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Mavridis T, Mavridi A, Karampela E, Galanos A, Gkiokas G, Iacovidou N, Xanthos T. Sovateltide (ILR-1620) Improves Motor Function and Reduces Hyperalgesia in a Rat Model of Spinal Cord Injury. Neurocrit Care 2024:10.1007/s12028-024-01950-2. [PMID: 38443708 DOI: 10.1007/s12028-024-01950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/26/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Spinal cord injury (SCI) presents a major global health challenge, with rising incidence rates and substantial disability. Although progress has been made in understanding SCI's pathophysiology and early management, there is still a lack of effective treatments to mitigate long-term consequences. This study investigates the potential of sovateltide, a selective endothelin B receptor agonist, in improving clinical outcomes in an acute SCI rat model. METHODS Thirty male Sprague-Dawley rats underwent sham surgery (group A) or SCI and treated with vehicle (group B) or sovateltide (group C). Clinical tests, including Basso, Beattie, and Bresnahan scoring, inclined plane, and allodynia testing with von Frey hair, were performed at various time points. Statistical analyses assessed treatment effects. RESULTS Sovateltide administration significantly improved motor function, reducing neurological deficits and enhancing locomotor recovery compared with vehicle-treated rats, starting from day 7 post injury. Additionally, the allodynic threshold improved, suggesting antinociceptive properties. Notably, the sovateltide group demonstrated sustained recovery, and even reached preinjury performance levels, whereas the vehicle group plateaued. CONCLUSIONS This study suggests that sovateltide may offer neuroprotective effects, enhancing neurogenesis and angiogenesis. Furthermore, it may possess anti-inflammatory and antinociceptive properties. Future clinical trials are needed to validate these findings, but sovateltide shows promise as a potential therapeutic strategy to improve functional outcomes in SCI. Sovateltide, an endothelin B receptor agonist, exhibits neuroprotective properties, enhancing motor recovery and ameliorating hyperalgesia in a rat SCI model. These findings could pave the way for innovative pharmacological interventions for SCI in clinical settings.
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Affiliation(s)
- Theodoros Mavridis
- First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- Department of Neurology, Tallaght University Hospital (TUH)/The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
| | - Artemis Mavridi
- First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Antonis Galanos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Department of Neonatology, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Xanthos
- School of Health and Caring Sciences, University of West Attica, Athens, Greece
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Sokou R, Parastatidou S, Konstantinidi A, Tsantes AG, Iacovidou N, Piovani D, Bonovas S, Tsantes AE. Contemporary tools for evaluation of hemostasis in neonates. Where are we and where are we headed? Blood Rev 2024; 64:101157. [PMID: 38016836 DOI: 10.1016/j.blre.2023.101157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
The assessment of hemostatic disorders in neonates is crucial, but remains challenging for clinicians. Although the concept of developmental hemostasis is widely accepted among hemostasis specialists globally, it is probably under-recognized by clinicians and laboratory practitioners. In parallel with age-dependent hemostatic status maturation, comprehension of the differences between normal values is crucial for the accurate diagnosis of potential hemorrhagic and thrombotic disorders of the vulnerable neonatal population. This review outlines the basics of developmental hemostasis and the features of the available coagulation testing methods, with a focus on novel tools for evaluating the neonatal hemostatic profile. Common errors, issues, and pitfalls during the assessment of neonatal hemostasis are discussed, along with their impact on patient management. Current knowledge gaps and research areas are addressed. Further studying to improve our understanding of developmental hemostasis and its reflection on everyday clinical practice is warranted.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece.
| | | | | | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
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Karapati E, Sokou R, Iliodromiti Z, Tsaousi M, Sulaj A, Tsantes AG, Petropoulou C, Pouliakis A, Tsantes AE, Boutsikou T, Iacovidou N. Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature. Semin Thromb Hemost 2024; 50:169-181. [PMID: 36807290 DOI: 10.1055/s-0043-1762893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Intrauterine growth restriction (IUGR) affects nearly 10 to 15% of pregnancies and is responsible for many short- and long-term adverse consequences, including hemostatic derangement. Both thrombotic and hemorrhagic events are described in the perinatal period in these neonates. The aim of this study was to systematically review the literature on the laboratory studies used to evaluate the hemostatic system of the IUGR small for gestational age neonate. We reviewed the current literature via PubMed and Scopus until September 2022. Following our inclusion/exclusion criteria, we finally included 60 studies in our review. Thrombocytopenia, characterized as hyporegenerative and a kinetic upshot of reduced platelet production due to in utero chronic hypoxia, was the main finding of most studies focusing on growth-restricted neonates, in most cases is mild and usually resolves spontaneously with the first 2 weeks of life. In regard to coagulation, growth-restricted newborns present with prolonged standard coagulation tests. Data regarding coagulation factors, fibrinolytic system, and anticoagulant proteins are scarce and conflicting, mainly due to confounding factors. As thromboelastography/rotational thromboelastometry (TEG/ROTEM) provides a more precise evaluation of the in vivo coagulation process compared with standard coagulation tests, its use in transfusion guidance is fundamental. Only one study regarding TEG/ROTEM was retrieved from this population, where no difference in ROTEM parameters compared with appropriate for gestational age neonates was found. Despite the laboratory aberrations, no correlation could be achieved with clinical manifestations of bleeding or thrombosis in the studies included. More studies are needed to assess hemostasis in IUGR neonates and guide targeted therapeutic interventions.
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Affiliation(s)
- Eleni Karapati
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Zoi Iliodromiti
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Marina Tsaousi
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Alma Sulaj
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, School of Medicine, National and Kapodistrian University of Athens, "Attiko" Hospital, Athens, Greece
| | - Chrysa Petropoulou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, University General Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, School of Medicine, National and Kapodistrian University of Athens, "Attiko" Hospital, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
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Karamantziani T, Pouliakis A, Xanthos T, Ekmektzoglou K, Paliatsiou S, Sokou R, Iacovidou N. The Effect of Oral Iron Supplementation/Fortification on the Gut Microbiota in Infancy: A Systematic Review and Meta-Analysis. Children (Basel) 2024; 11:231. [PMID: 38397343 PMCID: PMC10887499 DOI: 10.3390/children11020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
(1) Background: Iron is an essential metal for the proper growth and neurodevelopment of infants. To prevent and treat iron deficiency, iron supplementation or fortification is often required. It has been shown, though, that it affects the synthesis of gut microbiota. (2) Methods: This paper is a systematic review and meta-analysis of the effect of oral iron supplementation/fortification on the gut microbiota in infancy. Studies in healthy neonates and infants who received per os iron with existing data on gut microbiota were included. Three databases were searched: PUBMED, Scopus, and Google Scholar. Randomized controlled trials (RCTs) were included. Quality appraisal was assessed using the ROB2Tool. (3) Results: A total of six RCTs met inclusion criteria for a systematic review, and four of them were included in the meta-analysis using both the fixed and random effects methods. Our results showed that there is very good heterogeneity in the iron group (I2 = 62%), and excellent heterogeneity in the non-iron group (I2 = 98%). According to the meta-analysis outcomes, there is a 10.3% (95% CI: -15.0--5.55%) reduction in the bifidobacteria population in the iron group and a -2.96% reduction for the non-iron group. There is a confirmed difference (p = 0.02) in the aggregated outcomes between iron and non-iron supplement, indicative that the bifidobacteria population is reduced when iron supplementation is given (total reduction 6.37%, 95%CI: 10.16-25.8%). (4) Conclusions: The abundance of bifidobacteria decreases when iron supplementation or fortification is given to infants.
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Affiliation(s)
- Theoni Karamantziani
- B’ Neonatal Intensive Care Unit and Neonatal High Dependency Unit, “Aghia Sofia” General Children’s Hospital, 11527 Athens, Greece;
| | - Abraham Pouliakis
- 2nd Department of Pathology, “Attikon” University Hospital, National and Kapodistrian University of Athens, 12464 Athens, Greece
| | - Theodoros Xanthos
- School of Health Sciences, University of West Attica, 12243 Athens, Greece;
| | | | - Styliani Paliatsiou
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece;
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece;
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
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Papadogeorgou P, Valsami S, Boutsikou M, Pergantou E, Mantzou A, Papassotiriou I, Iliodromiti Z, Sokou R, Bouza E, Politou M, Iacovidou N, Boutsikou T. Coagulation Profile in Neonates with Congenital Heart Disease: A Pilot Study. Medicina (Kaunas) 2024; 60:268. [PMID: 38399555 PMCID: PMC10890703 DOI: 10.3390/medicina60020268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: congenital heart disease (CHD), cyanotic and, to a lesser degree, acyanotic, often are accompanied by coagulation abnormalities, impacting substantially morbidity and mortality. Until now, no consistent hemostatic patterns have been demonstrated in neonates and children with CHD because they represent a variable and heterogenous population. The aim of the present study is to investigate the hemostatic profile, as well as the role of ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type-1 motives), the cleaving protein of von Willebrand factor (VWF) in neonates with CHD and compare them to healthy age-matched controls. Materials and Methods: twenty neonates with a mean gestational age of 37.1 ± 2.5 weeks were included in the CHD group, and 18 healthy neonates with a mean gestational age of 38.2 ± 1.5 weeks were in the control group. Results: prothrombin time was significantly prolonged, and accordingly, factor VII (FVII) levels were significantly decreased in the CHD group in comparison to controls. Factor VIII (FVIII), VWF, and ristocetin cofactor activity (Rcof) levels were significantly higher in the study vs. control group. Concentrations of ADAMTS-13 were decreased in the CHD vs. control group, but the difference was not statistically significant. Our results, in combination, indicate a balanced hemostatic mechanism, although with greater variability in neonates with CHD, while developmental aspects of coagulation are evident in the specific patient population. Conclusions: the coagulation profile is moderately impaired early in the course of CHD, though increased thrombogenicity is already present and should not be ignored.
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Affiliation(s)
- Paraskevi Papadogeorgou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Serena Valsami
- Blood Transfusion Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Maria Boutsikou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Eleni Pergantou
- Haemostasis Unit/Haemophilia Centre, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece
| | - Aimilia Mantzou
- First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece (I.P.)
| | - Ioannis Papassotiriou
- First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece (I.P.)
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Elena Bouza
- 2nd Neonatal Intensive Care Unit, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece
| | - Marianna Politou
- Blood Transfusion Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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Sokou R, Tsantes AG, Lampridou M, Tsante KA, Houhoula D, Piovani D, Bonovas S, Boutsikou T, Iliodromiti Z, Iacovidou N, Tsantes AE, Konstantinidi A. Thromboelastometry and prediction of in-hospital mortality in neonates with sepsis. Int J Lab Hematol 2024; 46:113-119. [PMID: 37641388 DOI: 10.1111/ijlh.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION This study aimed at evaluating the role of rotational thromboelastometry (ROTEM) assays in the prediction of in-hospital mortality of neonates with sepsis. METHODS Over a 6-year period, 129 neonates with confirmed sepsis, hospitalized in our neonatal intensive care unit (NICU) were included in the study. Demographics, clinical, and laboratory data were recorded at the sepsis onset and ROTEM assays were performed. Modified neonatal multiple organ dysfunction (NEOMOD) and neonatal sequential organ failure assessment (nSOFA) were calculated simultaneously. Mortality during in-hospital stay was the main outcome measure. RESULTS In-hospital mortality was associated with patient intense hypocoagulability expressed by lower ROTEM MCF in the INTEM assay. The INTEM MCF demonstrated the best prognostic performance for NICU mortality in septic neonates among the other ROTEM parameters but without statistical significance (area under the curve [AUC] = 0.731; 95% confidence interval [CI]: 0.593-0.869). CONCLUSION Our results indicate that ROTEM INTEM MCF parameter has good predictive capacity for in-hospital mortality of septic neonates, similar to that of modified NEOMOD score, nSOFA score, and platelet count, highlighting the integral role of coagulation in sepsis pathophysiology. Hence, ROTEM could serve as a valuable monitoring tool to identify neonates at risk.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Konstantina A Tsante
- Laboratory of Reliability and Quality Control in Laboratory Hematology, Department of Biomedical Science, School of Health and Caring Science, University of West Attica, Athens, Greece
| | - Dimitra Houhoula
- Department of Food Science and Technology, University of West Attica, Egaleo, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Theodora Boutsikou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Argirios E Tsantes
- Laboratory of Reliability and Quality Control in Laboratory Hematology, Department of Biomedical Science, School of Health and Caring Science, University of West Attica, Athens, Greece
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Stylianou-Riga P, Boutsikou T, Kouis P, Michailidou K, Kinni P, Sokou R, Iliodromiti Z, Pitsios C, Yiallouros PK, Iacovidou N. Epidemiology, risk factors, clinical presentation and complications of late-onset neonatal sepsis among preterm neonates in Cyprus: a prospective case-control study. BMC Pediatr 2024; 24:50. [PMID: 38229029 DOI: 10.1186/s12887-023-04359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 10/12/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Late-onset neonatal sepsis (LOS) is common in preterm neonates, with increasing incidence in recent years. In the present study, we examined the epidemiology, clinical presentation, and complications of LOS in Cyprus and quantified possible risk factors for the development of this condition. METHODS The study subjects were preterm neonates admitted in the Neonatal Intensive Care Unit (NICU) of Archbishop Makarios III Hospital, the only neonatal tertiary centre in Cyprus. A prospective, case-control study was designed, and carried out between April 2017-October 2018. Depending on blood culture results, preterm neonates were classified as "Confirmed LOS": positive blood culture - microorganism isolated and LOS symptoms, "Unconfirmed LOS": negative blood culture and LOS symptoms, and "Controls" group: negative blood culture and absence of LOS symptoms. Comparisons between the 3 groups were performed and the associations between demographic, clinical and treatment characteristics with the likelihood of LOS were assessed using univariate and multivariate logistic regression. RESULTS A total of 350 preterm neonates were included in the study and the incidence of LOS was 41.1%. 79 (22.6%) and 65 (18.6%) neonates were classified as "Confirmed LOS", and "unconfirmed LOS" cases respectively while 206 (58.9%) served as controls. The rate of confirmed LOS ranged from 12.2% in moderate to late preterm neonates to 78.6% in extremely preterm neonates. In the multivariate model, we demonstrated an independent association between LOS and duration of hospitalization (OR: 1.06, 95%CI: 1.01-1.10), duration of ventilation (OR: 1.23, 95%CI: 1.07-1.43) and necrotising enterocolitis (OR: 3.41, 95%CI: 1.13-10.25). CONCLUSIONS The present study highlights the epidemiology of LOS in preterm neonates in Cyprus and its association with the duration of ventilation and hospitalization as well as with necrotizing enterocolitis. Establishment of protocols for the prevention of nosocomial infections during hospitalization in the NICUs and mechanical ventilation of preterm neonates is recommended.
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Affiliation(s)
- Paraskevi Stylianou-Riga
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus.
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus.
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodora Boutsikou
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus
| | | | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus
| | - Rozeta Sokou
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Pitsios
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus
| | - Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Karapati E, Valsami S, Sokou R, Pouliakis A, Tsaousi M, Sulaj A, Iliodromiti Z, Iacovidou N, Boutsikou T. Hemostatic Profile of Intrauterine Growth-Restricted Neonates: Assessment with the Use of NATEM Assay in Cord Blood Samples. Diagnostics (Basel) 2024; 14:178. [PMID: 38248055 PMCID: PMC10814959 DOI: 10.3390/diagnostics14020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/31/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is associated with hemorrhagic and thrombotic complications during the perinatal period. Thrombocytopenia, platelet dysfunction, and prolonged standard coagulation tests are observed in this population. The aim of this study is to examine the hemostatic profile of IUGR neonates with the use of a non-activated assay (NATEM) in cord blood samples. METHODS During an 18 month period, a NATEM ROTEM assay was performed on cord blood samples of 101 IUGR neonates. A total of 189 appropriate for gestational age (AGA) neonates were used as a control group. The NATEM variables recorded include the following: clotting time (CT); clot formation time (CFT); clot amplitude at 5, 10, and 20 min (A5, A10, A20); α-angle (a°); maximum clot firmness (MCF); lysis index at 30 and 60 min (LI30, LI60); and maximum clot elasticity (MCE). RESULTS IUGR neonates demonstrate a hypocoagulable state, with lower A5, A10, A2, MCF, and MCE values when compared to AGA. Using multiple linear regression, we determined IUGR as an independent factor influencing all NATEM parameters (except CT and LI30) exhibiting a hypocoagulable and hypofibrinolytic profile. Platelet count was positively correlated with A5, A10, A20, MCF, alpha angle, and MCE, and negatively correlated with CFT. CONCLUSION IUGR neonates appear with lower clot strength and elasticity and prolonged clot kinetics, as illustrated by ROTEM variables.
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Affiliation(s)
- Eleni Karapati
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (R.S.); (M.T.); (A.S.); (Z.I.); (N.I.); (T.B.)
| | - Serena Valsami
- Hematology Laboratory Blood Bank, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Rozeta Sokou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (R.S.); (M.T.); (A.S.); (Z.I.); (N.I.); (T.B.)
| | - Abraham Pouliakis
- Second Department of Pathology, University General Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Marina Tsaousi
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (R.S.); (M.T.); (A.S.); (Z.I.); (N.I.); (T.B.)
| | - Alma Sulaj
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (R.S.); (M.T.); (A.S.); (Z.I.); (N.I.); (T.B.)
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (R.S.); (M.T.); (A.S.); (Z.I.); (N.I.); (T.B.)
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (R.S.); (M.T.); (A.S.); (Z.I.); (N.I.); (T.B.)
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (R.S.); (M.T.); (A.S.); (Z.I.); (N.I.); (T.B.)
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9
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Sokou R, Batsiou A, Konstantinidi A, Kopanou-Taliaka P, Tsaousi M, Lampridou M, Tavoulari EF, Mitropoulos K, Liakou P, Willadara-Gamage S, Vlastarakos PV, Iliodromiti Z, Boutsikou T, Iacovidou N. Laryngotracheoesophageal Cleft Type IV in a Preterm Neonate. A Case Report and Literature Review. Prague Med Rep 2024; 125:47-55. [PMID: 38380453 DOI: 10.14712/23362936.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
We present a case of a preterm neonate with a type IV laryngo-tracheo-oesophageal cleft, an uncommon congenital malformation, resulting from the failure of separation of the trachea and the oesophagus during fetal development, often associated with other deformities as well. Data in the literature shows that the long-term morbidity from the entity has declined over the last decades, even though prognosis remains unfavourable for types III and IV. This report emphasizes the complex issues neonatologists are faced with, when treating neonates with this rare disorder in the first days of life, what will raise suspicion of this rare medical entity, and that direct laryngoscopy/bronchoscopy finally depicts the exact extension of the medical condition. At the same time extensive evaluation for coexisting congenital anomalies should be performed. For all the above reasons, these neonates should be treated in specialized tertiary pediatric centers for multidisciplinary prompt management, which may improve, the outcome.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece.
| | - Anastasia Batsiou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | | | - Marina Tsaousi
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | | | - Paraskevi Liakou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | - Petros V Vlastarakos
- 2nd ENT Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
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10
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Sokou R, Parastatidou S, Konstantinidi A, Tsantes AG, Iacovidou N, Piovani D, Bonovas S, Tsantes AE. Bleeding Scoring Systems in Neonates: A Systematic Review. Semin Thromb Hemost 2023. [PMID: 38016650 DOI: 10.1055/s-0043-1777070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
We conducted a systematic review aiming to summarize the data on the current hemorrhage prediction models and evaluate their potential for generalized application in the neonatal population. The electronic databases PubMed and Scopus were searched, up to September 20, 2023, for studies that focused on development and/or validation of a prediction model for bleeding risk in neonates, and described the process of model building. Nineteen studies fulfilled the inclusion criteria for the present review. Eighteen bleeding risk prediction models in the neonatal population were identified, four of which were internally validated, one temporally and one externally validated. The existing prediction models for neonatal hemorrhage are mostly based on clinical variables and do not take into account the clinical course and hemostatic profile of the neonates. Most studies aimed at predicting the risk of intraventricular hemorrhage (IVH) reflecting the fact that IVH is the most frequent and serious bleeding complication in preterm neonates. A justification for the study sample size for developing the prediction model was given only by one study. Prediction and stratification of risk of hemorrhage in neonates is yet to be optimized. To this end, qualitative standards for model development need to be further improved. The assessment of the risk of bleeding incorporating platelet count, coagulation parameters, and a set of relevant clinical variables is crucial. Large, rigorous, collaborative cohort studies are warranted to develop a robust prediction model to inform the need for transfusion, which is a fundamental step towards personalized transfusion therapy in neonates.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | | | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaeio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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11
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Sokou R, Filippatos F, Daniil V, Bikouli ED, Tsantes AG, Piovani D, Bonovas S, Iliodromiti Z, Boutsikou T, Tsantes AE, Iacovidou N, Konstantinidi A. Group A Streptococcus Infection in Neonatal Population: A Systematic Review of The Literature. J Clin Med 2023; 12:6974. [PMID: 38002589 PMCID: PMC10672068 DOI: 10.3390/jcm12226974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The importance of group A streptococcus (GAS) infection severity has been recognized in children and adults. However, to our knowledge, there have been no systematic reviews or pooled assessments of the incidence and outcome of invasive GAS (iGAS) disease in neonates, a potentially high-risk population. Therefore, we performed a systematic review of available data regarding the risk factors, clinical presentation, and outcome of GAS infection in neonates. (2) Methods: An electronic search of the existing literature was carried out during the period July 2023-September 2023 in the PubMed and Scopus databases, considering studies referring to GAS infection in the neonatal population. (3) Results: Overall, 39 studies met all the inclusion criteria and were included in this review, evaluating data from 194 neonates. Unfortunately, there were a lot of missing data among the retrieved studies. Our systematic review highlighted the presence of differences with regards to clinical presentation, infection sites, and outcome of GAS invasive disease between neonates with early-onset (EOS) or late-onset sepsis (LOS). Common characteristics of EOS included respiratory distress, rapid deterioration, and high mortality rate irrespective of the infection site, while rash, gastrointestinal tract symptoms, and fever appeared to be the most frequent symptoms/clinical signs and manifestations of LOS disease. The management of severe invasive iGAS disease consists mainly of specific antimicrobial treatment as well as supportive care with fluids and electrolyte supplementation, minimizing or counteracting the effects of toxins. Furthermore, a mortality rate of approximately 14% was recorded for iGAS disease in the total of all studies' neonates. (4) Conclusions: Although iGAS is a rare entity of neonatal infections, the potential severity of the disease and the rapid deterioration requires the development of quick analysis methods for the detection of GAS allowing the prompt diagnosis and administration of the indicated antibiotic treatment. Furthermore, given the exceptional risk for both the pregnant woman and the neonate, it is very important to raise awareness and create easily accessible guidelines that could facilitate the prevention and management of maternal as well as the subsequent neonatal severe iGAS disease.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece; (E.-D.B.); (A.K.)
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Filippos Filippatos
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Vasiliki Daniil
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Efstathia-Danai Bikouli
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece; (E.-D.B.); (A.K.)
| | - Andreas G. Tsantes
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece;
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Zoi Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Theodora Boutsikou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Argirios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece; (E.-D.B.); (A.K.)
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12
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Papadimitriou DT, Stratakis CA, Kattamis A, Glentis S, Dimitrakakis C, Spyridis GP, Christopoulos P, Mastorakos G, Vlahos NF, Iacovidou N. A Novel Variant in the TP53 Gene Causing Li-Fraumeni Syndrome. Children (Basel) 2023; 10:1150. [PMID: 37508646 PMCID: PMC10378136 DOI: 10.3390/children10071150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
Li-Fraumeni syndrome (LFS) is an autosomal dominant hereditary cancer syndrome associated with germline pathogenic variants in the tumor protein p53 (TP53) gene and elevated risk of a broad range of early-onset malignancies. Patients with LFS are at risk of a second and third primary tumor. A 15-month-old girl consulted for clitoromegaly and pubic hair. Adrenal ultrasound detected a large left adrenal tumor. Left total adrenalectomy confirmed adrenocortical carcinoma. Family history revealed multiple highly malignant neoplasms at an early age across five generations, and a genetic dominant trait seemed probable. Whole-genome sequencing was performed. Multiple members of the family were found positive for a novel likely pathogenic variant (c. 892delGinsTTT, p. Glu298PhefsX48, NM_000546.6) in the TP53 gene, causing the loss of normal protein function through non-sense-mediated mRNA decay. According to the PSV1 supporting criteria and the Auto PVS1 online tool this frameshift variant: hg19/17-7577045-TC-TAAA:NM_000546.6 has a very strong, definitive clinical validity for LFS with autosomal dominant inheritance. Proper guidance resulted in timely diagnosis of a second tumor (primary osteosarcoma) in the index case and in the early detection of breast and cervical cancer in her young mother. Patients with cancer predisposition syndromes like LFS require close multidisciplinary cancer surveillance and appropriate referral to expert centers.
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Affiliation(s)
- Dimitrios T Papadimitriou
- Endocrine Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, 11528 Athens, Greece
- Pediatric-Adolescent Endocrinology and Diabetes, Athens Medical Center, 15125 Marousi, Greece
| | - Constantine A Stratakis
- Section on Endocrinology & Genetics, The Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20814, USA
| | - Antonis Kattamis
- Division of Pediatric Hematology and Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece
- 'Aghia Sophia' Children's Hospital ERN-Genturis Center, 11527 Athina, Greece
| | - Stavros Glentis
- Division of Pediatric Hematology and Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece
- 'Aghia Sophia' Children's Hospital ERN-Genturis Center, 11527 Athina, Greece
| | - Constantine Dimitrakakis
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - George P Spyridis
- Surgical Pediatric Oncology, Mitera Children's Hospital, 15123 Marousi, Greece
| | | | - George Mastorakos
- Endocrine Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, 11528 Athens, Greece
| | - Nikolaos F Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, 11528 Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieion Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
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13
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Sokou R, Parastatidou S, Iliodromiti Z, Lampropoulou K, Vrachnis D, Boutsikou T, Konstantinidi A, Iacovidou N. Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases. Nutrients 2023; 15:2822. [PMID: 37447149 DOI: 10.3390/nu15132822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The prevalence of chronic maternal disease is rising in the last decades in the developed world. Recent evidence indicated that the incidence of chronic maternal disease ranges from 10 to 30% of pregnancies worldwide. Several epidemiological studies in mothers with chronic diseases have mainly focused on the risk for adverse obstetric outcomes. Evidence from these studies supports a correlation between maternal chronic conditions and adverse perinatal outcomes, including increased risk for preeclampsia, cesarean section, preterm birth, and admission in the Neonatal Intensive Care Unit (NICU). However, there is a knowledge gap pertaining to the management of these women during lactation. This review aimed at summarizing the available research literature regarding breastfeeding in mothers with chronic diseases. Adjusted and evidence-based support may be required to promote breastfeeding in women with chronic diseases; however, our comprehension of breastfeeding in this subpopulation is still unclear. The literature related to breastfeeding extends in various scientific areas and multidisciplinary effort is necessary to compile an overview of current evidence and knowledge regarding breastfeeding issues in mothers with chronic diseases.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D.Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Elena Venizelou" Maternity Hospital, 11521 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Katerina Lampropoulou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Dionysios Vrachnis
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D.Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
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14
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Boutsikou T, Sekkidou M, Karaglani E, Krepi A, Moschonis G, Nicolaou N, Iacovidou N, Pancheva R, Marinova-Achkar M, Popova S, Kapetanaki A, Iliodromiti Z, Papaevangelou V, Sardeli O, Papathoma E, Schaafsma A, Bos R, Manios Y, Xepapadaki P. The Impact of Infant Feeding Regimen on Cow's Milk Protein Allergy, Atopic Dermatitis and Growth in High-Risk Infants during the First 6 Months of Life: The Allergy Reduction Trial. Nutrients 2023; 15:nu15112622. [PMID: 37299585 DOI: 10.3390/nu15112622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The development of early-onset cow's milk protein allergy and atopic dermatitis during the first months of life is multifactorial, including both genetic and nutritional aspects. This study aims to assess the impact of different feeding patterns on the incidence of cow's milk protein allergy, atopic dermatitis, and growth among infants with a family history of allergy. A total of 551 high-risk infants were randomly recruited from 3 European countries in three feeding regimens: exclusive breastfeeding, partially hydrolyzed formula, or standard formula with intact protein either exclusively or supplementary to breastfeeding. During the first 6 months of intervention, amongst infants with a family history of atopic dermatitis, 6.5% of partially hydrolyzed formula-fed infants and 22.7% of exclusively breastfed infants (p = 0.007) presented with atopic dermatitis respectively. Growth as assessed by weight increase did not differ between the aforementioned groups. Although cow's milk protein allergy was not related to the different milk feeding regimens in the whole cohort, when adjusting for high breast milk intake, the respective incident was significantly lower in the infants consuming partially hydrolyzed formula (p < 0.001). This data indicates that a specific partially hydrolyzed formula could serve as a more appropriate complement to breast milk compared to a standard intact protein formula in high-risk infants, to reduce the incidence of atopic dermatitis.
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Affiliation(s)
- Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Mikaela Sekkidou
- Asthma and Allergy Center, 3025 Limassol, Cyprus
- University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave., 17671 Athens, Greece
| | - Adamantia Krepi
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Nicolaos Nicolaou
- Asthma and Allergy Center, 3025 Limassol, Cyprus
- University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Rouzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, 9000 Varna, Bulgaria
| | - Miglena Marinova-Achkar
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, 9000 Varna, Bulgaria
| | - Simoneta Popova
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, 9000 Varna, Bulgaria
| | - Anastasia Kapetanaki
- Neonatal Intensive Care Unit, General and Maternity Hospital Elena Venizelou, 11521 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, ATTIKON General University Hospital, 12462 Athens, Greece
| | - Olympia Sardeli
- Third Department of Pediatrics, National and Kapodistrian University of Athens, ATTIKON General University Hospital, 12462 Athens, Greece
| | - Evangelia Papathoma
- Neonatal Intensive Care Unit, Alexandra General Hospital, 11528 Athens, Greece
| | | | - Rolf Bos
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave., 17671 Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, 71410 Heraklion, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15771 Athens, Greece
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15
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Christou E, Iliodromiti Z, Pouliakis A, Loukatou E, Varela P, Panagoulia A, Chasiakou A, Zisimopoulos S, Iacovidou N, Boutsikou T. Urinary NT-proBNP: A Useful Biomarker for the Diagnosis of Respiratory Distress in the Neonatal Population. Cureus 2023; 15:e39019. [PMID: 37323310 PMCID: PMC10266900 DOI: 10.7759/cureus.39019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of urinary NT-proBNP levels in the detection and classification of the severity of respiratory distress in neonates after birth. METHODS We compared the urinary NT- proBNP levels between the respiratory distress (RD) group and the control group on the 1st, 3rd, and 5th day of life (DOL). RESULTS The RD group (55 neonates) showed higher levels of NT-proBNP compared to the control group (63 neonates) on DOL1 (585.4 pg/ml vs 396.1 pg/ml (p=0.014)), DOL3 (805.1 pg/ml vs 271.9 pg/ml (p<0.001)) and DOL5 (409.7 pg/ml vs 94.4 pg/ml (p<0.001)). Especially, on DOL5, the area under the ROC curve was 0.884 and the NT-proBNP cut-off value (221.8 pg/ml) showed a sensitivity of 71% and specificity of 79%. The RD group was subclassified into neonates with mild (21 neonates), moderate (19 neonates), and severe (15 neonates) disease. NT-proBNP cut-off point of 668 pg/ml for DOL5 can safely differentiate neonates with severe disease from those with mild and moderate disease (combined subgroups) since the sensitivity was 80% and specificity was 77.5% for DOL5. CONCLUSION Urinary NT-proBNP levels are a useful biomarker in detecting clinical signs of respiratory distress in neonates that are born within the first week of life; they can also detect neonates that are vulnerable to severe forms of the disease.
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Affiliation(s)
- Evangelos Christou
- Department of Pediatrics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC
- Department of Neonatology, Aretaieion University Hospital, Athens, GRC
| | - Zoi Iliodromiti
- Department of Neonatology, Aretaieion University Hospital, Athens, GRC
| | - Abraham Pouliakis
- Epidemiology and Public Health, 2nd Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Eirini Loukatou
- Department of Pediatrics, Alexandra General Hospital, Athens, GRC
| | - Pinelopi Varela
- Department of Pediatrics, Alexandra General Hospital, Athens, GRC
| | - Adamantia Panagoulia
- Department of Biochemistry, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC
| | - Anthia Chasiakou
- Department of Biopathology, Aretaieion University Hospital, Athens, GRC
| | - Spyridon Zisimopoulos
- Department of Pediatrics, Elena Venizelou General and Maternity Hospital, Athens, GRC
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16
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Dimitroglou M, Sokou R, Iacovidou N, Pouliakis A, Kafalidis G, Boutsikou T, Iliodromiti Z. Anti-SARS-CoV-2 Immunoglobulins in Human Milk after Coronavirus Disease or Vaccination-Time Frame and Duration of Detection in Human Milk and Factors That Affect Their Titers: A Systematic Review. Nutrients 2023; 15:nu15081905. [PMID: 37111124 PMCID: PMC10141636 DOI: 10.3390/nu15081905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Human milk (HM) of mothers infected with or vaccinated against SARS-CoV-2 contains specific immunoglobulins, which may protect their offspring against infection or severe disease. The time frame and duration after infection or vaccination, during which these immunoglobulins are detected in HM, as well as the major factors that influence their levels, have not been fully elucidated. This systematic review aimed to collect the existing literature and describe the immune response, specifically regarding the immunoglobulins in HM after COVID-19 disease or vaccination in non-immune women. We conducted a systematic search of PubMed and Scopus databases to identify studies published up until 19 March 2023. In total, 975 articles were screened, and out of which 75 were identified as being relevant and were finally included in this review. Infection by SARS-CoV-2 virus primarily induces an IgA immune response in HM, while vaccination predominantly elevates IgG levels. These immunoglobulins give HM a neutralizing capacity against SARS-CoV-2, highlighting the importance of breastfeeding during the pandemic. The mode of immune acquisition (infection or vaccination) and immunoglobulin levels in maternal serum are factors that seem to influence immunoglobulin levels in HM. Further studies are required to determine the impact of other factors, such as infection severity, lactation period, parity, maternal age and BMI on immunoglobulin level in HM.
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Affiliation(s)
- Margarita Dimitroglou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Abraham Pouliakis
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Georgios Kafalidis
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
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17
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Sokou R, Georgiadou P, Tsantes AG, Parastatidou S, Konstantinidi A, Ioakeimidis G, Makrogianni A, Theodoraki M, Kokoris S, Iacovidou N, Kriebardis AG, Piovani D, Bonovas S, Tsantes AE. The Utility of NATEM Assay in Predicting Bleeding Risk in Critically Ill Neonates. Semin Thromb Hemost 2023; 49:182-191. [PMID: 36055275 DOI: 10.1055/s-0042-1753513] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We aimed to investigate the hemostatic status of diseased neonates using nonactivated rotational thromboelastometry (ROTEM) assay (NATEM) assay and, in addition, to evaluate the discriminative power of NATEM parameters in predicting the risk of bleeding in critically ill neonates and compare it to that of EXTEM (extrinsically activated ROTEM) parameters. This cohort study included 158 consecutive, critically ill neonates with presumed sepsis, perinatal hypoxia, or respiratory distress syndrome. The EXTEM and NATEM assays were performed on the first day of disease onset. The neonatal bleeding assessment tool was used to record and assess clinical bleeding events on the day of ROTEM analysis. Several EXTEM and NATEM ROTEM parameters differed between neonates with and without clinical bleeding events, indicating a hypo-coagulable state in neonates with clinical bleeding. NATEM parameters had comparable predictive performance for clinical bleeding events with EXTEM parameters for clotting time, clot formation time (CFT), A10 (clot amplitude at 10minutes), maximum clot firmness, lysis index at 60minutes, and maximum clot elasticity (p>0.05). However, NATEM A20, A30, and α angle demonstrated better predictive ability than EXTEM A20, A30, and α angle, respectively (p<0.05). A NATEM CFT value ≥147seconds presented 95.2% sensitivity (95% confidence interval [CI]: 76.1-99.8%) and 65.6% specificity (95% CI: 57.1-73.5%) to detect neonates with clinical bleeding, while a NATEM A10 value ≤42mm had 80.8% sensitivity (95% CI: 71.8-85.9%) and 76.0% specificity (95% CI: 52.8-91.7%) to detect neonates with clinical bleeding events. The NATEM assay has shown remarkable sensitivity in predicting bleeding in critically ill neonates, exceeding EXTEM performance in some selected parameters. The incorporation of NATEM test parameters in predictive models for neonatal hemorrhage seems promising.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Petroula Georgiadou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Athanasia Makrogianni
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Martha Theodoraki
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Styliani Kokoris
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Laboratory of Reliability and Quality Control in Laboratory Hematology, Department of Biomedical Science, School of Health and Caring Science, University of West Attica, Egaleo, Athens, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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18
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Kopanou Taliaka P, Tsantes AG, Konstantinidi A, Liakou P, Tavoulari EF, Piovani D, Bonovas S, Iacovidou N, Tsantes AE, Sokou R. Monkeypox disease and pregnancy. Where are we today? A review of literature. J Perinatol 2023; 43:417-423. [PMID: 36725987 DOI: 10.1038/s41372-023-01629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
Monkeypox has emerged as a significant human pathogen, posing severe risks in vulnerable populations. At present, there is not enough data available as to whether pregnant women are more vulnerable to monkeypox infection, or they suffer more severe symptoms, and studies on this issue as well as to the possible adverse effects on the developing fetus are limited. The aim of this review, was to bring together what is known so far about monkeypox virus transmission, the clinical course of the disease, and associated maternal-fetal outcomes. Furthermore, to summarize the current available recommendations on the prevention and management of monkeypox infection during pregnancy, in order to help obstetricians and neonatologists navigate through this new challenging area and provide the best available care to their patients.
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Affiliation(s)
| | - Andreas G Tsantes
- Microbiology Department, "Saint Savvas" Oncology Hospital, Athens, Greece
| | | | - Paraskevi Liakou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | - Daniele Piovani
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Stefanos Bonovas
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece. .,Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
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19
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Matara DI, Sokou R, Xanthos T, Pouliakis A, Sarantaki A, Boutsikou T, Iliodromiti Z, Salakos C, Gazouli M, Iacovidou N. Asphyxia-Induced Bacterial Translocation in an Animal Experimental Model in Neonatal Piglets. Diagnostics (Basel) 2022; 12:diagnostics12123103. [PMID: 36553109 PMCID: PMC9776828 DOI: 10.3390/diagnostics12123103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The term "bacterial translocation" (BT) refers to the migration of bacteria or their products from the gastrointestinal tract to tissues located outside it, and may occur after intestinal ischemia-reperfusion injury. The term "endotoxin" is synonymous, and is used interchangeably with the term lipopolysaccharide (LPS). LPS, a component of Gram-negative gut bacteria, is a potent microbial virulence factor, that can trigger production of pro-inflammatory mediators, causing localized and systemic inflammation. The aim of this study is to investigate if neonatal asphyxia provokes BT and an increased concentration of LPS in an animal model of asphyxia in piglets. METHODS Twenty-one (21) newborn male Landrace/Large White piglets, 1-4 days old, were randomly allocated into three groups, Control (A), Asphyxia (B) and Asphyxia-Cardiopulmonary Resuscitation (CPR) (C). All animals were instrumented, anesthetized and underwent hemodynamic monitoring. In Group A, the animals were euthanized. In Group B, the endotracheal tube was occluded to cause asphyxia leading to cardiopulmonary arrest. In Group C, the animals were resuscitated after asphyxia and further monitored for 30'. Bacterial translocation was assessed by the measurement of endotoxin in blood from the portal vein and the aorta, and also by the measurement of endotoxin in mesenteric lymph nodes (MLNs) at euthanasia. The results are given as median (IQR) with LPS concentration in EU/mL. RESULTS BT was observed in all groups with minimum LPS concentration in the MLN and maximum concentration in the portal vein. LPS levels in the MLNs were higher in the Group B: 6.38 EU/mL (2.69-9.34) compared to the other groups (Group A: 2.1 EU/mL (1.08-2.52), Group C: 1.66 EU/mL (1.51-2.48), p = 0.012). The aorta to MLNs LPS difference (%) was lower in Group B: 0.13% (0.04-1.17), compared to Group A: 5.08% (2.2-10.7), and Group C: 3.42% (1.5-5.1)) (p = 0.042). The same was detected for portal to MLNs LPS difference (%) which was lower in Group B: 0.94% (0.5-3) compared to Group A: 4.9% (4-15), and Group C: 3.85% (1.5-5.1)) (p = 0.044). CONCLUSIONS Neonatal asphyxia can provoke ΒΤ and increased LPS concentration in blood and tissue located outside the gastrointestinal system.
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Affiliation(s)
- Dimitra-Ifigeneia Matara
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
- 1st Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-6980037484
| | - Rozeta Sokou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Theodoros Xanthos
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University Hospital, 12462 Athens, Greece
| | - Antigoni Sarantaki
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Christos Salakos
- Pediatric Surgical Department, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University Hospital, Medical School, 12462 Athens, Greece
| | - Maria Gazouli
- School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
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20
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Batsiou A, Mantzios P, Piovani D, Tsantes AG, Kopanou Taliaka P, Liakou P, Iacovidou N, Tsantes AE, Bonovas S, Sokou R. SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review. J Clin Med 2022; 11:jcm11237238. [PMID: 36498812 PMCID: PMC9737360 DOI: 10.3390/jcm11237238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
The impact of COVID-19 on pediatric patients with inflammatory bowel disease (PIBD) is still not clear and the knowledge acquired over the last 2 years is still evolving. This study aims to investigate the risk and clinical outcomes of COVID-19 in patients with PIBD. A systematic search of PubMed and Scopus databases was conducted to identify studies published up until September 2022. Out of the 475 articles screened, 14 studies were included in the review. Of the 4006 children with PIBD included, 390 (9.7%) tested positive for COVID-19. Among those with COVID-19, 5.9% (0-16.7%) needed hospitalization, 0.6% (0-1%) were admitted to the pediatric intensive care unit (PICU), and no deaths were reported. Among the included studies, only four presented details regarding patients' symptoms, with 21% (0-25%) presenting gastrointestinal (GI) symptoms. An association between PIBD activity or specific treatment and COVID-19 outcome could not be established. The prevalence of COVID-19 in patients with PIBD was low; therefore, the initial concerns regarding higher infection risk and worse prognosis in this population are not supported by the currently available data. Further research is needed to determine the natural history of the infection and the optimal treatment for these patients. Much is still unclear and additional studies should be performed in order to optimize prevention and care for this special group of patients.
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Affiliation(s)
- Anastasia Batsiou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece
| | - Petros Mantzios
- Department of Internal Medicine, General Hospital of Eastern Achaia, 25100 Aigio, Greece
| | - Daniele Piovani
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Andreas G. Tsantes
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece
| | | | - Paraskevi Liakou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Argirios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Stefanos Bonovas
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Correspondence: (S.B.); (R.S.)
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: (S.B.); (R.S.)
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21
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Tsaousi M, Iliodromiti Z, Iacovidou N, Karapati E, Sulaj A, Tsantes AG, Petropoulou C, Boutsikou T, Tsantes AE, Sokou R. Hemostasis in Neonates with Perinatal Hypoxia—Laboratory Approach: A Systematic Review. Semin Thromb Hemost 2022; 49:391-401. [PMID: 36368691 DOI: 10.1055/s-0042-1758148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractBirth asphyxia, with an estimated prevalence of 1 to 6 per 1,000 live births, may lead to multiorgan dysfunction due to impaired oxygen and/or blood supply to various organ systems, including the hemostatic system. Coagulopathy, a common complication of perinatal asphyxia, has been described since the 1960s. The aim of this study was to systematically review the literature for records on the use of hemostasis tests in the evaluation of coagulation disorders, in neonates who had suffered from perinatal hypoxia or asphyxia. We identified published studies by searching PubMed and Scopus, up until April 2022. The literature search retrieved 37 articles fulfilling the inclusion criteria of the review. According to the bibliography, thrombocytopenia is commonly associated with perinatal hypoxia/asphyxia. The thrombocytopenia is usually described as mild and platelets return to normal levels by the 10th day of life. Additionally, hypoxic neonates usually present with a hypocoagulable profile, as reflected by the prolongation of standard coagulation tests, including prothrombin time, activated partial thromboplastin time, and international normalized ratio, findings commonly associated with disseminated intravascular coagulation, and by the reduction of the levels of the physiologic inhibition of coagulation system. A few studies thus far using ROTEM/TEG in hypoxic neonates have come to the same conclusion as well; hypoxic newborns seem to be characterized by a hypocoagulable profile compared with healthy neonates. It should be emphasized, however, that standard coagulation tests provide only a rough estimation of the true bleeding or thrombotic risk of hypoxic neonates. On the contrary, viscoelastic methods seem to be more precise in the early detection of hemostasis disorders in the neonatal population. However, until now, there was uncertainty as to the most appropriate coagulation assays for diagnosis and management of coagulation derangement in neonates with perinatal hypoxia indicating the need for further research on this field.
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Affiliation(s)
- Marina Tsaousi
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Karapati
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alma Sulaj
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysa Petropoulou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argirios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, Piraeus, Greece
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22
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Sokou R, Parastatidou S, Ioakeimidis G, Tavoulari EF, Makrogianni A, Isaakidou E, Iacovidou N, Konstantinidi A. Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up. Nutrients 2022; 14:nu14183841. [PMID: 36145216 PMCID: PMC9500865 DOI: 10.3390/nu14183841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Athanasia Makrogianni
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Elina Isaakidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
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23
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Dimitroglou M, Iliodromiti Z, Christou E, Volaki P, Petropoulou C, Sokou R, Boutsikou T, Iacovidou N. Human Breast Milk: The Key Role in the Maturation of Immune, Gastrointestinal and Central Nervous Systems: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12092208. [PMID: 36140609 PMCID: PMC9498242 DOI: 10.3390/diagnostics12092208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 12/22/2022] Open
Abstract
Premature birth is a major cause of mortality and morbidity in the pediatric population. Because their immune, gastrointestinal and nervous systems are not fully developed, preterm infants (<37 weeks of gestation) and especially very preterm infants (VPIs, <32 weeks of gestation) are more prone to infectious diseases, tissue damage and future neurodevelopmental impairment. The aim of this narrative review is to report the immaturity of VPI systems and examine the role of Human Breast Milk (HBM) in their development and protection against infectious diseases, inflammation and tissue damage. For this purpose, we searched and synthesized the data from the existing literature published in the English language. Studies revealed the significance of HBM and indicate HBM as the best dietary choice for VPIs.
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24
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Sertedaki A, Tatsi EB, Vasilakis IA, Fylaktou I, Nikaina E, Iacovidou N, Siahanidou T, Kanaka-Gantenbein C. Whole Exome Sequencing Points towards a Multi-Gene Synergistic Action in the Pathogenesis of Congenital Combined Pituitary Hormone Deficiency. Cells 2022; 11:cells11132088. [PMID: 35805171 PMCID: PMC9265573 DOI: 10.3390/cells11132088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 12/21/2022] Open
Abstract
Combined pituitary hormone deficiency (CPHD) is characterized by deficiency of growth hormone and at least one other pituitary hormone. Pathogenic variants in more than 30 genes expressed during the development of the head, hypothalamus, and/or pituitary have been identified so far to cause genetic forms of CPHD. However, the etiology of around 85% of the cases remains unknown. The aim of this study was to unveil the genetic etiology of CPHD due to congenital hypopituitarism employing whole exome sequencing (WES) in two newborn patients, initially tested and found to be negative for PROP1, LHX3, LHX4 and HESX1 pathogenic variants by Sanger sequencing and for copy number variations by MLPA. In this study, the application of WES in these CPHD newborns revealed the presence of three different heterozygous gene variants in each patient. Specifically in patient 1, the variants BMP4; p.Ala42Pro, GNRH1; p.Arg73Ter and SRA1; p.Gln32Glu, and in patient 2, the SOX9; p.Val95Ile, HS6ST1; p.Arg306Gln, and IL17RD; p.Pro566Ser were identified as candidate gene variants. These findings further support the hypothesis that CPHD constitutes an oligogenic rather than a monogenic disease and that there is a genetic overlap between CPHD and congenital hypogonadotropic hypogonadism.
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Affiliation(s)
- Amalia Sertedaki
- Division of Endocrinology, Diabetes and Metabolism, Center for Rare Paediatric Endocrine Diseases, First Department of Pediatrics, Medical School, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.B.T.); (I.A.V.); (I.F.); (C.K.-G.)
- Correspondence:
| | - Elizabeth Barbara Tatsi
- Division of Endocrinology, Diabetes and Metabolism, Center for Rare Paediatric Endocrine Diseases, First Department of Pediatrics, Medical School, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.B.T.); (I.A.V.); (I.F.); (C.K.-G.)
| | - Ioannis Anargyros Vasilakis
- Division of Endocrinology, Diabetes and Metabolism, Center for Rare Paediatric Endocrine Diseases, First Department of Pediatrics, Medical School, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.B.T.); (I.A.V.); (I.F.); (C.K.-G.)
| | - Irene Fylaktou
- Division of Endocrinology, Diabetes and Metabolism, Center for Rare Paediatric Endocrine Diseases, First Department of Pediatrics, Medical School, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.B.T.); (I.A.V.); (I.F.); (C.K.-G.)
| | - Eirini Nikaina
- Neonatology Unit, First Department of Pediatrics, Medical School, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.N.); (T.S.)
| | - Nicoletta Iacovidou
- Department of Neonatology, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Tania Siahanidou
- Neonatology Unit, First Department of Pediatrics, Medical School, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.N.); (T.S.)
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Diabetes and Metabolism, Center for Rare Paediatric Endocrine Diseases, First Department of Pediatrics, Medical School, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.B.T.); (I.A.V.); (I.F.); (C.K.-G.)
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Tsantes AG, Konstantinidi A, Parastatidou S, Ioakeimidis G, Tsante KA, Mantzios PG, Kriebardis AG, Gialeraki A, Houhoula D, Iacovidou N, Piovani D, Bonovas S, Tsantes AE, Sokou R. Assessment of agreement between EXTEM and NATEM thromboelastometry measurement assays in critically ill neonates. Eur J Haematol 2022; 109:327-335. [PMID: 35690886 DOI: 10.1111/ejh.13812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the agreement between the EXTEM and NATEM measurements. METHODS In this retrospective observational study, EXTEM and NATEM analyses were performed on blood samples from 162 ill neonates, providing 324 paired measurements. The agreement between EXTEM and NATEM measurements was evaluated by the nonparametric spearman's rank correlation to assess the correlation between the paired measurements, by the Bland-Altman analysis for the graphical presentation of the agreement, and by the Deming regression model to assess the significance of the agreement. The agreement between the two methods for the detection of bleeding events was determined by kappa statistic. RESULTS Strong correlations were found between EXTEM and NATEM measurements for A10, MCF. The Bland-Altman plots showed good agreement for A10, MCF, LI60, and alpha angle parameters, while CT showed a nearly linear slope indicating that bias increased with the mean. The highest agreement for bleeding events was found for the A10 parameter (κ = 0.70, p < .001), while the lowest for the CT parameter (κ = 0.36, p = .94). CONCLUSIONS NATEM parameters that reflect clot firmness and fibrinolytic activity are strongly correlated with the corresponding EXTEM measurements with a good agreement between them, indicating that these two methods could be used interchangeably.
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Affiliation(s)
- Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Konstantina A Tsante
- Laboratory of Reliability and Quality Control in Laboratory Hematology, Department of Biomedical Science, School of Health and Caring Science, University of West Attica, Athens, Greece
| | - Petros G Mantzios
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Laboratory of Reliability and Quality Control in Laboratory Hematology, Department of Biomedical Science, School of Health and Caring Science, University of West Attica, Athens, Greece
| | - Argyri Gialeraki
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Houhoula
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
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Nicolaou N, Pancheva R, Karaglani E, Sekkidou M, Marinova-Achkar M, Popova S, Tzaki M, Kapetanaki A, Iacovidou N, Boutsikou T, Iliodromiti Z, Papaevangelou V, Sardeli O, Xepapadaki P, Papathoma E, Thijs-Verhoeven I, Kudla U, Ulfman LH, Schaafsma A, Manios Y. The Risk Reduction Effect of a Nutritional Intervention With a Partially Hydrolyzed Whey-Based Formula on Cow's Milk Protein Allergy and Atopic Dermatitis in High-Risk Infants Within the First 6 Months of Life: The Allergy Reduction Trial (A.R.T.), a Multicenter Double-Blinded Randomized Controlled Study. Front Nutr 2022; 9:863599. [PMID: 35694159 PMCID: PMC9174747 DOI: 10.3389/fnut.2022.863599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background The role of partially hydrolyzed formulas (pHF) as part of nutritional interventions to prevent the development of allergic manifestations (AM) is questioned, and efficacy of each specific pHF should be substantiated. Objective To investigate the risk-reduction effect of a whey-based pHF on the development of cow's milk protein allergy (CMPA) and atopic dermatitis (AD) in infants at high-risk for allergy within the first 6 months of life. Materials and Methods In a multicenter double-blinded randomized controlled setting, healthy non-exclusively breastfed full-term infants, received either a specific whey-based pHF or a standard cow's milk-based formula (SF) and were clinically assessed for AM at 2, 4, and 6 months of age, supported by the objective scoring tools SCORAD and CoMiSS. CMPA was confirmed by open food challenge. Intention-to-Treat (ITT) and Per-Protocol (PP) analyses were performed. Results Of 331 randomized subjects (ITT analysis set), 160 received the pHF and 171 the SF. Six (3.8%) infants in the pHF and 12 (7%) in the SF group developed CMPA (p = 0.186). AD incidence was significantly lower in those receiving pHF as compared to SF (10.6% vs. 18.7%, p = 0.024) with a relative risk (RR, 95% CI) of 0.54 (0.32, 0.92), in particular when adjusting for family history of AD [6.5% vs. 27.3%, RR 0.24 (0.07, 0.78), p = 0.018] representing a risk reduction of 76%. The PP analysis showed similar results. Conclusion This specific whey-based pHF reduced the risk of AD development, particularly in those with a family history of AD, and tended to reduce the development of CMPA in non-exclusively breastfed infants at high-risk for allergy. The A.R.T. study suggests that this particular pHF may contribute to measures aimed at prevention of allergic manifestations. However, further studies are needed to confirm this risk-reduction effect.
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Affiliation(s)
- Nicolaos Nicolaou
- Asthma and Allergy Centre, Limassol, Cyprus
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Rouzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
- *Correspondence: Rouzha Pancheva
| | - Eva Karaglani
- Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | | | - Miglena Marinova-Achkar
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
| | - Simoneta Popova
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
| | | | | | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, ATTIKON General University Hospital, Athens, Greece
| | - Olympia Sardeli
- Third Department of Pediatrics, National and Kapodistrian University of Athens, ATTIKON General University Hospital, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Papathoma
- Neonatal Intensive Care Unit, Alexandra University and State Maternity Hospital, Athens, Greece
| | | | | | | | | | - Yannis Manios
- Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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Chalkias A, Laou E, Papagiannakis N, Varvarousi G, Ragias D, Koutsovasilis A, Makris D, Varvarousis D, Iacovidou N, Pantazopoulos I, Xanthos T. Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study. Intensive Care Med Exp 2022; 10:13. [PMID: 35412084 PMCID: PMC9005574 DOI: 10.1186/s40635-022-00440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/05/2022] [Indexed: 01/02/2023] Open
Abstract
Background Mean circulatory filling pressure (Pmcf) provides information on stressed volume and is crucial for maintaining venous return. This study investigated the Pmcf and other determinants of venous return in dysrhythmic and asphyxial circulatory shock and arrest. Methods Twenty Landrace/Large-White piglets were allocated into two groups of 10 animals each. In the dysrhythmic group, ventricular fibrillation was induced with a 9 V cadmium battery, while in the asphyxia group, cardiac arrest was induced by stopping and disconnecting the ventilator and clamping the tracheal tube at the end of exhalation. Mean circulatory filling pressure was calculated using the equilibrium mean right atrial pressure at 5–7.5 s after the onset of cardiac arrest and then every 10 s until 1 min post-arrest. Successful resuscitation was defined as return of spontaneous circulation (ROSC) with a MAP of at least 60 mmHg for a minimum of 5 min. Results After the onset of asphyxia, a ΔPmca increase of 0.004 mmHg, 0.01 mmHg, and 1.26 mmHg was observed for each mmHg decrease in PaO2, each mmHg increase in PaCO2, and each unit decrease in pH, respectively. Mean Pmcf value in the ventricular fibrillation and asphyxia group was 14.81 ± 0.5 mmHg and 16.04 ± 0.6 mmHg (p < 0.001) and decreased by 0.031 mmHg and 0.013 mmHg (p < 0.001), respectively, for every additional second passing after the onset of cardiac arrest. With the exception of the 5–7.5 s time interval, post-cardiac arrest right atrial pressure was significantly higher in the asphyxia group. Mean circulatory filling pressure at 5 to 7.5 s after cardiac arrest predicted ROSC in both groups, with a cut-off value of 16 mmHg (AUC = 0.905, p < 0.001). Conclusion Mean circulatory filling pressure was higher in hypoxic hypercapnic conditions and decreased at a lower rate after cardiac arrest compared to normoxemic and normocapnic state. A Pmcf cut-off point of 16 mmHg at 5–7.5 s after cardiac arrest can highly predict ROSC. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-022-00440-z.
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Papailiou S, Soldatou A, Marmarinos A, Avgeris M, Papathoma E, Sindos M, Georgantzi S, Rodolakis Α, Iacovidou N, Gourgiotis D, Tsolia M. Inadequate protection against measles and rubella among pregnant women in Greece during the last measles outbreak. J Infect 2022; 84:e95-e97. [DOI: 10.1016/j.jinf.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Chatziioannidis I, Pouliakis A, Cuttini M, Boutsikou T, Giougi E, Volaki V, Sokou R, Xanthos T, Iliodromiti Z, Iacovidou N. Nurses' involvement in end-of-life decisions in neonatal intensive care units. Nurs Ethics 2022; 29:569-581. [PMID: 35142573 DOI: 10.1177/09697330211035505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND End-of-life decision-making for terminally ill neonates raises important legal and ethical issues. In Greece, no recent data on nurses' attitudes and involvement in end-of-life decisions are available. RESEARCH QUESTION/AIM To investigate neonatal nurses' attitudes and involvement in end-of-life decisions and the relation to their socio-demographic and work-related background data. RESEARCH DESIGN A survey was carried out in 28 neonatal intensive care units between September 2018 and January 2019. A structured questionnaire was distributed by post. PARTICIPANTS AND RESEARCH CONTEXT The questionnaire was answered anonymously by 312 nurses (response rate, 71.1%) and returned to the investigators. ETHICAL CONSIDERATIONS The study was approved by the Bioethics and Research Committee of Aretaieio Hospital in accordance with the Helsinki Declaration. FINDINGS Nurses more often reported involvement in various end-of-life decisions, such as continuation of treatment without adding further therapeutic interventions for terminally ill neonates, while less reported were mechanical ventilation withdrawal and drug administration to end life. Nurses with a high attitude score, reflecting a more quality-of-life approach, were more likely to be involved in setting limits to intensive care. α low score was consistent with life preservation. Nurses' religiousness (p = 0.097), parenthood (p = 0.093), involvement in daily practice (p = 0.03), and position on the existing legal framework (p < 0.002) influenced their attitude score. DISCUSSION The likelihood of nurses to support interventions in neonates with poor prognosis in neonatal intensive care units was related to their attitudes. After adjusting for potential confounders, the most important predictors for nurses' attitudes were parenthood, involvement in daily practice, and position supporting current legislation reform. CONCLUSION Variability in involvement in end-of-life decisions among nurses exists on a national level.
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Dimitrakopoulou EI, Pouliakis A, Falaina V, Xanthos T, Zoumpoulakis P, Tsiaka T, Sokou R, Iliodromiti Z, Boutsikou T, Iacovidou N. The Metagenomic and Metabolomic Profile of the Infantile Gut: Can They Be “Predicted” by the Feed Type? Children 2022; 9:children9020154. [PMID: 35204875 PMCID: PMC8870590 DOI: 10.3390/children9020154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/10/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
Abstract
Purpose: The composition and the metabolic activity of the gut microbiota of breastfed and formula-fed infants has been the focus of several studies over the last two decades. Gene sequencing techniques and metabolomics in biological samples have led to expansion of our knowledge in this field. A more thorough comprehension of the metabolic role of the intestinal microbiota could assist and expedite the development of optimal feeding strategies. The aim of this systematic review is to present available data regarding the effect of the feed type on the infantile intestinal microbiota (microbial composition and metabolites) by DNA-sequencing and metabolome analysis of neonatal stool. Methods: A systematic search of the literature in PubMed was attempted to establish relevant studies. Randomized controlled trials studying the diversity and composition of gut microbiota and metabolites of infants that received different types of feed were included. The study subjects were infants/neonates born at term or preterm receiving either breast, donor, or formula milk. Formula could be either classic or fortified with probiotics, prebiotics, or both. The included trials compared the differences on metagenomics and metabolomics of infantile stool, aiming at investigating the beneficial effects of fortification of formula with synbiotics. Results: Out of 1452 papers identified by the initial search, seven were selected for inclusion, following screening for eligibility. Eligibility was determined by closer examination for relevance of the title, abstract, and subsequent full text. The results of these studies mostly support that the feed type modulates the microbiome composition. In terms of the alpha-diversity, no significant difference exists between the feeding groups, whereas significant differences were noted with regards to beta-diversity in breastfed and formula-fed infants. As for the microbial composition, the studies revealed different populations in the formula-fed group compared to the breastfed group at the phylum and genus level. Bifidobacteria supplementation of infant formula did not seem to change the proportions of Bifidobacterial sequences during the first year of life. Another finding according to the studies is that the pH of fecal samples in breastfed as well as prebiotic-supplemented formula-fed infants. was significantly lower than that of formula-fed infants. Infant milk formula with a mixture of prebiotics (GOS/FOS oligosaccharides) was shown to be capable of selectively stimulating the growth of Bifidobacteria with analogous changes in fecal pH and short-chain fatty acid content in fully formula-fed infants. Conclusions: Overall, there is evidence to support that feed type modulates the infants’ microbiome constitution. The impact of feeding on term and preterm microbiota could have potential benefits on intestinal functionality, immune system, and metabolism, and probably pursuing the host for life.
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Affiliation(s)
- Eftychia Ioanna Dimitrakopoulou
- Department of Neonatology, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (R.S.); (Z.I.); (T.B.); (N.I.)
- Correspondence:
| | - Abraham Pouliakis
- 2nd Department of Pathology, National and Kapodistrian University of Athens, 124 62 Athens, Greece;
| | - Vasiliki Falaina
- Neonatal Intensive Care Unit, General Hospital of Nikaia, Piraeus “Agios Panteleimon”, 184 54 Piraeus, Greece;
| | - Theodoros Xanthos
- Department of Medicine, European University Cyprus, Nicosia 2404, Cyprus;
| | - Panagiotis Zoumpoulakis
- Institute of Chemical Biology, National Hellenic Research Foundation, 116 35 Athens, Greece; (P.Z.); (T.T.)
- Department of Food Science and Technology, University of West Attica, 122 43 Egaleo, Greece
| | - Thalia Tsiaka
- Institute of Chemical Biology, National Hellenic Research Foundation, 116 35 Athens, Greece; (P.Z.); (T.T.)
- Department of Food Science and Technology, University of West Attica, 122 43 Egaleo, Greece
| | - Rozeta Sokou
- Department of Neonatology, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (R.S.); (Z.I.); (T.B.); (N.I.)
| | - Zoi Iliodromiti
- Department of Neonatology, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (R.S.); (Z.I.); (T.B.); (N.I.)
| | - Theodora Boutsikou
- Department of Neonatology, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (R.S.); (Z.I.); (T.B.); (N.I.)
| | - Nicoletta Iacovidou
- Department of Neonatology, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (R.S.); (Z.I.); (T.B.); (N.I.)
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Sulaj A, Tsaousi M, Karapati E, Pouliakis A, Iliodromiti Z, Boutsikou T, Valsami S, Iacovidou N, Politou M, Sokou R. Reference Values of Thromboelastometry Parameters in Healthy Term Neonates Using NATEM in Cord Blood Samples. Children (Basel) 2022; 9:children9010047. [PMID: 35053672 PMCID: PMC8774236 DOI: 10.3390/children9010047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 12/16/2022]
Abstract
Background: ROTEM assay has gained increasing acceptance as a method for rapid and specific coagulation pathway assessment. However, its use in the neonatal population remains limited since reference ranges have not yet been established. Aims: (1) to determine reference ranges for healthy term neonates of ROTEM parameters using non-activated assay (NATEM) in cord blood samples; (2) to assess whether delivery mode, gender, gestational age, birth weight and blood group (ABO and Rhesus) of the neonate, coagulation disorder and anticoagulant medication of the mother have an impact on NATEM parameters. Methods: NATEM assay was conducted in cord blood samples of 189 term neonates without any medical history. Results: Reference ranges (2.5th and 97.5th percentiles) are established for clotting time (CT), clot formation time (CFT), α-angle, clot amplitude at 5, 10 and 20 min (A5, A10, A20), maximum clot firmness (MCF), lysis index at 30 and 60 min (LI30, LI60, %) and maximum clot elasticity (MCE). Reference ranges for NATEM are CT 182-499 s, CFT 63-176 s, α-angle 58-78°, A5 28-52 mm, A10 37-61 mm, A20 42-66 mm, MCF 43-67 mm, LI30 97-100%, LI60 87-98% and MCE 75-203. Male neonates appear to be more hypocoagulable than females. Conclusions: We demonstrate reference ranges for healthy term neonates in NATEM assay that could be used as a reference group for future studies of neonates with an underlying pathology.
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Affiliation(s)
- Alma Sulaj
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.S.); (M.T.); (E.K.); (Z.I.); (T.B.); (N.I.)
| | - Marina Tsaousi
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.S.); (M.T.); (E.K.); (Z.I.); (T.B.); (N.I.)
| | - Eleni Karapati
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.S.); (M.T.); (E.K.); (Z.I.); (T.B.); (N.I.)
| | - Abraham Pouliakis
- 2nd Department of Pathology, University General Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.S.); (M.T.); (E.K.); (Z.I.); (T.B.); (N.I.)
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.S.); (M.T.); (E.K.); (Z.I.); (T.B.); (N.I.)
| | - Serena Valsami
- Hematology Laboratory Blood Bank, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.V.); (M.P.)
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.S.); (M.T.); (E.K.); (Z.I.); (T.B.); (N.I.)
| | - Marianna Politou
- Hematology Laboratory Blood Bank, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (S.V.); (M.P.)
| | - Rozeta Sokou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.S.); (M.T.); (E.K.); (Z.I.); (T.B.); (N.I.)
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, 18454 Piraeus, Greece
- Correspondence: ; Tel.: +30-21-3207-7346 or +30-21-3207-7000
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Sokou R, Ioakeimidis G, Piovani D, Parastatidou S, Konstantinidi A, Tsantes AG, Lampridou M, Houhoula D, Iacovidou N, Kokoris S, Vaiopoulos AG, Gialeraki A, Kopterides P, Bonovas S, Tsantes AE. Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis. Front Pediatr 2022; 10:1004727. [PMID: 36275071 PMCID: PMC9582514 DOI: 10.3389/fped.2022.1004727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to develop and validate a diagnostic model for sepsis among neonates evaluated for suspected sepsis, by incorporating thromboelastometry parameters, maternal/neonatal risk factors, clinical signs/symptoms and laboratory results. METHODS This retrospective cohort study included 291 neonates with presumed sepsis, hospitalized in a NICU, from 07/2014 to 07/2021. Laboratory tests were obtained on disease onset and prior to initiating antibiotic therapy. Τhromboelastometry extrinsically activated (EXTEM) assay was performed simultaneously and Tοllner and nSOFA scores were calculated. Sepsis diagnosis was the outcome variable. A 10-fold cross-validation least absolute shrinkage and selection operator logit regression procedure was applied to derive the final multivariable score. Clinical utility was evaluated by decision curve analysis. RESULTS Gestational age, CRP, considerable skin discoloration, liver enlargement, neutrophil left shift, and EXTEM A10, were identified as the strongest predictors and included in the Neonatal Sepsis Diagnostic (NeoSeD) model. NeoSeD score demonstrated excellent discrimination capacity for sepsis and septic shock with an AUC: 0.918 (95% CI, 0.884-0.952) and 0.974 (95% CI, 0.958-0.989) respectively, which was significantly higher compared to Töllner and nSOFA scores. CONCLUSIONS The NeoSeD score is simple, accurate, practical, and may contribute to a timely diagnosis of sepsis in neonates with suspected sepsis. External validation in multinational cohorts is necessary before clinical application.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Dimitra Houhoula
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Styliani Kokoris
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristeidis G Vaiopoulos
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyri Gialeraki
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Kopterides
- Intensive Care Unit, Excela Health Westmoreland Hospital, Greensburg, PA, United States
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Sokou R, Iacovidou N, Parastatidou S, Konstantinidi A. Editorial: Filling the knowledge gap of neonatal hemostasis. Front Pediatr 2022; 10:1110481. [PMID: 36683803 PMCID: PMC9845756 DOI: 10.3389/fped.2022.1110481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon", Piraeus, Greece.,Department of Neonatology Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Department of Neonatology Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kollia M, Iacovidou N, Iliodromiti Z, Pouliakis A, Sokou R, Mougiou V, Boutsikou M, Politou M, Boutsikou T, Valsami S. Primary hemostasis in fetal growth restricted neonates studied via PFA-100 in cord blood samples. Front Pediatr 2022; 10:946932. [PMID: 36160789 PMCID: PMC9492943 DOI: 10.3389/fped.2022.946932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Platelet function of fetal growth restricted (FGR) neonates remains a field of debate. Platelet function analyzer (PFA-100) offers a quantitative in vitro assessment of primary, platelet-related hemostasis. Our aim was to examine platelet function using PFA-100 in FGR neonates and associate our results with perinatal parameters. METHODS PFA-100 was applied on 74 FGR neonates, 48 full-term (>37 weeks' gestation) and 26 preterm neonates (<37 weeks). The control group consisted of 118 healthy neonates. Two closure times (CTs) with COL/EPI and COL/ADP cartridges were determined on cord blood samples for each subject. Statistical analysis was performed by SAS 9.4. The statistical significance level was set at 0.05 and all tests were two-tailed. RESULTS COL/EPI CTs were prolonged in FGR (median 132 s, IQR 95-181 s) compared with control neonates (median 112.5 s, IQR 93-145 s), p = 0.04. Median COL/EPI CT for term and preterm FGR neonates was 126 s (IQR 90-157 s) and 137 s (IQR 104-203), respectively (p = 0.001), and COL/ADP CT was 70 s (IQR 62-80 s) for term and 75 s (IQR 68-82 s) for preterm FGR neonates (p = 0.08). Among FGR neonates, COL/EPI CT was related with delivery time (with preterm neonates exhibiting prolonged COL/EPI CTs), p = 0.05. No correlation was proved between both CTs and hematological parameters in FGR neonates. CONCLUSION FGR neonates showed impaired platelet function via PFA-100, with preterm FGR neonates confronting the greatest risk. Prolonged COL/EPI CTs in FGR neonates seemed to be independent of hematological parameters and could warn for closer evaluation during the first days of their lives.
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Affiliation(s)
- Maria Kollia
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Mougiou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Politou
- Haematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Serena Valsami
- Haematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Karapati E, Sulaj A, Krepi A, Pouliakis A, Iacovidou N, Paliatsiou S, Sokou R, Volaki P, Boutsikou T, Iliodromiti Z. Mothers in Need of Lactation Support May Benefit from Early Postnatal Galactagogue Administration: Experience from a Single Center. Nutrients 2021; 14:nu14010140. [PMID: 35011014 PMCID: PMC8747006 DOI: 10.3390/nu14010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Galactagogues are substances that promote lactation, although data on their effects on humans remain limited. We investigated the efficacy of Silitidil to increase milk supply and duration of breastfeeding of a specific subgroup of mothers in need of lactation support. Methods: 161 mothers from November 2018 until January 2021 were the study subjects in this retrospective study; during their hospitalization, due to neonatal or maternal factors that inhibited lactation, they were prescribed galactagogues. Mothers were surveyed by telephone interview via a 13-item questionnaire. Results: 73.91%, were primigravidas, 78.26% gave birth by cesarean section (CS) and 72.05% continued to take galactagogues after hospital discharge. Of the neonates, 24.22% were preterm ≤37 weeks of gestation, and 55.9% had birth weight (BW) between 2500 and 3500 g. With respect to breastfeeding rates, 100% were breastfed during their first week, 98.8% breastfed during the first month, 87% during the first 4 months, dropping to 56.5% at 6 months, 41% at 1 year and 19.3% over 1 year of age. Conclusions: This study demonstrates that administration of a galactagogue containing Silitidil (Piulatte-Humana) improves breastfeeding rates at from 1 until 12 months of life in mothers with low milk supply during their hospital stay. Further studies are needed to generate evidence-based strategies to improve breastfeeding outcomes.
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Affiliation(s)
- Eleni Karapati
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Alma Sulaj
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Adamantia Krepi
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, University General Hospital Attikon, 12462 Athens, Greece;
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Stella Paliatsiou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Paraskevi Volaki
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
- Correspondence:
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Sokou R, Tritzali M, Piovani D, Konstantinidi A, Tsantes AG, Ioakeimidis G, Lampridou M, Parastatidou S, Iacovidou N, Kokoris S, Nikolopoulos GK, Kopterides P, Bonovas S, Tsantes AE. Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry. Diagnostics (Basel) 2021; 11:diagnostics11111955. [PMID: 34829302 PMCID: PMC8619208 DOI: 10.3390/diagnostics11111955] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To compare the prognostic accuracy of the most commonly used indexes of mortality over time and evaluate the potential of adding thromboelastometry (ROTEM) results to these well-established clinical scores. METHODS The study population consisted of 473 consecutive term and preterm critically-ill neonates. On the first day of critical illness, modified Neonatal Multiple Organ Dysfunction (NEOMOD) scoring system, Score for Neonatal Acute Physiology (SNAP II), Perinatal extension of SNAP (SNAPPE), and SNAPPE II, were calculated and ROTEM standard extrinsically activated (EXTEM) assay was performed simultaneously. Time-to-event methodology for competing-risks was used to assess the performance of the aforementioned indexes in predicting in-hospital mortality over time. Time-dependent receiver operator characteristics curves for censored observation were compared across indexes. The addition of EXTEM parameters to each index was tested in terms of discrimination capacity. RESULTS The modified NEOMOD score performed similarly to SNAPPE. Both scores performed significantly better than SNAP II and SNAPPE II. Amplitude recorded at 10 min (A10) was the EXTEM parameter most strongly associated with mortality (A10 < 37 mm vs. ≥37 mm; sHR = 5.52; p < 0.001). Adding A10 to each index apparently increased the prognostic accuracy in the case of SNAP II and SNAPPE II. However, these increases did not reach statistical significance. CONCLUSION Although the four existing indexes considered showed good to excellent prognostic capacity, modified NEOMOD and SNAPPE scores performed significantly better. Though larger studies are needed, adding A10 to well-established neonatal severity scores not including biomarkers of coagulopathy might improve their prediction of in-hospital mortality.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Maroula Tritzali
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Thivon 1, Goudi, 11527 Athens, Greece;
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
| | - Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece; (A.G.T.); (S.K.); (A.E.T.)
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
| | - Maria Lampridou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 15772 Athens, Greece;
| | - Styliani Kokoris
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece; (A.G.T.); (S.K.); (A.E.T.)
| | | | - Petros Kopterides
- Intensive Care Unit, Excela Health Westmoreland Hospital, Greensburg, PA 15601, USA;
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Argirios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece; (A.G.T.); (S.K.); (A.E.T.)
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Kattamis C, Ladis V, Skafida M, Iacovidou N, Theodoridis C. The different patterns of insulin response during Oral Glucose Tolerance Test (OGTT) in transfused young patients with β-Thalassemia. Acta Biomed 2021; 92:e2021265. [PMID: 34487086 PMCID: PMC8477125 DOI: 10.23750/abm.v92i4.11144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Dysregulation of glucose metabolism is a common complication of transfusions in Transfusion Dependent Thalassemia (TDT) patients. For early diagnosis of glucose disturbances, screening is recommended. The age of starting and the type of screening vary; the more common methods are assessment of RPG, FPG, 2h PG and 2 hours OGTT. The combined assessment of glucose tolerance and insulin response during OGTT is rarely recommended. The main objective of the study is the evaluation of simultaneous assessment of Glucose Tolerance (GT) and Insulin Response (IR) during OGTT in patients with TDT. METHODS 43 TDT patients aged 12-28years, without clinical evidence of glucose disturbances, were randomly selected for the study. The 2-hour OGTT in 30 minutes intervals was applied. Plasma glucose and insulin were assessed in all samples using routine laboratory methods. RESULTS Of 43 patients 31(72%) had Normal GT; of them 9 (29%) had normal insulin response (NIR), 14 (45%) high IR and 8(26%) delayed peak IR. Delayed peak IR was found in 8 of the 9 patients with Impaired GT and in 2 of the 3 with diabetic GT. Deficient IR (hypoinsulinemia) was found in two patients. CONCLUSIONS Simultaneous assessment of GT and IR during OGTT in TDT patients, seems to be a most sensitive and creditable screening test for early diagnosis of glucose disturbances. High IR and delayed peak IR in normoglycemic patients are valuable indices for diagnosis of the pre-diabetic state that precede the development of glucose disturbances in TDT patients and start proper follow and management.
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Affiliation(s)
- Christos Kattamis
- Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens , "Aghia Sophia" Children Hospital, Athens Greece.
| | - Vassilis Ladis
- Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens , "Aghia Sophia" Children Hospital, Athens Greece.
| | | | - Nicoletta Iacovidou
- Deparment of Neonatalogy, Medical School, National and Kapodistrian University of Athens, Aretaieo Hospital, Athens Greece .
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Abstract
Human milk is the best possible nutrition for infants, as it supplies them with nutrients, bioactive molecules as well as antibodies, which contribute to immune maturation, organ development, and healthy microbial colonisation. Few situations are considered definitive contraindications for breastfeeding. The disastrous Coronavirus Disease-2019 (COVID-19) pandemic raised many health issues, including the safety of breastfeeding for infants born to affected mothers. To date relevant data are limited. This review will make an account of the published data so far, regarding the transmission risk of SARS-CoV-2 via human milk; it will also present the current feeding recommendations, issued by several international boards, though not always in agreement, for infants born to mothers suspected or positive for SARS-CoV-2. In most studies existing so far on women with COVID-19, the virus was not detected in breastmilk. Based on currently available data, it seems that breastfeeding and human milk are not contraindicated for infants born to mothers suspected or confirmed with COVID-19.
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Affiliation(s)
- Rozeta Sokou
- NICU, Nikaia General Hospital "Aghios Panteleimon", Piraeus, Greece
| | | | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Metallinou D, Karampas G, Nyktari G, Iacovidou N, Lykeridou K, Rizos D. Serum glial fibrillary acidic protein as a biomarker of brain injury in premature neonates. Bosn J Basic Med Sci 2021; 22:46-53. [PMID: 34278985 PMCID: PMC8860316 DOI: 10.17305/bjbms.2021.6205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
Neonatal brain injury is a serious adverse outcome of prematurity. Early detection of high risk premature neonates to develop neonatal brain injury is not currently feasible. The predictive value of many biomarkers has been tested, but none is used currently in clinical practice. The purpose of this study was to determine the levels and predictive value of serum glial fibrillary acidic protein (GFAP) in a prospective longitudinal case-control study during the first three days of life in premature neonates (<34 weeks of gestation) that later developed either intraventricular hemorrhage or periventricular leukomalacia. Each case (n=29) was matched according to birth weight and gestational age to one neonate with normal head ultrasound scans. No significant difference on GFAP levels was observed between the groups. Nevertheless, neonates with brain injury presented more frequently GFAP levels above the lowest detection limit (0.056 ng/ml) and this trend was significantly different during all days. The effectiveness of GFAP as an early biomarker of neonatal brain injury in premature neonates seems to be limited.
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Affiliation(s)
| | - Grigorios Karampas
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Aretaieio" Hospital, Athens, Greece
| | - Georgia Nyktari
- Neonatal Intensive Care Unit, "Gaia" Maternity Hospital, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, "Aretaieio" Hospital
| | | | - Demetrios Rizos
- Hormone Laboratory, Medical School, National and Kapodistrian University of Athens, "Aretaieio" Hospital, Athens, Greece
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40
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Sokou R, Tsantes AG, Konstantinidi A, Ioakeimidis G, Lampridou M, Parastatidou S, Theodoraki M, Piovani D, Iliodromiti Z, Boutsikou T, Iacovidou N, Douramani P, Poulis A, Kokoris S, Kriebardis AG, Bonovas S, Tsantes AE. Rotational Thromboelastometry in Neonates Admitted to a Neonatal Intensive Care Unit: A Large Cross-sectional Study. Semin Thromb Hemost 2021; 47:875-884. [PMID: 34130345 DOI: 10.1055/s-0041-1729964] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of the present study was to assess the coagulation profile in neonatal critical illness using rotational thromboelastometry (ROTEM), and to investigate its association with disease severity and its potential prognostic role in this clinical setting. Over a period of 67 months (July 2014-February 2020) 423 critically ill neonates with confirmed or suspected sepsis, perinatal hypoxia, or respiratory distress syndrome, hospitalized in our neonatal intensive care unit were included in the study. Demographic, clinical, and laboratory data were recorded on admission day and arterial blood was analyzed on ROTEM analyzer using the standard extrinsically activated rotational thromboelastometry assay (EXTEM). Neonatal illness severity scores (Modified NEOMOD [Neonatal Multiple Organ Dysfunction] and SNAPPE [Score for Neonatal Acute Physiology with Perinatal Extension]) were calculated at the same time as ROTEM analysis. Mortality during in-hospital stay was the main outcome measure. Multivariable analyses showed that a 10 mm decrease in EXTEM clot amplitude recorded at 10 minutes (A10) is significantly associated with a higher mortality (odds ratio [OR] = 1.69, 95% confidence interval [CI]: 1.33-2.08). Higher modified NEOMOD (OR = 1.36, 95% CI: 1.26-1.47) and higher SNAPPE scores (OR = 1.06, 95% CI: 1.04-1.08) were also associated with increased mortality. The CT and A10 variables demonstrated the best prognostic performance among the EXTEM parameters for mortality (area under the curve [AUC] = 0.78; 95% CI: 0.69-0.86 and AUC = 0.76; 95% CI: 0.66-0.85, respectively), showing an optimal cut-off CT ≥63 seconds and A10 ≤37 mm. Using optimal cut-off values of the EXTEM parameters for prediction of mortality, neonates with CT ≥63 seconds were 7.4 times more likely to die (OR = 7.40, 95% CI: 3.50-15.65), while neonates with A10 ≤37 mm were 5.8 times more likely to die (OR = 5.88, 95% CI: 2.94-12.50). An EXTEM hypocoagulable profile on disease onset was shown to be an independent risk factor for in-hospital mortality in neonatal critical illness.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Martha Theodoraki
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Zoe Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Panagiota Douramani
- Laboratory of Haematology and Blood Bank Unit, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristarchos Poulis
- Laboratory of Haematology and Blood Bank Unit, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Kokoris
- Laboratory of Haematology and Blood Bank Unit, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Laboratory of Hematology, Department of Biomedical Science, School of Health and Caring Science, University of West Attica, Egaleo, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Stylianou-Riga P, Boutsikou T, Kouis P, Kinni P, Krokou M, Ioannou A, Siahanidou T, Iliodromiti Z, Papadouri T, Yiallouros PK, Iacovidou N. Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case-control study. Ital J Pediatr 2021; 47:129. [PMID: 34082803 PMCID: PMC8176707 DOI: 10.1186/s13052-021-01086-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. Methods In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. Results During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). Conclusions This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-01086-5.
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Affiliation(s)
- Paraskevi Stylianou-Riga
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus. .,Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus. .,Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Marina Krokou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Andriani Ioannou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thalia Papadouri
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus
| | - Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Valsami S, Kollia M, Mougiou V, Sokou R, Isaakidou E, Boutsikou M, Pouliakis A, Iliodromiti Z, Carr R, Boutsikou T, Iacovidou N, Politou M. Evaluation of PFA-100 closure times in cord blood samples of healthy term and preterm neonates. Clin Chem Lab Med 2021; 58:e113-e116. [PMID: 31821165 DOI: 10.1515/cclm-2019-0948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/06/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Serena Valsami
- Haematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kollia
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Mougiou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elina Isaakidou
- 2nd Local Health Unit of Keratsini-Drapetsona, 2nd Health Region of Pireus, Pireus, Greece
| | - Maria Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Zoe Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Carr
- Department of Haematology, Guy's and St Thomas' Hospital, King's College London, London, UK
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Politou
- Hematology- Immunohematology, Head of Haematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Street, 11526 Athens, Greece
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Aggelina A, Pantazopoulos I, Giokas G, Chalkias A, Mavrovounis G, Papalois A, Douvanas A, Xanthos T, Iacovidou N. Continuous chest compressions with asynchronous ventilation improve survival in a neonatal swine model of asphyxial cardiac arrest. Am J Emerg Med 2021; 48:60-66. [PMID: 33839633 DOI: 10.1016/j.ajem.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/27/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Guidelines for neonatal resuscitation recommend a 3:1 compression to ventilation ratio. However, this recommendation is based on expert opinion and consensus rather than strong scientific evidence. Our primary aim was to assess whether continuous chest compressions with asynchronous ventilations would increase return of spontaneous circulation (ROSC) rate and survival compared to the 3:1 chest compression to ventilation ratio. METHODS This was a prospective, randomized, laboratory study. Twenty male Landrace-Large White pigs, aged 1-4 days with an average weight 1.650 ± 228.3 g were asphyxiated and left untreated until heart rate was less than 60 bpm or mean arterial pressure was below 15 mmHg. Animals were then randomly assigned to receive either continuous chest compressions with asynchronous ventilations (n = 10), or standard (3:1) chest compression to ventilation ratio (n = 10). Heart rate and arterial pressure were assessed every 30 s during cardiopulmonary resuscitation (CPR) until ROSC or asystole. All animals with ROSC were monitored for 4 h. RESULTS Coronary perfusion pressure (CPP) at 30 s of CPR was significantly higher in the experimental group (45.7 ± 16.9 vs. 21.8 ± 6 mmHg, p < 0.001) and remained significantly elevated throughout the experiment. End-tidal carbon dioxide (ETCO2) was also significantly higher in the experimental group throughout the experiment (23.4 ± 5.6 vs. 14.7 ± 5.9 mmHg, p < 0.001). ROSC was observed in six (60%) animals treated with 3:1 compression to ventilation ratio and nine (90%) animals treated with continuous chest compressions and asynchronous ventilation (p = 0.30). Time to ROSC was significantly lower in the experimental group (30 (30-30) vs. 60 (60-60) sec, p = 0.021). Of note, 7 (77.8%) animals in the experimental group and 1 (16.7%) animal in the control group achieved ROSC after 30 s (0.02). At 4 h, 2 (20%) animals survived in the control group compared to 7 (70%) animals in the experimental group (p = 0.022). CONCLUSION Continuous chest compressions with asynchronous ventilations significantly improved CPP, ETCO2, time to ROSC, ROSC at 30 s and survival in a porcine model of neonatal resuscitation.
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Affiliation(s)
- Afrodite Aggelina
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | - Ioannis Pantazopoulos
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Emergency Medicine, 41110 Larissa, Greece
| | - George Giokas
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | - Athanasios Chalkias
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Anesthesiology, 41110 Larissa, Greece
| | - Georgios Mavrovounis
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Emergency Medicine, 41110 Larissa, Greece.
| | - Apostolos Papalois
- Experimental, Educational and Research Center ELPEN, Greece; European University Cyprus, School of Medicine, 1516, Cyprus.
| | - Alexandros Douvanas
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | | | - Nicoletta Iacovidou
- National and Kapodistrian University of Athens, Medical School, 11527, Greece; Department of Neonatology, Aretaieio Hospital, 11528, Greece
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Gkiougki E, Chatziioannidis I, Pouliakis A, Iacovidou N. Periviable birth: A review of ethical considerations. Hippokratia 2021; 25:1-7. [PMID: 35221649 PMCID: PMC8877922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Advances in perinatology and medical technology have pushed the limits of viability to unprecedented extremes, leading to a growing population of NICU "graduates" with a wide range of health issues. Although survival rates from 22 weeks of gestation onwards have improved over the last 30 years, the incidence of disabilities remains the same. Providing intensive care to a high-risk population with significant mortality and morbidity raises the fundamental conflict between sanctity and quality of life. Potential severe handicap and need for frequent tertiary care inevitably impact the whole family unit and may outweigh the benefit of survival. The aim of this study is to explore and summarize the ethical considerations in neonatal care concerning perivable birth. METHODS Eligible studies published on PubMed were included after a systematic search using the PICO methodology. RESULTS Forty-eight studies were systematically reviewed regarding guidelines, withholding or withdrawing treatment, parental involvement, and principles applied in marginal viability. As periviable birth raises an array of complex ethical and legal concerns, strict guidelines are challenging to implement. CONCLUSIONS Active life-sustaining interventions in neonatology should be balanced against the risk of putting infants through painful and futile procedures and survival with severe sequelae. More evidence is needed on better prediction of long-term outcomes in situations of imminent preterm delivery, while good collaboration between the therapeutic team and the parents for life-and-death decision-making is of utmost importance. HIPPOKRATIA 2021, 25 (1):1-7.
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Affiliation(s)
- E Gkiougki
- Pediatric and Neonatal Department, Centre Hospitalier Reine Astrid, Malmedy, Belgium
| | - I Chatziioannidis
- 2 Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki
| | - A Pouliakis
- 2 Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon"
| | - N Iacovidou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital Athens, Greece
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Sokou R, Piovani D, Konstantinidi A, Tsantes AG, Parastatidou S, Lampridou M, Ioakeimidis G, Iacovidou N, Bonovas S, Tsantes AE. Prospective Temporal Validation of the Neonatal Bleeding Risk (NeoBRis) Index. Thromb Haemost 2020; 121:1263-1266. [PMID: 33368062 DOI: 10.1055/a-1343-3342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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46
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Sokou R, Piovani D, Konstantinidi A, Tsantes AG, Parastatidou S, Lampridou M, Ioakeimidis G, Gounaris A, Iacovidou N, Kriebardis AG, Politou M, Kopterides P, Bonovas S, Tsantes AE. Reply to Ghirardello et al Letter to the Editor. Thromb Haemost 2020; 121:1119-1120. [PMID: 33296941 DOI: 10.1055/a-1333-7387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | | | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Antonis Gounaris
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaeio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Laboratory of Reliability and Quality Control in Laboratory Hematology, Department of Biomedical Science, School of Health and Caring Science, University of West Attica, Egaleo, Greece
| | - Marianna Politou
- Department of Blood Transfusion, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Kopterides
- Intensive Care Unit, Excela Health Westmoreland Hospital, Greensburg, Pennsylvania, United States
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Theodoraki M, Sokou R, Valsami S, Iliodromiti Z, Pouliakis A, Parastatidou S, Karavana G, Ioakeimidis G, Georgiadou P, Iacovidou N, Boutsikou T. Reference Values of Thrombolastometry Parameters in Healthy Term Neonates. Children (Basel) 2020; 7:children7120259. [PMID: 33256197 PMCID: PMC7759895 DOI: 10.3390/children7120259] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022]
Abstract
Background: Thromboelastometry (ROTEM), as a point of care test, is an attractive tool for rapid evaluation of hemostasis. Currently, no reference ranges exist for all ROTEM assays in neonates, limiting its use in this vulnerable population. The aim of the present study was: (1) to establish reference ranges for standard extrinsically activated (EXTEM), intrinsically activated (INTEM), and fibrinogen polymerization (FIBTEM) ROTEM assays in whole blood samples of healthy term neonates; (2) to determine the impact of gender, delivery mode, and hematocrit on ROTEM parameters. Methods: EXTEM, INTEM, and FIBTEM ROTEM assays were performed simultaneously with complete blood count in 215 healthy term neonates. Results: Reference ranges (2.5th and 97.5th percentiles) were obtained for clotting time (CT), clot formation time (CFT), α-angle, clot firmness at 10 min (A10), maximum clot firmness (MCF), and lysis index at 60 min (LI60, %). Reference ranges for EXTEM were CT 38–78 s, CFT 49–148 s, A10 40–65 mm, and MCF 47–69 mm, LI60 83–98%. For INTEM, CT 134–270 s, CFT 50–142 s, A10 41–63 mm, and MCF 48–67 mm, LI60 85–97%, and finally, for FIBTEM: CT 36–85 s, A10 9–25 mm and MCF 10–26 mm, LI60 92–100%. Hematocrit values were positively correlated with CT, CFT and negatively with A10, MCF values. Conclusion: This study provides, for the first time, reference ranges for ROTEM EXTEM/INTEM/FIBTEM values simultaneously in healthy term neonates. The combined evaluation of ROTEM tests increases its diagnostic accuracy, contributing to the expansion of ROTEM use in the neonatal population.
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Affiliation(s)
- Martha Theodoraki
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, 184 54 Piraeus, Greece; (M.T.); (S.P.); (G.K.); (G.I.); (P.G.)
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, 184 54 Piraeus, Greece; (M.T.); (S.P.); (G.K.); (G.I.); (P.G.)
- Correspondence:
| | - Serena Valsami
- Hematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | - Zoi Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 157 72 Athens, Greece; (Z.I.); (N.I.); (T.B.)
| | - Abraham Pouliakis
- 2nd Department of Pathology, National and Kapodistrian University of Athens Medical School, University General Hospital Attikon, 124 62 Haidari, Greece;
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, 184 54 Piraeus, Greece; (M.T.); (S.P.); (G.K.); (G.I.); (P.G.)
| | - Georgia Karavana
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, 184 54 Piraeus, Greece; (M.T.); (S.P.); (G.K.); (G.I.); (P.G.)
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, 184 54 Piraeus, Greece; (M.T.); (S.P.); (G.K.); (G.I.); (P.G.)
| | - Petroula Georgiadou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, 184 54 Piraeus, Greece; (M.T.); (S.P.); (G.K.); (G.I.); (P.G.)
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 157 72 Athens, Greece; (Z.I.); (N.I.); (T.B.)
| | - Theodora Boutsikou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 157 72 Athens, Greece; (Z.I.); (N.I.); (T.B.)
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Chatziioannidis I, Iliodromiti Z, Boutsikou T, Pouliakis A, Giougi E, Sokou R, Vidalis T, Xanthos T, Marina C, Iacovidou N. Physicians' attitudes in relation to end-of-life decisions in Neonatal Intensive Care Units: a national multicenter survey. BMC Med Ethics 2020; 21:121. [PMID: 33225943 PMCID: PMC7681959 DOI: 10.1186/s12910-020-00555-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND End-of-life decisions for neonates with adverse prognosis are controversial and raise ethical and legal issues. In Greece, data on physicians' profiles, motivation, values and attitudes underlying such decisions and the correlation with their background are scarce. The aim was to investigate neonatologists' attitudes in Neonatal Intensive Care Units and correlate them with self-reported practices of end-of-life decisions and with their background data. METHODS A structured questionnaire was distributed to all 28 Neonatal Intensive Care Units in Greece. One hundred and sixty two out of 260 eligible physicians answered anonymously the questionnaire (response rate 66%). Demographic and professional characteristics, self-reported practices and opinions were included in the questionnaire, along with a questionnaire of 12 items measuring physicians' attitude and views ranging from value of life to quality of life approach (scale 1-5). RESULTS Continuation of treatment in neonates with adverse prognosis without adding further therapeutic interventions was the most commonly reported EoL practice, when compared to withdrawal of mechanical ventilation. Physicians with a high attitude score (indicative of value of quality-of-life) were more likely to limit, while those with a low score (indicative of value of sanctity-of-life) were more likely for continuation of intensive care. Physicians' educational level (p:0.097), involvement in research (p:0.093), religion (p:0.024) and position on the existing legal framework (p < 0.001) were factors that affected the attitude score. CONCLUSIONS Physicians presented with varying end-of-life practices. Limiting interventions in neonates with poor prognosis was strongly related to their attitudes. The most important predictors for physicians' attitudes were religiousness and belief for Greek legal system reform.
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Affiliation(s)
- Ilias Chatziioannidis
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
| | - Zoi Iliodromiti
- Neonatal Department, School of Medicine, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, School of Medicine, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Rozeta Sokou
- Neonatal Department, School of Medicine, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Takis Vidalis
- Hellenic National Bioethics Commission, Athens, Greece
| | | | - Cuttini Marina
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicoletta Iacovidou
- Neonatal Department, School of Medicine, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Parastatidou S, Sokou R, Tsantes AG, Konstantinidi A, Lampridou M, Ioakeimidis G, Panagiotounakou P, Kyriakou E, Kokoris S, Gialeraki A, Douramani P, Iacovidou N, Piovani D, Bonovas S, Nikolopoulos G, Tsantes AE. The role of ROTEM variables based on clot elasticity and platelet component in predicting bleeding risk in thrombocytopenic critically ill neonates. Eur J Haematol 2020; 106:175-183. [PMID: 33053216 DOI: 10.1111/ejh.13534] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Our aim was to investigate the role of thromboelastometry (ROTEM) parameters, including maximum clot elasticity (MCE) and platelet component (PLTEM MCE and PLTEM MCF), in early prediction of bleeding events in thrombocytopenic critically ill neonates. MATERIAL AND METHODS This single-center, prospective cohort study included 110 consecutive thrombocytopenic neonates with sepsis, suspected sepsis, or hypoxia. On the first day of disease onset, ROTEM EXTEM and FIBTEM assays were performed and the neonatal bleeding assessment tool was used for the evaluation of bleeding events. RESULTS Most EXTEM and FIBTEM ROTEM parameters significantly differed between neonates with (n = 77) and without bleeding events (n = 33). Neonates with bleeding events had significantly lower PLTEM MCE and PLTEM MCF values compared to those without bleeding events (P < .001). Platelet count was found to be strongly positively correlated with EXTEM A5 (Spearman's rho = 0.61, P < .001) and A10 (rho = 0.64, P < .001). EXTEM A10 demonstrated the best prognostic performance (AUC = 0.853) with an optimal cutoff value (≤37 mm) (sensitivity = 91%, specificity = 76%) for prediction of bleeding events in thrombocytopenic neonates. CONCLUSIONS EXTEM A5 and EXTEM A10 were found to be strong predictors of hemorrhage, compared to most ROTEM variables quantifying clot elasticity and platelet component in thrombocytopenic critically ill neonates.
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Affiliation(s)
- Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | | | - Elias Kyriakou
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Kokoris
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyri Gialeraki
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Douramani
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center- IRCCS, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center- IRCCS, Milan, Italy
| | | | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Tassopoulos A, Chalkias A, Papalois A, Karlovasiti P, Zanda JSA, Chatzidakis S, Gazouli M, Iacovidou N, Fanni D, Xanthos T. Assessment of Post-Resuscitation Intestinal Injury and Timing of Bacterial Translocation in Swine Anaesthetized With Propofol-Based Total Intravenous Anaesthesia. Cureus 2020; 12:e10362. [PMID: 33062485 PMCID: PMC7549874 DOI: 10.7759/cureus.10362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction and objectives Bacterial translocation (BT) is the passage of viable bacteria or endotoxins from the gastrointestinal lumen to extra-luminal tissues and is usually observed after intestinal ischaemia-reperfusion injury. The aim of this study was to investigate post-resuscitation BT after cardiac arrest and resuscitation in a swine anaesthetized with propofol-based total intravenous anaesthesia. Materials and methods Eighteen female Landrace/Large White piglets were randomly divided into control (CON), cardiac arrest (CA) and cardiac arrest-cardiopulmonary resuscitation (CA-CPR) groups. In the CON group, the animals were only monitored for two hours. In the CA group, the animals were not resuscitated and underwent necropsy immediately after cardiac arrest. In the CA-CPR group, the animals were resuscitated until the return of spontaneous circulation (ROSC) and were monitored for two hours. The animals of the CON and CA-CPR groups underwent necropsy 24 hours later. Bacterial translocation was assessed by blood and tissue cultures and endotoxin measurement in the portal and systemic circulation. Malondialdehyde content calculation and histological analysis of the intestine were performed in order to estimate ischemia and reperfusion (I/R) tissue damage. Results Malondialdehyde content, an indicator of oxidative stress, was significantly higher in the CA-CPR group compared to the CA in homogenized ileum (p=0.016). Malondialdehyde content in homogenized colon revealed significantly higher levels in the CA-CPR group compared to the CON (p=0.004) and the CA group (p=0.016). We found significantly higher levels of portal endotoxin in the CA-CPR group compared to the CON (p=0.026) and the CA group (p=0.026). The number of positive mesenteric lymph nodes cultures for E. coli was greater in the CA-CPR group, followed by the CA and CON groups, although the difference was not significant (67%, 33%, and 33%, respectively; p=0.407). Conclusions Malondialdehyde content and portal endotoxin levels do not increase during the cardiac arrest interval, but only after CPR and ROSC. Although the number of positive MLNs cultures was greater in the CA-CPR animals, no statistically significant differences were observed between the three groups due to the short monitoring period.
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Affiliation(s)
| | - Athanasios Chalkias
- Department of Anesthesiology, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larisa, GRC
| | - Apostolos Papalois
- Translational Research and Training, ELPEN Research & Experimental Center, Athens, GRC
| | - Paraskevi Karlovasiti
- Department of Biopathology - Microbiology and Biochemistry, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Stefanos Chatzidakis
- Department of Medicine, European University Cyprus, School of Medicine, Nicosia, CYP
| | - Maria Gazouli
- Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Nicoletta Iacovidou
- Department of Neonatology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Daniela Fanni
- Division of Pathology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, ITA
| | - Theodoros Xanthos
- Department of Physiology and Pathophysiology, European University Cyprus, School of Medicine, Nicosia, CYP
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