15,911 results on '"NEONATAL sepsis"'
Search Results
2. New and old lessons from a devastating case of neonatal E coli meningitis.
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Saleh, Tawny, Kamau, Edwin, and Rathe, Jennifer
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Acridine orange stain ,CSF sterility ,Neonatal E coli meningitis ,Neonatal sepsis ,Humans ,Infant ,Newborn ,Anti-Bacterial Agents ,Infant ,Premature ,Infant ,Premature ,Diseases ,Meningitis ,Escherichia coli - Abstract
BACKGROUND: Neonatal Escherichia coli (E coli) meningitis results in significant morbidity and mortality. We present a case of a premature infant with extensive central nervous system (CNS) injury from recurrent E coli infection and the non-traditional methods necessary to identify and clear the infection. CASE PRESENTATION: The infant was transferred to our institutions pediatric intensive care unit (PICU) after recurrence of E coli CNS infection requiring neurosurgical intervention. He had been treated for early onset sepsis (EOS) with ampicillin and gentamicin for 10 days followed by rapid development of ampicillin-resistant E coli septic shock and meningitis after discontinuation of antibiotics. Sterility of the CNS was not confirmed at the end of 21 days of cefepime therapy and was subsequently followed by recurrent ampicillin-resistant E coli septic shock and CNS infection. Despite 6 weeks of appropriate therapy with sterility of CSF by traditional methods, he suffered from intractable seizures with worsening hydrocephalus. Transferred to our institution, he underwent endoscopic 3rd ventriculostomy with cyst fenestration revealing purulent fluid and significant pleocytosis. An additional 3 weeks of systemic and intraventricular antibiotics with cefepime and tobramycin were given but a significant CNS neutrophil-predominant pleocytosis persisted (average of ∼ 21,000 cells/mm3). Repeated gram stains, cultures, polymerase chain reaction (PCR) testing, and metagenomic next generation sequencing (NGS) testing of CSF were negative for pathogens but acridine orange stain (AO) revealed numerous intact rod-shaped bacteria. After the addition of ciprofloxacin, sterility and resolution of CSF pleocytosis was finally achieved. CONCLUSION: Neonatal E coli meningitis is a well-known entity but unlike other bacterial infections, it has not proven amenable to shorter, more narrow-spectrum antibiotic courses or limiting invasive procedures such as lumbar punctures. Further, microbiologic techniques to determine CSF sterility suffer from poorly understood limitations leading to premature discontinuation of antibiotics risking further neurologic damage in vulnerable hosts.
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- 2024
3. Using Machine Learning to Model Early-onset Neonatal Sepsis Risk in Uganda and Zimbabwe (NeoRisk)
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MU-JHU CARE and Biomedical Research and Training Institute, Zimbabwe
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- 2024
4. Comparison Between Split Septum and Mechanical Valve Needleless Connector in Preterm Babies
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Dr. dr. Putri Maharani Tristanita Marsubrin, Sp. A(K), Neonatologist
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- 2024
5. Does Routine Assessment of Gastric Residuals in Preterm Neonates Influence Time Taken to Reach Full Enteral Feeding? (GRASS)
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Coombe Women and Infants University Hospital
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- 2024
6. Neonatal Sepsis and GBS Carriage Study (NSS)
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Wellcome Trust
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- 2024
7. Serosurveillance Study of Maternally Derived Anti-GBS Antibody (ProGreSs)
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MU-JHU CARE and MRC/UVRI and LSHTM Uganda Research Unit
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- 2024
8. Clinical Impact of an Antibiotic Stewardship Program in a Neonatal Intensive Care Unit
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Neveen Hassan, Principle investigator
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- 2024
9. Selective Antibiotics When Symptoms Develop Versus Universal Antibiotics for Preterm Neonates (SAUNA)
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Lady Hardinge Medical College, King George's Medical University, Indira Gandhi Institute of Child Health, Institute of Obstetrics and Gynecology, Government Medical College, Chandigarh, Pandit Bhagwat Dayal Sharma, PGIMS, Rohtak, Government Medical College, Aurangabad, King Edward Memorial Hospital, Mumbai, and Sourabh Dutta, Professor
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- 2024
10. Microfluidic Assessment of Clinical Outcomes in Preterm Newborns
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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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- 2024
11. Molecular Culture for the Diagnosis of Pediatric Sepsis (CHAMPIONS)
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InBiome and Jip Groen, Medical Doctor, PhD candidate
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- 2024
12. Intravenous Methylene Blue for Treating Refractory Neonatal Septic Shock
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Sourabh Dutta, Professor
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- 2024
13. Dopamine vs. Norepinephrine for Hypotension in Very Preterm Infants With Late-onset Sepsis
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Sunnybrook Health Sciences Centre, The Hospital for Sick Children, McMaster Children's Hospital, London Health Sciences Centre, Windsor Regional Hospital, Children's Hospital of Eastern Ontario, University of British Columbia, Foothills Medical Centre, Health Sciences Centre, Winnipeg, Manitoba, St. Boniface Hospital, Montreal Children's Hospital of the MUHC, Jewish General Hospital, St. Justine's Hospital, IWK Health Centre, The Rotunda Hospital, University College Cork, Coombe Women and Infants University Hospital, National Maternity Hospital, Ireland, Tel-Aviv Sourasky Medical Center, Island Health, Victoria, BC, Assaf-Harofeh Medical Center, El Paso Children's Hospital, The Woman's Hospital of Texas, CHRISTUS Health, Dayton Children's Hospital, Banner University Medical Center, and Methodist Healthcare
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- 2024
14. Parental Participation on the Neonatal Ward - the neoPARTNER Study (neoPARTNER)
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Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) and Dr. Sophie van der Schoor, Principal Investigator
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- 2024
15. Safely Reduce Newborn Antibiotic Exposure With the Early-onset Sepsis Calculator
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Dutch Society of Pediatrics, Zorgevaluatie Nederland, Care4Neo, everywhereIM, and prof. dr. Frans B. Plötz, Professor of Pediatric Health Care Evaluation
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- 2024
16. Presepsin to Safely Reduce Antibiotics in Preterm Infants (PRESAFE)
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Douwe Visser, Principal Investigator
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- 2024
17. Umbilical Cord Care in Term Neonates: The Role of Wondaleaf Adhesive Pouch (WLAP)
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Putra Medical Centre, Malaysia, Twin Catalyst Sdn Bhd, Malaysia, and Yu Chye Wah, Professor
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- 2024
18. Efficacy And Safety Of Short Course Antibiotic Therapy In Preterm Neonates With Early Onset Sepsis
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Sushma Nangia, M.D., Director Professor & Head, Department of Neonatology
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- 2024
19. NICU Antibiotics and Outcomes Trial (NANO)
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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and Michael Morowitz, Associate Professor
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- 2024
20. The High Initial Dose of Monitored Vitamin D Supplementation in Preterm Infants. (HIDVID)
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Medical University of Warsaw and Alicja Kołodziejczyk, MD, PhD
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- 2024
21. Late-onset Sepsis in Term and Pre-term Neonates and Infants up to 3 Months of Age
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- 2024
22. The Effect of Melatonin as an Adjuvant Therapy for Preterm Neonates With Sepsis
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Dwi Hidayah, Doctoral Program
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- 2024
23. How can we reduce neonatal sepsis after universal group B streptococcus screening?
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Fung, Tak Yuen and Sahota, Daljit Singh
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Background: Group B Streptococcus (GBS) infection remains a leading cause of newborn morbidity and mortality. The study aimed to determine the adherence rate to the universal screening policy a decade after its introduction. Secondly, whether the timing of antibiotics given in GBS carriers reduces the incidence of neonatal sepsis. Methods: Delivery records at Hong Kong Baptist Hospital in 2022 were examined to retrieve antenatal and intrapartum details regarding maternal GBS carrier status, previous maternal GBS carrier status, antibiotic treatment, timing of treatment, neonatal condition at birth and whether the neonate had sepsis. Univariate statistics was used to assess the relationship between maternal GBS carrier and neonatal sepsis overall. Incidence of neonatal sepsis was stratified according to mode of delivery and timing of antibiotic. Results: The adherence rate to the universal GBS screening policy was 97%. The risk of neonatal sepsis was 5.45 (95% CI 3.05 to 9.75) times higher in women who were GBS screened positive when compared to non-GBS carriers (p < 0.001). Amongst term neonates from GBS carriers delivered by Caesarean section, the risk of neonatal sepsis significantly decreased by 70% after antenatal antibiotic treatment (p = 0.041) whereas in term neonates delivered vaginally, the risk of neonatal sepsis decreased by 71% (p = 0.022) if intrapartum antibiotic prophylaxis was given 4 or more hours. Conclusion: Giving antenatal antibiotic treatment before Caesarean section or intrapartum antibiotic prophylaxis for 4 or more hours before vaginal delivery may decrease the risk of neonatal sepsis in term neonates delivered from GBS carriers. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Evaluation of the Efficacy and Safety of the Neonatal Sepsis Risk Calculator in a Tertiary Referral Center in Lebanon.
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Neaimeh, Yara, Ard, Natasha, Daher, Darine, Abourjeili, Joseph, Makki, Maha, Tamim, Hani, and Maalouf, Faouzi I.
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NEONATAL intensive care units , *DISEASE risk factors , *ANTIBIOTIC overuse , *ANTIMICROBIAL stewardship , *SEPSIS , *NEONATAL sepsis - Abstract
Objective Early onset sepsis (EOS) is a significant cause of morbidity and mortality in the newborn period. This has led to overinvestigation and antibiotic overuse, which remains a concern in EOS management. Sepsis risk calculator (SRC), a tool validated in American and European populations, aids physicians in sepsis risk stratification and has been shown to decrease antibiotics overuse for EOS. The aim of the study was to evaluate the efficacy and safety of the SRC in a tertiary referral center in Lebanon. Methods This was a single-center retrospective cohort study, conducted at a tertiary medical center in Beirut, Lebanon, that included infants born at more than 34 weeks' gestational age between January 1, 2017 and January 1, 2019. Data was collected on risk factors for neonatal sepsis and the clinical management performed on each newborn. The SRC was used to calculate a sepsis risk score for each patient. Comparison between actual management performed and SRC recommendation was measured. Results We reviewed 3,085 charts, out of which 257 charts were excluded. Patients were stratified into two groups: high sepsis risk and low sepsis risk. Out of the 2,828 patients included, 81 infants (2.9%) had high risk of sepsis, out of which 2 patients had positive blood cultures. There were no patients with a low SRC score who had positive blood cultures. There were no patients who were supposed to receive antibiotics per the SRC recommendation who did not undergo workup for sepsis. Implementing SRC would have prevented antibiotics administration in 42 (1.5%) patients. Conclusion SRC was adequately capable of detecting neonates with sepsis without missing actual cases of EOS, providing initial support for its safety in the population studied. Implementing the SRC would result in reduced usage of antibiotics, laboratory tests, and admissions to the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Neonatal transfer and duration of hospitalization of newborns as potential risk factors for impaired mother-infant bonding: The Japan Environment and Children's Study.
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Shinohara, Satoshi, Shinohara, Ryoji, Kojima, Reiji, Otawa, Sanae, Kushima, Megumi, Miyake, Kunio, Yui, Hideki, Ooka, Tadao, Akiyama, Yuka, Horiuchi, Sayaka, Yokomichi, Hiroshi, and Yamagata, Zentaro
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NEWBORN infants , *NEONATAL intensive care units , *RECEIVER operating characteristic curves , *MULTIPLE regression analysis , *HOSPITAL care , *NEONATAL sepsis - Abstract
Currently, there is no consensus regarding the relationship between neonatal transfer and duration of hospitalization in cases of impaired mother-infant bonding (MIB). This study aimed to determine whether neonatal transfer and duration of hospitalization of newborns increase the risk for impaired MIB. The MIB Scale was used to assess impaired MIB 1 year after delivery, using data from the Japan Environment and Children's Study. A score ≥ 5 points indicated impaired MIB. Multiple logistic regression analyses were performed to estimate the association between neonatal transfer and duration of hospitalization of newborns with the risk of impaired MIB. A total of 66,402 pregnant women were included in the study. The overall incidence rate of impaired MIB was 11.2 %. The mean duration of hospitalization of newborns was 7.1 ± 6.4 days. After adjusting for potential confounders, neonatal transfer (adjusted odd ratio (OR): 1.13 [95 % confidence interval (CI)), 1.01–1.27]) and duration of hospitalization of newborns (adjusted OR 1.007; 95 % CI 1.003–1.010) were associated with impaired MIB. The area under the receiver operating characteristic curve for the duration of hospitalization of newborns for impaired MIB was 0.53. Maternal childhood abuse and neglect history were not evaluated, and information regarding whether the infants were admitted to the neonatal intensive care unit was unavailable. Japanese women whose newborns underwent neonatal transfer should be followed up for at least 1 year after delivery, regardless of the duration of hospitalization of newborns. • We report whether newborn hospitalization duration indicates MIB impairment. • Neonatal transfer was associated with a MIB impairment 1 year after delivery. • Related neonates should be monitored for at least 1 year after delivery. [ABSTRACT FROM AUTHOR]
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- 2024
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26. Mother Knows Best! Getting a Second Opinion from an Experienced Pediatrician When a Primary Carer Fears that their Child's Deteriorating Condition is Not Being Adequately Recognized by Health Care Professionals.
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Glasper, Edward Alan
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FEAR , *SERIAL publications , *HEALTH services accessibility , *PEDIATRICIANS , *MEDICAL personnel , *PARENT-child relationships , *NEONATAL intensive care units , *CHILD health services , *NEONATAL intensive care , *PEDIATRICS , *PHYSICIAN-patient relations , *EARLY diagnosis , *NEONATAL sepsis , *PSYCHOSOCIAL factors , *MEDICAL referrals , *CRITICAL care medicine - Published
- 2024
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27. Novel Insights on Group B Streptococcus in Pregnancy.
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LITMAN, ETHAN, YOUNG, BRETT, and SPIEL, MELISSA
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STREPTOCOCCAL disease prevention , *ANTIBIOTICS , *IMMUNIZATION , *MEDICAL protocols , *INFANT mortality , *MICROBIAL sensitivity tests , *DRUG resistance in microorganisms , *AMPICILLIN , *HOST-bacteria relationships , *DISEASES , *INTRAPARTUM care , *INTRAVENOUS therapy , *STREPTOCOCCAL diseases , *ANTIBIOTIC prophylaxis , *NEONATAL sepsis , *PENICILLIN , *DISEASE risk factors , *PREGNANCY - Abstract
Group B Streptococcus (GBS) is a frequent colonizer of the human genital and gastrointestinal tract. In pregnant or postpartum persons, colonization is often asymptomatic and can contribute to infectious morbidity in both the parturient and the newborn. The prevalence of invasive GBS disease has dramatically decreased over the past 3 decades. However, despite standardized clinical algorithms, GBS disease remains a public health concern. Our review summarizes the GBS bacteria pathophysiology, morbidity, management guidelines, and summarizes ongoing research. While novel testing and parturient vaccination are being explored, barriers exist, preventing guideline updates and widespread implementation. [ABSTRACT FROM AUTHOR]
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- 2024
28. Pitfalls in the Interpretation of Biomarkers in Neonatal Sepsis.
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Ganesamoorthi, Rajasri Ambalam and Kumarasamy, Poongodi Santhana
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ANTIBIOTICS ,BLOOD ,PREDICTIVE tests ,ENZYME-linked immunosorbent assay ,PEPTIDE hormones ,DESCRIPTIVE statistics ,CELL culture ,AGGLUTINATION tests ,MEDICAL screening ,DATA analysis software ,NEONATAL sepsis ,BIOMARKERS ,C-reactive protein ,SENSITIVITY & specificity (Statistics) - Abstract
Background: In India, 25%–65% of neonatal deaths are due to sepsis. Since it produces nonspecific symptoms, it is difficult to diagnose and manage. The present study assessed the value of brain natriuretic peptide (BNP) and C-reactive protein (CRP) to predict sepsis along with blood culture. Materials and Methods: Samples were collected from 90 neonates with suspected sepsis, submitted for blood culture, CRP by latex agglutination kit, and BNP by ELISA. Results: Of the 90 cases, blood culture was positive in 25 (28%) cases, BNP in 45 (50%) cases, and CRP in 36 (40%) cases. BNP was positive among 25 (100%) blood culture-positive cases. CRP, BNP, and blood culture were positive in 16 (18%) cases. Conclusion: Although BNP is an equally good marker in predicting sepsis, it is not widely available. Hence, screening by serial CRP along with blood culture alone reinforces the diagnosis. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Incidence and predictors of mortality among neonates with congenital heart disease in Ethiopia: a retrospective cohort study.
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Ayfokru, Abatwoy, Shewasinad, Sisay, Ahmed, Fuad, Tefera, Mitku, Nigussie, Genet, Getaneh, Emawaysh, Mengstie, Leweyehu Alemaw, Teklehaimanot, Wegayehu Zeneb, Seyoum, Worku Abemie, Gebeyehu, Mohammed Tessema, Alemnew, Metages, and Girma, Bekahegn
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CONGENITAL heart disease ,GESTATIONAL diabetes ,MEDICAL personnel ,NEONATAL sepsis ,PROPORTIONAL hazards models ,NEONATAL mortality - Abstract
Background: Neonatal mortality poses a significant public health challenge in sub-Saharan Africa, with congenital heart disease emerging as the leading cause of morbidity and mortality among neonates, especially in countries like Ethiopia. Despite efforts to reduce neonatal mortality rates, Ethiopia continues to experience an increased mortality rate, particularly among neonates with congenital heart disease. This study aims to investigate the incidence and predictors of mortality in this vulnerable population within Ethiopia. Method: A retrospective cohort study was conducted at an institution, involving 583 randomly selected neonates diagnosed with congenital heart disease. In the current study, the dependent variable was survival status. Data entry utilized EpiData data version 4.6, and analysis was performed using STATA version 16. Probability of death was compared using the log-rank test and Kaplan-Meier failure curve. Significant predictors were identified using bivariable and multivariate Cox regression. Model fitness and proportional hazard assumptions were evaluated using the Cox-Snell graph and Global test, respectively. Associations were assessed by adjusted hazard ratios with 95% confidence intervals. Results: The study participants were followed for 4844 days. The mortality rate was 9.9%. The incidence density was 11.9 per 1000 person-days of observation. Neonatal sepsis (AHR: 2.24; 95% CI [1.18–4.23]), cyanotic congenital heart disease (AHR: 3.49; 95% CI [1.93–6.28]), home delivery (AHR: 1.9; 95% CI [1.06–3.6]), maternal history of gestational diabetes mellitus (AHR: 1.94; 95% CI [1.04–3.61]), and having additional congenital malformations (AHR: 2.49; 95% CI [1.33–4.67]) were significant predictors for neonatal mortality. Conclusion and recommendation: The incidence density of mortality was high compared to studies conducted in developed countries. Neonatal sepsis, type of congenital heart disease, place of delivery, maternal history of gestational diabetes mellitus, and having an additional congenital malformation were significant predictors of mortality among neonates with congenital heart disease. Therefore, healthcare providers should pay special attention to patients with identified predictors. Furthermore, the Federal Ministry of Health, stakeholders, and policymakers should collaborate to address this issue. [ABSTRACT FROM AUTHOR]
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- 2024
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30. The potential role of heparinbinding protein in neonatal sepsis: research progress.
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Xiyang Chen, Haiting Li, Jie Li, Xixi Liu, Linlin Chen, Caie Chen, Junhui Yuan, and Enfu Tao
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NEONATOLOGY ,HOSPITAL mortality ,NEONATAL sepsis ,EARLY diagnosis ,CLINICAL medicine ,INFLAMMATION - Abstract
Neonatal sepsis is a major global health challenge, leading to significant morbidity and mortality in newborns. The search for precise biomarkers for its early prediction in clinical settings has been ongoing, with heparin-binding protein (HBP) emerging as a promising candidate. Originating from granules in neutrophils, HBP is released into the bloodstream in response to infection and plays a pivotal role in the body's inflammatory response. Its significance extends beyond its inflammatory origins; research indicates dynamic changes in HBP levels are strongly linked to reduce in-hospital mortality, offering a prognostic advantage over existing biomarkers. Furthermore, HBP has demonstrated considerable clinical utility in the early diagnosis and stratification of neonatal sepsis, suggesting its potential as a reliable blood marker for early prediction of the disease and its severity. Its application may extend to guiding the judicious use of antibiotics in treating newborns, addressing a critical aspect of neonatal care. Despite these encouraging results, the precise clinical utility of HBP for diagnosing and treating sepsis in neonates still demands further clarification through extensive research. This review delves into the current scientific understanding of HBP's contribution to diagnosing, prognosticating, and treating neonatal sepsis, while considering its future clinical applications. [ABSTRACT FROM AUTHOR]
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- 2024
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31. Neonatal bacteraemia in Ireland: A ten-year single-institution retrospective review.
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Powell, James, Beirne, Irene, Minihan, Brid, O'Connell, Nuala H., Sharma, Santosh, Dunworth, Margo, Philip, Roy K., and Dunne, Colum P.
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STREPTOCOCCUS agalactiae , *NEONATAL sepsis , *BLOOD collection , *BACTEREMIA , *PARENTERAL feeding - Abstract
Neonatal sepsis is a catastrophic condition of global concern, with reported mortality rates exceeding 10%. Bloodstream infections are an important cause of sepsis, and epidemiological studies of these infections are crucial for predicting the most common aetiological agents and antimicrobial susceptibility patterns and for developing antimicrobial guidelines. For the ten-year study period from July 2013 to June 2023, all neonatal bacteraemia cases were reviewed prospectively using an enhanced surveillance protocol. The patients were stratified according to their age at the time of blood culture collection: early onset if diagnosed in the first 72 hours of life, and late onset if diagnosed after that time. During the study period, 170 blood cultures were positive from 144 patients, of which 89 specimens from 64 patients represented the growth of significant pathogens. Coagulase-negative staphylococci (CoNS) were the most common pathogens identified (52%, 33/64), followed by Escherichia coli (14%, 9/64), Group B Streptococcus (GBS: 11%, 7/64) and Staphylococcus aureus (11%, 7/64). GBS was more commonly identified in early onset patients, while CoNS were predominantly associated with late onset. The presence of an intravascular catheter, maternal urinary tract infections and the receipt of total parenteral nutrition or transfused blood were identified as significant risk factors. The fatality rate was 8% (5/64). in summary, this study provides a detailed overview of the epidemiology of neonatal bacteraemia in a large teaching hospital in the Midwest of Ireland over a decade. [ABSTRACT FROM AUTHOR]
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- 2024
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32. Vaginal colonization with virulent and methicillin resistant Staphylococcus aureus among Ugandan women in Labour.
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Bwanga, Freddie, Mukashyaka, Claudine, Kateete, David Patrick, Tumuhamye, Josephine, Okeng, Alfred, Aboce, Emmanuel, Namugga, Olive, Kwizera, Richard, Sommerfelt, Halvor, and Nankabirwa, Victoria
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METHICILLIN-resistant staphylococcus aureus , *TOXIC shock syndrome , *DELIVERY (Obstetrics) , *GENITALIA , *METHICILLIN resistance , *NEONATAL sepsis - Abstract
Background: Staphylococcus aureus (S. aureus) often colonizes the human skin, upper respiratory and genital tracts. In the female genital tract, it can be passed on to the newborn during vaginal delivery leading to either ordinary colonization, or neonatal infections notably umbilical stump sepsis, scalded skin syndrome, arthritis, or bacteraemia/sepsis. These infections are mediated by staphylococcal virulence factors such as (i) Staphylococcal Enterotoxins A, B, C, D, and E encoded by the sea, seb, sec, sed, see genes, (ii) Exfoliative Toxins A and B encoded by the eta and etb genes, (iii) Toxic Shock Syndrome Toxin 1 (TSST-1) encoded by the tst gene, (iv) Panton-Valentine Leukocidin (PVL) encoded by the pvl gene, and (v) Hemolysins alpha and delta encoded by the hla and hld genes, respectively. We determined the prevalence of S. aureus possessing one or more virulence factor genes and of methicillin resistant Staphylococcus aureus (MRSA) in this population. Methods: This was a cross-sectional study, which used 85 S. aureus isolates from the Chlorohexidine (CHX) clinical trial study in Uganda. The isolates had been obtained by culturing vaginal swabs (VS) from 1472 women in labour, frozen at minus 80oC, then thawed, sub-cultured, and tested for the selected virulence genes sea, seb, sec, sed, see eta, etb, tst, pvl, hla and hld, and for the methicillin resistance determining gene (mecA). Data were analyzed using SPSS version 20. Results: Of the 85 S. aureus isolates 13 (15.3%) were positive for one or more virulence factor genes, as follows: pvl 9/85 (10.6%), hld 5/85 (5.9%), sea 1/85 (1.2%) and seb genes 1/85 (1.2%). The other virulence genes (sec, sed, see, eta, etb, hla and tst) were not detected in any of the isolates. MRSA was detected in 55.3% (47/85) of the isolates, but only two of these carried the pvl virulence gene. Conclusion: This study demonstrated that 15% of the S. aureus colonizing the female lower genital tract of mothers in labour in central Uganda carried one or more virulence genes, mostly pvl, indicating potential for newborn infection with S. aureus acquired in the maternal birth canal. More than half of the isolates were MRSA. [ABSTRACT FROM AUTHOR]
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- 2024
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33. Efficacy of short‐course antibiotics for culture‐positive neonatal sepsis: A systematic review and meta‐analysis.
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Singh, Poonam, Priyadarshi, Mayank, Chaurasia, Suman, and Basu, Sriparna
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REPORTING of diseases , *NEONATAL mortality , *TREATMENT failure , *DEATH rate , *TREATMENT duration , *NEONATAL sepsis - Abstract
Sepsis is a common cause of neonatal mortality and morbidity. Though antibiotics are the mainstay of treatment in culture‐positive neonatal sepsis, the dilemma persists for the optimum duration of antimicrobial therapy. The present study aimed to evaluate the efficacy of short‐course antibiotics for uncomplicated culture‐positive neonatal sepsis. This systematic review and meta‐analysis (PROSPERO: CRD42023444899) identified, appraised, and synthesised the available evidence from randomised and quasi‐randomised controlled trials related to the efficacy of short‐course (7–10 days) versus standard‐course (14 days) antibiotics for uncomplicated culture‐positive neonatal sepsis on the rate of treatment failure, mortality, duration of hospitalisation, morbidities including antibiotics‐related adverse events, long‐term neurodevelopmental outcomes and cost analysis. Data were pooled using RevMan 5.4 software. Certainty of evidence (COE) for predefined outcomes was analysed by GRADE. Available evidence showed no significant difference in the rate of treatment failure between 7‐ to 10‐day versus 14‐day antibiotics courses [risk ratio (95% confidence interval, CI), 2.45 (0.93–6.47), I2 = 0%, six studies, n = 573, very low COE]. No incidence of death was reported in either treatment arm in the two included studies. Duration of hospitalisation was significantly shorter with the short‐course antibiotics arm compared to standard‐course [mean difference (95% CI), −3.88 (−4.22 to −3.54) days, I2 = 0%, five studies, n = 507, low COE]. Morbidities reported in the three studies were similar. Other outcomes were not reported. To conclude the evidence is very uncertain about the effect of short‐course antibiotic regimen, compared to a standard‐course, on the treatment failure rate in uncomplicated culture‐positive neonatal sepsis. Adequately powered trials with outcomes including death and long‐term neurodevelopmental impairment are needed. [ABSTRACT FROM AUTHOR]
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- 2024
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34. Insights into left heart dynamics in neonatal cold septic shock—A case series.
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Sehgal, Arvind and Roberts, Calum T.
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CHILD patients , *CARDIOVASCULAR diseases , *SEPTIC shock , *VASCULAR resistance , *PROGNOSIS , *NEONATAL sepsis - Abstract
This article provides insights into the left heart dynamics in neonatal cold septic shock through a case series of infants with septic shock and cardiovascular dysfunction. The study emphasizes the need for further research on the prognostic value of echocardiography in septic children and the lack of large-scale neonatal data on cardiovascular dysfunction in sepsis. The infants in the case series exhibited symptoms such as oxygenation failure, pulmonary hypertension, and metabolic acidosis, with echocardiograms revealing low biventricular output and valve regurgitation. The article underscores the importance of early and serial assessments using echocardiography to monitor shock progression and tailor treatment accordingly, but notes the absence of prospective studies on the prevalence of cardiac dysfunction and its impact on outcomes in neonatal sepsis. [Extracted from the article]
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- 2024
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35. Prevalence of carbapenem-resistant gram-negative bacteria among neonates suspected for sepsis in Africa: a systematic review and meta-analysis.
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Sisay, Assefa, Asmare, Zelalem, Kumie, Getinet, Gashaw, Yalewayker, Getachew, Ermias, Ashagre, Agenagnew, Nigatie, Marye, Ayana, Sisay, Misganaw, Tadesse, Dejazmach, Zelalem, Abebe, Wagaw, Gedfie, Solomon, Tadesse, Selamyhun, Gashaw, Muluken, Jemal, Abdu, Kassahun, Woldeteklehymanot, Kidie, Atitegeb Abera, Abate, Biruk Beletew, Mulugeta, Chalie, and Alamrew, Abebaw
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CARBAPENEM-resistant bacteria , *GRAM-negative bacteria , *ESCHERICHIA coli , *NEONATAL sepsis , *ANTIMICROBIAL stewardship , *KLEBSIELLA pneumoniae - Abstract
Background: The emergence and rapid spread of gram-negative bacteria resistant to carbapenems among newborns is concerning on a global scale. Nonetheless, the pooled estimate of gram-negative bacteria resistant to carbapenem that cause neonatal sepsis in developing nations remains unknown. Thus, this study aimed to determine the combined prevalence of gram-negative bacteria resistant to carbapenem in African newborns who were suspected of having sepsis. Methods: All studies published from January 1, 2010, up to December 30, 2023, from PubMed, Science Direct, Scopus electronic databases, and the Google Scholar search engine were researched. Isolates tested for carbapenem from neonates with sepsis, English language papers conducted in Africa, and cross-sectional and cohort studies papers were included. Using PRISMA guidelines, we systematically reviewed and meta-analyzed studies that assessed the prevalence of carbapenem-resistant gram-negative bacteria. The "Joanna Briggs Institute" was used critically to evaluate the quality of the included studies. The data analysis was carried out using STATA™ version 17. Heterogeneity across the studies was evaluated using Q and I 2 tests. The subgroup analysis was done and, funnel plot and Egger's regression test were used to detect publication bias. A sensitivity analysis was conducted. Results: All 36 studies were included in the meta-analysis and systematic review. The pooled prevalence of carbapenem resistance in Africa was 30.34% (95% CI 22.03–38.64%). The pooled estimate of gram-negative bacteria resistant to imipenem, and meropenem was 35.57% (95% CI 0.67–70.54%) and 34.35% (95% CI 20.04% – 48.67%), respectively. A. baumannii and Pseudomonas spp. had pooled prevalence of 45.9% (95% CI 33.1–58.7%) and 43.0% (95% CI 23.0–62.4%), respectively. Similarly, Pseudomonas spp. and A. baumannii also exhibited strong meropenem resistance, with a pooled prevalence of 29.2% (95% CI 4.8–53.5%) and 36.7% (95% CI 20.1–53.3%), respectively. E. coli and K. pneumoniae were the two most common isolates. Conclusion: There should be urgent antimicrobial stewardship practices, strengthened surveillance systems and effective treatment for neonates with sepsis. There was remarkable variation in resistance across the continent. [ABSTRACT FROM AUTHOR]
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- 2024
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36. Influencing factors for surgical treatment in neonatal necrotizing enterocolitis: a systematic review and meta-analysis.
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Wang, Dandan, Zhang, Fanhui, Pan, Jiarong, Yuan, Tianming, and Jin, Xuefeng
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NEONATAL necrotizing enterocolitis ,PREOPERATIVE risk factors ,THERAPEUTICS ,BLOOD coagulation disorders ,SURGICAL indications ,ENTEROCOLITIS ,NEONATAL sepsis - Abstract
Background: Necrotizing enterocolitis (NEC) is a complex disease characterized by gastrointestinal inflammation and is one of the most common gastrointestinal emergencies in neonates. Mild to moderate cases of NEC require medical treatment, whereas severe cases necessitate surgical intervention. However, evidence for surgical indications is limited and largely dependent on the surgeon's experience, leading to variability in outcomes. The primary aim of this study is to identify the risk factors for surgical intervention in neonatal NEC, which will aid in predicting the optimal timing for surgical intervention. Methods: A literature search was conducted in PubMed, Embase, and Web of Science databases for case-control studies exploring risk factors for NEC requiring surgical intervention. The search was completed on June 16, 2024, and data analysis was performed using R Studio 4.3.2. Results: 18 studies were included, comprising 1,104 cases in the surgery group and 1,686 in the medical treatment group. The meta-analysis indicated that high C-reactive protein (CRP) levels [OR = 1.42, 95% CI (1.01, 1.99)], lower gestational age [OR = 0.52, 95% CI (0.3, 0.91)], sepsis [OR = 2.94, 95% CI (1.87, 4.60)], coagulation disorder [OR = 3.45, 95% CI (1.81, 6.58)], lack of enteral feeding [OR = 3.18, 95% CI (1.37, 7.35)], and hyponatremia [OR = 1.22, 95% CI (1.07, 1.39)] are significant risk factors for surgical treatment in neonatal NEC. Conclusions: High CRP levels, coagulation disorders, sepsis, lower gestational age, lack of enteral feeding, and hyponatremia are significant risk factors for surgical intervention in neonatal NEC. These findings have potential clinical significance for predicting surgical risk. [ABSTRACT FROM AUTHOR]
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- 2024
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37. Impact of neonatal sepsis on neurocognitive outcomes: a systematic review and meta-analysis.
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Ong, Wei Jie, Seng, Jun Jie Benjamin, Yap, Beijun, He, George, Moochhala, Nooriyah Aliasgar, Ng, Chen Lin, Ganguly, Rehena, Lee, Jan Hau, and Chong, Shu-Ling
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RANDOM effects model ,HEARING disorders ,CEREBRAL palsy ,VISION disorders ,ODDS ratio - Abstract
Introduction: Sepsis is associated with neurocognitive impairment among preterm neonates but less is known about term neonates with sepsis. This systematic review and meta-analysis aims to provide an update of neurocognitive outcomes including cognitive delay, visual impairment, auditory impairment, and cerebral palsy, among neonates with sepsis. Methods: We performed a systematic review of PubMed, Embase, CENTRAL and Web of Science for eligible studies published between January 2011 and March 2023. We included case–control, cohort studies and cross-sectional studies. Case reports and articles not in English language were excluded. Using the adjusted estimates, we performed random effects model meta-analysis to evaluate the risk of developing neurocognitive impairment among neonates with sepsis. Results: Of 7,909 studies, 24 studies (n = 121,645) were included. Majority of studies were conducted in the United States (n = 7, 29.2%), and all studies were performed among neonates. 17 (70.8%) studies provided follow-up till 30 months. Sepsis was associated with increased risk of cognitive delay [adjusted odds ratio, aOR 1.14 (95% CI: 1.01—1.28)], visual impairment [aOR 2.57 (95%CI: 1.14- 5.82)], hearing impairment [aOR 1.70 (95% CI: 1.02–2.81)] and cerebral palsy [aOR 2.48 (95% CI: 1.03–5.99)]. Conclusion: Neonates surviving sepsis are at a higher risk of poorer neurodevelopment. Current evidence is limited by significant heterogeneity across studies, lack of data related to long-term neurodevelopmental outcomes and term infants. [ABSTRACT FROM AUTHOR]
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- 2024
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38. Effect of β-lactam antibiotics on the gut microbiota of term neonates.
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Gu, Hongdan, Tao, Enfu, Fan, Yijia, Long, Gao, Jia, Xinyi, Yuan, Tianming, Chen, Lihua, Shu, Xiaoli, Zheng, Wei, and Jiang, Mizu
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GUT microbiome ,LACTIC acid bacteria ,NEONATAL sepsis ,ENTEROCOCCUS ,ENTEROBACTER ,STREPTOCOCCUS pneumoniae - Abstract
β-Lactam antibiotics are a class of antibiotics commonly used to treat bacterial infections. However, the effects of β-lactam antibiotics on term neonatal intestinal flora have not been fully elucidated. Hospitalized full-term newborns receiving β-lactam antibiotics formed the antibiotic group (n = 67), while those without antibiotic treatment comprised the non-antibiotic group (n = 47). A healthy group included healthy full-term newborns (n = 16). Stool samples were collected for 16 S rDNA sequencing to analyze gut microbiota variations. Further investigation was carried out within the β-lactam antibiotic group, exploring the effects of antibiotic use on the newborns' gut microbiota in relation to the duration and type of antibiotic administration, delivery method, and feeding practices. The antibiotic group exhibited significant difference of microbial community composition compared to the other groups. Genera like Klebsiella, Enterococcus, Streptococcus, Alistipes, and Aeromonas were enriched, while Escherichia-Shigella, Clostridium sensu stricto 1, Bifidobacterium, and Parabacteroides were reduced. Klebsiella negatively correlated with Escherichia-Shigella, positively with Enterobacter, while Escherichia-Shigella negatively correlated with Enterococcus and Streptococcus. Regardless of neonatal age, β-lactam antibiotics induced an elevated abundance of Klebsiella and Enterococcus. The impact on gut microbiota varied with the duration and type of antibiotic (cefotaxime or ampicillin/sulbactam). Compared to vaginal delivery, cesarean delivery after β-lactam treatment heightened the abundance of Klebsiella, Enterobacteriaceae_Unclassified, Lactobacillales_Unclassified, and Pectobacterium. Feeding patterns minimally influenced β-lactam-induced alterations. In conclusion, β-lactam antibiotic treatment for neonatal pneumonia and sepsis markedly disrupted intestinal microbiota, favoring Klebsiella, Enterococcus, Streptococcus, Alistipes, and Aeromonas. The impact of β-lactam varied by duration, type, and delivery method, emphasizing heightened disruptions post-cesarean delivery. [ABSTRACT FROM AUTHOR]
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- 2024
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39. Etiology, risk factors and antibiotic resistance in neonatal sepsis.
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Bibi, Saneeda, Ashfaq, Muhammad, Hussain, Wajid, Ismail, Fatima, Bader-U-Nisa, and Yasir, Mehrunnisa
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NEONATAL sepsis , *ESCHERICHIA coli , *PEDIATRICS , *PREMATURE labor , *DRUG resistance in bacteria - Abstract
Objective: To determine the etiology, risk factors and antibiotic resistance in neonatal sepsis. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: October 2023 to March 2024. Methods: A total of 174 neonates of both genders, with suspected neonatal sepsis were analyzed. Neonatal and maternal characteristics were noted. Blood sample was collected in aseptic environment and sent to institutional laboratory for blood culture and drug susceptibility testing. Results: In a total of 174 neonates, 101 (58.0%) were boys. The mean age, and weight were 9.61±7.86 years, and 2.25±0.85 kg, respectively. Neonatal sepsis on the basis of positive blood culture was reported in 38 (21.8%) neonates. Preterm birth had significant association with neonatal sepsis (44.7% vs. 26.5%, p=0.019). History of maternal UTI during pregnancy had significant linkage with neonatal sepsis (36.8% vs. 11.0%, p<0.001). History of maternal fever during pregnancy had statistically significant association with neonatal sepsis (34.2% vs/ 19.1%, p=0.049). E. Coli, and Klebsiella were the most commonly found bacterial isolates, noted in 8 (21.1%), and 4 (10.5%) neonates, respectively. Most commonly used antimicrobial drugs were found to have high resistance rates against most frequent bacterial isolates. Conclusion: E. Coli, and Klebsiella were the most commonly found bacterial isolates in neonatal sepsis. Preterm birth, maternal history of UTI, and maternal history of fever were found to be significant factors linked to neonatal sepsis. Most commonly used antimicrobial drugs were found to have high resistance patterns which should raise alarms. [ABSTRACT FROM AUTHOR]
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- 2024
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40. Alteration of Maternal Serum Ferritin in Pregnancy and Maternal-fetal Infections: A retrospective cohort study.
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Xing Liao, Xiaoyan Xiu, Guizhen Xu, Ling Wu, Zhuanji Fang, and Huihui Huang
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CHORIOAMNIONITIS , *FERRITIN , *PREGNANCY outcomes , *NEONATAL sepsis , *PREGNANT women , *PREGNANCY - Abstract
Objectives: To investigate the association of altered serum ferritin during pregnancy with chorioamnionitis and neonatal sepsis. Methods: This retrospective cohort study included 78,521 pregnant women who attended antenatal check-ups at maternal and child health centers in Fujian Province, China. Study lasted from January 2014 to January 2019. A total of 59,812 pregnant women were followed up. Patients with suspected infection before the delivery were selected and divided into the chorioamnionitis and non-chorioamnionitis groups according to placental pathology. Differences in late and early pregnancy serum ferritin between the two groups were compared. Multiple logistics regression was used to adjust for confounding factors and to analyze the association between serum ferritin changes and pregnancy outcomes. Importance of altered serum ferritin during pregnancy was assessed by receiver operating characteristic (ROC) curve and net reclassification index (NRI). Results: Clinical records of 8506 pregnant women were included in the study. there were 1010 (11.9%) cases of confirmed chorioamnionitis and 263 (3.1%) cases of neonatal sepsis. There was a significant difference in maternal serum ferritin changes between the groups with and without chorioamnionitis. No significant difference was detected in cases with or without neonatal sepsis. Multiple logistic regressions, corrected for confounding factors yielded similar conclusions. Maternal serum ferritin difference NRI 12.18% (p = 0.00014) was similar to the ROC results in predicting the occurrence of chorioamnionitis. Conclusion: Differential serum ferritin during pregnancy may predict chorioamnionitis but does not correlate well with neonatal sepsis. [ABSTRACT FROM AUTHOR]
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- 2024
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41. Prevalence, perinatal outcomes and factors associated with neonatal sepsis in Nigeria.
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Onubogu, Chinyere Ukamaka, Ekwochi, Uchenna, Obumneme‐Anyim, Ijeoma, Nwokeji‐Onwe, Linda Nneka, Eleje, George Uchenna, Ojiegbe, Nnabuike Okechukwu, Ezebialu, Ifeanyichukwu Uzoma, Ezenkwele, Eziamaka Pauline, Nzeribe, Emily Akuabia, Umeh, Uchenna Anthony, Ugwu, Innocent Anayochukwu, Chianakwana, Ogochukwu, Ibekwe, Nkechi Theresa, Ezeaku, Onyebuchi Ignatius, Ekweagu, Gloria Nwuka, Onwe, Abraham Bong, Lavin, Tina, Ezekwe, Bose, Settecase, Eugenia, and Tukur, Jamilu
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NEONATAL intensive care units , *VERTICAL transmission (Communicable diseases) , *INTRAPARTUM care , *NEONATAL death , *WOMEN'S employment , *NEONATAL sepsis , *PREMATURE rupture of fetal membranes - Abstract
Objective: To examine the prevalence, perinatal outcomes and factors associated with neonatal sepsis in referral‐level facilities across Nigeria. Design: Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme in 54 referral‐level hospitals across Nigeria. Setting: Records covering the period from 1 September 2019 to 31 August 2020. Population: Mothers admitted for birth during the study period, and their live newborns. Methods: Analysis of prevalence and sociodemographic and clinical factors associated with neonatal sepsis and perinatal outcomes. Multilevel logistic regression modelling identified factors associated with neonatal sepsis. Main outcome measures: Neonatal sepsis and perinatal outcomes. Results: The prevalence of neonatal sepsis was 16.3 (95% CI 15.3–17.2) per 1000 live births (1113/68 459) with a 10.3% (115/1113) case fatality rate. Limited education, unemployment or employment in sales/trading/manual jobs, nulliparity/grand multiparity, chronic medical disorder, lack of antenatal care (ANC) or ANC outside the birthing hospital and referral for birth increased the odds of neonatal sepsis. Birthweight of <2500 g, non‐spontaneous vaginal birth, preterm birth, prolonged rupture of membranes, APGAR score of <7 at 5 min, birth asphyxia, birth trauma or jaundice were associated with neonatal sepsis. Neonates with sepsis were more frequently admitted to a neonatal intensive care unit (1037/1110, 93.4% vs 8237/67 346, 12.2%) and experienced a higher rate of death (115/1113, 10.3% vs 933/67 343, 1.4%). Conclusions: Neonatal sepsis remains a critical challenge in neonatal care, underscored by its high prevalence and mortality rate. The identification of maternal and neonatal risk factors underscores the importance of improved access to education and employment for women and targeted interventions in antenatal and intrapartum care. [ABSTRACT FROM AUTHOR]
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- 2024
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42. Incidence, predictors and immediate neonatal outcomes of birth asphyxia in Nigeria.
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Ikechebelu, Joseph Ifeanyichukwu, Eleje, George Uchenna, Onubogu, Chinyere Ukamaka, Ojiegbe, Nnabuike Okechukwu, Ekwochi, Uchenna, Ezebialu, Ifeanyichukwu Uzoma, Ezenkwele, Eziamaka Pauline, Nzeribe, Emily Akuabia, Umeh, Uchenna Anthony, Obumneme‐Anyim, Ijeoma, Nwokeji‐Onwe, Linda Nneka, Settecase, Eugenia, Ugwu, Innocent Anayochukwu, Chianakwana, Ogochukwu, Ibekwe, Nkechi Theresa, Ezeaku, Onyebuchi Ignatius, Ekweagu, Gloria Nwuka, Onwe, Abraham Bong, Lavin, Tina, and Tukur, Jamilu
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ABRUPTIO placentae , *PLACENTA praevia , *NEONATAL death , *WOMEN'S empowerment , *NEONATAL sepsis , *ASPHYXIA neonatorum - Abstract
Objective: To determine the incidence and sociodemographic and clinical risk factors associated with birth asphyxia and the immediate neonatal outcomes of birth asphyxia in Nigeria. Design: Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme. Setting: Fifty‐four consenting referral‐level hospitals (48 public and six private) across the six geopolitical zones of Nigeria. Population: Women (and their babies) who were admitted for delivery in the facilities between 1 September 2019 and 31 August 2020. Methods: Data were extracted and analysed on prevalence and sociodemographic and clinical factors associated with birth asphyxia and the immediate perinatal outcomes. Multilevel logistic regression modelling was used to ascertain the factors associated with birth asphyxia. Main outcome measures: Incidence, case fatality rate and factors associated with birth asphyxia. Results: Of the available data, 65 383 (91.1%) women and 67 602 (90.9%) babies had complete data and were included in the analysis. The incidence of birth asphyxia was 3.0% (2027/67 602) and the case fatality rate was 16.8% (339/2022). The risk factors for birth asphyxia were uterine rupture, pre‐eclampsia/eclampsia, abruptio placentae/placenta praevia, birth trauma, fetal distress and congenital anomaly. The following factors were independently associated with a risk of birth asphyxia: maternal age, woman's education level, husband's occupation, parity, antenatal care, referral status, cadre of health professional present at the birth, sex of the newborn, birthweight and mode of birth. Common adverse neonatal outcomes included: admission to a special care baby unit (SCBU), 88.4%; early neonatal death, 14.2%; neonatal sepsis, 4.5%; and respiratory distress, 4.4%. Conclusions: The incidence of reported birth asphyxia in the participating facilities was low, with around one in six or seven babies with birth asphyxia dying. Factors associated with birth asphyxia included sociodemographic and clinical considerations, underscoring a need for a comprehensive approach focused on the empowerment of women and ensuring access to quality antenatal, intrapartum and postnatal care. [ABSTRACT FROM AUTHOR]
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- 2024
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43. Lower plasma melatonin levels in non-hypoxic premature newborns associated with neonatal pain.
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Sánchez-Borja, Cristina, Cristóbal-Cañadas, Delia, Rodríguez-Lucenilla, María Isabel, Muñoz-Hoyos, Antonio, Agil, Ahmad, Vázquez-López, María Ángeles, Parrón-Carreño, Tesifón, Nievas-Soriano, Bruno José, Bonillo-Perales, Antonio, and Bonillo-Perales, Juan Carlos
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PREMATURE infants , *NEONATAL sepsis , *CEREBRAL anoxia-ischemia , *MELATONIN , *FREE radical scavengers , *BIRTH weight , *LOGISTIC regression analysis , *ATHLETE training - Abstract
We analyzed plasma melatonin levels in different groups of preterm newborns without hypoxia and their relationship with several perinatal variables like gestational age or neonatal pain. Prospective cohort study of preterm newborns (PTNB) without perinatal hypoxia, Apgar > 6 at 5 min, and oxygen needs on the third day of life. We compared melatonin levels at day 3 of life in different groups of non-hypoxic preterm infants (Student's t-tests, Mann-Whitney U, and chi2) and analyzed the relationship of melatonin with GA, birth weight, neonatal pain (Premature Infant Pain Profile (PIPP) scale), caffeine treatment, parenteral nutrition, or the development of free radical diseases (correlation study, linear regression) and factors associated with moderate/intense pain and free radical diseases (logistic regression analysis). Sixty-one preterm infants with gestational age (GA) of 30.7 ± 2.0 weeks with no oxygen requirements at day 3 of life were studied with plasma melatonin levels of 33.8 ± 12.01 pg/ml. Preterm infants weighing < 1250 g at birth had lower plasma melatonin levels (p = 0.05). Preterm infants with moderate or severe pain (PPIPP > 5) have lower melatonin levels (p = 0.01), and being preterm with PIPP > 5 is associated with lower plasma melatonin levels (p = 0.03). Being very preterm (GA < 32 GS), having low weight for gestational age (LWGA), receiving caffeine treatment, or requiring parenteral nutrition did not modify melatonin levels in non-hypoxic preterm infants (p = NS). Melatonin on day 3 of life in non-hypoxic preterm infants is not associated with later development of free radical diseases (BPD, sepsis, ROP, HIV, NEC). Conclusion: We observed that preterm infants with moderate to severe pain have lower melatonin levels. These findings are relevant because they reinforce the findings of other authors that melatonin supplementation decreases pain and oxidative stress in painful procedures in premature infants. Further studies are needed to evaluate whether melatonin could be used as an analgesic in painful procedures in preterm infants. Trial registration: Trial registration was not required since this was an observational study. What Is Known: • Melatonin is a potent antioxidant and free radical scavenger in newborns under stress conditions: hypoxia, acidosis, hypotension, painful procedures, or parenteral nutrition. • Pain stimulates the production of melatonin. • Various studies conclude that melatonin administration decreases pain during the neonatal period. What Is New: • Non-hypoxic preterm infants with moderate to severe pain (PIPP>5) have lower levels of melatonin. • Administration of caffeine and treatment with parenteral nutrition do not modify melatonin levels in non-hypoxic preterm infants. [ABSTRACT FROM AUTHOR]
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- 2024
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44. Surviving maternal sepsis: Clinical, laboratory, and treatment features.
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Ribeiro‐do‐Valle, Carolina C., Luz, Adriana G., Pacagnella, Rodolfo C., and Cecatti, José G.
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SEPSIS , *URINARY tract infections , *SEPTIC shock , *NEONATAL sepsis , *THIRD generation cephalosporins , *MEDICAL personnel , *RESPIRATORY infections - Abstract
Objective: To describe clinical, laboratory, and antibiotic treatment characteristics in pregnant or recently pregnant women diagnosed with maternal sepsis. Methods: A retrospective cohort study was conducted in a Brazilian tertiary hospital from March 2014 until February 2018. The hospital implemented a Sepsis Protocol, based on the Brazilian Ministry of Health recommendation. All women who were pregnant or recently pregnant (up to 42 days postpartum), and who presented with suspected sepsis were included. Unconfirmed infections were excluded. Three hundred sixty‐five women were included and divided into three groups according to sepsis severity (SEPSIS‐2): sepsis, severe sepsis, and septic shock. Clinical, laboratory, and management characteristics were described and compared. Results: Pregnancy‐related and respiratory tract infections were the greater causes of maternal sepsis, and the urinary tract was the major cause of septic shock. We found almost total compliance with blood culture sample collection, and samples were positive in 10.8% of the cases, and in 41% of septic shock patients. Escherichia coli was the most common pathogen found and it was resistant to third‐generation cephalosporins in none of the blood cultures and 3.3% of the urine cultures. Using the AWaRe (Access, Watch and Reserve) classification groups of antibiotics, Access and Watch antibiotics were used in virtually all women. We did not find any fatal maternal outcomes. Conclusion: Maternal sepsis is seldom the result of resistant microorganisms in this setting and the use of Access group antibiotics is widely possible. Health professionals' awareness of and institutional policies for maternal sepsis are crucial to its adequate treatment and better outcomes. Synopsis: A protocol for maternal sepsis to be routinely used is able to provide better treatment and improve outcomes reducing infectious complications. [ABSTRACT FROM AUTHOR]
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- 2024
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45. invariant Natural Killer T Cells Modulate the Peritoneal Macrophage Response to Polymicrobial Sepsis.
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Heffernan, Daithi S., Chun, Tristen T., Monaghan, Sean F., Chung, Chun-Shiang, and Ayala, Alfred
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KILLER cells , *CYTOTOXIC T cells , *PERITONEAL macrophages , *INTRA-abdominal hypertension , *SEPSIS , *MACROPHAGES , *NEONATAL sepsis - Abstract
A dysregulated immune system is a major driver of the mortality and long-term morbidity from sepsis. With respect to macrophages, it has been shown that phenotypic changes are critical to effector function in response to acute infections, including intra-abdominal sepsis. Invariant natural killer T cells (i NKT cells) have emerged as potential central regulators of the immune response to a variety of infectious insults. Specifically, various i NKT cell:macrophage interactions have been noted across a spectrum of diseases, including acute events such as sepsis. However, the potential for i NKT cells to affect peritoneal macrophages during an abdominal septic event is as yet unknown. Cecal ligation and puncture (CLP) was performed in both wild type (WT) and invariant natural killer T cell knockout (i NKT−/−) mice. 24 h following CLP or sham operation, peritoneal macrophages were collected for analysis. Analysis of macrophage phenotype and function was undertaken to include analysis of bactericidal activity and cytokine or superoxide production. Within i NKT−/− mice, a greater degree of intraperitoneal macrophages in response to the sepsis was noted. Compared to WT mice, within i NKT−/− mice, CLP did induce an increase in CD86+ and CD206+, but no difference in CD11b+. Unlike WT mice, intra-abdominal sepsis within iNKT−/− mice induced an increase in Ly6C-int (5.2% versus 14.9%; P < 0.05) and a decrease in Ly6C-high on peritoneal macrophages. Unlike phagocytosis, i NKT cells did not affect macrophage bactericidal activity. Although i NKT cells did not affect interleukin-6 production, i NKT cells did affect IL-10 production and both nitrite and superoxide production from peritoneal macrophages. The observations indicate that i NKT cells affect specific phenotypic and functional aspects of peritoneal macrophages during polymicrobial sepsis. Given that pharmacologic agents that affect i NKT cell functioning are currently in clinical trial, these findings may have the potential for translation to critically ill surgical patients with abdominal sepsis. [ABSTRACT FROM AUTHOR]
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- 2024
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46. Significance of Plasma Melatonin as a Diagnostic Marker in Full-term with Late Onset Sepsis.
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Ahmed, Amani A., El-Shal, Amal S., Abdelbar, Ahmed Tarek, Mohammed Rashad, Marwa lofty, and Elsharkawy, Mona Mohammed
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NEONATAL intensive care units , *MULTIDRUG resistance , *FREE radical scavengers , *SYMPTOMS , *DELAYED diagnosis , *NEONATAL sepsis - Abstract
Background: When newborn sepsis occurs, the pathogen may trigger an uncontrollable systemic inflammatory response that results in oxidative damage. Melatonin released naturally, which acts as a safe antioxidant and free radical scavenger in newborns. The aim of the work was to evaluate the significance of plasma melatonin level in early diagnosis of late onset sepsis neonatal sepsis. Methods: 58 full-term babies were included in a case-control study at Zagazig University's neonatal intensive care unit. Twenty-nine newborns in the patient group had complete clinical and biochemical signs of sepsis. The control group included twenty-nine newborns with no clinical or biochemical signs of sepsis. Melatonin level was measured by ELISA, and a septic work-up was done for all the patients. Results: The best cutoff plasma melatonin level in the diagnosis of late onset sepsis was16.2 pg/ml with an area under the curve of 0.97, a sensitivity of 92.6%, specificity of 86.4%, positive predictive value of 90.5 %, negative predictive value of 87% and over all accuracy of 88.6%. Conclusions: A significant elevation of endogenous plasma melatonin level was found in lateonset neonatal sepsis, so early identification of late-onset sepsis could considerably help cases by allowing both the prevention of complications and avoiding multiple drug resistance. [ABSTRACT FROM AUTHOR]
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- 2024
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47. Predictors of gentamicin therapy failure in neonates with sepsis.
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Singu, Bonifasius Siyuka, Pieper, Clarissa Hildegard, Verbeeck, Roger Karel, and Ette, Ene I.
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SEPSIS , *NEONATAL sepsis , *GENTAMICIN , *LEUKOCYTE count , *NEONATAL intensive care units , *NEWBORN infants , *NEONATAL intensive care - Abstract
Sepsis is a common disease with high morbidity and mortality among newborns in intensive care units world‐wide. Gram‐negative bacillary bacteria are the major source of infection in neonates. Gentamicin is the most widely used aminoglycoside antibiotic in empiric therapy against early‐onset sepsis. However, therapy failure may result due to various factors. The purpose of this study was to identify predictors of gentamicin therapy failure in neonates with sepsis. This was a prospective cross‐sectional study at the Neonatal Intensive Care Unit at Windhoek Central Hospital over a period of 5 months in 2019. Neonates received intravenous gentamicin 5 mg/kg/24 h in combination with either benzylpenicillin 100 000 IU/kg/12 h or ampicillin 50 mg/kg/8 h. Logistic regression modeling was performed to determine the predictors of treatment outcomes. 36% of the 50 neonates were classified as having gentamicin treatment failure. Increasing treatment duration by 1 day resulted in odds of treatment failure increasing from 1.0 to 2.41. Similarly, one unit increase in CRP increases odds of gentamicin treatment failure by 49%. The 1 kg increase in birthweight reduces the log odds of treatment failure by 6.848, resulting in 99.9% decrease in the odds of treatment failure. One unit increase in WBC reduces odds of gentamicin treatment failure by 27%. Estimates of significant predictors of treatment failure were precise, yielding odds ratios that were within 95% confidence interval. This study identified the following as predictors of gentamicin therapy failure in neonates: prolonged duration of treatment, elevated C‐reactive protein, low birthweight, and low white blood cell count. [ABSTRACT FROM AUTHOR]
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- 2024
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48. Utility of Anaerobic Blood Cultures in Neonatal Sepsis Evaluation.
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Gottschalk, Amanda, Coggins, Sarah, Dhudasia, Miren B, Flannery, Dustin D, Healy, Tracy, Puopolo, Karen M, Gerber, Jeffrey, and Mukhopadhyay, Sagori
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BLOOD , *ANAEROBIC bacteria , *MEDICAL logic , *STAPHYLOCOCCAL diseases , *NEONATOLOGY , *BACTEREMIA , *NEONATAL intensive care units , *NEONATAL intensive care , *RETROSPECTIVE studies , *STAPHYLOCOCCUS aureus , *DESCRIPTIVE statistics , *CELL culture , *LONGITUDINAL method , *HOSPITAL care of newborn infants , *ESCHERICHIA coli , *GESTATIONAL age , *COMPARATIVE studies , *NEONATAL sepsis - Abstract
Background Clinicians variably obtain anaerobic blood cultures as part of sepsis evaluations in the neonatal intensive care unit (NICU). Our objective was to determine if anaerobic blood culture bottles yielded clinically relevant information by either recovering pathogens exclusively or more rapidly than the concurrently obtained aerobic culture bottle in the NICU. Methods A retrospective cohort study of blood cultures obtained from infants admitted to the NICU from August 01, 2015 to August 31, 2023. Standard practice was to inoculate 2 mL of blood divided equally between an aerobic and an anaerobic culture bottle. We analyzed positive blood cultures where both aerobic and anaerobic bottles were obtained and compared pathogen recovery and time to positivity between the bottles. Results During the study period, 4599 blood cultures were obtained from 3665 infants, and 265 (5.8%) were positive. Of these, 182 cultures were sent as aerobic–anaerobic pairs and recovered pathogenic organisms. Organisms were recovered exclusively from the anaerobic bottle in 32 (17.6%) cultures. Three organisms were obligate anaerobes; the rest were facultative anaerobes including Coagulase-negative staphylococci (40.6%), Escherichia coli (15.6%), and Staphylococcus aureus (15.6%). Cultures with exclusive recovery in the anaerobic bottle were more frequently obtained ≤3 days after birth, compared to other cultures (31.3% vs 15.3%, P = .03). When both bottles recovered the pathogen (n = 113), the anaerobic bottle had a shorter time to positivity in 76 (67.3%) cultures. Conclusions Including anaerobic culture bottles could lead to the identification of pathogens not recovered in the aerobic bottle, as well as earlier identification of pathogens. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
49. Early-Onset Infection Caused by Escherichia coli Sequence Type 1193 in Late Preterm and Full-Term Neonates.
- Author
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Malaure, Célie, Geslain, Guillaume, Birgy, André, Bidet, Philippe, Poilane, Isabelle, Allain, Margaux, Liberge, Mathilde, Khattat, Nizar, Sikias, Paola, and Bonacorsi, Stéphane
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ESCHERICHIA coli diseases , *NEONATAL sepsis , *ESCHERICHIA coli , *WHOLE genome sequencing , *NEWBORN infants , *KLEBSIELLA pneumoniae , *UREAPLASMA - Abstract
Using whole-genome sequencing, we characterized Escherichia coli strains causing early-onset sepsis (EOS) in 32 neonatal cases from a 2019-2021 prospective multicenter study in France and compared them to E. coli strains collected from vaginal swab specimens from women in third-trimester gestation. We observed no major differences in phylogenetic groups or virulence profiles between the 2 collections. However, sequence type (ST) analysis showed the presence of 6/32 (19%) ST1193 strains causing EOS, the same frequency as in the highly virulent clonal group ST95. Three ST1193 strains caused meningitis, and 3 harbored extended-spectrum ß-lactamase. No ST1193 strains were isolated from vaginal swab specimens. Emerging ST1193 appears to be highly prevalent, virulent, and antimicrobial resistant in neonates. However, the physiopathology of EOS caused by ST1193 has not yet been elucidated. Clinicians should be aware of the possible presence of E. coli ST1193 in prenatal and neonatal contexts and provide appropriate monitoring and treatment. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
50. Near-miss and maternal sepsis mortality: A qualitative study of survivors and support persons.
- Author
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Bauer, Melissa E., Perez, Susan L., Main, Elliott K., Norman, Gwendolyn S., Fish, Laura J., Caldwell, Morgan A., Allen, Christie, Hughes, Brenna L., Gibbs, Ronald S., and Smith, Kendra L.
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MATERNAL mortality , *PATIENTS' attitudes , *DELAYED diagnosis , *QUALITATIVE research , *PATIENT education , *NEONATAL sepsis - Abstract
• Theme 1) participants reported a lack of awareness of pregnancy-related warning signs. • Theme 2) presenting symptoms participants experienced were not typical of expected warning signs. • Theme 3) participant concerns were met with dismissal leading to delays in diagnosis. • Theme 4) participants experienced long-term sequelae from maternal sepsis. Prior studies have shown that maternal deaths due to sepsis occur due to delays in recognition, treatment, and escalation of care through medical chart reviews. This study was conducted to obtain the patient perspective for near-miss and maternal mortality cases due to sepsis. To identify quality improvement opportunities for improving maternal sepsis through patient and support person experiences. Twenty semi-structured interviews and three follow-up focus groups with patients who experienced critical illness from maternal sepsis in the United States and their support persons (when available) were conducted from May 23, 2022, through October 14, 2022. In this qualitative study, data were analyzed using inductive thematic analysis. In this qualitative study of patients with maternal sepsis and their support persons, four main quality improvement themes were identified. The themes were the following: (1) participants reported a lack of awareness of pregnancy-related warning signs and symptoms of when to seek care, (2) many of the presenting symptoms participants experienced were not typical of expected warning signs of maternal sepsis, such as severe pain, overwhelming tiredness, and lack of fever (3) participant concerns were met with dismissal leading to delays in diagnosis, (4) participants experienced long-term sequelae but had difficulty receiving screening and referrals for treatment. The findings of this study suggest that standardized patient education about the warning signs of maternal sepsis and provider education about the presentation of maternal sepsis, improved listening to patients, and follow-up for sequalae of sepsis are needed. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
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