1
|
Duignan SM, Lakshminrusimha S, Armstrong K, de Boode WP, El-Khuffash A, Franklin O, Molloy EJ. Neonatal sepsis and cardiovascular dysfunction I: mechanisms and pathophysiology. Pediatr Res 2024; 95:1207-1216. [PMID: 38044334 DOI: 10.1038/s41390-023-02926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 12/05/2023]
Abstract
The highest incidence of sepsis across all age groups occurs in neonates leading to substantial mortality and morbidity. Cardiovascular dysfunction frequently complicates neonatal sepsis including biventricular systolic and/or diastolic dysfunction, vasoregulatory failure, and pulmonary arterial hypertension. The haemodynamic response in neonatal sepsis can be hyperdynamic or hypodynamic and the underlying pathophysiological mechanisms are heterogeneous. The diagnosis and definition of both neonatal sepsis and cardiovascular dysfunction complicating neonatal sepsis are challenging and not consensus-based. Future developments in neonatal sepsis management will be facilitated by common definitions and datasets especially in neonatal cardiovascular optimisation. IMPACT: Cardiovascular dysfunction is common in neonatal sepsis but there is no consensus-based definition, making calculating the incidence and designing clinical trials challenging. Neonatal cardiovascular dysfunction is related to the inflammatory response, which can directly target myocyte function and systemic haemodynamics.
Collapse
Affiliation(s)
- Sophie M Duignan
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | | | - Kathryn Armstrong
- Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Afif El-Khuffash
- School of Medicine, Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Orla Franklin
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- Discipline of Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland.
- Department of Neonatology, Children's Health Ireland at Crumlin, Dublin, Ireland.
- Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland.
- Paediatric Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland.
| |
Collapse
|
2
|
Taneri PE, Kirkham JJ, Molloy EJ, Biesty L, Polin RA, Wynn JL, Stoll BJ, Kissoon N, Kawaza K, Daly M, Branagan A, Bonnard LN, Giannoni E, Strunk T, Ohaja M, Mugabe K, Suguitani D, Quirke F, Devane D. Protocol for the development of a core outcome set for neonatal sepsis (NESCOS). PLoS One 2023; 18:e0295325. [PMID: 38051733 DOI: 10.1371/journal.pone.0295325] [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] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Abstract
Neonatal sepsis is a serious public health problem; however, there is substantial heterogeneity in the outcomes measured and reported in research evaluating the effectiveness of the treatments. Therefore, we aim to develop a Core Outcome Set (COS) for studies evaluating the effectiveness of treatments for neonatal sepsis. Since a systematic review of key outcomes from randomised trials of therapeutic interventions in neonatal sepsis was published recently, we will complement this with a qualitative systematic review of the key outcomes of neonatal sepsis identified by parents, other family members, parent representatives, healthcare providers, policymakers, and researchers. We will interpret the outcomes of both studies using a previously established framework. Stakeholders across three different groups i.e., (1) researchers, (2) healthcare providers, and (3) patients' parents/family members and parent representatives will rate the importance of the outcomes in an online Real-Time Delphi Survey. Afterwards, consensus meetings will be held to agree on the final COS through online discussions with key stakeholders. This COS is expected to minimize outcome heterogeneity in measurements and publications, improve comparability and synthesis, and decrease research waste.
Collapse
Affiliation(s)
- Petek Eylul Taneri
- HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Jamie J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Eleanor J Molloy
- Department of Neonatology, The Coombe Hospital, Dublin, Ireland
- Department of Paediatrics and Child Health, Trinity College Dublin, Trinity Research in Childhood Centre (TRiCC), Neonatology, Children's Health Ireland, Dublin, Ireland
| | - Linda Biesty
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland & Cochrane Ireland, University of Galway, Galway, Ireland
| | - Richard A Polin
- Department of Paediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - James L Wynn
- Department of Paediatrics, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Barbara J Stoll
- China Medical Board, China
- Emory University School of Medicine, Atlanta, GA, United States of America
- McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Niranjan Kissoon
- Department of Paediatrics, College of Medicine, University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mandy Daly
- Education and Research, Irish Neonatal Health Alliance, Bray, Ireland
| | - Aoife Branagan
- Department of Neonatology, The Coombe Hospital, Dublin, Ireland
- Department of Paediatrics and Child Health, Trinity College Dublin, Trinity Research in Childhood Centre (TRiCC), Neonatology, Children's Health Ireland, Dublin, Ireland
| | | | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, Wesfarmers' Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Magdalena Ohaja
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Kenneth Mugabe
- Mbale Regional Referral Hospital, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | | | - Fiona Quirke
- HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Declan Devane
- HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland & Cochrane Ireland, University of Galway, Galway, Ireland
| |
Collapse
|
3
|
Yadav P, Yadav SK. Progress in Diagnosis and Treatment of Neonatal Sepsis: A Review Article. JNMA J Nepal Med Assoc 2022; 60:318-324. [PMID: 35633256 PMCID: PMC9226748 DOI: 10.31729/jnma.7324] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Neonatal sepsis is a serious condition in which the pathogens infiltrate the bloodstream, multiply and produce toxins causing deleterious effects to the health of neonates. It is divided into two types on the basis of the time of onset. Early onset sepsis occurs within 72 hours of birth and late onset sepsis begins after 72 hours of delivery. Neonatal sepsis continues to be a common and significant health care burden, especially in very low birth weight infants (with birth weight less than 1500 grams). Though intrapartum antibiotic prophylaxis has decreased the incidence of early-onset group B streptococcal infection dramatically, it still remains a major cause of neonatal sepsis. As the signs and symptoms of neonatal sepsis are nonspecific, early diagnosis and prompt treatment remain a challenge.
Collapse
Affiliation(s)
- Pratibha Yadav
- Department of Pediatrics, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, People's Republic of China
| | - Shailendra Kumar Yadav
- Trishuli Hospital, Bidur, Nuwakot, Nepal
- Correspondence: Dr Shailendra Kumar Yadav, Trishuli Hospital, Bidur, Nuwakot, Nepal. , Phone: +977-9843165951
| |
Collapse
|
4
|
Mathias S, Balachander B, Bosco A, Britto C, Rao S. The effect of exchange transfusion on mortality in neonatal sepsis: a meta-analysis. Eur J Pediatr 2022; 181:369-381. [PMID: 34351474 DOI: 10.1007/s00431-021-04194-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Although antimicrobials are the cornerstone of neonatal sepsis management, adjunctive therapies are required to improve outcomes. The aim of our study was to evaluate the effect of exchange transfusion (ET) on mortality (primary outcome) in neonatal sepsis, as well as on immunoglobulin, complement and neutrophil levels and assess its complications (secondary outcomes). Databases searched include PubMed, NCBI, Google Scholar, CINHAL, Ovid and Scopus. Randomized controlled trials (RCTs), controlled observational studies (COSs) and uncontrolled observational studies (UOSs) reporting mortality data from using ET in neonatal sepsis were included. Studies with additional interventions, non-septic ET indications and populations aged > 28 days were excluded. Data extracted include demographics, features of study, sepsis and ET, as well as mortality rates, immunological and laboratory changes and complications. Data was meta-analysed and displayed using forest plots. The meta-analysis of 14 studies (3 RCTs, 11 COSs) revealed a mortality benefit in septic neonates who underwent ET-RR 0.72 (CI 0.61-0.86, p = 0.01) and a significant increase in pooled immunological parameters (immunoglobulin, complement levels) (SMD 1.13, [0.25, 2.02], p = 0.02) and neutrophil levels (SMD 1.07 [0.04, 2.11], p = 0.03) compared to controls. The descriptive analysis of 9 UOSs revealed thrombocytopenia as the most frequently reported complication (n = 48). Moderate-high risk of bias was largely due to inadequate sample sizes and follow-up durations.Conclusion: Currently, the use of ET in neonatal sepsis is not directly recommended due to low certainty of evidence, inadequate power and moderate-high risk of bias and heterogeneity.Trial registration: PROSPERO (CRD42020176629) ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=176629 ) What is Known: • Exchange transfusion is one of the adjunctive methods for treatment of neonatal sepsis. What is New: • The pooled analysis of all studies shows that exchange transfusion has a low certainty of evidence in the context of neonatal mortality. However, at this point, this intervention cannot be refuted or recommended due to heterogeneity of studies and inadequate power.
Collapse
Affiliation(s)
- Sitarah Mathias
- St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
| | - Bharathi Balachander
- St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India.
- Department of Neonatology, St. John's Medical College and Hospital, St. John's National Academy of Health Sciences, Bangalore, 560034, India.
| | - Ashish Bosco
- St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
| | - Carl Britto
- Department of Infectious Disease, St. John's Research Institute, Bangalore, India
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Boston Children's Hospital, Boston, USA
| | - Suman Rao
- St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
- Department of Neonatology, St. John's Medical College and Hospital, St. John's National Academy of Health Sciences, Bangalore, 560034, India
- Consultant, Division of Department of Maternal, Newborn and Adolescent Health, World Health Organisation, Geneva, Switzerland
| |
Collapse
|
5
|
Affiliation(s)
- Per T. Sangild
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics, Odense University Hospital, Odense, Denmark
| | - Tobias Strunk
- Centre for Molecular Medicine & Innovative Therapeutics, Murdoch University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- Neonatal Directorate, Child and Adolescent Health Service, Western, Australia
| | - Andrew J. Currie
- Neonatal Directorate, Child and Adolescent Health Service, Western, Australia
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, WA, Australia
| | - Duc Ninh Nguyen
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| |
Collapse
|
6
|
Moon CJ, Kwon TH, Lee KS, Lee HS. Recurrent neonatal sepsis and progressive white matter injury in a premature newborn culture-positive for group B Streptococcus: A case report. Medicine (Baltimore) 2021; 100:e26387. [PMID: 34160417 PMCID: PMC8238304 DOI: 10.1097/md.0000000000026387] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Group B Streptococcus (GBS) remains a principal pathogen causing neonatal sepsis and meningitis, particularly in premature infants with relatively insufficient immunity. Recurrence may occur uncommonly, largely associated with subclinical mucosal persistence or repetitive exposure to exogenous sources. White matter injury (WMI) including cystic periventricular leukomalacia (PVL) has been associated with intrauterine infection/inflammation, and neonatal infection as a more significant predictor including postnatal sepsis and recurrent infection, even without microbial neuroinvasion. Furthermore, clinical and experimental evidence of WMI by some bacteria other than GBS without central nervous system invasion has been reported. However, there is little evidence of WMI associated with neonatal GBS sepsis in the absence of meningitis in the literature. PATIENT CONCERNS A newborn at 30+4 weeks' gestation with low birthweight presented with 2 episodes (with a 13-day interval with no antibiotic therapy) of neonatal sepsis culture-proven for GBS with early-onset presentation after clinical chorioamnionitis via vertical GBS transmission and the associated conditions including prematurity-related neonatal immunodeficiency and persistent mucosal GBS carriage after the first antibiotic treatment. The perinatal GBS infection was complicated by progressive WMI presenting with ventriculomegaly and cystic PVL without a definite evidence of meningitis, intraventricular hemorrhage, and documented cerebral hypoxia or hypoperfusion conditions including septic shock. DIAGNOSES Recurrent group B streptococcal sepsis and cystic PVL with ventriculomegaly. INTERVENTIONS Two episodes of GBS sepsis were treated with 15-day parenteral antibiotic therapy, respectively. OUTCOMES Resolution of the recurrent GBS sepsis without further relapses, however, complicated by WMI and subsequent about 6 months delay in motor development at 12 months' corrected age. LESSONS This case suggests WMI associated with GBS bacteremia without central nervous system entry by viable GBS and also shows that in premature infants, intrauterine GBS infection with no interventions may lead to extensive and persistent GBS colonization, early-onset and recurrent GBS disease, and WMI. Postnatal as well as intrauterine infection/inflammation controls with maternal prophylaxis may be pivotal for prevention and limiting the magnitude of neurologic injury.
Collapse
MESH Headings
- Administration, Intravenous
- Anti-Bacterial Agents/administration & dosage
- Chorioamnionitis/diagnosis
- Chorioamnionitis/microbiology
- Developmental Disabilities/diagnosis
- Developmental Disabilities/microbiology
- Drug Therapy, Combination/methods
- Female
- Humans
- Hydrocephalus/diagnosis
- Hydrocephalus/microbiology
- Infant
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infectious Disease Transmission, Vertical
- Leukomalacia, Periventricular/diagnosis
- Leukomalacia, Periventricular/microbiology
- Leukomalacia, Periventricular/pathology
- Magnetic Resonance Imaging
- Male
- Maternal Age
- Neonatal Sepsis/diagnosis
- Neonatal Sepsis/microbiology
- Neonatal Sepsis/therapy
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/microbiology
- Recurrence
- Streptococcal Infections/complications
- Streptococcal Infections/diagnosis
- Streptococcal Infections/microbiology
- Streptococcal Infections/transmission
- Streptococcus agalactiae/isolation & purification
- White Matter/diagnostic imaging
- White Matter/microbiology
- White Matter/pathology
- Young Adult
Collapse
Affiliation(s)
- Cheong-Jun Moon
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Tae Hee Kwon
- Department of Radiology, Cha Gangnam Medical Center, Cha University School of Medicine
| | - Kyung Sang Lee
- Department of Radiology, Cha Gangnam Medical Center, Cha University School of Medicine
| | - Hyun-Seung Lee
- Department of Pediatrics, Incheon Worker‘s Compensation Hospital, Incheon
- Department of Pediatrics, Cha Gangnam Medical Center, Cha University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
7
|
Oliphant NP, Manda S, Daniels K, Odendaal WA, Besada D, Kinney M, White Johansson E, Doherty T. Integrated community case management of childhood illness in low- and middle-income countries. Cochrane Database Syst Rev 2021; 2:CD012882. [PMID: 33565123 PMCID: PMC8094443 DOI: 10.1002/14651858.cd012882.pub2] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The leading causes of mortality globally in children younger than five years of age (under-fives), and particularly in the regions of sub-Saharan Africa (SSA) and Southern Asia, in 2018 were infectious diseases, including pneumonia (15%), diarrhoea (8%), malaria (5%) and newborn sepsis (7%) (UNICEF 2019). Nutrition-related factors contributed to 45% of under-five deaths (UNICEF 2019). World Health Organization (WHO) and United Nations Children's Fund (UNICEF), in collaboration with other development partners, have developed an approach - now known as integrated community case management (iCCM) - to bring treatment services for children 'closer to home'. The iCCM approach provides integrated case management services for two or more illnesses - including diarrhoea, pneumonia, malaria, severe acute malnutrition or neonatal sepsis - among under-fives at community level (i.e. outside of healthcare facilities) by lay health workers where there is limited access to health facility-based case management services (WHO/UNICEF 2012). OBJECTIVES To assess the effects of the integrated community case management (iCCM) strategy on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for children younger than five years of age in low- and middle-income countries. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2019, Virtual Health Library on 8 November 2019, and Popline on 5 December 2018, three other databases on 22 March 2019 and two trial registers on 8 November 2019. We performed reference checking, and citation searching, and contacted study authors to identify additional studies. SELECTION CRITERIA Randomized controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), interrupted time series (ITS) studies and repeated measures studies comparing generic WHO/UNICEF iCCM (or local adaptation thereof) for at least two iCCM diseases with usual facility services (facility treatment services) with or without single disease community case management (CCM). We included studies reporting on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for under-fives in low- and middle-income countries. DATA COLLECTION AND ANALYSIS At least two review authors independently screened abstracts, screened full texts and extracted data using a standardised data collection form adapted from the EPOC Good Practice Data Collection Form. We resolved any disagreements through discussion or, if required, we consulted a third review author not involved in the original screening. We contacted study authors for clarification or additional details when necessary. We reported risk ratios (RR) for dichotomous outcomes and hazard ratios (HR) for time to event outcomes, with 95% confidence intervals (CI), adjusted for clustering, where possible. We used estimates of effect from the primary analysis reported by the investigators, where possible. We analysed the effects of randomized trials and other study types separately. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included seven studies, of which three were cluster RCTs and four were CBAs. Six of the seven studies were in SSA and one study was in Southern Asia. The iCCM components and inputs were fairly consistent across the seven studies with notable variation for the training and deployment component (e.g. on payment of iCCM providers) and the system component (e.g. on improving information systems). When compared to usual facility services, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (RR 0.96, 95% CI 0.77 to 1.19; 2 CBA studies, 5898 children; very low-certainty evidence). iCCM may have little to no effect on neonatal mortality (HR 1.01, 95% 0.73 to 1.28; 2 trials, 65,209 children; low-certainty evidence). We are uncertain of the effect of iCCM on infant mortality (HR 1.02, 95% CI 0.83 to 1.26; 2 trials, 60,480 children; very low-certainty evidence) and under-five mortality (HR 1.18, 95% CI 1.01 to 1.37; 1 trial, 4729 children; very low-certainty evidence). iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness by 68% (RR 1.68, 95% CI 1.24 to 2.27; 2 trials, 9853 children; moderate-certainty evidence). None of the studies reported quality of care, severity of illness or adverse events for this comparison. When compared to usual facility services plus CCM for malaria, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (very low-certainty evidence) and iCCM may have little or no effect on careseeking to an appropriate provider for any iCCM illness (RR 1.06, 95% CI 0.97 to 1.17; 1 trial, 811 children; low-certainty evidence). None of the studies reported quality of care, case load or severity of illness at health facilities, mortality or adverse events for this comparison. AUTHORS' CONCLUSIONS iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness. However, the evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems.
Collapse
Affiliation(s)
- Nicholas P Oliphant
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
- School of Public Health, University of the Western Cape, Belleville, South Africa
| | - Samuel Manda
- Biostatistics Unit, South African Medical Research Council, Hatfield, South Africa
- Department of Statistics, University of Pretoria, Hatfield, South Africa
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Willem A Odendaal
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Donela Besada
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Mary Kinney
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Emily White Johansson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health, University of the Western Cape, Belleville, South Africa
| |
Collapse
|
8
|
Affiliation(s)
- Faith Kim
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NY, USA
| | - Richard A Polin
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NY, USA
| | - Thomas A Hooven
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
9
|
Cai C, Qiu G, Hong W, Shen Y, Gong X. Clinical effect and safety of continuous renal replacement therapy in the treatment of neonatal sepsis-related acute kidney injury. BMC Nephrol 2020; 21:286. [PMID: 32682407 PMCID: PMC7368639 DOI: 10.1186/s12882-020-01945-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/16/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sepsis is the leading cause of acute kidney injury (AKI) in the neonatal intensive care unit (NICU). The aim of the study is to explore the efficacy and security of continuous renal replacement therapy (CRRT) in the treatment of neonatal sepsis-related AKI. METHOD Totally12 sepsis-related AKI neonates treated with CRRT were hospitalized in the NICU of Shanghai Children's Hospital between November 2012 and November 2019, and the clinical data of these 12 cases were retrospectively analyzed. Renal function, acid-base balance, electrolytes, blood pressure and hemodynamics indexes were recorded before CRRT initiation, 12/24/48 h after CRRT initiation and at the end of CRRT respectively. The efficacy of CRRT was evaluated and the clinical outcome was observed in these 12 sepsis-related AKI neonates. Repeated measurement analysis of variance was used for statistical analysis of the data. RESULT (1) Continuous veno-venous hemodialysis filtration (CVVHDF) was used in 12 cases of sepsis-related AKI neonates. There were 6 cases with oliguria, 3 cases with fluid overload (FO), 3 cases with septic shock. The duration of CRRT was 49 ~ 110 h, average (76.2 ± 23.5) h. (2) The blood pressure (BP) of 12 sepsis -related AKI neonates could reach the normal level (40-60 mmHg) 12 h after CRRT initiation, and the normal BP level could be maintained during the CRRT treatment. After 12 h CRRT, the blood pH value increased to the normal range (7.35 ~ 7.45). After 12 h CRRT treatment, the oxygenation index of 12sepsis-related AKI neonates could reach 200 mmHg. After 24 h CRRT treatment, it could rise to more than 300 mmHg. Serum potassium, serum urea nitrogen and serum creatinine levels decreased significantly 12 h after CRRT initiation, and reached the normal range 24 h after CRRT initiation. The urine volume significantly increased 24 h after CRRT initiation. (3) Venous catheterization was performed successfully in all sepsis-related AKI neonates. We observed 2 cases of thrombocytopenia, 1 case of obstruction and 1 case of hypotension in the course of CRRT. There were no complications such as hypothermia, hemorrhage, thrombosis and infection.11 neonates were cured and discharged. One neonate was treated with CRRT and passed through the oliguria stage of AKI, but died after the parents gave up the treatment. CONCLUSIONS It is safe and effective to treat neonatal sepsis-related AKI with CRRT, which should be an effective measure for the treatment of sepsis-related AKI neonates.
Collapse
Affiliation(s)
- Cheng Cai
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| | - Gang Qiu
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| | - Wenchao Hong
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| | - Yunlin Shen
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| |
Collapse
|
10
|
Furfaro LL, Payne MS, Chang BJ. Host range, morphological and genomic characterisation of bacteriophages with activity against clinical Streptococcus agalactiae isolates. PLoS One 2020; 15:e0235002. [PMID: 32574197 PMCID: PMC7310703 DOI: 10.1371/journal.pone.0235002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/06/2020] [Indexed: 01/21/2023] Open
Abstract
Streptococcus agalactiae or Group B Streptococcus (GBS) is a leading cause of sepsis in neonates. As a preventative measure prophylactic antibiotic administration is common in pregnant women colonised with GBS, but antibiotic-resistance and adverse effects on neonatal microbiomes may result. Use of bacteriophages (phages) is one option for targeted therapy. To this end, four phages (LF1 –LF4) were isolated from wastewater. They displayed lytic activity in vitro against S. agalactiae isolates collected from pregnant women and neonates, with 190/246 isolates (77.2%) and 10/10 (100%) isolates susceptible to at least one phage, respectively. Phage genomes ranged from 32,205–44,768 bp and all phages were members of the Siphoviridae family. High nucleotide identity (99.9%) was observed between LF1 and LF4, which were closely related to a putative prophage of S. agalactiae. The genome organisation of LF2 differed, and it showed similarity to a different S. agalactiae prophage, while LF3 was more closely related to a Streptococcus pyogenes phage. Lysogenic gene presence (integrase, repressor and regulatory modules), was suggestive of temperate phages. In a therapeutic context, temperate phages are not ideal candidates, however, the broad host range activity of these phages observed on clinical isolates in vitro is promising for future therapeutic approaches including bioengineered phage or lysin applications.
Collapse
Affiliation(s)
- Lucy L. Furfaro
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Crawley, Australia
- * E-mail:
| | - Matthew S. Payne
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Crawley, Australia
| | - Barbara J. Chang
- The School of Biomedical Sciences, The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Australia
| |
Collapse
|
11
|
MESH Headings
- Betacoronavirus/isolation & purification
- COVID-19
- Coronavirus Infections/complications
- Coronavirus Infections/therapy
- Coronavirus Infections/virology
- Humans
- Hypotension/etiology
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/therapy
- Infant, Premature, Diseases/virology
- Intensive Care Units, Pediatric
- Lung/diagnostic imaging
- Lung/pathology
- Male
- Neonatal Sepsis/therapy
- Neonatal Sepsis/virology
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/therapy
- Pneumonia, Viral/virology
- Pneumothorax/etiology
- Positive-Pressure Respiration
- SARS-CoV-2
Collapse
Affiliation(s)
| | - Upulie Nawaratne
- University of Texas Health Science Center at Houston, Houston, TX
| | - David McMann
- University of Texas Health Science Center at Houston, Houston, TX
| | - Misti Ellsworth
- University of Texas Health Science Center at Houston, Houston, TX
| | - Jon Meliones
- University of Texas Health Science Center at Houston, Houston, TX
| | | |
Collapse
|
12
|
Pollak U. Neonatal Sepsis and Extracorporeal Membrane Oxygenation Support: Pushing the Envelope. Isr Med Assoc J 2020; 22:255-257. [PMID: 32286031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Uri Pollak
- Pediatric Cardiac Critical Care Unit, Pediatric Cardiology and Pediatric Extracorporeal Support Program, Hadassah University Medical Center, Jerusalem, Israel
| |
Collapse
|
13
|
Rabinowicz S, Rubinshtein M, Strauss T, Barkai G, Vardi A, Paret G. Life Saving Extracorporeal Membrane Oxygenation Support Use in Neonatal Listeriosis. Isr Med Assoc J 2020; 22:258-259. [PMID: 32286032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Shira Rabinowicz
- Department of Pediatrics A, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Rubinshtein
- Department of Pediatric Intensive Care, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzipora Strauss
- Department of Neonatology, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Barkai
- Department of Infectious Disease, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Vardi
- Department of Pediatric Cardiac Intensive Care, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Paret
- Department of Pediatric Intensive Care, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
Giri S, Sharma U, Choden J, Diyali KB, Dorji L, Wangchuk C. Bhutan's First Emergency Air Medical Retrieval Service: The First Year of Operations. Air Med J 2019; 39:116-119. [PMID: 32197688 DOI: 10.1016/j.amj.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/03/2019] [Accepted: 11/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Bhutan Emergency Aeromedical Retrieval (BEAR) Team is the only helicopter emergency medical service in Bhutan. This study was performed to review the clinical cases cared for by the BEAR Team, ascertain the types of interventions that were performed, and determine the outcomes of patients evacuated in its first year of operations. METHODS This is a retrospective observational study in which medical evacuations performed in the first year of operations were analyzed. The number of airlifts activated during the study period determined the sample size (171). Data were obtained from case logs and trip sheets. RESULTS The BEAR Team provided services to all regions of the country in its first year. The overall survival rate was 73.1%. The most common intervention required was securing a definitive airway (n = 24). The top 3 conditions requiring air medical retrieval were sepsis, acute mountain sickness, and trauma. CONCLUSION Helicopter emergency medical services are known to decrease the time to definitive treatment. This is particularly pertinent in Bhutan, given the scattered population distribution, long transport times, and distribution of medical resources and specialty care. This study is the first of its kind in Bhutan, and this can pave way to conduct more studies involving patients transported by air ambulance.
Collapse
Affiliation(s)
- Sweta Giri
- Bhutan Emergency Aeromedical Retrieval Team, Emergency Department, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
| | - Urvashi Sharma
- Bhutan Emergency Aeromedical Retrieval Team, Emergency Department, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Jangchu Choden
- Bhutan Emergency Aeromedical Retrieval Team, Emergency Department, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kiran Biswa Diyali
- Bhutan Emergency Aeromedical Retrieval Team, Emergency Department, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Lhab Dorji
- Bhutan Emergency Aeromedical Retrieval Team, Emergency Department, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Cheki Wangchuk
- Bhutan Emergency Aeromedical Retrieval Team, Emergency Department, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| |
Collapse
|
15
|
Yismaw AE, Abebil TY, Biweta MA, Araya BM. Proportion of neonatal sepsis and determinant factors among neonates admitted in University of Gondar comprehensive specialized hospital neonatal Intensive care unit Northwest Ethiopia 2017. BMC Res Notes 2019; 12:542. [PMID: 31455414 PMCID: PMC6712769 DOI: 10.1186/s13104-019-4587-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/09/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Neonatal sepsis is one of the most common causes of neonatal hospitalization in developing countries. It is also a major cause of mortality in the world affecting both developed and developing countries. Diagnosis and management of sepsis are a great challenge facing neonatologists in neonatal intensive care units due to nonspecific signs and symptoms. This study, therefore, was aimed to determine proportion and risk factors of neonatal sepsis at university of Gondar comprehensive specialized hospital, North West Ethiopia. RESULT The proportion of neonatal sepsis was 11.7%. Factors significantly associated with neonatal sepsis were: Neonatal related factors were: Premature rupture of membrane (AOR = 2.74; 95% Cl (1.39, 5.38), congenital anomaly (AOR = 3.14; 95% CI (1.09, 10.28), and low Apgar score (AOR = 2.69; 95% Cl (1.37, 5.26). Maternal factors were: foul-smelling vaginal discharge (AOR = 2.75; 95% Cl (1.40, 5.38), and Intrapartum fever (AOR = 3.35; 95% Cl (1.7, 6.62). In this finding proportion of Neonatal sepsis was low as compared to previous studies. Measures targeting the prevention of premature rupture of membranes and low Apgar score need to be taken, like strengthening maternal birth preparedness and complication readiness plans. Also, identification of congenital anomalies earlier in pregnancy and taking measures to avoid birth injury may decrease neonatal sepsis.
Collapse
MESH Headings
- Adult
- Ethiopia/epidemiology
- Female
- Hospitals, Special
- Hospitals, University
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/therapy
- Intensive Care Units, Neonatal/statistics & numerical data
- Neonatal Sepsis/diagnosis
- Neonatal Sepsis/epidemiology
- Neonatal Sepsis/therapy
- Pregnancy
- Premature Birth/diagnosis
- Premature Birth/epidemiology
- Premature Birth/therapy
- Prenatal Care/methods
- Risk Factors
- Young Adult
Collapse
Affiliation(s)
- Ayenew Engida Yismaw
- College of Medicine and Health Science, School of Midwifery, University of Gondar, Gondar, Ethiopia
| | | | - Mulunesh Abuhay Biweta
- College of Medicine and Health Science, School of Midwifery, University of Gondar, Gondar, Ethiopia
| | - Bilen Mekonnen Araya
- College of Medicine and Health Science, School of Midwifery, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
16
|
Abstract
Neonatal sepsis is the cause of substantial morbidity and mortality. Precise estimates of neonatal sepsis burden vary by setting. Differing estimates of disease burden have been reported from high-income countries compared with reports from low-income and middle-income countries. The clinical manifestations range from subclinical infection to severe manifestations of focal or systemic disease. The source of the pathogen might be attributed to an in-utero infection, acquisition from maternal flora, or postnatal acquisition from the hospital or community. The timing of exposure, inoculum size, immune status of the infant, and virulence of the causative agent influence the clinical expression of neonatal sepsis. Immunological immaturity of the neonate might result in an impaired response to infectious agents. This is especially evident in premature infants whose prolonged stays in hospital and need for invasive procedures place them at increased risk for hospital-acquired infections. Clinically, there is often little difference between sepsis that is caused by an identified pathogen and sepsis that is caused by an unknown pathogen. Culture-independent diagnostics, the use of sepsis prediction scores, judicious antimicrobial use, and the development of preventive measures including maternal vaccines are ongoing efforts designed to reduce the burden of neonatal sepsis.
Collapse
Affiliation(s)
- Andi L Shane
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Pablo J Sánchez
- Divisions of Neonatology and Infectious Disease, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Barbara J Stoll
- University of Texas, Health McGovern Medical School, Houston, TX, USA
| |
Collapse
|
17
|
Tewabe T, Mohammed S, Tilahun Y, Melaku B, Fenta M, Dagnaw T, Belachew A, Molla A, Belete H. Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a retrospective chart review. BMC Res Notes 2017; 10:265. [PMID: 28693597 PMCID: PMC5504561 DOI: 10.1186/s13104-017-2573-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/28/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Sepsis remains a major cause of morbidity and mortality among neonates. The risk factors and clinical outcomes of sepsis are poorly understood. Most cases of sepsis occurred mostly within the first week of newborns life related to perinatal risk factors. Late onset sepsis is related to hospital acquired infections which is seen after seven days of age. The purpose of this study was to assess clinical outcome and risk factors of neonatal sepsis in Felege Hiwot referral hospital Bahir Dar, North West Ethiopia. RESULTS Among the total 225 neonatal charts reviewed; 164 (72.9%) were age less than or equal to 7 days, and 144 (64%) were males. About 29 (12.9%) neonates were with irregular respiratory signs and 40 (17.8%) had meconium aspiration syndrome. Regarding the clinical outcome of neonatal sepsis: 189 (84%) were improved after treatment, 9 (4%) were died and 13 (5.8%) referred to other organizations for further treatment. Respiratory distress syndrome [AOR = 0.258 (0.072-0.930)] and meconium aspiration syndrome [AOR = 0.1989 (0.059-0.664)] were the determinant factors for poor outcome of neonatal sepsis. CONCLUSION The clinical outcome of neonatal sepsis in Felege Hiwot referral hospital was not satisfactory. The significant risk factors for poor outcome of neonatal sepsis were respiratory distress syndrome and meconium aspiration syndrome. Recommendations to improve neonatal outcome are: performing essential newborn care for all newborns and arranging appropriate follow up until the end of neonatal period, increasing antenatal care and early detection and management of neonatal infections or problems.
Collapse
Affiliation(s)
- Tilahun Tewabe
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Seida Mohammed
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Tilahun
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Birhanie Melaku
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mequanint Fenta
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tsigiereda Dagnaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Belachew
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashagre Molla
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habte Belete
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
18
|
Abstract
Serious bacterial and viral infections occurring in early infancy are important factors affecting morbidity and mortality. Recognition of sepsis by healthcare professionals is vital and allows initiation of appropriate early treatment which can be life-saving and improve outcomes for these infants greatly. This article outlines the leading causes of sepsis, for example, group B Streptococcus (GBS), Escherichia coli and herpes simplex virus. We discuss the non-specific ways in which an infant with a serious infection may present to health professionals and highlight crucial features to look for in the history and during examination of an unwell infant, and these include 'red-flag' signs and symptoms that should be carefully elicited. A systematic approach for the management of an infant with suspected sepsis based on up-to-date evidence and the National Institute for Health and Care Excellence ( NICE 2012 ) recommendations are discussed. Implications for nursing practice are also included, with a summary of sepsis in early infancy to aid the continued professional development of nurses working with young children in clinical settings.
Collapse
|
19
|
Alvarado-Gamarra G, Alcalá-Marcos KM, Abarca-Alfaro DM, Bao-Castro V. [Microbiological and therapeutic characteristics of confirmed neonatal sepsis at a hospital in Lima, Peru]. Rev Peru Med Exp Salud Publica 2016; 33:74-82. [PMID: 27384625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 03/09/2016] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES To describe the microbiological and therapeutic characteristics of confirmed neonatal sepsis, and determineits incidence and mortality, at the National Hospital Arzobispo Loayza (HNAL) from 2011 to 2012, Lima, Peru. MATERIALS AND METHODS Retrospective longitudinal study. It was performed a monitoring to newborns with probable sepsis, and assessed the results from positive blood cultures. The newborns' characteristics were obtained from medical records. The acumulated incidences of confirmed sepsis, mortality and fatality rates were determined. Quantitative variables were reported as men ± standard deviation or median (interquartile range). Qualitative variables were reported as relative frequencies and percentages. RESULTS The incidence of confirmed sepsis was 4.1 per 1 000 live births (95% confidence interval [CI]: 2.7-5.5). The mortality rate was 0.97 per 1 000 live births (95% CI: 0.29-1.63) and the fatality rate was 23.5% (95% CI: 9-37). The most commonly isolated organism was coagulase-negative Staphylococcus, followed by Staphylococcus aureus, both with high rates of oxacillin resistance (90% and 66.6%, respectively). A 67% of the newborns were treated using ampicillin/amikacin or ampicillin/cefotaxime. Antibiotics were changed in 58% of the newborns because of poor clinical/laboratory evolution or blood culture results. In most cases the seconds antibiotic was vancomycin (42.8%). CONCLUSIONS There is a high incidence of confirmed sepsis and a high fatality rate. The administered treatments were not consistent with the microbiological profiles.
Collapse
|
20
|
Mahieu L, Langhendries JP, Cossey V, De Praeter C, Lepage P, Melin P. Management of the neonate at risk for early-onset Group B streptococcal disease (GBS EOD): new paediatric guidelines in Belgium. Acta Clin Belg 2014; 69:313-9. [PMID: 25056493 DOI: 10.1179/2295333714y.0000000054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Despite group B streptococcal (GBS) screening in late pregnancy and intrapartum antimicrobial prophylaxis, early-onset sepsis in neonates remains a common source of neonatal morbidity and mortality especially in preterm neonates. The identification of neonates with early-onset sepsis is usually based on perinatal risk factors. Clinical signs are aspecific and laboratory tests are not sensitive. Therefore, many clinicians will overtreat at-risk infants. Inappropriate treatment with antibiotics increases the risk for late-onset sepsis, necrotizing enterocolitis, mortality, and prolongs hospitalisation and costs. In 2003, the Belgian Health Council published guidelines for the prevention of perinatal GBS infections. This report presents the Belgian paediatric management guidelines, which have been endorsed by the Belgian and Flemish societies of neonatology and paediatrics. The most imported changes in the 2014 guidelines are the following: recommendations for a lumbar puncture; clarification of normal spinal fluid parameters and blood neutrophil indices corrected for gestation age; specific timing for diagnostic testing after birth; no indication for diagnostic testing in asymptomatic newborns unless additional risk factors; a revised algorithm for management of neonates according to maternal and neonatal risk factors; and premature infants described as those below 35 weeks instead of 37 weeks. The guidelines were made on the basis of the best evidence and on expert opinion when inadequate evidence exists.
Collapse
|