1
|
Jaya-Bodestyne SL, Tan YY, Sultan R, Yeo KT, Kong JY. Clinical Course and Outcomes of Infants with Streptococcus bovis/Streptococcus Gallolyticus subspecies pasteurianus Infection: A Systematic Review and Meta-analysis. Pediatr Infect Dis J 2024:00006454-990000000-00835. [PMID: 38621155 DOI: 10.1097/inf.0000000000004361] [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] [Indexed: 04/17/2024]
Abstract
BACKGROUND Streptococcus gallolyticus subspecies pasteurianus (SGP), a subtype of Streptococcus bovis, is an uncommon but important cause of neonatal sepsis. Although uncommon, SGP infections during infancy have been associated with an increased risk of morbidity and mortality. METHODS This is a systematic review and meta-analysis of available literature on the clinical course and outcomes of infants with SGP infection. Studies were identified using the following MeSH keywords: "Streptococcus gallolyticus," "Streptococcus bovis," "newborn" and "infant." Data including perinatal factors, clinical presentation, investigations, treatment and outcomes were extracted and analyzed. RESULTS A total of 46 articles were identified (116 cases: 60 S. bovis, 56 SGP). The cases were predominantly term (52%), male (57%) and born via vaginal delivery (67%). The most common symptom was fever [67% (95% confidence interval (CI): 43%-84%)], lethargy [66% (95% CI: 32%-89%)], tachypnea [59% (95% CI: 27%-85%)] and irritability [59% (95% CI: 34%-79%)]. Infants with early-onset infections (<3 days of life) were more likely to have respiratory symptoms and bacteremia (73%), whereas late-onset infections presented predominantly with gastrointestinal symptoms. Four mortalities were reported which occurred before antibiotic administration. Isolated bacteria were mostly penicillin-susceptible [95% (95% CI: 78-99%)] and cases treated with penicillin derivative had good recovery. CONCLUSIONS SGP is an important cause of neonatal sepsis and meningitis. Penicillin derivative is an effective treatment for SGP, and outcomes appear to be favorable.
Collapse
Affiliation(s)
| | - Yee Yin Tan
- From the Department of Neonatology, KK Women's & Children's Hospital
| | | | - Kee Thai Yeo
- From the Department of Neonatology, KK Women's & Children's Hospital
- Duke-NUS Medical School
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Juin Yee Kong
- From the Department of Neonatology, KK Women's & Children's Hospital
- Duke-NUS Medical School
- Lee Kong Chian School of Medicine, Singapore, Singapore
| |
Collapse
|
2
|
Gopagondanahalli KR, Abdul Haium AA, Vora SJ, Sundararaghavan S, Ng WD, Choo TLJ, Ang WL, Binte Mohamad Taib NQ, Wijedasa NHY, Rajadurai VS, Yeo KT, Tan TH. Serial tissue Doppler imaging in the evaluation of bronchopulmonary dysplasia-associated pulmonary hypertension among extremely preterm infants: a prospective observational study. Front Pediatr 2024; 12:1349175. [PMID: 38646509 PMCID: PMC11026596 DOI: 10.3389/fped.2024.1349175] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Objectives To evaluate serial tissue Doppler cardiac imaging (TDI) in the evolution of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) among extremely preterm infants. Design Prospective observational study. Setting Single-center, tertiary-level neonatal intensive care unit. Patients Infant born <28 weeks gestation. Main outcome measures Utility of TDI in the early diagnosis and prediction of BPD-PH and optimal timing for screening of BPD-PH. Results A total of 79 infants were included. Of them, 17 (23%) had BPD-PH. The mean gestational age was 25.9 ± 1.1 weeks, and mean birth weight was 830 ± 174 g. The BPD-PH group had a high incidence of hemodynamically significant patent ductus arteriosus (83% vs. 56%, p < 0.018), longer oxygen days (96.16 ± 68.09 vs. 59.35 ± 52.1, p < 0.008), and prolonged hospital stay (133.8 ± 45.9 vs. 106.5 ± 37.9 days, p < 0.005). The left ventricular eccentricity index (0.99 ± 0.1 vs. 1.1 ± 0.7, p < 0.01) and the ratio of acceleration time to right ventricular ejection time showed a statistically significant trend from 33 weeks (0.24 ± 0.05 vs. 0.28 ± 0.05, p < 0.05). At 33 weeks, the BPD-PH group showed prolonged isovolumetric contraction time (27.84 ± 5.5 vs. 22.77 ± 4, p < 0.001), prolonged isovolumetric relaxation time (40.3 ± 7.1 vs. 34.9 ± 5.3, p < 0.003), and abnormal myocardial performance index (0.39 ± 0.05 vs. 0.32 ± 0.03, p < 0.001). These differences persisted at 36 weeks after conceptional gestational age. Conclusions TDI parameters are sensitive in the early evolution of BPD-PH. Diagnostic accuracy can be increased by combining the TDI parameters with conventional echocardiographic parameters. BPD-PH can be recognizable as early as 33-34 weeks of gestation.
Collapse
Affiliation(s)
- Krishna Revanna Gopagondanahalli
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Abdul Alim Abdul Haium
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Shrenik Jitendrakumar Vora
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Sreekanthan Sundararaghavan
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
- Department of Paediatric Cardiology, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Wei Di Ng
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Tze Liang Jonathan Choo
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
- Department of Paediatric Cardiology, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Wai Lin Ang
- Department of Paediatric Cardiology, KK Women’s and Children’s Hospital, Singapore, Singapore
| | | | | | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Teng Hong Tan
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
- Department of Paediatric Cardiology, KK Women’s and Children’s Hospital, Singapore, Singapore
| |
Collapse
|
3
|
Wang X, Li Y, Shi T, Bont LJ, Chu HY, Zar HJ, Wahi-Singh B, Ma Y, Cong B, Sharland E, Riley RD, Deng J, Figueras-Aloy J, Heikkinen T, Jones MH, Liese JG, Markić J, Mejias A, Nunes MC, Resch B, Satav A, Yeo KT, Simões EAF, Nair H. Global disease burden of and risk factors for acute lower respiratory infections caused by respiratory syncytial virus in preterm infants and young children in 2019: a systematic review and meta-analysis of aggregated and individual participant data. Lancet 2024; 403:1241-1253. [PMID: 38367641 DOI: 10.1016/s0140-6736(24)00138-7] [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: 08/18/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Infants and young children born prematurely are at high risk of severe acute lower respiratory infection (ALRI) caused by respiratory syncytial virus (RSV). In this study, we aimed to assess the global disease burden of and risk factors for RSV-associated ALRI in infants and young children born before 37 weeks of gestation. METHODS We conducted a systematic review and meta-analysis of aggregated data from studies published between Jan 1, 1995, and Dec 31, 2021, identified from MEDLINE, Embase, and Global Health, and individual participant data shared by the Respiratory Virus Global Epidemiology Network on respiratory infectious diseases. We estimated RSV-associated ALRI incidence in community, hospital admission, in-hospital mortality, and overall mortality among children younger than 2 years born prematurely. We conducted two-stage random-effects meta-regression analyses accounting for chronological age groups, gestational age bands (early preterm, <32 weeks gestational age [wGA], and late preterm, 32 to <37 wGA), and changes over 5-year intervals from 2000 to 2019. Using individual participant data, we assessed perinatal, sociodemographic, and household factors, and underlying medical conditions for RSV-associated ALRI incidence, hospital admission, and three severity outcome groups (longer hospital stay [>4 days], use of supplemental oxygen and mechanical ventilation, or intensive care unit admission) by estimating pooled odds ratios (ORs) through a two-stage meta-analysis (multivariate logistic regression and random-effects meta-analysis). This study is registered with PROSPERO, CRD42021269742. FINDINGS We included 47 studies from the literature and 17 studies with individual participant-level data contributed by the participating investigators. We estimated that, in 2019, 1 650 000 (95% uncertainty range [UR] 1 350 000-1 990 000) RSV-associated ALRI episodes, 533 000 (385 000-730 000) RSV-associated hospital admissions, 3050 (1080-8620) RSV-associated in-hospital deaths, and 26 760 (11 190-46 240) RSV-attributable deaths occurred in preterm infants worldwide. Among early preterm infants, the RSV-associated ALRI incidence rate and hospitalisation rate were significantly higher (rate ratio [RR] ranging from 1·69 to 3·87 across different age groups and outcomes) than for all infants born at any gestational age. In the second year of life, early preterm infants and young children had a similar incidence rate but still a significantly higher hospitalisation rate (RR 2·26 [95% UR 1·27-3·98]) compared with all infants and young children. Although late preterm infants had RSV-associated ALRI incidence rates similar to that of all infants younger than 1 year, they had higher RSV-associated ALRI hospitalisation rate in the first 6 months (RR 1·93 [1·11-3·26]). Overall, preterm infants accounted for 25% (95% UR 16-37) of RSV-associated ALRI hospitalisations in all infants of any gestational age. RSV-associated ALRI in-hospital case fatality ratio in preterm infants was similar to all infants. The factors identified to be associated with RSV-associated ALRI incidence were mainly perinatal and sociodemographic characteristics, and factors associated with severe outcomes from infection were mainly underlying medical conditions including congenital heart disease, tracheostomy, bronchopulmonary dysplasia, chronic lung disease, or Down syndrome (with ORs ranging from 1·40 to 4·23). INTERPRETATION Preterm infants face a disproportionately high burden of RSV-associated disease, accounting for 25% of RSV hospitalisation burden. Early preterm infants have a substantial RSV hospitalisation burden persisting into the second year of life. Preventive products for RSV can have a substantial public health impact by preventing RSV-associated ALRI and severe outcomes from infection in preterm infants. FUNDING EU Innovative Medicines Initiative Respiratory Syncytial Virus Consortium in Europe.
Collapse
Affiliation(s)
- Xin Wang
- National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - You Li
- National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ting Shi
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Louis J Bont
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands; ReSViNET Foundation, Zeist, Netherlands
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Bhanu Wahi-Singh
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Yiming Ma
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bingbing Cong
- National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Emma Sharland
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | | | - Terho Heikkinen
- Department of Pediatrics, Turku University Hospital, Turku, Finland; Department of Pediatrics, University of Turku, Turku, Finland
| | - Marcus H Jones
- Department of Pediatrics, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Johannes G Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Joško Markić
- Department of Pediatrics, University Hospital Split, Split, Croatia; School of Medicine, University of Split, Split, Croatia
| | - Asuncion Mejias
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Marta C Nunes
- South African Medical Research Council, Wits Vaccines and Infectious Diseases Analytics Research Unit and Department of Science and Technology and National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Center of Excellence in Respiratory Pathogens, Hospices Civils de Lyon, and Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon, France
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria; Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Ashish Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, District Amaravati, Maharashtra, India
| | - Kee Thai Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Neonatology, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA; Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Harish Nair
- National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
4
|
Chan CS, Kong JY, Sultana R, Mundra V, Babata KL, Mazzarella K, Adhikari EH, Yeo KT, Hascoët JM, Brion LP. Optimal Delivery Management for the Prevention of Early Neonatal SARS-CoV-2 Infection: Systematic Review and Meta-analysis. Am J Perinatol 2024. [PMID: 38267002 DOI: 10.1055/a-2253-5665] [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] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Delivery management interventions (DMIs) were recommended to prevent delivery-associated transmission of maternal SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) to infants without evidence of effect on early neonatal SARS-CoV-2 infection (ENI) and neonatal death <28 days of life (ND). This systematic review describes different DMI combinations and the frequency of ENI and ND. STUDY DESIGN Individual patient data were collected from articles published from January 1, 2020 to December 31, 2021 from Cochrane review databases, Medline, and Google Scholar. Article inclusion criteria were: documented maternal SARS-CoV-2 polymerase chain reaction (PCR)-positive status 10 days before delivery or symptomatic at delivery with a positive test within 48 hours, known delivery method, and known infant SARS-CoV-2 PCR result. Primary outcomes were ENI (positive PCR at 12 hours to 10 days) and ND. All characteristics were pooled using the DerSimonian-Laird inverse variance method. Primary outcome analyses were performed using logit transformation and random effect. Pooled results were expressed as percentages (95% confidence intervals). Continuity correction was applied for all pooled results if any included study has 0 event. RESULTS A total of 11,075 publications were screened. 117 publications representing 244 infants and 230 mothers were included. All publications were case reports. ENI and ND were reported in 23.4% (18.2-29.18) and 2.1% (0.67-4.72) of cases, respectively. Among cases with available information, DMIs were reported for physical environment (85-100%), delivery-specific interventions (47-100%), and infant care practices (80-100%). No significant comparisons could be performed between different DMI combinations due to small sample size. CONCLUSION The evidence supporting any DMI in SARS-CoV-2-infected mothers to prevent ENI or ND is extremely limited. Limitations of this meta-analysis include high risk of bias, small sample size, and large confidence intervals. This identifies the need for multinational database generation and specific studies designed to provide evidence of DMI guidelines best suited to prevent transmission from mother to neonate. KEY POINTS · In this review we analyzed 2 years of maternal SARS-CoV-2 published cases.. · We assessed association of delivery management interventions with infant SARS-CoV-2 infection.. · We found no evidence supporting any DMI for that purpose..
Collapse
Affiliation(s)
- Christina S Chan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Juin Yee Kong
- Department of Neonatology, Kandang Kerbau Women's and Children's Hospital, Singapore
| | - Rehena Sultana
- Department of Quantitative Medicine, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Vatsala Mundra
- School of Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Kikelomo L Babata
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Kelly Mazzarella
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Emily H Adhikari
- Department of Obstetrics and Gynecology, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Kee Thai Yeo
- Department of Neonatology, Kandang Kerbau Women's and Children's Hospital, Singapore
| | - Jean-Michel Hascoët
- Department of Pediatrics, Division of Neonatology, Lorraine University, DevAH, CHRU-Nancy, France
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
5
|
Woodford S, Parmar T, Leong E, Zhong J, Oei JL, Suzuki K, Kumar K, Yeo KT, Ma L, De Luca D, Hummler H, Schmölzer G, Vento M, Schindler T. International Online Survey on the Management of Patent Ductus Arteriosus. Neonatology 2024:1-7. [PMID: 38211569 DOI: 10.1159/000535121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION There is uncertainty and lack of consensus regarding optimal management of patent ductus arteriosus (PDA). We aimed to determine current clinical practice in PDA management across a range of different regions internationally. MATERIALS AND METHODS We surveyed PDA management practices in neonatal intensive care units using a pre-piloted web-based survey, which was distributed to perinatal societies in 31 countries. The survey was available online from March 2018 to March 2019. RESULTS There were 812 responses. The majority of clinicians (54%) did not have institutional protocols for PDA treatment, and 42% reported variable management within their own unit. Among infants <28 weeks (or <1,000 g), most clinicians (60%) treat symptomatically. Respondents in Australasia were more likely to treat PDA pre-symptomatically (44% vs. 18% all countries [OR 4.1; 95% CI 2.6-6.5; p < 0.001]), and respondents from North America were more likely to treat symptomatic PDA (67% vs. 60% all countries [OR 2.0; 95% CI 1.5-2.6; p < 0.001]). In infants ≥28 weeks (or ≥1,000 g), most clinicians (54%) treat symptomatically. Respondents in North America were more likely to treat PDAs in this group of infants conservatively (47% vs. 38% all countries [OR 2.3; 95% CI 1.7-3.2; p < 0.001]), and respondents from Asia were more likely to treat the PDA pre-symptomatically (21% vs. 7% all countries [OR 5.5; 95% CI 3.2-9.8; p < 0.001]). DISCUSSION/CONCLUSION There were marked international differences in clinical practice, highlighting ongoing uncertainty and a lack of consensus regarding PDA management. An international conglomeration to coordinate research that prioritises and addresses these areas of contention is indicated.
Collapse
Affiliation(s)
- Sarah Woodford
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Trisha Parmar
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Emily Leong
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jiayue Zhong
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ju Lee Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Keiji Suzuki
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kishore Kumar
- Department of Neonatology and Pediatrics, Cloudnine Hospitals, Bangalore, India
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Li Ma
- Hebei Provincial Children's Hospital, Shijiazhuang, China
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, South "A. Beclere" Medical Center, South Paris University Hospitals, Paris, France
| | - Helmut Hummler
- Section Neonatology, Pediatric Intensive Care, Ulm University Children's Hospital, Ulm, Germany
| | - Georg Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - Timothy Schindler
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| |
Collapse
|
6
|
Heston SM, Lim CSE, Ong C, Chua MC, Kelly MS, Yeo KT. Strain-resolved metagenomic analysis of the gut as a reservoir for bloodstream infection pathogens among premature infants in Singapore. Gut Pathog 2023; 15:55. [PMID: 37974294 PMCID: PMC10652614 DOI: 10.1186/s13099-023-00583-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Gut dysbiosis contributes to the high risk of bloodstream infection (BSI) among premature infants. Most prior studies of the premature infant gut microbiota were conducted in Western countries and prior to development of current tools for strain-resolved analysis. METHODS We performed metagenomic sequencing of weekly fecal samples from 75 premature infants at a single hospital in Singapore. We evaluated associations between clinical factors and gut microbiota composition using PERMANOVA and mixed effects linear regression. We used inStrain to perform strain-level analyses evaluating for gut colonization by BSI-causing strains. RESULTS Median (interquartile range) gestation was 27 (25, 29) weeks, and 63% of infants were born via Cesarean section. Antibiotic exposures (PERMANOVA; R2 = 0.017, p = 0.001) and postnatal age (R2 = 0.015, p = 0.001) accounted for the largest amount of variability in gut microbiota composition. Increasing postnatal age was associated with higher relative abundances of several common pathogens (Enterococcus faecalis: p < 0.0001; Escherichia coli: p < 0.0001; Klebsiella aerogenes: p < 0.0001; Klebsiella pneumoniae: p < 0.0001). Antibiotic exposures were generally associated with lower relative abundances of both frequently beneficial bacteria (e.g., Bifidobacterium species) and common enteric pathogens (e.g., Enterobacter, Klebsiella species). We identified strains identical to the blood culture isolate in fecal samples from 12 of 16 (75%) infants who developed BSI, including all infections caused by typical enteric bacteria. CONCLUSIONS Antibiotic exposures were the dominant modifiable factor affecting gut microbiota composition in a large cohort of premature infants from South-East Asia. Strain-resolved analyses indicate that the gut is an important reservoir for organisms causing BSI among premature infants.
Collapse
Affiliation(s)
- Sarah M Heston
- Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Charis Shu En Lim
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chengsi Ong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mei Chien Chua
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| |
Collapse
|
7
|
Loe MWC, Yeo KT. Early-life surface colonization with multi-drug resistant organisms in the neonatal intensive care unit. Int J Infect Dis 2023; 136:11-13. [PMID: 37648095 DOI: 10.1016/j.ijid.2023.08.016] [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: 06/09/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES In this study, we aim to describe the patterns of early-life surface colonization with multi-drug resistant (MDR) organisms (MDROs) among newborns admitted to the neonatal intensive care unit (NICU). METHODS We conducted a retrospective descriptive study of infants with culture-positive external ear surface swabs performed immediately after admission to our NICU from January 1, 2017 - December 31, 2021. Clinical characteristics, culture and antibiotic susceptibility data were extracted from the department data collection and hospital electronic databases. RESULTS A total of 314 infants were included - median 34 weeks gestation (interquartile range [IQR] 30, 38) and median birthweight 2147 g (IQR 1470, 2875). Of the 379 bacterial isolates obtained, 259 (68.3%) were gram-negative with Escherichia coli (149/379, 39.3%) and Klebsiella spp (57/379, 15.0%) the most common gram-negatives isolated. MDROs accounted for 17.4% (45/259) of gram-negative isolates. There was no methicillin-resistant Staphylococcus aureus (0/22 isolates) or vancomycin-resistant Enterococcus (0/68) detected among isolates tested. A total of 27 (8.6%) infants developed bacteremia, of which 21/27 (77.8%) had concordant bacteria isolated from surface cultures, with identical resistance patterns, and 4/21 (19.0%) isolates were MDROs. CONCLUSION In our setting where gram-negative bacteria accounted for a high proportion of initial colonization, MDR gram-negatives accounted for up to 17% of colonizing gram-negative bacteria detected.
Collapse
Affiliation(s)
- Marcus Wing Choy Loe
- Department of Neonatology, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| |
Collapse
|
8
|
Yeo KT, Goh GL, Park WY, Wynn JL, Aziz KB. Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Neonates with Early-Onset Infection. Neonatology 2023; 120:796-800. [PMID: 37757759 DOI: 10.1159/000533467] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The discriminative utility of the neonatal sequential organ failure assessment (nSOFA) for early-onset sepsis (EOS) mortality in the neonatal intensive care unit (NICU) is unknown. OBJECTIVES The objective of the study was to determine the utility of nSOFA for EOS mortality. METHODS Multicenter, retrospective cohort study of NICU patients with EOS between 2012 and 2023. nSOFA scores of survivors and non-survivors were compared, and area under the receiver operating characteristics curve (AUROC) for mortality was calculated. RESULTS 104 subjects were identified (88 lived, 16 died). AUROC at blood culture collection (T0), 6 h after collection (T6), and the maximum nSOFA at T0 or T6 (T0-6max) were 0.76 (95% CI: 0.62, 0.91), 0.89 (0.80, 0.99), and 0.87 (0.77, 0.97), respectively. Analyses restricted to birthweight (<1.5, <1 kg) or gestational age (<32, <29 week) cutoffs revealed AUROC ranges of 0.86-0.92 for T6 and 0.82-0.84 for T0-6max. CONCLUSIONS The nSOFA showed good-to-excellent discrimination of mortality among infants with EOS in the NICU.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore,
- Duke-NUS School of Medicine, Singapore, Singapore,
| | - Guan Lin Goh
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Woo Yeon Park
- Biomedical Informatics and Data Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - James L Wynn
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Khyzer B Aziz
- Biomedical Informatics and Data Science, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Foo SXY, Lim CSE, de la Puerta R, Visvalingam D, Yung CF, Yeo KT. Perinatal bacterial colonization and neonatal early-onset sepsis: A case-control study. J Neonatal Perinatal Med 2022; 15:813-819. [PMID: 35811543 DOI: 10.3233/npm-210978] [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: 12/27/2022]
Abstract
BACKGROUND The utility of determining maternal-neonatal surface colonization as detected by standard microbiological cultures around the time of birth is unclear. The aim of this study is to evaluate the association between maternal and neonatal surface colonization at birth and neonatal early onset sepsis (EOS). OBJECTIVE To investigate the association of white matter hyperintensities (WMHs) present in the brain with AD CSF biomarker levels. METHODS We conducted a case-control study of newborns admitted to the neonatal department of a referral women's and children's hospital from 2009 to 2017. Cases were infants with blood-culture-confirmed EOS (<3 days of life), and controls were infants without EOS randomly chosen based on the cases' date of birth. Maternal genitourinary and neonatal ear swab cultures were used to determine bacterial surface colonization status. RESULTS Fifty-one infants were diagnosed with EOS during the study period, where Escherichia coli (45%), and Group B Streptococcus (23%) accounted for 68% of infecting organisms. Compared to infants without EOS, those infected were more likely to have surface colonization of the mothers (60% vs 40%, p = 0.048) and infants (90% vs 11%, p < 0.001). In univariate analysis, chorioamnionitis [7.1 (95% CI 2.9, 16.8)], small-for-gestational-age [OR 0.08 (95% CI 0.02, 0.4)], exposure to antibiotics around time of birth [2.3 (95% CI 1.0, 5.1)], maternal surface colonization [2.2 (95% CI 1.0, 4.9)] and neonatal surface colonization [23.5 (95% CI 7.3, 76.1)] were significantly associated with EOS. Adjusting for potential confounders, neonatal colonization remained significantly associated with neonatal EOS [AOR 15.0 (95% CI 3.5, 64.2), p < 0.001]. CONCLUSION In our setting with predominant Gram-negative EOS, neonatal colonization but not maternal colonization was significantly associated with EOS in the newborn.
Collapse
Affiliation(s)
- S X Y Foo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - C S E Lim
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - R de la Puerta
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - D Visvalingam
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - C F Yung
- Infectious Diseases Service, KK Women's & Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - K T Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Singapore
| |
Collapse
|
10
|
Ravichandran D, Lim JKB, Wee PH, Allen JC, Yung CF, Lee JH, Yeo KT. High burden of respiratory viral infection-associated mortality among critically ill children. Ann Acad Med Singap 2022; 51:575-577. [PMID: 36189702 DOI: 10.47102/annals-acadmedsg.2022168] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
|
11
|
Lim CCW, Goh MSSM, Chua KH, Seet MJ, Tay SG, Mathur M, Kong JY, Yeo KT. Knowledge and Expectations of Perinatal Care Among Pregnant Women During the COVID-19 Pandemic. Front Glob Womens Health 2022; 3:813731. [PMID: 35910001 PMCID: PMC9329695 DOI: 10.3389/fgwh.2022.813731] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction This study aimed to investigate the knowledge and expectations of pregnant women on perinatal care during the coronavirus disease 2019 (COVID-19) pandemic. Methods A cross-sectional survey was conducted among pregnant women ≥21 years, without a history of confirmed COVID-19, attending antenatal clinics between August and September 2020 via a secure online platform. The survey consisted of 10 questions which evaluated the knowledge and expectations on perinatal and neonatal care during the current pandemic. Results A total of 313 pregnant women completed the survey. The mean age of the participants was 30 years (SD 4; range 22–43 years). The median gestational age was 25 weeks (range 4–40 weeks). The participants were predominantly multiparous (54%) and almost all (98%) had completed secondary level education. Majority of participants were aware of the spread of COVID-19 by respiratory secretions and contact (90%), and the importance of prevention strategies (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a pregnant woman with active COVID-19. Although 46% were concerned about increased transmission risk with antenatal clinic visits, only 37% were agreeable to teleconferencing of clinic appointments. Maternal age >35 years was significantly associated with agreement with separation of mother-infant after birth [AOR 1.89 (95% CI 1.05, 3.39)], restrictions of visitors during the postnatal period [1.92 (1.05, 3.49)] and having their confinement practices were affected [2.3 (1.26, 4.17)]. Pregnant women who were multiparous disagreed that breastfeeding was safe in women with active COVID-19 [0.42 (0.23, 0.75)]. Conclusions There was significant uncertainty about the optimal delivery method and safety of breastfeeding with COVID-19 among expectant mothers, along with variable agreement with alterations to routine perinatal care.
Collapse
Affiliation(s)
- Caleb Chun Wei Lim
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Marlene Samantha Sze Minn Goh
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ka-Hee Chua
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Meei Jiun Seet
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Siew Guek Tay
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Manisha Mathur
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Juin Yee Kong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Kee Thai Yeo
| |
Collapse
|
12
|
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
13
|
Goh GL, Lim CSE, Sultana R, De La Puerta R, Rajadurai VS, Yeo KT. Risk Factors for Mortality From Late-Onset Sepsis Among Preterm Very-Low-Birthweight Infants: A Single-Center Cohort Study From Singapore. Front Pediatr 2022; 9:801955. [PMID: 35174116 PMCID: PMC8841856 DOI: 10.3389/fped.2021.801955] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the risk factors for mortality associated with late onset sepsis (LOS) among preterm very-low-birthweight (VLBW) infants. STUDY DESIGN We performed a retrospective cohort study of infants born <32 weeks gestation and <1,500 gm admitted to a Singaporean tertiary-level neonatal intensive care unit. We determined the clinical, microbial, and laboratory risk factors associated with mortality due to culture-positive LOS in this cohort. RESULTS A total of 1,740 infants were admitted, of which 169 (9.7%) developed LOS and 27 (16%) died. Compared to survivors, those who died had lower birth gestational age (median 24 vs. 25 weeks, p = 0.02) and earlier LOS occurrence (median 10 vs. 17 days, p = 0.007). There was no difference in the incidence of meningitis (11.1 vs. 16.9%, p = 0.3), NEC (18.5 vs. 14.8%, p = 0.6), or intestinal surgery (18.5 vs. 23.3%, p = 0.6) among infants who died compared to survivors. Gram-negative bacteria accounted for 21/27 (77.8%) LOS-associated deaths and almost all (13/14, 93%) fulminant episodes. The presence of multiorgan failure, as evidenced by the need for mechanical ventilation (100 vs. 79.0%, p = 0.008), elevated lactate (12.4 vs. 2.1 mmol/L, p < 0.001), and inotropic support (92.6 vs. 37.5%, p < 0.001), was significantly associated with mortality. Infants who died had significantly lower white blood cell (WBC) counts (median 4.2 × 109/L vs. 9.9 × 109/L, p = 0.001), lower platelet count (median 40 × 109/L vs. 62 × 109/L, p = 0.01), and higher immature to total neutrophil (I: T) ratio (0.2 vs. 0.1, p = 0.002). Inotrope requirement [AOR 22.4 (95%CI 2.9, 103.7)], WBC <4 × 109/L [AOR 4.7 (1.7, 13.2)], and I: T ratio >0.3 [AOR 3.6 (1.3, 9.7)] were independently associated with LOS mortality. CONCLUSIONS In a setting with predominantly Gram-negative bacterial infections, the need for inotropic support, leukopenia, and elevated I: T ratio were significantly associated with LOS mortality among preterm VLBW infants.
Collapse
Affiliation(s)
- Guan Lin Goh
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Charis Shu En Lim
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Rowena De La Puerta
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| |
Collapse
|
14
|
Yeo KT, Chia WN, Tan CW, Ong C, Yeo JG, Zhang J, Poh SL, Lim AJM, Sim KHZ, Sutamam N, Chua CJH, Albani S, Wang LF, Chua MC. Neutralizing Activity and SARS-CoV-2 Vaccine mRNA Persistence in Serum and Breastmilk After BNT162b2 Vaccination in Lactating Women. Front Immunol 2022; 12:783975. [PMID: 35087517 PMCID: PMC8787073 DOI: 10.3389/fimmu.2021.783975] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background There is limited information on the functional neutralizing capabilities of breastmilk SARS-CoV-2-specific antibodies and the potential adulteration of breastmilk with vaccine mRNA after SARS-CoV-2 mRNA vaccination. Methods We conducted a prospective cohort study of lactating healthcare workers who received the BNT162b2 vaccine and their infants. The presence of SARS-CoV-2 neutralizing antibodies, antibody isotypes (IgG, IgA, IgM) and intact mRNA in serum and breastmilk was evaluated at multiple time points using a surrogate neutralizing assay, ELISA, and PCR, over a 6 week period of the two-dose vaccination given 21 days apart. Results Thirty-five lactating mothers, median age 34 years (IQR 32-36), were included. All had detectable neutralizing antibodies in the serum immediately before dose 2, with significant increase in neutralizing antibody levels 7 days after this dose [median 168.4 IU/ml (IQR 100.7-288.5) compared to 2753.0 IU/ml (IQR 1627.0-4712.0), p <0.001]. Through the two vaccine doses, all mothers had detectable IgG1, IgA and IgM isotypes in their serum, with a notable increase in all three antibody isotypes after dose 2, especially IgG1 levels. Neutralizing antibodies were detected in majority of breastmilk samples a week after dose 2 [median 13.4 IU/ml (IQR 7.0-28.7)], with persistence of these antibodies up to 3 weeks after. Post the second vaccine dose, all (35/35, 100%) mothers had detectable breastmilk SARS-CoV-2 spike RBD-specific IgG1 and IgA antibody and 32/35 (88.6%) mothers with IgM. Transient, low intact vaccine mRNA levels was detected in 20/74 (27%) serum samples from 21 mothers, and 5/309 (2%) breastmilk samples from 4 mothers within 1 weeks of vaccine dose. Five infants, median age 8 months (IQR 7-16), were also recruited - none had detectable neutralizing antibodies or vaccine mRNA in their serum. Conclusion Majority of lactating mothers had detectable SARS-CoV-2 antibody isotypes and neutralizing antibodies in serum and breastmilk, especially after dose 2 of BNT162b2 vaccination. Transient, low levels of vaccine mRNA were detected in the serum of vaccinated mothers with occasional transfer to their breastmilk, but we did not detect evidence of infant sensitization. Importantly, the presence of breastmilk neutralising antibodies likely provides a foundation for passive immunisation of the breastmilk-fed infant.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women’s & Children’s Hospital, Singapore, Singapore
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Wan Ni Chia
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Chee Wah Tan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Chengsi Ong
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- KK Human Milk Bank, KK Women’s & Children’s Hospital, Singapore, Singapore
| | - Joo Guan Yeo
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women’s & Children’s Hospital, Singapore, Singapore
| | - Jinyan Zhang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Su Li Poh
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Amanda Jin Mei Lim
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Kirsten Hui Zhi Sim
- Department of Neonatology, KK Women’s & Children’s Hospital, Singapore, Singapore
| | - Nursyuhadah Sutamam
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Camillus Jian Hui Chua
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Salvatore Albani
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Lin-Fa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
- Singhealth Duke-NUS Global Health Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Mei Chien Chua
- Department of Neonatology, KK Women’s & Children’s Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- KK Human Milk Bank, KK Women’s & Children’s Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| |
Collapse
|
15
|
Singla M, Chalak L, Kumar K, Hayakawa M, Mehta S, Neoh SH, Kitsommart R, Yuan Y, Zhang H, Shah PS, Smyth J, Wandita S, Yeo KT, Lim G, Oei JL. "Mild'' Hypoxic-Ischaemic Encephalopathy and Therapeutic Hypothermia: A Survey of Clinical Practice and Opinion from 35 Countries. Neonatology 2022; 119:712-718. [PMID: 36202069 DOI: 10.1159/000526404] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/22/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We aimed to determine global professional opinion and practice for the use of therapeutic hypothermia (TH) for treating infants with mild hypoxic-ischaemic encephalopathy (HIE). METHODS A web-based survey (REDCap) was distributed via emails, social networking sites, and professional groups from October 2020 to February 2021 to neonatal clinicians in 35 countries. RESULTS A total of 484 responses were obtained from 35 countries and categorized into low/middle-income (43%, LMIC) or high-income (57%, HIC) countries. Of the 484 respondents, 53% would provide TH in mild HIE on case-to-case basis and only 25% would never cool. Clinicians from LMIC were more likely to routinely offer TH in mild HIE (25% v HIC 16%, p < 0.05), have a unit protocol for providing TH (50% v HIC 26%, p < 0.05), use adjunctive tools, e.g., aEEG (49% v HIC 32%, p < 0.001), conduct an MRI post TH (48% v HIC 40%, p < 0.05) and less likely to use neurological examinations as a HIE severity grading tool (80% v HIC 95%, p < 0.001). The majority of respondents (91%) would support a randomized controlled trial that was sufficiently large to examine neurodevelopmental outcomes in mild HIE after TH. CONCLUSIONS This is the first survey of global opinion for TH in mild HIE. The overwhelming majority of professionals would consider "cooling" an infant with mild HIE, but LMIC respondents were more likely to routinely cool infants with mild HIE and use adjunctive tools for diagnosis and follow-up. There is wide practice heterogeneity and a sufficiently large RCT designed to examine neurodevelopmental outcomes, is urgently needed and widely supported.
Collapse
Affiliation(s)
- Mani Singla
- Department of Neonatology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lina Chalak
- Department of Neonatology, University of Texas Southwestern Medical Centre, Dallas, Texas, USA
| | - Kishore Kumar
- Department of Neonatology, Cloudnine Hospitals, Bangalore, India
| | - Masahiro Hayakawa
- Centre for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Shailender Mehta
- Neonatal Unit, Fiona Stanley Hospital, Perth, Washington, Australia
| | - Siew Hong Neoh
- Department of Neonatology, Hospital Tunku Azizah, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | | | - Yuan Yuan
- Division of Neonatology, Department of Pediatrics, Guangzhou Women's and Children's Hospital, Guangzhou, China
| | - Huayan Zhang
- Division of Neonatology, Department of Pediatrics, Guangzhou Women's and Children's Hospital, Guangzhou, China.,Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - John Smyth
- Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Setya Wandita
- Department of Paediatrics, Universitas Gadjah Mada, Jogjakarta, Indonesia
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Gina Lim
- Department of Neonatology, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ju Lee Oei
- Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Kam KQ, Thoon KC, Tee WSN, Ang MLT, Tan NWH, Yeo KT, Li J, Chong CY. Serotype distribution and incidence of invasive early onset and late onset group B streptococcal disease amongst infants in Singapore. BMC Infect Dis 2021; 21:1221. [PMID: 34876053 PMCID: PMC8650237 DOI: 10.1186/s12879-021-06891-1] [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] [Received: 02/05/2020] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background The current group B streptococcal (GBS) preventive measures had reduced invasive GBS early onset disease (EOD) incidences worldwide, but the late onset disease (LOD) incidences had remained unchanged. Administration of a safe and effective GBS vaccine in addition to the current strategies were thought to be the next steps in reducing the incidences of invasive GBS infection especially LOD. In this study, we aimed to examine the causative GBS serotypes in invasive GBS disease, determine the incidences of EOD and LOD, and compare the risk factors between EOD and LOD. Methods A retrospective study of infants ≤ 90-day-old over an 8-year period (2010–2017). The incidences of EOD and LOD were obtained by using patients with EOD and LOD who were born in our institution as the numerator and the live births in our institution per year of the study period as the denominator. Available GBS isolates were serotyped by the National Public Health Laboratory using capsular serotyping methods. The risk factors of EOD and LOD were compared. Results A total of 71 infants were identified; 16 (22.5%) and 55 (77.5%) of them had EOD and LOD, respectively. Serotype III (n = 42, 71.2%) was the most common serotype amongst the 59 isolates available for serotyping. Serotypes Ia, Ib, II, III, and V accounted for 98.3% (n = 58) of the invasive GBS diseases. The overall incidence was 0.42 per 1000 live births. The mean incidences of EOD and LOD were 0.13 per 1000 live births and 0.29 per 1000 live births, respectively. On multivariate analysis, risk factors for LOD as compared to EOD were: Chinese ethnicity (OR 27.1, 95% CI 3.0–243.1, p = 0.003) and negative/unknown maternal GBS status (OR 20.0, 95% CI 2.0–250.0, p = 0.012). Prematurity and intrapartum risk factors (peripartum maternal pyrexia, prolonged rupture of membrane) of EOD were not associated with LOD. Conclusions The LOD incidence had remained higher than EOD incidence in our cohort. A GBS vaccine that covers the major causative serotypes found in our cohort can potentially reduce the overall GBS disease burden in the country.
Collapse
Affiliation(s)
- Kai-Qian Kam
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore. .,Duke-National University of Singapore Medical School, Singapore City, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
| | - Koh Cheng Thoon
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Wen Sim Nancy Tee
- Department of Laboratory Medicine, National University Health System, Singapore City, Singapore
| | - Michelle Lay Teng Ang
- National Public Health Laboratory, National Centre of Infectious Diseases, Singapore City, Singapore
| | - Natalie Woon Hui Tan
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Kee Thai Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.,Department of Neonatology, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Jiahui Li
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| |
Collapse
|
17
|
Sotiropoulos JX, Kapadia V, Vento M, Rabi Y, Saugstad OD, Kumar RK, Schmölzer GM, Zhang H, Yuan Y, Lim G, Kusuda S, Arimitsu T, Nguyen TT, Kitsommart R, Yeo KT, Oei JL. Oxygen for the delivery room respiratory support of moderate-to-late preterm infants. An international survey of clinical practice from 21 countries. Acta Paediatr 2021; 110:3261-3268. [PMID: 34473855 DOI: 10.1111/apa.16091] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022]
Abstract
AIM The aim of this study was to determine clinician opinion regarding oxygen management in moderate-late preterm resuscitation. METHODS An anonymous online questionnaire was distributed through email/social messaging platforms to neonatologists in 21 countries (October 2020-March 2021) via REDCap. RESULTS Of the 695 respondents, 69% had access to oxygen blenders and 90% had pulse oximeters. Respondents from high-income countries were more likely to have oxygen blenders than those from middle-income countries (72% vs. 66%). Most initiated respiratory support with FiO2 0.21 (43%) or 0.3 (36%) but only 45% titrated FiO2 to target SpO2 . Most (89%) considered heart rate as a more important indicator of response than SpO2 . Almost all (96%) supported the need for well-designed trials to examine oxygenation in moderate-late preterm resuscitation. CONCLUSION Most clinicians resuscitated moderate-late preterm infants with lower initial FiO2 but some cannot/will not target SpO2 or titrate FiO2 . Most consider heart rate as a more important indicator of infant response than SpO2 .Large and robust clinical trials examining oxygen use for moderate-late preterm resuscitation, including long-term neurodevelopmental outcomes, are supported amongst clinicians.
Collapse
Affiliation(s)
- James X. Sotiropoulos
- Faculty of Medicine School of Women’s and Children’s Health University of New South Wales Sydney NSW Australia
- Department of Newborn Care The Royal Hospital for Women Randwick NSW Australia
| | - Vishal Kapadia
- Department of Pediatrics U.T. Southwestern Medical Center Dallas TX USA
| | - Maximo Vento
- Health Research Institute La Fe Valencia Spain
- University and Polytechnic Hospital La Fe Valencia Spain
| | - Yacov Rabi
- Department of Pediatrics Alberta Children's Hospital Research Institute University of Calgary Calgary AB Canada
| | - Ola D. Saugstad
- Northwestern University Chicago USA
- University of Oslo Oslo Norway
| | | | - Georg M. Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation Neonatal Research Unit Royal Alexandra Hospital Edmonton AB Canada
- Department of Pediatrics University of Alberta Edmonton AB Canada
| | - Huyan Zhang
- Division of Neonatology Department of Pediatrics Children's Hospital of Philadelphia Philadelphia and University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
- Guangzhou Women and Children’s Medical Center Tianhe District Guangzhou China
| | - Yuan Yuan
- Guangzhou Women and Children’s Medical Center Tianhe District Guangzhou China
| | - Gina Lim
- Department of Pediatrics Ulsan University Hospital Ulsan South Korea
| | - Satoshi Kusuda
- Department of Pediatrics Faculty of Medicine Kyorin University Tokyo Japan
| | - Takeshi Arimitsu
- Department of Pediatrics Keio University School of Medicine Tokyo Japan
| | - Tinh Thu Nguyen
- Department of Pediatrics University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam
| | - Ratchada Kitsommart
- Division of Neonatology Department of Pediatrics Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Kee Thai Yeo
- Department of Neonatology KK Women’s and Children’s Hospital Singapore Singapore
| | - Ju Lee Oei
- Faculty of Medicine School of Women’s and Children’s Health University of New South Wales Sydney NSW Australia
- Department of Newborn Care The Royal Hospital for Women Randwick NSW Australia
| |
Collapse
|
18
|
Tam CC, Yeo KT, Tee N, Lin R, Mak TM, Thoon KC, Jit M, Yung CF. Burden and Cost of Hospitalization for Respiratory Syncytial Virus in Young Children, Singapore. Emerg Infect Dis 2021; 26:1489-1496. [PMID: 32568036 PMCID: PMC7323550 DOI: 10.3201/eid2607.190539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the most common cause of pediatric acute lower respiratory tract infection worldwide. Detailed data on the health and economic burden of RSV disease are lacking from tropical settings with year-round RSV transmission. We developed a statistical and economic model to estimate the annual incidence and healthcare cost of medically attended RSV disease among young children in Singapore, using Monte Carlo simulation to account for uncertainty in model parameters. RSV accounted for 708 hospitalizations in children <6 months of age (33.5/1,000 child-years) and 1,096 in children 6–29 months of age (13.2/1,000 child-years). The cost of hospitalization was SGD 5.7 million (US $4.3 million) at 2014 prices; patients bore 60% of the cost. RSV-associated disease burden in tropical settings in Asia is high and comparable to other settings. Further work incorporating efficacy data from ongoing vaccine trials will help to determine the potential cost-effectiveness of different vaccination strategies.
Collapse
|
19
|
Chan CS, Kong JY, Babata KL, Mazzarella K, Adhikari EH, Yeo KT, Hascoët JM, Brion LP. Optimal delivery management for the prevention of early neonatal SARS-CoV-2 infection. Hippokratia 2021. [DOI: 10.1002/14651858.cd013689.pub2] [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: 11/06/2022]
Affiliation(s)
- Christina S Chan
- Pediatrics / Div. Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Juin Yee Kong
- Department of Neonatology; KK Women's and Children's Hospital; Singapore Singapore
| | - Kikelomo L Babata
- Pediatrics / Div. Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Kelly Mazzarella
- Pediatrics / Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Emily H Adhikari
- Department of Obstetrics and Gynecology; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Kee Thai Yeo
- Department of Neonatology; KK Women's and Children's Hospital; Singapore Singapore
| | | | - Luc P Brion
- Division of Neonatal-Perinatal Medicine; University of Texas Southwestern at Dallas; Dallas Texas USA
| |
Collapse
|
20
|
Babata KL, Yeo KT, Chan CS, Mazzarella K, Adhikari EH, Kong JY, Hascoët JM, Brion LP. Feeding strategies to prevent neonatal SARS-CoV-2 infection in term or late preterm babies born to mothers with confirmed COVID-19. Hippokratia 2021. [DOI: 10.1002/14651858.cd013691.pub2] [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: 11/09/2022]
Affiliation(s)
- Kikelomo L Babata
- Pediatrics / Div. Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Kee Thai Yeo
- Department of Neonatology; KK Women's and Children's Hospital; Singapore Singapore
| | - Christina S Chan
- Pediatrics / Div. Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Kelly Mazzarella
- Pediatrics / Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Emily H Adhikari
- Department of Obstetrics and Gynecology; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Juin Yee Kong
- Department of Neonatology; KK Women's and Children's Hospital; Singapore Singapore
| | | | - Luc P Brion
- Division of Neonatal-Perinatal Medicine; University of Texas Southwestern at Dallas; Dallas Texas USA
| |
Collapse
|
21
|
Yeo JG, Leong JY, Tay SH, Nadua KD, Anderson DE, Lim AJM, Ng XW, Poh SL, Guo D, Yaung KN, Kumar P, Wasser M, Hazirah SN, Sutamam N, Chua CJH, Qui M, Foo R, Gamage AM, Yeo KT, Ramakrishna L, Arkachaisri T, Young BE, Lye DC, Wang LF, Chong CY, Tan NWH, Li J, Kam KQ, Ginhoux F, Thoon KC, Chan JKY, Yung CF, Albani S. A Virus-Specific Immune Rheostat in the Immunome of Patients Recovering From Mild COVID-19. Front Immunol 2021; 12:674279. [PMID: 34113347 PMCID: PMC8185226 DOI: 10.3389/fimmu.2021.674279] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/05/2021] [Indexed: 01/10/2023] Open
Abstract
An accurate depiction of the convalescent COVID-19 immunome will help delineate the immunological milieu crucial for disease resolution and protection. Using mass cytometry, we characterized the immune architecture in patients recovering from mild COVID-19. We identified a virus-specific immune rheostat composed of an effector T (Teff) cell recall response that is balanced by the enrichment of a highly specialized regulatory T (Treg) cell subset. Both components were reactive against a peptide pool covering the receptor binding domain (RBD) of the SARS-CoV-2 spike glycoprotein. We also observed expansion of IFNγ+ memory CD4+ T cells and virus-specific follicular helper T (TFH) cells. Overall, these findings pinpoint critical immune effector and regulatory mechanisms essential for a potent, yet harmless resolution of COVID-19 infection.
Collapse
Affiliation(s)
- Joo Guan Yeo
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,Rheumatology and Immunology Service, Department of Pediatric Subspecialities, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jing Yao Leong
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Shi Huan Tay
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Karen Donceras Nadua
- Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Amanda Jin Mei Lim
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Xiang Wen Ng
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Su Li Poh
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Dianyan Guo
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Katherine Nay Yaung
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Pavanish Kumar
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Martin Wasser
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Sharifah Nur Hazirah
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Nursyuhadah Sutamam
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Camillus Jian Hui Chua
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Martin Qui
- Duke-NUS Medical School, Singapore, Singapore
| | - Randy Foo
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Kee Thai Yeo
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lakshmi Ramakrishna
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Pediatric Subspecialities, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Barnaby E Young
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - David Chien Lye
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Lin-Fa Wang
- Duke-NUS Medical School, Singapore, Singapore
| | - Chia Yin Chong
- Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Natalie Woon Hui Tan
- Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Jiahui Li
- Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kai-Qian Kam
- Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Florent Ginhoux
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Jerry Kok Yen Chan
- Duke-NUS Medical School, Singapore, Singapore.,Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chee Fu Yung
- Duke-NUS Medical School, Singapore, Singapore.,Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Salvatore Albani
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,Rheumatology and Immunology Service, Department of Pediatric Subspecialities, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
22
|
Tong WY, Yung CF, Chiew LC, Chew SB, Ang LD, Thoon KC, Rajadurai VS, Yeo KT. Universal Face Masking Reduces Respiratory Viral Infections Among Inpatient Very-Low-Birthweight Neonatal Infants. Clin Infect Dis 2021; 71:2958-2961. [PMID: 32406498 DOI: 10.1093/cid/ciaa555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/01/2020] [Accepted: 05/07/2020] [Indexed: 01/19/2023] Open
Abstract
We reviewed the impact of a universal face masking policy on respiratory viral infections (RVIs) among admitted very-low-birthweight infants in our neonatal department. There was a significant decrease in RVI incidence, specifically in our step-down level 2 unit, with respiratory syncytial virus and parainfluenza virus being the most common viruses isolated.
Collapse
Affiliation(s)
- Wing Yee Tong
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
| | - Chee Fu Yung
- Infectious Diseases Service, KK Women's & Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
| | - Lee Chern Chiew
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Siong Beng Chew
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Li Duan Ang
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Koh Cheng Thoon
- Infectious Diseases Service, KK Women's & Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore
| | - Victor S Rajadurai
- Department of Neonatology, KK Women's & Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's & Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore
| |
Collapse
|
23
|
Yeo KT, Biswas A, Ho SKY, Kong JY, Bharadwaj S, Chinnadurai A, Yip WY, Ab Latiff NF, Quek BH, Yeo CL, Ng YPM, Ee KTT, Chua MC, Poon WB, Amin Z. Guidance for the clinical management of infants born to mothers with suspected/confirmed COVID-19 in Singapore. Singapore Med J 2021; 63:489-496. [PMID: 33866749 DOI: 10.11622/smedj.2021045] [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] [Indexed: 11/18/2022]
Abstract
In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Agnihotri Biswas
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Selina Kah Ying Ho
- Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Juin Yee Kong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Srabani Bharadwaj
- Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Amutha Chinnadurai
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wai Yan Yip
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Bin Huey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheo Lian Yeo
- Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Yvonne Peng Mei Ng
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Mei Chien Chua
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Woei Bing Poon
- Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Zubair Amin
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
24
|
Yeo KT, Yung CF, Khoo PC, Saffari SE, Sng JSP, How MS, Quek BH. Effectiveness of Palivizumab Against Respiratory Syncytial Virus Hospitalization Among Preterm Infants in a Setting With Year-Round Circulation. J Infect Dis 2020; 224:279-287. [PMID: 33274362 DOI: 10.1093/infdis/jiaa749] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/01/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The year-round respiratory syncytial virus (RSV) circulation in tropical regions leads to different transmission patterns and burden of disease among infants born very preterm. METHODS We conducted a retrospective cohort study to estimate the effectiveness of palivizumab in preventing RSV hospitalization at 6 and 12 months after discharge, among infants born at <32 weeks' gestation in our tropical setting. RESULTS A total of 109 infants (26.3%) received palivizumab at discharge, of 415 who were eligible. All patients received ≥4 doses, with 105 infants (96.3%) completing 5 doses. Within 1 year after discharge, there were 35 RSV-associated admissions (3 [2.8%] in the palivizumab vs 32 [10.5%] in the nonpalivizumab group; P = .02). After adjustment for confounders, the effectiveness of palivizumab against RSV hospitalization was estimated to be 90% (95% confidence interval, 10%-99%) up to 6 months after discharge. The median time to RSV hospitalization was shorter in the nonpalivizumab than in the palivizumab group (median [range], 155 [15-358] vs 287 [145-359] days, respectively; P = .11). Five infants (14.3%), all from the nonpalivizumab group, required admission to the intensive care unit. CONCLUSIONS In our setting with year-round RSV circulation, palivizumab prophylaxis was effective in reducing RSV hospitalization among high-risk preterm infants of <32 weeks' gestation within the initial 6 months after discharge.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women's & Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Chee Fu Yung
- Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Infectious Diseases Service, KK Women's & Children's Hospital, Singapore
| | - Poh Choo Khoo
- Department of Neonatology, KK Women's & Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Mee See How
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Bin Huey Quek
- Department of Neonatology, KK Women's & Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
25
|
Abstract
Meteorological drivers are known to affect transmissibility of respiratory viruses including respiratory syncytial virus (RSV), but there are few studies quantifying the role of these drivers. We used daily RSV hospitalization data to estimate the daily effective reproduction number (Rt), a real-time measure of transmissibility, and examined its relationship with environmental drivers in Singapore from 2005 through 2015. We used multivariable regression models to quantify the proportion of the variance in Rt explained by each meteorological driver. After constructing a basic model for RSV seasonality, we found that by adding meteorological variables into this model we were able to explain a further 15% of the variance in RSV transmissibility. Lower and higher value of mean temperature, diurnal temperature range (DTR), precipitation and relative humidity were associated with increased RSV transmissibility, while higher value of maximum wind speed was correlated with decreased RSV transmissibility. We found that a number of meteorological drivers were associated with RSV transmissibility. While indoor conditions may differ from ambient outdoor conditions, our findings are indicative of a role of ambient temperature, humidity and wind speed in affecting RSV transmission that could be biological or could reflect indirect effects via the consequences on time spent indoors.
Collapse
Affiliation(s)
- Sheikh Taslim Ali
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region, China
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Singapore.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region, China
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Infectious Diseases Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chee Fu Yung
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Infectious Diseases Service, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
26
|
Yeo KT, Oei JL, De Luca D, Schmölzer GM, Guaran R, Palasanthiran P, Kumar K, Buonocore G, Cheong J, Owen LS, Kusuda S, James J, Lim G, Sharma A, Uthaya S, Gale C, Whittaker E, Battersby C, Modi N, Norman M, Naver L, Giannoni E, Diambomba Y, Shah PS, Gagliardi L, Harrison M, Pillay S, Alburaey A, Yuan Y, Zhang H. Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID-19. Acta Paediatr 2020; 109:2192-2207. [PMID: 32716579 DOI: 10.1111/apa.15495] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
AIM This review examined how applicable national and regional clinical practice guidelines and recommendations for managing neonates born to mothers with COVID-19 mothers were to the evolving pandemic. METHODS A systematic search and review identified 20 guidelines and recommendations that had been published by May 25, 2020. We analysed documents from 17 countries: Australia, Brazil, Canada, China, France, India, Italy, Japan, Saudi Arabia, Singapore, South Africa, South Korea, Spain, Sweden, Switzerland, the UK and the United States. RESULTS The documents were based on expert consensus with limited evidence and were of variable, low methodological rigour. Most did not provide recommendations for delivery methods or managing symptomatic infants. None provided recommendations for post-discharge assimilation of potentially infected infants into the community. The majority encouraged keeping mothers and infants together, subject to infection control measures, but one-third recommended separation. Although breastfeeding or using breastmilk was widely encouraged, two countries specifically prohibited this. CONCLUSION The guidelines and recommendations for managing infants affected by COVID-19 were of low, variable quality and may be unsustainable. It is important that transmission risks are not increased when new information is incorporated into clinical recommendations. Practice guidelines should emphasise the extent of uncertainty and clearly define gaps in the evidence.
Collapse
Affiliation(s)
- Kee Thai Yeo
- KK Women’s & Children’s Hospital Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
| | - Ju Lee Oei
- School of Women's and Children's Health University of New South Wales Australia
- Royal Hospital for Women Randwick NSW Australia
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care “A. Béclère” Medical Center Paris Saclay University HospitalsAPHP Paris France
- Physiopathology and Therapeutic Innovation Unit‐INSERM U999 South Paris‐Saclay Paris France
| | | | | | | | | | | | - Jeanie Cheong
- Clinical Sciences Murdoch Children’s Research Institute Parkville VIC Australia
- Department of Obstetrics and Gynaecology University of Melbourne Parkville VIC Australia
- Royal Women’s Hospital Melbourne VIC Australia
| | - Louise S. Owen
- Clinical Sciences Murdoch Children’s Research Institute Parkville VIC Australia
- Department of Obstetrics and Gynaecology University of Melbourne Parkville VIC Australia
- Royal Women’s Hospital Melbourne VIC Australia
| | | | | | - Gina Lim
- Ulsan University Hospital Ulsan South Korea
| | | | - Sabita Uthaya
- Imperial College London and Chelsea and Westminster NHS Foundation Trust London UK
- Imperial College Healthcare NHS Trust London UK
| | - Christopher Gale
- Imperial College London and Chelsea and Westminster NHS Foundation Trust London UK
- Imperial College Healthcare NHS Trust London UK
| | - Elizabeth Whittaker
- Imperial College Healthcare NHS Trust London UK
- Imperial College London London UK
| | - Cheryl Battersby
- Imperial College London and Chelsea and Westminster NHS Foundation Trust London UK
- Imperial College Healthcare NHS Trust London UK
| | - Neena Modi
- Imperial College London and Chelsea and Westminster NHS Foundation Trust London UK
- Imperial College Healthcare NHS Trust London UK
| | - Mikael Norman
- Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - Lars Naver
- Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - Eric Giannoni
- Department Mother‐Woman‐Child Clinic of Neonatology Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | | | | | - Luigi Gagliardi
- Ospedale VersiliaLido di CamaioreAUSL Toscana Nord Ovest Pisa Italy
| | | | | | | | - Yuan Yuan
- Guangzhou Women and Children's Medical Center Guangzhou China
| | - Huayan Zhang
- Children’s Hospital of Philadelphia Philadelphia PA USA
- Guangzhou Women and Children's Medical Center Guangzhou China
- University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
| |
Collapse
|
27
|
Yeo JG, Wasser M, Kumar P, Pan L, Poh SL, Ally F, Arkachaisri T, Lim AJM, Leong JY, Lai L, Yeo KT, Lee ESC, Chua CJH, Larbi A, Nyunt MSZ, Ng TP, Chiesa S, Gattorno M, Martini A, Paleja BS, Dutertre CA, Chen J, Nay Yaung K, Tang SP, Ng SK, Yung CF, Tan AYJ, Lee SY, Ginhoux F, Albani S. The Extended Polydimensional Immunome Characterization (EPIC) web-based reference and discovery tool for cytometry data. Nat Biotechnol 2020; 38:679-684. [PMID: 32440006 DOI: 10.1038/s41587-020-0532-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Joo Guan Yeo
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - Martin Wasser
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Pavanish Kumar
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Lu Pan
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Su Li Poh
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Fauziah Ally
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Thaschawee Arkachaisri
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - Amanda Jin Mei Lim
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Jing Yao Leong
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Liyun Lai
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Kee Thai Yeo
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Camillus Jian Hui Chua
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | | | - Tze Pin Ng
- National University of Singapore, Singapore, Singapore
| | - Sabrina Chiesa
- IRCCS Istituto Giannina Gaslini, Ospedale Pediatrico Gaslini, Genoa, Italy
| | - Marco Gattorno
- IRCCS Istituto Giannina Gaslini, Ospedale Pediatrico Gaslini, Genoa, Italy
| | - Alberto Martini
- IRCCS Istituto Giannina Gaslini, Ospedale Pediatrico Gaslini, Genoa, Italy
| | - Bhairav Suryakant Paleja
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Charles-Antoine Dutertre
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Jinmiao Chen
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Katherine Nay Yaung
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Swee Ping Tang
- Rheumatology Section, Department of Pediatrics, Selayang Hospital, Kuala Lumpur, Malaysia
| | - Sue Kheng Ng
- Rheumatology Section, Department of Pediatrics, Selayang Hospital, Kuala Lumpur, Malaysia
| | - Chee Fu Yung
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Shu Ying Lee
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Florent Ginhoux
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.,Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Salvatore Albani
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore. .,KK Women's and Children's Hospital, Singapore, Singapore.
| |
Collapse
|
28
|
Babata KL, Yeo KT, Chan CS, Mazzarella K, Adhikari EH, Kong JY, Hascoët JM, Brion LP. Feeding strategies to prevent neonatal SARS-CoV-2 infection in term or late preterm babies born to mothers with confirmed COVID-19. Hippokratia 2020. [DOI: 10.1002/14651858.cd013691] [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: 11/11/2022]
Affiliation(s)
- Kikelomo L Babata
- Pediatrics / Div. Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Kee Thai Yeo
- Department of Neonatology; KK Women's and Children's Hospital; Singapore Singapore
| | - Christina S Chan
- Pediatrics / Div. Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Kelly Mazzarella
- Pediatrics / Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Emily H Adhikari
- Department of Obstetrics and Gynecology; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Juin Yee Kong
- Department of Neonatology; KK Women's and Children's Hospital; Singapore Singapore
| | | | - Luc P Brion
- Division of Neonatal-Perinatal Medicine; University of Texas Southwestern at Dallas; Dallas Texas USA
| |
Collapse
|
29
|
Chan CS, Kong JY, Babata KL, Mazzarella K, Adhikari EH, Yeo KT, Hascoët JM, Brion LP. Optimal delivery management for the prevention of early neonatal SARS-CoV-2 infection. Hippokratia 2020. [DOI: 10.1002/14651858.cd013689] [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: 11/10/2022]
Affiliation(s)
- Christina S Chan
- Pediatrics / Div. Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Juin Yee Kong
- Department of Neonatology; KK Women's and Children's Hospital; Singapore Singapore
| | - Kikelomo L Babata
- Pediatrics / Div. Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Kelly Mazzarella
- Pediatrics / Neonatal-Perinatal Medicine; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Emily H Adhikari
- Department of Obstetrics and Gynecology; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Kee Thai Yeo
- Department of Neonatology; KK Women's and Children's Hospital; Singapore Singapore
| | | | - Luc P Brion
- Division of Neonatal-Perinatal Medicine; University of Texas Southwestern at Dallas; Dallas Texas USA
| |
Collapse
|
30
|
Schindler T, Yeo KT, Bolisetty S, Michalowski J, Tan AHK, Lui K. FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial. BMC Pediatr 2020; 20:346. [PMID: 32664953 PMCID: PMC7359615 DOI: 10.1186/s12887-020-02233-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/17/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022] Open
Abstract
Background Necrotising Enterocolitis (NEC) is a devastating neonatal disease. A temporal association between red cell transfusion and NEC has been recognized and there have been concerns about the effects of feeding during transfusion. We aimed to assess the effect of different enteral feeding regimens on splanchnic oxygenation in preterm infants receiving red cell transfusions. Methods This was an open, multi-arm, parallel-group, randomised controlled trial conducted in a single centre in Australia. We compared three different enteral feeding regimes during a single red cell transfusion in preterm infants < 35 weeks gestational age at birth. Infants were randomised to either: (1) Withholding enteral feeds for 12 h from the start of transfusion or; (2) Continuing enteral feeds or; (3) Restriction of enteral feed volume to 120 ml/kg/day (maximum 20 kcal/30 ml) for 12 h. The primary outcome was mean splanchnic-cerebral oxygenation ratio (SCOR) and mean splanchnic fractional oxygen extraction (FOE) before (1 h prior), during (1 h into transfusion) and after (end of transfusion; 12 and 24 h post) transfusion. Results There were 60 transfusion episodes (20 transfusion episodes in each group) included in the analysis. 41 infants with a median gestational age at birth of 27 weeks (range 23–32 weeks) were enrolled. The median postnatal age was 43 days (range 19–94 days) and the median pre-transfusion haematocrit was 0.27 (range 0.22–0.32). All three groups were similar at baseline. There were no differences in mean SCOR and mean splanchnic FOE at any of the pre-specified time points. There were also no differences in clinical outcomes. There were no episodes of NEC in any infant. Across all groups the mean SCOR increased from the start to the end of each transfusion (0.97 [CI95% 0.96–0.98] vs 1.00 [CI95% 0.99–1.01]; p = 0.04) and the mean FOE decreased from the start to the end of each transfusion (0.22 [CI95% 0.21–0.23] vs 0.17 [CI95% 0.16–0.18]; p < 0.001). Conclusions There were no differences in splanchnic oxygenation when enteral feeds were either withheld, continued or restricted during a transfusion. However, the successful conduct of this study supports the feasibility of a large trial powered to assess clinical outcomes. Trial registration ANZCTR, ACTRN12616000160437. Registered 10 February 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370069
Collapse
Affiliation(s)
- Tim Schindler
- Department of Newborn Care, Royal Hospital for Women, Sydney, Australia. .,School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's & Children's Hospital, Singapore, Singapore
| | - Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | | | - Alvin Hock Kuan Tan
- Department of Neonatal and Perinatal Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
31
|
Wasser M, Yeo JG, Kumar P, Chew V, Lim CJ, Arkachaisri T, Poh SL, Leong JY, Yeo KT, Albani S. The EPIC data analytics platform for clinical mass cytometry. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.159.7] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Single cell technologies, such as high-dimensional cytometry, promise to enable the discovery of immune cell populations that will serve as clinical biomarkers. Recently, we reported the creation of a reference database of the healthy immune system from birth to old age and the development of the EPIC (Extended Poly-dimensional Immunome characterisation) data mining platform (Nature Biotech, accepted). Here we extend the analytics pipeline to facilitate detection of clinically stratifying cell populations in mass cytometry (CyTOF or cytometry by time-of-flight) data. Data structures called immune maps are used to integrate single cell protein expression data (over 40) of multiple samples with clinical metadata and phenotypic information inferred from automated clustering and assisted cell type annotation. Clustering is combined with batch effect correction to reduce technical while preserving biological variations. Subsequent single cell exploratory data analysis and statistical tests help to identify cell populations whose frequencies differ significantly between groups of patients. To gain further insights, users can compare their cytometry data with the healthy reference immunome by performing two types of analysis; (1) mapping to existing clusters helps obtain abundance estimates of immune cell types, (2) reclustering of uploaded data merged with reference immunomes uncovers differences to healthy immune profiles of different ages. We implemented the EPIC pipeline using R Shiny to provide interactive visualisation and an intuitive user interface. We will show examples on how the EPIC platform can characterise cellular diversity in the context of disease and the morphogenesis of the healthy immune system.
Collapse
Affiliation(s)
- Martin Wasser
- 1SingHealth Duke NUS Academic Medical Centre, Singapore
| | - Joo Guan Yeo
- 1SingHealth Duke NUS Academic Medical Centre, Singapore
- 2KK Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Valerie Chew
- 1SingHealth Duke NUS Academic Medical Centre, Singapore
| | - Chun Jye Lim
- 1SingHealth Duke NUS Academic Medical Centre, Singapore
| | | | - Su Li Poh
- 1SingHealth Duke NUS Academic Medical Centre, Singapore
| | | | - Kee Thai Yeo
- 2KK Women’s and Children’s Hospital, Singapore, Singapore
| | | |
Collapse
|
32
|
Yeo KT, Thomas R, Chow SS, Bolisetty S, Haslam R, Tarnow-Mordi W, Lui K. Improving incidence trends of severe intraventricular haemorrhages in preterm infants <32 weeks gestation: a cohort study. Arch Dis Child Fetal Neonatal Ed 2020; 105:145-150. [PMID: 31201252 DOI: 10.1136/archdischild-2018-316664] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the trend and risk factors for severe intraventricular haemorrhage (IVH) among infants <32 weeks gestation. DESIGN Population-based cohort study. SETTING Australia and New Zealand. PATIENTS All preterm infants <32 weeks gestation in the Australian and New Zealand Neonatal Network (ANZNN) from 1995 to 2012. INTERVENTIONS Comparison of IVH incidence between 6-year epochs. MAIN OUTCOME MEASURES Overall IVH and severe IVH incidence. RESULTS A total of 60 068 infants were included, and overall survival to discharge increased from 89% to 93% over the three epochs. As the percentage of infants with IVH decreased from 23.6% to 21.3% and 21.4% (p<0.001) from epoch 1 to 3, respectively, fewer survivors had severe IVH (4.0%, 3.3% and 2.8%, respectively, p<0.001). Over time, there were fewer antenatal complications, higher antenatal steroid usage and more caesarean-section births. Fewer infants were intubated at birth, had low 5 min Apgar score, had sepsis or pneumothorax needing drainage. Adjusted for perinatal confounders, there was significant reduction in odds of severe IVH from epoch 1 to 3 (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9). Factors associated with development of severe IVH include no antenatal steroids (AOR 1.7, 95% CI 1.5 to 1.9), male (AOR 1.3, 95% CI 1.2 to 1.4), 5 min Apgar score <7 (AOR 2.0, 95% CI 1.9 to 2.2), intubated at birth (AOR 2.0, 95% CI 1.8 to 2.2), extremely low gestational age (AOR 4.0, 95% CI 3.7 to 4.4), outborn (AOR 1.6, 95% CI 1.5 to 1.8) and vaginal delivery (AOR 1.4, 95% CI 1.3 to 1.6). CONCLUSIONS Along with increased survival among infants born <32 weeks gestation, the incidence of severe IVH has decreased over the 18 years, especially in the most recent period. This coincided with reduction in rates of risk factors for severe IVH development.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Reji Thomas
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,Mount Gambier Hospital, Mount Gambier, South Australia, Australia
| | - Sharon Sw Chow
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ross Haslam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - William Tarnow-Mordi
- National Health & Medical Research Council Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | | |
Collapse
|
33
|
Yeo KT, de la Puerta R, Tee NWS, Thoon KC, Rajadurai VS, Yung CF. Burden, Etiology, and Risk Factors of Respiratory Virus Infections Among Symptomatic Preterm Infants in the Tropics: A Retrospective Single-Center Cohort Study. Clin Infect Dis 2019; 67:1603-1609. [PMID: 29659748 PMCID: PMC7108101 DOI: 10.1093/cid/ciy311] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/01/2017] [Accepted: 04/10/2018] [Indexed: 01/02/2023] Open
Abstract
Background The burden of respiratory viral infections (RVIs) among preterm infants in the first few years of life, especially those living in the tropics with year-long transmissions of respiratory viruses, remains unknown. We aimed to describe the clinical epidemiology and associated risk factors for RVIs among symptomatic preterm infants ≤32 weeks up to 2 years of life. Methods We performed a data linkage analysis of clinical and hospital laboratory databases for preterm infants born at KK Women's and Children's Hospital, Singapore, from 2005 to 2015. RVI episodes during initial admission and subsequent hospital readmissions were included. Results Of 1854 infants in the study, 270 (14.5%) infants were diagnosed with at least 1 RVI. A total of 285 (85.3%) episodes were diagnosed postdischarge, with the highest risk for RVIs being from 3 to 5 months of age. The incidence of RVI in this population was 116 per 1000 infant-years and respiratory syncytial virus was the main overall causative pathogen. Infants with RVIs were more likely to be born at ≤27 weeks' gestational age (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.3), to have received postnatal steroids (OR, 1.5; 95% CI, 1.0-2.1), and to be diagnosed with bronchopulmonary dysplasia (OR, 1.7; 95% CI, 1.2-2.4). Conclusions The burden of RVIs is high in preterm infants in the tropics, affecting >1 of 10 infants born at ≤32 weeks' gestation before 2 years of age. Respiratory syncytial virus was the main causative pathogen identified. Risk factors for RVI included extremely low gestational age, receipt of postnatal steroids, and bronchopulmonary dysplasia.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rowena de la Puerta
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Nancy Wen Sim Tee
- Duke-NUS Medical School, Singapore, Singapore.,Department of Pathology and Laboratory Medicine, Singapore, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Infectious Diseases Service, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Victor S Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chee Fu Yung
- Duke-NUS Medical School, Singapore, Singapore.,Infectious Diseases Service, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
34
|
Yeo KT, Kong JY, Sasi A, Tan K, Lai NM, Schindler T. Stopping enteral feeds for prevention of transfusion-associated necrotising enterocolitis in preterm infants. Cochrane Database Syst Rev 2019; 2019:CD012888. [PMID: 31684689 PMCID: PMC6815687 DOI: 10.1002/14651858.cd012888.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Feeding practices around the time of packed red blood cell transfusion have been implicated in the subsequent development of necrotising enterocolitis (NEC) in preterm infants. Specifically, it has been suggested that withholding feeds around the time of transfusion may reduce the risk of subsequent NEC. It is important to determine if withholding feeds around transfusion reduces the risk of subsequent NEC and associated mortality. OBJECTIVES • To assess the benefits and risks of stopping compared to continuing feed management before, during, and after blood transfusion in preterm infants • To assess the effects of stopping versus continuing feeds in the following subgroups of infants: infants of different gestations; infants with symptomatic and asymptomatic anaemia; infants who received different feeding schedules, types of feed, and methods of feed delivery; infants who were transfused with different blood products, at different blood volumes, via different routes of delivery; and those who received blood transfusion with and without co-interventions such as use of diuretics • To determine the effectiveness and safety of stopping feeds around the time of a blood transfusion in reducing the risk of subsequent necrotising enterocolitis (NEC) in preterm infants SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11), in the Cochrane Library; MEDLINE (1966 to 14 November 2018); Embase (1980 to 14 November 2018); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 14 November 2018). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared stopping feeds versus continuing feeds around the time of blood transfusion in preterm infants. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed trial quality, and extracted data from the included studies. MAIN RESULTS The search revealed seven studies that assessed effects of stopping feeds during blood transfusion. However, only one RCT involving 22 preterm infants was eligible for inclusion in the review. This RCT had low risk of selection bias but high risk of performance bias, as care personnel were not blinded to the study allocation. The primary objective of this trial was to investigate changes in mesenteric blood flow, and no cases of NEC were reported in any of the infants included in the trial. We were unable to draw any conclusions from this single study. The overall GRADE rating for quality of evidence was very low. AUTHORS' CONCLUSIONS Randomised controlled trial evidence is insufficient to show whether stopping feeds has an effect on the incidence of subsequent NEC or death. Large, adequately powered RCTs are needed to address this issue.
Collapse
Affiliation(s)
- Kee Thai Yeo
- KK Women's and Children's HospitalDepartment of NeonatologySingaporeSingapore
| | - Juin Yee Kong
- KK Women's and Children's HospitalDepartment of NeonatologySingaporeSingapore
| | - Arun Sasi
- Monash Medical CentreNeonatology/Newborn246 Clayton RdClaytonVictoriaAustralia3168
| | - Kenneth Tan
- Monash UniversityDepartment of Paediatrics246 Clayton RoadClaytonMelbourneVictoriaAustraliaVIC 3168
| | - Nai Ming Lai
- Taylor's UniversitySchool of MedicineSubang JayaMalaysia
- Monash University MalaysiaSchool of PharmacySelangorMalaysia
- Asian Centre for Evidence SynthesisKuala LumpurMalaysia
| | - Tim Schindler
- Royal Hospital for WomenNewborn CareBarker StreetRandwickNSWAustralia2031
| | | |
Collapse
|
35
|
Yeo KT, Embury P, Anderson T, Mungai P, Malhotra I, King C, Kazura J, Dent A. HIV, Cytomegalovirus, and Malaria Infections during Pregnancy Lead to Inflammation and Shifts in Memory B Cell Subsets in Kenyan Neonates. J Immunol 2019; 202:1465-1478. [PMID: 30674575 PMCID: PMC6379806 DOI: 10.4049/jimmunol.1801024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/17/2018] [Indexed: 11/19/2022]
Abstract
Infections during pregnancy can expose the fetus to microbial Ags, leading to inflammation that affects B cell development. Prenatal fetal immune priming may have an important role in infant acquisition of pathogen-specific immunity. We examined plasma proinflammatory biomarkers, the proportions of various B cell subsets, and fetal priming to tetanus vaccination in cord blood from human United States and Kenyan neonates. United States neonates had no identified prenatal infectious exposures, whereas Kenyan neonates examined had congenital CMV or mothers with prenatal HIV or Plasmodium falciparum or no identified infectious exposures. Kenyan neonates had higher levels of IP-10, TNF-α, CRP, sCD14, and BAFF than United States neonates. Among the Kenyan groups, neonates with prenatal infections/infectious exposures had higher levels of cord blood IFN-γ, IL-7, sTNFR1, and sTNFR2 compared with neonates with no infectious exposures. Kenyan neonates had greater proportions of activated memory B cells (MBC) compared with United States neonates. Among the Kenyan groups, HIV-exposed neonates had greater proportions of atypical MBC compared with the other groups. Although HIV-exposed neonates had altered MBC subset distributions, detection of tetanus-specific MBC from cord blood, indicative of fetal priming with tetanus vaccine given to pregnant women, was comparable in HIV-exposed and non-HIV-exposed neonates. These results indicate that the presence of infections during pregnancy induces fetal immune activation with inflammation and increased activated MBC frequencies in neonates. The immunologic significance and long-term health consequences of these differences warrant further investigation.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH 44106; and
| | - Paula Embury
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106
| | - Timothy Anderson
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106
| | - Peter Mungai
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi 00200, Kenya
| | - Indu Malhotra
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106
| | - Christopher King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106
| | - James Kazura
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106
| | - Arlene Dent
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106;
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH 44106; and
| |
Collapse
|
36
|
Yeo KT, Lahra M, Bajuk B, Hilder L, Abdel-Latif ME, Wright IM, Oei JL. Long-term outcomes after group B streptococcus infection: a cohort study. Arch Dis Child 2019; 104:172-178. [PMID: 30018069 DOI: 10.1136/archdischild-2017-314642] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the risk of death and hospitalisation until adolescence of children after group B streptococcus (GBS) infection during infancy. DESIGN Population-based cohort study. SETTING New South Wales, Australia. PATIENTS All registered live births from 2000 to 2011. INTERVENTIONS Comparison of long-term outcomes in children with the International Statistical Classification of Diseases and Related Health Problems-10th Revision discharge codes corresponding to GBS infections and those without. MAIN OUTCOME MEASURES Death and hospitalisation. RESULTS A total of 1206 (0.1%) children (936 (77.6%)≥37 weeks' gestation) were diagnosed with GBS infection. Over the study period, infection rates decreased from 2.1 (95% CI 1.8 to 2.4) to 0.7 (95% CI 0.5 to 0.9) per 1000 live births. Infants with GBS infection were born at lower gestation (mean 37.6 vs 39.0 weeks), were more likely very low birth weight (<1500 g, OR 9.1(95% CI 7.4 to 11.3)), born premature (OR 3.9(95% CI 3.4 to 4.5)) and have 5 min Apgar scores ≤5 (OR 6.7(95% CI 5.1 to 8.8)). Children with GBS had three times the adjusted odds of death (adjusted OR (AOR) 3.0(95% CI 2.1 to 4.3)) or rehospitalisations (AOR 3.1(95% CI 2.7 to 3.5)). Thirty-six (3.0%) with GBS died, with >50% of deaths occurring <28 days. Children with GBS were hospitalised more frequently (median 2 vs 1), for longer duration (mean 3.7 vs 2.2 days) and were at higher risk for problems with genitourinary (OR 3.1(95% CI 2.8 to 3.5)) and nervous (OR 2.0 (95% CI1.7 to 2.3)) systems. CONCLUSIONS Despite decreasing GBS rates, the risk of poor health outcomes for GBS-infected children remains elevated, especially during the first 5 years. Survivors continue to be at increased risk of death and chronic conditions requiring hospitalisations, such as cerebral palsy and epilepsy.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Monica Lahra
- Department of Microbiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Barbara Bajuk
- Sydney Children's Hospital Network, NSW Pregnancy and Newborn Services, Randwick, New South Wales, Australia
| | - Lisa Hilder
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Mohamed E Abdel-Latif
- Department of Neonatology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,Faculty of Medicine, The Australian National University, Deakin, Australian Capital Territory, Australia
| | - Ian M Wright
- Early Start Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.,Department of Paediatrics, Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute and School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ju-Lee Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| |
Collapse
|
37
|
Ma L, Liu C, Cheah I, Yeo KT, Chambers GM, Kamar AA, Travadi J, Oei JL. Cost is an important factor influencing active management of extremely preterm infants. Acta Paediatr 2019; 108:70-75. [PMID: 30080290 DOI: 10.1111/apa.14533] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
AIM The attitudes of neonatologists towards the active management of extremely premature infants in a developing country like China are uncertain. METHODS A web-based survey was sent to neonatologists from 16 provinces representing 59.6% (824.2 million) of the total population of China on October 2015 and December 2017. RESULTS A total of 117 and 219 responses were received in 2015 and 2017, respectively. Compared to 2015, respondents in 2017 were more likely to resuscitate infants <25 weeks of gestation (86% vs. 72%; p < 0.05), but few would resuscitate infants ≤23 weeks of gestation in either epoch (10% vs. 6%). In both epochs, parents were responsible for >50% of the costs of intensive care, but in 2017, significantly fewer clinicians would cease intensive care (75% vs. 88%; p < 0.05) and more would request for economic aid (40% vs. 20%; p < 0.05) if parents could not afford to pay. Resource availability (e.g. ventilators) was not an important factor in either initiation or continuation of intensive care (~60% in both epochs). CONCLUSION Cost is an important factor in the initiation and continuation of neonatal intensive care in a developing country like China. Such factors need to be taken into consideration when interpreting outcome data from these regions.
Collapse
Affiliation(s)
- Li Ma
- Department of Neonatology Children's Hospital of Hebei Province Shijiazhuang China
| | - Cuiqing Liu
- Department of Neonatology Children's Hospital of Hebei Province Shijiazhuang China
| | - Irene Cheah
- Department of Neonatology Hospital Kuala Lumpur Kuala Lumpur Malaysia
| | - Kee Thai Yeo
- Department of Neonatology KK Women and Children's Hospital Singapore City Singapore
| | - Georgina M. Chambers
- Centre for Big Data and School of Women's and Children's Health University of New South Wales Sydney Australia
| | - Azanna Ahmad Kamar
- Department of Neonatology University of Malaya Medical Center Kuala Lumpur Malaysia
| | - Javeed Travadi
- Department of Neonatology John Hunter Hospital Newcastle NSW Australia
| | - Ju Lee Oei
- Centre for Big Data and School of Women's and Children's Health University of New South Wales Sydney Australia
- Department of Newborn Care Royal Hospital for Women Randwick NSW Australia
| |
Collapse
|
38
|
Yeo KT, Kong JY, Sasi A, Tan K, Lai NM. Stopping feeds for prevention of transfusion-associated necrotising enterocolitis in preterm infants. Hippokratia 2017. [DOI: 10.1002/14651858.cd012888] [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: 11/08/2022]
Affiliation(s)
- Kee Thai Yeo
- KK Women's and Children's Hospital; Department of Neonatology; Singapore Singapore
| | - Juin Yee Kong
- KK Women's and Children's Hospital; Department of Neonatology; Singapore Singapore
| | - Arun Sasi
- Monash Medical Centre; Neonatology/Newborn; 246 Clayton Rd Clayton Victoria Australia 3168
| | - Kenneth Tan
- Monash University; Department of Paediatrics; 246 Clayton Road Clayton Melbourne Victoria Australia VIC 3168
| | - Nai Ming Lai
- Taylor's University; School of Medicine; Subang Jaya Malaysia
- Monash University Malaysia; School of Pharmacy; Selangor Malaysia
- Asian Centre for Evidence Synthesis; Kuala Lumpur Malaysia
| |
Collapse
|
39
|
Sanderson E, Yeo KT, Wang AY, Callander I, Bajuk B, Bolisetty S, Lui K. Dwell time and risk of central-line-associated bloodstream infection in neonates. J Hosp Infect 2017; 97:267-274. [PMID: 28651859 DOI: 10.1016/j.jhin.2017.06.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 12/21/2016] [Accepted: 06/18/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). AIM To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. METHODS The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). FINDINGS There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12-20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. CONCLUSION There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.
Collapse
Affiliation(s)
- E Sanderson
- University of New South Wales, Sydney, Australia
| | - K T Yeo
- Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia; Department of Neonatology, KK Women's & Children's Hospital, Singapore
| | - A Y Wang
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - I Callander
- Department of Newborn Care, Liverpool Hospital, Sydney, New South Wales, Australia
| | - B Bajuk
- New South Wales Pregnancy and Newborn Services Network, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - S Bolisetty
- Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - K Lui
- University of New South Wales, Sydney, Australia; Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.
| |
Collapse
|
40
|
Yeo KT, Yung CF, Chiew LC, Yunus HM, Thoon KC, Gomez M, Rajadurai V. Universal Mask Policy in the Neonatal Unit to Reduce Respiratory Viral Infections. Clin Infect Dis 2017; 64:817. [PMID: 27986668 DOI: 10.1093/cid/ciw842] [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: 11/13/2022] Open
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
| | - Chee Fu Yung
- Infectious Disease Services, KK Women's and Children's Hospital, Singapore
| | - Lee Chern Chiew
- Division of Nursing, KK Women's & Children's Hospital, Singapore
| | | | - Koh Cheng Thoon
- Infectious Disease Services, KK Women's and Children's Hospital, Singapore
| | - Manuel Gomez
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
| | - Victor Rajadurai
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
| |
Collapse
|
41
|
Yeo KT, Safi N, Wang YA, Marsney RL, Schindler T, Bolisetty S, Haslam R, Lui K. Prediction of outcomes of extremely low gestational age newborns in Australia and New Zealand. BMJ Paediatr Open 2017; 1:e000205. [PMID: 29637177 PMCID: PMC5862164 DOI: 10.1136/bmjpo-2017-000205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/21/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the accuracy of the National Institute of Child Health and Human Development (NICHD) calculator in predicting death and neurodevelopmental impairment in Australian and New Zealand infants. DESIGN Population-based cohort study. SETTING Australia and New Zealand. PATIENTS Preterm infants 22-25 completed weeks gestation. INTERVENTIONS Comparison of NICHD calculator predicted rates of death and death or neurodevelopmental impairment, with actual rates recorded in the Australian and New Zealand Neonatal Network cohort. MAIN OUTCOME MEASURES Infant death and death or neurodevelopmental impairment rates. RESULTS A total of 714 infants were included in the study. Of these infants, 100 (14.0%) were <24 weeks, 389 (54.5%) male, 529 (74.1%) were singletons, 42 (5.9%) had intrauterine growth restriction, 563 (78.9%) received antenatal steroids and 625 (87.5 %) were born in a tertiary hospital. There were 288 deaths (40.3%), 75 infants (10.5%) with neurodevelopment impairment and 363 (50.8%) with death or neurodevelopmental impairment. The area under the curve (AUC) for prediction of death and the composite death or neurodevelopmental impairment by the NICHD calculator in our population was 0.65(95% CI 0.61 to 0.69) and 0.65 (95% CI 0.61 to 0.69), respectively. When stratified and compared with gestational age outcomes, the AUC did not change substantially for the outcomes investigated. The calculator was less accurate with outcome predictions at the extreme categories of predicted outcomes-underestimation of outcomes for those predicted to have the lowest risk (<20%) and overestimation for those in the highest risk category (>80%). CONCLUSION In our recent cohort of extremely preterm infants, the NICHD model does not accurately predict outcomes and is marginally better than gestational age based outcomes.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,Department of Neonatology, KK Women's & Children's Hospital, Singapore, Singapore
| | - Nadom Safi
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Yueping Alex Wang
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Renate Le Marsney
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy Schindler
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Child's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Child's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ross Haslam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Child's Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
42
|
Kong JY, Yeo KT, Abdel-Latif ME, Bajuk B, Holland AJA, Adams S, Jiwane A, Heck S, Yeong M, Lui K, Oei JL. Outcomes of infants with abdominal wall defects over 18years. J Pediatr Surg 2016; 51:1644-9. [PMID: 27364305 DOI: 10.1016/j.jpedsurg.2016.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/20/2016] [Accepted: 06/05/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND/PURPOSE Infants with abdominal wall defects (AWD) are at risk of poor outcomes including prolonged hospitalization, infections and mortality. Our objective was to describe and compare the outcomes of infants admitted with gastroschisis and omphalocele over 18years. METHODS Population-based study of clinical data and outcomes of live-born infants with AWD admitted to all tertiary-level neonatal intensive care units in New South Wales and Australian Capital Territory from 1992 to 2009. RESULT There were 502 infants with AWD - 336 gastroschisis, 166 omphalocele. Infants with gastroschisis required a longer duration of total parenteral nutrition (19 vs 4days, p<0.05), longer hospitalization (28 vs 15days, p<0.05) and had a higher rate of systemic infection [23.5% vs 13.3%, OR 1.77 (1.15-2.74), p<0.05] compared to infants with omphalocele. Overall, omphalocele infants had higher mortality rate compared to gastroschisis infants [OR 2.77 (1.53, 5.04), p<0.05]. Gastroschisis mortality rates increased from epoch 1 to epoch 3 (4.2% to 8.8%). CONCLUSION Compared to infants with omphalocele, infants with gastroschisis required significantly longer hospitalization and parenteral nutrition with higher rates of infection. Infants with omphalocele had higher overall mortality rates. However, there has been an increase in the gastroschisis mortality rates but the cause for this is unclear.
Collapse
Affiliation(s)
- Juin Yee Kong
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia; Department of Neonatology, KK Women's and Children's Hospital, Singapore.
| | - Kee Thai Yeo
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia; Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Mohamed E Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Garran, ACT, Australia; School of Clinical Medicine, Australian National University, Woden, ACT, Australia
| | - Barbara Bajuk
- Neonatal Intensive Care Units' Data Collection, NSW Pregnancy and Newborn Services Network, Westmead, NSW, Australia
| | - Andrew J A Holland
- The Children's Hospital at Westmead, The University of Sydney, NSW, Australia;; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Susan Adams
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia;; Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Ashish Jiwane
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia;; Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Sandra Heck
- The Children's Hospital at Westmead, The University of Sydney, NSW, Australia
| | - Michael Yeong
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Ju Lee Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | | |
Collapse
|
43
|
Yung CF, Chong CY, Yeo KT, Liew C, Ng LC, Tan NW, Yeo GS, Tee NW, Lin RT, Tan TC, Rajadurai VS, Chan JK, Thoon KC. Zika Virus: An Evolving Public Health Threat. Ann Acad Med Singap 2016; 45:148-151. [PMID: 27292005] [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: 06/06/2023]
Affiliation(s)
- Chee Fu Yung
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Yeo KT, Lee QY, Quek WS, Wang YA, Bolisetty S, Lui K. Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns. Pediatrics 2015; 136:263-71. [PMID: 26169427 DOI: 10.1542/peds.2014-4075] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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] [Accepted: 05/26/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the risk of mortality and major morbidities in extremely preterm multiple gestation infants compared with singletons over time. METHODS This is a retrospective study of 15,402 infants born ≤27 weeks' gestation, admitted to NICUs in the Australian and New Zealand Neonatal Network from 1995 to 2009. Mortality and major morbidities were compared between singletons and multiples across three 5-year epochs. RESULTS Extreme preterm multiples were more likely to have lower birth weight; higher maternal age; and higher rates of assisted conception, antenatal steroid use, and cesarean delivery compared with singletons. The mortality rate was significantly higher in multiples compared with singletons even as there was a trend of decreasing gestational-age stratified mortality in multiples over the time period investigated. The rates of major morbidities or composite adverse outcomes were not different between multiples and singletons across all epochs. The adjusted odds ratio (AOR) for mortality in multiples was significantly higher in multiples compared with singletons (AOR 1.20, 95% confidence interval [CI] 1.08-1.34). There were no differences in the adjusted odds for poor outcomes in multiples compared with singletons in the most recent epoch: mortality (AOR 1.00, 95% CI 0.84-1.19), major morbidity (0.95, 95% CI 0.81-1.10), and composite adverse outcome (0.96, 95% CI 0.83-1.11). CONCLUSIONS Over the 15-year period, the odds for mortality in extremely preterm NICU infants of multiple gestation was significantly higher compared with singletons. The adjusted odds of poor outcomes in multiples were not significantly different from that of singletons in the most recent epoch.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia; Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Qin Ying Lee
- School of Women's and Child's Health, University of New South Wales, Sydney, Australia; and
| | - Wei Shern Quek
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia;Department of Neonatology, KK Women's and Children's Hospital, Singapore;School of Women's and Child's Health, University of New South Wales, Sydney, Australia; andFaculty of Health, University of Technology, Sydney, Australia
| | | | - Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia; School of Women's and Child's Health, University of New South Wales, Sydney, Australia; and
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia; School of Women's and Child's Health, University of New South Wales, Sydney, Australia; and
| | | |
Collapse
|
45
|
Dent A, Yeo KT, Embury P, Anderson T, Mungai P, Holding P, Malhotra I, King C, Kazura J. Chronic infectious exposures during pregnancy shift the distribution of cord blood fetal memory B cell subpopulations in a Kenyan cohort (HUM8P.332). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.185.7] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Chronic infections during pregnancy can expose the fetus to foreign antigens leading to cytokine responses that affect fetal B cell development. We hypothesize that this exposure shifts the distribution of B cell subpopulations. Using flow cytometry, we examined the proportions of various B cell subpopulations in cord blood from North American (Nam) and Kenyan neonates. NAm neonates had no prenatal infectious exposures whereas Kenyan neonates examined had prenatal HIV, CMV, or P falciparum exposure, or no infectious exposures. We also measured the plasma levels of pro-inflammatory biomarkers and BAFF in NAm and Kenyan cord plasma. We found that Kenyan neonates exposed to prenatal infections had greater proportions of memory B cells (CD19+CD27+), especially the activated (CD19+CD27+CD21-IgD-) memory B cells compared to NAm neonates. HIV exposed neonates had greater proportions of atypical MBC compared to the other Kenyan infectious exposed groups. Kenyan neonates had higher levels of IP-10, TNFa, CRP, sCD14 and BAFF than NAm neonates. Among the Kenyan groups, those with prenatal infectious exposures had higher levels of INFg, IL-7, sTNFR1 and sTNFR2 compared to Kenyan neonates with no infectious exposures. These results suggest that the presence of chronic infections during pregnancy affects B cell development including activated memory B cells, some pro-inflammatory biomarkers, and BAFF levels. The functional significance of these differences needs to be further investigated.
Collapse
Affiliation(s)
- Arlene Dent
- 1Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH
- 2Pediatrics, Rainbow Babies and Children, Cleveland, OH
| | - Kee Thai Yeo
- 2Pediatrics, Rainbow Babies and Children, Cleveland, OH
| | - Paula Embury
- 1Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH
| | - Timothy Anderson
- 1Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH
| | - Peter Mungai
- 1Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH
| | - Penny Holding
- 3Mental Health, International Centre for Behavioural Studies, Mombasa, Kenya
| | - Indu Malhotra
- 1Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH
| | - Christopher King
- 1Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH
| | - James Kazura
- 1Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH
| |
Collapse
|
46
|
Abstract
A 6-week-old ex-25-week gestation male infant developed candidal sepsis with subsequent bilateral acute obstructive nephropathy that was not responsive to intravenous antifungal therapy. Bilateral percutaneous nephrotomies were performed and irrigation with fluconazole started. Owing to the persistence of the candidaemia and left renal obstruction, streptokinase was administered through the nephrostomy with eventual resolution of obstruction and improvement in his kidney function. This case report discusses the use of the streptokinase therapy as an adjunct therapy in the clearance of fungal bezoars.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | | | | |
Collapse
|
47
|
Weaver G, Newmyer R, Yeo KT, Jacobs MR, Tamburro J, Isham NC, Ghannoum M, Gonzalez BE. PHOTO QUIZ. An unusual periorbital rash in a child. Clin Infect Dis 2012; 55:844, 885-6. [PMID: 22912372 DOI: 10.1093/cid/cis498] [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: 11/14/2022] Open
Affiliation(s)
- Gregory Weaver
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
We conducted a prospective longitudinal study evaluating Candida skin testing among international adoptees presenting to our clinic between 2000 and 2006. Nineteen (17%) and 17 (15%) children had negative tests at presentation and at 6 months, respectively--only 3 were negative at both points. Our study suggests that Candida skin test reactivity is an unstable measure of anergy among international adoptees.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Rainbow Babies and Children's Hospital, and Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106, USA.
| | - Xiaobei Zhu
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - H. Lester Kirchner
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
,Geisinger Center for Health Research, Geisinger Health System, Danville, Pennsylvania, United States
| | - A. Desiree LaBeaud
- Rainbow Babies & Children’s Hospital, Cleveland, Ohio, United States
,Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Anna Mandalakas
- Rainbow Babies & Children’s Hospital, Cleveland, Ohio, United States
,Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| |
Collapse
|
49
|
Wong MHY, Yang M, Yeo KT. Elastic cord-related ocular injury. Singapore Med J 2008; 49:e90-e92. [PMID: 18418513] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a case of an elastic cord-related ocular injury, to increase the public's awareness of the seriousness of this type of injury. A 43-year-old Chinese postman presented with decreased visual acuity in the left eye after being hit by an elastic cord at work. Slit lamp examination revealed pupillary sphincter rupture with iridodonesis and phacodonesis. There was also a traumatic nuclear cataract, gross hyphaema and vitreous haemorrhage. The patient was started on topical steroids and antibiotics. His visual acuity and vitreous haemorrhage improved during subsequent visits. Elastic cord-related ocular injuries have potential sight-threatening consequences. The public should be aware of the possible danger of using elastic cords.
Collapse
Affiliation(s)
- M H Y Wong
- Singapore National Eye Centre, 11 Third Hospital Avenue, Outram Road, Singapore 168751.
| | | | | |
Collapse
|
50
|
Khng CY, Voon LW, Yeo KT. Causes and management of Descemet's membrane detachment associated with cataract surgery--not always a benign problem. Ann Acad Med Singap 2001; 30:532-5. [PMID: 11603141] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Detachments of Descemet's membrane (DM) occur with not uncommon frequency during cataract surgery. The figure for extracapsular cataract extraction (ECCE) is 2.6%, and that for phacoemulsification is 0.5%. Most detachments are small and of little visual consequence. Large detachments are rare but can lead to loss of vision. Early recognition and appropriate management is the key to a favourable outcome. This review provides cataract surgeons with guidelines to the management of this problem. METHODS A review of reported studies on the subject was made using a MEDLINE search. A summary of the reviewed data is presented. RESULTS The problem is fairly widespread, given the number of cataract operations done today. The important points with regard to aetiology, classification, recognition and appropriate management are presented in this article. CONCLUSION DM detachment should not be taken lightly because of the potential for serious visual outcome. It may be avoided in a large majority of cases. Appropriate and prompt management may prevent the patient from suffering visual loss should it occur.
Collapse
Affiliation(s)
- C Y Khng
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | | | | |
Collapse
|