Micro-Erythrocyte Sedimentation Rate in Neonatal Sepsis of a Tertiary Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Neonatal sepsis is the most important cause of morbidity and mortality among low birth weight and preterm babies in developing countries. The main objective of this study is to find the level of micro-Erythrocyte sedimentation rate in neonatal sepsis. METHODS: This is a descriptive cross-sectional study conducted at the neonatal unit over six months period (November 2019 to April 2020). All preterm, term and post-term babies with neonatal sepsisdelivered at Kathmandu Medical College Teaching Hospital were enrolled. Ethical clearance was received from the Institutional Review Committee of Kathmandu Medical College (Ref: 181020191). Convenient sampling method was applied and statistical analysis was done with Statistical package for social sciences 19 version. RESULTS: Out of 75 babies, confirm sepsis is 13 (17.3%), probable sepsis is 40 (53.4%) and suspected sepsis is 22 (29.2%). Micro-Erythrocyte sedimentation level is elevated (≥15mm in 1st hr) in 25 (33.3%) babies with a mean micro-Erythrocyte sedimentation level 9.32±5.4 (2-18) mm in 1st hr. The elevated micro- Erythrocyte sedimentation level was seen in relation to sepsis types and C-reactive protein. CONCLUSIONS: The bedside micro-Erythrocyte sedimentation level aids in the diagnosis of neonatal sepsis.

Interpreting complete blood counts soon after birth in newborns at risk for sepsis.

BACKGROUND: A complete blood count (CBC) with white blood cell differential is commonly ordered to evaluate newborns at risk for sepsis. OBJECTIVES: To quantify how well components of the CBC predict sepsis in the first 72 hours after birth. METHODS: For this retrospective cross-sectional study we identified 67 623 term and late-preterm (≥ 34 weeks gestation) newborns from 12 northern California Kaiser hospitals and 1 Boston, Massachusetts hospital who had a CBC and blood culture within 1 hour of each other at <72 hours of age. We compared CBC results among newborns whose blood cultures were and were not positive and quantified discrimination by using receiver operating characteristic curves and likelihood ratios. RESULTS: Blood cultures of 245 infants (3.6 of 1000 tested newborns) were positive. Mean white blood cell (WBC) counts and mean absolute neutrophil counts (ANCs) were lower, and mean proportions of immature neutrophils were higher in newborns with infection; platelet counts did not differ. Discrimination improved with age in the first few hours, especially for WBC counts and ANCs (eg, the area under the receiver operating characteristic curve for WBC counts was 0.52 at <1 hour and 0.87 at ≥ 4 hours). Both WBC counts and ANCs were most informative when very low (eg, the likelihood ratio for ANC < 1000 was 115 at ≥ 4 hours). No test was very sensitive; the lowest likelihood ratio (for WBC count ≥ 20 000 at ≥ 4 hours) was 0.16. CONCLUSION: Optimal interpretation of the CBC requires using interval likelihood ratios for the newborn's age in hours.

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants.

OBJECTIVE: To determine whether plasma N-terminal probrain natriuretic peptide (NT-proBNP) in premature infants could identify hemodynamically significant patent ductus arteriosus (HsPDA) and to determine the correlation between serial plasma NT-proBNP and echocardiographic assessment of ductal shunting. STUDY DESIGN: An observational study involving 35 preterm infants who underwent echocardiographic assessment for PDA on day 2, 4 and 7 of life with simultaneous blood sampling for determination of NT-proBNP concentrations. HsPDA was diagnosed by left-to-right ductal shunt on color Doppler, measuring diameter >1.5 mm on two-dimensional echocardiography plus > or =2 clinical features of PDA. RESULT: Plasma NT-proNBP levels on day 2 in the HsPDA group (n=12) were significantly higher than in non-HsPDA group (n=23) with a median of 16,353 pg ml(-1) (interquartile range (IQR), 12,360-33,459; range, 10,316-104,998) vs 3914 pg ml(-1) (IQR, 2601-5782; range, 1535-19,516) (P<0.001), respectively. Eight infants (67%) in the HsPDA group responded to an initial course of indomethacin or ibuprofen and their NT-proBNP levels significantly decreased within 48 h after treatment compared with non-responders (P=0.007). NT-proBNP concentrations were significantly correlated with left atrial to aortic root ratio. A cut-off NT-proBNP on day 2 of 10,180 pg ml(-1) offered the best predictive values for HsPDA with a sensitivity of 100% and a specificity of 91%. CONCLUSION: Plasma NT-proBNP on day 2 was found as a sensitive marker for predicting HsPDA in preterm infants. Successful closure of PDA was also correspondent with the decline in plasma NT-proBNP.

[Assesment of the specific oxidase activity of ceruloplasmin in pregnant women].

The specific oxidase activity of ceruloplasmin (activity per unit mass of enzyme protein) was studied in plasma of pregnant women with gestosis, feto-placental insufficiency, postmature and in normal pregnancy. The specific oxidase activity decreased in all groups with pathology. The ceruloplasmin concentration decreased in the postmature group.

Arylsulfatase-A in umbilical cord blood: gestational age and mode of delivery do not influence enzyme activity.

The possibility of using umbilical cord blood for transplantation in several enzyme deficiencies has received increasing attention because of the availability of cord blood, the reduced incidence of post-transplantation complications, such as graft-versus-host disease and the possible accomplishment of good corrective results following transplantation, even in cases of greater HLA disparity. The use of hematopoietic stem cells from unrelated donors is even more highly recommended for the treatment of inherited enzyme deficiencies, because it might reduce the risk of the transplanted cells originating from a carrier of the defect, which might have an inadequate corrective ability. Our study was designed to elucidate whether the gestational age and mode of delivery influences the arylsulfatase-A activity in the umbilical cord blood. Enzyme activities proved to be similar in the four populations studied (full-term normal spontaneous vaginal delivery, full-term caesarean section, preterm normal spontaneous vaginal delivery and preterm caesarean section). Therefore, umbilical cord blood samples seem to be suitable for transplantation in metachromatic leukodystrophy, regardless of gestational age and mode of delivery. Moreover, our results are the first published data on normal values for arylsulfatase-A activity in human umbilical cord blood.

Plasma selenium in preterm and term infants during the first 12 months of life.

The goal of the present study was to prospectively assess the plasma selenium (Se) concentrations of term and preterm infants during the first year of life in relation to gestational age and nutrition. Blood specimens were collected from orally formula-fed preterm infants (gestational age < 32 weeks, birth weight < 1500 g): 1.) in hospital and 2.) corrected for gestational age parallel to healthy term breast and formula-fed infants at the ages of 1, 4 and 12 months. All infants were fed according to a standardized nutritional concept, solids and follow-up formula were introduced at the age of 4 months. Plasma selenium in preterm infants in hospital was 11.7 (6.5-20.8) microg/l and 11.6 (8.8-16.7) microg/l at 4 weeks corrected for gestational age. At the age of 4 months plasma selenium was still significantly lower than in the other groups: Preterm infants: 17.1 (10.4-30.5) microg/l; formula-fed term infants: 31.3 (24.3-47.5) microg/l; breast-fed term infants: 45.6 (27.1-65.1) microg/l). The levels of breast-fed infants were significantly higher than those of both formula-fed groups up until the introduction of solids. Preterm infants had significantly low plasma selenium levels up until a postnatal age of at least 6 months. The levels were lower than those of term infants fed an identical unsupplemented infant formula during the first 4 months of life. These data support routine monitoring in hospital and selenium supplementation of preterm infants, preferably in hospital before discharge.

Postterm pregnancy: effects on temperature and glucose regulation.

Pregnancies that extend beyond 42 weeks of gestation have a higher risk for uteroplacental insufficiency than do pregnancies delivered prior to this time. Postterm infants are at risk for meconium aspiration due to uteroplacental insufficiency. Prior research has shown that postterm infants are at risk for temperature- and glucose-regulating difficulties following birth. In this study, the abilities of 63 postterm infants and 88 term infants to regulate temperature and glucose during the first 24 hours of infant age were compared. No significant differences were found in the two groups on the two variables.

Physiologic jaundice in the Nigerian neonate.

In the course of a systemic study of physiologic hyperbilirubinaemia, 200 Nigerian newborn infants were evaluated daily over a 12-day period. The pre-term and post-term neonates exhibited a distinct biphasic pattern of hyperbilirubinaemia. Mean peak bilirubin levels of 8.20 mg/dl for the pre-term, 7.15 mg/dl for the post-term and 8.34 for the term were attained on the fourth, third and fifth days, respectively. Term small for gestational age neonates experienced mean peak bilirubin levels of 7.02 mg/dl at the age of 4 days and maintained a sustained elevation for as long as the last day of the study. Higher values of physiologic hyperbilirubinaemia are observed in this study than has been reported for American neonates.