Pediatric Investigation最新文献

Newborn screening (NBS) is a public health service aimed at identifying infants with severe genetic disorders, thus providing effective treatment early enough to prevent or ameliorate the onset of symptoms. Current NBS uses biochemical analysis of dried blood spots, predominately with time-resolved fluorescence immunoassay and tandem mass spectrometry, which produces some false positives and false negatives. The application of enzymatic activity-based testing technology provides a reliable screening method for some disorders. Genetic testing is now commonly used for secondary or confirmatory testing after a positive result in some NBS programs. Recently, next-generation sequencing (NGS) has emerged as a robust tool that enables large panels of genes to be scanned together rapidly. Rapid advances in NGS emphasize the potential for genomic sequencing to improve NBS programs. However, some challenges still remain and require solution before this is applied for population screening.

Using the US National Inpatient Sample dataset (2010 to 2018), we compared outcomes of neonates with Tetralogy of Fallot who had early primary surgical repair (1726 neonate) and those who had staged palliative intervention with transcatheter (1702 neonate) or surgical palliative shunt (2661 neonate).

Importance: Staphylococcus lugdunensis (S. lugdunensis) is a coagulase-negative staphylococcus (CoNS), found commonly as skin flora in humans. While most species of CoNS are clinically benign, S. lugdunensis can exhibit a similar virulence to that of S. aureus. However, there is scant data concerning S. lugdunensis infection in the pediatric population.

Objective: To ascertain local S. lugdunensis infection rates and sensitivity patterns in the pediatric population.

Methods: A retrospective analysis was undertaken of all S. lugdunensis isolates across a 6-year period from 2015 to 2020. Data were collected from electronic patient notes and laboratory records. Matrix-assisted laser desorption ionization and time of flight mass spectrometry were used to identify isolates.

Results: Ninety-six isolates of S. lugdunensis were identified from 86 patients. Of these, 34 isolates were treated as an infection. Twenty-three (67.6%) were found to have skin as the primary source of infection. While the observed number was small, central nervous system (CNS) sources of S. lugdunensis infection appear to be a significant source: all three isolates cultured from cerebrospinal fluid were clinically managed as infection. All three were associated with ventriculoperitoneal (VP) shunt infection. No cases of S. lugdunensis infective endocarditis were identified. About 18.6% of S. lugdunensis isolates were resistant to flucloxacillin.

Interpretation: S. lugdunensis is an uncommon but significant cause of infection in the pediatric population and appears to be a rising cause of CNS infection, particularly when associated with VP shunts. Flucloxacillin is recommended locally as the first choice of antibiotic.

Importance: Bacteremia tuberculosis (TB) is a severe form of extrapulmonary TB. Studies assessing bacteremia TB in children are limited, especially for HIV-negative children.

Objective: To explore the detailed clinical features of the bacteremia TB in children under 18 years of age.

Methods: We reviewed the clinical records of the patients retrospectively and collected the strains isolated from their blood cultures. We used mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) to characterize the bacterial genotypes and alamarBlue to determine their drug susceptibility profiles. Polymerase chain reactions and DNA sequencing were used to identify drug-resistant mutations.

Results: There were 13 pediatric bacteremia TB patients, 10 of whom were diagnosed with Bacillus Calmette-Guérin (BCG) bacteremia TB. Thirteen patients aged from 0.30 to 11.58 years were enrolled, of whom 76.92% were boys. All had fevers before hospitalization, and 76.92% had respiratory symptoms. All had received BCG vaccinations, and 46.15% had adverse post-vaccination reactions. Compared with Mycobacterium tuberculosis, BCG bacteremia was more likely to appear in younger children. Patients with BCG bacteremia had primary immunodeficiency diseases, and lower CD4, IgA, and IgE levels.

Interpretation: Bacteremia TB was rapidly fatal in a large proportion of the immunodeficient children. Because classic findings may not be diagnostically specific, a high level of clinical suspicion is required, especially for patients with certain types of immunosuppression. Studies are needed to develop rapid diagnostic tests and to determine the value of empirical therapy in childhood bacteremia TB.

Importance: Effective screening strategies for early-onset neonatal sepsis (EONS) have the potential to reduce high volume parenteral antibiotics (PAb) usage in neonates.

Objective: To compare management decisions for EONS, between CG149 National Institute for Health and Care Excellence (NICE) guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator (SRC) in a level 2 neonatal unit at a district general hospital (DGH).

Methods: Hospital records were reviewed for maternal and neonatal risk factors for EONS, neonatal clinical examination findings, and microbial culture results for all neonates born at ≥34 weeks' gestation between February and July 2019, who were (1) managed according to CG149-NICE guidelines or (2) received PAb within 72 h following birth at a DGH in Winchester, UK. SRC projections were obtained using its virtual risk estimator.

Results: Sixty infants received PAb within the first 72 h of birth during the study period. Of these, 19 (31.7%) met SRC criteria for antibiotics; 20 (33.3%) met the criteria for enhanced observations and none had culture-proven sepsis. Based on SRC projections, neonates with '≥1 NICE clinical indicator and ≥1 risk factor' were most likely to have a sepsis risk score (SRS) >3. Birth below 37 weeks' gestation (risk ratio [RR] = 2.31, 95% confidence interval [CI]: 1.02-5.22) and prolonged rupture of membranes (RR = 3.14, 95% CI: 1.16-8.48) increased the risk of an SRS >3.

Interpretation: Screening for EONS on the SRC could potentially reduce PAb usage by 68% in term and near-term neonates in level 2 neonatal units.