The relationship of serum albumin level and early-onset sepsis in very low birth weight infants / 中国新生儿科杂志

Objective:To study the predictive value of serum albumin (ALB) on the first day of life for early-onset sepsis (EOS) in very low birth weight infants (VLBWI).Methods:From January 2015 to December 2020, clinical data of VLBWI (gestational age < 34 weeks, birth weight < 1 500 g) born and hospitalized in our hospital were collected. Based on the serum ALB level at admission, the infants were assigned into high, moderate and low ALB groups. C-reactive protein (CRP) and procalcitonin (PCT) levels among different ALB groups were compared. The infants were also assigned into EOS and non-EOS groups according to the occurrence of EOS and perinatal complications were compared between the two groups. The relationship between EOS and ALB level was analyzed. The predictive value of serum ALB was studied using receiver operating characteristic (ROC) curve analysis.Results:A total of 183 infants were enrolled, including 62 in the high ALB group, 87 in the moderate ALB group and 34 in the low ALB group; and 36 in EOS group and 147 in non-EOS group. The incidence of maternal chorioamnionitis was significantly higher in EOS group than non-EOS group [33.3% (12/36) vs. 6.8% (10/147), P<0.001]. Serum CRP and PCT in the low and moderate ALB groups were significantly higher than the high ALB group ( P<0.05), and the low ALB group showed higher CRP and PCT than the moderate ALB group ( P<0.05). Compared with the non-EOS groups, ALB in the EOS group was significantly lower [24.9 (24.0, 28.5) g/L vs. 29.5 (27.4, 31.2) g/L, P<0.001] and the incidence of hypoproteinemia was significantly higher [52.8% vs.10.2%, P<0.001]. As ALB decreased, the incidence of EOS increased. The incidence of EOS was 55.9% in the low ALB group, 16.1% in the moderate ALB group and 4.8% in the high ALB group ( P<0.001). The sensitivity and specificity of ALB predicting EOS was 69.4% and 79.6%, respectively, with a cut-off value of 27.0 g/L. Conclusions:The VLBWI with maternal chorioamnionitis and serum albumin lower than 27.0 g/L on the first day of life have higher risk of EOS.

Clinical study of early-onset sepsis with positive blood culture in extremely preterm and super preterm infants / 中华实用儿科临床杂志

Objective:To study the clinical features and high-risk factors of early-onset sepsis (EOS) in extremely preterm and super preterm infants.Methods:Retrospective study.Clinical data of extremely preterm and super preterm infants with the gestational age < 32 weeks were obtained from the clinical database of breast milk quality improvement registration in the Woman′s Hospital of Nanjing Medical University between January 2019 and December 2019.EOS cases were enrolled in the EOS group, and the remaining were enrolled in the control group.Risk factors for EOS, distribution of pathogenic bacteria, clinical features, complications, and outcomes between groups were analyzed.Measurement data were compared between the independent sample t-test.Counting data between groups were compared by the Chi- square test, corrected Chi- square test or Fisher′ s exact test.Multivariable Logistic regression model was used to analyze the risk factors of EOS in extremely and super preterm infants. Results:A total of 347 eligible neonates were recruited, including 22 neonates with EOS and 325 neonates without EOS.The incidence rate of EOS was 6.3%.Multivariate Logistic regression analysis showed that cesarean delivery was the protective factor for EOS ( OR=0.277, 95% CI: 0.091-0.847); while maternal prenatal infection ( OR=2.750, 95% CI: 1.053-2.908), fetid amniotic fluid ( OR=3.878, 95% CI: 1.344-11.187), chorioamnionitis ( OR=4.363, 95% CI: 1.552-12.236) and intubation ( OR=3.883, 95% CI: 1.133-13.306) were risk factors for EOS.A total of 22 strains of pathogenic bacteria were cultured in the EOS group, including 14 strains (63.6%) of Gram-positive bacteria, 7 strains (31.8%) of Gram-negative bacteria and 1 strain (4.6%) of fungus.The acute respiratory distress syndrome (54.5%), poor peripheral circulation perfusion (54.5%), mental depression (50.0%), and procalcitonin>0.5 mg/L (40.9%) were the main clinical features of EOS.Compared with the control group, extremely preterm and super preterm infants with EOS had a significantly higher rate of septic shock, disseminated intravascular coagulation, severe intraventricular hemorrhage (≥Ⅲ), acute respiratory distress syndrome (ARDS), and bronchopulmonary dysplasia( χ2=36.696, 33.255, 13.534, 95.455 and 3.886, respectively; all P<0.05). Conclusions:Maternal perinatal infection, odor amniotic fluid, chorioamnionitis and delivery room tracheal intubation are high-risk factors for preterm and super preterm infants with EOS, which can be prevented by cesarean section.Gram-positive cocci are the main pathogenic bacteria of EOS.ARDS and poor peripheral circulation perfusion are the main clinical manifestations of EOS, which increase the occurrence of severe intracranial hemorrhage and other complications.

Clinical and etiological profile of neonatal sepsis in children admitted to tertiary care hospital

Background: Neonatal sepsis is leading cause of mortality in children. The clinical presentation of neonatal sepsis is non-specific and variable. This study was undertaken to study clinical and etiological profile of neonatal sepsis.Methods: This was a prospective study conducted over a period of one year from March 2018 to March 2019. The patients with clinically suspected sepsis were included in this study. Detailed history and examination was done in all patients. In addition to baseline investigations, C-reactive protein and blood culture was done in all patients. Blood culture was done prior to administration of antibiotics.Results: In this study there were total of 102 patients out of which 54 were male and 48 were female. Among 102 patients, 69 patients were premature born before 37 weeks of gestation. Prematurity   emerged to be the most common   risk factor. In this study 62% patients had EOS (<72 hours of life) and 38% had LOS (>72 hours of life). The most common presenting feature were refusal of feeds, lethargy, respiratory distress and hypothermia. Other features were seizures, abdominal distension, apnea and sclerema. Blood culture was positive in 41% patients. The most common organism isolated on culture was Kleibsella followed by E. coli.Conclusions: Neonatal sepsis is leading cause of mortality in children. Early diagnosis and treatment is of paramount importance to prevent mortality. The clinical presentation of neonatal sepsis is non-specific and variable. So, high index of suspicion is required to detect sepsis at earliest. Gram negative organism like Kleibsella and E. coli are the common causative organism in neonatal sepsis.

Study of changes noted in the platelet count in cord blood of neonates born to hypertensive mothers in a tertiary care hospital, Bangalore, India

Background: Hypertensive disorders of pregnancy pose several problems to both mother and newborn. Complications in new-born like intrauterine death (IUD), intrauterine growth retardation (IUGR), perinatal asphyxia, neonatal sepsis and bleeding disorders are associated with toxemia of pregnancy. To decrease the perinatal morbidity and mortality, babies of hypertensive mothers should be carefully monitored and managed. Aim of this study was to establish the changes in total platelet count in umbilical cord blood.Methods: This is a hospital based prospective observational study which included the babies born to mothers having hypertensive disorders of pregnancy, total cases accounting about 158. Detailed clinical history taken including details of labour and clinical examination done.' In all the subjects, 2 ml of umbilical cord blood anticoagulated with EDTA was collected and haematological tests for total platelet count (TPC) count was done.Results: This study shows that the incidence of neonatal thrombocytopenia is 43.67%. The incidence of sepsis among thrombocytopenia group accounts for about 60% in gestational hypertension, 64.2% in pre-eclampsia and 50% in eclampsia group.Conclusions: With respectively, these findings it can be concluded that the incidence of Neonatal Thrombocytopenia is significantly higher in babies born to HDP mothers and it can be taken as a marker to evaluate Sepsis in such a situation in resource limited setting. As less number of studies is available in this area of interest, this study supports the cause.

Clinico-epidemiological spectrum of early onset neonatal sepsis in neonates admitted in NICU of a tertiary care institute

Background: Neonatal' sepsis' is' a' clinical syndrome' characterized by signs and symptoms' of' infection' with' or' without' accompanying' bacteremia' in' the' first' month' of' life. Neonatal' sepsis' may' be' classified' into' two' groups : early onset' sepsis and' late onset' sepsis . Early onset neonatal sepsis' is' generally' associated' with' the' acquisition' of' microorganisms' from' the' mother' and' usually' presents' with' respiratory' distress' and' pneumonia.Methods: The study included one hundred' term' neonates with early onset neonatal sepsis. A septic screen including total leukocyte count, absolute neutrophil count, blood smear evaluation, blood cultures and C-reactive protein (CRP) were performed in all neonates with suspected sepsis to corroborate early onset sepsis diagnosis. Epidemiological parameters including gender of the neonate, mode of delivery, rural/urban residence were recorded in addition to clinical profile.Results: Respiratory distress was the most common presentation in the form of tachypnea, seen in 63 (63.0%) neonates. In present study, Staphylococcus aureus was the most common organism isolated followed by Staphylococcus epidermidis, Staphylococcus hominis, Acinetobacter baumannii and Klebsiella pneumonae.Conclusions: Early onset neonatal sepsis' was seen more in males. Among the gram-positive Staphylococcus aureus and among gram negative Acinetobacter baumannii and Klebsiella pneumonae were most common organisms to be isolated.

Association of vitamin D deficiency with early onset sepsis in term neonates

Background: Vitamin D is a fat-soluble steroid hormone. Vitamin D also has immunomodulatory effects on immune function. Early onset sepsis (EOS) is characterized by signs and symptoms of infection with or without accompanying bacteremia in the first three days of life. The objective of the study was to determine the possible association between neonatal vitamin D levels and EOS in term neonates.Methods: 100 term neonates with clinical and laboratory findings of EOS (study group) and 100 healthy infants with no signs of clinical/laboratory infection (control group) were enrolled. Sera was drawn during first 3 postnatal days of life in both groups for measurement of 25-hydroxyvitamin D (25-OHD) levels.Results: Neonatal 25-OHD levels (17.4ng/dL) in the study group were significantly lower than those of the control group (26.8 ng/dL) (p=0.001). In present study negative correlation was found between vitamin D level and CRP.Conclusions: Lower neonatal 25-OHD levels are associated with EOS. Adequate vitamin D supplementation during pregnancy may be helpful to prevent EOS in term neonates.

Clinical features and prognostic factors of early-onset sepsis: a 7.5-year experience in one neonatal intensive care unit / 소아과

PURPOSE: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. METHODS: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. RESULTS: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P < 0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4–1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3–1,628.7) and decreased activity (OR, 34; 95% CI, 1.8–633.4), were found to be associated with fatality. CONCLUSION: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.

The comparison between management recommendations of the Neonatal Early Onset Sepsis Calculator and CDC/AAP guidelines among culture-proven early onset sepsis admitted at University of East Ramon Magsaysay Memorial Medical Center from January 2013 to December 2017 / The Health Sciences Journal

INTRODUCTION Early onset sepsis is difficult to diagnose due to nonspecific symptoms and a lack ofreliable tests. It can progress quickly, and lead to neurodevelopmental consequences or be fatal if nottreated. However, approximately 10-fold more newborns are treated with antibiotics empirically and oftenunnecessarily. This study aimed to compare the management recommendations of the Neonatal EarlyOnset Sepsis Calculator with those of the Centers for Disease Control/American Academy of Pediatricsguidelines.METHODS Neonatal Early Onset Sepsis Calculator was applied to the data set to examine how an alternativemodel would perform compared to current guidelines published by the CDC and compared to currentpractice within the institution. Chi square and kappa value agreement was used to determine the differencebetween treatment recommendations of NEOS calculator and AAP guideline.RESULTS Of the 330 patients who received therapy, only 14.2% were recommended empiric antibiotics bythe EOS calculator, compared to the 39% recommended by the CDC guidelines (p Eleven patients were identified to have culture-positive sepsis.CONCLUSION The number of infants suspected with EOS and subsequently require antibiotic use at birthmay be dramatically reduced with the use of the neonatal EOS calculator.

Cord blood vitamin D levels and its relationship to early-onset sepsis in the very low birth weight infants / 中国小儿急救医学

Objective To investigate the association between serum 25(OH) D levels and the inci-dence of early-onset sepsis(EOS) in the very low birth weight infants(VLBWI) and the gestational age be-low 34 weeks. Methods The cord blood of 159 VLBWI were collected between January and December 2017,including 31 clinically diagnosed EOS and 128 non-EOS patients. Serum 25(OH)D<10 ng/ml was de-fined as severe vitamin D deficiency,25(OH)D 10 to 20 ng/ml as vitamin D deficiency,25(OH)D 20 to 30 ng/ml as vitamin D insufficiency and 25(OH)D >30 ng/ml as vitamin D sufficiency. Results There were no differences in gender,gestational age,birth weight and Apgar score between the EOS group and the non-EOS group(P>0. 05). Serum 25(OH) D was(9. 08 ± 4. 21) ng/ml in the EOS group and(11. 91 ± 5. 37) ng/ml in the non-EOS group(P＝0. 007). The rate of severe vitamin D deficiency was 67. 7%(21/31)in the EOS group and 41. 4%(53/128) in the non-EOS group. The rate of vitamin D deficiency was 32. 3%(10/31)in the EOS group and 52. 3%(67/128)in the non-EOS group. But there was no difference of vitamin D deficiency distribution in the two groups(P＝0. 152). The cut-off value of serum 25(OH)D level in predic-ting EOS was 10. 06 ng/ml. Conclusion The incidence of vitamin D deficiency is as high as 95%,calling for urgent attention on vitamin D supplementation in those VLBWI. Low 25(OH)D level( <10 ng/ml)might be predictive of EOS.

Clinical characteristics of extremely premature infants at low risk for early-onset sepsis / 临床儿科杂志

Objective To explore and analyze the clinical characteristics of extremely premature infants at low risk for early-onset sepsis (EOS) , so as to avoid overuse of antibiotics. Method The clinical data of extremely premature infants hospitalized from January 1, 2010 to December 31, 2017 were collected. Extremely premature infants born from mothers without premature rupture of membranes and without maternal clinical manifestations of chorioamnionitis during pregnancy were classified assigned into the low-risk group, and those who did not meet the low-risk conditions were regarded assigned intoas the control group. EOS was diagnosed according to the results of blood culture within 72 hours after birth. The clinical characteristics, treatment and outcome of extremely premature infants between the two groups were retrospectively analyzed. Results A total of 245 extremely preterm infants were enrolled, including 153 (62.4％) in low-risk group. Compared with the control group, mothers in low-risk group had higher rates of gestational diabetes and hypertension, higher rates of antenatal hormone use and lower rates of antenatal antibiotics use; furthermore, neonates in low-risk group had lower rates of Apgar score ＜ 5, higher rates of pulmonary surfactant use, respiratory support and mechanical ventilation, and lower risk of death and incidence of early-onset sepsis. The differences were statistically significant (P＜0.05) . Among In extremely premature infants whose having survival time＞ 24 hours, compared with control group, infants in low-risk group had higher incidences of respiratory distress syndrome, patent ductus arteriosus, intracranial hemorrhage and bronchopulmonary dysplasia, and lower incidence of pulmonary hemorrhage than control group, and the differences were statistically significant (all P＜0.05) . In low-risk group, the risks of death, respiratory distress syndrome, pulmonary hemorrhage and bronchopulmonary hemorrhage in long-term antibiotic group were higher than the short-term antibiotic group. Conclusion Early identification of extremely preterm infants at low risk of early-onset sepsis in extremely preterm infants is of clinical significance in reducing early empirical use of antibiotics therapy.

A matched case-control study on perinatal risk factors of early onset thrombocytopenia in full-term small for gestational age infants / 临床儿科杂志

Objective To explore the perinatal risk factors of early onset thrombocytopenia (EOT) in full-term small for gestational age infants. Methods A 1:1 or 1:2 matched case control study was carried out. A total of 93 full-term small for gestational age infants with EOT were selected from April 2008 to July 2014 as the case group, and the non EOT full-term small for gestational age infants with the birth weight difference <250 g and the gestational age difference <3 days were selected as the control group. The clinical data during perinatal period and laboratory examination results after admission were collected retrospectively. And the differences between the two groups were compared. Results The incidence of intrauterine distress (41.9％ vs. 25.8％, χ2=7.35, P=0.007), amniotic fluid contamination (39.8％ vs. 27％, χ2=4.66, P=0.031), and early-onset sepsis (39.8％ vs. 27％, χ2=4.66, P=0.031) were significantly higher in the case group than those in the control group. Conditional logistics regression analysis showed that intrauterine distress (β=0.60, OR=1.82, 95％CI=1.04～3.17, P=0.035) and early-onset sepsis (β=1.69, OR=5.44, 95％CI=1.11～26.76, P=0.037) were related to EOT. Conclusions Intrauterine distress and early-onset sepsis are risk factors for the onset of EOT in full-term small for gestational age infants.

The Association between Vitamin D Levels and Neonatal Early-onset Sepsis : A Systematic Review and Meta-analysis

BACKGROUND: Vitamin D has been associated with sepsis in pediatric and adult patients. The association with neonates is unclear. This systematic review and meta-analysis examined the effect of neonatal and maternal vitamin D levels on neonatal early-onset sepsis. METHODS: We searched studies published up to November 2017 in PubMed/Medline, Embase, and the Cochrane Library databases. All studies that reported 25-hydroxyvitamin D levels in neonates with or without early-onset sepsis were included. Meta-analysis was performed using RevMan 5.3 software. RESULTS: Four studies were eligible. The weighted mean difference of 25-hydroxyvitamin D levels in neonates with early-onset sepsis and controls was −7.27 ng/mL (95% confidence interval = −7.62, −6.92). Maternal vitamin D levels in neonates with early-onset sepsis were significantly lower than those in controls (weighted mean difference −7.24 ng/mL, 95% confidence interval −8.45, −6.03). All neonates with early onset sepsis had vitamin D deficiency (25-hydroxyvitamin D < 20 ng/mL). CONCLUSION: Lower neonatal and maternal 25-hydroxyvitamin D levels were associated with neonatal early-onset sepsis. Vitamin D supplementation during pregnancy may be helpful to prevent neonatal early-onset sepsis. The effects of vitamin D supplementation on early-onset sepsis in neonates warrant further study.

The early survival rate and its influencing factors of extremely premature and extremely low birth weight infants / 中国新生儿科杂志

Objective To study the early survival rate and its influencing factors of extremely preterm infants and extremely low birth weight ( ELBW ) infants.Method All extremely preterm infants and/or ELBW infants in Shandong Provincial Hospital from January , 2010 to December 2015 were studied retrospectively.The factors affecting their survival rate and their complications were analyzed retrospectively . All cases were assigned into the survival group and the death group .On the other hand , they were also assigned into two groups according to their birth , pre-2014 and post-2014.Result A total of 142 extremely preterm infants and/or ELBW infants were enrolled, their gestational age was 28 (27, 29) weeks, birth weight was 925 (830, 965) g.76 cases (53.5%) survived, 66 cases (46.5%) died.Factors associated with the survival rate were early onset sepsis , placental abruption , perinatal asphyxia , birth weight and pulmonary hemorrhage (P<0.05).There were 67 cases pre-2014 in which 30 cases survived (44.8%), while 75 cases post-2014 in which 46 cases survived ( 61.3%) .Comparative analysis between the two groups pre-2014 and post-2014 revealed that the survival rate was significantly different (χ2 =3.900, P=0.048).The top 2 underlying causes of death before 2014 were perinatal asphyxia and early onset sepsis . Furthermore, early onset infection became the first cause of death after 2014.Conclusion Along with the prevalence of neonatal resuscitation program and the optimization of respiratory support strategies in premature infants , the early survival rate of extremely preterm infants and /or ELBW infants has improved significantly.However, early onset sepsis may have been the crucial cause for their perinatal mortality .

Diagnosis value of age-specific Procalcitionin and C-reactive protein on early-onset neonatal sepsis / 实用医学杂志

Objective To compare different diagnosis values of age-specific procalcitionin (PCT) and C-reactive protein (CRP) on early-onset neonatal sepsis (EONS) during the first 72h of life.Methods From September 2008 to December 2015,96 neonates (including 2 confirmed sepsis and 94 clinical sepsis) without severe complications were chosen as the EONS group and 170 non-infectious newborns as the control group.A total of 605 blood samples were collected from all 266 newborns.Serum concentration of PCT and CRP were measured in both the EONS group and the control group at each age over the first 72 h of life.The diagnostic value of PCT and CRP within 1 ～ 12 h and 13 ～ 24 h and 25 ～ 48 h and 49 ～ 72 h of life was evaluated by calculating the cut-off values,sensitivity,specificity,and the area under the receiver operating characteristic curve (ROC).Results PCT and CRP levels of neonates within each age in the EONS group were significantly higher than those in the control group during the first 72h of life.(all P ＜ 0.05).Within 1 ～ 12 h,13 ～ 24 h,25 ～ 48 h and 49 ～ 72 h of life,the cutoff value of PCT was 0.45 μg/L (sensitivity 84.2％,specificity 74.4％),1.885 μg/L (sensitivity 73.5％,specificity 75％),0.995 μg/L (sensitivity 82.4％,specificity 74.1％) and 0.51 μg/L (sensitivity 83.3％,specificity 79.2％) respectively;that of CRP3 185 mg/L (sensitivity 68.4％,specificity 82.1％),6.29 mg/L (sensitivity 58.8％,specificity 89.7％),8.615 mg/L (sensitivity 54.3％,specificity 93.9％) and 10.27 mg/L (sensitivity 59.1％,specificity 100％) respectively,and the area under ROC of PCT for the diagnosis of EONS was 0.767,0.754 and 0.755,and 0.8 respectively;that of CRP 0.773,0.8,0.815 and 0.789 respectively.Conclusions There are age-specific cut-off values of PCT and CRP in the diagnosis of EONS without severe complications during the first 72 h of life.Both PCT and CRP are moderately accurate for the diagnosis of EONS.PCT may be more helpful for the early diagnosis of EONS for its higher sensitivity but CRP presents higher specificity.

Effects of cord blood vitamin D levels on the risk of neonatal sepsis in premature infants / 소아과

PURPOSE: Vitamin D plays a key role in immune function. Vitamin D deficiency may play a role in the pathogenesis of infections, and low levels of circulating vitamin D are strongly associated with infectious diseases. In this study, we aimed to evaluate the effects of low vitamin D levels in cord blood on neonatal sepsis in preterm infants. METHODS: One hundred seventeen premature infants with gestational age of <37 weeks were enrolled. In the present study, severe vitamin D deficiency (group 1) was defined as a 25-hydroxyvitamin D (25(OH)D) concentration <5 ng/mL; vitamin D insufficiency (group 2), 25(OH)D concentration ≥5 ng/mL and <15 ng/mL; and vitamin D sufficiency (group 3), 25(OH)D concentration ≥15 ng/mL. RESULTS: Sixty-three percent of the infants had deficient levels of cord blood vitamin D (group 1), 24% had insufficient levels (group 2), and 13% were found to have sufficient levels (group 3). The rate of neonatal sepsis was higher in group 2 than in groups 1 and 3. CONCLUSION: There was no significant relationship between the cord blood vitamin D levels and the risk of neonatal sepsis in premature infants.

Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age / 대한주산의학회잡지

PURPOSE: The aim of this study is to determine the clinical characteristics of early onset sepsis (EOS) in micropreemie. METHODS: We retrospectively reviewed medical records of 107 extremely preterm infants born at 25 or less than 25 weeks of gestation and admitted to the neonatal intensive care unit of Samsung Medical Center from January 2013 to August 2015. Infants were divided into two groups based on the presence of culture-proven EOS in the first 7 days of life. Retrospective analysis of perinatal factors and laboratory findings within the first week of life was done between two groups. We compared the neonatal outcomes among two groups. RESULTS: Culture-proven EOS was diagnosed in 11 of 107 infants (10.3%). Main pathogen of EOS was Staphylococcus epidermidis (45.5%). There were no significant differences between control group and EOS group in gestational age, birth weight, Apgar score, delivery type and pathologic chorioamnionitis. Among 11 infants with EOS, 9 showed fetal tachycardia (P=0.001). And EOS group presented lower platelet count at 3rd day and 7th day of life than that of control group (P=0.033, P=0.045). Neonatal outcomes in EOS group were compatible with control group. Main cause of death was sepsis in EOS group. CONCLUSION: In micropreemie, EOS is important factor of mortality. Our data suggest that fetal tachycardia and low platelet count during the first 7 days of life were associated with EOS.

Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age / 대한주산의학회잡지

PURPOSE: The aim of this study is to determine the clinical characteristics of early onset sepsis (EOS) in micropreemie. METHODS: We retrospectively reviewed medical records of 107 extremely preterm infants born at 25 or less than 25 weeks of gestation and admitted to the neonatal intensive care unit of Samsung Medical Center from January 2013 to August 2015. Infants were divided into two groups based on the presence of culture-proven EOS in the first 7 days of life. Retrospective analysis of perinatal factors and laboratory findings within the first week of life was done between two groups. We compared the neonatal outcomes among two groups. RESULTS: Culture-proven EOS was diagnosed in 11 of 107 infants (10.3%). Main pathogen of EOS was Staphylococcus epidermidis (45.5%). There were no significant differences between control group and EOS group in gestational age, birth weight, Apgar score, delivery type and pathologic chorioamnionitis. Among 11 infants with EOS, 9 showed fetal tachycardia (P=0.001). And EOS group presented lower platelet count at 3rd day and 7th day of life than that of control group (P=0.033, P=0.045). Neonatal outcomes in EOS group were compatible with control group. Main cause of death was sepsis in EOS group. CONCLUSION: In micropreemie, EOS is important factor of mortality. Our data suggest that fetal tachycardia and low platelet count during the first 7 days of life were associated with EOS.

Procalcitonin-Guided Antibiotic Theraphy in pediatric patients: A systematic review

Background@#Serum procalcitonin is a useful biomarker in establishing the presence of bacterial infections and has been used in algorithms to guide antibiotic treatment among adults. It role in pediatric infections, however, remains unclear. @*Objectives@#This research aims to evaluate the impact of serum procalcitonin in guiding antibiotic therapy among pediatric patients with suspected local or systemic infections. @*Methodology@#Randomized controlled trials comparing procalcitonin-guided antibiotic therapy to clinically guided therapy in pediatric patients with local or systemic infections were searched through MEDLINE, Cochrane, EMBASE, HERDIN and ClinicalTrials.gov. Hand search in various search engines was also done. Outcomes included antibiotic usage, morbidity and mortality. Two reviewers independently assessed potentially relevant studies. Statistical analysis was conducted using RevMan 5.3 using inverse variance weighting and random effects model. @*Results@#Five randomized controlled trials were included. Overall, there was a reduction in antibiotic prescription rate in the procalcitonin group compared to controls for all groups (RD -0.13, 95% CI [-021,0.06]; p <0.00001), however, pooled studies were heterogenous. Subgroup analysis showed that for children with pneumonia, procalcitonin guidance significantly reduced antibiotic prescription rate (RD – 012,95% CI [-021,0.04]; p <0.005 ), and may have potential in reducing the duration of therapy (95% CI [-6.8,2,54], p <0.0001) and antibiotic-related adverse effects (RD- 0.17, 95% CI[-0.24,-0.10], p<0.00001) compared to controls. In one study on neonates with early onset sepsis, procalcitonin guidance reduced antibiotic prescription rate by 27% (p=0.0009) and duration of therapy by 22.4 hours (p=0.0009). Procalcitonin guidance has no significant impact on antibiotic prescription rate in children with fever without a source (RD -0.11, 95% CI[0.28,0.05], p=0.190). @*Conclusion@#Procalcitonin guidance significantly reduces antibiotic prescription rate among children with pneumonia and neonates with early onset sepsis. It has the potential in reducing the duration of antibiotic therapy and antibiotic-related side effects in these populations. ON the other hand, it had no impact among children with fever without a source. These results highlight the need for algorithm-based approaches using procalcitonin cut-off values to guide antibiotic therapy in children.

Clinico-microbiological study of neonatal sepsis.

Neonatal sepsis, a systemic infection manifesting in the first month of life is a leading cause of mortality in the newborn .Blood culture is the main stay in the diagnosis of neonatal sepsis. The present study focuses on the bacterial agents, the antibiogram and the clinical risk factors associated with neonatal sepsis. One hundred and ten neonates with clinical suspicion of neonatal sepsis were included in this study. Bacterial pathogens isolated in positive blood cultures were identified and the antibiotic susceptibility testing was performed. The risk factors were noted from the case records & statistical analysis was done using the Chi square test. Thirty six (32.72%) cultures were positive among 110 suspected cases of neonatal sepsis. 22(61.11%) cases presented with early onset sepsis and 14(38.89%) presented as late onset sepsis. The common bacteria isolated were Klebsiella spp., Escherichia coli & Staphylococcus aureus. Antibiotics effective against gram negative bacilli were cefaperazone/sulbactam and piperacillin/tazobactam. The rate of Methicillin resistant Staphylococcus aureus isolation was 57%. Gram negative bacilli predominate as agents of neonatal sepsis & antibiotic resistance among bacteria is on rise. Thus there is a need for continuous screening and surveillance for antibiotic resistance in NICU.

Clinical significance of distinguishing neonatal septicemia between early-onset and late-onset sepsis / 中华实用儿科临床杂志

Obgective To analyze the demographic data,non-specific items,pathogens and antibiotic sensitivity between the children with early-onset and late-onset sepsis,in order to guide the diagnosis and treatment of neonatal sepsis.Methods Three hundred and fifty-two cases with positive blood culture were retrospectively recruited and divided into an early-onset group and a late-onset sepsis group according to the onset of sepsis.Results Of 352 cases,144 cases (40.91％) were the early-onset children while 208 cases (59.09％) were the late-onset children,and in the late-onset group,108 cases occurred due to nosocomial infection.Most neonates of the early-onset term were term infants [107/144 cases (74.31％)],while the preterm infants [77/208 cases (37.02％)] and low birth weight infants[70/208 cases(33.65％)] accounted for the majority of the late-onset group.The asphyxia,perinatal intrauterine distress,meconium-staining amniotic fluid and premature rupture of fetal membranes ≥ 18 h occurred more frequently in the early-onset group [21/144 cases (14.58％),14/144 cases (9.72％),26/144 cases (18.06％),31/144 cases (21.53％)],respectively,while those in the late-onset group were [17/208 cases (8.17％),9/208 cases(4.33％),13/208 cases(6.25％),17/208 cases(8.17％)],respectively,there were significant differences (x2 =4.622,3.886,5.950,13.345,all P ＜ 0.05) between 2 groups.In the early-onset group abnormal temperature[72/208 cases(34.62％)vs 30/144 cases(20.83％)],vomiting or abdominal distention[109/208 cases (52.40％) vs 35/144 cases (24.31％)],lethargy [79/208 cases (37.98％) vs 38/144 cases (26.39 ％)] and umbilicalitis or skin pustule [33/208 cases (15.87 ％) vs 11 / 1 44 cases (7.64 ％)] occurred more frequently in late-onset group,and there were significant differences (x2 =7.853,8.763,5.153,5.265,all P ＜ 0.05).Besides,more cases in the late-onset group had elevated immature neutrophil vs total neutrophil count ratio [27/184 cases (14.67％)] and C-reactive protein value [76/206 cases (36.89％)],compared with those in early-onset group [9/133 cases (6.77％),38/143 cases(26.57％)],and there were significant differences (x2 =4.794,4.087,allP ＜ 0.05).Compared with early-onset group,patients in the late-onset group were more likely to suffer from suppurative meningitis [17.79％ (37/208 cases) vs 8.33％ (12/144 cases);x2 =6.348,P ＜ 0.05].In terms of pathogens,the main pathogens in the early-onset group were gram negative bacteria[39.58％ (57/144 cases),including detection of Klebisella pneumoniae in 21 cases and E.coli in 20 cases] and coagulase negative staphylococcus[32.64％ (47/144 cases)].In late-onset group,the main pathogens were gram positive bacteria [58.65％ (122/208 cases)],including detection of coagulase negative staphylococcus in 90 cases(43.27％) and E.coli [17.79％ (37/208 cases)].There was no significant difference in prognosis between 2 groups(x2 =1.187,P =0.552).Conclusions Early-onset sepsis and late onset sepsis differ in the clinical manifestation and laboratory findings.Distinguishing neonatal early-onset and late onset septicemia is of clinical significance in choosing appropriate antibiotics.