Metabolic responses in neonatal sepsis—A systematic review of human metabolomic studies

Aim - To systematically review human metabolomic studies investigating metabolic responses in septic neonates. Methods - A systematic literature search was performed in the databases MEDLINE, EMBASE and Cochrane library up to the 1st of January 2021. We included studies that assessed neonatal sepsis and the following outcomes; (1) change in the metabolism compared to healthy neonates and/or (2) metabolomics compared to traditional diagnostic tools of neonatal sepsis. The screened abstracts were independently considered for eligibility by two researchers. PROSPERO ID: CRD42020164454. Results - The search identified in total 762 articles. Fifteen articles were assessed for eligibility. Four studies were included, with totally 78 neonates. The studies used different diagnostic criteria and had between 1 and 16 sepsis cases. All studies with bacterial sepsis found alterations in the glucose and lactate metabolism, reflecting possible redistribution of glucose consumption from mitochondrial oxidative phosphorylation to the lactate and pentose phosphate pathway. We also found signs of increased oxidative stress and fatty acid oxidation in sepsis cases. Conclusion - We found signs of metabolomic signatures in neonatal sepsis. This may lead to better understanding of sepsis pathophysiology and detection of new candidate biomarkers. Results should be validated in large-scale multicentre studies

Cardiopulmonary Collapse during Labour

Cardiopulmonary collapse during labour is a catastrophic event caused by various medical, surgical and obstetrical conditions. It is an emergency that threatens the life of the mother and her unborn child. We present a case of a pregnant woman who suffered from preeclampsia and underwent induction of labour. Severe lung edema occurred early in labour that caused cardiopulmonary collapse. Advanced heart-lung resuscitation was established immediately and continued until an emergency cesarean section was performed few minutes later. The outcome was favourable for both mother and child. We further discuss some aspects of the pathophysiology and appropriate treatment of cardiorespiratory arrest during labour, which involves the coordinated action of the obstetric, pediatric and surgical ward personnel

Planar n-in-n quad module prototypes for the ATLAS ITk upgrade at HL-LHC

In order to meet the requirements of the High Luminosity LHC (HL-LHC), it will be necessary to replace the current tracker of the ATLAS experiment. Therefore, a new all-silicon tracking detector is being developed, the so-called Inner Tracker (ITk). The use of quad chip modules is intended in its pixel region. These modules consist of a silicon sensor that forms a unit along with four read-out chips. The current ATLAS pixel detector consists of planar n-in-n silicon pixel sensors. Similar sensors and four FE-I4 read-out chips were assembled to first prototypes of planar n-in-n quad modules. The main focus of the investigation of these modules was the region between the read-out chips, especially the central area between all four read-out chips. There are special pixel cells placed on the sensor which cover the gap between the read-out chips. This contribution focuses on the characterization of a non-irradiated device, including important sensor characteristics, charge collection determined with radioactive sources as well as hit efficiency measurements, performed in the laboratory and at testbeams. In addition, first laboratory results of an irradiated device are presented

Antenatal breastmilk expression for women with diabetes in pregnancy - a feasibility study

Background: Mothers with diabetes are less likely to achieve successful breastfeeding. Antenatal breastmilk expression (ABE) may facilitate earlier breastfeeding, but feasibility of introducing ABE and its acceptance among Scandinavian women have previously not been investigated. Methods: This observational trial was conducted between the 1 January 2019 and the 12 March 2020 in Tromsø, Norway. We aimed to determine the feasibility of ABE in terms of practicality and acceptability among women with medically (metformin or insulin) treated diabetes. Women were invited to participate during antenatal visits from 32 weeks gestation. Participants received instruction and started ABE from gestation week 37 + 0. Participants, and their infants, were followed until 6–8 weeks after birth. We collected data on breastfeeding rates, infant hypoglycemia, transfer to the neonatal unit, and the women’s overall experience and satisfaction with antenatal breastmilk expression. Results: Twenty-eight of 34 (82%) invited women consented to participate. All started ABE from week 37 + 0, and continued until hospital admission. No women reported any discomfort or side effects. Labor was induced at 38 weeks gestation. Twenty-four women brought harvested colostrum to the maternity ward, which was given to their infants during the first 24 h of life. Breastfeeding rates at discharge were 24/28 (86%) and 21/27 (78%) at 6–8 weeks after delivery. Seven (25%) infants were transferred to the neonatal unit; four because of hypoglycemia. Maternal satisfaction assessed 6–8 weeks after delivery revealed that all participants felt positive about the ABE, but one woman would not recommend it to other pregnant women. Conclusions: Implementing a structured ABE guideline for women with medically treated diabetes was feasible. The intervention was associated with high level of satisfaction among study participants. No obvious side effects were observed, and breastfeeding rates at discharge and 6–8 weeks after delivery were higher than in comparable studies. Trial registration: The study was registered at the research study registry at the University Hospital of North Norway (Nr 2018/7181)

Delivery Room ST Segment Analysis to Predict Short Term Outcomes in Near-Term and Term Newborns

Background: ST-segment changes to the fetal electrocardiogram (ECG) may indicate fetal acidosis. No large-scale characterization of ECG morphology immediately after birth has been performed, but ECG is used for heart rate (HR) assessment. We aimed to investigate ECG morphology immediately after birth in asphyxiated infants, using one-lead dry-electrode ECG developed for HR measurement. Methods: Observational study in Tanzania, between 2013-2018. Near-term and term infants that received bag-mask ventilation (BMV), and healthy controls, were monitored with one-lead dry-electrode ECG with a non-diagnostic bandwidth. ECGs were classified as normal, with ST-elevations or other ST-segment abnormalities including a biphasic ST-segment. We analyzed ECG morphology in relation to perinatal variables or short-term outcomes. Results: A total of 494 resuscitated and 25 healthy infants were included. ST-elevations were commonly seen both in healthy infants (7/25; 28%) and resuscitated (320/494; 65%) infants. The apparent ST-elevations were not associated with perinatal variables or short-term outcomes. Among the 32 (6.4%) resuscitated infants with other ST-segment abnormalities , duration of BMV was longer, 1-min Apgar score lower and normal outcomes less frequent than in the resuscitated infants with normal ECG or ST-elevations. Conclusions: ST-segment elevation was commonly seen and not associated with negative outcomes when using one-lead dry-electrode ECG. Other ST-segment abnormalities were associated with prolonged BMV and worse outcome. ECG with appropriate bandwidth and automated analysis may potentially in the future aid in the identification of severely asphyxiated infants

Erfaringer med helsevesenet blant foreldre til barn med Downs syndrom

BAKGRUNN Barn og ungdom med Downs syndrom har et stort behov for oppfølging i primær- og spesialisthelsetjenesten. MATERIALE OG METODE Vi publiserte i juni 2019 et spørreskjema på Norsk Nettverk for Down syndrom sin Facebook-gruppe. Formålet var å undersøke brukererfaringer med helsevesenet blant foreldre til barn og ungdom (0–20 år) med Downs syndrom. RESULTATER Vi fikk 174 svar. Mest fornøyd var foreldre med oppfølgingen av tilleggsdiagnoser som synsproblemer, hjertefeil og stoffskiftesykdom. Minst fornøyd var foreldrene til barn med problemer knyttet til adferd, søvn og pubertet. Omtrent 6 av 10 foreldre rapporterte ingen negative opplevelser med helsevesenet, men 29/161 (18 %) rapporterte at diagnosen Downs syndrom hadde bidratt til behandlingssvikt hos barnelege eller i barnehabiliteringstjenesten. FORTOLKNING Studien indikerer at det både i primær- og spesialisthelsetjenesten er behov for bedre oppfølging av barn og unge med Downs syndrom

Delivery Room ST Segment Analysis to Predict Short Term Outcomes in Near-Term and Term Newborns

Background: ST-segment changes to the fetal electrocardiogram (ECG) may indicate fetal acidosis. No large-scale characterization of ECG morphology immediately after birth has been performed, but ECG is used for heart rate (HR) assessment. We aimed to investigate ECG morphology immediately after birth in asphyxiated infants, using one-lead dry-electrode ECG developed for HR measurement. Methods: Observational study in Tanzania, between 2013–2018. Near-term and term infants that received bag-mask ventilation (BMV), and healthy controls, were monitored with one-lead dry-electrode ECG with a non-diagnostic bandwidth. ECGs were classified as normal, with ST-elevations or other ST-segment abnormalities including a biphasic ST-segment. We analyzed ECG morphology in relation to perinatal variables or short-term outcomes. Results: A total of 494 resuscitated and 25 healthy infants were included. ST-elevations were commonly seen both in healthy infants (7/25; 28%) and resuscitated (320/494; 65%) infants. The apparent ST-elevations were not associated with perinatal variables or short-term outcomes. Among the 32 (6.4%) resuscitated infants with “other ST-segment abnormalities”, duration of BMV was longer, 1-min Apgar score lower and normal outcomes less frequent than in the resuscitated infants with normal ECG or ST-elevations. Conclusions: ST-segment elevation was commonly seen and not associated with negative outcomes when using one-lead dry-electrode ECG. Other ST-segment abnormalities were associated with prolonged BMV and worse outcome. ECG with appropriate bandwidth and automated analysis may potentially in the future aid in the identification of severely asphyxiated infants

Expired carbon dioxide during newborn resuscitation as predictor of outcome

Aim: To explore and compare expired CO2 (ECO2) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome. Methods: Observational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO2, ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR \u3c 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO2 and HR within three selected time intervals after onset of ventilation (0-30 s, 30.1-60 s and 60.1-300 s). Results: Among 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s of ventilation, ECO2 added extra predictive information compared to HR alone. After 60 s, ECO2 lost significance when adjusted for HR. In 70% of newborns with initial ECO2 Conclusions: Higher levels and a faster rise in ECO2 and HR during newborn resuscitation were independently associated with improved survival compared to persisting low values. ECO2 increased before HR and may serve as an earlier predictor of survival

Meticillinresistente gule stafylokokker i sårsekret hos barn

BAKGRUNN - Hud- og bløtvevsinfeksjoner er vanlig hos barn. Vi ønsket å undersøke forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge. MATERIALE OG METODE - Vi gjennomførte en observasjonsstudie basert på data fra Norsk overvåkingssystem for antibiotikaresistens hos mikrober (NORM) for perioden 2013–21. Resistensdata fra sårsekret med vekst av gule stafylokokker fra barn (0–17 år) og voksne ble inkludert i studien. RESULTATER - Totalt ble 1 416 isolat fra sårsekret fra barn og 7 623 isolat fra voksne med vekst av gule stafylokokker inkludert. Meticillinresistente gule stafylokokker (MRSA, meticillinresistente Staphylococcus aureus) ble påvist i 33 (2,3 %) av isolatene fra barn og 95 (1,2 %) av isolatene fra voksne (p = 0,002). Hos barn var det høyest forekomst av MRSA blant barn i barnehagealder (1–5 år, 4,4 %), sammenlignet med spedbarn ( FORTOLKNING - Forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge var generelt lav, men noe høyere i sekret fra barnehagebarn sammenlignet med andre aldersgrupper. En trenger normalt ikke ta høyde for meticillinresistens ved empirisk behandling av hud- og bløtvevsinfeksjoner hos barn i Norge. HOVEDFUNN - Forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge var på 2,3 %. Høyest forekomst av meticillinresistente gule stafylokokker ble påvist i sårsekret fra barnehagebarn (4,4 %)

Development of early life gut resistome and mobilome across gestational ages and microbiota-modifying treatments

Background: Gestational age (GA) and associated level of gastrointestinal tract maturation are major factors driving the initial gut microbiota composition in preterm infants. Besides, compared to term infants, premature infants often receive antibiotics to treat infections and probiotics to restore optimal gut microbiota. How GA, antibiotics, and probiotics modulate the microbiota\u27s core characteristics, gut resistome and mobilome, remains nascent. Methods: We analysed metagenomic data from a longitudinal observational study in six Norwegian neonatal intensive care units to describe the bacterial microbiota of infants of varying GA and receiving different treatments. The cohort consisted of probiotic-supplemented and antibiotic-exposed extremely preterm infants (n = 29), antibiotic-exposed very preterm (n = 25), antibiotic-unexposed very preterm (n = 8), and antibiotic-unexposed full-term (n = 10) infants. The stool samples were collected on days of life 7, 28, 120, and 365, and DNA extraction was followed by shotgun metagenome sequencing and bioinformatical analysis. Findings: The top predictors of microbiota maturation were hospitalisation length and GA. Probiotic administration rendered the gut microbiota and resistome of extremely preterm infants more alike to term infants on day 7 and ameliorated GA-driven loss of microbiota interconnectivity and stability. GA, hospitalisation, and both microbiota-modifying treatments (antibiotics and probiotics) contributed to an elevated carriage of mobile genetic elements in preterm infants compared to term controls. Finally, Escherichia coli was associated with the highest number of antibiotic-resistance genes, followed by Klebsiella pneumoniae and Klebsiella aerogenes. Interpretation: Prolonged hospitalisation, antibiotics, and probiotic intervention contribute to dynamic alterations in resistome and mobilome, gut microbiota characteristics relevant to infection risk. Funding: Odd-Berg Group, Northern Norway Regional Health Authority