ABSTRACT
AIM: To compare the frequency of elevated concentrations of inflammation-related proteins in the blood of infants born before the 28th week of gestation who had documented bacteraemia and those who had presumed (antibiotic-treated but culture-negative) bacteraemia to those who had neither. METHODS: The subjects of this study are the 868 infants born at 14 institutions for whom information about protein measurements on at least two of the three protocol days (days 1, 7, and 14) was available and who did not have Bell stage 3 necrotizing enterocolitis or isolated bowel perforation, which were strongly associated with bacteraemia in this sample. RESULTS: Newborns with presumed early (week 1) bacteraemia had elevated concentrations of only a few inflammation-related proteins, while those who had presumed late (weeks 2-4) bacteraemia did not have any elevations. In contrast, newborns who had documented early bacteraemia had a moderately strong signal, while those who had documented late bacteraemia had a stronger signal with more protein concentrations elevated on two separate occasions a week apart. CONCLUSIONS: Culture-confirmed early and late bacteraemia are accompanied/followed by systemic inflammatory responses not seen with presumed early and late bacteraemia.
Subject(s)
Acute-Phase Proteins/analysis , Bacteremia/diagnosis , Infant, Premature, Diseases/blood , Infant, Premature, Diseases/diagnosis , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Culture Techniques , Gestational Age , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/drug therapy , Time FactorsABSTRACT
OBJECTIVE: This study tested the hypothesis that preterm infants who had a blood gas derangement on at least 2 of the first 3 postnatal days are at increased risk for more severe retinopathy of prematurity (ROP). METHOD: 1,042 infants born before 28 weeks' gestational age (GA) were included. An infant was considered to be exposed if his/her blood gas measure was in the highest or lowest quartile for GA on at least 2 of the first 3 postnatal days. RESULTS: Multivariable models adjusting for confounders indicate that exposure to a PCO(2) in the highest quartile predicts ROP (stage 3, 4 or 5: OR = 1.6, 95% CI = 1.1-2.3); zone 1: 2.0, 1.1-3.6; prethreshold/threshold: 1.9, 1.2-3.0; plus disease: 1.8, 1.1-2.9). Estimates are similar for a low pH for zone 1 (2.1, 1.2-3.8), prethreshold/threshold (1.8, 1.1-2.8), but did not quite achieve statistical significance for ROP stage 3, 4, or 5 (1.4, 0.9-2.0) and plus disease (1.5, 0.9-2.4). A PaO(2) in the highest quartile for GA on at least 2 of the first 3 postnatal days was associated with a doubling of the risk of ROP in zone 1 (2.5, 1.4-4.4) and of prethreshold/threshold disease (2.1, 1.4-3.3), a 70% risk increase for plus disease (1.7, 1.04-2.8), while a 40% risk increase for ROP stage 3 or higher did not achieve statistical significance (1.4, 0.96-2.0). CONCLUSION: Infants exposed to high PCO(2), low pH and high PaO(2) appear to be at increased risk of more severe ROP.
Subject(s)
Carbon Dioxide/blood , Infant, Premature/blood , Oxygen/blood , Retinopathy of Prematurity/blood , Female , Humans , Hydrogen-Ion Concentration , Infant, Newborn , Logistic Models , Male , Multivariate Analysis , PregnancyABSTRACT
INTRODUCTION: We have previously demonstrated that, as compared to adults, the platelets of extremely low birth weight (ELBW) neonates are markedly hyporeactive on day 0-1 of life. The purpose of this study was to examine the age dependency of this hyporeactivity. MATERIALS AND METHODS: On days 0-1, 3-4, and 10-14, peripheral blood was collected from 14 stable ELBW neonates and compared to peripheral blood from normal adults run in parallel. Whole blood flow cytometry was used to examine the activation-dependent increase in platelet surface P-selectin (reflecting degranulation) and platelet surface binding of factor V/Va (reflecting platelet surface procoagulant activity) and decrease in platelet surface glycoprotein (GP) Ib (the von Willebrand factor receptor). RESULTS: In the physiologic milieu of whole blood, ELBW neonatal platelets on days 0-1 and 3-4 were markedly less reactive than adult platelets. However, by day 10-14, the platelet function of ELBW neonates improved significantly, although not completely to adult levels. CONCLUSIONS: The age-dependent platelet hyporeactivity of ELBW neonates demonstrated in this study may be a contributing factor to the similar age-dependent propensity of ELBW neonates to intraventricular hemorrhage.
