Late Sepsis Research Articles

Comparison of Derangement of Cerebrospinal Fluid Markers in Neonates with Early and Late-Onset Sepsis

Objective: To compare derangement of cerebrospinal fluid markers in neonates with early and late-onset sepsis managed at the Neonatal Intensive Care Unit. Study Design: Comparative cross-sectional study. Setting and Duration of Study: Neonatology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2021 to Jun 2022. Methodology: This study was conducted on neonates managed at our Neonatal Intensive Care Unit for late or early-onset sepsis. A consultant neonatologist diagnosed neonatal sepsis based on clinical and laboratory findings. The cerebrospinal fluid routine examination was performed on all the study participants, and the derangement of various markers was compared in neonates with early and late-onset sepsis. Results: A total of 348 neonates admitted to the neonatal intensive care unit with sepsis were included in the final analysis. The mean age of the newborns included in the study was 5.38±4.53 days. Out of all the neonates in the study, 194(55.7%) had early-onset sepsis, while 154(44.3%) neonates had late-onset sepsis. All the cerebrospinal fluid markers were statistically significantly deranged in patients with late-onset sepsis (p-value<0.005). Conclusion: Derangement of cerebrospinal fluid markers was seen more in patients with late-onset neonatal sepsis admitted to the neonatal intensive care unit. Emphasis should be laid on performing this necessary investigation timely in neonates with late-onset sepsis as chances of meningeal involvement are higher in this group.

BREAST MILK BANKS – THE WAY TO GLOBAL BREASTFEEDING SUPPORT IN UKRAINE AND THE WORLD

Breast milk is the standard of infant nutrition, recognized worldwide as the optimal fi rst source of food, and breastfeedingis the ideal way to feed children, meeting all their needs. Breast milk is especially valuable for premature infants, who require specialized medical care from the fi rst seconds of life and for a long time, and for sick newborns born at term. Preterm or sick preterm infants are most vulnerable to perinatal illness, have a high probability of dying and, most importantly, are at the greatest risk of not receiving the life-saving benefi ts of breast milk. In today’s world, the World Health Organization and the American Academy of Pediatrics recommend the use of donor human milk as the fi rst alternative for feeding preterm infants of any gestational age, including very preterm infants (<32 weeks gestation) or very low birth weight infants (<1500 g), when human milk is not available. Studies have shown that breastfeeding, even partial breastfeeding, reduces the risk of necrotizing enterocolitis and late neonatal sepsis, retinopathy of prematurity, and sudden infant death, improves cognitive outcomes in preterm infants, and helps establish optimal functioning of the digestive system and enteric digestive processes. In many countries around the world, targeted support for breastfeeding in neonatal intensive care units, including enteral feeding of sick and premature infants, is provided by donor human breast milk that is concentrated and stored in an established and functioning network of breast milk banks.A breast milk bank is an institution whose purpose is to collect breast milk from mothers who produce more than theirinfants need, and to process and store breast milk for the feeding of infants who, for medical or other reasons, cannot receive it temporarily or for a long period. International associations of breast milk banks have been established throughout the world to promote the activities of banks and to establish international cooperation among breast milk banks.The European Milk Banks Association (EMBA) was offi cially launched on October 15, 2010. There are currently 282 activebanks in 31 European countries and 18 banks in the process of becoming active. The Southern African Milk Banks Association (HMBASA) was established in 2009. HMBASA coordinates the activities of the network of milk banks throughout the country. The North American Milk Banks Association (HMBANA) was founded in 1985 and brings together 30 non-profi t breast milk banks in the United States and Canada. There is a positive trend in the establishment of new breast milk banks in all countries of the world. There are currently about 500 in 37 countries. Brazil is the world leader in breast milk banks, with 222 breast milk banks and 217 milk collection centers. The first donor breast milk bank in Ukraine was established in 2019 in Kyiv at the Perinatal Center, where about 80 % of all premature babies in the city are born. In December 2022, when the country was at war, a high-tech breast milk bank was opened at the Lviv Regional Clinical Perinatal Center. This is the second bank of donated breast milk successfully operating in Ukraine on the basis of perinatal centers.The operation of the breast milk bank at the Lviv Oblast Clinical Perinatal Center is one of the many modern high-tech areasof the healthcare facility. The breast milk bank is equipped with all the necessary equipment, which meets the highest modern world standards. Active daily teamwork of obstetricians, neonatologists, lactation consultants and mothers has allowed the bank to attract 32 donors of breast milk and collect more than 380 liters of donor milk since its opening. The fi rst batch of donor milk was received on January 12, 2023.Promoting the creation of a network of mother’s milk banks in Ukraine at the state level will help to make a signifi cantcontribution to the preservation of the full healthy development of newborns and infants in our country, which has becomeespecially important in the current military situation in Ukraine.

Clinical Observation in Premature Babies with Feeding Intolerance

Objective: Feeding intolerance (FI) is a digestive disorder that manifests itself with gastric residue, abdominal distension, and vomiting, especially in preterm infants, and often causes a prolongation of the transition to full enteral feeding. Nutrition strategy is a significant clinical challenge for neonatologists. It is tried to treat feeding intolerance with methods such as minimal enteral nutrition and slow increase in sustenance, probiotic use, prevention/treatment of NEC and sepsis, and use of specially formulated foods, but these methods are only partially effective.
 Methods: Babies under 32 weeks and 1500 g hospitalized in Konya City Hospital between August 2020 and January 2022 were evaluated retrospectively. Babies with and without feeding intolerance were divided into two groups, and their demographic and clinical conditions were examined. The treatment modalities of the group with feeding intolerance were evaluated.
 Results: Of the 86 patients in the study, 36 were included in the FI group, and 50 were in the healthy control group. Late neonatal sepsis and duration of parenteral nutrition were found to be statistically significantly higher in the group with feeding intolerance compared to the control group (p

Assessment of Salivary versus Serum Procalcitonin Level in Diagnosis of Late Onset Neonatal Sepsis in Preterm Neonates

Assessment of Salivary versus Serum Procalcitonin Level in Diagnosis of Late Onset Neonatal Sepsis in Preterm Neonates

Bronchopulmonary Dysplasia: A Five-Year Retrospective Cohort Study on Differences in Clinical Characteristics and Morbidities According to Severity Grading.

Bronchopulmonary dysplasia (BPD) is the most common complication associated with extreme prematurity. Although several criteria defining severity were developed over time, there are a few studies describing the differences in BPD phenotype and neonatal morbidities and complications between severity groups. We aimed to describe these differences in BPD patients of a neonatal intensive care unit (NICU). We conducted an observational retrospective cohort study through a medical record review over a five-year period. Participants were newborns admitted to an NICU who were diagnosed with BPD. We performed a descriptive statistical analysis of gestational complications and the use of antenatal corticosteroid therapy, birth-related data, and complications throughout the NICU stay, as well as the respiratory support used. We also compared different severity groups across these variables. The patients were divided into severe and non-severe BPD using the severity criteria of the 2001 NICHD/NHLBI/ORD consensus workshop. A total of 101 newborns with BPD participated in the study and 73 had data on BPD severity. The median gestational age was 27 weeks, ranging from 23 to 32 weeks. Of these 73 newborns, 36 had mild BPD (49.3%), 10 had moderate BPD (13.7%), and 27 had severe BPD (37.0%). When comparing severe and non-severe BPD, we found that extreme prematurity, extremely low birth weight, and small size for gestational age were more frequent in the severe BPD group (p-value=0.012, p-value<0.001, and p-value=0.012, respectively). Infants with severe BPD had a longer duration of invasive ventilation than those with mild or moderate BPD (p-value<0.001). Late sepsis, necrotizing enterocolitis, severe brain injury, and retinopathy of prematurity were more frequent in severe BPD (p-value=0.017, p-value=0.045, p-value=0.033, p-value=0.003, respectively). Previously published evidence describing causal links between BPD development and comorbidities exists but data on their impact on BPD severity are scarce. In our study, severe BPD seemed to be associated with a higher frequency of comorbidities and complications. Further studies are needed to ascertain the impact of each morbidity on the severity of BPD and if measures to prevent them could lead to potentially milder BPD disease.

Outcome of Second Allogeneic HSCT for Patients with Inborn Errors of Immunity: Retrospective Study of 20 Years' Experience.

A significant complication of HSCT is graft failure, although few studies focus on this problem in patients with inborn errors of immunity (IE). We explored outcome of second HSCT for IEI by a retrospective, single-centre study between 2002 and 2022. Four hundred ninety-three patients underwent allogeneic HSCT for severe combined immunodeficiency (SCID; n = 113, 22.9%) or non-SCID IEI (n = 380, 77.1%). Thirty patients (6.0%) required second HSCT. Unconditioned infusion or no serotherapy at first HSCT was more common in patients who required second transplant. Median interval between first and second HSCT was 0.97years (range: 0.19-8.60years); a different donor was selected for second HSCT in 24/30 (80.0%) patients. Conditioning regimens for second HSCT were predominately treosulfan-based (with thiotepa: n = 18, 60.0%; without, n = 6, 20.0%). Patients received grafts from peripheral blood stem cell (n = 25, 83.3%) or bone marrow (n = 5, 16.7%) with median stem cell dose 9.5 × 106 CD34 + cells/kilogram (range: 1.4-32.3). Median follow-up was 1.92years (0.22-16.0). Overall survival was 80.8% and event-free survival was 64.7%. Four patients died, two of early-transplant related complications, and two of late sepsis post-second HSCT. Three patients required third HSCT; all are alive with 100% donor chimerism. Cumulative incidence of acute graft-versus-host disease was 28.4%, (all grade I-II). Viral reactivation was seen in 13/30 (43.3%) patients, including HHV6 (n = 6), CMV (n = 4), and adenovirus (n = 2). At latest follow-up, 25/26 surviving patients have donor chimerism ≥ 90% and 16/25 (64.0%) have discontinued immunoglobulin replacement. Second HSCT offers IEI patients with graft failure curative treatment with good overall survival and immunological recovery.

Single-cell transcriptome profiling of sepsis identifies HLA-DRlowS100Ahigh monocytes with immunosuppressive function

BackgroundSustained yet intractable immunosuppression is commonly observed in septic patients, resulting in aggravated clinical outcomes. However, due to the substantial heterogeneity within septic patients, precise indicators in deciphering clinical trajectories and immunological alterations for septic patients remain largely lacking.MethodsWe adopted cross-species, single-cell RNA sequencing (scRNA-seq) analysis based on two published datasets containing circulating immune cell profile of septic patients as well as immune cell atlas of murine model of sepsis. Flow cytometry, laser scanning confocal microscopy (LSCM) imaging and Western blotting were applied to identify the presence of S100A9+ monocytes at protein level. To interrogate the immunosuppressive function of this subset, splenic monocytes isolated from septic wild-type or S100a9−/− mice were co-cultured with naïve CD4+ T cells, followed by proliferative assay. Pharmacological inhibition of S100A9 was implemented using Paquinimod via oral gavage.ResultsScRNA-seq analysis of human sepsis revealed substantial heterogeneity in monocyte compartments following the onset of sepsis, for which distinct monocyte subsets were enriched in disparate subclusters of septic patients. We identified a unique monocyte subset characterized by high expression of S100A family genes and low expression of human leukocyte antigen DR (HLA-DR), which were prominently enriched in septic patients and might exert immunosuppressive function. By combining single-cell transcriptomics of murine model of sepsis with in vivo experiments, we uncovered a similar subtype of monocyte significantly associated with late sepsis and immunocompromised status of septic mice, corresponding to HLA-DRlowS100Ahigh monocytes in human sepsis. Moreover, we found that S100A9+ monocytes exhibited profound immunosuppressive function on CD4+ T cell immune response and blockade of S100A9 using Paquinimod could partially reverse sepsis-induced immunosuppression.ConclusionsThis study identifies HLA-DRlowS100Ahigh monocytes correlated with immunosuppressive state upon septic challenge, inhibition of which can markedly mitigate sepsis-induced immune depression, thereby providing a novel therapeutic strategy for the management of sepsis.

Bacterial Microorganisms in Definitive Neonatal Sepsis

Background The proper diagnosis and treatment of neonatal sepsis is done depends on the understanding of its causative organisms. Objective The present study aimed to investigate the types of microorganisms in definitive neonatal sepsis. Methods Neonatal sepsis is a serious infectious disease with high mortality. And its diagnosed by blood culture. It includes early (appearance of clinical symptoms from birth to the third-seventh day) and late (from the third day to the twenty-eighth day) types with specific and sometimes common clinical symptoms. This cross-sectional study was performed on 266 neonates hospitalized with definitive sepsis in Ghaem Hospital in Mashhad from 2010 to 2020 using available sampling method. Infants suspected of bacterial infection who had positive blood cultures were included in the study. Type of bacterial organism, time of sepsis, main causes of death and need for mechanical ventilation were evaluated. Results Eighty eight neonates had early sepsis and 197 neonates had late sepsis. The bacterial organism of early sepsis was gram negative as 70.1% and in late sepsis was gram negative as 77.1%. The most common causes of early sepsis were Klebsiella pneumonia 21 cases (23.9%), Staphylococcus epidermis 16 cases (18.2%) and 10 cases (11.4%) E. coli . And the most common causes of late sepsis were K. pneumonia 35 cases (25.4%), Enterobacter aeroginosa 25(18.1%), S. epidermis 12(8.7%) and E. coli 11(8%). Conclusion K. pneumonia, S. epidermis and E. coli were three most common organisms in early neonatal sepsis and K. pneumonia, S. epidermis and Enterobacter were the most common organisms in late neonatal sepsis.

Effect of Maternal Coronavirus Disease on Preterm Morbidities.

Coronavirus disease (COVID-19) during pregnancy may have an impact on preterm morbidities due to the inflammatory nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Exposure to intrauterine inflammation could result in adverse consequences in preterm infants. We aimed to determine the effect of maternal coronavirus disease on preterm morbidities at a tertiary neonatal intensive care unit. This observational cohort study compared the clinical outcomes of preterm infants < 37 gestational weeks with and without maternal COVID-19. The study was conducted in a tertiary-level neonatal intensive care unit between March 2020 and December 2021. Demographics and clinical data of the study groups were collected from the medical files. A total of 254 infants (127 in the maternal COVID-19 group and 127 in the control group) were included in the study. Respiratory distress syndrome, early and late neonatal sepsis, intraventricular hemorrhage, patent ductus arteriosus (PDA), necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity rates were similar between groups. In the subgroup analysis, the rate of PDA was significantly higher in preterm infants ≤1,500 g with maternal SARS-CoV-2 infection (38 vs. 15% p = 0.023). Presence of maternal COVID-19 was found to be an independent predictor for PDA in very low birthweight infants, as revealed by multivariate analyses (odds ratio: 3.4; 95% confidence interval: 1.12-10.4; p = 0.031). Mortality rates and duration of hospitalization were similar in both groups. Our results suggest that COVID-19 infection during pregnancy seems to have no adverse effect on preterm morbidities and mortality. However, maternal COVID-19 was found to be a risk factor for PDA in preterm infants ≤1,500 g. · The effect of maternal COVID-19 on preterm morbidities still has not well defined.. · Maternal COVID-19 seems to have no adverse effect on preterm morbidities and mortality.. · The exact impact of the COVID-19 on fetal/neonatal health is yet to be clarified..

Evaluation of Haematological Parameters and Uric Acid in the Diagnosis of Late Onset Neonatal Sepsis.

Introduction A number of parameters studied in a whole blood count can be helpful in the diagnosis of neonatal sepsis. The platelet/lymphocyte ratio (PLR) is a systemic inflammatory marker in early sepsis and has been used as a diagnostic indicator in cardiovascular events and cancer. Being one of the major antioxidants in human biological fluids, serum uric acid is responsible for neutralising free radicals. The red cell distribution width/platelet ratio (RPR) is a diagnostic marker in adult inflammatory diseases. The objective of our study is to investigate the relationship of late neonatal sepsis with whole blood count parameters and serum uric acid levels. Materials and methods Newborns older than postnatal three days who had clinical and laboratory findings of sepsis were included in the study. The study included 140 newborns who were divided into three groups, 53 in the culture-proven late sepsis group, 47 in the clinical sepsis group, and 40 in the healthy control group. The whole blood count parameters and serum uric acid levels were examined in both the clinical sepsis and proven sepsis patients at the time when they were diagnosed with sepsis. Results The birth week was significantly lower in the evidenced and clinical sepsis patients compared to the healthy control group. Development of late sepsis was significantly higher in the male gender than in healthy controls. Serum uric acid levels were significantly higher in proven or clinical sepsis than in healthy controls. The level of serum uric acid (3.77±1.6) in proven sepsis was significantly higher than the control group (2.83±1.1). The uric acid level had an area under the curve (AUC) 0.552-0.717, 35% sensitivity, 95% specificity, 94.6% positive predictive value (PPV), and 36.9% negative predictive value (NPV) in the diagnosis of proven and clinical late sepsis. Neutrophil/lymphocyte ratio (NLR) was significantly higher in proven sepsis than in healthy newborns and was higher in the clinical sepsis group than in the proven sepsis group (p: 0.002). While the mean eosinophil value was 618.5±472.1 in proven sepsis, it was 549.3±294.9 in the control group and there was a statistically significant difference between the two groups (p: 0.036). Conclusion In late-onset neonatal sepsis, the NLR level was higher, and the eosinophil level was lower in the clinical sepsis patients than in healthy newborns. We believe that a higher level of serum uric acid in sepsis is effective in the early diagnosis of patients who also had other clinical findings of sepsis.

Effect of Early Administration of Oropharyngeal Colostrum in Reducing Late Onset Neonatal Sepsis

Background: Early administration of colostrum by oropharyngeal route plays a tremendous role in preventing mortality and morbidity in preterm infants. The objective of this study was to determine if oropharyngeal administration of mother’s own colostrum within 24 hrs of life can reduce rates of Late Onset Neonatal Sepsis (LONS) in preterm neonates. Methods: This randomized, placebo-controlled study was conducted in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka from July, 2019 to June, 2021. Neonates with birth weight ≤ 1800 g and/or gestational age ≤ 34 weeks were enrolled in this study. Intervention group received maternal colostrum (0.2 mL), within 24 hours of birth, every 3 hrly for the next 3 days. Serum IgA was measured at 24hrs and 7th day of postnatal age. Results: A total of 104 neonates were enrolled, 52 were randomized to oropharyngeal administration of colostrum group and 52 to placebo group. Finally, 40 patients among the placebo group completed the study. There was reduction in the incidence of LONS 55.7% vs. 85% (p = 0.003); probable sepsis 46.1% vs. 70% (p = 0.033), proven sepsis 36.5% vs. 57.5% (p = 0.058). Among the secondary outcome there was reduction of DIC 23% vs. 55% (p = 0.002), use of mechanical ventilators 21.1% vs 55% (p = 0.001), no of inotropes 1.18±0.395 vs 1.61±0.497 (p = 0.002), duration of inotropes 19.77±14.249 vs. 36.57±17.502; (p = 0.002). Conclusion: This study concluded that the incidence of late-onset neonatal sepsis, DIC, use of MV and inotropes, duration of inotropes can be significantly reduced in preterm neonates by oropharyngeal administration of mother’s own colostrum.

Establishing the role of the FES tyrosine kinase in the pathogenesis, pathophysiology, and severity of sepsis and its outcomes.

Sepsis is a result of initial over-activation of the immune system in response to an infection or trauma that results in reduced blood flow and life-threatening end-organ damage, followed by suppression of the immune system that prevents proper clearance of the infection or trauma. Because of this, therapies that not only limit the activation of the immune system early on, but also improve blood flow to crucial organs and reactivate the immune system in late-stage sepsis, may be effective treatments. The tyrosine kinase FES may fulfill this role. FES is present in immune cells and serves to limit immune system activation. We hypothesize that by enhancing FES in early sepsis and inhibiting its effects in late sepsis, the severity and outcome of septic illness can be improved. In vitro and in vivo modeling will be performed to determine the degree of inflammatory signaling, cytokine production, and neutrophil extracellular trap (NET) formation that occurs in wild-type (WT) and FES knockout (FES-/- ) mice. Clinically available treatments known to enhance or inhibit FES expression (lorlatinib and decitabine, respectively), will be used to explore the impact of early vs. late FES modulation on outcomes in WT mice. Bioinformatic analysis will be performed to examine FES expression levels in RNA transcriptomic data from sepsis patient cohorts, and correlate FES expression data with clinical outcomes (diagnosis of sepsis, illness severity, hospital length-of-stay). Ethics approval pending from the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board. Results will be disseminated through scientific publications and through lay summaries to patients and families.

Pattern of microbial profile and their susceptibility pattern in a tertiary level neonatal intensive care unit, Dubai, UAE: 11 years surveillance study

Introduction: Neonatal sepsis is a global burden on the health and wellbeing of the neonates. It mounts too many neonatal mortality and morbidity. However, rational use of antimicrobial therapy and aggressive supportive management has modified the outcome over the past few decades. A good knowledge of locally prevalent microbes and antibiotics sensitivity pattern help in formulating antibiotics regimen. Methodology: This study is a retrospective analysis of prevalent microorganisms isolated from various culture samples collected from neonates aged 0 - 90 days, suspected to have early or late onset neonatal sepsis. All the neonates were admitted to Neonatal intensive care unit (NICU) of Latifa Women and Children Hospital (LWCH) over an 11 year period (from January 2011 till December 2021). Descriptive analyses were used with results presented as proportions. Data were analyzed using Microsoft excel 2016 and online calculators. Results: A total of 4849 microbial culture positive isolates were identified from our NICU. These isolates included samples taken from, blood, cerebrospinal fluid, endotracheal aspirates, throat/nasopharynx, urine, rectal, stool, eyes and superficial cultures. Gram-negative bacteria were isolated in 56.3% (n= 2730). Gram positive bacteria accounted for 43.7% (n=2119) of isolates. Most common isolated bacterial species were Klebsiella pneumoniae (15.7%), Coagulase Negative Staphylococcus (CONS) (14.6%), Stenotrophomonas maltophilia (11.5%) and Pseudomonas aeruginosa (11.1%). Among the multidrug resistant organism (MDRO), Extended spectrum beta lactamase (ESBL) K. pneumoniae (n=208, 4.3%) and Methicillin resistant staphylococcus aureus (MRSA) (n=145, 3%) are the predominant strain. Over the study period, there is a significant reduction in both gram positive and gram negative bacterias (n=1055 in 2011 to 226 in 2021). Discussion/conclusion: The need of the hour is implementation of strict infection control measures and rationalized use of broad-spectrum antibiotics and continuous surveillance of emergence of MDROs. Regular tracking of the microbiological prevalence pattern kept us updated regarding prevailing organisms and emergence of MDROs. Our NICU antimicrobial policy modified in accordance with the surveillance data.

Pharmacokinetic parameters over time during sepsis and the association of target attainment and outcomes in critically ill children and young adults receiving ceftriaxone.

Early sepsis results in pharmacokinetic (PK) changes due to physiologic alterations. PK changes can lead to suboptimal drug target attainment, risking inadequate coverage from antibiotics like ceftriaxone. Little is known about how ceftriaxone PK and target attainment quantitatively change over time in patients with sepsis or the association between target attainment and outcomes in critically ill children and young adults. A retrospective analysis of a prospective study was conducted in a single-center pediatric intensive care unit. Septic patients given at least one ceftriaxone dose (commonly as 50 mg/kg every 12h) and who had blood obtained in both the first 48h of therapy (early) and afterwards (late) were included. Normalized clearance and central volume were estimated and compared in both sepsis phases. We evaluated target attainment, defined as concentrations above 1× or 4× the minimum inhibitory concentration (MIC) for 100% of dosing intervals, and investigated the association between target attainment and clinical outcomes. Fifty-five septic patients (median age: 7.5 years) were included. Normalized clearance and central volume were similar in both phases (6.18 ± 1.48 L/h/70 kg early vs. 6.10 ± 1.61 L/h/70 kg late, p=0.60; 26.6 [IQR 22.3, 31.3] L/70 kg early vs. 24.5 [IQR 22.0, 29.4] L/70 kg late, p=0.18). Individual percent differences in normalized clearance and central volume between sepsis phases ranged from -39% to 276% and -51% to 212% (reference, late sepsis), respectively. Fewer patients attained the 1× MIC target in late sepsis (82% late vs. 96% early, p=0.013), which was associated with transition to once daily dosing, typically done due to transfer from the pediatric intensive care unit (PICU) to a lower acuity unit. Failure to attain either target in late sepsis was associated with antibiotic broadening. Ceftriaxone PK parameters were similar between early and late sepsis, but there were large individual differences. Fewer patients attained MIC targets in late sepsis and all who did not attain the less stringent target received once daily dosing during this period. The failure to attain targets in late sepsis was associated with antibiotic broadening and could be an area for antibiotic stewardship intervention.

Sepsis-Induced Coagulopathy: An Update on Pathophysiology, Biomarkers, and Current Guidelines.

Significant cross talk occurs between inflammation and coagulation. Thus, coagulopathy is common in sepsis, potentially aggravating the prognosis. Initially, septic patients tend to exhibit a prothrombotic state through extrinsic pathway activation, cytokine-induced coagulation amplification, anticoagulant pathways suppression, and fibrinolysis impairment. In late sepsis stages, with the establishment of disseminated intravascular coagulation (DIC), hypocoagulability ensues. Traditional laboratory findings of sepsis, including thrombocytopenia, increased prothrombin time (PT) and fibrin degradation products (FDPs), and decreased fibrinogen, only present late in the course of sepsis. A recently introduced definition of sepsis-induced coagulopathy (SIC) aims to identify patients at an earlier stage when changes to coagulation status are still reversible. Nonconventional assays, such as the measurement of anticoagulant proteins and nuclear material levels, and viscoelastic studies, have shown promising sensitivity and specificity in detecting patients at risk for DIC, allowing for timely therapeutic interventions. This review outlines current insights into the pathophysiological mechanisms and diagnostic options of SIC.

The Prevalence and Risk Factors of Late Onset Neonatal Sepsis in SCANU (Special Care Newborn Unit)

Background: Despite significant attempts to mitigate its effects, neonatal sepsis including late onset neonatal sepsis is regarded as a major cause of morbidity and death in newborns. Objective: In this study our main goal is to evaluate the prevalence and risk factors of late onset neonatal sepsis in SCANU (Special Care Newborn Unit). Method: This cross sectional study was carried out at tertiary medical college and hospital where 100 neonates suspected of having neonatal sepsis and admitted in the neonatal unit were included. Clinical sepsis was diagnosed based on presence of one or more of clinical features. Clinical features considered were fever (≥38.0°C), hypothermia (≤36.5°C), convulsions, lethargy, poor feeding, respiratory distress, vomiting, bulging fontanels, jaundice, and umbilical pus infections. Results: The research found that 46% of the instances occurred in the 15-22 day age range, and that 88% of the participants were female. Seventy-five percent of the babies were fed formula, 20 percent of the babies used a bottle, and 80 percent of the patients had poor hygiene status. There were 6% instances of very low birth weight and 35% occurrences of low birth weight. In addition, a cough was seen in 51.7% of cases, a cough accompanied by respiratory distress in 66.0% of cases, a fever in 76.0% of cases, a reduction in urine output in 50% of cases, convulsions in 20% of cases, a skin rash in 92.0% of cases, and jaundice in 18.0% of cases. Sixty percent were given antibiotics for 1-5 days, and 58 percent of those admitted remained in the hospital for 6-10 days. The prevalence of Klebsiella pneumoniae was highest (38%), followed by staphylococcus aureus (27%), Pseudomonas aeruginosa (15%), Citrobacter species (10%), and Klebsiella oxytoca (8%). As part of the therapy, many antibiotics were administered all at once. These included Tazid, meropenem, kacin, Gentamicin, and others. 62% of patients were advised to follow up once therapy was completed (DA). ....

Gram-negative Late Onset Neonatal Sepsis in a Tertiary Care Center From Central India: A Retrospective Analysis.

Neonatal sepsis has been a major cause of neonatal mortality and morbidity globally. Late onset sepsis is on the rise mostly due to better health care services and improved survival of premature neonates. Gram-negative sepsis has emerged as a major public health problem constituting significant morbidity and mortality. There is limited data on gram-negative late onset sepsis from the central part of India, therefore this study was conducted at a tertiary care center from rural part of India. To determine the clinical profile and outcome among neonates with gram-negative late onset sepsis. It is a retrospective analysis conducted among neonates with gram-negative late onset sepsis at a tertiary care center from central India. All neonates below 28 days of age suspected to have late onset sepsis were enrolled in the study. The data for the period of January 2019 to December 2021 was collected and analyzed using software SPSS version 29. The outcome variables studied were discharge (good outcome) and death (poor outcome). In the present study, overall prevalence of gram-negative late onset sepsis was 4.8%. Respiratory distress (52.2%), seizure (18.9%), jaundice (15.6%), and lethargy (15.6%) were common clinical symptoms among neonates with sepsis. The most common organism isolated was Klebsiella spp. (36.7%) followed by Acinetobacter spp. (31.1%) and E. coli (17.8%). Low gestational age (n = 20 vs n = 7, P = .002) and low birth weight (n = 33 vs n = 4, P = .02) were associated with poor outcomes in neonates with gram negative LOS. The overall mortality rate was found to be 30% among neonates with gram negative sepsis. The prevalence of gram-negative sepsis was found to be 4.8%. Factors associated with poor outcome in gram-negative sepsis were low birth weight, and prematurity. Klebsiella spp. was found to be a common cause of gram-negative LOS, therefore, the empiric antibiotic policy must provide coverage against these micro-organisms.

Seis meses de aleitamento materno exclusivo no pré-termo de muito baixo peso submetido ao método canguru

OBJECTIVE: To know the rate and factors associated with exclusive breastfeeding in the follow-up of the preterm submitted to the kangaroo method. METHODS: Cross-sectional study performed with pre-terms smaller than 33 weeks and/or birth weight &lt;1,500 grams, born in 2019, submitted to the kangaroo method and followed up to six months. Descriptive analysis and association and comparison tests were carried out for the maternal and neonatal factors for the outcome of exclusive breastfeeding yes (G1) and not (G2) by the IBM-SPSS/Statistics program 22. RESULTS: Of the 111 patients who were discharged, 82 (100%) were followed up to the corrected ages 3.8/4.2 and chronological 5.9/6.3 months, respectively, in the G1/G2. Exclusive breastfeeding was present in G1 at 22 (26.8%) patients and 60 (73.2%) in the G2 had already introduced formula. Maternal age averages 28/29 years, gestational age 30.3/30.4 weeks, birth weight 1295/1434g, mechanical ventilation time 5.0/5.8 and total hospitalization 56/49 days in groups G1 and G2, respectively. Cesarian section frequencies 68/61%, necrotizing enterocolitis 4.5/8.3%, severe peri-intraventricular hemorrhage 4,5/8.3%, late sepsis 19/16.9%, and rehospitalization after discharge 4.5/6,8% in G1 and G2 patients. There was no statistical significance of the variables analyzed for the outcome of exclusive breastfeeding. CONCLUSION: Compared to other cohorts and at the service itself in 2010 analysis, the breastfeeding rate was high and, especially the exclusive breastfeeding, condition associated with the best development of the preterm. The perinatal variables were not determinants of the success of exclusive breastfeeding in these patients treated by the kangaroo method.

Early Detection of Late Onset Neonatal Sepsis Using Machine Learning Algorithms

Early Detection of Late Onset Neonatal Sepsis Using Machine Learning Algorithms

Bacteriological profiles and antibiotic susceptibility of neonatal sepsis in a university hospital of Northern India.

Knowledge of epidemiology of bacterial isolates and their anti-biograms in hospital settings is necessary for prompt empirical anti-microbial therapy of neonatal sepsis. To study risk factors, bacteriological profiles, and anti-biograms of blood culture isolates of both early and late onset neonatal sepsis. It is a prospective observational study conducted from January 2020 till July 2021 at our tertiary care center. Neonates (0-28 days) admitted to this neonatal intensive care unit clinically suspected with sepsis were subjected to blood cultures, and the isolates were identified both biochemically and by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system. Antibiotic susceptibility testing (AST) was performed as per CLSI guidelines. Chi-square test was used. Out of 280 suspected cases of neonatal sepsis, 43 (15.3%) cases showed positive blood culture. Of these, the majority (30, 69.8%) had late-onset neonatal sepsis. Major pre-disposing risk factors were pre-term birth and a low birth weight (26, 60.5%). Gram-negative bacteria and Gram-positive bacteria were isolated in 25 (58.1%) and 18 (41.9%) blood cultures, respectively. Klebsiella pneumoniae (37.5%) was the most predominant pathogen in both early-onset (23.1%) and late-onset (46.7%) sepsis. Coagulase negative Staphylococcus (34.8%) was the second most common organism and was more common in late onset (23.2%) neonatal sepsis. A high level of antibiotic resistance was noted in Klebsiella pneumoniae isolates, even to amikacin (76.5%) and carbapenems (66.7%). Increased resistance in bacterial isolates of neonatal sepsis emphasizes the need of AST of bacterial isolates for proper antibiotic administration.