Relationship between placental weight and late-onset circulatory collapse.

BACKGROUND: Late-onset circulatory collapse (LCC) is a serious complication in preterm infants and is increasing in Japan. The underlying pathophysiology is thought to be relative adrenal insufficiency and it is more likely to develop at a young gestational age (GA) and in low birthweight (BW) infants. BW to placental weight ratio (BPR) is an index of pregnancy outcomes and early neonatal morbidity. We aimed to analyze the relationship between LCC and potential predicting factors including BPR. METHODS: This retrospective study included 261 singletons born before 32 weeks of gestation between 2007 and 2017. Perinatal data, including the placental weight and BPR, were collected from medical records and were assessed for their relationship with LCC. Propensity score analysis was performed and matched factors were GA and BW. RESULTS: Sixty-seven infants (25.7%) had LCC (median GA 27.4 weeks). GA and BW differed significantly between the LCC and non-LCC groups (P < 0.001, respectively). The placental weight and BPR of the LCC group were significantly lower than those of the non-LCC group, while Z-score of BPR did not differ significantly between the groups. After propensity score matching, there was a significant difference in the incidence of severe intraventricular hemorrhage (grades III-IV; P = 0.042), but no differences in BPR and Z-score of BPR between the groups. CONCLUSION: In the propensity score analysis matched for GA and BW, there was no significant difference in perinatal factors including BPR between the LCC and non-LCC groups, except for incidence of severe intraventricular hemorrhage.

Presepsin as a predictor of positive blood culture in suspected neonatal sepsis.

BACKGROUND: Although the incidence of neonatal sepsis is decreasing, neonatal sepsis remains a severe life-threatening disease. No current biochemical marker can provide perfect diagnostic accuracy for neonatal sepsis. The aim of this study was therefore to evaluate the accuracy of presepsin (P-SEP) as a novel biomarker of bacterial infection for neonatal sepsis diagnosis. METHODS: We prospectively studied newborns with sepsis (sepsis group; n = 13) during the first 30 days after birth and compared them with control preterm newborns (control group; n = 18). In addition, we evaluated term newborns with some clinical signs of early onset sepsis (non-sepsis term group; n = 35). RESULTS: P-SEP in the sepsis group was significantly higher than in the control group (P < 0.001) The area under the curve for P-SEP was 0.868 (95%CI: 0.71-1.00). A P-SEP cut-off of 795 pg/mL was established, with 85% sensitivity and 89% specificity. The positive and negative predictive values were 85% and 89%, respectively. In the non-sepsis term group, P-SEP had better stability than white blood cells and C-reactive protein for 3 days after birth. CONCLUSIONS: P-SEP can better discriminate between infections and non-infectious inflammatory conditions than the currently used biomarkers.

Cardiovascular Remodeling and Dysfunction Across a Range of Growth Restriction Severity in Small for Gestational Age Infants　- Implications for Fetal Programming.

BACKGROUND: The purpose of this study was to clarify cardiovascular structure and function in small for gestational age (SGA) infants across a range of intrauterine growth restriction (IUGR) severity. METHODS AND RESULTS: This prospective study included 38 SGA infants and 30 appropriate for gestational age (AGA) infants. SGA infants were subclassified into severe and mild SGA according to the degree of IUGR. Cardiovascular structure and function were evaluated using echocardiography at 1 week of age. Compared with the AGA infants, both the severe and mild SGA infants showed increased left ventricular diastolic dimensions (severe SGA 10.2±2.4, mild SGA 8.2±1.3, and AGA 7.3±0.7 mm/kg, P<0.05 for all) and decreased global longitudinal strain (severe -21.1±1.6, mild -22.5±1.8, and AGA -23.8±1.8%, P<0.05 for all). Severe SGA infants showed a decreased mitral annular early diastolic velocity (severe 5.6±1.4 vs. AGA 7.0±1.3 cm/s, P<0.01) and increased isovolumic relaxation time (severe 51.3±9.2 vs. AGA 42.7±8.2 ms, P<0.01). Weight-adjusted aortic intima-media thickness and arterial wall stiffness were significantly greater in both SGA infant groups. These cardiovascular parameters tended to deteriorate with increasing IUGR severity. CONCLUSIONS: SGA infants, including those with mild SGA, showed cardiovascular remodeling and dysfunction, which increased with IUGR severity. (Circ J 2016; 80: 2212-2220).

Ampicillin- and ampicillin/sulbactam-resistant Escherichia coli infection in a neonatal intensive care unit in Japan.

The incidence of ampicillin (ABPC)-resistant Escherichia coli (E. coli) infection in very low-birthweight infants has been increasing. The rate of ABPC/sulbactam (ABPC/SBT)-resistant E. coli in this population, however, is currently unknown. We encountered two cases of severe infection due to resistant E. coli and retrospectively studied the prevalence of ABPC- and ABPC/SBT-resistant E. coli in regular surveillance cultures obtained from all neonatal intensive care unit (NICU) patients between 2000 and 2013. The overall prevalence of ABPC-resistant E. coli was 39% (47/120), accounting for 63% of cases (32/51) between 2007 and 2013, compared with 22% (15/69) between 2000 and 2006. The prevalence of ABPC/SBT resistance was 17% (20/120), which was similar in both periods (16%, 8/51 vs 17%, 12/69). According to these results, not only ABPC, but also ABPC/SBT-resistant E. coli must be considered in the NICU.

Predictors of a non-response to prophylactic indomethacin for patent ductus arteriosus in preterm infants.

BACKGROUND: Preterm infants are recommended for prophylactic indomethacin (PIND) to promote closure of patent ductus arteriosus (PDA) and reduce morbidity and mortality. This study investigated the predictive factors of a non-response to PIND for PDA in preterm-birth infants. METHODS: Consecutive preterm-birth infants (gestational age: < 28 weeks) who received PIND between 2009 and 2019 were retrospectively enrolled. Seventy-six eligible participants were classified as PIND responders (N = 42) or non-responders (N = 34). Information on potential confounders in maternal obstetric and perinatal data were collected from medical records. Multiple logistic regression analysis was carried out to identify the prognostic factors of a PIND response in preterm-birth infants. RESULTS: The prevalence of intrauterine infection and multiple births was significantly different between responders and non-responders to PIND (intrauterine infection: 2 [4.8%] vs. 8 [23.5%], P = 0.036; twins: 3 [7.1%] vs. 9 [ 26.5%], P = 0.029, respectively). In multivariate logistic regression analysis after adjustment for multiple births, intrauterine infection was a significant and independent predictive factor of a non-response to PIND (odds ratio [OR] 5.54, 95% confidence interval [CI] 1.05-29.2, P = 0.044). A remarkable association was also noted for multiple births with a non-response to PIND (OR 4.22, 95% CI 0.99-17.8, P = 0.050). CONCLUSIONS: Intrauterine infection and multiple births were identified as potential risk factors of a non-response to PIND for PDA in preterm infants.

Impact of Decreased Serum Insulin-Like Growth Factor-1 Levels on Central Aortic Compliance in Small-for-Gestational-Age Infants.

BACKGROUND: Intrauterine growth restriction is associated with arterial hypertension in adulthood; however, the underlying mechanism is unclear. OBJECTIVES: We hypothesized that serum insulin-like growth factor-1 (IGF-1) levels affect central aortic elastic properties and structure in small-for-gestational-age (SGA) infants. METHODS: Eighteen SGA infants and 22 appropriate-for-gestational-age (AGA) infants were enrolled in this study. The serum IGF-1 level within 1 h of birth and abdominal aortic echo parameters at 1 week of age were retrospectively compared. RESULTS: In the SGA infants, IGF-1 levels (27.6 ± 17.7 vs. 42.6 ± 15 ng/ml, p = 0.006), aortic strain (10.2 ± 3.1 vs. 12.8 ± 3.1%, p = 0.01), and aortic distensibility (0.73 ± 0.19 vs. 0.92 ± 0.34 cm2/dyn × 10-4, p = 0.05) were significantly lower compared with AGA infants. By contrast, blood pressure, aortic intima-media thickness (aIMT) in relation to body weight (383 ± 163 vs. 256 ± 43 µm/kg, p < 0.001), aortic stiffness index in relation to body weight (2.0 ± 1.7 vs. 1.1 ± 0.4, p = 0.005), and arterial pressure-strain elastic modulus (293 ± 72 vs. 242 ± 78 mm Hg, p = 0.04) were higher compared with AGA infants. In the SGA infants, IGF-1 levels were significantly correlated with aortic strain (r = 0.49, p = 0.04), aIMT in relation to body weight (r = -0.61, p = 0.007), and aortic stiffness index in relation to body weight (r = -0.63, p = 0.005). CONCLUSIONS: Decreased serum IGF-1 levels in SGA infants may affect the vascular compliance and structure of the central aorta.