Pilot study demonstrates that placental histology can provide an additional tool for diagnosing early‐onset neonatal sepsis
Aim We explored whether placental histology could help to diagnose early‐onset neonatal sepsis (EONS), guide clinical decision‐making 48 hours after birth and reduce antibiotic use. Methods This study comprised 109 infants born at less than 32 weeks of gestation, who were admitted to the neonatal in...
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| Veröffentlicht in: | Acta Paediatrica 2018-12, Vol.107 (12), p.2086-2091 |
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| container_title | Acta Paediatrica |
| container_volume | 107 |
| creator | Ykema, J M A D'Haens, E J Havenith, M Eyck, J Lingen, R A Hemels, M A C |
| description | Aim
We explored whether placental histology could help to diagnose early‐onset neonatal sepsis (EONS), guide clinical decision‐making 48 hours after birth and reduce antibiotic use.
Methods
This study comprised 109 infants born at less than 32 weeks of gestation, who were admitted to the neonatal intensive care unit of Isala, Zwolle, The Netherlands, between January 2013 and December 2013. EONS was defined as clinical symptoms plus raised serial C‐reactive protein (CRP) >10 mg/L and a positive (proven EONS) or a negative (suspected EONS) blood culture. Placentas were studied for a histological inflammatory response and scored according to Redline's criteria.
Results
A histological inflammatory response was seen in 15/88 (17%) placentas and this occurred significantly more often in infants with a high suspicion of EONS (p < 0.05). No histological inflammatory response was seen if maternal risk factors for EONS were absent, despite a raised CRP level. Based on placental histology, the duration of antibiotic therapy was reduced from more than five days to 48 hours in 20/27 infants (74%).
Conclusion
Histological examination of the placenta helped to diagnose EONS and guide clinical decision‐making 48 hours after birth and led to a clinically relevant reduction in antibiotic use. |
| doi_str_mv | 10.1111/apa.14410 |
| format | Article |
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We explored whether placental histology could help to diagnose early‐onset neonatal sepsis (EONS), guide clinical decision‐making 48 hours after birth and reduce antibiotic use.
Methods
This study comprised 109 infants born at less than 32 weeks of gestation, who were admitted to the neonatal intensive care unit of Isala, Zwolle, The Netherlands, between January 2013 and December 2013. EONS was defined as clinical symptoms plus raised serial C‐reactive protein (CRP) >10 mg/L and a positive (proven EONS) or a negative (suspected EONS) blood culture. Placentas were studied for a histological inflammatory response and scored according to Redline's criteria.
Results
A histological inflammatory response was seen in 15/88 (17%) placentas and this occurred significantly more often in infants with a high suspicion of EONS (p < 0.05). No histological inflammatory response was seen if maternal risk factors for EONS were absent, despite a raised CRP level. Based on placental histology, the duration of antibiotic therapy was reduced from more than five days to 48 hours in 20/27 infants (74%).
Conclusion
Histological examination of the placenta helped to diagnose EONS and guide clinical decision‐making 48 hours after birth and led to a clinically relevant reduction in antibiotic use.</description><identifier>ISSN: 0803-5253</identifier><identifier>EISSN: 1651-2227</identifier><identifier>DOI: 10.1111/apa.14410</identifier><identifier>PMID: 29786145</identifier><language>eng</language><publisher>Norway: Wiley Subscription Services, Inc</publisher><subject>Antibiotics ; Birth ; Blood culture ; Chorioamnionitis ; Decision making ; Funisitis ; Gestation ; Histology ; Infants ; Inflammation ; Inflammatory response ; Neonates ; Placenta ; Prematurity ; Risk factors ; Sepsis</subject><ispartof>Acta Paediatrica, 2018-12, Vol.107 (12), p.2086-2091</ispartof><rights>2018 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd</rights><rights>2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.</rights><rights>2018 Foundation Acta Pædiatrica</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3880-8afde93baa3d3537d7dd6cb5d1914e4c28e8006770a453c26961e8e4267ded2b3</citedby><cites>FETCH-LOGICAL-c3880-8afde93baa3d3537d7dd6cb5d1914e4c28e8006770a453c26961e8e4267ded2b3</cites><orcidid>0000-0003-3950-7696</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapa.14410$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapa.14410$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29786145$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ykema, J M A</creatorcontrib><creatorcontrib>D'Haens, E J</creatorcontrib><creatorcontrib>Havenith, M</creatorcontrib><creatorcontrib>Eyck, J</creatorcontrib><creatorcontrib>Lingen, R A</creatorcontrib><creatorcontrib>Hemels, M A C</creatorcontrib><title>Pilot study demonstrates that placental histology can provide an additional tool for diagnosing early‐onset neonatal sepsis</title><title>Acta Paediatrica</title><addtitle>Acta Paediatr</addtitle><description>Aim
We explored whether placental histology could help to diagnose early‐onset neonatal sepsis (EONS), guide clinical decision‐making 48 hours after birth and reduce antibiotic use.
Methods
This study comprised 109 infants born at less than 32 weeks of gestation, who were admitted to the neonatal intensive care unit of Isala, Zwolle, The Netherlands, between January 2013 and December 2013. EONS was defined as clinical symptoms plus raised serial C‐reactive protein (CRP) >10 mg/L and a positive (proven EONS) or a negative (suspected EONS) blood culture. Placentas were studied for a histological inflammatory response and scored according to Redline's criteria.
Results
A histological inflammatory response was seen in 15/88 (17%) placentas and this occurred significantly more often in infants with a high suspicion of EONS (p < 0.05). No histological inflammatory response was seen if maternal risk factors for EONS were absent, despite a raised CRP level. Based on placental histology, the duration of antibiotic therapy was reduced from more than five days to 48 hours in 20/27 infants (74%).
Conclusion
Histological examination of the placenta helped to diagnose EONS and guide clinical decision‐making 48 hours after birth and led to a clinically relevant reduction in antibiotic use.</description><subject>Antibiotics</subject><subject>Birth</subject><subject>Blood culture</subject><subject>Chorioamnionitis</subject><subject>Decision making</subject><subject>Funisitis</subject><subject>Gestation</subject><subject>Histology</subject><subject>Infants</subject><subject>Inflammation</subject><subject>Inflammatory response</subject><subject>Neonates</subject><subject>Placenta</subject><subject>Prematurity</subject><subject>Risk factors</subject><subject>Sepsis</subject><issn>0803-5253</issn><issn>1651-2227</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp10btuFDEUBmALgcgSKHgBZIkGikl890y5irhJkUgB9ejs-OzGkXc82J6gKZDyCHlGngQvGyiQcHNcfPp1jn5CXnJ2xus7hwnOuFKcPSIrbjRvhBD2MVmxlslGCy1PyLOcbxgTslPmKTkRnW0NV3pFflz5EAvNZXYLdbiPYy4JCmZarqHQKcCAY4FAr30uMcTdQgcY6ZTirXdI6xec88XHsZoSY6DbmKjzsBtj9uOOIqSw_Ly7r8FY6IgVHuIyTtnn5-TJFkLGFw_zlHx9_-7Lxcfm8vOHTxfry2aQbcuaFrYOO7kBkE5qaZ11zgwb7XjHFapBtNgyZqxloLQchOkMxxaVMNahExt5St4cc-ve32bMpd_7PGAIUBeacy-YElZLrnmlr_-hN3FO9bqq-EEY29mq3h7VkGLOCbf9lPwe0tJz1h866Wsn_e9Oqn31kDhv9uj-yj8lVHB-BN99wOX_Sf36an2M_AU3PZh_</recordid><startdate>201812</startdate><enddate>201812</enddate><creator>Ykema, J M A</creator><creator>D'Haens, E J</creator><creator>Havenith, M</creator><creator>Eyck, J</creator><creator>Lingen, R A</creator><creator>Hemels, M A C</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TM</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3950-7696</orcidid></search><sort><creationdate>201812</creationdate><title>Pilot study demonstrates that placental histology can provide an additional tool for diagnosing early‐onset neonatal sepsis</title><author>Ykema, J M A ; D'Haens, E J ; Havenith, M ; Eyck, J ; Lingen, R A ; Hemels, M A C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3880-8afde93baa3d3537d7dd6cb5d1914e4c28e8006770a453c26961e8e4267ded2b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Antibiotics</topic><topic>Birth</topic><topic>Blood culture</topic><topic>Chorioamnionitis</topic><topic>Decision making</topic><topic>Funisitis</topic><topic>Gestation</topic><topic>Histology</topic><topic>Infants</topic><topic>Inflammation</topic><topic>Inflammatory response</topic><topic>Neonates</topic><topic>Placenta</topic><topic>Prematurity</topic><topic>Risk factors</topic><topic>Sepsis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ykema, J M A</creatorcontrib><creatorcontrib>D'Haens, E J</creatorcontrib><creatorcontrib>Havenith, M</creatorcontrib><creatorcontrib>Eyck, J</creatorcontrib><creatorcontrib>Lingen, R A</creatorcontrib><creatorcontrib>Hemels, M A C</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta Paediatrica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ykema, J M A</au><au>D'Haens, E J</au><au>Havenith, M</au><au>Eyck, J</au><au>Lingen, R A</au><au>Hemels, M A C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pilot study demonstrates that placental histology can provide an additional tool for diagnosing early‐onset neonatal sepsis</atitle><jtitle>Acta Paediatrica</jtitle><addtitle>Acta Paediatr</addtitle><date>2018-12</date><risdate>2018</risdate><volume>107</volume><issue>12</issue><spage>2086</spage><epage>2091</epage><pages>2086-2091</pages><issn>0803-5253</issn><eissn>1651-2227</eissn><abstract>Aim
We explored whether placental histology could help to diagnose early‐onset neonatal sepsis (EONS), guide clinical decision‐making 48 hours after birth and reduce antibiotic use.
Methods
This study comprised 109 infants born at less than 32 weeks of gestation, who were admitted to the neonatal intensive care unit of Isala, Zwolle, The Netherlands, between January 2013 and December 2013. EONS was defined as clinical symptoms plus raised serial C‐reactive protein (CRP) >10 mg/L and a positive (proven EONS) or a negative (suspected EONS) blood culture. Placentas were studied for a histological inflammatory response and scored according to Redline's criteria.
Results
A histological inflammatory response was seen in 15/88 (17%) placentas and this occurred significantly more often in infants with a high suspicion of EONS (p < 0.05). No histological inflammatory response was seen if maternal risk factors for EONS were absent, despite a raised CRP level. Based on placental histology, the duration of antibiotic therapy was reduced from more than five days to 48 hours in 20/27 infants (74%).
Conclusion
Histological examination of the placenta helped to diagnose EONS and guide clinical decision‐making 48 hours after birth and led to a clinically relevant reduction in antibiotic use.</abstract><cop>Norway</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29786145</pmid><doi>10.1111/apa.14410</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-3950-7696</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library All Journals; Alma/SFX Local Collection |
| subjects | Antibiotics Birth Blood culture Chorioamnionitis Decision making Funisitis Gestation Histology Infants Inflammation Inflammatory response Neonates Placenta Prematurity Risk factors Sepsis |
| title | Pilot study demonstrates that placental histology can provide an additional tool for diagnosing early‐onset neonatal sepsis |
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