MeMed BV and TRAIL Protein Use in Neonatal Sepsis Evaluation - A Retrospective Cohort Study.

INTRODUCTION: The purpose of this study is to characterize the rates of neonatal sepsis among infants born to mothers with diabetes mellitus, gestational diabetes, and chronic hypertension. METHODS: This is a retrospective cohort study of non-anomalous, singleton and twin deliveries in the US. We compared rates of sepsis among infants born to mothers with diabetes mellitus, gestational diabetes, and chronic hypertension to infants born to healthy mothers. Results were analyzed using Pearson Chi-Squared tests to control for maternal race, maternal age, insurance status, education level, diabetes, chronic hypertension, preeclampsia, chorioamnionitis, postpartum hemorrhage, cesarean section, nulliparity, and gestational age. RESULTS: Rates of neonatal sepsis were higher among infants born to mothers with diabetes mellitus and gestational diabetes than among infants born to mothers without diabetes (p<0.001). Diabetes mellitus yielded an odds ratio of 1.31 (95% CI 1.18-1.44) for neonatal sepsis. Gestational diabetes yielded an odds ratio of 1.17 (95% CI 1.12-1.22) for neonatal sepsis. Rates of neonatal sepsis were higher among infants born to mothers with chronic hypertension than among those born to healthy mothers (p<0.001). Chronic hypertension predicted neonatal sepsis with an odds ratio of 1.09 (95% CI 1.00-1.19). CONCLUSION: Infant rates of sepsis increase with maternal diabetes mellitus, gestational diabetes, and chronic hypertension. Maternal diabetes increases risk of neonatal sepsis independent of maternal race, maternal age, insurance status, education level, chronic hypertension, preeclampsia, chorioamnionitis, postpartum hemorrhage, cesarean section, nulliparity, and gestational age. Future research is needed to provide a causative explanation of the relationship between maternal diabetes, chronic hypertension, and neonatal sepsis.

nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp Background Early diagnosis and treatment of neonatal sepsis may be helpful in decreasing neonatal mortality Neonatal sepsis is considered as one of the major causes of morbidity and mortality nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp Methods This cross sectional study was conducted in the Department of Clinical Pathology Department of Neonatology and Department of Microbiology and Immunology BSMMU Dhaka from March to February Neonates with signs and symptoms of sepsis admitted in the Neonatology department in BSMMU and Neonates with no symptoms or signs of sepsis as control were included in the study nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp Results We found high percentage of expression of CD on neutrophils in patients plusmn when compared with controls plusmn and also their percentage of expression was higher in culture positive sepsis plusmn than culture negative sepsis plusmn In the present study I T ratio gt had a sensitivity specificity PPV NPV and accuracy i e and respectively nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp nbsp Conclusion Neutrophil CD expression is increased in neonates with early and late onset neonatal sepsis and correlated well with other laboratory markers of sepsis

Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics. We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery. The rates of maternal intrapartum fever >100.4 degrees F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined. Rate ratios and 95% confidence intervals (CI) were calculated. Multiple logistic regression was used to examine associations while controlling for confounding factors. Intrapartum fever >100.4 degrees F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2). Without epidural, the rate of fever remained low regardless of length of labor; with epidural, the rate of fever increased from 7% for labors < or = 6 hours to 36% for labors >18 hours. Neonates whose mothers received epidurals were more often evaluated for sepsis (34.0% vs 9.8%; adjusted OR = 4.3, 95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1). Although 63% of women received epidurals, 96.2% of intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5% of neonatal antibiotic treatment occurred in the epidural group. Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.

Sepsis is the leading cause of mortality and morbidity in neonates. Blood cultures are the gold standard in diagnosing neonatal sepsis; however, there are currently no consensus guidelines for blood culture collection in neonates and significant practice variation exists in Neonatal Intensive Care Units (NICUs) globally. To examine current practices in obtaining blood cultures in the evaluation of neonatal sepsis in NICUs across Canada. A nine-item electronic survey was sent to each of the 29 level-3 NICUs in Canada, which are equipped to provide highly specialized care for newborns. Responses were received from 90% (26/29) of sites. Sixty-five percent (17/26) of sites have blood culture collection guidelines for the investigation of neonatal sepsis. Forty-eight percent (12/25) of sites routinely target 1.0 mL per culture bottle. In late-onset sepsis (LOS), 58% (15/26) of sites process one aerobic culture bottle, whereas four sites routinely add anaerobic culture bottles. In early-onset sepsis (EOS) in very low birth weight infants (BW <1.5 kg), 73% (19/26) of sites use umbilical cord blood, and 72% (18/25) use peripheral venipuncture. Two sites routinely collect cord blood for culture in EOS. Only one site applies the concept of differential time-to-positivity to diagnose central-line-associated bloodstream infection. There is significant practice variation in methods used to obtain blood cultures in level-3 NICUs across Canada. Standardization of blood culture collection practices can provide reliable estimates of the true incidence of neonatal sepsis and help to develop appropriate antimicrobial stewardship strategies.

Meningitis is a devastating infection in infants and is linked to adverse long-term outcomes. The prevalence of meningitis is variable and depends on gestational age, postnatal age, and clinical setting. Early diagnosis and treatment with appropriate antibiotics are crucial to decrease the risk of morbidity and mortality. Lumbar punctures are essential for the diagnosis of meningitis, but clinicians may defer lumbar puncture if the risk for meningitis is low or if there are substantial concerns regarding the risk associated with the procedure. Awareness of the epidemiology and microbiology of meningitis in infants, as well as valid contraindications to performing a lumbar puncture, is necessary to avoid missed diagnoses and procedure-related adverse effects.

The effect of interventions designed to help prevent or treat pressure ulcers can be assessed through a number of study designs including retrospective and prospective cohort studies. This article highlights the strengths and weaknesses of these 2 approaches to data collection and analysis. Retrospective studies provide for analysis of large amounts of data with less investment, while prospective cohorts may capture clinically relevant variables missing from retrospective data sets. Prospective studies may also gather data in a more consistent and accurate manner. However, ensuring comparability between the various study groups (patient groups managed with different products or interventions) remains a challenge for both prospective and retrospective cohort studies. In retrospective cohort studies, allocation may be based on arbitrary reimbursement decisions, while prospective cohort designs may mask unequal distribution of key risk factors.

Objective To study the therapeutic effect and safety of orthokeratology in the teenagers with high myopia. Methods A retrospective cohort study was carried out.The clinical data of 120 eyes from 60 high myopia patients wearing orthokeratology contact lens for 1 year in Henan Eye Hospital from June 2013 to June 2014 was analyzed, and the data of contemporaneous 118 eyes from 59 matched high myopia patients wearing conventional glasses were used as controls.The initial spherical equivalent (SE) of all the patients was -6.00 to -9.00 D. The maximum correction amplitude of the orthokeratology contact lens was set as 6.00 D based on the Regulation of China Food & Drug Administration.The contact lenses were worn for 1 month firstly and then the conventional glasses were used at daytime and contact lenses were consecutively worn at night for 1 year in the contact lenses group, and only glasses were worn in the conventional glasses group.The uncorrective visual acuity (UCVA), SE, corneal fluorescein staining were examined 1 week, 1 month, 3 months, 6 months and 12 months after wearing lenses.The changes of corneal endothelial cells were examined 6 and 12 months after wearing lenses. Results The UCVA was improved and SE was reduced 1 month and 3, 6 and 12 months after wearing lenses in comparison with 1 week after wearing lenses in the contact lenses group (all at P 0.05). Compared with wearing contact lenses, the SE was increased in various time points after wearing glasses in the conventional glasses group (all at P<0.01). The axial length and SE extended by (0.08±0.12)mm and (0.19±0.21)D in the contact lenses group and those in the conventional glasses group were (0.29±0.14)mm and (0.69±0.27)D, showing significant differences between the two groups (t=10.024, 5.691, both at P<0.01). No significant differences were found in corneal endothelial cell density, percentage of hexagonal cells and coefficient of variation of corneal endothelial cells in various time points after wearing contact lenses (corneal endothelial cell density: Fgroup=0.090, P=0.769; Ftime=0.133, P=0.563.percentage of hexagonal cells: Fgroup=0.071, P=0.836; Ftime=1.091, P=0.203.coefficient of variation: Fgroup=0.107, P=0.734; Ftime=1.948, P=0.156). The incidence of corneal fluorescein staining was 31.67% in the contact lens group, which was much higher than 3.51% in the conventional glasses group (χ2=97.910, P=0.001). Conclusions Compared with wearing only conventional glasses, orthokeratology can improve UCVA and control axial length extension in juvenile with high myopia, but orthokeratology is more likely to damage the corneal superficial layer. Key words: Orthokeratology; Contact lens; High myopia; Corneal endothelial cells; Axial length; Retrospective study

Understanding Study Design

BackgroundWe examined the long-term changes in the management of diabetes at a single institution in Japan.MethodsTwo repeated cross-sectional studies and a retrospective cohort study were conducted among patients who visited our institution between 2001 and 2013. We examined the changes in glycated hemoglobin (HbA1c) and glycated albumin levels, the prescription frequencies, and the daily doses of each antidiabetic agent among patients treated regularly for diabetes during the 13-year study period. The trends in control and treatment parameters were analyzed using Spearman’s rank correlation coefficient.ResultsIn the first repeated cross-sectional studies, 200,298 patients had their glucose metabolism indicators measured, and diabetologists prescribed medications to 193, 445 patients. Of these, 170 patients were included in the retrospective cohort study. The patients’ diabetic control tended to improve over the study period. The mean HbA1c level improved from 7.9 to 7.6% (from 63 to 60 mmol/mol) (rs = −0.11, p < 0.01) in the cross-sectional study, corresponding to a change from 8.2 to 7.7% (from 66 to 61 mmol/mol) (rs = −0.22, p < 0.01) in the retrospective study. The mean GA level improved from 22.7 to 20.7% (rs = −0.13, p < 0.01) in the cross-sectional study and from 23.5 to 21.5% (rs = −0.14, p < 0.01) in the retrospective study. Over the study period, prescription frequencies and daily doses of antidiabetic agents changed as treatment guidelines were altered.ConclusionsThe present study revealed a tendency toward long-term improvements in diabetic control, with changes in the prescription patterns consistent with research and guideline evidence.Electronic supplementary materialThe online version of this article (doi:10.1186/s13098-016-0187-8) contains supplementary material, which is available to authorized users.

This study aimed to examine whether the addition of latency antibiotics in late preterm rupture of membranes (ROM) decreases neonatal infection and increases latency. This retrospective two-center study was conducted at Holy Family Hospital (HFH) in Nazareth and Emek Medical Center (EMC) in Afula, on data collected between January 2017 and April 2023. HFH is the smaller institution. EMC and HFH implement similar policies regarding ROM at 340/7 to 366/7 weeks' gestation; the only difference is that a 10-day course of latency antibiotics is implemented at EMC. All women with ROM between 340/7 and 366/7 weeks' gestation who were admitted to one of the centers during the study period, and had a live fetus without major malformations, were included. The primary outcome was neonatal sepsis rate. Secondary outcomes included a composite of neonatal sepsis, mechanical ventilation ≥24 hours, and perinatal death. Additionally, gestational age at delivery and delivery mode were examined. Overall, 721 neonates were delivered during the study period: 534 at EMC (where latency antibiotics were administered) and 187 at HFH. The gestational age at ROM was similar (35.8 and 35.9 weeks, respectively, p = 0.14). Neonatal sepsis occurred in six (1.1%) neonates at EMC and one (0.5%) neonate at HFH (adjusted p = 0.71; OR: 1.69; 95% Confidence Interval [CI]: 0.11-27.14). The composite secondary outcome occurred in nine (1.7%) and three (1.6%) neonates at EMC and HFH, respectively (adjusted p = 0.71; OR: 0.73; 95% CI: 0.14-3.83). The gestational age at delivery was 36.1 and 36.2 weeks at EMC and HFH, respectively (mean difference: 5 h; adjusted p = 0.02). The cesarean delivery rate was 24.7% and 19.3% at EMC and HFH, respectively (adjusted p = 0.96). Latency antibiotics administered to women admitted with ROM between 340/7 and 366/7 weeks' gestation did not decrease the rate of neonatal sepsis. · Latency antibiotics in late preterm ROM does not decrease neonatal sepsis.. · Latency antibiotics in late preterm ROM does not prolong gestational age at delivery.. · Latency antibiotics in late preterm ROM does not affect the mode of delivery..

Objective: Neonatal sepsis is a critical condition with considerable mortality and morbidity. The prognostic nutritional index (PNI), calculated from serum albumin level and lymphocyte count, is a marker for assessing nutritional and inflammatory states. This study evaluates the clinical value of PNIs in predicting late-onset sepsis and mortality in late-preterm neonates. Methods: This retrospective single-center study included 210 neonates with suspected sepsis. Clinical and laboratory data were collected, and PNI was calculated using the formula: serum albumin (g/L) + 5 × total lymphocyte count (10^9/L). Of the total cohort, 130 neonates with confirmed sepsis were assigned to the sepsis group, while 80 neonates with signs of infection but no sepsis made up the control group. Multivariable logistic regression and receiver operating characteristic curve analyses were performed to determine the predictive value of PNI for neonatal sepsis and mortality. Results: The PNI value was significantly lower in the sepsis group compared with the control group. The mortality rate in the sepsis group was 25.4%, with non-survivors having significantly lower PNI values than survivors (40.26±10.35 [standard deviation, SD] vs 49.62±9.53 SD). Multivariate logistic regression analysis identified a negative independent relationship between PNI and both sepsis diagnosis and mortality. PNI was an independent risk factor for sepsis (odds ratio [OR]=6.03, 95% CI=3–12.11, p<0.001). A PNI cutoff value of 40.9 predicted sepsis-related mortality with 66.67% sensitivity, 78.3% specificity, 51.2% positive predictive value, and 87.4% negative predictive value (area under the curve=0.76, p<0.001). Each unit increase in PNI was associated with a 2.83-fold increase in survival rate (OR=2.83, 95% CI=1.37–5.86, p<0.005). Conclusion: Our study shows that PNI is a significant independent marker for predicting neonatal sepsis and associated mortality in late preterm neonates. PNI can be used as a serum biomarker for early-stage neonatal sepsis, aiding in timely intervention and potentially improving clinical outcomes.

A comparison of 3 antibiotic regimens for prevention of postcesarean endometritis: an historical cohort study

Research Type:Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studiesIntroduction/Purpose:Over 10% of patients remain dissatisfied following hallux valgus (HV) surgery, which may be related to recurrence of the deformity. While the original Lapidus procedure included medial-middle (C1-C2) intercuneiform and first and second metatarsal base stabilization, the procedure has been modified to include only arthrodesis of the first TMT joint. However, Kim et al. (Foot and Ankle International 2024) reported a recurrence rate of 17.3% following a modified Lapidus procedure with no intercuneiform fixation (NS) and found an association between C1-C2 joint widening with a higher rate of HV recurrence. This study aims to identify whether the addition of an intercuneiform screw (ICS) from the base of the first metatarsal to C2 to a first TMT arthrodesis reduces HV recurrence and minimizes C1-C2 joint gapping.Methods:This retrospective comparative cohort study analyzed HV patients who underwent a modified Lapidus procedure, using data from a prospectively collected foot and ankle registry. A total of 171 patients were identified, of which 18 (11%) were male and 153 (89%) were female. Patients were categorized by screw fixation: 87 (51%) in the group without intercuneiform fixation (NS) and 84 (49%) in the intercuneiform screw (ICS) group. Otherwise, the surgical technique was similar between the groups. The primary outcome was HV recurrence, defined as a postoperative hallux valgus angle (HVA) exceeding 20° as previously defined in the literature (Park and Lee J Bone Joint Surg Am 2017). Preoperative and postoperative radiographic measurements including HVA, intermetatarsal angle (IMA), C1-C2 distance, sesamoid position, and first TMT pronation of the first ray were analyzed using coronal multiplanar reconstructed weight-bearing CT (WBCT) images to assess C1-C2 joint gapping.Results:Mean ages were 52.8 years for the NS group and 54.0 years for the ICS group (p=0.534). Recurrence occurred in six of 87 (7%) NS patients, but none in the ICS group (p=0.029). Preoperative HVA was similar between groups but was lower postoperatively in the ICS group (p=0.036). IMA was higher preoperatively for the IS group (p=0.011), though it did not differ postoperatively (Table 1). C1-C2 joint distance in the ICS group was significantly higher preoperatively (p=0.020) and lower postoperatively (p < 0.001). Change in intercuneiform gapping was significantly reduced in the ICS group (p < 0.001). Postoperative first TMT pronation and sesamoid station were both lower in the ICS group (p=0.009; p=0.009).Conclusion:Our findings suggest that an additional first metatarsal base - C2 screw fixation reduces recurrence and decreases C1-C2 joint gapping in the modified Lapidus procedure. Additionally, patients with stabilization across the intercuneiform joint had improved first metatarsal pronation and sesamoid reduction compared with patients who did not have a screw from the first metatarsal base to C2. These results suggest that stabilization of the intercuneiform joint may improve HV deformity correction. However, further research on failure rates and patient-reported outcomes (PROMIS) is needed to evaluate long-term clinical efficacy.Comparison of Intercuneiform C1-C2 Stability Between NS and ICS Fixation TechniquesThis figure presents a radiographic and WBCT Analysis comparing C1-C2 joint stability between NS and ICS fixation techniques. It illustrates differences in preoperative and postoperative joint distance, percent change distribution, and the stabilizing effect of the additional intercuneiform screw (ICS).

Introduction: Neonatal period is a very vulnerable period of life as it accounts for high morbidity and mortality and most diseases common in neonatal period are preventable. Objective of this study was to analyze the pattern of morbidity and mortality in neonates admitted in NICU of a tertiary care hospital. Methods: A retrospective cross sectional study was conducted in Nepal Police Hospital which included neonates admitted in NICU for a period of 2 years. (Jan 2023-Jan 2025). Data on morbidity and mortality were obtained from medical record. Data were analyzed using SPSS(v20). Results: A total of 165 neonates were admitted in a period of 2 years. There was male preponderance with 63.4% admitted cases being male. Majority of neonates were term (88%) and normal birth weight (76.9%). The most common indication for admission was neonatal sepsis (43.6%) which was followed by neonatal hyperbilirubinemia (29.69%) and perinatal asphyxia (5.4%). Conclusion: Neonatal sepsis was leading cause of admission for neonates in NICU. This can be prevented by improvement in antenatal care, training of human resources and better NICU care.

Incidence and mortality due to thromboembolic events during the COVID-19 pandemic: Multi-sourced population-based health records cohort study