Nutritional Management and the Multisystem Organ Failure/systemic Inflammatory Response Syndrome in Critically Ill Preterm Neonates

Adan, Dante; Gamma, Edmund F. La; Browne, Lyle E.

doi:10.1016/s0749-0704(18)30063-0

Cited by 32 publications

(12 citation statements)

References 114 publications

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“…The failure to identify a change in the hematocrit is likely a result of our practice of administering booster-packed red-cell transfusions to all oxygen requiring ventilated patients to maintain their hematocrits at or approximately 40%. 40,41 Although, the changes in the absolute monocyte and lymphocyte counts were statistically significant at the 7-to 10-day point, they always remained within the range of published normal values. 36 No adverse effects could be attributed to these unintended study drug responses.…”

Section: Discussionmentioning

confidence: 72%

“…2,4,5,14,15 Although a good reason for cautious optimism, current thinking suggests that reperfusion injury (after hypoxia or reduced blood flow or both) may involve a significant activation of macrophages and local invasion of peripheral blood neutrophils, that could be detrimental to recovery. 40,44 Thus, it is conceivable that bronchopulmonary dysplasia, NEC, retinopathy of prematurity, or even intraventricular hemorrhage may be considerably worsened by adjunctive treatment with this drug.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Human Granulocyte Colony-stimulating Factor May Improve Outcome Attributable to Neonatal Sepsis Complicated by Neutropenia

Kocherlakota

Gamma

1997

Pediatrics

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ABSTRACT. Objectives. To determine whether adjunctive therapy with recombinant human granulocyte colony-stimulating factor (rhG-CSF) could reverse sepsis-associated neonatal neutropenia and improve neonatal survival compared with conventional therapy in a phase I/II-type trial.Study Design. An intravenous infusion of rhG-CSF (10 g/kg/d ؋ 3 d) was administered to 14 septic neutropenic neonates. Neutrophilic responses and outcome of these neonates were compared with 11 concurrently treated, retrospectively selected, case-matched control septic patients identified by using a search of medical records coded for sepsis with neutropenia ( 24 hours).Results. Seven neonates with early-onset sepsis with neutropenia at birth and seven neonates with late-onset sepsis plus neutropenia (all with necrotizing enterocolitis) were entered in the rhG-CSF treatment group. Results were compared with a conventional therapy control group (five early onset, six late onset). No significant differences existed in the birth weight, gestational age, use of antibiotic therapy, magnitude of respiratory support, severity of metabolic acidosis, use of vasopressors, or other supportive therapy between the two groups. In the rhG-CSF-treated group and in the conventionally treated control group, the absolute neutrophil count (ANC) (mean ؎ SEM) was 585 ؎ 138 and 438 ؎ 152, respectively. The ANC increased to more than baseline in the rhG-CSF-treated group by 10-fold versus 2-fold at 24 hours, 18-fold versus 4-fold at 48 hours, 24-fold versus 5-fold at 72 hours (significant by one-way analysis of variance in the rhG-CSF group only), and 29-fold versus 16-fold at 7 to 10 days when compared with the conventional therapy group. There were no nonresponders in the rhG-CSF group by 24 hours after the first dose of study drug. Monocyte cell counts also increased significantly in both groups by 7 days after entry into this protocol but remained within normal range for age. No clinically significant effect on lymphocytes, erythrocytes, or platelet counts was noted. Thirteen patients in the rhG-CSF-treated group (92%; 13 out of 14) and five in the conventionally treated group (55%; 5 out of 11) survived to 28 days after the onset of the signs of sepsis. No adverse effects were noted in the rhG-CSF-treated group.Conclusions. rhG-CSF can increase the neutrophil count in critically ill septic neutropenic neonates. This finding suggests that rhG-CSF may be effective in a therapeutically useful time frame to treat septic neonates with neonatal neutropenia attributable to bone marrow suppression or neutrophil consumption. Future randomized trials are needed to validate the beneficial effects of rhG-CSF and to determine whether any significant side effects of therapy exist. Pediatrics 1997;100(1). URL: http: //www.pediatrics.org/cgi/content/full/100/1/e6; neonatal sepsis, recombinant human granulocyte colony stimulating factor, bacteremia, cytokines, very low birth weight, neutropenia.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Human Granulocyte Colony-stimulating Factor May Improve Outcome Attributable to Neonatal Sepsis Complicated by Neutropenia

Kocherlakota

Gamma

1997

Pediatrics

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“…All patients were managed according to predefined NICU ventilator, fluid and electrolyte management, and feeding protocols [27][28][29] and no prospective decisions were influenced or made based upon observed NIRS results. NaHCO 3 correction practices NaHCO 3 corrections were provided as a component of routine care as decided by the NICU clinical team using unit-specific policies.…”

Section: Neonatal Intensive Care Unit (Nicu) Carementioning

confidence: 99%

Effects of sodium bicarbonate correction of metabolic acidosis on regional tissue oxygenation in very low birth weight neonates

et al. 2015

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NaHCO3 infusions decreased base deficits and increased pH though produced no discernible effects or benefits on cardiopulmonary parameters including rSO2 and FTOE. These findings warrant further prospective evaluation in larger populations with more significant metabolic acidosis to determine the utility of tissue oxygenation monitoring in differentiating metabolic acidosis due to oxygen delivery/consumption imbalance versus renal bicarbonate losses.

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“…Throughout the study period, medical care was rendered under the direction of an attending neonatologist according to predefined respiratory, fluid and electrolyte, and feeding protocols [23][24][25]. NIRS values were shielded from view by maintaining the Vital Sync monitor in "sleep" mode; nursing staff were instructed to return the monitor to "sleep" following any data entry.…”

Section: Nicu Carementioning

confidence: 99%

Quiescent variability of cerebral, renal, and splanchnic regional tissue oxygenation in very low birth weight neonates

Mintzer

Parvez

Chelala

et al. 2014

Journal of Neonatal-Perinatal Medicine

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OBJECTIVE: In extremely premature neonates, data concerning the normal baseline variability of near-infrared spectroscopy (NIRS)-derived regional oxygen saturation (rSO 2 ) are lacking. We sought to determine: 1) the quiescent variability of cerebral, renal, and splanchnic rSO 2 in clinically stable, undisturbed very low birth weight neonates and 2) the effects of different data averaging epochs on site-specific variability. STUDY DESIGN: In this prospective, observational study, neonates between 500 and 1250 g underwent seven days of continuous, real-time cerebral, renal, and splanchnic NIRS monitoring starting within the first seventy-two postnatal hours. Demographic, cardiopulmonary, bedside care, and rSO 2 data were collected. rSO 2 variability was analyzed utilizing data from quiescent periods identified using pre-specified stability criteria. Between-and within-monitoring site comparisons of data averaging methods were made utilizing ANOVA. RESULT: Twenty-four subjects (GA 27 ± 0.3 wk, birth weight 988 ± 34 g; mean ± SEM) were monitored. Coefficients of variation (CoVar = SD/mean) were calculated for each monitoring site using varied data averaging epochs. CoVar was lowest for cerebral, intermediate for renal, and highest for splanchnic rSO 2 (P < 0.01). For renal and splanchnic sites, shorter epochs (5-and 15-min) resulted in significantly smaller CoVars [P < 0.01 and P < 0.05, respectively]. Splanchnic variability was highly dependent on epoch length, ranging from 16% over 5 min to 23% over 60 min. CONCLUSION: 1) rSO 2 variability differs significantly between monitoring sites and 2) shorter data sampling epochs decrease rSO 2 variability. These observations may assist clinicians in operationally defining minimally significant departures to enable medical decision making utilizing this monitoring technique.

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Nutritional Management and the Multisystem Organ Failure/systemic Inflammatory Response Syndrome in Critically Ill Preterm Neonates

Cited by 32 publications

References 114 publications

Human Granulocyte Colony-stimulating Factor May Improve Outcome Attributable to Neonatal Sepsis Complicated by Neutropenia

Human Granulocyte Colony-stimulating Factor May Improve Outcome Attributable to Neonatal Sepsis Complicated by Neutropenia

Effects of sodium bicarbonate correction of metabolic acidosis on regional tissue oxygenation in very low birth weight neonates

Quiescent variability of cerebral, renal, and splanchnic regional tissue oxygenation in very low birth weight neonates

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