👉Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies

📌In this study, EOS incidence and associated mortality disproportionately occurred in preterm infants. Contemporary cases have demonstrated the limitations of current GBS prevention strategies. The increase in E coli infections among very low-birth-weight infants warrants continued study. Ampicillin and gentamicin remained effective antibiotics in most cases, but ongoing surveillance should monitor antibiotic susceptibilities of EOS pathogens.

🔗https://jamanetwork.com/journals/jamapediatrics/article-abstract/2765163

#sepsis #streptococcus #ecoli #jama #eos #neonatology #infection

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👉Challenges in developing a consensus definition of neonatal sepsis

📌Sepsis remains a leading cause of morbidity and mortality in the neonatal population, and at present, there is no unified definition of neonatal sepsis. Existing consensus sepsis definitions within paediatrics are not suited for use in the NICU and do not address sepsis in the premature population. Many neonatal research and surveillance networks have criteria for the definition of sepsis within their publications though these vary greatly and there is typically a heavy emphasis on microbiological culture. The concept of organ dysfunction as a diagnostic criterion for sepsis is rarely considered in neonatal literature, and it remains unclear how to most accurately screen neonates for organ dysfunction. Accurately defining and screening for sepsis is important for clinical management, health service design and future research. The progress made by the Sepsis-3 group provides a roadmap of how definitions and screening criteria may be developed. Similar initiatives in neonatology are likely to be more challenging and would need to account for the unique presentation of sepsis in term and premature neonates. The outputs of similar consensus work within neonatology should be twofold: a validated definition of neonatal sepsis and screening criteria to identify at-risk patients earlier in their clinical course.

🔗https://www.nature.com/articles/s41390-020-0785-x

#sepsis #nature #nicu

👉Iron Homeostasis and #Ferritin in Sepsis-Associated Kidney Injury

📌#Sepsis associated acute #kidney injury (SA-AKI) is a common clinical syndrome that occurs among hospitalized patients and significantly impacts mortality. Furthermore, survival after sepsis is intricately dependent on recovery of kidney function. In this review, we discuss the role of iron imbalance in mediating the pathogenic events during sepsis. Intracellular ferritin serves as a repository for iron and prevents iron-mediated injury and may limit the availability of iron to pathogens. Circulating levels of ferritin also increase during sepsis and often correlate with severity of sepsis. Herein, we examine preclinical and clinical data and discuss recent findings that suggest immunomodulatory roles for ferritin. We also discuss the possible mechanistic roles for ferritin in mitigating the pathogenic sequelae of sepsis and highlight current gaps in knowledge.

🔗https://doi.org/10.1159/000508857

👉Listen to real-world advice and guidance on how to manage paediatric sepsis.

🔗https://www.rcpch.ac.uk/resources/paediatric-sepsis-podcasts

#sepsis #infection #mp3 #podcast

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👉Early #antibiotic therapy and adverse outcomes in preterm infants: Time for a trial!

📌For decades, #antibiotics have been prescribed after delivery to preterm infants cared for in the neonatal intensive care unit. Given the risks of early-onset #sepsis, particularly during the peak of group B streptococcal disease, a “better safe than sorry” approach to empiric antibiotics became commonplace. Like Thetis dipping her newborn Achilles into the river Styx to confer invulnerability, neonatologists would routinely administer ampicillin and gentamicin for days or even weeks, often in the absence of any objective evidence for infection. As recently as 2008, approximately half of extremely-low-birth-weight (ELBW, <1000 g) infants received >5 days of empiric antibiotic therapy after delivery.
Unfortunately, as with Achilles, a critical weakness in that strategy was identified. In 2009, Cotton et al
associated prolonged early antibiotic therapy with an increased risk for necrotizing enterocolitis (NEC) and death in ELBW infants (OR 1.04 [95% CI 1.02-1.06] per day of antibiotics). A variety of other study groups in different centers and countries have since found similar associations.
Over the last 10 years, prolonged empiric antibiotic use among preterm infants has decreased, although more than a third of ELBW infants still receive prolonged empiric antibiotics.

🔗https://doi.org/10.1016/j.jpeds.2020.07.046

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👉C-Reactive Protein, Procalcitonin, and White Blood Count to Rule Out Neonatal Early-onset #Sepsis Within 36 Hours: A Secondary Analysis of the Neonatal #Procalcitonin Intervention Study

📌Normal serial #CRP and #PCT measurements within 36 hours after the start of empiric antibiotic therapy can exclude the presence of neonatal #EOS with a high probability. The negative predictive values of CRP and PCT do not increase after 36 hours.

🔗https://doi.org/10.1093/cid/ciaa876

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👉Suspected or Proven Early-Onset #Sepsis and NLR, PLR, and MPV Parameters in Neonates with Born through MSAF

📌MSAF might be as a risk factor for EOS in neonates.. · CRP and procalcitonin values may help to be determined at EOS in asymtomatic neonates with MSAF.. · MPV, NLR, PLR, and MLR values do not seem to be helpful for the early detection of sepsis in #meconium-stained term neonates..

🔗https://doi.org/10.1055/s-0040-1718369

Peripheral #blood culture contamination (BCC) can lead to an initiation of unnecessary antimicrobial treatment, further laboratory tests, increased length of stay, and increased costs. This study describes a 12-month quality improvement (QI) program to reduce the BCC rate in a neonatal unit by 50%.

#sepsis
doi: 10.1097/pq9.0000000000000413
*The full text is in the comments

In non-sick appearing infants with a negative blood culture at 24 h and normal laboratory values, #sepsis is highly unlikely and discontinuing #antibiotics after 24 h is a viable option.

https://doi.org/10.3389/fped.2021.693882

The purpose of this review is to place into context the #platelet and its role in immunology and examine the evidence where available for its role as an immune cell in childhood #sepsis.

https://doi.org/10.1038/s41390-021-01715-z