Neonatal Gram Negative and Candida Sepsis Survival and Neurodevelopmental Outcome at the Corrected Age of 24 Months

Objectives: To evaluate the long term neurodevelopmental outcome of premature infants exposed to either gram- negative sepsis (GNS) or neonatal Candida sepsis (NCS), and to compare their outcome with premature infants without sepsis. Methods: Historical cohort study in a population of infants born at <30 weeks gestation and admitted to the Neonatal Intensive Care Unit (NICU) of the Academic Medical Center in Amsterdam during the period 1997-2007. Outcome of infants exposed to GNS or NCS and 120 randomly chosen uncomplicated controls (UC) from the same NICU were compared. Clinical data during hospitalization and neurodevelopmental outcome data (clinical neurological status; Bayley -test results and vision/hearing test results) at the corrected age of 24 months were collected. An association model with sepsis as the central determinant of either good or adverse outcome (death or severe developmental delay) was made, corrected for confounders using multiple logistic regression analysis. Results: Of 1362 patients, 55 suffered from GNS and 29 suffered from NCS; cumulative incidence 4.2% and 2.2%, respectively. During the follow-up period the mortality rate was 34% for both GNS and NCS and 5% for UC. The adjusted Odds Ratio (OR) [95% CI] for adverse outcome in the GNS group compared to the NCS group was 1.4 [0.4-4.9]. The adjusted ORs [95% CI] for adverse outcome in the GNS and NCS groups compared to the UC group were 4.8 [1.5-15.9] and 3.2 [0.7-14.7], respectively. Conclusions: We found no statistically significant difference in outcome at the corrected age of 24 months between neonatal GNS and NCS cases. Suffering from either gram -negative or Candida sepsis increased the odds for adverse outcome compared with an uncomplicated neonatal period

MOSAICS session at OMAI 2023

European industrial research project dessimination at the objective measures in auditory implants conference 2023. All four early stage researchers presented part of their work within the MOSAICS project. The following topics were discussed: - Exploring reaction times as objective measures of auditory periphery. - Assessing top-down auditory processing using objective measures based on electroencephalographic recordings and behaviour. - Individualised phoneme training fro adult CI users - AuDiET: Auditory Diagnostics and Error-based Treament - Towards performance-based fitting

Kandinsky Longitudinal Study (KLS)

The Kandinsky Longitudinal Study (KLS) is an ongoing longitudinal study, aimed at detecting adolescents at risk for social and emotional problems in secondary education. The socio-emotional functioning of students in grades 7 through 10 is assessed yearly with self- and peer-reports

Effectiveness and costs of a stepwise versus an all-in-one approach to diagnose mild bleeding disorders.

The diagnostic work-up of patients referred to the haematologist for bleeding evaluation is performed in a stepwise way: bleeding history and results of screening laboratory tests guide further diagnostic evaluation. This can be ineffective, time-consuming and burdensome for patients. To improve this strategy, the initial laboratory investigation can be extended. In a model-based approach, effectiveness and costs of a conventional stepwise versus a newly proposed all-in-one diagnostic approach for bleeding evaluation were evaluated and compared, using data from an observational patient cohort study, including adult patients referred for bleeding evaluation. In the all-in-one approach, specialized platelet function tests, coagulation factors, and fibrinolysis tests were included in the initial investigation. Final diagnosis, hospital resource use and costs and patient burden were compared. A total of 150 patients were included. Compared to the stepwise approach, in the all-in-one approach, 19 additional patients reached a diagnosis and patient burden was lower, but total costs per patient were higher [€359, 95% bootstrapped confidence interval (BCI) 283-518, p = 0.001]. For bleeding evaluation of patients referred to the haematologist, an all-in-one diagnostic approach has a higher diagnostic yield and reduces patient burden, at a higher cost. This raises the question what costs justify the diagnosis of a bleeding disorder and a less burdensome diagnostic strategy

Thrombocytopenia and the effect of platelet transfusions on the occurrence of intracranial hemorrhage in patients with acute leukemia - a nested case-control study

We designed a study to describe the incidence of intracranial hemorrhage according to severity and duration of thrombocytopenia and to quantify the associations of platelet transfusions with intracranial hemorrhage in patients with acute leukemia. In this case-control study nested in a cohort of 859 leukemia patients, cases (n = 17) were patients diagnosed with intracranial hemorrhage who were matched with control patients (n = 55). We documented platelet counts and transfusions for seven days before the intracranial hemorrhage in cases and in a "matched" week for control patients. Three measures of platelet count exposure were assessed in four potentially important time periods before hemorrhage. Among these leukemia patients, we observed the cumulative incidence of intracranial hemorrhage of 3.5%. Low platelet counts were, especially in the three to seven days preceding intracranial hemorrhage, associated with the incidence of intracranial hemorrhage, although with wide confidence intervals. Platelet transfusions during the week preceding the hemorrhage were associated with higher incidences of intracranial hemorrhage; rate ratios (95% confidence interval) for one or two platelet transfusions and for more than two transfusions compared with none were 4.04 (0.73 to 22.27) and 8.91 (1.53 to 51.73) respectively. Thus, among acute leukemia patients, the risk of intracranial hemorrhage was higher among patients with low platelet counts and after receiving more platelet transfusions. Especially, the latter is likely due to clinical factors leading to increased transfusion needs

Raw and adjusted association (Odds Ratios) between sepsis type and adverse outcome.

<p>GNS: gram negative sepsis; NCS: neonatal Candida sepsis; UC: uncomplicated control infants; OR: odds ratio; CI: 95% confidence interval; Adjusted for the following confounders: gestational age; abnormal newborn hearing test; duration of ventilation; total number of days admitted.</p

Population Characteristics.

c<p>Number of subjects for whom the information was obtained. NCS: Neonatal candida Sepsis; GNS: Gram Negative Sepsis; UC: Uncomplicated Controls; Abbrevations: NEC: surgery for Necrotising Entero Colitis; n.a. = not applicable; IQR = Interquartile Range; SD = standard deviation, BPD36 = diagnosis BPD at 36 weeks, ROP: Retinopathy of Prematurity; NTISS: Neonatal Therapeutic Intervention Score; CUS: cerebral ultrasound; CVL: central venous line; Good outcome = as defined in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0059214#s2" target="_blank">methods</a>; Adverse outcome = as defined in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0059214#s2" target="_blank">methods</a>.</p>*<p>death: all deaths were during admission, no postdischarge mortality.</p

Neurodevelopmental outcome in detail.

<p>NCS: Neonatal Candida Sepsis; Gram Negative Sepsis; UC: Uncomplicated Controls. FU: Follow Up.</p>*<p>Median, minimum-maximum. ^#: number of total cases noted and percentage. PDI: Psychomotor Developmental Index; MDI: Mental Developmental Index.</p

Population Flow sheet.

<p>LFUP: Long Term Follow Up completed; LTF: Loss to follow up.</p

Association between cardiovascular risk factors and intracranial hemorrhage in patients with acute leukemia

BACKGROUND: Intracranial hemorrhage is seen more frequently in acute leukemia patients compared to the general population. Besides leukemia-related risk factors, also risk factors that are present in the general population might contribute to hemorrhagic complications in leukemia patients. Of those, cardiovascular risk factors leading to chronic vascular damage could modulate the occurrence of intracranial hemorrhage in these patients, as during their disease and treatment acute endothelial damage occurs due to factors like thrombocytopenia and inflammation.OBJECTIVES: Our aim was to explore if cardiovascular risk factors can predict intracranial hemorrhage in acute leukemia patients.METHODS: In a case-control study nested in a cohort of acute leukemia patients, including 17 cases with intracranial hemorrhage and 55 matched control patients without intracranial hemorrhage, data on cardiovascular risk factors were collected for all patients. Analyses were performed via conditional logistic regression.RESULTS: Pre-existing hypertension and ischemic heart disease in the medical history were associated with intracranial hemorrhage, with an incidence rate ratio of 12.9 (95% confidence interval [CI] 1.5 to 109.2) and 12.1 (95% CI 1.3 to110.7), respectively.CONCLUSION: Both pre-existing hypertension and ischemic heart disease seem to be strong predictors of an increased risk for intracranial hemorrhage in leukemia patients.</p