Multiple vital signs analysis algorithm detects systemic inflammatory response in premature infants with late‐onset sepsis and necrotising enterocolitis

2019 ◽  
Author(s):  
Nikolina Zdraveska
Keyword(s):  
Inflammatory Response ◽  
Premature Infants ◽  
Late Onset ◽  
Vital Signs ◽  
Necrotising Enterocolitis ◽  
Systemic Inflammatory Response ◽  
Analysis Algorithm ◽  
Late Onset Sepsis

scholarly journals Vital signs analysis algorithm detects inflammatory response in premature infants with late onset sepsis and necrotizing enterocolitis

2017 ◽  
Author(s):  
Leena B. Mithal ◽  
Ram Yogev ◽  
Hannah L. Palac ◽  
Daniel Kaminsky ◽  
Ilan Gur ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Inflammatory Responses ◽  
Late Onset ◽  
Clinical Signs ◽  
Vital Signs ◽  
Clinical Suspicion ◽  
Accurate Identification ◽  
Late Onset Sepsis

BackgroundNonspecific clinical signs and suboptimal diagnostic tests limit accurate identification of late onset sepsis (LOS) and necrotizing enterocolitis (NEC) in premature infants, resulting in significant morbidity and antibiotic overuse. An infant’s systemic inflammatory response may be identified earlier than clinical suspicion through analysis of multiple vital signs by a computerized algorithm (RALIS).AimTo evaluate the revised RALIS algorithm for detection of LOS and NEC in preterm infants.MethodsIn this nested case-control study, VS data (heart rate, respiratory rate, temperature, desaturations, bradycardias) were extracted from medical records of infants 23-32 weeks gestation. RALIS generated an output, with score >5 triggering an alert. Patient episodes were classified based on culture, radiograph, and antibiotic data into categories: LOS, expanded LOS, NEC, and controls. Paired t-tests, linear regression and cross-validation analyses were used to evaluate the relationship between RALIS alert and LOS/NEC.ResultsAmong 155 infants with 161 episodes, there were 41 expanded LOS (+ blood, CSF, urine, respiratory culture), 31 LOS (+ blood, CSF, urine), 9 NEC, and 93 controls. RALIS alert was 43.1+/-79 hours before culture in LOS (p=0.012). There was a significant association between RALIS alert and LOS/NEC (β=0.72, p<0.0001). Sensitivity and specificity for LOS/NEC were 84% and 80%, (PPV=63%; NPV=93%). The regression model demonstrated an AUC of 89.9%.ConclusionsFor infants <32 weeks, RALIS detects systemic inflammatory responses in LOS and NEC in the first month of life. The algorithm identifies infection earlier than clinical suspicion, even for NEC with negative cultures. RALIS has high NPV to rule-out LOS and NEC, and may, after prospective validation, aid in antibiotic treatment decisions.

scholarly journals Probiotics to prevent necrotising enterocolitis and nosocomial infection in very low birth weight preterm infants

2017 ◽  
Vol 117 (7) ◽  
pp. 994-1000 ◽  
Author(s):  
J. Uberos ◽  
E. Aguilera-Rodríguez ◽  
A. Jerez-Calero ◽  
M. Molina-Oya ◽  
A. Molina-Carballo ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Necrotising Enterocolitis ◽  
Stage Ii ◽  
Preterm Neonates ◽  
Probiotic Supplementation ◽  
Late Onset Sepsis ◽  
Reduced Risk

AbstractThe aim of the study was to determine whether routine probiotic supplementation (RPS) with Lactobacillus rhamnosus GG (LGG) or Lactobacillus acidophilus +Lactobacillus bifidum is associated with reduced risk of necrotising enterocolitis (NEC)≥Stage II in preterm neonates born at ≤32 weeks’ gestation. We conducted a retrospective cohort study on the effect of probiotic supplementation in very low birth weight infants in our neonatal unit by comparing two periods: before and after supplementation. The incidence of NEC≥Stage II, late-onset sepsis and all-cause mortality was compared for an equal period ‘before’ (Period I) and ‘after’ (Period II) RPS with LGG or L. acidophillus+L. bifidum. Multivariate logistic regression analysis was conducted to adjust for relevant confounders. The study population was composed of 261 neonates (Period I v. II: 134 v. 127) with comparable gestation duration and birth weights. In <32 weeks, we observed a significant reduction in NEC≥Stage II (11·3 v. 4·8 %), late-onset sepsis (16 v. 10·5 %) and mortality (19·4 v. 2·3 %). The benefits in neonates aged ≤27 weeks did not reach statistical significance. RPS with LGG or L. acidophillus+L. bifidum is associated with a reduced risk of NEC≥Stage II, late-onset sepsis and mortality in preterm neonates born at ≤32 weeks’ gestation.

Tocopherol Efficacy and Safety for Preventing Retinopathy of Prematurity: A Randomized, Controlled, Double-Masked Trial

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 489-500 ◽  
Author(s):  
Dale L. Phelps ◽  
Arthur L. Rosenbaum ◽  
Sherwin J. lsenberg ◽  
Rosemary D. Leake ◽  
Frederick J. Dorey
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Plasma Levels ◽  
Late Onset ◽  
Retinal Hemorrhage ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Late Onset Sepsis ◽  
Prospective Monitoring

To test the efficacy and safety of vitamin E in preventing retinopathy of prematurity, 287 infants with birth weights of less than 1.5 kg or gestational ages of less than 33 weeks were enrolled within 24 hours of birth in a randomized, double-masked trial of IV, followed by oral, placebo v tocopherol (adjusted to plasma levels of 3 to 3.5 mg/dL). In the 196 infants completing ophthalmic follow-up, tocopherol did not prevent retinopathy of prematurity of any stage (28% placebo treated v 26% tocopherol treated) or moderately severe retinopathy of prematurity (8% placebo treated v 11% tocopherol treated). Cicatricial sequelae were not significantly different (1/97 placebo treated v 3/99 tocopherol treated), with one placebo-treated infant and one tocopherol-treated infant having retinal detachments. Among all 232 infants examined, those treated with tocopherol had more retinal hemorrhage than placebo-treated infants (8/121 placebo treated v 16/111 tocopherol treated), and retinal hemorrhage correlated positively (P &lt; .01) with plasma levels of tocopherol after the first 2 weeks of age. Prospective monitoring of morbidity including late-onset sepsis, necrotizing enterocolitis, etc revealed no differences between groups except that grades 3 and 4 intraventricular hemorrhage occurred more frequently in infants weighing less than 1 kg at birth who had received tocopherol (14/42, 33%) v those who had received placebo (4/43, 9%) (P &lt; .02). Our data do not support the use of tocopherol for prophylaxis against retinopathy of prematurity in premature infants and suggest that IV tocopherol treatment starting on day 1 may increase the incidence of hemorrhagic complications of prematurity, particularly in infants with birth weights of less than 1 kg.

Optimized Detection of Central Apneas Preceding Late-Onset Sepsis in Premature Infants

2021 ◽  
Author(s):  
Gabriele Varisco ◽  
Deedee Kommers ◽  
Xi Long ◽  
Zhuozhao Zhan ◽  
Marina M. Nano ◽  
...  
Keyword(s):  
Premature Infants ◽  
Late Onset ◽  
Late Onset Sepsis ◽  
Central Apneas

scholarly journals Intestinal microbiome colonization patterns differ prior to late onset sepsis in premature infants (637.3)

2014 ◽  
Vol 28 (S1) ◽  
Author(s):  
Diana Taft ◽  
Doyle Ward ◽  
Kurt Schibler ◽  
Zhuoteng Yu ◽  
David Newburg ◽  
...  
Keyword(s):  
Premature Infants ◽  
Late Onset ◽  
Intestinal Microbiome ◽  
Late Onset Sepsis ◽  
Colonization Patterns

scholarly journals A randomised controlled trial of the probiotic Bifidobacterium breve BBG-001 in preterm babies to prevent sepsis, necrotising enterocolitis and death: the Probiotics in Preterm infantS (PiPS) trial

2016 ◽  
Vol 20 (66) ◽  
pp. 1-194 ◽  
Author(s):  
Kate Costeloe ◽  
Ursula Bowler ◽  
Peter Brocklehurst ◽  
Pollyanna Hardy ◽  
Paul Heal ◽  
...  
Keyword(s):  
Late Onset ◽  
Controlled Trial ◽  
Health Technology ◽  
Necrotising Enterocolitis ◽  
Bifidobacterium Breve ◽  
Probiotic Group ◽  
Late Onset Sepsis ◽  
Postmenstrual Age ◽  
Preterm Babies ◽  
To Receive

BackgroundNecrotising enterocolitis (NEC) and late-onset sepsis remain important causes of death and morbidity in preterm babies. Probiotic administration might strengthen intestinal barrier function and provide protection; this is supported by published meta-analyses, but there is a lack of large well-designed trials.ObjectiveTo test the use of the probioticBifidobacterium brevestrain BBG-001 to prevent NEC, late-onset sepsis and death in preterm babies while monitoring probiotic colonisation of participants.DesignDouble-blind, randomised, placebo-controlled trial.SettingRecruitment was carried out in 24 hospitals, and the randomisation programme used a minimisation algorithm. Parents, clinicians and outcome assessors were blinded to the allocation.ParticipantsBabies born between 23 and 30 weeks’ gestation and randomised within 48 hours of birth. Exclusions included life-threatening or any gastrointestinal malformation detected within 48 hours of birth and no realistic chance of survival.InterventionsActive intervention: 1 ml ofB. breveBBG-001 in one-eighth-strength infant formula Neocate®(Nutricia Ltd, Trowbridge, UK), (6.7 × 107to 6.7 × 109colony-forming units) per dose administered enterally. Placebo: 1 ml of one-eighth-strength infant formula Neocate. Started as soon as practicable and continued daily until 36 weeks’ postmenstrual age.Main outcome measuresPrimary outcomes were an episode of bloodstream infection, with any organism other than a skin commensal, in any baby between 72 hours and 46 weeks’ postmenstrual age; an episode of NEC Bell stage ≥ 2 in any baby; and death before discharge from hospital. Secondary outcomes included stool colonisation withB. breve.ResultsIn total, 654 babies were allocated to receive probiotic and 661 to receive placebo over 37 months from July 2010. Five babies were withdrawn; 650 babies from the probiotic group and 660 from the placebo group were included in the primary analysis. Baseline characteristics were well balanced. There was no evidence of benefit for the primary outcomes {sepsis: 11.2% vs. 11.7% [adjusted relative risk (RR) 0.97, 95% confidence interval (CI) 0.73 to 1.29]; NEC Bell stage ≥ 2: 9.4% vs. 10.0% [adjusted RR 0.93, 95% CI 0.68 to 1.27]; and death: 8.3% vs. 8.5% [adjusted RR 0.93, 95% CI 0.67 to 1.30]}.B. brevecolonisation status was available for 1186 (94%) survivors at 2 weeks’ postnatal age, of whom 724 (61%) were positive: 85% of the probiotic group and 37% of the placebo group. There were no differences for subgroup analyses by minimisation criteria and by stool colonisation withB. breveat 2 weeks. No harms associated with the interventions were reported.LimitationsCross-colonisation of the placebo arm could have reduced statistical power and confounded results; analyses suggest that this did not happen.ConclusionsThis is the largest trial to date of a probiotic intervention. It shows no evidence of benefit and does not support routine use of probiotics for preterm infants.Future work recommendationsThe increasing understanding of the pathogenesis of NEC and sepsis will inform the choice of probiotics for testing and better define the target population. Future Phase III trials should incorporate monitoring of the quality and viability of the intervention and colonisation rates of participants; cluster design should be considered.Trial registrationCurrent Controlled Trials ISRCTN05511098 and EudraCT 2006-003445-17.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 66. See the NIHR Journals Library website for further project information.

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