Diagnostic Performance of 1→3-β-d-Glucan in Neonatal and Pediatric Patients with Candidemia

Fungal sepsis is one of the major problems in neonatal and pediatric care unit settings. The availability of new diagnostic techniques could allow medical practitioners to rapidly identify septic patients and to improve their outcome. The aim of this study was to evaluate the performance of the 1→3-β-d-glucan (BDG), individually and in comparison with the Candida mannan (CM) antigen, in ten preterm infants and five onco-haematological pediatric patients with Candida bloodstream infections already proven by positive culture. The serum levels of BDG were >80 pg/mL on the same day as a positive blood culture in all examined patients, while CM antigen was negative in the patients with C. parapsilosis fungemia and in one further case due to C. albicans. These results suggest that a regular monitoring of serum circulating antigens (i.e., 1→3-β-d-glucan) combined with other microbiological and clinical information, may allow earlier and accurate diagnosis. However, further studies are necessary to confirm its usefulness in routine clinical practice

Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data

We evaluated the epidemiology of Candida bloodstream infections in the neonatal intensive care unit (NICU) of an Italian university hospital during a 9-year period as a means of quantifying the burden of infection and identifying emerging trends. Clinical data were searched for in the microbiological laboratory database. For comparative purposes, we performed a review of NICU candidemia. Forty-one candidemia cases were reviewed (overall incidence, 3.0 per 100 admissions). Candida parapsilosis sensu stricto (58.5%) and C. albicans (34.1%) were the most common species recovered. A variable drift through years was observed; in 2015, 75% of the cases were caused by non-albicans species. The duration of NICU hospitalization of patients with non-albicans was significantly longer than in those with C. albicans (median days, 10 versus 12). Patients with non-albicans species were more likely to have parenteral nutrition than those with C. albicans (96.3% versus 71.4%). Candida albicans was the dominant species in Europe and America (median, 55% and 60%; resp.); non-albicans species predominate in Asia (75%). Significant geographic variation is evident among cases of candidemia in different parts of the world, recognizing the importance of epidemiological data to facilitate the treatment

The role of procalcitonin in neonatal intensive care unit patients with candidemia

Candidemia is a major infectious complication in neonatal patients. The isolation of yeasts from blood is still the “gold standard” for its diagnosis, but other laboratory markers (i.e., circulating antigens) have been studied with varying specificities and sensitivities. The aim of this study was to evaluate the role of procalcitonin for the diagnosis of candidemia in neonatal patients at high risk. To verify if the use of different commercial methods can highlight dissimilar results of sensitivity and/or specificity, the determination of procalcitonin serum levels was estimated by two systems. Overall, 90 patients from a Neonatal Intensive Care Units were enrolled, of whom six developed Candida bloodstream infection. Four of six infants with candidemia had slight increase of procalcitonin values (0.5–1 ng/mL). Only one baby showed very high levels but he had fungal and bacterial sepsis at the same time, while no elevation was observed in the sixth patient. No statistically significant difference was observed between two different methods at the time of monitoring (p > 0.643). Both methods showed a sensitivity of 83.3 % at diagnosis, while the specificity was 73.8 and 63.1 % by methods A and B, respectively. In the light of the low sensibility and specificity of this assay, we can assume that the determination of procalcitonin would not seem to play a significant role in the diagnosis of fungal infection in neonatal patients

Shorter time to full enteral feedings among infants fed an intact protein (IP) vs an extensively hydrolyzed (EH) formula does not appear to be related to differences in gastric emptying

Shorter time to full enteral feedings among infants fed an intact protein (IP) vs an extensively hydrolyzed (EH) formula does not appear to be related to differences in gastric emptying Maria Elisabetta Baldassarre1, Antonio Di Mauro2, Margherita Fanelli3, Osvaldo Montagna1, Jennifer Wampler4, Timothy Cooper4, Nicola Laforgia5 1University of Bari-Policlinico Hospital, Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, Bari, Italy 2University of Bari "Aldo Moro", Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, Bari, Italy 3University of Bari "Aldo Moro", Department of Interdisciplinary Medicine, Bari, Italy 4Mead Johnson Nutrition, Department of Medical Affairs, Evansville, United States 5University of Bari "Aldo Moro" , Department of Biomedical Science and Human Oncology, Bari, Italy Objectives and study: Hydrolyzed cow’s milk protein infant formulas are often used in preterm infant feeding despite little clinical evidence of improvement in feeding advancement or markers of feeding tolerance. An objective of the current study was to evaluate the relationship of days to full feeding with gastric emptying time in preterm infants randomly assigned to receive one of two marketed study formulas for the first 14 feeding days. Methods: In this double-blind, controlled, parallel-group, prospective study, eligible infants (28-33 weeks’ gestational age; birth weight of 700-1750g and AGA) were enrolled within 24 hours of first enteral feeding. All mothers were encouraged to provide their own breast milk; study formula was supplemented as needed per randomization. The primary outcome was days to full enteral feeding (≥140 mL/kg/day). Gastric emptying rate and half-emptying time (T1/2) were assessed by real-time ultrasonography on Study Day 14 using antral measurements from 0 (before bolus) to 90 min (15-min intervals). Populations for analysis included participants who 1) completed the study per protocol and 2) received ≥75% study formula intake. Results: Of 65 enrolled preterm infants (IP: n=32; EH: n=33), 60 completed the study per protocol (IP: 30; EH: 30); of these, 54 (90%) received some breast milk and 23 received ≥75% study formula intake (IP: 11; EH: 12). Median time to achievement of full feeding was significantly shorter for the IP vs EH group (Day 10 vs 14, P=0.030) for participants receiving ≥75% study formula intake. Achievement of full enteral feeding by Day 14 was similar between groups overall (IP: 24/30, 80%; EH: 19/30, 63%; P=0.121), but higher in the IP group for participants receiving ≥75% study formula intake (IP: 10/11, 90.9%; EH: 6/12, 50% P=0.069). Median gastric emptying at Day 14 was significantly slower for the IP vs EH group overall (T1/2; 59 vs 54 min; P=0.031) and in participants who received ≥75% study formula intake (62 vs 53 min, P=0.018). However, gastric emptying time had no correlation with achievement of full feeding for participants who completed the study per protocol (r2=0.008; P=0.49) (Figure). No group differences were detected in tolerance measures (abdominal distention, regurgitation/emesis, feedings withheld ≥4h, or bloody stools) or in positive cultures for sepsis (IP: 2, EH: 3; evaluations performed in 63.3% of participants). No episodes of NEC were reported. Vol. 64, Supplement 1, April 2017 920 Fig: Conclusion: Feeding intact cow milk protein formula vs extensively hydrolyzed casein formula was associated with shorter time to full enteral feeding. However, faster emptying with extensively hydrolyzed formula did not predict feeding success, raising questions around the clinical relevance of this surrogate marker of feeding tolerance

Maturation of gastric electrical activity, gastric emptying and intestinal permeability in preterm newborns during the first month of life

Abstract Introduction Immaturity of motility, intestinal epithelial barrier function and absorptive capacity may play a role in the pathophysiology of intestinal diseases in preterms. We determined the gastric electrical activity and emptying, and intestinal permeability, in preterm newborns to verify if a maturation pattern exists in preterm newborns during the first month of life. Patients and methods Eighteen preterm newborns (median 34 wks, range 2 wks) completed the study. They underwent the recording of gastric electrical activity by means of cutaneous electrogastrography, the ultrasound examination of gastric emptying, and the lactulose-to-mannitol ratio from permeability-absorption test on days 3, 7, 15, and 30 after birth. Results Gastric electrical activity and emptying showed only slight changes between day 3 and day 7. On the contrary, an evident maturation in permeability, expressed as L/Mratio, was evident over time (Friedman Repeated Measures Analysis, p = 0.004). Conclusion In preterm healthy newborns of 34 weeks gestational age, electrical and motor activity are completely developed at birth whilst the intestinal epithelial barrier clearly improves during the first week of life.</p

Faster Gastric Emptying Is Unrelated to Feeding Success in Preterm Infants: Randomized Controlled Trial

Objectives: To evaluate the relationship between gastric emptying (GE) time and days to achievement of full enteral feeding (≥140 mL/kg/day) in preterm infants randomly assigned to receive one of two marketed study formulas for the first 14 feeding days: intact protein premature formula (IPF) or extensively hydrolyzed protein (EHF) formula. Methods: In this triple-blind, controlled, prospective, clinical trial, we report GE time (time to half-emptying, t1/2) by real-time ultrasonography on Study Day 14, in preterm infants receiving IPF or EHF formula. The association between GE time and achievement of full enteral feeding was evaluated by Pearson correlation. Per-protocol populations for analysis included participants who (1) completed the study (overall) and (2) who received ≥ 75% study formula intake (mL/kg/day). Results: Median GE time at Day 14 was significantly faster for the EHF vs. IPF group overall and in participants who received ≥ 75% study formula intake (p ≤ 0.018). However, we demonstrated GE time had no correlation with the achievement of full enteral feeding (r = 0.08; p = 0.547). Conclusion: Feeding IP premature formula vs. EH formula was associated with shorter time to full enteral feeding. However, faster GE time did not predict feeding success and may not be a clinically relevant surrogate for assessing feeding tolerance