Outcome and prognostic factors in neonates with septic shock*

Kermorvant‐Duchemin, Elsa; Laborie, Sophie; Rabilloud, Muriel; Lapillonne, Alexandre; Claris, Olivier

doi:10.1097/pcc.0b013e31816689a8

Cited by 91 publications

(77 citation statements)

References 23 publications

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“…Neonatal sepsis is a major cause of morbidity and mortality during the first 28 days of life, contributing to 13% -15% of all neonatal deaths (16). Our study showed a higher prevalence (66.7%) of neonatal sepsis among males compared to females.…”

Section: Discussionsupporting

confidence: 45%

Apoptotic Changes in the Early Diagnosis and Severity Determination of Neonatal Sepsis

Barseem

Helwa

2016

Iran J Pediatr

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Objectives: The aim of this study was to assess the presence of DNA damage in full-term newborns with neonatal sepsis. Methods: Sixty neonates with early onset neonatal sepsis and 45 apparently healthy controls were enrolled in the study. Screening of neonates was done using a modified clinical sepsis score and hematological scoring system, adjusted to the results of blood culture and screening tests. Complete blood count, C-reactive protein (CRP), and DNA studies were done. Results: Sepsis was likely in 41 (68.3%) patients with scores of 3 or 4 and CRP levels of 12 -48 mg/L. Sepsis was very likely in 19 (31.7%) patients with scores of ≥ 5 and CRP of 48 -96 mg/L. Sepsis was unlikely in all controls with scores of ≤ 2. The mean neutrophil count was 9700 ± 4600/µL in patients and 4230 ± 1400/µL in controls. The higher the total polymorphonuclear count and CRP level, the more severe was the sepsis. Twenty-six of 60 (43.3%) sepsis patients and 5 of 45 controls (11%) had DNA damage. There was a highly significant negative correlation between DNA damage, blood culture results, and CRP levels. Conclusions: DNA damage, demonstrated by clinical and laboratory evidence with a combination of blood cultures, CRP, and hematological scoring system results, can be used as an indicator of both the immune status of the neonate and the severity of the sepsis.

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Section: Discussionsupporting

confidence: 45%

Apoptotic Changes in the Early Diagnosis and Severity Determination of Neonatal Sepsis

Barseem

Helwa

2016

Iran J Pediatr

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“…The association of shock with adverse outcome in LBW neonates was found in other studies also. For example studies done by Kermorvant-Duchemin, et al [13], Mukhyopadhyay, et al [11] showed similar results. However our study was different in that we studied impact of shock on admission only.…”

Section: Discussionsupporting

confidence: 64%

Clinicoepidemiological Profile and Predictors of Mortality in LBW Babies:A Hospital Based Observational Study

Ishtiyaq¹,

Am²,

Qazi³

2016

Neonat Pediatr Med

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“…18 Shock was defined as a mean blood pressure less than the lower limit according to gestational age that was unresponsive to fluid treatment or required vasoactive agents. 19 Congenital infection and early-onset sepsis were defined as a definite infectious focus and septicemia that occurred within the first 3 days of life. 3 Previous antibiotic therapy was defined as systemic antibiotic use for .72 hours in the preceding 30 days before bacteremia onset.…”

Section: Definitionsmentioning

confidence: 99%

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:There is a perception that Gram-negative bacilli (GNB) bloodstream infection is increasing in the NICU, and those infections caused by a multidrug-resistant (MDR) strain are a growing threat to hospitalized patients. WHAT THIS STUDY ADDS:Exposure to broad-spectrum antibiotics is the most important risk factor for MDR GNB bacteremia, which is associated with higher mortality. Neonates with risk factors for bacteremia caused by a MDR GNB strain may benefit from empirical antimicrobial therapy with carbapenem. abstract OBJECTIVES: To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients. METHODS:Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study. RESULTS:Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum b-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37-15.08; P , .001) and carbapenem (OR: 3.60; 95% CI: 1.26-10.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74-28.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P , .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality 1rate (28.6% vs 10.5%; P , .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41-7.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88-20.31; P = .003).CONCLUSIONS: MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum b-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate. Pediatrics 2014;133:e322-e329

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Outcome and prognostic factors in neonates with septic shock*

Abstract: Septic shock in the neonatal period has a very poor outcome. Data underscore the extreme vulnerability of very low birth weight infants to septic shock, particularly to gram-negative species.

Cited by 91 publications

References 23 publications

Apoptotic Changes in the Early Diagnosis and Severity Determination of Neonatal Sepsis

Apoptotic Changes in the Early Diagnosis and Severity Determination of Neonatal Sepsis

Clinicoepidemiological Profile and Predictors of Mortality in LBW Babies:A Hospital Based Observational Study

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

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