requires careful evaluation in the context of the clinical history, macroscopic and microscopic findings.
These guidelines were developed by a multidisciplinary team with experts in various fields of microbiology and pathology on behalf of the ESGFOR (ESCMID – European Society of Clinical Microbiology and Infectious Diseases - Study Group of Forensic and Post-mortem Microbiology, in collaboration with the ESP -European Society of Pathology-) based on a literature search and the author’s expertise. Microbiological sampling methods for MIA are presented for various scenarios: adults, children, developed and developing countries. Concordance between MIA and conventional invasive autopsy is substantial for children and adults and moderate for neonates and maternal deaths. Networking and closer collaboration among microbiologists and pathologists is vital to maximize the yield of PMM in MIA.
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Affiliation(s)
- Veroniek Saegeman
- Clinical Laboratory, Sint-Niklaas, and Infection Control Department, AZ Nikolaas, University Hospitals Leuven, Moerlandstraat 1Herestraat 49, 91003000, Leuven, Belgium
| | - Marta C Cohen
- FT. Histopathology Department. Western Bank, Sheffield Children's Hospital NHS, Sheffield, S10 2TH, UK
| | | | - Miguel J Martinez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amaka C Offiah
- Department of Oncology and Metabolism, Department of Radiology, Academic Unit of Child Health, Sheffield Children's NHS FT, University of Sheffield, Sheffield, UK
| | - Amparo Fernandez-Rodriguez
- Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas de Madrid, Madrid, Spain.
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13
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Comprehensive Detection of Candidate Pathogens in the Lower Respiratory Tract of Pediatric Patients With Unexpected Cardiopulmonary Deterioration Using Next-Generation Sequencing. Pediatr Crit Care Med 2020; 21:e1026-e1030. [PMID: 32956172 DOI: 10.1097/pcc.0000000000002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Next-generation sequencing has been applied to the investigation of microorganisms in several clinical settings. We investigated the infectious etiologies in respiratory specimens from pediatric patients with unexpected cardiopulmonary deterioration using next-generation sequencing. DESIGN Retrospective, single-center, observational study. SETTING Tertiary care, a children's hospital. SUBJECTS The study enrolled a total of 16 pediatric patients with unexpected cardiopulmonary deterioration who were admitted to the PICU. Ten bronchoalveolar lavage fluid and six transtracheal aspirate samples were analyzed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS RNA libraries were prepared from specimens and analyzed using next-generation sequencing. One or more bacterial/viral pathogens were detected in the bronchoalveolar lavage fluid or transtracheal aspirate specimens from 10 patients. Bacterial and viral coinfection was considered in four cases. Compared with the conventional culture and viral antigen test results, an additional six bacterial and four viral pathogens were identified by next-generation sequencing. Conversely, among 18 pathogens identified by the conventional methods, nine pathogens were detected by next-generation sequencing. Candidate pathogens (e.g., coxsackievirus A6 and Chlamydia trachomatis) were detected by next-generation sequencing in four of 10 patients in whom no causative pathogen had been identified by conventional methods. CONCLUSIONS Our results suggest that viral and bacterial infections are common triggers in unexpected cardiopulmonary deterioration in pediatric patients. Next-generation sequencing has the potential to contribute to clarification of the etiology of pediatric critical illness.
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14
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Goldwater PN, Kelmanson IA, Little BB. Increased thymus weight in sudden infant death syndrome compared to controls: The role of sub-clinical infections. Am J Hum Biol 2020; 33:e23528. [PMID: 33107139 DOI: 10.1002/ajhb.23528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The goal of the present investigation is to analyze thymus, brain, heart, liver, and kidney weights in SIDS victims compared to controls. BACKGROUND Epidemiologic risk factors for SIDS (eg, male gender, genetic, obstetric, environmental, smoke exposure, nonbreastfeeding, etc.) are consistent with an infectious process underlying many of these deaths. METHODS Data from autopsy reports on 585 SIDS victims and comparison deaths (n = 294 control, n = 291 SIDS) were analyzed. Cases were obtained from Australia (n = 184 controls, n = 98 SIDS) and Russia (n = 122 controls, n = 181 SIDS). Log10 transform of thymus and other organ weights was computed because variables were skewed. Multivariate analysis of variance (MANOVA) of standardized log values were age-adjusted by multivariate analysis of covariance (MANCOVA). The standardized log10 thymus residual adjusted for age, brain and liver weights was computed for the final analysis. RESULTS After controlling for age by MANCOVA, thymus, body, brain and liver weights were significantly higher among SIDS compared to non-SIDS victims. The largest difference as between covariate-adjusted log10 non-SIDS thymus weight differed (mean = 1.423, 95% CI: 1.393-1.452) and log10 non-SIDS thymus weight (mean = 1.269, 95% CI: 1.243-1.294) were significantly different (P < .0001). Heart weight was significantly lower in SIDS victims. DISCUSSION When adjusted for confounders (age, body, and organ weights), SIDS victims have a significantly heavier thymus and brain compared to non-SIDS controls who died of trauma. This finding supports previously published studies that link infection to SIDS deaths.
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Affiliation(s)
- Paul Nathan Goldwater
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Igor A Kelmanson
- Department of Children's Diseases, St. Petersburg State Institute of Psychology and Social Work, Institute for Medical Education of the V.A. Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Bertis B Little
- Health Management and Systems Science, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA
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15
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Lewis C, Hutchinson JC, Riddington M, Hill M, Arthurs OJ, Fisher J, Wade A, Doré CJ, Chitty LS, Sebire NJ. Minimally invasive autopsy for fetuses and children based on a combination of post-mortem MRI and endoscopic examination: a feasibility study. Health Technol Assess 2020; 23:1-104. [PMID: 31461397 DOI: 10.3310/hta23460] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Less invasive perinatal and paediatric autopsy methods, such as imaging alongside targeted endoscopy and organ biopsy, may address declining consent rates for traditional autopsy, but their acceptability and accuracy are not known. OBJECTIVES The aims of this study were to provide empirical data on the acceptability and likely uptake for different types of autopsy among key stakeholders (study 1); and to analyse existing autopsy data sources to provide estimates of the potential efficacy of less invasive autopsy (LIA) and its projected utility in clinical practice (study 2). REVIEW METHODS Study 1: this was a mixed-methods study. Parents were involved in research design and interpretation of findings. Substudy 1: a cross-sectional survey of 859 parents who had experienced miscarriage, termination of pregnancy for fetal anomaly, stillbirth, infant or child death, and interviews with 20 responders. Substudy 2: interviews with 25 health professionals and four coroners. Substudy 3: interviews with 16 religious leaders and eight focus groups, with 76 members of the Muslim and Jewish community. Study 2: a retrospective analysis of national data in addition to detailed information from an existing in-house autopsy database of > 5000 clinical cases that had undergone standard autopsy to determine the proportion of cases by clinical indication group for which tissue sampling of specific internal organs significantly contributed to the diagnosis. RESULTS Substudy 1: 91% of participants indicated that they would consent to some form of LIA, 54% would consent to standard autopsy, 74% to minimally invasive autopsy (MIA) and 77% to non-invasive autopsy (NIA). Substudy 2: participants viewed LIA as a positive development, but had concerns around the limitations of the technology and de-skilling the workforce. Cost implications, skills and training requirements were identified as implementation challenges. Substudy 3: religious leaders agreed that NIA was religiously permissible, but MIA was considered less acceptable. Community members indicated that they might consent to NIA if the body could be returned for burial within 24 hours. Study 2: in 5-10% of cases of sudden unexplained death in childhood and sudden unexplained death in infants, the final cause of death is determined by routine histological sampling of macroscopically normal organs, predominantly the heart and lungs, and in this group routine histological sampling therefore remains an important aspect of investigation. In contrast, routine histological examination of macroscopically normal organs rarely (< 0.5%) provides the cause of death in fetal cases, making LIA and NIA approaches potentially highly applicable. LIMITATIONS A key limitation of the empirical research is that it is hypothetical. Further research is required to determine actual uptake. Furthermore, because of the retrospective nature of the autopsy data set, findings regarding the likely contribution of organ sampling to final diagnosis are based on extrapolation of findings from historical autopsies, and prospective data collection is required to validate the conclusions. CONCLUSIONS LIA is viable and acceptable (except for unexplained deaths), and likely to increase uptake. Further health economic, performance and implementation studies are required to determine the optimal service configuration required to offer this as routine clinical care. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - John C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Angie Wade
- Institute of Child Health; Population, Policy and Practice, University College London, London, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
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16
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Goldwater PN. SIDS, prone sleep position and infection: An overlooked epidemiological link in current SIDS research? Key evidence for the "Infection Hypothesis". Med Hypotheses 2020; 144:110114. [PMID: 32758900 PMCID: PMC7366103 DOI: 10.1016/j.mehy.2020.110114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
Mainstream researchers explain the etiology of SIDS with the cardiorespiratory paradigm. This has been the focus of intense study for many decades without providing consistent supporting data to link CNS findings to epidemiological risk factors or to the usual clinicopathological findings. Despite this, and the apparent oversight of the link between prone sleep position and respiratory infection, papers citing CNS, cardiac and sleep arousal findings continue to be published. Discovery of the prone sleep position risk factor provided tangential support for the cardiorespiratory control hypothesis which defines the mainstream approach. Despite many decades of research and huge expenditure, no aetiological answer has been forthcoming. In asking why?This paper exposes some of the shortcomings regarding this apparent oversight by mainstream SIDS researchers and examines the role of respiratory infection and puts the case for the “Infection Hypothesis.” In addition, the paper provides encouragement to neuropathologists to examine the potential link between CNS findings and cardiac function (as opposed to respiratory function) in relation to infection and to examine possible correlates between CNS findings and established risk factors such as recent infection, contaminated sleeping surfaces, maternal/obstetric/higher birth, ethnicity, non-breast-feeding, male gender, etc. or with the usual gross pathological findings of SIDS (intrathoracic petechial hemorrhages, liquid blood, congested lungs). The shortcomings exposed through this review invite questions over current research directions and hopefully encourage research into other more plausible hypotheses, such as the infection paradigm.Mainstream SIDS researchers appear to have overlooked the key relationship between prone sleep position and infection. This omission has major implications for current and future SIDS research.
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Affiliation(s)
- Paul N Goldwater
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia.
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17
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Nault S, Creuze V, Al-Omar S, Levasseur A, Nadeau C, Samson N, Imane R, Tremblay S, Carrault G, Pladys P, Praud JP. Cardiorespiratory Alterations in a Newborn Ovine Model of Systemic Inflammation Induced by Lipopolysaccharide Injection. Front Physiol 2020; 11:585. [PMID: 32625107 PMCID: PMC7311791 DOI: 10.3389/fphys.2020.00585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
Although it is well known that neonatal sepsis can induce important alterations in cardiorespiratory control, their detailed early features and the mechanisms involved remain poorly understood. As a first step in resolving this issue, the main goal of this study was to characterize these alterations more extensively by setting up a full-term newborn lamb model of systemic inflammation using lipopolysaccharide (LPS) injection. Two 6-h polysomnographic recordings were performed on two consecutive days on eight full-term lambs: the first after an IV saline injection (control condition, CTRL); the second, after an IV injection of 2.5 μg/kg Escherichia coli LPS 0127:B8 (LPS condition). Rectal temperature, locomotor activity, state of alertness, arterial blood gases, respiratory frequency and heart rate, mean arterial blood pressure, apneas and cardiac decelerations, and heart-rate and respiratory-rate variability (HRV and RRV) were assessed. LPS injection decreased locomotor activity (p = 0.03) and active wakefulness (p = 0.01) compared to the CTRL. In addition, LPS injection led to a biphasic increase in rectal temperature (p = 0.01 at ∼30 and 180 min) and in respiratory frequency and heart rate (p = 0.0005 and 0.005, respectively), and to an increase in cardiac decelerations (p = 0.05). An overall decrease in HRV and RRV was also observed. Interestingly, the novel analysis of the representations of the horizontal and vertical visibility network yielded the most statistically significant alterations in HRV structure, suggesting its potential clinical importance for providing an earlier diagnosis of neonatal bacterial sepsis. A second goal was to assess whether the reflexivity of the autonomic nervous system was altered after LPS injection by studying the cardiorespiratory components of the laryngeal and pulmonary chemoreflexes. No difference was found. Lastly, preliminary results provide proof of principle that brainstem inflammation (increased IL-8 and TNF-α mRNA expression) can be shown 6 h after LPS injection. In conclusion, this full-term lamb model of systemic inflammation reproduces several important aspects of neonatal bacterial sepsis and paves the way for studies in preterm lambs aiming to assess both the effect of prematurity and the central neural mechanisms of cardiorespiratory control alterations observed during neonatal sepsis.
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Affiliation(s)
- Stéphanie Nault
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Sally Al-Omar
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Annabelle Levasseur
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Charlène Nadeau
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nathalie Samson
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Roqaya Imane
- CHU Sainte-Justine Research Center, Departments of Neurosciences and Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sophie Tremblay
- CHU Sainte-Justine Research Center, Departments of Neurosciences and Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Guy Carrault
- Inserm, LTSI - UMR 1099, CHU Rennes, Université Rennes 1, Rennes, France
| | - Patrick Pladys
- Inserm, LTSI - UMR 1099, CHU Rennes, Université Rennes 1, Rennes, France
| | - Jean-Paul Praud
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
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18
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Dylag AM, Raffay TM. Rodent models of respiratory control and respiratory system development-Clinical significance. Respir Physiol Neurobiol 2019; 268:103249. [PMID: 31315068 DOI: 10.1016/j.resp.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/24/2019] [Accepted: 06/29/2019] [Indexed: 01/13/2023]
Abstract
The newborn infant's respiratory system must rapidly adapt to extra-uterine life. Neonatal rat and mouse models have been used to investigate early development of respiratory control and reactivity in both health and disease. This review highlights several rodent models of control of breathing and respiratory system development (including pulmonary function), discusses their translational strengths and limitations, and underscores the importance of creating clinically relevant models applicable to the human infant.
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Affiliation(s)
- Andrew M Dylag
- Division of Neonatology, Golisano Children's Hospital, Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Thomas M Raffay
- Division of Neonatology, Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States.
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19
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Tuchtan L, Delteil C, Levrat F, Bacquet J, Garcia P, Fayol L, Gorincour G, Zandotti C, Girard N, Drancourt M, Léonetti G, Piercecchi Marti MD, Bartoli C. Sudden unexpected infant death characteristics in the French region of West Provence-Alpes-Côte d'Azur. Paediatr Int Child Health 2019; 39:104-110. [PMID: 30382004 DOI: 10.1080/20469047.2018.1533734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Although the incidence of sudden unexpected infant death (SUID) has decreased since the 'Back to Sleep' campaign in English-speaking countries and other preventive campaigns, the circumstances of such deaths remain unclear. Aim: To analyse infant deaths recorded at the referral centre for sudden infant death of the West Provence-Alpes-Côte d'Azur region of France (West PACA) and the forensic medicine department of Marseille University Hospital. Methods: Information on all SUID cases from 2000 to 2017 was extracted from the referral centre for sudden infant deaths in West PACA and the forensic medicine department of Marseille. Results: The study included 130 infants over the 17 years with a very similar distribution. There was a marked male preponderance, with 61.6% of boys whatever the age at death (sex ratio 1.6). Half of the deaths occurred in the first 6 months of life and the majority (61%) of infants died during autumn and winter. Nearly one-third (33.2%) had presented with minor infections and 21% had been seen by a doctor or had been admitted to hospital. Most deaths (86.4%) occurred during sleep (night or day). Nearly half of the infants (47.7%) were discovered in a prone position. A large majority of parents (90.7%) agreed to a post-mortem examination. Only 6.2% of deaths led to legal proceedings. Nearly 16.9% remained unexplained after compiling all the data included in the protocol and 9.2% remained unexplained because of incomplete investigation, including refusal of post-mortem examination. Abuse was involved in 2.3% of cases. Conclusions: Asymptomatic infectious conditions were associated with a high proportion of SUID cases. Non-supine sleep positions were still practised. There is a need to increase SUID prevention campaigns. Abbreviations: HAS, Haute Autorité de Santé: French National Health Authority; NICHD, National Institute of Child Health and Human Development; PACA, Provence-Alpes-Côte d'Azur region of France; SUID, sudden unexpected infant death; SIDS, sudden infant death syndrome; CépiDc, Centre d'Epidémiologie sur les Causes Médicales de Décès/Center for Epidemiology on the Medical Causes of Death.
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Affiliation(s)
- Lucile Tuchtan
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Clémence Delteil
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Flore Levrat
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France
| | - Juliette Bacquet
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Patricia Garcia
- c Service de Néonatologie , APHM, Hôpital de la Conception , Marseille , France
| | - Laurence Fayol
- c Service de Néonatologie , APHM, Hôpital de la Conception , Marseille , France
| | - Guillaume Gorincour
- d Département d'Imagerie Médicale , APHM, Hôpital de la Timone , Marseille , France
| | - Christine Zandotti
- e Département de Microbiologie , APHM, Hôpital de la Timone , Marseille , France
| | - Nadine Girard
- d Département d'Imagerie Médicale , APHM, Hôpital de la Timone , Marseille , France
| | - Michel Drancourt
- e Département de Microbiologie , APHM, Hôpital de la Timone , Marseille , France
| | - Georges Léonetti
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Marie Dominique Piercecchi Marti
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
| | - Christophe Bartoli
- a Forensic Department , APHM, Hôpital de la Timone , Marseille , France.,b CNRS, EFS, ADES , Aix Marseille Université , Marseille , France
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20
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Mularski A, Żaba C. Fatal meningococcal meningitis in a 2-year-old child: A case report. World J Clin Cases 2019; 7:636-641. [PMID: 30863763 PMCID: PMC6406201 DOI: 10.12998/wjcc.v7.i5.636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/14/2019] [Accepted: 01/30/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In fatal cases of meningococcal septicemia, bacteriological diagnosis may not be straightforward due to postmortem replication and relocation of endogenic microflora. In medicolegal practice, aside from routine autopsy and histopathology, also other diagnostic methods, such as microbiological tests, immunohistochemistry and polymerase chain reaction (PCR), are used to examine body fluids and tissues.
CASE SUMMARY We present the case of sudden death in a 2-year-old child. The patient died approximately 30 min after hospital admission before any routine diagnostic procedures were undertaken. Presence of whole-body rash and fulminant course of the disease raised suspicion of meningococcal septicemia. An autopsy was performed seven days after death when the body showed the signs of late postmortem decomposition. No etiological factor of septicemia could be identified based on macro- and microscopic findings. However, PCR demonstrated the presence of genetic material of group W Neisseria meningitidis in patient’s cerebrospinal fluid and blood.
CONCLUSION Microbiological PCR should be conducted postmortem whenever a specific etiological factor could not be identified with conventional methods.
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Affiliation(s)
- Aleksander Mularski
- Department of Legal and Forensic Medicine, Poznan University of Medical Sciences, Poznan 60-781, Poland
| | - Czesław Żaba
- Institute of Forensic Research, Cracow 31-033, Poland
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21
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Ventura Spagnolo E, Stassi C, Mondello C, Zerbo S, Milone L, Argo A. Forensic microbiology applications: A systematic review. Leg Med (Tokyo) 2019; 36:73-80. [DOI: 10.1016/j.legalmed.2018.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/09/2018] [Accepted: 11/02/2018] [Indexed: 01/17/2023]
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22
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Hurtado JC, Quintó L, Castillo P, Carrilho C, Fernandes F, Jordao D, Lovane L, Navarro M, Casas I, Bene R, Nhampossa T, Santos Ritchie P, Bandeira S, Sambo C, Chicamba V, Mocumbi S, Jaze Z, Mabota F, Ismail MR, Lorenzoni C, Guisseve A, Rakislova N, Marimon L, Castrejon N, Sanz A, Cossa A, Mandomando I, Munguambe K, Maixenchs M, Muñoz-Almagro C, Macete E, Alonso P, Vila J, Bassat Q, Menéndez C, Martínez MJ, Ordi J. Postmortem Interval and Diagnostic Performance of the Autopsy Methods. Sci Rep 2018; 8:16112. [PMID: 30382145 PMCID: PMC6208334 DOI: 10.1038/s41598-018-34436-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/10/2018] [Indexed: 11/09/2022] Open
Abstract
Postmortem studies, including the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), an innovative approach to post-mortem sampling and cause of death investigation, are commonly performed within 24 hours after death because the quality of the tissues deteriorates over time. This short timeframe may hamper the feasibility of the procedure. In this study, we compared the diagnostic performance of the two postmortem procedures when carried out earlier and later than 24 hours after death, as well as the impact of increasing postmortem intervals (PMIs) on the results of the microbiological tests in a series of 282 coupled MIA/CDA procedures performed at the Maputo Central Hospital in Mozambique between 2013 and 2015. 214 procedures were conducted within 24 hours of death (early autopsies), and 68 after 24 hours of death (late autopsies). No significant differences were observed in the number of non-conclusive diagnoses (2/214 [1%] vs. 1/68 [1%] p = 0.5645 for the CDA; 27/214 [13%] vs. 5/68 [7%] p = 0.2332 for the MIA). However, increasing PMIs were associated with a raise in the number of bacteria identified (rate: 1.014 per hour [95%CI: 1.002–1.026]; p = 0.0228). This increase was mainly due to rising numbers of bacteria of the Enterobacteriaceae family and Pseudomonas genus strains. Thus, performing MIA or CDA more than 24 hours after death can still render reliable diagnostic results, not only for non-infectious conditions but also for many infectious diseases, although, the contribution of Enterobacteriaceae and Pseudomonas spp. as etiological agents of infections leading to death may be overestimated.
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Affiliation(s)
- Juan Carlos Hurtado
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Isaac Casas
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | | | | | - Sónia Bandeira
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Calvino Sambo
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Valeria Chicamba
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Sibone Mocumbi
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Zara Jaze
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Flora Mabota
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Assucena Guisseve
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Natalia Rakislova
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Natalia Castrejon
- Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Ariadna Sanz
- Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Khátia Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Carmen Muñoz-Almagro
- Department of Molecular Microbiology, University Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Faculty of Medicine, Univesitat Internacional de Catalunya, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Jordi Vila
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain. .,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
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23
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Kruger MM, Martin LJ, Maistry S, Heathfield LJ. A systematic review exploring the relationship between infection and sudden unexpected death between 2000 and 2016: A forensic perspective. Forensic Sci Int 2018; 289:108-119. [PMID: 29860163 DOI: 10.1016/j.forsciint.2018.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Abstract
Death due to infectious diseases is a major health concern worldwide. This is of particular concern in developing countries where poor-socio economic status and a lack of healthcare resources contribute to the high burden of disease. In some cases death due to infection can be acute and aggressive, and death may occur without a diagnosis whilst the person is still alive. These deaths may ultimately lead to a medico-legal autopsy being performed. There are various mechanisms by which sudden death due to infection may occur. In addition, there are many risk factors associated with sudden death due to infection, which differ between infants and older individuals. However, it is unclear which pathogens and risk factors are most frequently associated with sudden death due to infection. Therefore a systematic review of articles and case reports published between 1 January 2000 and 30 June 2016 was undertaken in order to (1) explore the relationship between pathogens and their causative role and (2) identify the relationship between predisposing and/or risk factors associated with sudden death due to infection. Major databases were searched and after critical appraisal 143 articles were identified. It was found that respiratory infections and deaths involving bacterial pathogens were most commonly associated with these deaths. In addition the most common risk factors in infants were exposure to tobacco smoke and co-sleeping. In adults the most common risk factors were co-morbid conditions and illnesses. This information aids in a better understanding of these deaths and highlights the need for more research in this field, particularly in developing countries.
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Affiliation(s)
- Mia M Kruger
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| | - Lorna J Martin
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| | - Sairita Maistry
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| | - Laura J Heathfield
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
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24
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Stojanovska V, Miller SL, Hooper SB, Polglase GR. The Consequences of Preterm Birth and Chorioamnionitis on Brainstem Respiratory Centers: Implications for Neurochemical Development and Altered Functions by Inflammation and Prostaglandins. Front Cell Neurosci 2018; 12:26. [PMID: 29449803 PMCID: PMC5799271 DOI: 10.3389/fncel.2018.00026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/17/2018] [Indexed: 11/16/2022] Open
Abstract
Preterm birth is a major cause for neonatal morbidity and mortality, and is frequently associated with adverse neurological outcomes. The transition from intrauterine to extrauterine life at birth is particularly challenging for preterm infants. The main physiological driver for extrauterine transition is the establishment of spontaneous breathing. However, preterm infants have difficulty clearing lung liquid, have insufficient surfactant levels, and underdeveloped lungs. Further, preterm infants have an underdeveloped brainstem, resulting in reduced respiratory drive. These factors facilitate the increased requirement for respiratory support. A principal cause of preterm birth is intrauterine infection/inflammation (chorioamnionitis), and infants with chorioamnionitis have an increased risk and severity of neurological damage, but also demonstrate impaired autoresuscitation capacity and prevalent apnoeic episodes. The brainstem contains vital respiratory centers which provide the neural drive for breathing, but the impact of preterm birth and/or chorioamnionitis on this brain region is not well understood. The aim of this review is to provide an overview of the role and function of the brainstem respiratory centers, and to highlight the proposed mechanisms of how preterm birth and chorioamnionitis may affect central respiratory functions.
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Affiliation(s)
- Vanesa Stojanovska
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
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25
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Leong LEX, Taylor SL, Shivasami A, Goldwater PN, Rogers GB. Intestinal Microbiota Composition in Sudden Infant Death Syndrome and Age-Matched Controls. J Pediatr 2017; 191:63-68.e1. [PMID: 29173325 DOI: 10.1016/j.jpeds.2017.08.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/25/2017] [Accepted: 08/24/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess whether features of the infant intestinal microbiome, including the carriage of toxigenic bacteria, are associated with sudden infant death syndrome (SIDS). STUDY DESIGN We undertook a case-controlled analysis of fecal microbiology in SIDS. Fecal material was obtained from 44 cases and 44 aged-matched controls. Microbiota composition was determined by 16S ribosomal RNA gene amplicon sequencing and comparisons between cases and controls made based on both bacterial alpha diversity measures and unconstrained ordination. Specific quantitative polymerase chain reaction assays were used to determine intestinal carriage of Staphylococcus aureus, toxigenic Clostridium difficile, and pathogenic and nonpathogenic Escherichia coli. RESULTS The microbial composition for the study population as a whole was consistent with previous studies of infants <12 months of age, with a correlation between alpha diversity and age (r2 = 0.08; P = .007). However, no difference was observed in alpha diversity between SIDS cases and controls (P > .4). Nonmetric multidimensional scaling also revealed no evidence of differences in microbiota dispersal between SIDS cases and controls (P = .4, permutational multivariate ANOVA test; Pseudo-F = 0.9), nor was a difference observed in microbiota dispersion (P = .19, PERMDISP test; F = 1.9). There were no significant intergroup differences in the carriage of S aureus, toxigenic C difficile, total E coli, or pathogenic E coli. CONCLUSIONS We found no evidence of an association between altered intestinal microbiology and SIDS, or to support the development of strategies to reduce the incidence of SIDS that target intestinal microbiology.
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Affiliation(s)
- Lex E X Leong
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Microbiome Research Laboratory, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Steven L Taylor
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Microbiome Research Laboratory, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Aravind Shivasami
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Microbiome Research Laboratory, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Paul N Goldwater
- School of Pediatrics and Reproductive Health, Discipline of Pediatrics, University of Adelaide, South Australia, Australia
| | - Geraint B Rogers
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Microbiome Research Laboratory, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
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26
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Abstract
Despite decades of investigation and millions of dollars spent, the cause of sudden infant death syndrome (SIDS) eludes researchers. It is timely therefore to reconsider the reasons for this failure and to explore how research might go forward with better prospects. This review assesses SIDS research in the context of clinicopathological and epidemiological features and determines that only infection attains congruence.
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27
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Goldwater PN. Sudden Infant Death Syndrome, Infection, Prone Sleep Position, and Vagal Neuroimmunology. Front Pediatr 2017; 5:223. [PMID: 29184885 PMCID: PMC5694444 DOI: 10.3389/fped.2017.00223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/04/2017] [Indexed: 12/16/2022] Open
Abstract
Recent findings suggest that infection (and sepsis) stand alone as the only plausible mechanism of causation of sudden infant death syndrome (SIDS) and accordingly achieves congruence with all clinicopathological and epidemiological findings. This review examines the role of infection in the pathogenesis of SIDS in the context of the major risk factor of prone sleep position. The study explores how sleep position could interact with the immune system and inflammatory response via vagal neural connections, which could play key roles in gut and immune homeostasis. A plausible and congruent clinicopathological and epidemiological paradigm is suggested.
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Affiliation(s)
- Paul Nathan Goldwater
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, North Adelaide, SA, Australia
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28
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Squier W, Mack J, Jansen AC. Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms. Dev Med Child Neurol 2016; 58:1223-1234. [PMID: 27435495 DOI: 10.1111/dmcn.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 01/01/2023]
Abstract
The cause of death in infants who die suddenly and unexpectedly (sudden unexpected death in infancy [SUDI]) remains a diagnostic challenge. Some infants have identified diseases (explained SUDI); those without explanation are called sudden infant death syndrome (SIDS). Demographic data indicate subgroups among SUDI and SIDS cases, such as unsafe sleeping and apparent life-threatening events. Infants dying suddenly with retinal and dural bleeding are often classified as abused, but in many there is no evidence of trauma. Demographic features suggest that they may represent a further subgroup of SUDI. This review examines the neuropathological hypotheses to explain SIDS and highlights the interaction of infant oxygen-conserving reflexes with the brainstem networks considered responsible for SIDS. We consider sex- and age-specific vulnerabilities related to dural bleeding and how sensitization of the dural innervation by bleeding may influence these reflexes, potentially leading to collapse or even death after otherwise trivial insults.
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Affiliation(s)
- Waney Squier
- Formerly Department of Neuropathology, Oxford University John Radcliffe Hospital, Oxford, UK
| | - Julie Mack
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Anna C Jansen
- Paediatric Neurology Unit, Department of Paediatrics, UZ Brussel, Brussels, Belgium.,Neurogenetics Research Unit, Vrije Universiteit Brussel, Brussels, Belgium
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29
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Schmiedeberg K, Krause H, Röhl FW, Hartig R, Jorch G, Brunner-Weinzierl MC. T Cells of Infants Are Mature, but Hyporeactive Due to Limited Ca2+ Influx. PLoS One 2016; 11:e0166633. [PMID: 27893767 PMCID: PMC5125607 DOI: 10.1371/journal.pone.0166633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/01/2016] [Indexed: 12/12/2022] Open
Abstract
CD4 T cells in human infants and adults differ in the initiation and strength of their responses. The molecular basis for these differences is not yet understood. To address this the principle key molecular events of TCR- and CD28-induced signaling in naive CD4 T cells, such as Ca2+ influx, NFAT expression, phosphorylation and translocation into the nucleus, ERK activation and IL-2 response, were analyzed over at least the first 3 years of life. We report dramatically reduced IL-2 and TNFα responses in naive CD31+ T cells during infancy. Looking at the obligatory Ca2+ influx required to induce T cell activation and proliferation, we demonstrate characteristic patterns of impairment for each stage of infancy that are partly due to the differential usage of Ca2+ stores. Consistent with those findings, translocation of NFATc2 is limited, but still dependent on Ca2+ influx as demonstrated by sensitivity to cyclosporin A (CsA) treatment. Thus weak Ca2+ influx functions as a catalyst for the implementation of restricted IL-2 response in T cells during infancy. Our studies also define limited mobilization of Ca2+ ions as a characteristic property of T cells during infancy. This work adds to our understanding of infants’ poor T cell responsiveness against pathogens.
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Affiliation(s)
- Kristin Schmiedeberg
- Department of Experimental Pediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Hardy Krause
- Clinic of Pediatric Surgery University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Friedrich-Wilhelm Röhl
- Institute of Biometry and Medical Informatics University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Roland Hartig
- Institute for Molecular and Clinical Immunology, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Gerhard Jorch
- Department of Experimental Pediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Monika C. Brunner-Weinzierl
- Department of Experimental Pediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
- * E-mail:
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30
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Asgari S, McLaren PJ, Peake J, Wong M, Wong R, Bartha I, Francis JR, Abarca K, Gelderman KA, Agyeman P, Aebi C, Berger C, Fellay J, Schlapbach LJ. Exome Sequencing Reveals Primary Immunodeficiencies in Children with Community-Acquired Pseudomonas aeruginosa Sepsis. Front Immunol 2016; 7:357. [PMID: 27703454 PMCID: PMC5028722 DOI: 10.3389/fimmu.2016.00357] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023] Open
Abstract
One out of three pediatric sepsis deaths in high income countries occur in previously healthy children. Primary immunodeficiencies (PIDs) have been postulated to underlie fulminant sepsis, but this concept remains to be confirmed in clinical practice. Pseudomonas aeruginosa (P. aeruginosa) is a common bacterium mostly associated with health care-related infections in immunocompromised individuals. However, in rare cases, it can cause sepsis in previously healthy children. We used exome sequencing and bioinformatic analysis to systematically search for genetic factors underpinning severe P. aeruginosa infection in the pediatric population. We collected blood samples from 11 previously healthy children, with no family history of immunodeficiency, who presented with severe sepsis due to community-acquired P. aeruginosa bacteremia. Genomic DNA was extracted from blood or tissue samples obtained intravitam or postmortem. We obtained high-coverage exome sequencing data and searched for rare loss-of-function variants. After rigorous filtrations, 12 potentially causal variants were identified. Two out of eight (25%) fatal cases were found to carry novel pathogenic variants in PID genes, including BTK and DNMT3B. This study demonstrates that exome sequencing allows to identify rare, deleterious human genetic variants responsible for fulminant sepsis in apparently healthy children. Diagnosing PIDs in such patients is of high relevance to survivors and affected families. We propose that unusually severe and fatal sepsis cases in previously healthy children should be considered for exome/genome sequencing to search for underlying PIDs.
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Affiliation(s)
- Samira Asgari
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Paul J McLaren
- National HIV and Retrovirology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Jane Peake
- Lady Cilento Children's Hospital , Brisbane, QLD , Australia
| | - Melanie Wong
- Children's Hospital Westmead , Sydney, NSW , Australia
| | - Richard Wong
- Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital , Brisbane, QLD , Australia
| | - Istvan Bartha
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Royal Darwin Hospital, Darwin, NT, Australia
| | - Katia Abarca
- Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile , Santiago , Chile
| | | | - Philipp Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | | | - Jacques Fellay
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Luregn J Schlapbach
- Lady Cilento Children's Hospital, Brisbane, QLD, Australia; Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Paediatric Critical Care Research Group (PCCRG), Mater Research, University of Queensland, Brisbane, QLD, Australia
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31
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McDonald FB, Chandrasekharan K, Wilson RJA, Hasan SU. Cardiorespiratory control and cytokine profile in response to heat stress, hypoxia, and lipopolysaccharide (LPS) exposure during early neonatal period. Physiol Rep 2016; 4:4/2/e12688. [PMID: 26811056 PMCID: PMC4760388 DOI: 10.14814/phy2.12688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Sudden infant death syndrome (SIDS) is one of the most common causes of postneonatal infant mortality in the developed world. An insufficient cardiorespiratory response to multiple environmental stressors (such as prone sleeping positioning, overwrapping, and infection), during a critical period of development in a vulnerable infant, may result in SIDS. However, the effect of multiple risk factors on cardiorespiratory responses has rarely been tested experimentally. Therefore, this study aimed to quantify the independent and possible interactive effects of infection, hyperthermia, and hypoxia on cardiorespiratory control in rats during the neonatal period. We hypothesized that lipopolysaccharide (LPS) administration will negatively impact cardiorespiratory responses to increased ambient temperature and hypoxia in neonatal rats. Sprague-Dawley neonatal rat pups were studied at postnatal day 6-8. Rats were examined at an ambient temperature of 33°C or 38°C. Within each group, rats were allocated to control, saline, or LPS (200 μg/kg) treatments. Cardiorespiratory and thermal responses were recorded and analyzed before, during, and after a hypoxic exposure (10% O2). Serum samples were taken at the end of each experiment to measure cytokine concentrations. LPS significantly increased cytokine concentrations (such as TNFα, IL-1β, MCP-1, and IL-10) compared to control. Our results do not support a three-way interaction between experimental factors on cardiorespiratory control. However, independently, heat stress decreased minute ventilation during normoxia and increased the hypoxic ventilatory response. Furthermore, LPS decreased hypoxia-induced tachycardia. Herein, we provide an extensive serum cytokine profile under various experimental conditions and new evidence that neonatal cardiorespiratory responses are adversely affected by dual interactions of environmental stress factors.
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Affiliation(s)
- Fiona B McDonald
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kumaran Chandrasekharan
- Fetal and Neonatal Physiology, Department of Pediatrics, Faculty of Medicine B271, Health Sciences Center, University of Calgary, Calgary, Alberta, Canada
| | - Richard J A Wilson
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shabih U Hasan
- Fetal and Neonatal Physiology, Department of Pediatrics, Faculty of Medicine B271, Health Sciences Center, University of Calgary, Calgary, Alberta, Canada
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32
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Performance of post-mortem CT compared to autopsy in children. Int J Legal Med 2016; 130:1089-1099. [PMID: 27221535 DOI: 10.1007/s00414-016-1370-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Radiological techniques such as non-enhanced post-mortem computed tomography (PMCT) play an increasingly important role in death investigations, especially in cases of non-medicolegal context of death, where the consent of the next of kin is required to perform autopsy. Such consent is often difficult to obtain for deceased children, and radiological methods may be an acceptable alternative. The aim of our study was to evaluate the performance of PMCT explorations compared to medicolegal conventional autopsies in children and its potential usefulness in non-medicolegal situations. METHODS We retrospectively reviewed a group of 26 children aged 0-12 years who died of different causes, which were investigated by both conventional autopsy and PMCT. We compared the findings extracted from radiological and autopsy reports. All findings were grouped according to their importance with respect to cause of death and to the anatomical structure they covered: organs, vascular system, soft tissue, and skeletal system. RESULTS A significantly larger number of findings were detected by autopsy compared to PMCT. Autopsy proved to be superior to PMCT, notably at detecting organ, soft tissue, and vascular findings, while PMCT was superior at detecting bone findings. However, no statistically significant differences were found between the methods concerning the essential findings used to define the cause of death. CONCLUSIONS In children, PMCT was less sensitive than conventional autopsy for detecting general findings. However, most essential findings were detected by both methods. PMCT was superior to autopsy for the detection of bone lesions in children. ADVANCES IN KNOWLEDGE Up to today, very rare literature exists concerning PMCT in children, especially in a forensic setting. This article investigates the advantages and limitations of PMCT compared to autopsy in a unique study group and discusses possibilities for future developments.
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33
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Palmiere C, Egger C, Prod'Hom G, Greub G. Bacterial Translocation and Sample Contamination in Postmortem Microbiological Analyses. J Forensic Sci 2015; 61:367-374. [PMID: 27404610 DOI: 10.1111/1556-4029.12991] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 01/14/2023]
Abstract
The diagnostic value of postmortem bacteriology has been discussed controversially for decades. In the study herein, contamination during sampling procedures and postmortem translocation were investigated to interpret postmortem microbiology results. One hundred medicolegal autopsy cases in total were included. Radiology, histology, bacteriology, and biochemistry were performed in all cases. Based on all investigation findings, 4 groups of cases were identified: death unrelated to infection, true infections, false positive (contamination during sampling procedures, postmortem translocation and mixed situations), and undetermined. The results of this study indicate that postmortem bacteriology provides useful data supporting infection-related deaths, especially when potentially significant observations are accompanied by consistent autopsy, histology, and biochemistry. Result interpretation requires careful evaluation of number and type of isolated microorganisms.
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Affiliation(s)
- Cristian Palmiere
- University Centre of Legal Medicine, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Coraline Egger
- University Centre of Legal Medicine, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Guy Prod'Hom
- Institute of Microbiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland.,Service of Infectious Diseases, University Hospital Center, Lausanne, Switzerland
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34
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Siljehav V, Hofstetter AM, Leifsdottir K, Herlenius E. Prostaglandin E2 Mediates Cardiorespiratory Disturbances during Infection in Neonates. J Pediatr 2015; 167:1207-13.e3. [PMID: 26434370 DOI: 10.1016/j.jpeds.2015.08.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/06/2015] [Accepted: 08/25/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine whether infection, with associated eicosanoid release, is a main cause of respiratory disruption in neonates, by measuring levels of prostaglandin E2 (PGE2) and its metabolite (PGEM) in cerebrospinal fluid (CSF). STUDY DESIGN Of 59 eligible infants, 25 preterm infants (mean gestational age, 28 ± 0.5 weeks) and 22 full-term infants (mean gestational age, 40 ± 0.5 weeks) from a level 3 neonatal intensive care unit and the general maternity neonatal ward were enrolled prospectively. Infants with a condition that can cause secondary apnea were excluded. Cardiorespiratory disturbances, such as apnea, bradycardia, and desaturation (ABD) events, were quantified. All infants were subjected to standard laboratory analysis of blood and CSF concentrations of biomarkers, including PGE2 and PGEM, within 24 hours of lumbar puncture, which were correlated with ABD events and culture-verified infections. RESULTS PGEM levels were highest in infants with culture-verified sepsis and meningitis (P < .01). In infants without culture-verified bacterial infections, PGEM levels were higher in preterm infants compared with term infants (P < .05). The numbers of desaturation events and apnea events in neonates were positively associated with PGE2 levels in CSF (P < .05). CONCLUSION PGE2 and PGEM are rapidly elevated in CSF during an infectious event and may explain cardiorespiratory disturbances, which are the major presenting symptoms of neonatal infections. PGE2 and PGEM are released during bacterial infections and could serve as biomarkers for sepsis and autonomic dysfunction in neonates.
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Affiliation(s)
- Veronica Siljehav
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Annika M Hofstetter
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristin Leifsdottir
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eric Herlenius
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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35
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Törő K, Vörös K, Mészner Z, Váradi-T A, Tóth A, Kovács K. Evidence for Infection and Inflammation in Infant Deaths in a Country with Historically Low Incidences of Sudden Infant Death Syndrome. Front Immunol 2015; 6:389. [PMID: 26379661 PMCID: PMC4547042 DOI: 10.3389/fimmu.2015.00389] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/15/2015] [Indexed: 11/13/2022] Open
Abstract
Total infant mortality in Hungary has been higher than other European countries; however, the reported incidence of sudden infant death syndrome (SIDS) has been lower. The low incidence of SIDS in Hungary has been supported by evidence obtained from the high rate of scene of death investigation and medico-legal autopsy mandatory since the 1950s. In this study, we compared the incidence of explained and unexplained infant deaths in Hungary for three periods: 1979–1989 when the incidence of SIDS was high in western Europe; 1990–1999 when the incidence of infant deaths was falling following introduction of the public health campaigns to reduce the risk factors associated with SIDS; and 2000–2012 to determine if introduction of Haemophilus influenzae type b or pneumococcal vaccines or introduction of an earlier immunization schedule during this period had an effect on SIDS. Explained infant deaths fell consistently during this period; however, SIDS rose during the second period when the incidence of SIDS was falling in other European countries. Evidence for infection and/or inflammation was observed for the majority of SIDS during each period. The results are discussed in relation to campaigns to reduce infant mortality in Hungary and the introduction of new vaccines and an earlier immunization schedule in 2006.
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Affiliation(s)
- Klára Törő
- Department of Forensic and Insurance Medicine, Semmelweis University , Budapest , Hungary
| | - Krisztina Vörös
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University , Budapest , Hungary
| | - Zsófia Mészner
- St. László Hospital for Infectious Diseases, National Institute of Child Health , Budapest , Hungary
| | - Aletta Váradi-T
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University , Budapest , Hungary
| | - Adrienn Tóth
- Department of Pathology, Military Hospital - National Health Center , Budapest , Hungary
| | - Katalin Kovács
- Hungarian Demographic Research Institute , Budapest , Hungary
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36
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Bamber AR, Paine SML, Ridout DA, Pryce JW, Jacques TS, Sebire NJ. Brain weight in sudden unexpected death in infancy: experience from a large single-centre cohort. Neuropathol Appl Neurobiol 2015; 42:344-51. [PMID: 26095474 DOI: 10.1111/nan.12251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
AIMS Published reports of brain weight in sudden infant death syndrome (SIDS) are contradictory, although several have concluded that brain weight is increased in SIDS compared with controls or reference data. This is important as, if brain weight is significantly different, it may be of diagnostic use or provide insights into the aetiology of SIDS. The aim of this study was to use a large series of well-characterized sudden unexpected infant deaths from a single centre to provide definitive data regarding this issue. METHODS A retrospective review identified 1100 infants who had died suddenly and undergone a comprehensive autopsy at Great Ormond Street Hospital between 1996 and 2011. They were split into two groups: those in whom death could be explained and those whose deaths remained unexplained despite full investigation (SIDS/unexplained sudden unexpected death in infancy). RESULTS There were 1100 cases of whom 573 (52%) were unexplained and 527 (48%) explained. Multiple regression analysis, which adjusted for sex, age and post-mortem interval, showed no difference in the ratio of brain weight : body weight between those infants dying of explained causes and those in whom no cause could be found. This finding remained true when restricting analysis to those with macroscopically normal brains. CONCLUSIONS In this large series of infants dying of both explained and unexplained causes, brain weight, once corrected for body weight, did not vary consistently with the cause of death. Brain weight cannot be used as a diagnostic indicator of the cause of death or to inform hypothetical models of the pathogenesis of SIDS.
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Affiliation(s)
- Andrew R Bamber
- UCL Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon M L Paine
- UCL Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Jeremy W Pryce
- UCL Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- UCL Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil J Sebire
- UCL Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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37
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Bettelheim KA, Goldwater PN. Escherichia coli and Sudden Infant Death Syndrome. Front Immunol 2015; 6:343. [PMID: 26191064 PMCID: PMC4490240 DOI: 10.3389/fimmu.2015.00343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/19/2015] [Indexed: 01/02/2023] Open
Abstract
This review examines the association of strains of Escherichia coli with sudden infant death syndrome (SIDS) and the possible role these bacteria play in this enigmatic condition. The review addresses evidence for E. coli in SIDS infants, potential sources of E. coli in the environment, colonization by commensal and pathogenic strains, the variety of currently accepted pathotypes, and how these pathotypes could compromise intestinal integrity and induce inflammation. Both intestinal and extraintestinal pathotypes are compared in relation to the apparent liability in which virulence traits can be gained or lost by strains of E. coli. The way in which E. coli infections fit with current views on infant sleeping position and other SIDS risk factors is highlighted.
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Affiliation(s)
- Karl A Bettelheim
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide , North Adelaide, SA , Australia
| | - Paul N Goldwater
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide , North Adelaide, SA , Australia
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38
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Kell D, Potgieter M, Pretorius E. Individuality, phenotypic differentiation, dormancy and 'persistence' in culturable bacterial systems: commonalities shared by environmental, laboratory, and clinical microbiology. F1000Res 2015; 4:179. [PMID: 26629334 PMCID: PMC4642849 DOI: 10.12688/f1000research.6709.2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 01/28/2023] Open
Abstract
For bacteria, replication mainly involves growth by binary fission. However, in a very great many natural environments there are examples of phenotypically dormant, non-growing cells that do not replicate immediately and that are phenotypically 'nonculturable' on media that normally admit their growth. They thereby evade detection by conventional culture-based methods. Such dormant cells may also be observed in laboratory cultures and in clinical microbiology. They are usually more tolerant to stresses such as antibiotics, and in clinical microbiology they are typically referred to as 'persisters'. Bacterial cultures necessarily share a great deal of relatedness, and inclusive fitness theory implies that there are conceptual evolutionary advantages in trading a variation in growth rate against its mean, equivalent to hedging one's bets. There is much evidence that bacteria exploit this strategy widely. We here bring together data that show the commonality of these phenomena across environmental, laboratory and clinical microbiology. Considerable evidence, using methods similar to those common in environmental microbiology, now suggests that many supposedly non-communicable, chronic and inflammatory diseases are exacerbated (if not indeed largely caused) by the presence of dormant or persistent bacteria (the ability of whose components to cause inflammation is well known). This dormancy (and resuscitation therefrom) often reflects the extent of the availability of free iron. Together, these phenomena can provide a ready explanation for the continuing inflammation common to such chronic diseases and its correlation with iron dysregulation. This implies that measures designed to assess and to inhibit or remove such organisms (or their access to iron) might be of much therapeutic benefit.
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Affiliation(s)
- Douglas Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, Manchester, Lancashire, M1 7DN, UK
| | - Marnie Potgieter
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
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39
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Testing for Infectious Diseases in Sudden Unexpected Infant Death: A Survey of Medical Examiner and Coroner Offices in the United States. J Pediatr 2015; 167:178-82.e1. [PMID: 25929979 DOI: 10.1016/j.jpeds.2015.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/05/2015] [Accepted: 04/02/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine interoffice variability in routinely performed sudden unexpected infant death (SUID) postmortem studies for infection and to assess availability and perceived utility of various tests of infectious diseases. STUDY DESIGN Online surveys were sent to all 154 offices of US medical examiners and coroners serving populations >300,000 people. Surveys included a set of potential laboratory tests for infectious disease. Respondents were asked to select which tests were available in their offices, and which tests were performed routinely in SUIDs vs which tests should be performed routinely. RESULTS Of the 45 complete responses, 4.4% did not routinely perform histology, 8.9% did not routinely perform viral studies (ie, culture or molecular diagnostics), 22.2% did not routinely perform blood cultures, 26.7% did not routinely perform lung bacterial cultures, and 44.4% did not routinely perform cerebrospinal fluid cultures. CONCLUSIONS Our findings suggest that there is considerable interoffice variability with testing for infectious diseases in SUIDs. This appeared to be largely the result of a perceived lack of testing utility rather than a lack of test availability. Evidence-based practice guidelines regarding the interpretation of microbial testing results, as well as common testing protocols/algorithms, may lead to more accurate and standardized data, thus improving SUID investigation and surveillance.
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40
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Kell D, Potgieter M, Pretorius E. Individuality, phenotypic differentiation, dormancy and 'persistence' in culturable bacterial systems: commonalities shared by environmental, laboratory, and clinical microbiology. F1000Res 2015; 4:179. [PMID: 26629334 DOI: 10.12688/f1000research.6709.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 01/28/2023] Open
Abstract
For bacteria, replication mainly involves growth by binary fission. However, in a very great many natural environments there are examples of phenotypically dormant, non-growing cells that do not replicate immediately and that are phenotypically 'nonculturable' on media that normally admit their growth. They thereby evade detection by conventional culture-based methods. Such dormant cells may also be observed in laboratory cultures and in clinical microbiology. They are usually more tolerant to stresses such as antibiotics, and in clinical microbiology they are typically referred to as 'persisters'. Bacterial cultures necessarily share a great deal of relatedness, and inclusive fitness theory implies that there are conceptual evolutionary advantages in trading a variation in growth rate against its mean, equivalent to hedging one's bets. There is much evidence that bacteria exploit this strategy widely. We here bring together data that show the commonality of these phenomena across environmental, laboratory and clinical microbiology. Considerable evidence, using methods similar to those common in environmental microbiology, now suggests that many supposedly non-communicable, chronic and inflammatory diseases are exacerbated (if not indeed largely caused) by the presence of dormant or persistent bacteria (the ability of whose components to cause inflammation is well known). This dormancy (and resuscitation therefrom) often reflects the extent of the availability of free iron. Together, these phenomena can provide a ready explanation for the continuing inflammation common to such chronic diseases and its correlation with iron dysregulation. This implies that measures designed to assess and to inhibit or remove such organisms (or their access to iron) might be of much therapeutic benefit.
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Affiliation(s)
- Douglas Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, Manchester, Lancashire, M1 7DN, UK
| | - Marnie Potgieter
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
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41
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Blackwell C. The Role of Infection and Inflammation in Stillbirths: Parallels with SIDS? Front Immunol 2015; 6:248. [PMID: 26106385 PMCID: PMC4460799 DOI: 10.3389/fimmu.2015.00248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/07/2015] [Indexed: 11/13/2022] Open
Abstract
It has been suggested that stillbirths are part of the spectrum of infant deaths that includes sudden infant death syndrome (SIDS). This paper examines the hypothesis that risk factors associated with stillbirths might contribute to dysregulation of inflammatory responses to infections that could trigger the physiological responses leading to fetal loss. These include genetic factors (ethnic group, sex), environmental (infection, cigarette smoke, obesity), and developmental (testosterone levels) factors. Interactions between the genetic, environmental, and developmental risk factors are also considered, e.g., the excess of male stillborn infants in relation to the effects of testosterone levels during development on pro-inflammatory responses. In contrast to SIDS, inflammatory responses of both mother and fetus need to be considered. Approaches for examining the hypothesis are proposed.
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Affiliation(s)
- Caroline Blackwell
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle , Newcastle, NSW , Australia ; Information Based Medicine, Hunter Medical Research Institute , New Lambton, NSW , Australia
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42
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Goldwater PN. Gut Microbiota and Immunity: Possible Role in Sudden Infant Death Syndrome. Front Immunol 2015; 6:269. [PMID: 26089821 PMCID: PMC4453473 DOI: 10.3389/fimmu.2015.00269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/15/2015] [Indexed: 11/23/2022] Open
Abstract
The gut microbiome influences the development of the immune system of young mammals; the establishment of a normal gut microbiome is thought to be important for the health of the infant during its early development. As the role of bacteria in the causation of sudden infant death syndrome (SIDS) is backed by strong evidence, the balance between host immunity and potential bacterial pathogens is likely to be pivotal. Bacterial colonization of the infant colon is influenced by age, mode of delivery, diet, environment, and antibiotic exposure. The gut microbiome influences several systems including gut integrity and development of the immune system; therefore, gut microflora could be important in protection against bacteria and/or their toxins identified in SIDS infants. The aims of the review are to explore (1) the role of the gut microbiome in relation to the developmentally critical period in which most SIDS cases occur; (2) the mechanisms by which the gut microbiome might induce inflammation resulting in transit of bacteria from the lumen into the bloodstream; and (3) assessment of the clinical, physiological, pathological, and microbiological evidence for bacteremia leading to the final events in SIDS pathogenesis.
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Affiliation(s)
- Paul N Goldwater
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide , North Adelaide, SA , Australia
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43
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Moscovis SM, Gordon AE, Al Madani OM, Gleeson M, Scott RJ, Hall ST, Burns C, Blackwell C. Virus Infections and Sudden Death in Infancy: The Role of Interferon-γ. Front Immunol 2015; 6:107. [PMID: 25814991 PMCID: PMC4356164 DOI: 10.3389/fimmu.2015.00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/24/2015] [Indexed: 11/13/2022] Open
Abstract
Respiratory infections have been implicated in sudden infant death syndrome (SIDS). As interferon-γ (IFN-γ) is a major response to virus infection, we examined (1) the frequency of single nucleotide polymorphism (SNP), IFNG T + 874A, in SIDS infants, their parents, and ethnic groups with different incidences of SIDS; (2) model systems with a monocytic cell line (THP-1) and human peripheral blood monocytes (PBMC) for effects of levels of IFN-γ on inflammatory responses to bacterial antigens identified in SIDS; (3) interactions between genetic and environmental factors on IFN-γ responses. IFNG T + 874A genotypes were determined for SIDS infants from three countries; families who had a SIDS death; populations with high (Indigenous Australian), medium (Caucasian), and low (Bangladeshi) SIDS incidences. The effect of IFN-γ on cytokine responses to endotoxin was examined in model systems with THP-1 cells and human PBMC. The IFN-γ responses to endotoxin and toxic shock syndrome toxin (TSST-1) were assessed in relation to genotype, gender, and reported smoking. There was a marginal association with IFNG T + 874A genotype and SIDS (p = 0.06). Indigenous Australians had significantly higher proportions of the IFNG T + 874A SNP (TT) associated with high responses of IFN-γ. THP-1 cells showed a dose dependent effect of IFN-γ on cytokine responses to endotoxin. For PBMC, IFN-γ enhanced interleukin (IL)-1β, IL-6, and tumor necrosis factor-α responses but reduced IL-8 and IL-10 responses. Active smoking had a suppressive effect on baseline levels of IFN-γ. There was no effect of gender or genotype on IFN-γ responses to bacterial antigens tested; however, significant differences were observed between genotypes in relation to smoking. The results indicate virus infections contribute to dysregulation of cytokine responses to bacterial antigens and studies on physiological effects of genetic factors must include controls for recent or concurrent infection and exposure to cigarette smoke.
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Affiliation(s)
- Sophia M Moscovis
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute , Newcastle, NSW , Australia ; Hunter Medical Research Institute , New Lambton, NSW , Australia
| | - Ann E Gordon
- Medical Microbiology, University of Edinburgh , Edinburgh , UK
| | | | - Maree Gleeson
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute , Newcastle, NSW , Australia ; Hunter Medical Research Institute , New Lambton, NSW , Australia
| | - Rodney J Scott
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute , Newcastle, NSW , Australia ; Hunter Medical Research Institute , New Lambton, NSW , Australia ; Hunter Area Pathology Service Genetics, John Hunter Hospital , New Lambton, NSW , Australia
| | - Sharron T Hall
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute , Newcastle, NSW , Australia ; Hunter Medical Research Institute , New Lambton, NSW , Australia ; Hunter Area Pathology Service Immunology, John Hunter Hospital , New Lambton, NSW , Australia
| | - Christine Burns
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute , Newcastle, NSW , Australia ; Hunter Medical Research Institute , New Lambton, NSW , Australia ; Hunter Area Pathology Service Immunology, John Hunter Hospital , New Lambton, NSW , Australia
| | - Caroline Blackwell
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute , Newcastle, NSW , Australia ; Hunter Medical Research Institute , New Lambton, NSW , Australia
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44
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Blackwell C, Moscovis S, Hall S, Burns C, Scott RJ. Exploring the risk factors for sudden infant deaths and their role in inflammatory responses to infection. Front Immunol 2015; 6:44. [PMID: 25798137 PMCID: PMC4350416 DOI: 10.3389/fimmu.2015.00044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/23/2015] [Indexed: 12/31/2022] Open
Abstract
The risk factors for sudden infant death syndrome (SIDS) parallel those associated with susceptibility to or severity of infectious diseases. There is no evidence that a single infectious agent is associated with SIDS; the common thread appears to be induction of inflammatory responses to infections. In this review, interactions between genetic and environmental risk factors for SIDS are assessed in relation to the hypothesis that many infant deaths result from dysregulation of inflammatory responses to "minor" infections. Risk factors are assessed in relation to three important stages of infection: (1) bacterial colonization (frequency or density); (2) induction of temperature-dependent toxins; (3) induction or control of inflammatory responses. In this article, we review the interactions among risk factors for SIDS for their effects on induction or control of inflammatory responses. The risk factors studied are genetic factors (sex, cytokine gene polymorphisms among ethnic groups at high or low risk of SIDS); developmental stage (changes in cortisol and testosterone levels associated with 2- to 4-month age range); environmental factors (virus infection, exposure to cigarette smoke). These interactions help to explain differences in the incidences of SIDS observed between ethnic groups prior to public health campaigns to reduce these infant deaths.
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Affiliation(s)
- Caroline Blackwell
- Faculty of Health and Medicine, Hunter Medical Research Institute, School of Biomedical Sciences, University of Newcastle, Newcastle, NSW, Australia
- Information Based Medicine, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Sophia Moscovis
- Faculty of Health and Medicine, Hunter Medical Research Institute, School of Biomedical Sciences, University of Newcastle, Newcastle, NSW, Australia
- Information Based Medicine, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Sharron Hall
- Faculty of Health and Medicine, Hunter Medical Research Institute, School of Biomedical Sciences, University of Newcastle, Newcastle, NSW, Australia
- Information Based Medicine, Hunter Medical Research Institute, New Lambton, NSW, Australia
- Hunter Area Pathology Service Immunology, John Hunter Hospital, New Lambton, NSW, Australia
| | - Christine Burns
- Faculty of Health and Medicine, Hunter Medical Research Institute, School of Biomedical Sciences, University of Newcastle, Newcastle, NSW, Australia
- Information Based Medicine, Hunter Medical Research Institute, New Lambton, NSW, Australia
- Hunter Area Pathology Service Immunology, John Hunter Hospital, New Lambton, NSW, Australia
| | - Rodney J. Scott
- Faculty of Health and Medicine, Hunter Medical Research Institute, School of Biomedical Sciences, University of Newcastle, Newcastle, NSW, Australia
- Information Based Medicine, Hunter Medical Research Institute, New Lambton, NSW, Australia
- Hunter Area Pathology Service Genetics, John Hunter Hospital, New Lambton, NSW, Australia
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45
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Lübkemeier I, Bosen F, Kim JS, Sasse P, Malan D, Fleischmann BK, Willecke K. Human Connexin43E42K Mutation From a Sudden Infant Death Victim Leads to Impaired Ventricular Activation and Neonatal Death in Mice. ACTA ACUST UNITED AC 2015; 8:21-9. [DOI: 10.1161/circgenetics.114.000793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Sudden infant death syndrome (SIDS) describes the sudden, unexplained death of a baby during its first year of age and is the third leading cause of infant mortality. It is assumed that ≤20% of all SIDS cases are because of cardiac arrhythmias resulting from mutations in ion channel proteins. Besides ion channels also cardiac gap junction channels are important for proper conduction of cardiac electric activation. In the mammalian heart Connexin43 (Cx43) is the major gap junction protein expressed in ventricular cardiomyocytes. Recently, a novel Connexin43 loss-of-function mutation (Cx43E42K) was identified in a 2-month-old SIDS victim.
Methods and Results—
We have generated Cx43E42K-expressing mice as a model for SIDS. Heterozygous cardiac-restricted Cx43E42K-mutated mice die neonatally without major cardiac morphological defects. Electrocardiographic recordings of embryonic Cx43+/E42K mice reveal severely disturbed ventricular activation, whereas immunohistochemical analyses show normal localization and expression patterns of gap junctional Connexin43 protein in the Cx43E42K-mutated newborn mouse heart.
Conclusions—
Because we did not find heterogeneous gap junction loss in Cx43E42K mouse hearts, we conclude that the Cx43E42K gap junction channel creates an arrhythmogenic substrate leading to lethal ventricular arrhythmias. The strong cardiac phenotype of Cx43E42K expressing mice supports the association between the human Cx43E42K mutation and SIDS and indicates that Connexin43 mutations should be considered in future studies when SIDS cases are to be molecularly explained.
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Affiliation(s)
- Indra Lübkemeier
- From the Life and Medical Sciences (LIMES) Institute, Molecular Genetics (I.L., F.B., K.W.) and Institute of Physiology I, Life and Brain Center (P.S., D.M., B.K.F.), University of Bonn, Bonn, Germany; and Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-S.K.)
| | - Felicitas Bosen
- From the Life and Medical Sciences (LIMES) Institute, Molecular Genetics (I.L., F.B., K.W.) and Institute of Physiology I, Life and Brain Center (P.S., D.M., B.K.F.), University of Bonn, Bonn, Germany; and Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-S.K.)
| | - Jung-Sun Kim
- From the Life and Medical Sciences (LIMES) Institute, Molecular Genetics (I.L., F.B., K.W.) and Institute of Physiology I, Life and Brain Center (P.S., D.M., B.K.F.), University of Bonn, Bonn, Germany; and Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-S.K.)
| | - Philipp Sasse
- From the Life and Medical Sciences (LIMES) Institute, Molecular Genetics (I.L., F.B., K.W.) and Institute of Physiology I, Life and Brain Center (P.S., D.M., B.K.F.), University of Bonn, Bonn, Germany; and Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-S.K.)
| | - Daniela Malan
- From the Life and Medical Sciences (LIMES) Institute, Molecular Genetics (I.L., F.B., K.W.) and Institute of Physiology I, Life and Brain Center (P.S., D.M., B.K.F.), University of Bonn, Bonn, Germany; and Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-S.K.)
| | - Bernd K. Fleischmann
- From the Life and Medical Sciences (LIMES) Institute, Molecular Genetics (I.L., F.B., K.W.) and Institute of Physiology I, Life and Brain Center (P.S., D.M., B.K.F.), University of Bonn, Bonn, Germany; and Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-S.K.)
| | - Klaus Willecke
- From the Life and Medical Sciences (LIMES) Institute, Molecular Genetics (I.L., F.B., K.W.) and Institute of Physiology I, Life and Brain Center (P.S., D.M., B.K.F.), University of Bonn, Bonn, Germany; and Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-S.K.)
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46
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Cerebrospinal fluid PCR analysis and biochemistry in bodies with severe decomposition. J Forensic Leg Med 2014; 30:21-4. [PMID: 25623190 DOI: 10.1016/j.jflm.2014.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/28/2014] [Accepted: 12/13/2014] [Indexed: 12/11/2022]
Abstract
The aim of this study was to assess whether Neisseria meningitidis, Listeria monocytogenes, Streptococcus pneumoniae and Haemophilus influenzae can be identified using the polymerase chain reaction technique in the cerebrospinal fluid of severely decomposed bodies with known, noninfectious causes of death or whether postmortem changes can lead to false positive results and thus erroneous diagnostic information. Biochemical investigations, postmortem bacteriology and real-time polymerase chain reaction analysis in cerebrospinal fluid were performed in a series of medico-legal autopsies that included noninfectious causes of death with decomposition, bacterial meningitis without decomposition, bacterial meningitis with decomposition, low respiratory tract infections with decomposition and abdominal infections with decomposition. In noninfectious causes of death with decomposition, postmortem investigations failed to reveal results consistent with generalized inflammation or bacterial infections at the time of death. Real-time polymerase chain reaction analysis in cerebrospinal fluid did not identify the studied bacteria in any of these cases. The results of this study highlight the usefulness of molecular approaches in bacteriology as well as the use of alternative biological samples in postmortem biochemistry in order to obtain suitable information even in corpses with severe decompositional changes.
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47
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Arthurs OJ, Thayyil S, Owens CM, Olsen OE, Wade A, Addison S, Jones R, Norman W, Scott RJ, Robertson NJ, Taylor AM, Chitty LS, Sebire NJ. Diagnostic accuracy of post mortem MRI for abdominal abnormalities in foetuses and children. Eur J Radiol 2014; 84:474-481. [PMID: 25533719 DOI: 10.1016/j.ejrad.2014.11.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/20/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for abdominal pathology in foetuses and children, compared to conventional autopsy. METHODS Institutional ethics approval and parental consent was obtained. 400 unselected foetuses and children underwent PMMR using a 1.5T Siemens Avanto MR scanner before conventional autopsy. PMMR images and autopsy findings were reported blinded to the other data respectively. RESULTS Abdominal abnormalities were found in 70/400 (12%) autopsies. Overall sensitivity and specificity (95% confidence interval) of PMMR for abdominal pathology was 72.5% (61.0, 81.6) and 90.8% (87.0, 93.6), with positive (PPV) and negative predictive values (NPV) of 64.1% (53.0, 73.9) and 93.6% (90.2, 95.8) respectively. PMMR was good at detecting renal abnormalities (sensitivity 80%), particularly in foetuses, and relatively poor at detecting intestinal abnormalities (sensitivity 50%). Overall accuracy was 87.4% (83.6, 90.4). CONCLUSIONS PMMR has high overall accuracy for abdominal pathology in foetuses, newborns and children. PMMR is particularly good at detecting renal abnormalities, and relatively poor at detecting intestinal abnormalities. In clinical practice, PMMR may be a useful alternative or adjunct to conventional autopsy in foetuses and children for detecting abdominal abnormalities.
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Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Institute of Child Health, UCL, London, UK.
| | - Sudhin Thayyil
- Perinatal Neurology and Neonatology, Imperial College London, London, UK.
| | - Catherine M Owens
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Oystein E Olsen
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Institute of Child Health, UCL, London, UK.
| | - Angie Wade
- Clinical Epidemiology, Nutrition and Biostatistics Section, UCL Institute of Child health, London, UK.
| | - Shea Addison
- Perinatal Neurology and Neonatology, Imperial College London, London, UK.
| | - Rod Jones
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Wendy Norman
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Rosemary J Scott
- Department of Histopathology, University College London Hospital NHS Trust, London, UK.
| | | | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health, London, Great Ormond Street Hospital for Children NHS Foundation Trust, London, and UCLH NHS Foundation Trusts, London, UK.
| | - Neil J Sebire
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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48
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Alfelali M, Khandaker G. Infectious causes of sudden infant death syndrome. Paediatr Respir Rev 2014; 15:307-11. [PMID: 25441371 DOI: 10.1016/j.prrv.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 12/18/2022]
Abstract
Investigators have long suspected the role of infection in sudden infant death syndrome (SIDS). Evidence of infectious associations with SIDS is accentuated through the presence of markers of infection and inflammation on autopsy of SIDS infants and isolates of some bacteria and viruses. Several observational studies have looked into the relation between seasonality and incidence of SIDS, which often showed a winter peak. These all may suggest an infectious aetiology of SIDS. In this review we have summarised the current literature on infectious aetiologies of SIDS by looking at viral, bacterial, genetic and environmental factors which are believed to be associated with SIDS.
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Affiliation(s)
- Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Saudi Arabia.
| | - Gulam Khandaker
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Centre for Perinatal Infection Research, The Children's Hospital at Westmead and The University of Sydney, Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia
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49
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Palmiere C, Egger C, Grabherr S, Jaton-Ogay K, Greub G. Postmortem angiography using femoral cannulation and postmortem microbiology. Int J Legal Med 2014; 129:861-7. [PMID: 25381195 DOI: 10.1007/s00414-014-1099-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 10/29/2014] [Indexed: 12/16/2022]
Abstract
Despite the undeniable advantages of postmortem angiography, numerous questions have arisen concerning the influence that the injected contrast media may exercise on biological fluids and tissues collected for toxicological and biochemical investigations. Moreover, cardiac blood for microbiological investigations cannot be obtained post-angiography. In this study, we examined whether the peripheral blood collected prior to postmortem angiography, using percutaneous access to femoral vessels after skin surface disinfection, could be suitable for microbiological investigations when postmortem angiography with femoral vessel cannulation is also performed. A total of 66 cases were included in the study and were divided into two subgroups (angiography and bacteriology group, 33 cases and control group, 33 cases). Autopsies, histology, toxicology, bacteriology, and biochemical investigations (procalcitonin, C-reactive protein, interleukin-6, and soluble triggering receptors expressed on myeloid cells type 1) were performed in all cases. No statistically significant differences between the two groups were noted, and identified category distribution (death unrelated to infection, true infection, false positive, and undetermined) was rather similar in both studied populations. These preliminary results suggest that postmortem angiography using a femoral approach does not constitute an impediment to the collection of peripheral blood for microbiology and vice versa. Moreover, the use of femoral blood for microbiology does not lead to an increased risk of doubtful results.
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Affiliation(s)
- Cristian Palmiere
- University Centre of Legal Medicine, University Hospital Center and University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland,
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50
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Siljehav V, Shvarev Y, Herlenius E. Il-1β and prostaglandin E2 attenuate the hypercapnic as well as the hypoxic respiratory response via prostaglandin E receptor type 3 in neonatal mice. J Appl Physiol (1985) 2014; 117:1027-36. [DOI: 10.1152/japplphysiol.00542.2014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Prostaglandin E2 (PGE2) serves as a critical mediator of hypoxia, infection, and apnea in term and preterm babies. We hypothesized that the prostaglandin E receptor type 3 (EP3R) is the receptor responsible for PGE2-induced apneas. Plethysmographic recordings revealed that IL-1β (ip) attenuated the hypercapnic response in C57BL/6J wild-type (WT) but not in neonatal (P9) EP3R−/− mice ( P < 0.05). The hypercapnic responses in brain stem spinal cord en bloc preparations also differed depending on EP3R expression whereby the response was attenuated in EP3R−/− preparations ( P < 0.05). After severe hypoxic exposure in vivo, IL-1β prolonged time to autoresuscitation in WT but not in EP3R−/− mice. Moreover, during severe hypoxic stress EP3R−/− mice had an increased gasping duration ( P < 0.01) as well as number of gasps ( P < 0.01), irrespective of intraperitoneal treatment, compared with WT mice. Furthermore, EP3R−/− mice exhibited longer hyperpneic breathing efforts when exposed to severe hypoxia ( P < 0.01). This was then followed by a longer period of secondary apnea before autoresuscitation occurred in EP3R−/− mice ( P < 0.05). In vitro, EP3R−/− brain stem spinal cord preparations had a prolonged respiratory burst activity during severe hypoxia accompanied by a prolonged neuronal arrest during recovery in oxygenated medium ( P < 0.05). In conclusion, PGE2 exerts its effects on respiration via EP3R activation that attenuates the respiratory response to hypercapnia as well as severe hypoxia. Modulation of the EP3R may serve as a potential therapeutic target for treatment of inflammatory and hypoxic-induced detrimental apneas and respiratory disorders in neonates.
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Affiliation(s)
- Veronica Siljehav
- Neonatal Research Unit Q2:07, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; and
| | - Yuri Shvarev
- Neonatal Research Unit Q2:07, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; and
- Institute of Cytology and Genetics, Siberian Division of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Eric Herlenius
- Neonatal Research Unit Q2:07, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; and
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