Wojciech Podraza

Early detection of an early onset infection in the neonate based on measurements of procalcitonin and C-reactive protein concentrations in cord blood

Abstract Background: The aim of this study was to test the diagnostic model of combining procalcitonin (PCT) and C-reactive protein (CRP) levels in the cord blood and routinely used biochemical parameters and clinical data in the prediction of early onset neonatal infection. Methods: PCT and CRP concentrations were measured in cord blood of neonates with infection (group A, n=46) and compared with uninfected neonates (group B, n=240). Inclusion criteria for group A were based on obstetric history, clinical data and results of laboratory tests. Logistic regression was applied. The receiver operating characteristic (ROC) curves were constructed for PCT, CRP and the diagnostic model. Results: There was a highly significant (p<0.000001) difference in PCT and CRP concentrations between both groups. The cut-off point for PCT in cord blood was 1.22 ng/mL [sensitivity % (SE%) 80.43, specificity % (SP%) 71.67, positive predictive value % (PPV%) 35.24, negative predictive value % (NPV%) 95.03], and 1.0 mg/L for CRP (SE% 73.91, SP% 77.92, PPV% 39.08, NPV% 93.97). In total, seven variables were included in the model (concentrations of PCT and CRP in cord blood, tocolysis, nutritional status of the newborn, Apgar score, neutrophil ratio and red blood cell count in neonatal venous blood), which proved to offer the highest sensitivity (91.3%; 95% CI: 83–99) and specificity (90%; 95% CI: 86–94) for the detection of early onset neonatal infection. The likelihood ratio for the model was high at 9.13, with PPV% 63.64 (95% CI: 52–75), NPV% 98.18 (95% CI: 96–100) and calculated area under the curve at 0.973. Conclusions: The diagnostic model based on seven clinical and laboratory parameters, using the concentration of PCT and CRP measurements in the cord blood, could be a useful tool for the prediction of early onset neonatal infection. Clin Chem Lab Med 2008;46:1143–8.

Utilization of a 3D printer to fabricate boluses used for electron therapy of skin lesions of the eye canthi

Abstract This work describes the use of 3D printing technology to create individualized boluses for patients treated with electron beam therapy for skin lesions of the eye canthi. It aimed to demonstrate the effectiveness of 3D‐printed over manually fabricated paraffin boluses. The study involved 11 patients for whom the construction of individual boluses were required. CT scans of the fabricated 3D‐printed boluses and paraffin boluses were acquired and superimposed onto patient CT scans to compare their fitting, bolus homogeneity, and underlying dose distribution. To quantify the level of matching, multiple metrics were utilized. Matching Level Index (ML) values ranged from 0 to 100%, where 100% indicated a perfect fit between the reference bolus (planned in treatment planning system) and 3D‐printed and paraffin bolus. The average ML (± 1 SD) of the 3D‐printed boluses was 95.1 ± 2.1%, compared to 46.0 ± 10.1% for the manually fabricated paraffin bolus. Correspondingly, mean doses were closer to the prescribed doses, and dose spreads were less for the dose distributions from the 3D‐printed boluses, as compared to those for the manually fabricated paraffin boluses. It was concluded that 3D‐printing technology is a viable method for fabricating boluses for small eye lesions and provides boluses superior to our boluses manually fabricated from paraffin sheets.

Recording of amplitude-integrated electroencephalography, oxygen saturation, pulse rate, and cerebral blood flow during massage of premature infants.

OBJECTIVE Stimulation of the nervous system plays an important role in brain function and psychomotor development of children. Massage can benefit premature infants, but has limitations. STUDY DESIGN The authors conducted a study to verify the direct effects of massage on amplitude-integrated electroencephalography (aEEG), oxygen saturation (SaO(2)), and pulse analyzed by color cerebral function monitor (CCFM) and cerebral blood flow assessed by the Doppler technique. RESULTS The amplitude of the aEEG trend during massage significantly increased. Massage also impacted the dominant frequency δ waves. Frequency significantly increased during the massage and return to baseline after treatment. SaO(2) significantly decreased during massage. In four premature infants, massage was discontinued due to desaturation below 85%. Pulse frequency during the massage decreased but remained within physiological limits of greater than 100 beats per minute in all infants. Doppler flow values in the anterior cerebral artery measured before and after massage did not show statistically significant changes. Resistance index after massage decreased, which might provide greater perfusion of the brain, but this difference was not statistically significant. CONCLUSION Use of the CCFM device allows for monitoring of three basic physiologic functions, namely aEEG, SaO(2), and pulse, and increases the safety of massage in preterm infants.

Does prenatal antibiotic therapy compromise the diagnosis of early-onset infection and management of the neonate?

Abstract Aim: To assess the impact of prenatal antibiotic treatment on procalcitonin (PCT) and C-reactive protein (CRP) concentrations in cord blood, and on the rate of positive neonatal blood cultures. Methods: Neonates with early-onset infection (Group A; n=46) were compared with healthy controls (Group B; n=240). We evaluated the relationship between prenatal antibiotic therapy and early-onset infection, and for interactions with antibiotic therapy in the neonate immediately after birth. Results: In the Group A antibiotics were administered significantly more often prenatally and more often to neonates just after birth. The percentage of negative blood cultures in infected neonates was higher when antibiotic treatment was instituted prenatally. Differences in cord blood PCT and CRP concentrations were significant between both groups and were independent of prenatal antibiotic treatment. Streptococcus agalactiae was the most frequent species. Conclusions: Almost one-third of neonates present with early-onset infection in spite of prenatal antibiotic therapy. Cord blood PCT and CRP measurements may be helpful in the diagnosis of infection also in cases when antibiotic therapy was started prenatally. Prenatal antibiotic administration reduced the number of positive blood cultures in neonates with early-onset infection and was associated with a greater rate of antibiotic treatment after birth in neonates without infection.

The Determination of Procalcitonin Concentration in Early-Onset Neonatal Infection: A Valuable Test Regardless of Prenatal Antibiotic Therapy

The aim of this study was to assess the clinical usefulness of blood procalcitonin (PCT) levels for the diagnosis and therapeutic monitoring of early-onset neonatal sepsis (EONS). PCT as well as C-reactive protein (CRP) levels and white blood cell (WBC) count were measured in venous blood from 57 infected and 72 uninfected neonates. Differences between groups for PCT, CRP, and WBC levels were significant. The threshold value on the receiver operating characteristic curve in the prediction of EONS was 5.33 ng/mL for PCT, 9.3 mg/L for CRP, and 14.9 × 109/L for WBC. There was no effect of antibiotic administered to the mother on PCT, CRP, and WBC levels in neonatal blood sampled before treatment of EONS. Evidently reduced PCT levels are observed after 2 days of treatment. The authors conclude that prenatal antibiotic therapy does not reduce the value of PCT levels in blood for the diagnosis of EONS.

Usefulness of estimation of blood procalcitonin concentration versus C-reactive protein concentration and white blood cell count for therapeutic monitoring of sepsis in neonates.

AIM This study was intended to assess the clinical usefulness of blood procalcitonin (PCT) concentrations for the diagnosis and therapeutic monitoring of nosocomial neonatal sepsis. MATERIAL/METHODS The enrolment criterion was sepsis clinically manifesting after three days of life. PCT concentrations were measured in venous blood from 52 infected and 88 uninfected neonates. The results were interpreted against C-reactive protein (CRP) concentrations and white blood cell counts (WBC). RESULTS Differences between the two groups in PCT and CRP concentrations were highly significant. No significant differences between the groups were noted for WBC. The threshold value on the receiver operator characteristic curve was 2.06 ng/mL for PCT (SE 75%; SP 80.68%; PPV 62.22%; NPV 88.75%; AUC 0.805), 5.0 mg/L for CRP (SE 67.44%; SP 73.68%; PPV 42.02%; NPV 88.89%; AUC 0.801), and 11.9 x109/L for WBC (SE 51.16%; SP 50.68%; PPV 23.16%; NPV 78.13%; AUC 0.484). Procalcitonin concentrations decreased 24 hours after initiation of antibiotic therapy and reverted to the control level after 5-7 days. C-reactive protein concentrations began to decline after two days of antibiotic therapy but were still higher than in the control group after 5-7 days of treatment. No significant changes in WBC during the treatment were observed. CONCLUSIONS Procalcitonin concentrations in blood appear to be of use for the diagnosis and therapeutic monitoring of nosocomial infections in neonates as this parameter demonstrates greater sensitivity and specificity than C-reactive protein. White blood cell counts appear to be of little diagnostic value in the early phase of infection or for therapeutic monitoring.

EEG, brain maturation, and the development of retinopathy of prematurity.

Objectives: The factors that influence the central nervous system (CNS) development can affect either the retina or the brain cortex. Immaturity of the brain cortex reflects immaturity of the retina and vice versa. The immature retina is more vulnerable than the mature retina, and is therefore more likely to develop retinopathy of prematurity (ROP). The aim of this study was to compare electroencephalographic brain maturity with ROP severity. Methods: Twenty-one prematurely born infants were divided into two groups according to the severity of ROP. The first group included 12 infants with ROP stage 3 or more and the second group included nine infants with ROP stage 2 or less. We have proposed an index of CNS maturity (M) as a percentage of interburst interval elongation compared with the norm using video-electroencephalography (vEEG). Results: The median M value was 1.07 (range = 0.43–4.44) for infants with severe ROP and −0.1 (range = −1.0 to 1.45) for infants with mild or no ROP (p = 0.000948). Conclusions: The study revealed that CNS maturation delay expressed as M value was higher among infants with severe ROP than among infants with mild or no ROP. EEG examination in prematurely born infants may prove to be a useful tool for predicting ROP development.

The Role of Hemoglobin Variant Replacement in Retinopathy of Prematurity

ObjectiveTo conduct tests of relationships between different factors that could influence the course of retinopathy of prematurity (ROP) and ROP, particularly the role of hemoglobin variant replacement in adult blood transfusions.MethodsA retrospective, observational study of 83 infants born between 23 and 34 wks gestation was conducted.ResultsThe infants without ROP, with 1 and 2 stage of ROP and with ≥3 stage of ROP received Q 28 (12–134); 51 (14–149); 156 (38–244) ml/kg of transfused blood, respectively, and the factor Qt was 1,545 (560–10,045); 3,093 (614–13,419); 11,907 (1,288–20,638) (ml/kg)·day, respectively. For the same groups MCV35 (mean cell volume at the arbitrary time of the 35th wk post-conception) was 92.3 (82.9–110.5); 91.0 (79.3–101.4); 87.1 (80.2–94.8) fl, respectively, and factor PMCV/t was 99.5 (89.2–108.8); 96.3 (84.6–106.3); 90.7 (85.3–96.5) fl, respectively. There is high influence on the stage of ROP of the amount of transfused blood and MCV, both with or without the time factor. The statistical differences between PMCV/t were more significant than the differences between MCV35, for different stages of ROP.ConclusionsThe influence of the time factor on the statistical differences of MCV but not on the amount of transfused adult blood suggests that HbF – HbA replacement may play a role in ROP development.

Neonatal RBC Transfusions – Comparison of Two Patterns

Background: Red blood cell (RBC) transfusions performed over 5 years in a neonatal ward were retrospectively analyzed. Despite the fact that ‘fresh’ RBC smallvolume transfusions given to preterm infants are called ‘traditional’ or even ‘historic’, this method of treatment is still used in all neonatal wards in Poland. Patients and Methods: A total of 846 RBC units were transfused to 216 patients, including 26 term and 190 preterm neonates. The transfusion rate and donor exposure rate were calculated. The same parameters were calculated for hypothetical use of blood satellite packs for transfusions in the analyzed patients and compared with the original data. Results: Application of a limited donor program could diminish the donor exposure rate more than twofold, from 3.5 to 1.63, in the very-low-birth-weight infants group and reduce the maximum number of donors from 11 to 3, at the same transfusion rate of 5.35. Conclusion: Introduction of strict RBC transfusion guidelines and a limited-donor blood program would improve transfusion therapy.

Correlation of retinopathy of prematurity with bronchopulmonary dysplasia

Abstract Retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) are diseases that occur only in preterm infants. The etiology of these disorders is multifactorial; however, it is believed that some of the factors in children presenting with BPD affect both the initiation and severity of ROP. The aim of the study was to evaluate the degree of clinical severity of ROP in infants with BPD compared to those without BPD. Methodology Infants were divided into two groups: the BPD+ study group and BPD- control group. Parameters including the incidence of ROP and its severity were compared. Results In neonates with BPD, more severe forms of ROP occurred significantly more frequently than in infants without BPD. Newborns with BPD required significantly longer use of mechanical ventilation; moreover, the number of days in which the concentration of oxygen in the respiratory mixture exceeded 50% was greater in BPD+ children . Children with BPD also received more blood transfusions compared to children without BPD. Conclusions Newborns in the BPD+ study group showed advanced stages of ROP more often than newborns in the BPD- control group. The etiology of ROP and BPD is multifactorial; however, our findings suggest oxygen plays a significant role in the development of these diseases.