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Article ; Online: Game changer or gimmick: inflammatory markers to guide antibiotic treatment decisions in neonatal early-onset sepsis.

Stocker, Martin / Giannoni, Eric

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

2023 Volume 30, Issue 1, Page(s) 22–27

Abstract: Background: The diagnosis of neonatal early-onset sepsis (EOS) is challenging, and inflammatory markers are widely used to guide decision-making and therapies.: Objectives: This narrative review presents the current state of knowledge regarding the ... ...

Abstract	Background: The diagnosis of neonatal early-onset sepsis (EOS) is challenging, and inflammatory markers are widely used to guide decision-making and therapies. Objectives: This narrative review presents the current state of knowledge regarding the diagnostic value and potential pitfalls in the interpretation of inflammatory markers for EOS. Sources: PubMed until October 2022 and searched references in identified articles using the search terms: neonatal EOS, biomarker or inflammatory marker, and antibiotic therapy or antibiotic stewardship. Content: In situations with a high or low probability of sepsis, the measurements of inflammatory markers have no impact on the decision to start or stop antibiotics and are just gimmick, whereas they may be a game changer for neonates with intermediate risk and therefore an unclear situation. There is no single or combination of inflammatory markers that can predict EOS with high probability, allowing us to make decisions regarding the start of antibiotics based only on inflammatory markers. The main reason for the limited accuracy is most probably the numerous noninfectious conditions that influence the levels of inflammatory markers. However, there is evidence that C-reactive protein and procalcitonin have good negative predictive accuracy to rule out sepsis within 24 to 48 hours. Nevertheless, several publications have reported more investigations and prolonged antibiotic treatments with the use of inflammatory markers. Given the limitations of current strategies, using an algorithm with only moderate diagnostic accuracy may have a positive impact, as reported for the EOS calculator and the NeoPInS algorithm. Implications: As the decision regarding the start of antibiotic therapy is different from the process of stopping antibiotics, the accuracy of inflammatory markers needs to be evaluated separately. Novel machine learning-based algorithms are required to improve accuracy in the diagnosis of EOS. In the future, inflammatory markers included in algorithms may be a game changer reducing bias and noise in the decision-making process.
MeSH term(s)	Infant, Newborn ; Humans ; Neonatal Sepsis/diagnosis ; Neonatal Sepsis/drug therapy ; Anti-Bacterial Agents/therapeutic use ; Sepsis/diagnosis ; Sepsis/drug therapy ; Biomarkers ; C-Reactive Protein/analysis
Chemical Substances	Anti-Bacterial Agents ; Biomarkers ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2023-03-05
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1328418-6
ISSN	1469-0691 ; 1470-9465 ; 1198-743X
ISSN (online)	1469-0691
ISSN	1470-9465 ; 1198-743X
DOI	10.1016/j.cmi.2023.02.021
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Article ; Online: Time to tackle early-onset sepsis in low-income and middle-income countries.

Schlapbach, Luregn J / Hagmann, Cornelia / Giannoni, Eric

The Lancet. Global health

2022 Volume 10, Issue 5, Page(s) e592–e593

MeSH term(s)	Developing Countries ; Humans ; Income ; Poverty ; Sepsis/epidemiology ; Sepsis/prevention & control
Language	English
Publishing date	2022-04-14
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	2723488-5
ISSN	2214-109X ; 2214-109X
ISSN (online)	2214-109X
ISSN	2214-109X
DOI	10.1016/S2214-109X(22)00086-9
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Article: Editorial: Sepsis in Neonates and Children.

Giannoni, Eric / Schlapbach, Luregn J

Frontiers in pediatrics

2020 Volume 8, Page(s) 621663

Language	English
Publishing date	2020-11-27
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2020.621663
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Article ; Online: Fetal Omphalocele: Review of Predictive Factors Important for Antenatal Counseling?

Rieder, Wawrzyniec / Maurer, Sabine Vasseur / Giannoni, Eric / Baud, David

Obstetrical & gynecological survey

2022 Volume 77, Issue 11, Page(s) 683–695

Abstract: Importance: Congenital omphalocele is among the most common antenatally diagnosed anomalies. As additional abnormalities are found in majority of cases, antenatal investigations target the search for additional structural anomalies and genetic disorders, ...

Abstract	Importance: Congenital omphalocele is among the most common antenatally diagnosed anomalies. As additional abnormalities are found in majority of cases, antenatal investigations target the search for additional structural anomalies and genetic disorders, including aneuploidy. Antenatal management focuses on the assessment of fetal well-being. Unfortunately, antenatal prediction of postnatal and long-term outcomes represents 2 less well-documented but crucial facets of this pathology. A large part of the prognosis relies on aspects that are difficult to predict such as quality of life, neurological development, and autonomy, which cause significant anxiety in expectant parents. Objective: This article offers a comprehensive review of antenatal management of omphalocele with a specific focus on predictive factors and long-term outcomes. Evidence acquisition, results: We conducted an extensive literature review targeting management of fetal omphalocele. We had a specific interest in factors predictive of fetal and neonatal outcome as well as long-term consequences of omphalocele. Fetuses with large defects and those containing the liver are at higher risk of having a complicated postnatal course. Neonates may experience pulmonary hypoplasia, pulmonary hypertension, and gastroesophageal reflux. In selected cases, motor and cognitive delay may be present, but the overall life-long prognosis and quality of life is good. Conclusions and relevance: A multidisciplinary approach should be encouraged after the diagnosis of fetal omphalocele. In addition to clinical team experience, antenatal counseling should be based on objective and gestational age-dependent criteria and should include long-term outcomes.
MeSH term(s)	Infant, Newborn ; Female ; Pregnancy ; Humans ; Hernia, Umbilical/diagnosis ; Hernia, Umbilical/complications ; Hernia, Umbilical/genetics ; Ultrasonography, Prenatal ; Quality of Life ; Retrospective Studies ; Fetus ; Counseling
Language	English
Publishing date	2022-11-03
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	391345-4
ISSN	1533-9866 ; 0029-7828
ISSN (online)	1533-9866
ISSN	0029-7828
DOI	10.1097/OGX.0000000000001073
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Article: Serum Ascorbic Acid and Thiamine Concentrations in Sepsis: Secondary Analysis of the Swiss Pediatric Sepsis Study.

Equey, Lucile / Agyeman, Philipp K A / Veraguth, Rosemarie / Rezzi, Serge / Schlapbach, Luregn J / Giannoni, Eric

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2022 Volume 23, Issue 5, Page(s) 390–394

Abstract: Objectives: To determine circulating levels of ascorbic acid (VitC) and thiamine (VitB1) in neonates and children with blood culture-proven sepsis.: Design: Nested single-center study of neonates and children prospectively included in the Swiss ... ...

Abstract	Objectives: To determine circulating levels of ascorbic acid (VitC) and thiamine (VitB1) in neonates and children with blood culture-proven sepsis. Design: Nested single-center study of neonates and children prospectively included in the Swiss Pediatric Sepsis Study. Setting: One tertiary care academic hospital. Patients: Sixty-one neonates and children 0-16 years old. Interventions: None. Measurements and main results: VitC and VitB1 were quantified in serum of patients (median age, 10.5 mo; interquartile range [IQR], 0.5-62.1 mo) with blood culture-proven sepsis. Median time between sepsis onset and sampling for measurement of vitamins was 3 days (IQR, 2-4 d). Median serum levels of VitC and VitB1 were 32.4 μmol/L (18.9-53.3 μmol/L) and 22.5 nmol/L (12.6-82 nmol/L); 36% of the patients (22/61) had low VitC and 10% (6/61) had VitC deficiency; and 72% (44/61) had low VitB1 and 13% (8/61) had VitB1 deficiency. Children with low VitC were older (p = 0.007) and had higher C-reactive protein (p = 0.004) compared with children with VitC within the normal range. Children with low VitB1 levels were older (p = 0.0009) and were less frequently receiving enteral or parenteral vitamin supplementation (p = 0.0000003) compared with children with normal VitB1 levels. Conclusions: In this cohort of newborns and children with sepsis, low and deficient VitC and VitB1 levels were frequently observed. Age, systemic inflammation, and vitamin supplementation were associated with vitamin levels during sepsis.
MeSH term(s)	Adolescent ; Ascorbic Acid/metabolism ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; Sepsis/complications ; Sepsis/drug therapy ; Switzerland ; Thiamine ; Vitamins
Chemical Substances	Vitamins ; Ascorbic Acid (PQ6CK8PD0R) ; Thiamine (X66NSO3N35)
Language	English
Publishing date	2022-05-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000002911
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Article ; Online: The changing clinical presentation of COVID-19 in children during the course of the pandemic.

Wurm, Juliane / Uka, Anita / Bernet, Vera / Buettcher, Michael / Giannoni, Eric / Kottanattu, Lisa / Schöbi, Nina / Zemmouri, Abdelaziz / Ritz, Nicole / Zimmermann, Petra

Acta paediatrica (Oslo, Norway : 1992)

2023 Volume 113, Issue 4, Page(s) 771–777

Abstract: Aim: To investigate the evolution of clinical symptoms of COVID-19 in children throughout the pandemic.: Methods: In this national prospective surveillance study, symptoms in children hospitalised with COVID-19 were collected from all paediatric ... ...

Abstract	Aim: To investigate the evolution of clinical symptoms of COVID-19 in children throughout the pandemic. Methods: In this national prospective surveillance study, symptoms in children hospitalised with COVID-19 were collected from all paediatric hospitals in Switzerland between March 2020 and March 2023. Data was analysed across four time periods, according to the predominantly circulating SARS-CoV-2 variant: T1 (wild-type), T2 (Alpha), T3 (Delta) and T4 (Omicron), as well as by age group. Results: The study included 1323 children. The proportion of children admitted to an intensive care unit remained stable throughout the pandemic. However, the pattern and frequency of clinical manifestations changed over time. Respiratory symptoms were less prevalent during T1 (wild-type), fever during T2 (Alpha) and rash during T4 (Omicron). In contrast, fever and neurological symptoms were more prevalent during T4 (Omicron). Newly described symptoms during T4 (Omicron) included conjunctivitis, laryngotracheitis and seizures. Fever was more prevalent among neonates and infants whereas respiratory symptoms were more common among infants. Gastrointestinal symptoms were more frequent among toddlers, while both toddlers and school-aged children presented with neurological symptoms more often than other age groups. Conclusion: Continuous surveillance is required to detect changes in manifestations and there by be prepared for the optimal management of complications in children with COVID-19.
MeSH term(s)	Infant ; Infant, Newborn ; Child ; Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Pandemics ; Prospective Studies ; Fever/etiology
Language	English
Publishing date	2023-12-16
Publishing country	Norway
Document type	Journal Article
ZDB-ID	203487-6
ISSN	1651-2227 ; 0365-1436 ; 0803-5253
ISSN (online)	1651-2227
ISSN	0365-1436 ; 0803-5253
DOI	10.1111/apa.17061
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Article ; Online: Dysregulated monocyte-derived macrophage response to Group B

Ravi, Denho / Ntinopoulou, Erato / Guetta, Nessim / Weier, Manuela / Vogel, Verena / Spellerberg, Barbara / Sendi, Parham / Gremlich, Sandrine / Roger, Thierry / Giannoni, Eric

Frontiers in immunology

2023 Volume 14, Page(s) 1268804

Abstract: Introduction: Streptococcus agalactiae: Methods: Monocytes from umbilical cord blood of healthy term newborns and from peripheral blood of healthy adult subjects were cultured with M-CSF to induce MDMs. M-CSF-MDMs, GM-CSF- and IFNγ-activated MDMs ... ...

Abstract	Introduction: Streptococcus agalactiae Methods: Monocytes from umbilical cord blood of healthy term newborns and from peripheral blood of healthy adult subjects were cultured with M-CSF to induce MDMs. M-CSF-MDMs, GM-CSF- and IFNγ-activated MDMs were exposed to GBS COH1, a reference strain for neonatal sepsis. Results: GBS induced a greater release of IL-1β, IL-6, IL-10, IL-12p70 and IL-23 in newborn compared to adult MDMs, while IL-18, IL-21, IL-22, TNF, RANTES/CCL5, MCP-1/CCL2 and IL-8/CXCL8 were released at similar levels. MDM responses to GBS were strongly influenced by conditions of activation and were distinct from those to synthetic bacterial lipopeptides and lipopolysaccharides. Under similar conditions of opsonization, newborn MDMs phagocytosed and killed GBS as efficiently as adult MDMs. Discussion: Altogether, the production of excessive levels of Th1- (IL-12p70), Th17-related (IL-1β, IL-6, IL-23) and anti-inflammatory (IL-10) cytokines is consistent with a dysregulated response to GBS in newborns. The high responsiveness of newborn MDMs may play a role in the progression of GBS infection in newborns, possibly contributing to the development of life-threatening organ dysfunction.
MeSH term(s)	Adult ; Infant, Newborn ; Humans ; Interleukin-10 ; Macrophage Colony-Stimulating Factor ; Interleukin-6 ; Neonatal Sepsis ; Streptococcus agalactiae ; Macrophages ; Interleukin-12 ; Interleukin-23
Chemical Substances	Interleukin-10 (130068-27-8) ; Macrophage Colony-Stimulating Factor (81627-83-0) ; Interleukin-6 ; Interleukin-12 (187348-17-0) ; Interleukin-23
Language	English
Publishing date	2023-11-14
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2023.1268804
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Article ; Online: Intra-hospital transport of newborn infants dataset.

Delacrétaz, Romaine / Fumeaux, Céline J Fischer / Stadelmann, Corinne / Rodriguez Trejo, Adriana / Destaillats, Alice / Giannoni, Eric

Data in brief

2021 Volume 39, Page(s) 107510

Abstract: This article presents a dataset on intra-hospital transport of newborn infants. We collected prospectively data from patients hospitalized between 1.6.2015 and 31.5.2017 at the tertiary care neonatal unit of the University Hospital of Lausanne, ... ...

Abstract	This article presents a dataset on intra-hospital transport of newborn infants. We collected prospectively data from patients hospitalized between 1.6.2015 and 31.5.2017 at the tertiary care neonatal unit of the University Hospital of Lausanne, Switzerland. An intra-hospital transport was defined as a transport for a diagnostic or a therapeutic intervention outside the neonatal unit, but within the hospital. Healthcare professionals present during the transport collected data in a case report form. We obtained additional data from electronic medical charts and through the clinical information system Metavision®. We recorded information on patients' demographics and clinical characteristics, transports (indication, date, duration, destination, number and type of staff involved, medical devices and treatments), adverse events and interventions. Heart rate, peripheral oxygen saturation and fraction of inspired oxygen were recorded within 5 min before and after the transport, with an additional measure during transport for patients that had continuous monitoring of vital signs. This dataset will be of use to clinicians, researchers and policy makers, to inform clinical practice, for benchmarking, and for the development of future guidelines. These data have been further analyzed and interpreted in the article "Adverse events and associated factors during intra-hospital transport of newborn infants" (Delacrétaz et al, 2021).
Language	English
Publishing date	2021-10-29
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2786545-9
ISSN	2352-3409 ; 2352-3409
ISSN (online)	2352-3409
ISSN	2352-3409
DOI	10.1016/j.dib.2021.107510
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Article ; Online: Monitoring of heart rate characteristics to detect neonatal sepsis.

Rio, Laura / Ramelet, Anne-Sylvie / Ballabeni, Pierluigi / Stadelmann, Corinne / Asner, Sandra / Giannoni, Eric

Pediatric research

2021 Volume 92, Issue 4, Page(s) 1070–1074

Abstract: Background: Monitoring of heart rate characteristics (HRC) index may improve outcomes of late-onset neonatal sepsis (LOS) through early detection. We aimed at describing the association between LOS and elevated HRC index.: Methods: This single-center ...

Abstract	Background: Monitoring of heart rate characteristics (HRC) index may improve outcomes of late-onset neonatal sepsis (LOS) through early detection. We aimed at describing the association between LOS and elevated HRC index. Methods: This single-center retrospective case-control study included neonates who presented with blood culture-proven hospital-acquired LOS. Controls were matched to cases (ratio 1:2) based on gestational age, postnatal age, and birthweight. We compared the highest HRC indexes in the 48 h preceding blood culture sampling in LOS cases to the highest HRC indexes at the same postnatal days in controls. Results: In 59 LOS cases and 123 controls, an HRC index > 2 was associated with LOS (OR 7.1, 95% CI 2.6-19.0). Sensitivity and specificity of an HRC index > 2 to predict LOS were 53% (32/59) and 79% (98/123). Sensitivity increased from 25% in infants born > 32 weeks to 76% in infants born < 28 weeks. Specificity decreased from 97% in infants > 32 weeks to 63% in those born < 28 weeks. Conclusions: An increase of HRC index > 2 has a significant association with the diagnosis of LOS, supporting the use of HRC monitoring to assist early detection of LOS. Clinicians using HRC monitoring should be aware of its diagnostic accuracy and limitations in different gestational age groups. Impact: There is a paucity of data regarding the predictive value of heart rate characteristics (HRC) monitoring for early diagnosis of late-onset neonatal sepsis (LOS) in daily clinical practice. Monitoring of heart rate characteristics provides valuable information to assist the early diagnosis of LOS across all gestational age groups. However, the strong influence of gestational age on positive and negative predictive values adds complexity to the interpretation of HRC indexes.
MeSH term(s)	Infant, Newborn ; Infant ; Humans ; Neonatal Sepsis/diagnosis ; Heart Rate/physiology ; Retrospective Studies ; Case-Control Studies ; Gestational Age
Language	English
Publishing date	2021-12-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	4411-8
ISSN	1530-0447 ; 0031-3998
ISSN (online)	1530-0447
ISSN	0031-3998
DOI	10.1038/s41390-021-01913-9
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Article: Intra-hospital transport of newborn infants dataset

Delacrétaz, Romaine / Fumeaux, Céline J. Fischer / Stadelmann, Corinne / Rodriguez Trejo, Adriana / Destaillats, Alice / Giannoni, Eric

Data in Brief. 2021 Dec., v. 39

2021

Abstract	This article presents a dataset on intra-hospital transport of newborn infants. We collected prospectively data from patients hospitalized between 1.6.2015 and 31.5.2017 at the tertiary care neonatal unit of the University Hospital of Lausanne, Switzerland. An intra-hospital transport was defined as a transport for a diagnostic or a therapeutic intervention outside the neonatal unit, but within the hospital. Healthcare professionals present during the transport collected data in a case report form. We obtained additional data from electronic medical charts and through the clinical information system Metavision®. We recorded information on patients’ demographics and clinical characteristics, transports (indication, date, duration, destination, number and type of staff involved, medical devices and treatments), adverse events and interventions. Heart rate, peripheral oxygen saturation and fraction of inspired oxygen were recorded within 5 min before and after the transport, with an additional measure during transport for patients that had continuous monitoring of vital signs. This dataset will be of use to clinicians, researchers and policy makers, to inform clinical practice, for benchmarking, and for the development of future guidelines. These data have been further analyzed and interpreted in the article “Adverse events and associated factors during intra-hospital transport of newborn infants” (Delacrétaz et al, 2021).
Keywords	case studies ; data collection ; demographic statistics ; health services ; heart rate ; hospitals ; information systems ; issues and policy ; neonates ; oxygen ; therapeutics ; Switzerland
Language	English
Dates of publication	2021-12
Publishing place	Elsevier Inc.
Document type	Article
ZDB-ID	2786545-9
ISSN	2352-3409
ISSN	2352-3409
DOI	10.1016/j.dib.2021.107510
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