Diagnostic Value of Neutrophil to Lymphocyte Ratio and Mean Platelet Volume on Early Onset Neonatal Sepsis on Term Neonate.

By setting out from increased neutrophil count, decreased lymphocyte count, and increased mean platelet volume (MPV), which is a result of the effect of inflammation on blood cells, we aimed to investigate whether neutrophil to lymphocyte ratio (NLP) and MPV can be used as an auxiliary parameter for the diagnosis of early-onset neonatal sepsis (EOS). This study was conducted by analyzing term neonates with EOS and physiological jaundice who were admitted to the neonatal intensive care unit of Izmir Katip Celebi University Ataturk Training and Research Hospital. A total of 63 neonate files were examined to include 30 term neonates with EOS, and 77 neonate files were examined to include 30 term neonates with physiological jaundice as a control group. NLR had an area under the curve (AUC) of 0.891 for prediction of EOS. At a cut-off level of 1.42, NLR had a likelihood ratio (LR) of 5.5, sensitivity of 88%, a specificity of 84%, a positive predictive value (PPV) of 84.6%, and a negative predictive value (NPV) of 87.5%. MPV had an AUC of 0.666 for the prediction of EOS and at a cut-off level of 9.3 fL, MPV had an LR of 1.23, sensitivity of 84%, a specificity of 32%, a PPV of 55.2%, and an NPV of 66.6%. In conclusion, this study provides evidence that NLR and MPV can be used in addition to conventional parameters in the diagnosis of EOS.

Hemolysis due to Alpha-Hemolytic Enterococcus Urinary Infection: A Rare Cause of Early and Severe Unconjugated Hyperbilirubinemia in a Neonate.

The reason for reporting this case is to remind that some microorganisms may cause hemolysis leading to early and severe hyperbilirubinemia by secreting hemolysin in cases; where bilirubin levels cannot be successfully decreased despite effective phototherapy, intravenous immunoglobulin, and even exchange transfusion, or in cases of increased rebound bilirubin (although urinary tract infection is associated with increased conjugated bilirubin fraction and prolonged jaundice). The most common causes of hemolysis are ABO/Rh incompatibility and enzyme deficiencies such as glucose-6-phosphate dehydrogenase (G6PDH), pyruvate kinase (PK), and galactose-1-phosphate uridyltransferase (GALT). Our patient was a male infant, weighing 3,160 g, at 38 + 4 gestational week; he was referred to our unit with total bilirubin level of 14.7 mg/dL recorded at the postnatal 20th hour and was initiated treatment with intensive phototherapy and prepared for exchange transfusion. The G6PD, PK, and GALT enzyme levels studied at the postnatal 96th hour and reducing substances in urine were detected to be normal/negative, whereas complete urinalysis revealed pyuria (7 leukocytes per each high power field). α-hemolysis-producing 105 colony-forming unit/mL Enterobacter cloacae grew on blood agar in the urine culture. As reported in our case, hemolysin-secreting α and ß-hemolytic bacteria can lead to severe and early hemolysis and unconjugated hyperbilirubinemia, as in blood type incompatibility and enzyme deficiencies.

Utility of the Platelet-to-Lymphocyte Ratio in Diagnosing and Predicting Treatment Success in Preterm Neonates with Patent Ductus Arteriosus.

BACKGROUND: We investigated the predictive ability of the platelet-to-lymphocyte ratio (PLR) in preterm infants to discriminate those with and without hemodynamically significant PDA (hsPDA and non-hsPDA), hsPDA defined by those requiring medical intervention. METHODS: This observational retrospective cohort study included premature neonates (<34 weeks gestational age) with routine complete blood counts in a neonatal intensive care unit. RESULTS: PLR values on the 1st, 2nd, 3rd, and 7th days of birth were higher and lymphocyte counts were lower in the hsPDA than in the non-hsPDA group. Plateletcrit (PCT) values on the 2nd and 3rd days of birth were lower in the hsPDA group. All hsPDAs closed with medical therapy. CONCLUSIONS: PLR may be a supportive tool for predicting those preterm infants with PDAs requiring medical intervention. This may serve as a guide for future studies investigating the predictive value of PCT and PLR for hsPDA in preterm infants.

Autism Spectrum Disorder Screening at 18-36 Months in Infants with Moderate and Severe Neonatal Encephalopathy: Is Routine Screening Required?

Background: Hypoxia, acidosis, and inflammation cause impairment of neuronal development due to lack of sufficient oxygen and nutrition, and there may be an increased risk of ASD in neonates with Neonatal Encephalopathy (NE). To evaluate the frequency of Autism Spectrum Disorder (ASD) in moderate and severe NE requiring therapeutic hypothermia at 18-36 months. Methods: In this prospective study, infants with moderate and severe NE requiring hypothermia were included. Results: Throughout the study period, 33 of 85 neonates with NE admitted to our unit were included in the study. M-CHAT results of six infants included in the study showed positive and results of twenty-seven patients were negative. Four of six infants with a positive screening test completed a psychiatric examination, and two infants did not complete the clinical examination. The results of the examination showed that one infant was diagnosed with ASD, one was diagnosed with attention deficit hyperactivity disorder (ADHD), and two infants were diagnosed with no psychiatric disorder. Conclusion: Our results showed that the risk of ASD increases in infants with moderate and severe NE, and this relationship should be considered in long-term clinical follow-ups.

New Diagnostic Possibilities for Early Onset Neonatal Sepsis: Red Cell Distribution Width to Platelet Ratio.

Aims: Red cell distribution width to platelet ratio (RPR) has been reported as a useful inflammatory marker and prognostic indicator of adult inflammatory diseases. In the present study, red cell distribution width (RDW) and RPR parameters, which are parts of a complete blood count analysis, were compared to the traditional C reactive protein (CRP) and procalcitonin (PCT) parameters to investigate the potential to predict early onset sepsis (EOS) in neonates with or without positive blood cultures. Methods: An observational, retrospective cohort study was conducted to evaluate newborns born in our hospital. Results: RDW, RPR, CRP, PCT, Immature to total neutrophil ratio (I/T), and white blood cell (WBC) counts were higher in suspected and proven EOS compared to control group. Conclusion: We believe that RPR may be used in diagnosis of early onset neonatal sepsis and may be a good alternative to other tools as a readily available biomarker.

A Neglected and Promising Predictor of Severe Hyperbilirubinemia Due to Hemolysis: Carboxyhemoglobin.

Aims: We investigated the relationship between total serum bilirubin (TSB) and carboxyhemoglobin (COHb) in term neonates with detected and treated hemolysis within a particular time frame with the aim of augmenting the case for early diagnosis and prevention of morbidity in hemolysis. Materials and Methods: The study group comprised term newborns who were above the 95th percentile for TSB, underwent intravenous immunoglobulin (IVIG) or applied total exchange transfusion due to hemolysis. Newborns without hemolysis who were above the 95th TSB percentile and required phototherapy comprised the control group. Results: At a cutoff COHb value of 2.2%, 80.8% sensitivity, 95.5% specificity, 18.1 likelihood ratio, positive predictive value of 94.7%, and negative predictive value of 83.2% were identified. Conclusion: We found that COHb is a sensitive and specific method for detecting hemolysis, and it can be used in the early diagnosis of hemolytic diseases causing early and severe hyperbilirubinemia.

Platelet to Lymphocyte Ratio in Neonates: A Predictor of Early onset Neonatal Sepsis.

BACKGROUND: Neonatal sepsis (NS) is a common systemic disease that causes morbidity and mortality in newborns. But there is no ideal biomarker that can be used in the early diagnosis of NS. In recent studies, platelet to lymphocyte ratio (PLR) has been reported to play a critical role in the inflammatory process. In this study, we aimed to contribute to the research about whether or not PLR can be used as an early predictor of the diagnosis of NS. METHODS: This retrospective cohort study was conducted among the newborns born in Izmir Buca Maternity and Pediatric Hospital between March 2015-February 2016. During these twelve months, 611 neonates with Early-Onset Sepsis (EOS) were admitted to our neonatal intensive care unit. One hundred and forty-nine neonates with suspected EOS, 67 neonates with proven EOS and 92 healthy neonates were enrolled in the study. RESULTS: Platelet to lymphocyte ratio (PLR) values of the three groups were calculated 56.5 ± 17.8 vs. 62.4± 14.9 vs. 15.3 ± 2.1, respectively. PLR values of suspected or proven EOS group were significantly higher than the control group. PLR has AUC 0.89 to 0.93, the cutoff value of 39.5 to 57.7, the sensitivity of 88.9% to 91.3% and specificity of 94.7% to 97.6%, the positive predictive value of 94.3% to 97.4%, and negative predictive value of 88.6% to 91.8% in suspected and proven sepsis diagnosis. CONCLUSIONS: Our results suggest that PLR can be used as a parameter in the prediction of neonatal sepsis.

Efficacy and Safety of Oral Paracetamol vs. Oral Ibuprofen in the Treatment of Symptomatic Patent Ductus Arteriosus in Premature Infants.

BACKGROUND: The ductus arteriosus (DA) is situated between the aortic arch and the pulmonary artery in fetal circulation, and its closure is one of the most important changes required for the transition to extrauterine life. Prolonged duration of patent DA (PDA) impairs hemodynamics and contributes both to morbidity associated with prematurity and to mortality. Therefore, when best to initiate treatment and what drug to use as first-line treatment to close the ductus is important. OBJECTIVE: The aim of this study was to compare the efficacy and side effects of the oral forms of ibuprofen and paracetamol and to contribute to the literature investigating the first drug to be selected in the medical treatment of PDA. METHODS: This observational, retrospective cohort study was conducted in infants born at ≤ 28 weeks' gestation and admitted to our Neonatal Intensive Care Unit (Manisa Merkezefendi State Hospital, Manisa, Turkey) between February 2015 and April 2018. Included infants were born at ≤ 28 weeks' gestation, had PDA-related clinical findings and hemodynamically significant PDA on echocardiography, and received oral ibuprofen or oral paracetamol therapy as the closure treatment. RESULTS: The most common clinical findings for the diagnosis of PDA were hyperdynamic circulation, tachycardia, and increased oxygen requirement. In total, 43 of the 51 (84.3%) premature infants in the ibuprofen group and 32 of the 36 (88.8%) in the paracetamol group achieved PDA closure after the first treatment cycle. There was no statistically significant difference between the two groups in terms of respiratory morbidity, renal and liver function, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, length of hospital stay, and mortality. CONCLUSIONS: Our results indicate that oral paracetamol was as effective as oral ibuprofen in the medical treatment of PDA. In addition, both drugs were considered well-tolerated in terms of effects on kidney, liver, and intestinal functions. Our results demonstrate that oral paracetamol can be used effectively and safely as the first-line treatment of PDA.