Plasma lactoferrin levels in newborn preterm infants with sepsis

Introduction: Lactoferrin (Lf) is one of the major proteins of all exocrine secretions with a role in the antinfective process. Our aim was to evaluate how plasma Fl levels may change in response to infection in newborn preterm infants.

Methods: A total of 15 (8 females, 7 males) newborn preterm infants with a postnatal age >72?h of life, underwent to blood culture and others markers of infection, for suspected sepsis, were enrolled in the study.

Results: We found that Lf serum concentration was significantly lowest in four neonates (26.7%) with confirmed sepsis than in 11 (73.3%) with clinical sepsis. The AUC was 0.90 (95%CI: 0.63–0.99). The optimal cutoff for Lf was?<1.2?μg/ml with a sensibility of 100% and a specificity of 81.8%. Lf serum concentration was positively correlated with WBC or neutrophil (Spearman rho = 0.69 and 0.49, respectively).

Conclusions: Serum Lf could prove a promising, sensitive and specific marker in the diagnostic approach to infants with suspected sepsis, thanks to its role in defense mechanisms and physiological functions of the immune system. Low levels of Lf in sepsis may suggest an immature response due to suboptimal leukocites activity in newborn preterm infants.     

Kernicterus in late preterm infants cared for as term healthy infants

OBJECTIVE: To compare the clinical profile and health care experiences related to management of newborn jaundice and hyperbilirubinemia in preterm infants (<37(0/7) weeks gestation) who are cared for as term infants (> or =37(0/7) weeks) and develop acute and/or chronic posticteric sequelae. METHODS: Retrospective study of a convenient sample of term and near term infants voluntarily reported to the Pilot Kernicterus Registry (1992-2003). Study infants were required to meet the clinical definitions for acute bilirubin encephalopathy (moderate or advanced severity) and/or the classical signs of kernicterus. Main outcome measures were the comparison of etiology, severity and duration of extreme hyperbilirubinemia (TSB levels >20 mg/dL), response to interventions of intensive phototherapy and exchange transfusion, and health care delivery experiences in preterm as compared with term infants. RESULTS: No targeted attention was accorded to preterm infants during their neonatal health care experiences as related to predischarge risk assessment, feeding, discharge follow-up instructions, or breastfeeding, regardless of the known vulnerability of preterm infants to safely transition during the first week after birth. The TSB levels, age at re-hospitalization, and birth weight distribution were similar for late preterm and term infants. Large for gestational age and late preterm infants disproportionately developed kernicterus as compared with those who were appropriate for gestational age and term. Clinical management of extreme of hyperbilirubinemia, by the attending clinical providers, was not impacted or influenced by the gestational age, clinical signs, or risk assessment. This resulted in severe posticteric sequelae which was more severe and frequent in late preterm infants. CONCLUSIONS: Late prematurity (34(0/7) to 36(6/7) weeks) of healthy infants was not recognized as a risk factor for hazardous hyperbilirubinemia by clinical practitioners. Unsuccessful lactation experience was the most frequent experience; being large for gestational age as well as the other known biologic risk factors for hyperbilirubinemia and bilirubin neurotoxicity were not identified by the clinical care providers either before discharge or at immediate postdischarge follow up.     

Histologic chorioamnionitis is associated with fetal growth restriction in term and preterm infants

OBJECTIVE: Our aim was to evaluate associations between chorioamnionitis and fetal growth restriction in infants enrolled in the Collaborative Perinatal Project. STUDY DESIGN: A total of 2579 nonanomalous, singleton infants delivered at 28 to 44 weeks' gestation with chorioamnionitis were matched 1:3 for ethnicity, gestational age, parity, and maternal cigarette use (all of which were correlated with both chorioamnionitis and markers of fetal growth restriction) with 7732 control infants. Moderate or marked leukocytic infiltrates of the placenta defined chorioamnionitis. Birth weight, length, head circumference, weight/length ratio, ponderal index, and birth weight/head circumference ratio in the lowest 5th percentile were markers of fetal growth restriction. Placental weight and the birth weight/placental weight ratio were also evaluated. RESULTS: Compared with data on matched control infants, histologic chorioamnionitis was associated with all markers of fetal growth restriction and with low birth weight/placental weight ratios (odds ratios, 1.3-1.7). The strongest associations were found at 28 to 32 weeks' gestation (odds ratios, 2.2-11). Attributable risks for several markers of fetal growth restriction exceeded 50% in infants born at <33 weeks' gestation. CONCLUSION: Histologic chorioamnionitis is associated with multiple markers of fetal growth restriction, with stronger associations noted in prematurity.     

Compassionate care for terminally ill term and preterm infants

Involvement of the family in decisions to withhold or withdraw intensive care and parental involvement in care planning for terminally ill infants does not aggravate or prolong parents' grief responses, their feelings of guilt, or the incidence of pathological grief responses. Effective physical pain and symptom management is critically important. Compassionate care plans, however, need to implement a number of other and equally important components. Parents are not uniform in their perceived needs to make various kinds of contacts with their dying infant. They should be allowed to make their individual choices regarding contact with their baby during that time. The perinatal loss of a twin infant appears to evoke no less serious stress and risks to parents' compared to the loss of a singleton. The disruption of family life during a perinatal loss affects siblings of the baby, and their specific needs should be acknowledged. Post-death or post-autopsy meetings with the family should routinely be scheduled a few weeks after death, and bereavement support should actively be offered. Parents need to be informed about differences to be expected between maternal and paternal grief responses. The risk of pathological grief variants and chronic grief should be mentioned to parents because professional help is required in such occurrence.     

Atypical acute respiratory disorder in late preterm and term newborn infants

Objective: We were to describe the clinical characteristics of late preterm and term newborn infants who needed invasive or non-invasive ventilation for respiratory distress but did not meet the diagnostic criteria of common neonatal respiratory disorders (atypical acute respiratory disorder; aRD).

Methods: We retrospectively reviewed electronic medical records of 242 late preterm and term newborn infants born who were admitted to the neonatal intensive care unit for acute respiratory distress developed within 24?h after birth.

Results: Newborn infants with aRD had significantly higher mean, maximum blood PCO₂ levels and maximum FiO₂ levels during the first 72?h after birth than infants with transient tachypnea of the newborn (TTN). Total periods of oxygen supplementation of the infants with aRD were significantly longer than those of infants with TTN, but shorter than those of the infants with meconium aspiration syndrome (MAS).

Conclusions: Except for definite diagnosis, higher oxygen need and PCO₂ level on blood gas analysis during the initial period of their respiratory illness may be able to predict aRD, and these interventions may be able to decrease neonatal respiratory morbidity.     

Late preterm infants, early term infants, and timing of elective deliveries

Delivery of infants who are physiologically mature and capable of successful transition to the extrauterine environment is an important priority for obstetric practitioner. A corollary of this goal is to avoid iatrogenic complications of prematurity and maternal complications from delivery. The purpose of this review is to describe the consequences of birth before physiologic maturity in late preterm and term infants, to identify factors contributing to the decline in gestational age of deliveries in the United States, and to describe strategies to reduce premature delivery of late preterm and early term infants.     

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.     

Arterial red cell indices in preterm and term infants at birth.

Baseline arterial red cell indices were determined at birth in 105 infants of various gestational ages. These arterial samples were obtained through an umbilical artery catheter or radial artery puncture from a selected group of patients who were evaluated for respiratory distress or possible infection. The red cell distribution width, a quantitative measure of heterogeneity of red cells in the peripheral blood, was consistently elevated, revealing a physiologic state of anisocytosis in the newborn. This new information has provided a useful baseline reference for normal red cell indices from arterial blood in neonates in the first 24 hours of life.     

The prognostic virtue of inflammatory markers during late-onset sepsis in preterm infants

AIM: Late-onset sepsis (occurring after the first three days of life) is a serious complication in preterm infants. In order to assess the possible prognostic virtues of the acute phase inflammatory response in the disease, we compared the inflammatory response of preterm infants who died within 72 hours (h) (fulminant sepsis) to infants who recovered from the disease (non-fulminant sepsis). METHODS: Of 42 preterm infants that were evaluated: 10 had fulminant sepsis and 32 non-fulminant sepsis. Acute phase inflammatory response markers-C-reactive protein (CRP), serum amyloid A (SAA), interleukin (IL)-6 levels and white blood cell (WBC) counts were measured at the first suspicion of LOS and after 8, 24 and 48 h. RESULTS: Small for gestational age (SGA) infants who were treated with fewer days of antibiotics characterized the fulminant sepsis group. The initial high levels of inflammatory markers were similar in both groups, but as early as 8 h after onset significantly lower levels of SAA, CRP and WBC counts were documented in the fulminant sepsis group. The inflammatory response remained low at 24 and 48 h in the fulminant sepsis group, while in the survivors, significantly increased inflammatory markers were measured. Decreases in the levels of the inflammatory markers preceded episodes of metabolic acidosis and arterial hypotension that were more common in the fulminant sepsis group. Infant mortality correlated inversely with SAA levels at 8 h and with CRP and WBC counts at 24 h after onset. CONCLUSION: SAA, CRP and WBC counts can be used as prognostic markers in LOS in preterm infants, with SAA being the earliest prognostic marker.     

Maternal infection and risk of cerebral palsy in term and preterm infants.

OBJECTIVE: We tested the hypothesis that term and preterm infants exposed to maternal infection at the time of delivery are at increased risk of developing cerebral palsy (CP). STUDY DESIGN: A population-based case-control study was conducted using Washington State birth certificate data linked to hospital discharge data. Cases (688) were children 相似文献   

Fully automated simultaneous umbilical arteriovenous exchange transfusion in term and late preterm infants with neonatal hyperbilirubinemia

Objectives: The purpose of this study was to compare the efficacy and safety of two different catheterization techniques of exchange transfusion (ET) used in the therapy of newborn jaundice: fully automated two-way ET technique and the classical one-way ET.

Patients and methods: The study included babies at gestational age of >34 weeks. In total, 107 ETs were performed on 86 babies. Totally, the umbilical vein (UV) group included 54 babies having undergone 69 ETs and the UV/UA group included 32 babies having undergone 38 ETs.

Results: The declines in bilirubin levels right after ET (p?=?0.018) and 8?h after ET (p?=?0.014) were higher in the fully automated UV/UA technique than in the classical UV technique. Furthermore, the duration of intensive phototherapy following ET was shorter in the UV/UA method than in the UV method (p?=?0.003). There was no difference between the two methods in terms of ET-associated complications (p?=?0.927).

Conclusions: In neonatal hyperbilirubinemia, ET with fully automated UV/UA technique is more efficient than the classical ET technique, causing no additional side-effects. It is also more physiological than the classical technique, since it minimizes the fluctuations in the blood volume and intravascular pressure during ET.     

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.     

不同类型病原体所致早产儿败血症的临床特点

目的 探讨革兰阴性杆菌、革兰阳性球菌及真菌性早产儿败血症的临床特点. 方法 回顾性分析2008年10月至2011年6月北京军区总医院附属八一儿童医院极早产新生儿监护病房140例早产儿败血症资料,对不同类型病原体早产儿败血症临床特点进行比较.计量资料采取单因素方差分析,组间比较采用LSD方法.多组率的比较采取卡方检验或Fisher精确概率法. 结果 140例早产儿败血症中,革兰阴性杆菌感染70例,革兰阳性球菌感染36例,真菌感染34例.革兰阴性杆菌败血症前3位病原体依次为肺炎克雷伯菌(39例,55.7％)、大肠埃希菌(14例,20.0％)和鲍曼不动杆菌(9例,12.9％);革兰阳性球菌败血症前3位病原体依次为表皮葡萄球菌(13例,36.1％)、人葡萄球菌(8例,22.2％)和溶血葡萄球菌(7例,19.4％).真菌败血症前3位病原体依次为近平滑假丝酵母菌(15例,44.1％)、白假丝酵母菌(8例,23.5％)和无名假丝酵母菌、罗伦特隐球菌(各3例,各8.8％).革兰阴性杆菌组、革兰阳性球菌组及真菌组患儿在娩出方式、胎儿窘迫、窒息、胎儿生长受限、羊水粪染、母亲产前感染、妊娠期高血压疾病、母亲糖尿病、新生儿外周静脉置入中心静脉导管、感染前机械通气、皮质激素暴露、脑室内出血及脑室周围白质软化发生率、未成熟中性粒细胞数与中性粒细胞总数比值、血小板恢复正常时间、发病时间、发热、体温不升方面差异无统计学意义(均P＞0.05),但在出生胎龄[分别为(30.4±2.3)、(31.0±2.4)、(29.5±1.8)周,F=4.317,P=0.015]、出生体重[分别为(1512.5±406.0)、(1563.8±485.4)、(1328.8±303.2)g,F=3.190,P=0.044]、胎膜早破[分别为24.3％(17/70)、16.7％(6/36)、44.1％(15/34),X2=7.241,P=0.034]、新生儿外科手术[分别为12.9％(9/70)、38.9％(14/36)、11.8％(4/34),X2=10.430,P=0.005]、低灌注[分别为64.3％(45/70)、30.6％(11/36)、50.0％(17/34),X2=10.922,P=0.004]、频繁呼吸暂停[分别为67.1％(47/70)、36.1％(13/36)、55.9％(19/34),X2=9.341,P=0.009]、白细胞降低[分别为21.4％(15/70)、8.3％(3/36)、32.4％(11/34),X2=6.267,P=0.042]、血小板减少[分别为64.3％(45/70)、16.7％(6/36)、67.6％(23/34),X2=25.576,P=0.000]、外周血白细胞计数[分别为(19.9±17.8)、(19.9±14.3)、(12.0±8.1)×109/L,F=3.553,P=0.031]、血小板计数[分别为(159.1±169.1)、(311.8±179.7)、(121.4±123.4)×109/L,F=14.140,P=0.000]、C-反应蛋白水平[分别为(76.8±70.1)、(16.6±27.2)、(31.8±27.5) mg/L,F=17.248,P=0.000]及中枢神经系统感染[分别为1.4％(1/70)、2.8％(1/36)、11.8％(4/34),X2=5.066,P=0.043]、早产儿视网膜病变[分别为38.6％(27/70)、50.0％(18/36)、67.7％(23/34),X2=8.780,P=0.012]、肺支气管发育不良[分别为8.6％(6/70)、11.1％(4/36)、26.5％(9/34),X2=5.837,P=0.044]以及病死率[分别为11.4％ (8/70)、0.0％(0/36)、2.9％(1/34),X2=5.361,P=0.042]等方面差异有统计学意义. 结论 不同类型病原体早产儿败血症在危险因素(出生胎龄、出生体重、胎膜早破、新生儿外科手术)、临床表现、感染指标以及预后方面存在差异.革兰阴性杆菌易于出现休克表现,C-反应蛋白升高最明显,预后最差;真菌感染易于侵犯中枢,早产儿视网膜病变及肺支气管发育不良的发病率较高;革兰阳性球菌败血症临床表现最轻,感染指标变化较小,预后相对较好.     

Mood states and milk output in lactating mothers of preterm and term infants.

The purpose of this study is to compare psychological distress via both negative and positive mood states between 2 different groups of lactating mothers during the first 6 weeks postpartum with a large sample. Mood states were measured using the Multiple Affect Adjective Check List-Revised by a convenience sample of newly delivered mothers from 4 tertiary care units in Illinois. Preterm mothers' negative mood states of anxiety, depression, hostility, and dysphoria were significantly greater than those reported for term mothers. For the positive mood states of positive affect and PASS (positive affect + sensation seeking), preterm mothers had significantly lower scores than term mothers; there were no differences for the positive mood state, Sensation Seeking. Maternal perceived mood states had no apparent effect upon lactation as measured by milk volume produced. Further study is warranted to determine what factors influence milk output in mothers of preterm and term infants who are at risk for lactation failure.