Usefulness of the delta neutrophil index for assessing neonatal sepsis.

AIM: We investigated the significance of the calculated delta neutrophil index (DNI) as a diagnostic factor for neonatal sepsis. METHODS: In retrospective study, 24 infants were diagnosed with blood culture-proven sepsis, and 48 non-septic neonates matched for gestational age, and birth weight served as controls. Among the 24 infants with sepsis, 5 died within 7 days at diagnosis. RESULTS: Mean DNI (at diagnosis, after 24 h and 72 h), CRP and WBC counts were significantly higher, and neutrophil and platelet counts were significantly lower in sepsis group than control group. In sepsis group, mean DNI at the time of diagnosis, DNI at 72 h, and CRP at 72 h were significantly higher, and platelet counts were significantly lower for patients with sepsis who died compared with those who survived. In multiple logistic regression analysis, mortality in neonates with sepsis significantly correlated with DNI at 72 h (OR 1.47, 95% CI 1.1-5.6, p = 0.032) and with platelet count (OR 0.93, 95% CI 0.51-0.99, p = 0.014). ROC analysis for DNI at 72 h revealed a cut-off value of 12%, which predicted mortality with 81% sensitivity and 87% specificity. CONCLUSION: DNI may be a valuable tool in assessing the prognosis of patients with neonatal sepsis.

Patent ductus arteriosus treatment trends and associated morbidities in neonates.

To evaluate national epidemiologic data on infants treated for patent ductus arteriosus (PDA) in Korea and analyze outcomes associated with different PDA treatments. We retrospectively evaluated data on 12,336 patients diagnosed with PDA (International Classification of Diseases-10 code: Q250) between 2015 and 2018 from the Health Insurance Review and Assessment database. Among them, 1623 patients underwent surgical ligation (code: O1671). We used birth certificate data from Statistics Korea to estimate the prevalence, diagnosis, and treatment of PDA. The prevalence of infants with PDA was 81 infants per 10,000 live births and 45.2% in very low birth weight (VLBW) infants, which increased from 2015 to 2018. PDA ligation was performed in 2571 infants and 22% VLBW infants. Medical treatment was administered to 4202 infants, which decreased significantly, especially in VLBW infants (62% to 53%). The proportion of treatment was as follows: conservative treatment (53.1%), intravenous ibuprofen (24.4%), surgery (20.4%), and oral ibuprofen (10.7%); that among 4854 VLBW infants was as follows: intravenous ibuprofen (46.3%), conservative treatment (33.2%), surgery (22.2%), and oral ibuprofen (14.2%). Surgical treatment had a significantly higher risk (odds ratio 1.36) of mortality than conservative treatment. Surgical and/or medical treatments were associated with a higher risk of morbidity. Recently, increased use of conservative management of PDA has contributed to improved neonatal outcomes in VLBW infants. Select patients may still benefit from surgical ligation following careful consideration.

Functional recovery following traumatic spinal cord injury mediated by a unique polymer scaffold seeded with neural stem cells.

To better direct repair following spinal cord injury (SCI), we designed an implant modeled after the intact spinal cord consisting of a multicomponent polymer scaffold seeded with neural stem cells. Implantation of the scaffold-neural stem cells unit into an adult rat hemisection model of SCI promoted long-term improvement in function (persistent for 1 year in some animals) relative to a lesion-control group. At 70 days postinjury, animals implanted with scaffold-plus-cells exhibited coordinated, weight-bearing hindlimb stepping. Histology and immunocytochemical analysis suggested that this recovery might be attributable partly to a reduction in tissue loss from secondary injury processes as well as in diminished glial scarring. Tract tracing demonstrated corticospinal tract fibers passing through the injury epicenter to the caudal cord, a phenomenon not present in untreated groups. Together with evidence of enhanced local GAP-43 expression not seen in controls, these findings suggest a possible regeneration component. These results may suggest a new approach to SCI and, more broadly, may serve as a prototype for multidisciplinary strategies against complex neurological problems.