It is unclear whether routine testing of women for group B streptococcus (GBS) colonisation either in late pregnancy or during labour reduces early-onset neonatal sepsis, compared with a risk factor-based strategy.

Cluster randomised trial.

320 000 women from up to 80 hospital maternity units.

Sites will be randomised 1:1 to a routine testing strategy or the risk factor-based strategy, using a web-based minimisation algorithm. A second-level randomisation allocates routine testing sites to either antenatal enriched culture medium testing or intrapartum rapid testing. Intrapartum antibiotic prophylaxis will be offered if a test is positive for GBS, or if a maternal risk factor for early-onset GBS infection in her baby is identified before or during labour. Economic and acceptability evaluations will be embedded within the trial design.

The primary outcome is all-cause early (<7 days of birth) neonatal sepsis, defined as either a positive blood/cerebrospinal fluid culture, early neonatal death from infection or a negative/unknown culture status with ≥3 agreed clinical signs or symptoms, who receive intravenous antibiotics ≥5 days. All women giving birth ≥24 weeks' gestation, regardless of mode of birth, and all her babies will be included in the dataset. Cost-effectiveness will be expressed in terms of incremental cost per case of early neonatal sepsis avoided and incremental cost per quality-adjusted life-year associated with each strategy.

The trial received a favourable opinion from Derby Research Ethics Committee on 16 September 2019 (19/EM/0253). The allocated testing strategy will be adopted as standard clinical practice by the site. Women in the routine testing sites will give verbal consent for the test. The trial will use routinely collected data retrieved from National Health Service databases, supplemented with limited participant-level collection of process outcomes. Individual written consent will not be sought. The trial results, and parallel economic, qualitative, implementation and methodological results, will be published in the journal Health Technology Assessment.

ISRCTN49639731.

Objective: The potential association between sepsis risk and circulating levels of fibroblast growth factors (FGFs) and their receptors (FGFRs) has been a focus of research; however, the causal relationship between them remains to be elucidated. We hypothesize a causal association between genetically predicted FGFs, FGFRs, and sepsis risk, and we conduct a Mendelian randomization (MR) study to validate this hypothesis. Methods: We utilized a two-sample MR design to assess the effect of genetic variants associated with various FGFs (FGF1, FGF2, FGF7, FGF16, FGF19, FGF21, FGF23, FGF5) and FGFRs (FGFR1, FGFR2, FGFR3, α-Klotho) on sepsis risk, using genome-wide association study summary statistics. Our MR analyses employed the inverse-variance weighted (IVW) method, along with weighted median, weighted mode, and MR-Egger regression, supplemented by sensitivity analyses to ensure robustness. Results: The MR analysis identified an unequal number of instrumental variables ranging from 2 to 17 for FGFs and FGFRs when sepsis was the outcome. No significant correlation was found between genetically determined FGF levels and sepsis risk by IVW analysis (all P > 0.05). Correspondingly, similar nonsignificant associations were observed for FGFRs (all P > 0.05). Other MR methods corroborated the IVW findings. Sensitivity analyses, including Cochran's Q test, MR-Egger, and MR pleiotropy residual sum and outlier, indicated no significant heterogeneity or pleiotropy in the relationships, with the exception of a nonsignificant correlation between FGFR1 and sepsis that persisted after the exclusion of an outlier (odds ratio, 0.84; P = 0.34). Conclusion: The analysis found no significant causal associations between FGFs, their receptors, and sepsis risk, indicating a need for further research on their complex interactions.

Early onset sepsis (EOS) is rare but potentially lethal. French guidelines were published in 2017 to improve the care of children. The aim of this study was to qualify and quantify inadequate antibiotic therapy management compared with the recommendations made by the new French guidelines.

This prospective observational study was conducted at the Robert Debré Hospital (Paris, France), a tertiary pediatric teaching center. Data were prospectively collected between May and October 2019. We included all neonates born at a gestational age ≥ 34 weeks who needed emergency transportation by the pediatric intensive care unit transport team during the first 72 hours of life. The primary outcome was the rate of antibiotic therapy initiation (or abstention) that did not respect the new French guidelines.

One hundred and seven patients were included. The median gestational age was 39 weeks and 6 days. Median weight was 3355 g. Fifty-eight births (54%) had at least 1 risk factor for EOS. Ninety-seven (91%) infants had at least 1 symptom of EOS, and 76 (71%) were treated with antibiotics. Three newborns (3%) had a documented EOS, and all of them survived. Antibiotic therapy initiation or abstention was adequate for 91% of our cohort (n = 107). Physicians prescribed inadequate biologic tests for 67 (63%) infants.

There was a high adherence to the French EOS guidelines for antibiotic therapy initiation or abstention. No death related to EOS occurred in our cohort. Nevertheless, a high proportion of children had undergone inadequate biological tests.

Septicemia triggers a profound systemic inflammatory response, ultimately leading to cellular senescence. Understanding the mechanisms underlying intercellular interactions associated with sepsis is crucial for developing therapeutic strategies targeting sepsis and its associated complications. Neonatal septicemia (NS) is a critical condition characterized by systemic infection in newborns. Currently, there are no effective indicators for the early identification of sepsis and precise screening of newborns who truly require antibiotic treatment, which results in delayed diagnosis of neonatal sepsis and the overuse of antibiotics. We aimed to elucidate cellular senescence-related genes (CSRGs) in the context of NS and to investigate their potential regulatory networks and immune infiltration patterns. Our analysis identified 391 DEGs, including 301 upregulated and 90 downregulated genes and 15 differentially expressed CSRGs (CSRDEGs), including STAT3, MAPK14, IGFBP7, PPARG, and ETS2. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed enrichment in biological processes, including cellular senescence, and pathways involving PD-L1 expression in cancer. Gene Set Enrichment Analysis highlighted significant pathways, including selenoamino acid metabolism and neutrophil degranulation. Protein-protein interaction network analysis identified eight hub genes: STAT3, MAPK14, CEBPB, TLR2, ETS1, JUNB, PPARG, and MAP3K5. Regulatory network analysis revealed interactions between CSRDEGs and multiple transcription factors/miRNAs. Immune infiltration analysis revealed profound differences in the composition of immune cells between the normal and NS groups. Our study findings offer valuable information for future research on therapeutic targets and diagnostic markers of NS.

Interleukin-8 (IL-8) is a key biomarker linked to inflammation and disability in neonates. However, current IL-8 detection methods are often costly, labor-intensive, and require highly trained personnel. While electrochemical techniques have been employed for sensitive IL-8 quantification, they typically rely on redox probes and three-electrode electrochemical cells, leading to issues such as toxicity, prolonged fabrication time, and increased waste generation. Additionally, conventional electrochemical biosensors fabrication techniques are expensive and time-consuming, limiting their scalability for mass disease screening. In this study, we introduce a low-cost, non-faradaic electrochemical nanobiosensor for the direct detection of IL-8. The sensor consists of interdigitated graphite/carbon dot conjugates flexographically printed onto a flexible polyimide substrate. The printed layer's physical properties were systematically characterized using SEM, AFM and surface profilometer, and biofunctionalization was achieved using aminopropyltriethoxysilane (APTES) and glutaraldehyde. Successful surface modification was confirmed through ATR-FTIR and EDS elemental mapping. Electrochemical impedance spectroscopy (EIS) analysis demonstrated the nanobiosensor's response to varying IL-8 concentrations, with capacitance, Zmod, Zreal, and Zimag measurements. Among these, Zimag exhibited the highest sensitivity, with a response of 2.7 kΩ/log(ng/mL) and a detection limit of 50 pg/mL-well below the clinically established threshold of 600 pg/mL. This study demonstrates that, in addition to capacitance, there are multiple parameters that warrant exploration in non-faradaic biosensors to improve their sensing performance. The nanobiosensor fabrication via flexographic printing enables scalable, cost-effective production while maintaining high sensitivity and selectivity through a non-faradaic detection mechanism. This work paves the way for the development of affordable, mass-producible biosensors for early biomarker detection, facilitating timely medical intervention and improved neonatal healthcare outcomes.

Neonatal sepsis is a severe clinical syndrome that continues to be a common and significant health care burden. Knowledge of the local epidemiology allows for a better empirical treatment and improves morbidity and mortality. The aim of this study was to determine the prevalence, epidemiology, and etiology of blood culture-proven sepsis in neonates and to determine whether there are differences between preterm and term newborns.

A retrospective study was carried out in a tertiary hospital in Madrid, Spain, during 2021, including 1443 patients at risk of developing sepsis.

The majority of sepsis episodes occurred in preterm newborns (64.81%) and most of them were very low birth weight infants (74.29%). Late-onset sepsis represented 94.92% of all the episodes reported with an incidence of 11.4 (95% CI 8.8-14.8) per 1000 live newborns. Early onset sepsis incidence was 0.6 (95% CI 0.2-1.8) per 1000 live newborns. Coagulase-negative staphylococci took the first place as causative agents of sepsis (66.10%), causing in all the episodes late onset catheter-related bloodstream infection. When the newborns who developed sepsis were compared with those who did not developed sepsis, the presence of venous/arterial access device was significantly associated with sepsis in both preterm (odds ratio (OR) 8.12, 95% CI 0.47-141.40) and term newborns (OR 16.58, 95% CI 1.00-275.20). Recent surgery was nevertheless the main risk factor in term newborns (OR 45.29, 95% CI 13.70-149.70). Among those patients who developed sepsis, no differences between preterm and term newborns were found regarding time onset, mechanism of transmission, etiological agents, and mortality. A 100% of the preterm and 42.11% of the term newborns presented two or more risk factors. The mortality rate observed here has been 1.85% (95% CI 0.33-9.77%).

The main risk factors for sepsis were venous/arterial access device (for both preterm and term newborns) and recent surgery (term newborns). Prematurity and being a catheter carrier were strongly associated with late-onset neonatal sepsis, mainly due to coagulase-negative staphylococci. The mortality rate was lower than that observed in other high-income countries.

Maternal and neonatal infections pose a significant public health challenge, particularly in developing countries like Benin. This retrospective study investigates the frequency and determinants of maternal and neonatal infections in Benin during 2022, utilizing data from six reference hospitals. The study includes 123 neonates suspected of infection, analyzing factors such as birth weight, breastfeeding practices, clinical delivery parameters, and laboratory-confirmed infection rates. Findings reveal that 32% of suspected cases were confirmed infections, with a higher prevalence among premature newborns and those born in specific hospitals. The study emphasizes the need for improved diagnostic facilities, infection control practices, and awareness among healthcare workers and pregnant women. Recommendations for future research include broader geographic coverage and enhanced training programs.

Neonatal acute respiratory distress syndrome (NARDS) is a severe and potentially life-threatening form of lung injury recently defined by the International Neonatal ARDS Consensus. It is marked by extensive lung inflammation and damage to the alveolar epithelium and vascular endothelium. NARDS can be triggered by direct inflammatory exposures, such as pneumonia and aspiration, and indirect exposures, including sepsis, necrotizing enterocolitis, and chorioamnionitis. This review provides clinicians and researchers with the latest insights on NARDS. We adopt a cross-disciplinary approach to discuss the diagnostic criteria, pathobiology, triggers, epidemiology, and treatments of NARDS. In addition, we summarize existing clinical studies and advanced preclinical models that help address current knowledge gaps. Future research should focus on standardizing the Montreux consensus definition of NARDS in preclinical and clinical studies, identifying biomarkers, developing prediction models, and exploring novel therapies for affected infants.

As a Gram-positive bacterium, Streptococcus agalactiae or Group B Streptococcus (GBS) is normally found as a transient flora of the gastrointestinal and genitourinary tracts of women. The high prevalence of GBS in the urethra warrants investigation of UTIs and antibiotic resistance frequency associated with GBS. Given the paucity of research on antibiotic resistance of GBS in Iran, the present study investigated the UTIs associated with GBS and the antibiotic susceptibility patterns associated with GBS.

This study included 65 GBS strains collected from urine samples obtained from the Bouali Laboratory Complex, one of the largest laboratories in western Iran. VITEK 2 GP ID cards were used to identify all GBS isolates. VITEK 2 susceptibility testing for Gram-positive bacteria was performed according to the manufacturer's instructions using the AST-ST card. MIC method was performed after the detection of GBS strains.

We found that 53 (81.5%) of the GBS isolates showed resistance to tetracycline; 47 (72.3%), 40 (61.5%), and 30 (46.15%) of these had a resistance to erythromycin, clindamycin and ampicillin respectively.

In the present study, the VITEK 2 system was validated as a user-friendly system that can serve as a rapid and accurate tool for identification and antimicrobial susceptibility testing of GBS.

Extraintestinal bacterial infections (EBIs), e.g., urinary tract infection, bacteremia, and meningitis, occur in approximately 10% of febrile infants younger than 60 days. Although many EBI-causing species commonly reside in the infant gut, proof that the digestive system is a pre-infection habitat remains unestablished.

We studied a cohort of febrile term infants < 60 days old who presented to one of thirteen US emergency departments in the Pediatric Emergency Care Applied Research Network from 2016 to 2019. Forty EBI cases and 74 febrile controls matched for age, sex, and race without documented EBIs were selected for analysis. Shotgun sequencing was performed of the gut microbiome and of strains cultured from the gut and extraintestinal site(s) of EBI cases, including blood, urine, and/or cerebrospinal fluid. Using a combination of EBI isolate genomics and fecal metagenomics, we detected an intestinal strain presumptively isogenic to the EBI pathogen (> 99.999% average nucleotide identity) in 63% of infants with EBIs. Although there was no difference in gut microbiome diversity between cases and controls, we observed significantly increased Escherichia coli relative abundance in the gut microbiome of infants with EBIs caused by E. coli. Infants with E. coli infections who were colonized by the putatively isogenic pathogen strain had significantly higher E. coli phylogroup B2 abundance in their gut, and their microbiome was more likely to contain virulence factor loci associated with adherence, exotoxin production, and nutritional/metabolic function.

The intestine plausibly serves as a reservoir for EBI pathogens in a subset of febrile term infants, prompting consideration of new opportunities for surveillance and EBI prevention among colonized, pre-symptomatic infants. Video Abstract.

This study aimed to compare serum levels of pentraxin-3 (PTX-3) in neonates with sepsis against those without sepsis and to assess the diagnostic value of PTX-3 in relation to conventional inflammatory markers.

Between June and December 2020, a total of 109 neonates aged 1 to 21 days, with birth weights ranging from 1795 g to 4200 g, and who met the diagnostic criteria outlined in the "Expert Consensus on the Diagnosis and Treatment of Neonatal Sepsis" (2019) were examined in this prospective study, including 35 with sepsis, 36 with localized infections, and 38 without any infections. Neonates with congenital malformations, intrauterine viral infections, prior antibiotic treatment or without parental consent were excluded from the study. Blood samples were collected and analyzed for routine blood parameters, liver and kidney function metrics, levels of C-reactive protein (CRP), procalcitonin (PCT), lactic acid, and PTX-3.

The incidence of premature rupture of membranes was significantly lower in the sepsis and localized infection groups compared to the non-infected group (22.86%, 11.11%, and 2.63%; P < 0.05). White blood cell (WBC) counts were significantly elevated in both the sepsis and localized infection groups when compared to the non-infected group (P < 0.05). Notable differences were also found in lactate dehydrogenase (LDH) and calcium (Ca) levels (P < 0.05). Serum levels of CRP, PCT, and PTX-3 were significantly higher in the sepsis group (P < 0.05). Additionally, PTX-3 levels demonstrated a strong correlation with both CRP and PCT (P < 0.01). PTX-3, PCT, and platelet distribution width (PDW) emerged as independent risk factors for neonatal infection, while WBC, platelet count (PLT), CRP, PTX-3, PDW, and pH were identified as independent risk factors for sepsis (P < 0.05). The combination of PTX-3, CRP, PCT, and WBC exhibited the highest diagnostic efficiency for neonatal infection (AUC = 0.954, sensitivity 97.4%, specificity 83.1%; P < 0.01). For sepsis, the combined markers also demonstrated the best diagnostic performance (AUC = 0.855, sensitivity 83.3%, specificity 80.0%; P < 0.01).

PTX-3 shows promise as a biomarker for neonatal sepsis, and when combined with WBC, CRP, and PCT, it significantly enhances both diagnostic sensitivity and specificity.

Not applicable.

Neonatal sepsis, a leading cause of newborn mortality, arises from systemic infections due to an immature immune system. Its subtle early symptoms complicate timely diagnosis. Hematological parameters act as an indicator for early detection, crucial for prompt treatment, improving prognosis, and are not a challenging or cumbersome process.

The primary objective was to evaluate the significance of hematological parameters including red blood cell (RBC), WBC, and platelet counts in the context of neonatal sepsis.

This hospital-based cohort study examined 73 neonates admitted to the neonatal intensive care unit (NICU) of Saveetha Medical College and Hospital, Chennai, India during the period of January 2023 to March 2024. All the new born patients were presented with blood culture-confirmed septicemia.

The investigation identified Klebsiella pneumoniae as the most prevalent etiological agent (26.02%), followed by Coagulase-Negative Staphylococci (CONS) and Acinetobacter baumannii (both 8.2%). Alterations in total leukocyte count and hematocrit were observed in 57% and 68.1% of cases, respectively, providing a prompt indication of infection status. Subsequent analyses revealed prominent leukocytosis, hematocrit irregularities, and thrombocytopenia, frequently manifesting in septic cases and demonstrating potential as early markers for neonatal sepsis.

The study highlights the diagnostic value of hematological alterations, such as leukocytosis and hematocrit distortion, in the prompt identification of septicemia among neonates. Based on the findings, it is recommended that routine hematological screening to be integrated as a standard component of neonatal sepsis diagnosis for rapid investigation of neonatal sepsis.

Sepsis is a major cause of neonatal mortality worldwide. However, its risk factors, clinical characteristics, laboratory findings, and bacterial etiology vary across countries. Therefore, this study compared these factors between early-onset sepsis (EOS) and late-onset sepsis (LOS) in Sana'a city, Yemen.

A prospective, cross-sectional study was conducted among 156 neonates with suspected sepsis in Sana'a. Data about risk factors, clinical characteristics, and laboratory findings were collected using a data collection sheet, and blood samples were collected for culture according to established procedures. The data were then analyzed at a significance level of < 0.05.

Of neonates with suspected sepsis, 65.4% had LOS and 34.6% had EOS. However, sepsis was confirmed in 62.2% of cases. Compared to EOS, preterm birth (OR = 4.1, 95% CI: 1.27-13.02; P = 0.013), and exteremely low birthweight (ELBW) and very low birthweight (VLBW) (OR = 4.7, 95% CI: 1.02-22.19; P = 0.033) were significantly associated with a higher risk of LOS, while premature rupture of membranes (PROM) was significantly associated with a lower risk of LOS (OR = 0.2, 95% CI: 0.03-0.99; P = 0.043). Jaundice was significantly more common in neonates with EOS, while apnea was significantly more common in those with LOS. However, no significant differences were found between EOS and LOS in terms of other clinical characteristics, leukocyte and platelet counts, or C-reactive protein (CRP). Gram-positive cocci were the most frequent bacterial isolates (63.9%), with coagulase-negative staphylococci (CoNS) being the predominant species (63.6% in EOS and 42.2% in LOS). Gram-negative bacilli were isolated from 36.1% of cases and were more common in LOS (77.1%) than in EOS (22.9%), with Klebsiella species being the most predominant (19.6%).

Most neonatal sepsis cases in Sana'a are LOS, mostly commonly caused by Gram-positive cocci and associated with preterm birth and ELBW and VLBW. Differences in risk factors associated with EOS and LOS highlight the need for targeted preventive measures in neonatal care settings.

Background: Basic healthcare may significantly decrease neonatal morbidity and mortality. Attention to this, particularly in populations where rates of potentially preventable illness and death within the first weeks of life are extremely high, will have a positive impact on global health. Objective: This manuscript presents the development and impact of a quality improvement programme to reduce the evidence-practice gap in care for neonates admitted to the NICU in a public hospital in India. The programme was locally customised for optimal and sustainable results. Method: The backbone of the project was educational exchange of neonatal nurses and physicians between Norway and India. Areas of potential improvement in the care for the neonates were mainly identified by the clinicians and focus areas were subject to dynamic changes over time. In addition, a service centre for lactation counselling and milk banking was established. Progress over the timeframe 2017-2019 was compared with baseline data. Results: The project has shown that after a collaborative effort, there is a significant reduction in mortality from 11% in the year 2016 to 5.5% in the year 2019. The morbidity was reduced, as illustrated by the decrease in the proportion of neonates with culture-proven sepsis. Nutrition improved with consumption of human milk by the NICU-admitted neonates remarkably increasing from one third to more than three forth of their total intake, and weight gain in a subgroup was shown to increase. With the introduction of family participatory care, hours of skin-to-skin contact for the neonates significantly increased. Additional indicators of improved care were also observed. Conclusions: It is feasible to reduce neonatal mortality and morbidity in a low- and middle-income hospitalised population by improving basic care including nutrition relatively inexpensively when utilising human resources.

Neonatal sepsis is a significant cause of newborn mortality in low- and middle-income countries (LMICs). Together, infections, complications of preterm birth, and intrapartum-related conditions contribute to nearly 90% of all neonatal deaths. Africa experiences high rates of neonatal deaths due to sepsis, with insufficient prevention efforts. Understanding the burden of neonatal sepsis is essential to reducing these deaths in the region. This study aims to estimate the pooled magnitude of neonatal sepsis and identify its associated risk factors in Africa.

For this study, we gathered data by searching various databases until August 20, 2024, including PubMed/MEDLINE, PubMed Central, Hinari, Google, Cochrane Library, African Journals Online, Web of Science, and Google Scholar. Full-text articles in English, both published and unpublished, from 2000 to 2024 were included. However, sources like citations without abstracts or full texts, unidentified reports, editorials, summaries of research, meta-analyses, and qualitative studies were not included in the study. We evaluated the quality of the selected papers using the Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies. Data extraction was completed in Microsoft Excel, and analysis was conducted using STATA V.17 Statistical Software. We assessed study heterogeneity with the I2 statistic and the Cochrane Q test. Publication bias was evaluated both visually through a funnel plot and statistically through Egger's regression and Begg's tests. Subgroup analyses were performed to identify sources of heterogeneity, and a sensitivity analysis was conducted to find any outlier studies.

This review includes 49 studies with 87,548 neonates. The overall magnitude of neonatal sepsis in Africa was found to be 40.98% (95% confidence interval (CI): 30.50% to 51.46%) P: 0.00. The study found that factors such as prolonged rupture of membranes (Odds ratio (OR) 4.11, 95% CI: 2.81-5.41) P: 0.00, a history of the urinary tract or sexually transmitted infections (OR 3.28, 95% CI: 1.97-4.58) P: 0.00, low birth weight (< 2500 g) (OR 6.95, 95% CI: 3-10.89) P: 0.00, an Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score below 7 at the first minute (OR 7.56, 95% CI: 3.39-11.73) P: 0.00, preterm birth (OR 5.38, 95% CI: 3.23-7.5) P: 0.00, and neonates who were resuscitated at birth (OR 3.26, 95% CI: 1.96-4.56) P: 0.00.

The magnitude of neonatal sepsis in Africa remains high. This study identified several contributing factors, including prolonged rupture of membranes, a history of urinary tract or sexually transmitted infections, low birth weight (< 2500 g), an APGAR score below 7 at one minute, preterm birth, and resuscitation at birth. These findings underscore the importance of routinely screening for risk factors such as prolonged membrane rupture and maternal infections. Enhancing antenatal care, training providers in early neonatal sepsis management, and enforcing infection control measures.

Presence of leucocytic infiltration in perivascular area or in Wharton jelly indicates funisitis. While conventional histopathological examination is the gold standard, its time delay hampers timely intervention. The frozen section technique offers a rapid alternative, enabling clinicians to promptly manage preterm early onset sepsis.

This is a prospective study of 18 months. 125 preterms analyzed. Frozen sections and conventional sections of umbilical cord prepared and examined for inflammation by two researchers. Diagnostic accuracy of frozen sections versus conventional sections evaluated for sensitivity and specificity in detecting funisitis.

The frozen section of the umbilical cord was 85.5% sensitive and 86.7% specific in diagnosing funisitis. The inter-rater agreement for diagnosing funisitis was 72.2%. Funisitis on frozen section was 82.2% sensitive and 26.3% specific in diagnosing neonatal sepsis.

Frozen section examination of umbilical cord has good diagnostic ability in detecting funisitis. The inter-rater agreement is substantial.

The present work reports fabrication of nanomaterial based electrochemical genosensor for efficient detection of neonatal sepsis. For this purpose, virulent cfb gene of its major causative organisms, i.e. Group B Streptococcus (GBS) was selected. Further, a cfb specific 19-mer long amine terminated DNA probe was designed to be used as bioreceptor. The genosensing platform is fabricated by utilizing graphene oxide as nanomaterial which is deposited onto screen printed electrode (SPE) by electrophoretic deposition technique. Thereafter, the designed probe DNA is immobilized on graphene oxide modified SPE through EDC-NHS chemistry. Characterization of nanomaterial and fabricated genosensing platform is studied via X-ray diffraction, Scanning electron microscopy, atomic force microscopy, Fourier transmission infrared spectroscopy and cyclic voltammetry techniques. The fabricated genosensor (BSA/pDNA/GO/SPE) is able to efficiently detect target cfb gene with a linear detection range of 10-12-10-7 M, lower detection limit of 10-12 M and sensitivity of 725.9 µA M-1 cm-2. The biosensing ability of developed genosenor is also investigated in artificial serum sample and the obtained results are found within acceptable percentage relative standard deviation (%RSD), indicating its application in detecting neonatal sepsis in serum samples.

The online version contains supplementary material available at 10.1007/s12088-024-01348-w.

Neonatal sepsis is a significant cause of morbidity and mortality in low- income countries. Neonatal sepsis is classified as early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS). Etiologies responsible for EONS are mostly acquired vertically from the mother during or before birth with the possibility of prevention. The burden and etiology of neonatal sepsis is not uniform across the globe with huge disparities based on the income level of the countries. This study aimed to determine neonatal sepsis trends, prevalence, and etiologies at Hawassa University Comprehensive Specialised Hospital (HUCSH).

A hospital-based retrospective cross-sectional study was conducted among newborns aged 0 to 90 days who were admitted to the HUCSH from January 2019 to July 2023. Patient-related information and the culture results were obtained from HUCSH microbiology laboratory registration book. Data analysis was performed using SPSS version 25 software.

Out of 2364 newborns suspected of having sepsis, 56% (95% CI: 54-58%) had culture-confirmed sepsis. When excluding Coagulase Negative Staphylococcus (CONS), the prevalence of culture-confirmed neonatal sepsis was 36.9%. The highest numbers of culture-confirmed cases was observed in 2021. The predominant bacteria identified were Coagulase Negative Staphylococcus (CONS) (34.1%), Klebsiella pneumoniae (12.9%), and Enterococcus (10.6%). Among culture-confirmed neonatal sepsis, 59.9% and 40.1% of cases were EONS and LONS, respectively. Coagulase Negative Staphylococcus and Enterococcus were the major bacteria found in both EONS and LONS while. Klebsiella pneumoniae was the second most common bacteria among newborns with EONS following CONS.

The prevalence of culture-confirmed neonatal sepsis was relatively high in the study area. Early-onset neonatal sepsis was consistently more prevalent than LONS. The predominant etiologies of neonatal sepsis excluding CONS were K. pneumoniae, Enterococcus, Enterobacter agglomerans, Acinetobacter species, and Staphylococcus aureus. Among newborns with EONS, the predominant bacteria were K. pneumoniae, Enterococcus, Enterobacter agglomerans, and Acinetobacter species.

Early-onset sepsis (EOS) is a serious, grave, and frequently fatal condition in premature infants. This study aimed to assess the diagnostic value of interleukin-6 (IL-6) levels in umbilical cord blood for identifying EOS in preterm infants.

This prospective cohort study was conducted on preterm infants between May 2019 and April 2021. Based on the diagnostic criteria for EOS, the participants were divided into EOS and non-EOS groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of cord blood IL-6 levels for EOS.

The levels of IL-6 were significantly higher in the EOS group (n = 10) compared to the non-EOS group (n = 178) [617.5 pg/mL (323.3, 1579.8) vs. 49.7 pg/mL (15.8, 142.8), respectively; p = 0.000]. ROC curve analysis demonstrated that a cutoff value of 250.5 pg/mL for cord blood IL-6 yielded a sensitivity of 90%, specificity of 82%, and area under the curve of 0.876, with a confidence interval of 0.753-0.999, indicating its high accuracy as a diagnostic marker for EOS among preterm infants (p < 0.001).

The detection of IL-6 in the umbilical cord blood offers convenience and exhibits significant diagnostic potential for EOS in preterm infants, thereby providing valuable support for clinical decision-making.

Early-onset sepsis (EOS) remains a significant cause of morbidity and mortality in neonates worldwide, particularly in low-income countries. Identification of causative bacterial pathogens and assessment of their antimicrobial susceptibility are essential for guiding appropriate therapy and improving outcomes. The aim of this study was to determine the incidence, bacteriological profile and antibiotic susceptibility patterns of culture-positive EOS among a cohort of neonates in the Occupied Palestinian Territories (oPt).

This retrospective observational study was conducted on neonates with proven positive blood cultures or positive cerebrospinal fluid (CSF) admitted to eight neonatal intensive care units (NICU) in the West Bank, oPt between January 2017 and December 2019. Data on microbiology laboratory blood cultures were retrieved from NICU registers and medical records were reviewed to obtain data on mothers and neonates.

Among the 95,319 neonates admitted to the eight NICUs during the study period, we detected 292 neonates with culture-proven EOS, resulting in an incidence rate of 3 per 1000 live births. The most common gram-positive bacteria identified among neonates were α hemolytic streptococcus (11.6%), CoNS (11.3%), and GBS (8.6%). E. coli (15.1%) and Klebsiella spp. (15.1%) were the most common gram-negative bacteria, followed by Acinetobacter (7.9%). Findings revealed gram-positive organisms were resistant to ciprofloxacin (57.1%) and highly sensitive to vancomycin (97.9%), meropenem (89.2%), amikacin (82.6%) and Piperacillin-Tazobactam (82.4%). Gram-negative organisms showed the highest antibiotic resistance to ampicillin (87.2%), cetofaxime, and highest sensitivity to meropenem (82.0%), Piperacillin-Tazobactam (70.7%), and amikacin (66.4%).

Our findings underscore the importance of continuous surveillance of bacterial pathogens and their antimicrobial susceptibility patterns in the management of EOS among neonates in Palestinian hospitals. The findings generated will guide clinicians in selecting appropriate empirical therapies and facilitating early and targeted interventions. Future research should focus on strategies to enhance infection prevention and control measures in Palestinian neonatal care unites to mitigate the burden of EOS and antimicrobial resistance.

Vaginal colonization by pathogenic bacteria increases the risk of bacterial infections such as sepsis, which is associated with high neonatal mortality. More than half a million newborn deaths occur globally each year due to infections that lead to sepsis. However, the problem is worsening in Ethiopia the evidence of vaginal colonization and vertical transmission is scarce.

A healthcare facility-based cross-sectional study was conducted in Dessie town from April 1 to June 30, 2023, among 348 pregnant women and their newborns. Socio-demographic, clinical, and related data were collected using a pre-tested semi-structured questionnaire. Vaginal swab samples from pregnant women and pooled external ear, nasal area, and umbilical swab samples from the newborns were collected and transported using Amies transport media. Samples were inoculated into blood agar, Todd Hewitt selective enrichment broth, and MacConkey agar for bacterial isolation, and Sabouraud Dextrose Agar and CHROM Agar for Candida species isolation. The antimicrobial susceptibility was performed on isolates using the Kirby-Bauer disc diffusion technique. Data was analyzed by SPSS version 25.0. Logistic regression model was used to identify the associated factors. Finally, variables with p < 0.05 and their 95% confidence interval were considered statistically significant.

A total of 348 pregnant women attending vaginal delivery were included in the study. The maternal colonization and vertical transmission rates were 55.5% (193/348) and 53.9% (104/348), respectively. The most frequent potential pathogen among pregnant women was Escherichia coli (27.6%), followed by Candida spp. (14.1%), and Klebsiella spp. (6%). Similarly, the predominant isolates in the newborns were E. coli (16.4%), Candida spp. (6.3%), and Klebsiella spp. (3.6%). The overall multidrug resistance levels of potential pathogens were 37.3%. Living with domestic animals (p = 0.001), having premature rupture of membrane (p = 0.010) and history of urinary tract infection (p = 0.013) were significantly associated with maternal colonization. Potential pathogen colonization newborn was significantly associated with duration of labor (p = 0.024) and low birth weight (p < 0.001).

The finding of the present study revealed that vaginal colonization and vertical transmissions of potential pathogens and their antimicrobial resistance is still a significant problem. This alarms the urgency of evidence based-intervention to improve maternal and neonatal health.

Healthcare-associated infections (HAI) are a leading contributor to morbidity and mortality in hospitalised neonates. Diagnosing neonatal HAI is challenging owing to non-specific symptoms and lack of definitive diagnostic markers, contributing to high rates of inappropriate antibiotic use. This study evaluated the theoretical impact of implementing a bedside tool for decision-making on antibiotic length of therapy (LOT).

This prospective observational physician-blinded study consecutively enrolled patients with suspected HAI events at a large South African neonatal unit from September 2022 to September 2023. The antibiotic decision-making tool included an infection prediction score (NeoHoP), and a point-of-care C-reactive protein test (CRP) performed at HAI diagnosis and 24 h later. The theoretical impact of the tool on antibiotic LOT was calculated.

We recruited 180 neonates with 214 episodes of suspected HAI, of which 22 (10.3%) were proven HAI, 56 (26.2%) were presumed HAI and 136 (63.6%) had HAI ruled out. The median observed antibiotic LOT was three days (9 days for proven HAI, 7 days for presumed HAI, and 3 days for no HAI). The antibiotic decision-making tool would theoretically reduce overall antibiotic LOT by 2 days (p < 0.001), particularly in neonates where HAI was subsequently excluded.

We developed an antibiotic decision-making tool to support the clinical evaluation of suspected neonatal HAI and demonstrated a significant potential impact on reducing antibiotic LOT. Given increasing antibiotic resistance rates globally, this tool should be further evaluated to minimise unnecessary antibiotic use in hospitalised neonates.

The global evolution of pathogens causing early-onset sepsis (EOS), a critical condition in preterm infants, necessitates a re-evaluation of risk factors to develop updated prevention and treatment strategies. This nationwide case-control study in Taiwan analyzed data from the National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database from 2010 to 2019. The study included 176,681 mother-child pairs with preterm births. We identified 2942 clinical EOS cases from 5535 diagnosed sepsis cases, excluding unlikely cases. A control group of 14,710 preterm neonates without EOS was selected at a 1:5 ratio. Clinical EOS increased since 2017. Adjusted logistic regression identified significant EOS risk factors in preterm infants, including maternal fever, chorioamnionitis, maternal diabetes mellitus, maternal antibiotic usage, very preterm birth, birth weight (all with p < 0.001), maternal pneumonia (p = 0.002), and maternal CS (p = 0.004). Effective treatment of maternal conditions like diabetes, fever, and infections is essential to prevent EOS in preterm infants. Key measures include reducing unnecessary antibiotics or steroids, minimizing unnecessary cesarean sections, avoiding premature or prolonged rupture of membranes (PPROM), and increasing gestational age and neonatal birth weight. High-risk preterm neonates should be closely monitored for EOS and considered for antibiotics when warranted.

To determine the threshold of umbilical cord blood procalcitonin for early-onset neonatal infection diagnosis.

This prospective study was conducted on 126 neonates in the neonatal care unit of Hue University of Medicine and Pharmacy Hospital, Vietnam, from June 01, 2023 to August 31, 2024. All neonates showed signs at birth or risk factors for early-onset infection (EOI) and were divided into two groups: EOI group and non-EOI group. Umbilical cord blood samples were collected for procalcitonin analysis immediately after birth.

The median procalcitonin (PCT) levels in umbilical cord blood were significantly higher in the EOI group (0.154 ng/ml [0.092-0.197]) compared to the non-EOI group (0.097 ng/ml [0.082-0.134]; p < 0.001). Receiver operating characteristic (ROC) curve determined the optimal threshold value of PCT of 0.142 ng/ml with an AUC 0.751 (95% CI: 0.661-0.841, p<0.001) in the total population. At this cut-off, the Se, Sp, PPV, and NPV were 68.2%, 76.8%, 61.2%, and 81.8%, respectively. The optimal cut-off value for preterm neonates was 0.122 ng/ml (AUC: 0.785, 95% CI: 0.658-0.911, p<0.001) corresponding a Se of 79.2%, Sp of 74.1%, PPV of 73.1%, and NPV of 80.0%. In term group, the optimal cut-off value was 0.150 ng/ml (AUC: 0.726, 95% CI: 0.583-0.860, p<0.01), with a Se of 60.0%, Sp of 80.4%, PPV of 52.2%, and NPV of 84.9%.

Umbilical cord blood PCT concentration were elevated in neonates with EOI. PCT could be a valuable marker for the early diagnosis of EOI.

Early-onset sepsis in neonates is a potentially catastrophic condition that demands prompt management. However, laboratory diagnosis via cerebral spinal fluid and blood tests is often inconclusive, so diagnosis on the basis of clinical symptoms and risk factors is frequently required, and the majority of neonates treated with antibiotics for presumed early-onset sepsis (PEOS) do not have culture-proven sepsis. The management of such PEOS is mainly achieved via antibiotic therapy, which itself has adverse effects, creating a dilemma for clinicians in optimising healthcare. This study aimed to assess the impact of PEOS management on the common neonatal concerns of feeding tolerance, hyperbilirubinaemia, weight gain, and length of stay (LoS) in moderate to late preterm infants.

A single-site, matched-cohort, retrospective study was performed on infants born between 32+3 and 36+6 weeks (2016 to 2019) admitted to the Neonatal Unit. PEOS infants on antibiotics (PEOS) were strictly matched by gestational age (±1 day) and birthweight (±5%) against a non-PEOS reference group (NPEOS). The key outcomes included the following: enteral feeding commencement and achievement; feeding intolerance (FI); phototherapy commencement and duration; antibiotic therapy duration; maximum bilirubin (MaxBili); LoS; and net postbirth weight gain.

There were no cases of culture-proven early-onset sepsis. PEOS (n = 185): NPEOS (n = 185) via multivariable analysis showed delayed enteral feed commencement (adjusted Odds Ratio [aOR]: 2.75; 95% confidence interval [CI]: 2.32, 3.27); there was no difference in FI, delayed onset of peak jaundice (aOR: 1.24; 95%CI: 1.12, 1.37), increased duration of phototherapy (aOR: 1.24; 95%CI: 1.10, 1.41), and increased LoS (aOR: 1.31; 95%CI; 1.02, 1.67). A univariate analysis also showed the following results (PEOS: NPEOS): no significant difference in MaxBili and delayed full enteral feed achievement (p = 0.010). Univariant or multivariable analysis showed no difference in irradiance levels. However, for NPEOS infants undergoing 0 or 1 phototherapy light treatment, there was an increased irradiance for PEOS (<0.001, 0.037, respectively).

In moderate to late preterm infants, while PEOS diagnosis and management resolve the negative health impacts of potential sepsis, they are associated with negative healthcare outcomes on feeding, jaundice, and hospital length of stay.

The aim of this study is to investigate the utility of interleukin-6 (IL-6) in the early diagnosis of serious bacterial infections (SBI) in febrile infants and to compare it with C-reactive protein (CRP).

Retrospective study conducted in the paediatric emergency department in Gothenburg, Sweden, on previously healthy, full-term infants aged ≤60 days with fever without a source (FWS) from 2014 to 2017.

We included 536 infants with FWS, of whom IL-6 was analysed in 364 (68%) and CRP was analysed in 494 (92%). Approximately 70% of the infants presented with a fever duration of less than 12 h. The prevalence of SBIs was 14.8% (95% CI,11.3-18.9) in the IL-6 group and 17.8% (95% CI,14.5-21.5) in the CRP group. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of IL-6 ≥50 ng/L were 93%, 66%, 98% and 33%, respectively. For CRP ≥20 mg/L, the sensitivity, specificity, NPV, and PPV were 76%, 89%, 95%, and 55%, respectively. Logistic regression analysis showed that CRP was significantly associated with SBI (p < 0.0001) in the entire population, whereas IL-6 was not.

Interleukin-6 showed high sensitivity and NPV, which might assist in identifying SBIs early in febrile infants. However, IL-6 was not shown to be superior to CRP and further studies are needed to investigate whether IL-6 should be incorporated in clinical management.

Neonatal sepsis is a major cause of neonatal mortality worldwide. It remains a detrimental bottleneck to the WHO goal of eradicating preventable deaths for children below 5 years of age by 2030. Though the risk factors for adverse clinical outcomes for neonatal sepsis have been widely studied there is no universal consensus. Length of hospitalization is considered an indicator for adverse clinical outcome of neonatal sepsis. Markedly, literature is scarce regarding the drivers of extended hospitalization for neonatal sepsis in Kenya.

This study determined the predictors of prolonged hospital stay for neonatal sepsis at the pediatric wards, KNH, Kenya. This was prospective cross-sectional research carried out among 314 mother/neonate pairs. The neonates were confirmed to have sepsis. Logistic regression analysis was conducted to determine maternal and neonate status predictive of duration of hospitalization.

The median duration of hospital stay was 11 days and the majority (52.9%) were hospitalized for more than 11 days. The findings identified that maternal age ≥ 35 years (OR = 3.72, 95% CI: 1.61-8.59, p = 0.03), UTI during pregnancy (OR = 1.82, 95% CI: 1.07-3.11, p = 0.03), not breastfeeding (OR = 2.31, 95% CI: 1.29-4.14, p = 0.005), convulsion (OR = 2.03, 95% CI: 1.22-3.37, p = 0.01), jaundice (OR = 1.45, 95% CI: 1.10-1.91, p = 0.002), reduced movements (OR = 1.72, 95% CI: 1.08-2.72, p = 0.02), low birthweight (OR = 6.1, 95% CI: 2.48-14.99, p < 0.001) and preterm birth (OR = 3.1, 95% CI: 1.64-5.86, p < 0.001) were significant predictors of longer hospital stay.

The findings provide insights into the factors that can be monitored to predict the prognosis of neonatal sepsis. Besides, remedies can target these variables to mitigate prolonged hospitalization and severity of neonatal sepsis.

Early biomarkers are needed to improve diagnosis and support antibiotic stewardship in neonatal sepsis. Heart rate variability (HRV) is proposed as such a biomarker. However, there is a lack of studies in term newborns. Infusion of lipopolysaccharide (LPS) from Escherichia coli induces systemic inflammation comparable to sepsis in newborns. We aimed to study the effect of systemic LPS induced inflammation on HRV in term newborn piglets.

Baseline HRV was recorded for 1 h. This control period was compared to the hourly HRV for each piglet (n = 9) during 4 h of LPS infusion. For comparison, we used a mixed-effects regression model.

Systemic inflammation induced by LPS was found to reduce HRV. Compared to baseline, most measures of HRV decreased to lower values compared to baseline at 2 h, 3 h, and 4 h after initiation of LPS infusion. Heart rate (HR) was increased at 2 h, 3 h, and 4 h. When adjusting for HR in the mixed-effects regression model all reductions in HRV were explained by the increase in HR.

Reduced HRV may be an early biomarker of neonatal sepsis. However, an increase in HR alone could be an already available, more accessible, and interpretable biomarker of sepsis in term neonates.

In a term newborn piglet model, systemic inflammation induced by lipopolysaccharide from Escherichia coli reduced heart rate variability measures and increased heart rate. All reductions in heart rate variability were mediated by heart rate. While heart rate variability may be a biomarker of sepsis in term newborns, changes in heart rate alone could be a more readily available biomarker.

We report 72 metagenome-assembled genomes (MAGs) of Escherichia coli recovered from the vaginal microbiomes of pregnant women. The MAGs have an estimated median genome size of 5.1 Mb (IQR 4.9-5.3). The average number of unique genes identified per genome was 3,330 genes (IQR 3,356-3,501), with a mean of 1,708 per genome being annotated.

Neonatal illness severity scores are not extensively studied for their ability to predict mortality or morbidity in preterm infants. The aim of this study was to compare the Neonatal Sequential Organ Failure Assessment (nSOFA), Clinical Risk Index for Babies-II (CRIB-II), and Score for Neonatal Acute Physiology with Perinatal extension-II (SNAPPE-II) for predicting mortality and short-term morbidities in preterm infants ≤32 weeks.

In this retrospective study, infants born in 2017-2018 with gestational age (GA) ≤32 weeks were evaluated. nSOFA, CRIB-II, and SNAPPE-II scores were calculated for each patient, and the ability of these scores to predict mortality and morbidities was compared. The morbidities were categorized as mod/sev bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) requiring surgery, early-onset sepsis (EOS), late-onset sepsis (LOS), retinopathy of prematurity (ROP) requiring treatment, and severe intraventricular hemorrhage (IVH). Calculating the area under the curve (AUC) on receiver operating characteristic curves (ROC) analysis to predict and compare scoring systems' accuracy.

A total of 759 preterm infants were enrolled, of whom 88 deceased. The median nSOFA, CRIB-II, and SNAPPE-II scores were 2 (0, 3), 6 (4, 8), and 13 (5, 26), respectively. Compared with infants who survived, these three scores were significantly higher in those who deceased (p < 0.05). For predicting mortality, the AUC of the nSOFA, SNAPPE-II, and CRIB-II were 0.90, 0.82, and 0.79, respectively. The nSOFA scoring system had significantly higher AUC than CRIB-II and SNAPPE-II (p < 0.05). However, short-term morbidities were not strongly correlated with these three scoring systems.

In infants ≤32 weeks gestation, nSOFA scoring system is more valuable in predicting mortality than SNAPPE-II and CRIB-II. However, further studies are required to assess the predictive power of neonatal illness severity scores for morbidity.

Neonatal sepsis is a deadly disease with non-specific clinical signs, delaying diagnosis and treatment. There remains a need for early biomarkers to facilitate timely intervention. Our objective was to identify neonatal sepsis gene expression biomarkers that could predict sepsis at birth, prior to clinical presentation.

Among 720 initially healthy full-term neonates in two hospitals (The Gambia, West Africa), we identified 21 newborns who were later hospitalized for sepsis in the first 28 days of life, split into early-onset sepsis (EOS, onset ≤7 days of life) and late-onset sepsis (LOS, onset 8-28 days of life), 12 neonates later hospitalized for localized infection without evidence of systemic involvement, and 33 matched control neonates who remained healthy. RNA-seq was performed on peripheral blood collected at birth when all neonates were healthy and also within the first week of life to identify differentially expressed genes (DEGs). Machine learning methods (sPLS-DA, LASSO) identified genes expressed at birth that predicted onset of neonatal sepsis at a later time.

Neonates who later developed EOS already had ∼1000 DEGs at birth when compared to control neonates or those who later developed a localized infection or LOS. Based on these DEGs, a 4-gene signature (HSPH1, BORA, NCAPG2, PRIM1) for predicting EOS at birth was developed (training AUC = 0.94, sensitivity = 0.93, specificity = 0.92) and validated in an external cohort (validation AUC = 0.72, sensitivity = 0.83, and specificity = 0.83). Additionally, during the first week of life, EOS disrupted expression of >1800 genes including those influencing immune and metabolic transitions observed in healthy controls.

Despite appearing healthy at birth, neonates who later developed EOS already had distinct whole blood gene expression changes at birth, which enabled the development of a 4-gene predictive signature for EOS. This could facilitate early recognition and treatment of neonatal sepsis, potentially mitigating its long-term sequelae.

CIHR and NIH/NIAID.

Introduction Neonatal sepsis is defined as a systemic illness caused by bacteria, viruses, or fungi, characterized by hemodynamic abnormalities and clinical findings that result in morbidity and mortality. Neonatal morbidity and mortality are significantly influenced by neonatal sepsis. Causative pathogens and antimicrobial sensitivity profiles have changed over time, with significant geographic variation. Aim To determine the characteristics and associated risk factors of sepsis among neonates admitted into neonatal intensive care units (NICU) in Maternity and Children Hospital, AlAhsa, Saudi Arabia. Methodology An institution-based retrospective cross-sectional study was conducted among neonates who were admitted to the neonatal intensive care unit from January 2022 to December 2023 at the Maternity and Children Hospital, AlAhsa, Saudi Arabia. All neonates born with clinically diagnosed sepsis and positive culture were included in this study. Results This study included 134 neonates with a culture-proven diagnosis of neonatal sepsis during the study period. There were 23 (17.2%) cases of early-onset sepsis (EOS) and 111 (82.8%) cases of late-onset sepsis (LOS). Compared to late-onset sepsis (18.8%), Pseudomonas aeruginosa is more common in early-onset sepsis (33.3%). In cases of early-onset sepsis, Escherichia coli is isolated more often (33.3%) than in cases of late-onset (9.4%). Neonatal sepsis mortality is higher in LOS (25 [22.5%]) than in EOS (3 [13%]). Neonates with extremely preterm birth weight, gram-negative sepsis, and thrombocytopenia have a significantly higher mortality rate (p=<0.05). Conclusion In order to lower the risk among newborns, policymakers and/or managers will benefit from the information provided by the assessment of the prevalence, clinical outcomes, and risk factors for neonatal sepsis. Furthermore, developing hospital-based care strategies requires an understanding of the microorganisms that cause infections among neonates.

Streptococcus gallolyticus subspecies pasteurianus (SGSP) is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings. Hence, we present a case of SGSP-induced infant meningitis and sepsis, accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus (MRSA), providing insights into the identification, management, and prognosis of this bacterial infection.

A 45-day-old female infant presented with two episodes of high fever (maximum temperature: 39.5 °C) and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms. Postadmission, the patient's C-reactive protein level was 40.73 mg/L, white blood cell count was 13.42 × 109/L, neutrophil ratio was 78.4%, procalcitonin level was 7.89 μg/L, cerebrospinal fluid (CSF) white cell count was 36 × 106/L, multinucleated cell ratio was 95.2%, and protein concentration was 0.41 g/L. Blood and CSF culture revealed that the pathogen was SGSP. The bacterium was sensitive to ampicillin, furazolidone, penicillin, lincomycin, moxifloxacin, rifampicin, vancomycin, and levofloxacin but resistant to clindamycin and tetracycline. Sputum culture revealed the presence of MRSA, which was sensitive to vancomycin. The patient was diagnosed with meningitis and sepsis caused by SGSP, accompanied by bronchopneumonia induced by MRSA. Ceftriaxone (100 mg/kg/d) combined with vancomycin (10 mg/kg/dose, q6h) was given as an anti-infective treatment postadmission. After 12 days of treatment, the infant was discharged from the hospital with normal CSF, blood culture, and routine blood test results, and no complications, such as subdural effusion, were observed on cranial computed tomography. No growth retardation or neurological sequelae occurred during follow-up.

SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures, and a sensitive antibiotic therapy to ensure a favorable prognosis.

The objective is to study to what extent the development of retinopathy of prematurity (ROP) is associated with assisted conception (AC) and in vitro fertilization (IVF) in a tertiary referral hospital.

This study is a retrospective observational cohort study. Very-low-birth weight (VLBW) infants with gestational age (GA) <32 weeks or birth weight <1500 g were admitted to the neonatal unit of a tertiary care hospital between January 1, 2011, and December 31, 2021. The study determined the degree of ROP developed according to the type of fertilization used for conception. Main outcome measures were ROP prevalence in pregnancies obtained after IVF/intracytoplasmic sperm injection (ICSI) in the period from January 1, 2011, to December 31, 2021, in a tertiary hospital.

Of the 408 infants included in the study sample, 105 (25.7%) were born following AC and 12.4% of these developed ROP. In our sample, the practice of IVF was not associated with an increase in the incidence of VLBW infants (R2 = 0.12; P = .29).

Conception achieved via AC or IVF is not significantly associated with ROP in any degree of severity.

Sepsis is a complex clinical syndrome characterized by a heterogenous host immune response. Historically, static protein and transcriptomic metrics have been employed to describe the underlying biology. Here, we tested the hypothesis that ex vivo functional TNF expression as well as an immunologic endotype based on both IFNγ and TNF expression could be used to model clinical outcomes in sepsis patients.

This prospective, observational study of patient samples collected from the SPIES consortium included patients at five health systems enrolled over 17 months, with 46 healthy control patients, 68 ICU patients without sepsis, and 107 ICU patients with sepsis. Whole blood was collected on day 1, 4, and 7 of ICU admission. Outcomes included in-hospital and 180-day mortality and non-favorable discharge disposition defined by skilled nursing facility, long-term acute care facility, or hospice. Whole blood ELISpot assays were conducted to quantify TNF expression [stimulated by lipopolysaccharide (LPS)] and IFNγ expression (stimulated by anti-CD3/CD28 mAb), which were then used for assignment to one of four subgroups including an 'immunocompetent', 'immunosuppressed endotype', and two 'mixed' endotypes.

Whole blood TNF spot-forming units were significantly increased in septic and CINS patients on days 4 and 7 compared to healthy subjects. In contrast, TNF expression per cell on days 1, 4, and 7 was significantly lower in both septic and critically ill non-septic (CINS) patients compared to healthy subjects. Early increases in total TNF expression were associated with favorable discharge disposition and lower in-hospital mortality. 'Immunocompetent' endotype patients on day 1 had a higher proportion of favorable to non-favorable discharges compared to the 'immunosuppressed' endotype. Similarly, 'immunocompetent' endotype patients on day 4 had a higher in-hospital survival compared to the 'immunosuppressed' endotype patients. Finally, among septic patients, decreased total TNF and IFNγ expression were associated with 180-day mortality.

Increased ex vivo whole blood TNF expression is associated with improved clinical outcomes. Further, the early 'immunocompetent' endotype is associated with favorable discharge and improved in-hospital and 180-day survival. The ability to functionally stratify septic patients based on blood cell function ex vivo may allow for identification of future immune modulating therapies.