Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates.

Backgrounds: The large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age.

Methods: Data from the NeoPInS trial in neonates born after 34 weeks of gestational age with suspected EOS in the first 72 h of life requiring antibiotic therapy were used.

Machine Learning Used to Compare the Diagnostic Accuracy of Risk Factors, Clinical Signs and Biomarkers and to Develop a New Prediction Model for Neonatal Early-onset Sepsis.

Background: Current strategies for risk stratification and prediction of neonatal early-onset sepsis (EOS) are inefficient and lack diagnostic performance. The aim of this study was to use machine learning to analyze the diagnostic accuracy of risk factors (RFs), clinical signs and biomarkers and to develop a prediction model for culture-proven EOS. We hypothesized that the contribution to diagnostic accuracy of biomarkers is higher than of RFs or clinical signs.

C-Reactive Protein, Procalcitonin, and White Blood Count to Rule Out Neonatal Early-onset Sepsis Within 36 Hours: A Secondary Analysis of the Neonatal Procalcitonin Intervention Study.

Background: Neonatal early-onset sepsis (EOS) is one of the main causes of global neonatal mortality and morbidity, and initiation of early antibiotic treatment is key. However, antibiotics may be harmful.

Methods: We performed a secondary analysis of results from the Neonatal Procalcitonin Intervention Study, a prospective, multicenter, randomized, controlled intervention study.

Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia.

Background: Worldwide, many newborns who are preterm, small or large for gestational age, or born to mothers with diabetes are screened for hypoglycemia, with a goal of preventing brain injury. However, there is no consensus on a treatment threshold that is safe but also avoids overtreatment.

Methods: In a multicenter, randomized, noninferiority trial involving 689 otherwise healthy newborns born at 35 weeks of gestation or later and identified as being at risk for hypoglycemia, we compared two threshold values for treatment of asymptomatic moderate hypoglycemia.

An infant formula with large, milk phospholipid-coated lipid droplets containing a mixture of dairy and vegetable lipids supports adequate growth and is well tolerated in healthy, term infants.

Background: Lipid droplets in human milk have a mode diameter of ∼4 μm and are surrounded by a native phospholipid-rich membrane. Current infant milk formulas (IMFs) contain small lipid droplets (mode diameter ∼0.5 μm) primarily coated by proteins.

Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: a multicentre, randomised controlled trial (NeoPIns).

Background: Up to 7% of term and late-preterm neonates in high-income countries receive antibiotics during the first 3 days of life because of suspected early-onset sepsis. The prevalence of culture-proven early-onset sepsis is 0·1% or less in high-income countries, suggesting substantial overtreatment. We assess whether procalcitonin-guided decision making for suspected early-onset sepsis can safely reduce the duration of antibiotic treatment.

Is Ara h 2 indeed the best predictor for peanut allergy in Dutch children?

Background: Specific immunoglobulin E to Ara h 2 (sIgE to Ara h 2) is described as an upcoming predicting factor for diagnosing peanut allergy in children. The gold standard for diagnosing peanut allergy is a double blind placebo controlled food challenge, however this is time consuming and potentially harmful. We investigate Ara h 2 as a preliminary less invasive diagnostic tool for diagnosing peanut allergy in a general population of peanut sensitized children.

The diagnostic value of routine antenatal ultrasound in screening for congenital uropathies.

Background: Antenatal hydronephrosis (ANH) is characteristic for congenital obstructive abnormalities of the urinary tract (COAUT). COAUT is the most common cause of urinary tract infections (UTI's) in newborns. The prognosis of mild to moderate ANH is unclear.

[An acute vomiting infant with profuse diarrhoea: enterocolitis due to non-IgE-mediated cow's milk allergy].

Background: Food protein-induced enterocolitis is a manifestation of non-IgE-mediated cow's milk allergy, characterized by acute vomiting and profuse diarrhoea. This reaction is often not recognized as cow's milk allergy.

Case Description: We present a 6-week-old, formula-fed girl with frequent vomiting, diarrhoea and failure to thrive.

Reference ranges for serum β-trace protein in neonates and children younger than 1 year of age.

Background: β-Trace protein (BTP) has been proposed as an alternative endogenous marker of glomerular filtration rate. Data on BTP reference ranges in young children are scarce. We therefore aim to establish reference ranges and examine the developmental course of serum BTP in basically healthy children younger than 1 year of age.

ECMO in neonates: neuroimaging findings and outcome.

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for newborns with severe but reversible respiratory failure. Although ECMO has significantly improved survival, it is associated with substantial complications, of which intracranial injuries are the most important. These injuries consist of hemorrhagic and non-hemorrhagic, ischemic lesions.

Cerebral aspects of neonatal extracorporeal membrane oxygenation: a review.

Background: Neonatal extracorporeal membrane oxygenation (ECMO) is a lifesaving therapeutic approach in newborns suffering from severe, but potentially reversible, respiratory insufficiency, mostly complicated by neonatal persistent pulmonary hypertension. However, cerebral damage, intracerebral hemorrhage as well as ischemia belong to the most devastating complications of ECMO.

Objectives: The objectives are to give insights into what is known from the literature concerning cerebral damage related to neonatal ECMO treatment for pulmonary reasons.

Health-related quality of life, emotional and behavioral problems in mild to moderate prematures at (pre-)school age.

Background: There is a gap in the knowledge of longterm outcome of mild to moderate prematures compared to the extreme prematures or very low birth weight infants.

Aim: Determine health-related quality of life (HRQoL) and prevalence of emotional and behavioral problems in (pre-)school age children born at 32 to 36 weeks' gestation.

Study Design: A descriptive cohort study in a non-Neonatal Intensive Care Unit.

Omphalocele and alveolar capillary dysplasia: a new association.

Objective: First report of an infant with coexistent omphalocele and alveolar capillary dysplasia.

Design: Descriptive case report.

Setting: Neonatal intensive care unit of a tertiary care children's hospital.

Effect of bladderbox alarms during venoarterial extracorporeal membrane oxygenation on cerebral oxygenation and hemodynamics in lambs.

To determine the effects of bladderbox alarms during venoarterial extracorporeal membrane oxygenation (va-ECMO) on cerebral oxygenation and hemodynamics, six lambs were prospectively treated with va-ECMO and bladderbox alarms were simulated. Changes in concentrations of oxyhemoglobin (deltacO2Hb), deoxyhemoglobin (deltacHHb), and total Hb (deltactHb) were measured using near infrared spectrophotometry. Fluctuations in Hb oxygenation index (deltaHbD) and cerebral blood volume (deltaCBV) were calculated.

The effect of inhaled nitric oxide on the course of extracorporeal membrane oxygenation and the occurrence of hemorrhagic complications.

This study evaluated the relation between prior inhaled nitric oxide (iNO) and the time to initiation and duration of treatment with veno-arterial extracorporeal membrane oxygenation (ECMO) and the occurrence of hemorrhagic complications. A retrospective study was conducted in 59 human newborns treated for respiratory insufficiency with ECMO over a 5-year period. Patients received iNO before ECMO (iNO group) or not (control group).

Intravascular volume administration: a contributing risk factor for intracranial hemorrhage during extracorporeal membrane oxygenation?

Objective: The objective of this study was to determine the relationship between the frequency and total volume of intravascular volume administration and the development of intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation.

Methods: In a retrospective, matched, case-control study, 24 newborns who developed an intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation treatment were compared with 40 control subjects. Both groups were analyzed for gestational age, gender, race, Apgar scores at 1 and 5 minutes, birth weight, cardiopulmonary resuscitation before venoarterial extracorporeal membrane oxygenation, age at the start of treatment, duration of treatment, worst arterial blood gas sample preceding treatment, activated clotting time values, need for platelet transfusions, mean blood pressure, and the use of inotropics and steroids before the treatment.

Abnormalities of coagulation related to the use of inhaled nitric oxide before extracorporeal membrane oxygenation.

Objective: Evaluation of the influence of previous inhaled nitric oxide (iNO) treatment on the occurrence of clotting complications and disseminated intravascular coagulation during extracorporeal membrane oxygenation (ECMO).

Design: Retrospective study in newborns treated with venoarterial ECMO during a 5-yr period.

Setting: Neonatal intensive care unit of a university medical center.