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late onset sepsis

Joseph B Cantey, Kelsey R Anderson, Ram R Kalagiri, Lea H Mallett
BACKGROUND: Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in the neonatal intensive care unit (NICU) and usually require vancomycin treatment. Our objective was to determine whether CoNS are associated with neonatal morbidity and mortality. METHODS: This was a retrospective cohort study of very-low-birth-weight (VLBW, ≤ 1500 g) infants from 1989 to 2015. Exclusion criteria were major congenital anomaly or death within 72 h...
March 13, 2018: World Journal of Pediatrics: WJP
Emma de Jong, David G Hancock, Christine Wells, Peter Richmond, Karen Simmer, David Burgner, Tobias Strunk, Andrew J Currie
Preterm infants are uniquely susceptible to late-onset sepsis that is frequently caused by the skin commensal Staphylococcus epidermidis. Innate immune responses, particularly from monocytes, are a key protective mechanism. Impaired cytokine production by preterm infant monocytes is well described, but few studies have comprehensively assessed the corresponding monocyte transcriptional response. Innate immune responses in preterm infants may be modulated by inflammation such as prenatal exposure to histologic chorioamnionitis which complicates 40-70% of preterm pregnancies...
March 13, 2018: Immunology and Cell Biology
B N Conway, M F Lopes-Virella, W J Blot
AIMS: To estimate the overall and cause-specific mortality in a population of African-Americans and white Americans with a low socio-economic status who had young-onset insulin-treated diabetes and had survived beyond the age of 40 years, and to examine whether any excess risk varied according to age at diabetes onset. METHODS: Using the Southern Community Cohort Study, we conducted a mortality follow-up of a cohort of mostly low-income participants aged 40-79 years (mean 50 years) at cohort entry with insulin-treated diabetes diagnosed before age 30 years (n=475) and without diabetes (n=62 266)...
March 12, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Ryszard Lauterbach, Tobias Strunk, Sanjay Patole, Joanna Hurkała, Dorota Pawlik
Pentoxifylline (PTX) is a methylxanthine with immunomodulating properties that may be beneficial in neonatal sepsis.(1, 2) Mechanisms include inhibition of TLR-mediated inflammation, particularly in cord blood.(3, 4) PTX-related adverse events are rare, including in neonates. Systematic reviews suggest PTX is safe and potentially beneficial in this context.(5) Based on our clinical trials, we have been using PTX for the past 20 years in neonatal sepsis.(2) This article is protected by copyright. All rights reserved...
March 9, 2018: Acta Paediatrica
Ahmet Yagmur Bas, Nihal Demirel, Esin Koc, Dilek Ulubas Isik, İbrahim Murat Hirfanoglu, Turan Tunc
BACKGROUND: To evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition. METHODS: A prospective cohort study (TR-ROP) was performed between 1 April 2016 and 30 April 2017 in 69 neonatal intensive care units (NICUs). Infants with a birth weight (BW)≤1500 g or gestational age (GA)≤32 weeks and those with a BW>1500 g or GA>32 weeks with an unstable clinical course were included in the study...
March 8, 2018: British Journal of Ophthalmology
Rowena L McMullan, Adrienne Gordon
BACKGROUND: Late-onset sepsis is associated with increased rates of mortality and morbidity in newborn infants, in addition to poorer long-term developmental outcomes and increased length of stay and hospital costs. Central line-associated blood stream infection (CLABSI) is the most common cause of late-onset sepsis in hospitalised infants, and prevention of CLABSI is a key objective in neonatal care. Increased frequency of CLABSI around the time of removal of central venous catheters (CVCs) has been reported, and use of antibiotics at the time of removal may reduce the incidence and impact of late-onset sepsis in vulnerable newborn infants...
March 7, 2018: Cochrane Database of Systematic Reviews
Elita Jauneikaite, Georgia Kapatai, Frances Davies, Ioana Gozar, Juliana Coelho, Kathleen B Bamford, Benedetto Simone, Lipi Begum, Shannon Katiyo, Bharat Patel, Peter Hoffman, Theresa Lamagni, Eimear T Brannigan, Alison Holmes, Tokozani Kadhani, Tracey Galletly, Kate Martin, Hermione Lyall, Yimmy Chow, Sunit Godambe, Victoria Chalker, Shiranee Sriskandan
Background: Invasive Group B streptococcus (GBS) is a major cause of serious neonatal infection. Current strategies to reduce early onset GBS disease have no impact on late onset disease (LOD). Although GBS is a normal part of the enteric microbiota in healthy term infants, LOD cases arising in the neonatal intensive care unit setting raise questions about mode of acquisition. Methods: Enhanced surveillance for any case of late onset GBS sepsis admitted to a level 3, 24-bed neonatal intensive care unit over a 2 year period was instituted following a cluster of four cases...
March 2, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
David A Osborn, Tim Schindler, Lisa J Jones, John Kh Sinn, Srinivas Bolisetty
BACKGROUND: Sick newborn and preterm infants frequently are not able to be fed enterally, necessitating parenteral fluid and nutrition. Potential benefits of higher parenteral amino acid (AA) intake for improved nitrogen balance, growth, and infant health may be outweighed by the infant's ability to utilise high intake of parenteral AA, especially in the days after birth. OBJECTIVES: The primary objective is to determine whether higher versus lower intake of parenteral AA is associated with improved growth and disability-free survival in newborn infants receiving parenteral nutrition...
March 5, 2018: Cochrane Database of Systematic Reviews
Daniel Johannes Cornelis Berkhout, Hendrik Johannes Niemarkt, Nanne Klaas de Boer, Marc Alexander Benninga, Timotheüs Gualtherus Jacob de Meij
Although the exact pathophysiological mechanisms of both necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in preterm infants are yet to be elucidated, evidence is emerging that the gut microbiota plays a key role in their pathophysiology. Areas covered: In this review, initial microbial colonization and factors influencing microbiota composition are discussed. For both NEC and LOS, an overview of studies investigating preclinical alterations in gut microbiota composition and fecal volatile organic compounds (VOCs) is provided...
February 28, 2018: Expert Review of Gastroenterology & Hepatology
Thomas A Hooven, Tara M Randis, Richard A Polin
Asymptomatic term and late-preterm newborns with risk factors for early onset sepsis commonly undergo laboratory evaluation and receive empiric antibiotic therapy. Some have challenged the rationale for current "rule-out sepsis" practices, arguing that they lead to unnecessary overtreatment and healthcare costs. A series of recent clinical studies has explored scheduled serial observations as an alternative to laboratory testing and empiric antibiotics for asymptomatic newborns with historical risk factors for sepsis...
February 26, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Senem Alkan Ozdemir, Esra Arun Ozer, Ozkan Ilhan, Sumer Sutcuoglu, Mansur Tatlı
Objective Sepsis is a complex clinical condition caused by a dysregulated immune response to an infection resulting in a fatal outcome. This study aimed to investigate the value of urine soluble triggering receptor expressed on myeloid cells (sTREM-1) for diagnosing culture-proven sepsis in preterm infants. Methods Preterm neonates were evaluated for late-onset sepsis (LOS). Laboratory investigations were performed. Urine sTREM-1 samples and blood cultures were synchronously collected. Using blood culture results, preterm neonates were divided into the culture-proven group and suspected sepsis group...
January 1, 2018: Journal of International Medical Research
Jennifer A Muszynski, Ryan Nofziger, Melissa Moore-Clingenpeel, Kristin Greathouse, Larissa Anglim, Lisa Steele, Josey Hensley, Lisa Hanson-Huber, Jyotsna Nateri, Octavio Ramilo, Mark W Hall
RATIONALE: Late immune suppression is associated with nosocomial infection and mortality in septic adults and children. Relationships between early immune suppression and outcomes in septic children remain unclear. OBJECTIVE: Prospective observational study to test the hypothesis that early innate and adaptive immune suppression are associated with longer duration of organ dysfunction in children with severe sepsis/septic shock. Methods, Measurements and Main Results: Children aged < 18 years meeting consensus criteria for severe sepsis or septic shock were sampled within 48 hours of sepsis onset...
February 22, 2018: American Journal of Respiratory and Critical Care Medicine
Upasana Kulkarni, Christoph Herrmenau, Stephanie J Win, Michael Bauer, Thomas Kamradt
Immunological dysregulation in sepsis is associated with often lethal secondary infections. Loss of effector cells and an expansion of immunoregulatory cell populations both contribute to sepsis-induced immunosuppression. The extent and duration of this immunosuppression are unknown. Interleukin 7 (IL-7) is important for the maintenance of lymphocytes and can accelerate the reconstitution of effector lymphocytes in sepsis. How IL-7 influences immunosuppressive cell populations is unknown. We have used the mouse model of peritoneal contamination and infection (PCI) to investigate the expansion of immunoregulatory cells as long-term sequelae of sepsis with or without IL-7 treatment...
2018: PloS One
Helgi Padari, Tuuli Metsvaht, Eva Germovsek, Charlotte I Barker, Karin Kipper, Koit Herodes, Joseph F Standing, Kersti Oselin, Tõnis Tasa, Hiie Soeorg, Irja Lutsar
Group B streptococci are common causative agents of early-onset neonatal sepsis (EOS). Pharmacokinetic (PK) data for penicillin G have been described for extremely preterm neonates but poorly for late-preterm and term neonates. Thus, evidence-based dosing recommendations are lacking. We described PK of penicillin G in neonates with gestational age (GA) ≥32 weeks and postnatal age <72 h. Penicillin G was administered intravenously at a dose of 25,000 or 50,000 IU/kg/q12h. At steady state, PK blood samples were collected prior to and at 5 min, 1 h, 3 h, 8 h, 12 h after injection...
February 20, 2018: Antimicrobial Agents and Chemotherapy
Nalin Choudhary, Kenneth Tan, Atul Malhotra
Neonatal units have started to switch from using conventional soy-based to alternate lipid emulsions, like SMOFlipid. SMOFlipid has been associated with an improvement in biochemical parameters and delays progression of parenteral nutrition-associated liver disease (PNALD). This retrospective epoch study aimed to compare clinically relevant neonatal outcomes in preterm infants (< 32 weeks), receiving SMOFlipid versus Intralipid. We compared clinical outcomes in two epochs-epoch 1 (Intralipid, October 2013-June 2015) versus epoch 2 (SMOFlipid, July 2015-March 2017)...
February 14, 2018: European Journal of Pediatrics
Mark Greer, Cristina Berastegui, Peter Jaksch, Christian Benden, John Aubert, Antoine Roux, Elodie Lhuillier, Sandrine Hirschi, Martine Reynaud-Gaubert, François Philit, Johanna Claustre, Pierre LePalud, Marc Stern, Christiane Knoop, Robin Vos, Erik Verschuuren, Andrew Fisher, Gerdt Riise, Lennart Hansson, Martin Iversen, Pekka Hämmäinen, Hans Wedel, Jacqueline Smits, Jens Gottlieb, Are M Holm
Late-onset noninfectious pulmonary complications (LONIPCs) affect 6% of allogeneic stem cell transplantation (SCT) recipients within 5 years, conferring subsequent 5-year survival of 50%. Lung transplantation is rarely performed in this setting due to concomitant extrapulmonary morbidity, excessive immunosuppression and concerns about recurring malignancy being considered contraindications. This study assesses survival in highly selected patients undergoing lung transplantation for LONIPCs after SCT.SCT patients undergoing lung transplantation at 20 European centres between 1996 and 2014 were included...
February 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Matthew D Haslam, Sarka Lisonkova, Dianne Creighton, Paige Church, Junmin Yang, Prakesh S Shah, K S Joseph, Anne Synnes
OBJECTIVE: To assess the impact of variations in the definition of severe neurodevelopmental impairment (NDI) on the incidence of severe NDI and the association with risk factors using the Canadian Neonatal Follow-Up Network cohort. STUDY DESIGN: Literature review of severe NDI definitions and application of these definitions were performed in this database cohort study. Infants born at 23-28 completed weeks of gestation between 2009 and 2011 (n = 2187) admitted to a Canadian Neonatal Network neonatal intensive care unit and assessed at 21 months' corrected age were included...
February 2, 2018: Journal of Pediatrics
Chris H P van den Akker, Johannes B van Goudoever, Hania Szajewska, Nicholas D Embleton, Iva Hojsak, Daan Reid, Raanan Shamir
OBJECTIVES: Several randomised controlled trials (RCTs) on the use of probiotics to reduce morbidity and mortality in preterm infants have provided inconsistent results. Whilst meta-analyses that group all of the used strains together, suggest efficacy, it is not possible to determine the most effective strain which is more relevant to the clinician. We therefore used a network meta-analysis (NMA) approach in order to identify strains with greatest efficacy. METHODS: A PubMed search identified placebo-controlled or head-to-head RCTs investigating probiotics in preterm infants...
January 30, 2018: Journal of Pediatric Gastroenterology and Nutrition
Marc Beltempo, Isabelle Viel-Thériault, Roseline Thibeault, Anne-Sophie Julien, Bruno Piedboeuf
BACKGROUND: Late-onset sepsis in very low birth weight (VLBW) infants is a diagnostic challenge. We aimed to evaluate the diagnostic utility of the C-Reactive protein (CRP) and the complete blood count (CBC) for late-onset sepsis in VLBW infants. METHODS: In a 5-year retrospective cohort of 416 VLBW infants born at less than 1500 g, there were 590 separate late-onset sepsis evaluations. CRP and CBC were drawn at time of initial blood culture (T0), at 16-24 h (T24) and 40-48 h (T48) after...
January 30, 2018: BMC Pediatrics
Magdalena Zasada, Marzena Lenart, Magdalena Rutkowska-Zapała, Małgorzata Stec, Ola Czyz, Nina Mól, Maciej Siedlar, Przemko Kwinta
BACKGROUND: Immature immune systems predispose very low birth weight (VLBW) neonates to systemic infections in early life. Defective inflammasome function may increase a neonate's susceptibility to late-onset sepsis (LOS). METHODS: Blood samples were taken on the 5th day of life (DOL) for all VLBW neonates (non-LOS and before-LOS groups; n=76), and within 24 hours of sepsis onset (LOS group; n=39). Monocyte (MO) subsets and intracellular interleukin-1β (IL-1β) expression were analysed using flow cytometry...
January 29, 2018: Minerva Pediatrica
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