Diagnosis Of Neonatal Infection Research Articles

Are complete blood cell counts useful in the evaluation of asymptomatic neonates exposed to suspected chorioamnionitis?

Chorioamnionitis complicates 1% to 10% of pregnancies and increases the risk of neonatal infection. Women with chorioamnionitis receive intrapartum antibiotics, often resulting in inconclusive neonatal blood cultures. Peripheral neutrophil values are used frequently to assist in the diagnosis of neonatal infection and to determine duration of antibiotics; we sought to determine the utility of this approach. A prospective observational study was performed in 856 near-term/term neonates who were exposed to suspected chorioamnionitis. Each received antibiotics for 48 hours unless clinical infection or positive blood cultures occurred. Peripheral neutrophils were measured serially and analyzed using the reference ranges of Manroe et al; an additional analysis of only the initial neutrophil values used the normal ranges of Schelonka et al. Results of neutrophil analyses were not used to determine duration of therapy. Fifty percent of asymptomatic neonates were seen postdischarge to ascertain recurrent infection. Local patient charges were examined. Ninety-six percent of neonates were asymptomatic and had negative cultures, and antibiotics were discontinued at 48 hours. A total of 2427 neutrophil counts were analyzed. Although abnormal neutrophil values were more frequent in infected or symptomatic neonates, 99% of asymptomatic neonates had > or = 1 abnormal value. The specificity and negative predictive values for abnormal neutrophil values ranged between 0.12 and 0.95 and 0.91 and 0.97, respectively; sensitivity was 0.27 to 0.76. Significant differences in interpretation of the initial neutrophil values were noted, depending on the normal values used. Follow-up was performed for 373 asymptomatic neonates until 3 weeks' postnatal age. Eight required rehospitalization; none had evidence of bacterial infection. If neutrophil values had been used to determine duration of antibiotics, then local costs would have increased by 76,000 dollars to 425,000 dollars per year. Single or serial neutrophil values do not assist in the diagnosis of early-onset infection or determination of duration of antibiotic therapy in asymptomatic, culture-negative neonates who are > or = 35 weeks' gestation and are delivered of women with suspected chorioamnionitis.

Diagnosis of Human Immunodeficiency Virus Infection in Children

Since the availability of specific virologic assays for the diagnosis of human immunodeficiency virus infection, the diagnosis of neonatal infection is more specific and confirmed at an earlier age. An early diagnosis of human immunodeficiency virus infection has important implications for the initiation of antiretroviral therapy. Whereas the diagnosis of this infection is primarily antibody-based prior to 18 months of age, the diagnosis at less than 18 months is virologically based.

Nested polymerase chain reaction in the diagnosis of congenital cytomegalovirus infection.

Human cytomegalovirus infection is highly prevalent in Indian population. It is the commonest congenitally acquired infection causing various anomalies. The diagnosis of infection in neonates is difficult as IgM may not be detected in all cases. The polymerase chain reaction is reported as alternative and better option in these patients. However, there is lack of data to substantiate this preference in a resource poor country like India. Blood samples from 930 neonates/fetuses were first tested for specific anti-CMV IgM antibodies using mu-capture enzyme linked immunosorbent assay, Mac-ELISA. Nested PCR was first standardised on clinically and therapeutically confirmed cases of CMV disease. In the second phase blood samples randomly from 20 babies suspected of CMV infection were collected for serology and PCR and both tests were run independently. Twenty healthy controls were also included. IgM ELISA and PCR were performed on these samples and results of these 20 samples were compared to evaluate the sensitivity and specificity of each method. Out of 930 serum samples of suspected congenital CMV infection 188 (20.2%) were found positive for CMV specific IgM antibodies. While comparing the results of 40 paired samples, PCR was found to be highly specific (100%) but less sensitive than Mac-ELISA (95%) with negative predictive value of 100% and positive predictive value of 95%. Thus in congenital CMV infection Mac-ELISA was less costly, less cumbersome and more user friendly. The Mac-ELISA seem to have parallel sensitivity and specificity as PCR for diagnosing congenital CMV infection.

Group B streptococcal neonatal infections in Rio Grande do Sul, Brazil.

Group B Streptococcus is the most common pathogen found in neonatal sepsis in North America. We describe 15 cases of neonatal infections by Group B Streptococcus (Streptococcus agalactiae) at a Neonatal Intensive Care Unit of a public and teaching hospital. We conducted a study at Hospital de Clínicas de Porto Alegre, from January 1st, 1996 to June 30, 1999. Diagnosis of neonatal infection was established according to the findings of Group B Streptococcus in blood culture associated with alterations resembling sepsis on the basis of clinical picture and laboratory findings. Fifteen cases of neonatal infections by Group B Streptococcus were detected. Eleven cases consisted of early-onset sepsis, 2 cases of occult bacteremia and 2 cases of late-onset sepsis. Eight cases had septic shock (53%), 8 cases had pneumonia (53%), and 4 cases had meningitis (27%). Fourteen cases were diagnosed from a positive blood culture, and 1 case from evidence of these bacteria in pulmonary anatomopathological examination. Thirteen cases (87%) were diagnosed before 72 hours of life. We had 3 deaths (20%), and 3 cases of meningitis developing neurological deficits. Streptococcus Group B is one of the most important pathogens in the etiology of early-onset neonatal sepsis at our hospital, with high mortality and morbidity. However, we do not know the incidence of GBS neonatal infections at other hospitals. More data are needed to establish a basis for trials of different strategies to reduce these infections.

Thrombopoietin levels of thrombocytopenic term and preterm newborns with infection.

We measured Thrombopoietin (Tpo) levels in thrombocytopenic term and preterm babies with infection to investigate the relationship between thrombopietin levels and platelet counts. Sixteen preterm (27-34 weeks' gestational age) and 5 term neonates (38-41 weeks' gestational age) with the diagnosis of neonatal infection and thrombocytopenia (platelets <150 x 10(9)/L) but, without the evidence of disseminated intravascular coagulation, were prospectively enrolled in the study. Fifteen preterm (27-34 weeks' gestational age) and 9 term (38-40 weeks' gestational age) age-matched healthy neonates were enrolled in the study as control. Blood samples were obtained from each subject at the time when infection and thrombocytopenia were detected and stored until assay. Bacterial infection was confirmed by blood cultures in five patients and by tracheal cultures in five. Median Tpo levels of term controls were lower than those of preterm controls (62 pg/mL vs. 87 pg/mL) (p <0.05). Median Tpo levels of thrombocyopenic preterm patients were higher than the levels of healthy preterms (258 pg/mL vs. 87 pg/mL) (p <0.05). Similarly, median Tpo levels of sick terms were significantly higher than those of healthy term controls (209 pg/mL vs. 62 pg/mL) (p <0.001). There was not significant difference between the median Tpo levels of term and preterm babies with infection (258 pg/mL vs. 209 pg/mL) (p >0.05). There was no correlation between platelet counts and Tpo levels in both term and preterm groups. The results of our study show that healthy term and preterm babies have detectable levels of Tpo and preterm babies have higher Tpo levels than term infants. Although thrombocytopenic babies with infection have increased levels of Tpo, these levels are still lower than the levels of thrombocytopenic children/adult patients and there seems to be no correlation between platelet counts and thrombopoietin levels. So our observation of increased Tpo levels may still be inadequate for normal platelet production in this period. and this group of babies may also be candidates for the administration of recombinant human Tpo.

Serum sICAM-1 levels in the diagnosis of neonatal infection

Serum sICAM-1 levels in the diagnosis of neonatal infection

Blood serum concentration of C-reactive protein and interleukin-6 in diagnosis of neonatal infections.

Blood serum concentration of C-reactive protein and interleukin-6 in diagnosis of neonatal infections.

RAPID SEROLOGIC TESTING WITH IMMUNE-COMPLEX-DISSOCIATED HIV p24 ANTIGEN FOR EARLY DETECTION OF HIV INFECTION IN NEONATES

The ICD p24 antigen assay is a rapid, relatively simple serologic test that is likely to be of value in the early diagnosis of HIV infection in neonates.

The value of C‐reactive protein measurement in the diagnosis of neonatal infection

We examined whether serum C-reactive protein (CRP) measurements used in conjunction with leucocyte counts help in the diagnosis of perinatally acquired and nosocomial infections in very preterm newborn infants. One hundred and twenty-five infants born at a gestational age between 23 and 31 weeks with respiratory distress were studied at birth. A similar group of 85 infants beyond 3 days of age were also studied on 100 occasions for suspected infection. The diagnosis of proven or probable infection was correlated with abnormal haematology (leucopenia less than 5000/mm3, leucocytosis greater than 20,000/mm3 or ratio of immature forms to total neutrophils of greater than 0.2) and an elevated CRP (greater than 10 mg/L) singly or in combination. The sensitivity of an elevated CRP was relatively higher than abnormal haematology in both early and late infections and the sensitivity was highest when either test was abnormal. Similarly, the specificity, positive and negative predictive values and efficiency of an elevated CRP was relatively higher than abnormal haematology. The performance of the tests in 45 infants born at 23-28 weeks gestation was similar to that in 80 infants born at 29-31 weeks gestation. It was concluded that both CRP and leucocyte counts should be determined as they provide valuable information in the diagnosis of neonatal bacterial infection.

Incidence and diagnosis of rotavirus infection in neonates: Results of two studies

The present study investigates the incidence of human rotavirus excretion in neonates of two hospitals. From April 1, 1983 to March 31, 1984, rotaviruses were detected with Rotazyme in the feces of 57 (15%) of 383 neonates at the Department of Pediatrics, University of Berne, in a total in 71 (5.2%) of the 1369 stool samples tested. Of the 57 neonates with Rotazyme-positive stool samples, 53 (93%) were asymptomatic. The problems of the specificity of Rotazyme in neonatal feces and the possibility of rapid testing on neonatology wards are discussed. In a prospective study carried out in April 1986 at the "Schweizerische Pflegerinnenschule in Zurich", rotaviruses were detected with genome gel electrophoresis in the feces of 15 (63%) of 24 risk neonates in the premature baby ward and in 36 (46%) of 79 neonates from the infant nursery, in a total in 63 (34%) of the 188 stool samples tested. In this rotavirus outbreak all rotaviruses detected showed the same band pattern, and therefore had an identical electrophorotype. Symptoms and hospital hygiene aspects of this outbreak will be dealt with in subsequent papers.

Mini-erythrocyte sedimentation rates in healthy and infected Nigerian neonates

Normal values for mini-erythrocyte sedimentation rates (mini-ESR) in healthy Nigerian neonates are reported and compared with values obtained for infected neonates. The mean and 95th percentile values, measured in mm/h in healthy neonates in the first week of life, range from 1.8 to 7.7, and in the 4th week of life from 9.1 to 16. The mini-ESR values of the infected neonates were significantly higher than the 95th percentile values of healthy neonates. Because the sensitivity and specificity of the mini-ESR in the diagnosis of neonatal infection are high, its application as an appropriate technology for evaluating suspected cases of infection in the developing countries should be encouraged.

Is there a relation between an increase in IgM in the newborn infant and the course of pregnancy and labor?

In order to check the significance of the serum IgM concentration in newborns the IgM levels in the placental blood of 263 randomly selected neonates were determined; in 105 of these children the IgM concentration was again determined on the 6th day of life. The maternal IgM concentrations were also determined for the purpose of comparison. All of the newborns were allocated to infection risk categories on the basis of history and clinical data. The findings were evaluated on the basis of the mean values with simple standard deviation, single-case analysis and arrangement of the medium values in sequence. Significantly elevated IgM concentrations were found in newborns with the risk factor asphyxia on the 6th day of life. There was a certain tendency to elevated IgM concentrations - established on the basis of the mean values and the median value grouping - in the groups with maternal infection, premature rupture, frequent vaginal examination, and post-term birth of the child. The investigation shows that the majority of elevated IgM concentrations in neonates in whom no infection can be found are not closely correlated to a certain risk factor. An elevated IgM concentration in a newborn appears to be a factor of low specificity with regard to infection. However, in the diagnosis of neonatal infections it provides additional information in the overall context of the clinical examination.

Thallium 201 scintigraphy in patients with anomalous origin of the left coronary artery from the main pulmonary artery

3. Xanthou M: Leucocyte blood picture in ill newborn babies, Arch Dis Child 47:741, 1972. 4. Akenzua GI, Hui YT, Milner R, and Zipursky A: Neutrophil and band counts in the diagnosis of neonatal infections, Pediatrics 54:38, 1974. 5. O'Kell RT, and Axon LL: Leukocyte alkaline phosphatase in the newborn infant, Am J Obstet Gynecol 93:1181, 1965. 6. Gorecka M: Alkaline phosphatase in segmented, neutrophil granulocytes in children, Bull Pol Med Sci Hist 10:174, 1967. 7. Halbretch I, and Shabtay F: Leukocyte alkaline phosphatase activity in pre-term, term and post-term infants, Isr J Med Sci 8:1956, 1972. 8. Corberand J: Cytochemical leukocyte reactions in normal newborn infants, Biol Neonate 22:280, 1973. 9. Sadovsky E, Matz D, Diamant YZ, and Polishuk WZ: Leukocyte alkaline phosphatase in the newborn, Biol Neonate 27:96, 1975. 10. Tanaka KR, Valentine WN, and Fredricks RE: Diseases or clinical conditions associated with low leukocyte alkaline phosphatase, N Engl J Med 262:912, 1960. 11. Trubowitz S, Feldman D, Benante C, and Hunt VM: The alkaline phosphatase content of the human polymorphonuclear leukocyte in blood and marrow, Am J Clin Pathol 31:483, 1959.

INFLUENCE OF MATERNAL CORTICOSTEROID (CS) ADMINISTRATION ON NEONATAL NEUTROPHIL COUNT

Measurements of absolute neutrophil and band counts are now utilized with increasing frequency for the early diagnosis of infection in neonates. Unfortunately all the factors that may influence the absolute neutrophil count (ANC) during this period of life have not been elucidated. For this purpose ANC were de-determined at 3, 12-15, 48 and 72 hrs. of life in 4 groups of Caucasian premature infants who were appropriate weight for gestational age. One group did not develop respiratory distress syndrome (RDS), one group did, while a third group were born after their mothers received corticosteroids (CS) for 3 days prior to delivery - some of these infants developed RDS and others did not. The ANC (×103/mm3 ± ISD) in these infants are depicted below:These studies illustrate that the administration of CS to mothers significantly increases the ANC of their offspring if they do not develop RDS (p <.005). The CS had no effect in infants who developed RDS. The ANC in neonates is influenced by maternal CS therapy and may be of predictive value in identifying those CS treated patients who will develop RDS.

Neutrophil and Band Counts in the Diagnosis of Neonatal Infections

A system has been developed for the evaluation of hematological data in the newborn. Normal values were established for segmented (neutrophil) and nonsegmented (band) polymorphonuclear leukocytes in the peripheral blood of 169 healthy full-term infants during the first five days of life. This normal data is displayed graphically and the values for infants under study are compared directly. Newborn infants with proven bacterial infections had normal neutrophil counts; however, the band counts increased significantly beyond the normal range. Therefore, the simple laboratory procedure for ennumerating band neutrophils with comparison of absolute values and changes to a normal range represents a hematologic technique of major importance in the diagnosis of sepsis of the newborn infant.

Immunofluorescence of Tracheal Secretions in Neonatal Syphilis

A case of congenital syphilis was diagnosed by aspiration of tracheobronchial secretions and immunofluorescent stain. The value of this microscopic technique for prompt diagnosis of neonatal infection is emphasized.

Serum IgM in diagnosis of infection in the newborn.

Serum IgM levels were determined at weekly intervals from birth in 100 normal low birthweight and 100 normal birthweight infants during the first 4 weeks of life. The dynamics of serum IgM was also studied in 36 newborn infants with different types of infection and in 19 infants with probable infection. The behaviour of serum IgM in the infants with systemic infection and also in those suffering from superficial infection with systemic symptoms was significantly different from the normal. Serum IgM rose within two days of appearance of symptoms and the rise persisted as long as the infection was `active9. With the eradication of infection the IgM level tended to fall. This characteristic dynamic pattern of serum IgM may be of considerable help in the diagnosis of neonatal infection, especially the clinically inapparent and atypical varieties that may have serious sequelae later in life.