Neonatal Sepsis In Preterm Infants Research Articles

Value of Combination of Heart Rate Observation (HeRO) Score and The Newborn Early Warning (NEW) System in Early Diagnosis of Sepsis in Preterm Infants

Abstract Background Although all newborns are at an increased risk of developing sepsis, this is particularly true for premature infants because of their immune systems haven’t fully matured. Early detection of sepsis, prior to overt clinical deterioration, would allow earlier institution of antibiotics and supportive therapies will result in better outcomes. Aim of the Work The aim of this study was to determine the effectiveness of combination of HeRO score and NEW system in early detection of neonatal sepsis in preterm infants by using HeRO score and NEW chart combined together. Methods The study included 170 preterm infants at Ain Shams Children Hospital, Cairo, Egypt: Prospective observational study. All studied neonates were subjected to NEW and HeRO scores which displayed a number or score, which represented the risk that a patient would experience clinical deterioration. Confirmation of neonatal sepsis done by withdrawal of C-reactive protein (CRP) and Blood culture. NEW system and HeRO scores followed throughout their hospital stay. The NEW system score chart divided into 3 colours (white, Amber and red). These colours used for identifying the risk for the patient. A HeRO score of 1 is “normal” for healthy preterm infants, and a score of 5 indicates a five-fold increased risk that the patient will be diagnosed with sepsis within the next 24 hours up to 5 days. Results The total number of our studied neonates were divided according to the sepsis or not into 80 neonates were sepsis free, 69 neonates who had initial sepsis and 21 who developed sepsis and NEW and HeRO scores showed statistically higher significance in patients with initial sepsis and developed sepsis than non-septic patients. NEW and HeRO score were significantly higher in septic patients than non- septic patients as cut of value of NEW and HeRO scores was >1 and >0 respectively. Conclusion The combination of HeRO score and NEW system can be used for early detection of neonatal sepsis in preterm infants.

Combination of red cell distribution width and procalcitonin as diagnostic biomarkers of neonatal sepsis in preterm infants

Background Diagnosis of neonatal sepsis is still challenging. Several diagnostics test have been developed to help diagnose of neonatal sepsis, but sometimes it could not be done routinely in limited facilities. Procalcitonin (PCT) and red cell distribution width (RDW) have been reported to have correlations with the risk of developing sepsis.
 Objective To evaluate the diagnostic value of combined of PCT and RDW as markers for neonatal sepsis in preterm infants.
 Methods A cross sectional study was conducted in the neonatal ward, Syaiful Anwar hospital, Malang, East Java. The subjects were preterm infants with neonatal sepsis. Blood culture were taken as the gold standard and RDW and PCT levels were assessed as the comparison. All of the test were performed at the begining of the study. The incidence of sepsis was reported as the main outcome. The data obtained were processed and analyzed using the receiver operating characteristic (ROC) method to obtain the area under curve (AUC) value.
 Results Fifty-five preterm infants presenting neonatal sepsis were enrolled in this study. The combination of RDW and PCT showed AUC 0.814 (P=0.199) with sensitivity and specificity 78.9% and 80.6%, respectively in diagnosing neonatal sepsis compared to blood culture.
 Conclusion Combination of RDW and PCT as markers of sepsis in preterm infants have good sensitivity and specificity.

Preterm sepsis is associated with acute lung injury as measured by pulmonary severity score.

Sepsis related acute lung injury (ALI) is established in adults but has not been investigated in premature infants. Herein, we used pulmonary severity score (PSS) trajectories and C-reactive protein (CRP) to examine the relation between sepsis and ALI in premature infants. This retrospective study identified 211 sepsis and 123 rule out (RO) events in 443 infants born <31 weeks and <1500 grams. The PSS was calculated prior to, at the time of, and up to 1 week after each event. Initial and peak CRP values were collected for each event. PSS significantly increased at 0 h from baseline (-72h) and remained increased at all subsequent time points (all p < 0.002) in sepsis events. Mean PSS in sepsis episodes were also higher compared to RO events at +24 h, +48 h, +72 h, and +168 h (all p < 0.004). A positive correlation was noted between peak CRP values in sepsis events and PSS at 0 h, +24 h, +48 h, and +72 h. The temporal PSS trends and correlation with CRP levels observed in sepsis but not in RO events supports the hypothesis that neonatal sepsis is associated with ALI and contributes to the accumulating evidence that neonatal ARDS occurs. To evaluate pulmonary severity scores and c-reactive protein values over time to establish an association between preterm neonatal sepsis and acute lung injury (ALI). Though sepsis is well established as the most common indirect cause of ALI leading to acute respiratory distress syndrome (ARDS) in adults and pediatrics, this phenomenon remains undefined in neonates. This study validates the proposal by the Neonatal ARDS Project that ARDS also occurs in neonates by demonstrating acute and sustained changes in markers of pulmonary injury temporally related to a diagnosis of neonatal sepsis in preterm infants.

Development of the cutaneous microbiome in the preterm infant: A prospective longitudinal study.

BackgroundNeonatal sepsis in preterm infants is often due to organisms that colonize the skin including Staphylococcus spp. and Candida spp. Development and maturation of the skin microbiome in the neonatal period, especially in preterm infants, may be critical in preventing colonization with pathogens and subsequent progression to neonatal sepsis. Development of the skin microbiome in preterm infants or its determinants in the first 4 weeks of life has not been evaluated.MethodsWe evaluated the skin microbiome from three body sites, antecubital fossa, forehead and gluteal region, in a prospective cohort of 15 preterm (birth weight < 1500 g and < 32 weeks of gestation) and 15 term neonates. The microbiome community membership and relative abundance were evaluated by amplification and sequencing the bacterial V3-V5 region of the16S rRNA gene on the 454 GS FLX platform. We used linear mixed effects models to analyze longitudinal data.ResultsThe structure and composition of the skin microbiome did not differ between the three sampling sites for term and preterm infants in the neonatal period. However, skin bacterial richness was positively associated with gestational age in the first four weeks of life. Intravenous antibiotics negatively impacted the bacterial diversity of the skin but we did not see differences with respect to feeding or mode of delivery.ConclusionsGestational age, which influences the maturity of skin structure and function, is associated with the development of the preterm cutaneous microbiome. Understanding the maturation of a healthy skin microbiome, prevention of pathogen colonization and its role in the development of immunity will be pivotal in the development of novel interventions to prevent infections in critically ill preterm infants.

Cord Blood Acute Phase Reactants Predict Early Onset Neonatal Sepsis in Preterm Infants.

BackgroundEarly onset sepsis (EOS) is a major cause of morbidity and mortality in preterm infants, yet diagnosis remains inadequate resulting in missed cases or prolonged empiric antibiotics with adverse consequences. Evaluation of acute phase reactant (APR) biomarkers in umbilical cord blood at birth may improve EOS detection in preterm infants with intrauterine infection.MethodsIn this nested case-control study, infants (29.7 weeks gestation, IQR: 27.7–32.2) were identified from a longitudinal cohort with archived cord blood and placental histopathology. Patients were categorized using culture, laboratory, clinical, and antibiotic treatment data into sepsis groups: confirmed sepsis (cEOS, n = 12); presumed sepsis (PS, n = 30); and no sepsis (controls, n = 30). Nine APRs were measured in duplicate from cord blood using commercially available multiplex immunoassays (Bio-Plex Pro™). In addition, placental histopathologic data were linked to biomarker results.ResultscEOS organisms were Escherichia coli, Streptococcus agalactiae, Proteus mirabilis, Haemophilus influenzae and Listeria monocytogenes. C-reactive protein (CRP), serum amyloid A (SAA), haptoglobin (Hp), serum amyloid P and ferritin were significantly elevated in cEOS compared to controls (p<0.01). SAA, CRP, and Hp were elevated in cEOS but not in PS (p<0.01) and had AUCs of 99%, 96%, and 95% respectively in predicting cEOS. Regression analysis revealed robust associations of SAA, CRP, and Hp with EOS after adjustment for covariates. Procalcitonin, fibrinogen, α-2-macroglobulin and tissue plasminogen activator were not significantly different across groups. Placental acute inflammation was associated with APR elevation and was present in all cEOS, 9 PS, and 17 control infants.ConclusionThis study shows that certain APRs are elevated in cord blood of premature infants with EOS of intrauterine origin. SAA, CRP, and Hp at birth have potential diagnostic utility for risk stratification and identification of infants with EOS.

The risk of early-onset neonatal sepsis in preterm infants with maternal histologic chorioamnionitis

Background Chorioamnionitis, usually a subclinical condition, maycause preterm delivery and long-term morbidity.Objective The objective of this study was to determine the risk ofearly-onset neonatal sepsis in preterm infants with maternal histo-logic chorioamnionitis (HCA).Methods This was a prospective cohort study of preterm infantsborn at Sanglah Hospital, Denpasar from September 2002 to Feb-ruary 2004. Histopathological examinations of the subjects’ placen-tas were done and the infants were monitored for 72 hours for clini-cal signs of early-onset neonatal sepsis. Maternal and neonatal riskfactors were analyzed using multivariate statistical analysis.Results Eighty-two preterm infants were included, of which 41 werepositive for maternal HCA. Twenty-five (61%) of the infants posi-tive for maternal HCA developed early-onset neonatal sepsis, com-pared to 5 (12%) of those negative for maternal HCA (RR=5, 95%CI2.12;11.78). Nine infants died from early onset neonatal sepsis.Eight of them had positive HCA, and only one had negative HCA.The average length of hospital stay between infants with and with-out maternal HCA did not differ significantly [12.0 (SD 5.08) vs.12.6 (SD 1.34); P=0.80]. Logistic regression model analysis iden-tified only HCA as a significant risk factor for early-onset neonatalsepsis (OR=6.9, 95%CI 2.0;23). Gestational age (OR=1.3, 95%CI0.8;2.0), birth weight (OR=1.0, 95%CI 0.9;1.0), and neonatal as-phyxia (OR=1.0, 95%CI 0.1;4.4) were not found to be significantrisk factors.Conclusion Preterm infants with maternal histologicchorioamnionitis are at a higher risk for developing early-onsetneonatal sepsis

Late-onset neonatal sepsis in preterm infants with birth weight under 1.500 g

The research objective was to characterize preterm infants with birth weight under 1500 g, and to identify the incidence of late-onset neonatal sepsis among this population. A prospective cohort study with a sample of 30 preterm newborns that weighed under 1500 g and were hospitalized in the NICU of the university hospital. Data were collected from January to December 2013 using a structured instrument. Of the 30 neonates included in the study, 14 developed late-onset neonatal sepsis with a prevalence of coagulase-negative staphylococci. The incidence of late-onset neonatal sepsis indicates a vulnerability in preterm infants due to immunological immaturity. These results reveal that knowledge of the profile of newborn infants admitted to the NICU and the risk factors to which they are exposed are central to the planning of nursing care for these patients. Future studies should address strategies for preventing nosocomial infection.

Role of presepsin in the diagnosis of late-onset neonatal sepsis in preterm infants

Objective: One of the most challenging aspects in the management of neonates with late-onset neonatal sepsis (LOS) is to make the diagnosis. Presepsin is a novel and promising marker of sepsis. The aim of this study was to assess the role of presepsin in the diagnosis of LOS in preterm infants.Methods: Forty-two premature newborns ≤32 weeks gestational age with a diagnosis of LOS were prospectively involved in the study. Forty gestational and postnatal age-matched infants without sepsis served as controls. Levels of presepsin, C-reactive protein, and procalcitonin were measured at enrollment and on the third and seventh days of sepsis.Results: Initial presepsin levels in the LOS group were significantly higher than in the control group (1024 pg/mL, min–max: 295–8202; versus 530 pg/mL, min–max: 190–782; p < 0.0001). The area under the receiver-operating curve for presepsin was 0.864. A presepsin value of 800.5 pg/mL was established as a cut-off value, with 67% sensitivity and 100% specificity. Presepsin levels gradually decreased during treatment.Conclusion: Presepsin can be used as a reliable biomarker for LOS and treatment response in preterm infants. However, we could not demonstrate the efficacy of presepsin for the detection of disease severity or prognosis.

The effect of topical ointment on neonatal sepsis in preterm infants

Objective: To investigate the effects of topical ointment therapy on neonatal sepsis in premature infants.Methods: A total of 197 premature infants ≤ 34 weeks gestation were randomized to receive topical ointment (Aquaphor Original Emollient) or routine skin care group. Skin cultures were obtained on 3th, 7th and 14th day and blood cultures were obtained if sepsis was suspected clinically. Data included the maternal and neonatal characteristics, factors affecting the risk of sepsis and neonatal outcomes of both groups were collected.Results: There were no significant differences in terms of gestational age, birth weight, gender, mode of delivery, multiple pregnancy and receiving antenatal corticosteroids between the study and control group. No statistically significant difference was found in the prevalence of sepsis, in the positive skin culture rates at any follow-up and in terms of the neonatal morbidities including patent ductus arteriosus and necrotizing enterocolitis between the groups. Although the rate of death was higher in the topical ointment group, no statistically significant difference was found between the groups.Conclusions: Our data suggests that applying topical ointment during the first 2 postnatal weeks did not affect the risk of neonatal sepsis in preterm infants, although it changed the bacterial flora on the skin compare to the routine care group.

Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants

The purpose of this study was to determine the role of serum amyloid A (SAA) in diagnosis of neonatal sepsis and evaluation of clinical response to antibiotic therapy. We also aimed to compare the efficiency of SAA with that of C-reactive protein (CRP) and procalcitonin (PCT) in diagnosis and follow-up of neonatal sepsis in preterm infants. A total of 163 infants were enrolled in this prospective study. The infants were classified into four groups: group 1 (high probable sepsis), group 2 (probable sepsis), group 3 (possible sepsis) and group 4 (no sepsis, control group). Blood samples for whole blood count, CRP, PCT, SAA and culture were obtained before initiating antibiotic treatment. This procedure was repeated three times at 48 h, 7 and 10 days. Initial CRP, PCT and SAA levels were found to be positive in 73.2, 75.6 and 77.2% of all infants, respectively. Sensitivities of CRP, PCT and SAA at 0 h were 72.3, 74.8 and 76.4%, respectively. Although it was not statistically significant, SAA was found to be more sensitive than CRP and PCT in diagnosis of neonatal sepsis. The area under the curve (AUC) for CRP, PCT and SAA at 0 h were 0.870, 0.870 and 0.875, respectively. Although the AUC for SAA at 0 h was higher than PCT and CRP, the difference was not statistically significant. SAA is an accurate and reliable marker for diagnosis and follow-up of neonatal sepsis. It is especially useful at the onset of inflammation for rapid diagnosis of neonatal sepsis and can be safely and accurately used in combination with other sepsis markers such as CRP and PCT in diagnosis and follow-up of neonatal sepsis in preterm infants.

Inmunofenotipificación de linfocitos T como marcador diagnóstico de sepsis neonatal tardía

Given the high risks associated with neonatal sepsis, there is a need for a diagnostic marker that would predict the disease before the results of blood or cerebrospinal fluid cultures are available. We evaluated changes in the CD4+ T lymphocyte immunophenotype in neonates with late-onset sepsis to try to improve the test combinations currently used (C reactive protein, immature:total neutrophil ratio, leukocytosis). We performed a prospective cohort study in 24 neonates with late-onset sepsis and 48 non-infected controls with a gestational age of 37 weeks or less. CD4+ T lymphocyte subpopulations in peripheral blood samples were identified by labeling with monoclonal antibodies and quantified by flow cytometry. Diagnostic performance curves were constructed by logistic regression. As a marker of late-onset neonatal sepsis, a percentage of CD4+/CD45RO+/CD45RA- T lymphocytes of >3.5% showed a sensitivity of 94.1%, specificity of 69.2%, positive predictive value of 80.0%, negative predictive value of 90.0%, and odds ratio of 36.0 (p<0.001). When we combined this marker with a C-reactive protein level of >10.0 mg/L, the specificity of this combination of tests increased to 94.7% and the positive predictive value to 85.7%. A percentage of CD4+/CD45RO+/CD45RA- T lymphocytes of >3.5% is an effective indicator of late-onset neonatal sepsis in preterm infants. If this marker is combined with a C-reactive protein level of >10.0 mg/l, its diagnostic performance is improved.