Incidence and risk factors of bacterial sepsis and invasive fungal infection in neonates and infants requiring major surgery: an Italian multicentre prospective study.

BACKGROUND: Limited data are currently available on the incidence rates and risk factors for bacterial sepsis and invasive fungal infections (IFIs) among neonates and infants undergoing major surgery. AIM: To assess the incidence of bacterial sepsis and IFI, fungal colonization, risk factors for sepsis, and mortality in neonates and infants aged <3 months undergoing major surgery. METHODS: A multicentre prospective study was conducted involving 13 level-3 neonatal intensive care units in Italy, enrolling all infants aged ≤3 months undergoing major surgery. FINDINGS: From 2018 to 2021, 541 patients were enrolled. During hospitalization, 248 patients had a bacterial infection, and 23 patients had a fungal infection. Eighty-four patients were colonized by fungal strains. Overall, in-hospital mortality was 2.8%, but this was higher in infected than in uninfected infants (P = 0.034). In multivariate analysis, antibiotic exposure before surgery, ultrasound-guided or surgical placement of vascular catheters, vascular catheterization duration, and gestational age ≤28 weeks were all associated with bacterial sepsis. The risk of IFI was markedly higher in colonized infants (odds ratio (OR): 8.20; P < 0.001) and was linearly associated with the duration of vascular catheterization. Fungal colonization in infants with abdominal surgery increased the probability of IFI 11-fold (OR: 11.1; P < 0.001). CONCLUSION: Preventive strategies such as early removal of vascular catheters and the fluconazole prophylaxis should be considered to prevent bacterial and fungal sepsis in infants undergoing abdominal surgery, and even more so in those with fungal colonization.

Different subsets of circulating angiogenic cells do not predict bronchopulmonary dysplasia or other diseases of prematurity in preterm infants.

Bronchopulmonary dysplasia (BPD) is a chronic lung disease occurring in very and extremely preterm infants undergoing mechanical ventilation. Given the altered lung vascular growth characterizing BPD, circulating angiogenic cells could be useful biomarkers to predict the risk. The objective of the study was to determine whether the percentages of circulating angiogenic cells (CD34+VEGFR-2+, CD34+CD133+VEGFR-2+, and CD45-CD34+CD133+VEGFR-2+ cells), assessed in the peripheral blood at birth by flow cytometry, could be used as markers for the risk of BPD. In one-hundred and forty-two preterm neonates (gestational age less than 32 weeks and/or birth weight less than 1500 g) admitted to our tertiary care Neonatal Intensive Care Unit between 2006 and 2009, we evaluated the percentages of circulating angiogenic cells at birth, at 7 days, and, in a subset of infants (n=40), at 28 days of life. The main outcome was the correlation between cell counts at birth and the subsequent risk of developing BPD. In our study, all the three cell populations failed to predict the development of BPD or other diseases of prematurity. We suggest that these cells cannot be used as biomarkers in preterm infants, and that research is needed to find other early predictors of BPD.

Circulating endothelial progenitor cells and diseases of the preterm infant.

During the last decade, multiple techniques have been developed to isolate and quantify human endothelial progenitor cells (EPCs). In parallel, a number of studies have applied these methodologies to investigate the number and function of circulating EPCs in adult diseases characterized by vascular dysfunction. However, very little is known about different subtypes of EPCs during gestation, during the neonatal age or in neonatal diseases. Initial evidence supports the hypothesis that circulating angiogenic cells may play an important role during development, and attention has particularly focused in clarifying the function of EPCs in lung vascular development, and the role of the impairment of EPC mobilization and homing in hyperoxia-induced lung injury characteristic of bronchopulmonary dysplasia. Among different subtypes of EPCs, both the role of angiogenic mononuclear cells (triple-positive CD34+CD133+VEGFR-2+ cells and colony forming unit-Hill cells) and endothelial colony forming cells (ECFCs) in physiological vascular development and during neonatal diseases need to be elucidated. A better understanding of EPC biology during gestation, during the neonatal age and in preterm infants will unravel the pathologic basis of bronchopulmonary dysplasia and other preterm and term neonatal diseases characterized by a prominent defect in vascular growth, including retinopathy of prematurity and persistent pulmonary hypertension of the newborn.

Achievements, difficulties and future challenges for the FARMING network.

The EC FARMING network (Food and Agriculture Restoration Management Involving Networked Groups) was set up to bring together the many and diverse stakeholders who would be involved in intervention following wide scale radioactive contamination of the food chain, so that acceptable strategies can be developed for maintaining agricultural production and safe food supply. The network comprises stakeholder panels in the UK, Finland, Belgium, France and Greece that have met regularly since 2001 to debate, discuss and exchange opinion on the acceptability, constraints and impact of various countermeasure options and strategies. The objectives of this paper are to consolidate the main achievements of the FARMING project over the period 2000-2004, to highlight the various difficulties that were encountered and to discuss the challenges for engaging stakeholders in off-site emergency management and long-term rehabilitation in the future.

Stakeholder involvement in nuclear crisis management in Greece.

The setting up of the Greek Stakeholders Group in the framework of the EC Food and Agriculture Restoration Management Involving Networked Groups (FARMING) project is described. The Group included members from more than 20 governmental and non-governmental organisations, having interest and/or responsibilities in the management of a crisis following a nuclear accident. The stakeholders, during their meetings in 2002, discussed the agricultural countermeasures and rural waste disposal options which have been compiled by the EC Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems (STRATEGY) project. All stakeholders agreed that the most preferable were those options that ensure public acceptance, minimise environmental impact and maintain farming practices and acceptable living and working conditions. Their views are synoptically presented along with the major conclusions from the stakeholders meetings regarding nuclear crisis management.

Effect of soil amendments on radiocesium transfer to alfalfa.

Greenhouse experiments were carried out to evaluate the effect of different soil-based countermeasures on radiocesium transfer to Medicago saliva (alfalfa) grown on artificially contaminated loamy-clayey soil. Various rates of potassium, ammonium, and Prussian Blue supplements were applied, and the uptake of radiocesium by control and treated alfalfa plants was monitored during four growth periods. Transfer factors ranging between 0.06 and 0.02 were determined for control plants. Application of potassium at rates higher than 0.1 meq per 100 g soil was found to suppress radiocesium uptake, the effect being more pronounced at increasing fertilization rates. On the contrary, soil treatment with ammonium enhanced the bio-accumulation of radiocesium, indicating that Cs+ ions, previously unavailable to plant roots, were released from soil particles. Prussian Blue supplements had practically no effect on soil-to-alfalfa transfer of the radionuclide.