CC BY
6
Original articles Оригинальные статьи
Russian Journal of Infection and Immunity = Infektsiya i immunitet Инфекция и иммунитет
2023, vol. 13, no. 1, pp. 127-132 2023, Т. 13, № 1, с. 127-132
CLINICAL CHARACTERISTICS AND LABORATORY TEST IN FULL-TERM NEONATES WITH SEPSIS IN VIETNAM NATIONAL CHILDREN'S HOSPITAL (NORTHERN VIETNAM)
T.B. Nguyenab, T.N.T. Nguyena, T.H. Danga, B.N. Nguyena, T.M.H. Truonga, T.H. Lea, N.D. Lea
a Vietnam National Children's Hospital, Hanoi City, Vietnam b Hanoi Medical University, Hanoi City, Vietnam
Abstract. Background. Sepsis is a life-threatening condition in response to an infectious agent, causing damage to organs. Sepsis causes serious consequences in neonates due to high rates of mortality, sequelae, and disability. The Southeast Asian country of Vietnam features on of the highest infectious disease rates in the world (high rates of infection, disability and mortality), as well as being a middle-income country with a stratified health care system. The aim of this study was to evaluate the clinical and laboratory characteristics of patients at the Vietnam National Children's Hospital. Materials and methods. This descriptive study was conducted with 85 full-term infants with sepsis admitted to Vietnam National Children's Hospital in the period from December 2019 to April 2021. Patients had at least 2 clinical symptoms and 2 laboratory signs according to the criteria for assessment of neonatal sepsis (European Medicines Agency in 2010) along with positive blood culture results. Results. Common clinical symptoms in neonates with sepsis included poor feeding (89.4%), respiratory failure (69.4%), fever (51.8%), tachycardia (52.8%), and shock (25%). Anemic patients accounted for many (72.9%). Patients with increased white blood counts accounted for 41.2%. Newborns with a low white blood count accounted for 15.4%. Patients with thrombocytopenia were 49.6%. Most patients had elevated CRP (88.3%). The mean value of nCD64 was 10167.1±6136.9 molecules bound/cell. mHLA-DR was 9898.4±14173.9 molecules bound/cell. The Sepsis Index was 274.6±287.5. Conclusions. We recorded differences in clinical characteristics and laboratory tests in full-term neonates with sepsis at National Children's Hospital, of which, nCD64, mHLA-DR, and Sepsis Index should be further investigated and referred to as prospective routine biomarkers in diagnosis of neonatal sepsis.
Key words: neonatal sepsis, nCD64, mHLA-DR, sepsis index, clinical symptoms, laboratory signs.
КЛИНИЧЕСКАЯ ХАРАКТЕРИСТИКА И ЛАБОРАТОРНЫЕ ИССЛЕДОВАНИЯ У ДОНОШЕННЫХ НОВОРОЖДЕННЫХ С СЕПСИСОМ ВО ВЬЕТНАМСКОЙ НАЦИОНАЛЬНОЙ ДЕТСКОЙ БОЛЬНИЦЕ (СЕВЕРНЫЙ ВЬЕТНАМ)
Нгуен Т.Б.12, Нгуен Т.Н.Т.1, Данг Т.Х.1, Нгуен Б.Н.1, Чыонг Т.М.Х.1, Ле Т.Х.1, Ле Н.Д.1
1 Вьетнамская национальная детская больница, Ханой, Вьетнам 2Ханойский медицинский университет, Ханой, Вьетнам
Резюме. Актуальность. Сепсис — опасное для жизни состояние, развивающееся в ответ на инфекционный агент и вызывающее полиорганное поражение. Сепсис у новорожденных часто имеет тяжелые последствия, приводя к инвалидности, а нередко и к летальному исходу . Вьетнам, страна Юго-Восточной Азии, отличается
Адрес для переписки:
Ле Нгок Дюи
18/879 La Thanh, Lang Thuong Ward, Dong Da District, Hanoi, Вьетнамская национальная детская больница. Тел.: (84-024) 6 273 8532. E-mail: Drduy2411@gmail.com
Для цитирования:
Нгуен Т.Б., Нгуен Т.Н.Т, Данг Т.Х., Нгуен Б.Н., Чыонг Т.М.Х., Ле Т.Х., Ле Н.Д. Клиническая характеристика и лабораторные исследования у доношенных новорожденных с сепсисом во Вьетнамской национальной детской больнице (Северный Вьетнам) // Инфекция и иммунитет. 2023. Т. 13, № 1. C. 127-132. doi: 10.15789/2220-7619-CCA-1861
© Nguyen T.B. et al., 2023
Contacts:
Le Ngoc Duy
18/879 La Thanh, Lang Thuong Ward, Dong Da District, Hanoi, Vietnam National Children's Hospital. Phone: (84-024) 6 273 8532. E-mail: Drduy2411@gmail.com
Citation:
Nguyen T.B., Nguyen T.N.T., Dang T.H., Nguyen B.N., Truong T.M.H., Le T.H., Le N.D. Clinical characteristics and laboratory test In full-term neonates with sepsis in Vietnam national children's hospital (Northern Vietnam) // Russian Journal of Infection and Immunity = Infektsiya i immunitet, 2023, vol. 13, no. 1, pp. 127-132. doi: 10.15789/2220-7619-CCA-1861
DOI: http://dx.doi.org/10.15789/2220-7619-CCA-1861
Статья доступна по лицензии Creative Commons Attribution 4.0
The article can be used under the Creative Commons Attribution 4.0 License
одним из самых высоких показателей инфекционных заболеваний в мире (высокий уровень инфицирования, инвалидности и смертности), а также является страной со средним уровнем дохода и стратифицированной системой здравоохранения. Цель этого исследования состояла в том, чтобы оценить клинико-лабораторные характеристики пациентов с сепсисом во Вьетнамской национальной детской больнице. Материалы и методы. Описательное исследование было проведено с участием 85 доношенных новорожденных с сепсисом, поступивших во Вьетнамскую национальную детскую больницу в период с декабря 2019 г. по апрель 2021 г., имевших не менее 2 клинических симптомов и 2 лабораторных признаков в соответствии с критериями оценки неонатального сепсиса (Европейское агентство по лекарственным средствам, 2010 г.) в сочетании с положительными результатами посева крови. Результаты. Общие клинические симптомы у новорожденных с сепсисом включали вялое сосание (89,4%), дыхательную недостаточность (69,4%), лихорадку (51,8%), тахикардию (52,8%) и шок (25%). Преобладали больные с анемией (72,9%). Больные с повышенным содержанием лейкоцитов составили 41,2%, с пониженным содержанием лейкоцитов — 15,4%, с тромбоцитопенией — 49,6%. У большинства пациентов был повышен СРБ (88,3%). Среднее значение пСБ64 составило 10167,1+6136,9 связанных молекул/клетку, шНЬА-БЯ — 9898,4+14173,9 связанных молекул/клетку. Индекс сепсиса составил 274,6+287,5. Выводы. Нами обнаружены различия в клинических характеристиках и лабораторных показателях у доношенных новорожденных с сепсисом в Национальной детской больнице. Следует дополнительно исследовать показатели пСБ64, шНЬА-БЯ и индекс сепсиса, которые можно рассматривать как возможные рутинные биомаркеры в диагностике неонатального сепсиса.
Ключевые слова: неонатальный сепсис, nCD64, mHLA-DR, индекс сепсиса, клинические симптомы, лабораторные признаки.
Introduction
According to a report by the World Health Organization (WHO), in 2019 globally, there were 2.4 million infant deaths, of which neonatal sepsis is one ofthe leading causes [26]. Surveys conducted worldwide in the period 1990—2017 estimated there were more than 25 million cases of sepsis, mainly neonates [22]. Another study in 13 countries and territories from 1979 to 2019 also showed that the infant mortality rate was 17.6%, being higher in low- and middle-income countries [27]. Sepsis is a life-threatening condition in response to an infectious agent, causing damage to tissues and organs. Sepsis causes serious consequences in neonates due to high rates of mortality, sequelae, and disability [17, 27]. Vietnam is a country in Southeast Asia featuring some of the highest infectious disease rates in the world, including high rates of infection, disability, and mortality [22]. This prospective study aimed to evaluate the clinical and laboratory characteristics of patients at the Vietnam National Children'sHospital to show the clearest and most complete picture of full-term neonatal sepsisin NorthernVietnam.
Materials and methods
Patients. A descriptive study was conducted of 85 full-term infants admitted to the Neonatal Center of Vietnam National Children's Hospital in the period from 12/2019 to 4/2021.
Selection criteria: term newborns with at least 2 clinical symptoms and 2 laboratory signs according to the criteria for assessment of neonatal sepsis of the European Medicines Agency in 2010 (EMA 2010) [21] along with positive blood culture results.
Exclusion criteria: major congenital anomaly, inborn errors of metabolism, neonates who have received blood transfusion.
Laboratory tests. On the first day of admission, blood samples were taken for complete analysis of blood cells, blood gases, liver and kidney function, blood sugar, C-reactive protein, and blood culture by routine laboratory tests. Neutrophil CD64 (nCD64) and monocyte HLA-DR (mHLA-DR) expression were evaluated by flow cytometry (Becton Dickinson, Mountain View, CA, USA) using a phycoerythrin (PE) fluorescence quantification kit (QuantiBRITE PE, Becton Dickinson) and calculated into phyco-erythrin molecules bound/cell. Sepsis Index (SI) was calculated from nCD64 and mHLA-DR values.
Statistical analysis. Results were analyzed with SPSS 20.0 statistical software (SPSS Inc, IL). The level of significance considered was 0.05. According to EMA 2010 criteria, we chosecut-offval-ues for CRP, WBC and PLT of 15 mg/L, 20 000/mm3 and 100 000/mm3, respectively.
Ethics statement. Conduct of the study was approved by the Medical Research Ethics Committee at the Vietnam National Children's Hospital according to Decision No. 332 (dated March 10, 2020).
Results
In theperiod from December 2019 to April 2021 at the Neonatal Center in Vietnam National Children's Hospital, 85 patients with positive blood culture results met the research criteria. Among them, 39 were girls (45.9%), and 46 were boys (54.1%). Other features were:average gestational age 38.6+1.1 weeks; average weight 2918.2+548 grams; and age average hospital admission 10.4+8.2 days.
Most of the children received frontline treatment 78/85 (91.8%). The majority of children received frontline antibiotics 73/85 (85.9%) and frontline mechanical ventilation. Other characteristics were: 31/85 (36.5%) children had central catheters; 43/85
children were born by caesarean section; and 9/85 mothers had fever around delivery. Time of onset of infection: 52/85 children had early onset of infection (< 7 days); 33/85 children had late onset of infection (> 7 days).
Discussion
Currently, the trend of early neonatal sepsis is decreasing, and the rate of late neonatal sepsis is increasing. A. van den Hoogen tracked data from 1978—2006. The rate of early sepsis decreased from 52.1% to 28.1%. In contrast, the rate of late sepsis increased from 11.4% to 13.9% [25]. This may be due to better management of pregnancy, the mother are vaccinated against Group B streptococcus avoid infecting the baby, or-maternalinfections are better managed.
The rate of children with fever accounted for 51.8%. Our results are similar to the results of A Sorsa in Ethiopia with the rate of 47.5% of full-term infants with sepsis having fever, but higher than the rate of 23.9% of infants with febrile illness in J. Davis's study [3, 23]. The rate of febrile children with severe infections (septicemia, meningitis, etc.) ranged from 6.3% to 28% [8].
Our rate of children with hypoxemia was higher than that of A. Sorsa (34%) [23]. In our study, 21.2% of children with rales showed damage due to bron-chopneumonia or pneumonia, so many children had rapid breathing.
Tachycardia is the most common symptom (51.8%), especially in 1/3 children with septic shock and capillary refill times > 3 seconds. Tachycardia is a common finding in neonatal sepsis, but is not specific. In our study, many children's fever may be the cause affecting the rate of tachycardia. Poor perfusion and hypotension are often detected late. The rate of these two symptoms in our study was 25/85 (29.4%), equivalent to the research results of B.J. Stoll [24].
Poor feeding was the most common digestive symptom, accounting for 92.9%. Abdominal distention and diarrhea accounted for 43.5% and 2.4%. The study of M.S. Edwards showed that gastrointestinal symptoms presented with the rates of: jaundice 35%, hepatomegaly 33%, poor appetite 28%, vomit-
Table 1. Clinical characteristics of the study group
(n = 85)
Parameter Number Percentage
Rapid breathing 30 35.3
Apnea > 20 seconds 4 4.7
SpO2 < 85% 64 75.3
Rales 18 21.2
Tachycardia 44 51.8
Shock 24 29.4
Refill > 3 seconds 25 29.4
Mottled skin 19 22.4
Oliguria 15 17.6
Hypotension 13 15.3
Poor sucking 79 92.9
Delayed gastric emptying 60 70.6
Abdomen distention 37 43.5
Diarrhea 2 2.4
Lethargy 25 29.4
Seizures 2 2.4
Hypertonic 2 2.4
Hypotonic 1 1.2
Scleroderma 17 20.0
Petechiae 15 17.6
Jaundice 10 11.8
Abscess 3 3.5
Boil 3 3.5
Skin necrosis 2 2.4
Rash 2 2.4
Purulent dermatitis 1 1.2
ing 25%, abdominal distention 17%, and diarrhea 11% [6].
Neurological symptoms in our study were mainly lethargy. In V. Anand's study, 38% of neonates with sepsis had seizures [1]. L. Pugni, evaluating a group of neonates with severe sepsis, showed common neurological symptoms including 56% hypotonicity, 56% lethargy, and 3.9% seizures [19].
The mean Hct of the study group was 40.3+7.3%, and 72.9% of children were anemic. Our rate of children with anemia is lower than that of N. Cai (84.9%) [2]. Anemia is one of the common conditions in neonatal sepsis.
Table 2. Peripheral blood count and CRP (n = 85)
Parameter X±SD Increase (n, %) Decrease (n, %) Normal (n, %)
White blood cell, x 109 cells/L 16.78±10.31 (2.15-54.98) 35 (41.2) 13 (15.4) 37 (43.5)
Platelet, x 109 cells/L 21.17±20.44 (4-77.3) 0 42 (49.6) 43 (50.4)
Hct, % 40.3±7.3 23 (27.1) 62 (72.9) 0
CRP, mg/L 84.2±76.8 75 (88.3) 0 10 (11.7)
Table 3. Coagulation (n = 80)
X±SD Increased (n, %) Reduced (n, %) Normal (n, %)
Prothrombin, % 65.5±26.2 0(0.0) 48 (60) 32 (40)
APTT, second 47.5±23.3 46 (57.2) 34 (42.8)
Fib, second 3.5±1.5 40 (50) 40 (50)
Table 4. Blood biochemical index (n = 85)
X±SD (mmol/L) Increased (n, %) Reduced (n, %) Normal (n, %)
Na+ 134.3±5.2 5 (4.6) 42 (50.1) 38 (45.3)
K+ 4.6±1.4 33 (38.2) 8(9.5) 44 (52.3)
Glucose 5.6±5.1 20 (23.6) 2 (2.3) 63 (74.1)
GOT 511.7±185.3 39 (45.2) 46 (54.8)
GPT 272.2±89.6 18 (20.6) 67 (79.4)
Urea 29.5±5.1 18 (20.6) 67 (79.4)
Creatinin 76.7±42.8 25 (28.8) 60 (71.2)
Albumin 7.9±6.6 50 (58.8) 35 (41.2)
Table 5. Blood gas indices (n = 51)
X±SD (mmol/L) Increased (n, %) Reduced (n, %) Normal (n, %)
pH 7.4±1.24 1 (2.0) 35 (68.6) 15 (29.4)
BE -6.8±8.1 24 (74.1) 27 (25.9)
Lactate 5.1±3.7 46 (90.1) 5(9.9)
Our study showed 41.2% of children with increased white blood cells (> 20 x 109 cells/L) and 15.4% of children with reduced white blood cells (< 4 x 109 cells/L). Newman and Hornik showed that low white blood cell counts were more strongly associated with early sepsis in premature infants than in term infants, especially after 4 hours of age. The author also found that white blood cell counts have diagnostic value in early-onset sepsis rather than late-onset [10, 15].
Platelet values in our results were higher than in the study of I.M.C. Ree. The proportion of children with platelets < 150 x 109 cells/L accounted for 49%. Platelet reduction < 100 x 109 cells/L accounted for 39%. The rate of platelets < 150 x 109/L in neonatal sepsis due to Gram-negative bacteria was 69%. For Gram-positive bacteria it was 47% [20].
The average CRP concentration was 84.2± 76.8 mg/L. Most patients had CRP increased above 15 mg/L (88.3%). The study of A. Sorsa showed that CRP > 20 mg/L increased the risk of sepsis by 5.7fold compared with the group with negative blood cultures [23]. However, J.R. Delanghe suggested that CRP has low sensitivity to detect early-onset sepsis due to the physiological increase in CRP in 3 days postpartum [4]. Elevated CRP may also be caused by non-infectious inflammatory processes, such as meconium aspiration. Therefore, CRP should be combined with other indices (such as nCD64, IL-6 or IL-8) to increase diagnostic value.
In our study, 60% of children had low prothrom-bin. Coagulation disorder is a serious and common complication in neonatal sepsis. We had a low rate of children with severe electrolyte disturbances (Na+ < 125 mmol/L, K+ > 14.2 mmol/L). These
Table 6. nCD64, mHLA-DR, and Sepsis Index (n = 85)
Index X±SD
nCD64(ABC) 10 167.1±6136.9 (1198-32 965)
mHLA-DR (ABC) 9898.4±14 173.9 (434-96 881)
Sepsis Index 274.6±287.5 (18.7-1376.8)
Note. ABC — aantibody-phycoerythrin molecules bound/cell.
were cases of septic shock and death. Research by M.S. Ahmad on a group of neonates with septic shock showed that the rate of children with electrolyte disorders was up to 75.5%; hyperkalemia was the most common electrolyte disorder (39%). The author also showed a strong association between electrolyte disturbances and mortality in children, wherein all children who died had electrolyte disturbances [4].
We also encountered a low rate of children with renal failure with urea > 200 mmol/L and liver damage with GOT > 2000 UI/L. The study of N.B. Mathur showed that the rate of acute renal failure in neonate with septicemia was 6,5%, and the mortality rate of acute renal failure was 30.7% [12].
Most children had mild metabolic acidosis, but the range was also very wide with: pH = 7.24+1.24 (6.91-7.46) and BE = -6.8+8.1 mEq/L (-22-15). Children with severe metabolic acidosis (pH < 7) and disturbances in major blood gas indices (lactate > 15) are children with unrecoverable septic shock. Blood gas abnormalities are common in neonates treated in the neonatal intensive care unit and are associated with increased mortality. The study by M. Mohammad Yusuf showed that: the mortality group had a lower blood pH (7.3+0.19) than the alive group (7.36+0.1); and the BE of the mortality group was lower (-10.74+15.89 mmol/L) than the live group (-4.3+6.88 mmol/L) [14].
nCD64 had an average value of 10167.1 molecules bound/cell in our study. N. Efe Iris studied adult patients and showed that the sepsis group had an average nCD64 index of 8006 molecules bound/cell, significantly higher than the control group (average nCD64 of 2786 molecules bound/cell). The cut-off value of nCD64 of 2500 molecules bound/cell is considered to have diagnostic value for sepsis in adults, with a sensitivity of 94.1% [7]. P.C. Ng's study showed that the value of nCD64 was not high. The averages in the neonate infected group at the 1st and 24th hour were: 8320 molecules bound/cell and 9704 molecules bound/cell, respectively. These werehigher
than the non-infected group for thelsthour and 24th hour: 3915 molecules bound/celland 4491 molecules bound/cell, respectively.
In the control group (healthy children), nCD64 had an average value of 3426 molecules bound/cell [16]. The nCD64 valuesin premature infants were also very different in the sepsis group, non-sepsis group, and healthy children in J. Du's study The sepsis group had an average nCD64 of 2869.67 molecules bound/ cell, while the healthy group of children had an average of 1610.80 molecules bound/cell (p = 0.0001) [5].
mHAL-DR had an average value of 9898.4 molecules bound/cell, equivalent to 32.4% of the value of healthy children. In the study of T.F. Manzoli, areduction in mHLA-DR (< 30% compared with the control group) was a predictor of mortality in the first week of admission [11]. C. Meisel showed that all patients with severe sepsis had mHLA-DR < 8000 molecules bound/cell [13]. S. Tamulyte's study determined that mHLA-DR thresholds (< 8000/< 5000/< 2000 molecules bound/cell) are levels that predict the severity of the patient's condition independent of disease etiology. mHLA-DR values of 2000 molecules bound/cell and 5000 molecules bound/cell were predictive of: longer stay in the intensive care unit; duration of mechanical ventilation and antibiotic therapy; as well as higher microbiological pathogen concentrations.
In our study, the sepsis index (SI) had an average value of 274.6+287.5 (18.7-1376.8). S. Goswami's study of nCD64 and mHLA-DR by mean fluorescence concentration (MFI) also showed that nCD64 was sig-
References
nificantly increased in the sepsis group compared with the healthy group (p < 0.05), but mHLA-DR was decreased. We found significant difference in the sepsis group and the non-infectious group [9]. The mean value of SI in the group of adult patients with trauma of Ngoc Thao was 112.95 (46.16-270.66). Our results are higher because our patients are full-term infants [18].
Conclusion
In summary, we found that common clinical symptoms in neonates with sepsis included poor feeding (89.4%), respiratory failure (69.4%), fever (51.8%), tachycardia (52.8%), shock (25%), and anemic (72.9%). Increased white blood count accounted for 41.2%; low white blood count accounted for 15.4%. In patients, 49.6% had thrombocytopenia. Most patients had elevated CRP (88.3%). The mean value of nCD64 was 10 167.1+6136.9 molecules bound/cell. mHLA-DR was 9898.4+14 173.9 molecules bound/ cell. Sepsis Index was 274.6+287.5.
Conflict of interest
We declare that we have no conflict of interest.
Acknowledgements
We would like to thank the DM Tran Thi Hong Ha who supported apart of this study. We also thank our colleagues at Vietnam National Children's Hospital for collaboration and assistance.
1. Anand V., Nair P.M. Neonatal seizures: predictors of adverse outcome. J. Pediatr. Neurosci, 2014, vol. 9, no. 2, pp. 97—99. doi: 10.4103/1817-1745.139261
2. Cai N., Fan W., Tao M., Liao W. A significant decrease in hemoglobin concentrations may predict occurrence of necrotizing enterocolitis in preterm infants with late-onset sepsis. J. Int. Med. Res., 2020, vol. 48, no. 9: 300060520952275. doi: 10.1177/0300060520952275
3. Davis J., Lehman E. Fever characteristics and risk of serious bacterial infection in febrile infants. J. Emerg. Med., 2019, vol. 57, no. 3,pp. 306-313. doi: 10.1016/j.jemermed.2019.06.028
4. Delanghe J.R., Speeckaert M.M. Translational research and biomarkers in neonatal sepsis. Clin. Chim. Acta, 2015, vol. 451, pt A, pp. 46-64. doi: 10.1016/j.cca.2015.01.031
5. Du J., Li L., Dou Y., Li P., Chen R., Liu H. Diagnostic utility of neutrophil CD64 as a marker for early-onset sepsis in preterm neonates. PLoS One, 2014, vol. 9, no. 7: e102647. doi: 10.1371/journal.pone.0102647
6. Edwards M.S., Kaplan S.L., Garcia-Prats J.A. Clinical features and diagnosis of sepsis in term and late preterm infants. In: Basow D.S. (ed.), UpToDate. UpToDate, Waltham, MA. URL: http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-sepsis-in-term-and-late-preterm-infants?source=search_result&search =neonatal+sepsis&selectedTitle=1~58 (09/07/2021)
7. Efe iris N., Yildirmak T., Gedik H., §im§ek F., Aydin D., Demirel N., Yoku§ O. Could neutrophil CD64 expression be used as a diagnostic parameter of bacteremia in patients with febrile neutropenia? Turk. J. Haematol., 2017, vol. 34, no. 2, pp. 167-173. doi: 10.4274/tjh.2016.0123
8. Geskey J.M., Beck M.J., Brummel G.L. Neonatal fever in the term infant: evaluation and management strategies. Curr. Pediatr. Rev., 2008, vol. 4, no. 2, pp. 84-95. doi: 10.2174/157339608784462052
9. Goswami S., Gupta R., Ramji S. Flow cytometry: an important diagnostic tool in critically ill preterm neonates with suspected sepsis. Am. J. Perinatol., 2022, vol. 39, no. 6,pp. 616-622. doi: 10.1055/s-0040-1718370
10. Hornik C.P., Benjamin D.K., Becker K.C., Benjamin D.K. Jr., Li J., Clark R.H., Cohen-Wolkowiez M., Smith P.B. Use of the complete blood cell count in late-onset neonatal sepsis. Pediatr. Infect. Dis. J, 2012, vol. 31, no. 8, pp. 803-807. doi: 10.1097/ INF. 0b 013e31825691e4
11. Manzoli T.F., Troster E.J., Ferranti J.F., Sales M.M. Prolonged suppression of monocytic human leukocyte antigen-DR expression correlates with mortality in pediatric septic patients in a pediatric tertiary Intensive Care Unit. J. Crit. Care, 2016, vol. 33, pp. 84-89. doi: 10.1016/j.jcrc.2016.01.027
12. Mathur N.B., Agarwal H.S., Maria A. Acute renal failure in neonatal sepsis. Indian J. Pediatr., 2006, vol. 73, no. 6, pp. 499—502. doi: 10.1007/BF02759894
13. Meisel C., Schefold J.C., Pschowski R., Baumann T., Hetzger K., Gregor J., Weber-Carstens S., Hasper D., Keh D., Zuckermann H., Reinke P., Volk H.D. Granulocyte-macrophage colony-stimulating factor to reverse sepsis-associated immunosuppression: a double-blind, randomized, placebo-controlled multicenter trial. Am. J. Respir. Crit. Care Med., 2009, vol. 180, no. 7, pp. 640-648. doi: 10.1164/rccm.200903-03630C
14. Mohammad Yusuf M., Chowdhury M.A. Correlation ofblood gas status with the mortality of neonates admitted in ICU. Northern Int. Med. Coll. J., vol. 9, no. 1, pp. 261-263.
15. Newman T.B., Puopolo K.M., Wi S., Draper D., Escobar G.J. Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics, 2010, vol. 126, no. 5, pp. 903-909. doi: 10.1542/peds.2010-0935
16. Ng P.C., Li G., Chui K.M., Chu W.C., Li K., Wong R.P., Chik K.W., Wong E., Fok T.F. Neutrophil CD64 is a sensitive diagnostic marker for early-onset neonatal infection.PediatrRes., 2004, vol. 56,no. 5,pp. 796-803.doi: 10.1203/01.PDR.0000142586.47798.5E
17. Pek J.H., Yap B.J., Gan M.Y., Seethor S.T.T., Greenberg R., Hornik C.P.V., Tan B., Lee J.H., Chong S.L. Neurocognitive impairment after neonatal sepsis: protocol for a systematic review and meta-analysis. BMJ Open, 2020, vol. 10, no. 6: e038816. doi: 10.1136/bmjopen -2020-038816
18. Pham Thi Ngoc Thao, Nguyen Ly Minh Duy, Tran Thanh Tung, Pham Van Loi, Le Hung Phong, Trang Hong Thuy Duong. The value of sepsis index (Neutrophil CD64/Monocyte HLA-DR expression) in sepsis/septic shock patients. HCM City Journal of Vietnamese Medicine, 2020, vol. 24 (suppl.), no. 2, pp. 138-144.
19. Pugni L., Ronchi A., Bizzarri B., Consonni D., Pietrasanta C., Ghirardi B., Fumagalli M., Ghirardello S., Mosca F. Exchange transfusion in the treatment of neonatal septic shock: a ten-year experience in a neonatal intensive care unit. Int. J. Mol. Sci., 2016, vol. 17, no. 5: 695. doi: 10.3390/ijms17050695
20. Ree I.M.C., Fustolo-Gunnink S.F., Bekker V., Fijnvandraat K.J., Steggerda S.J., Lopriore E. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One, 2017, vol. 12, no. 10: e0185581. doi: 10.1371/journal.pone.0185581
21. Report on the Expert Meeting on Neonatal and Paediatric Sepsis, 8 June 2010. European Medicines Agency. URL: https://www. ema.europa.eu/en/documents/report/report-expert-meeting-neonatal-paediatric-sepsis_en.pdf (09/07/2021)
22. Rudd K.E., Johnson S.C., Agesa K.M., Shackelford K.A., Tsoi D., Kievlan D.R., Colombara D.V., Ikuta K.S., Kissoon N., Finfer S., Fleischmann-Struzek C., Machado F.R., Reinhart K.K., Rowan K., Seymour C.W., Watson R.S., West T.E., Marinho F., Hay S.I., Lozano R., Lopez A.D., Angus D.C., Murray C.J.L., Naghavi M. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet, 2020, vol. 395, no. 10219, pp. 200-211. doi: 10.1016/S0140-6736(19)32989-7
23. Sorsa A. Epidemiology of neonatal sepsis and associated factors implicated: observational study at neonatal intensive care unit of Arsi university teaching and referral hospital, South East Ethiopia. Ethiop. J. Health. Sci., 2019, vol. 29, no. 3, pp. 333-342. doi: 10.4314/ejhs. v29i3.5
24. Stoll B.J., Hansen N.I., Sánchez P.J., Faix R.G., Poindexter B.B., Van Meurs K.P., Bizzarro M.J., Goldberg R.N., Frantz ID 3rd, Hale E.C., Shankaran S., Kennedy K., Carlo W.A., Watterberg K.L., Bell E.F., Walsh M.C., Schibler K., Laptook A.R., Shane A.L., Schrag S.J., Das A., Higgins R.D.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics, 2011, vol. 127, no. 5, pp. 817-826. doi: 10.1542/peds.2010-2217
25. Van den Hoogen A., Gerards L.J., Verboon-Maciolek M.A., Fleer A., Krediet T.G. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology, 2010, vol. 97, no. 1, pp. 22-28. doi: 10.1159/000226604
26. WHO. Newborns: improving survival and well-being. URL: https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality (06.07.2021)
27. WHO. Shining a spotlight on maternal and neonatal sepsis: World Sepsis Day, 2017. URL: http://www.who.int/reproductivehealth/ topics/maternal_perinatal/world-sepsis-day/en (06.07.2021)
Авторы:
Нгуен Т.Б., д.м.н., зам. зав. гематологическим отделением Вьетнамской национальной детской больницы, Ханой, Вьетнам; Ханойский медицинский университет, Ханой, Вьетнам; Нгуен Т.Н.Т., д.м.н., отделение общей медицины Вьетнамской национальной детской больницы, Ханой, Вьетнам; Данг Т.Х., врач гематологического отделения Вьетнамской национальной детской больницы, Ханой, Вьетнам; Нгуен Б.Н., доктор медицины, отделение гематологии Вьетнамской национальной детской больницы, Ханой, Вьетнам; Чыонг Т.М.Х., профессор, д.м.н., отделение неотложной помощи Вьетнамской национальной детской больницы, Ханой, Вьетнам;
Ле Т.Х., менеджер неонатального центра Вьетнамской национальной детской больницы, Ханой, Вьетнам; Ле Н.Д., зав. отделением неотложной помощи Вьетнамской национальной детской больницы, Ханой, Вьетнам.
Поступила в редакцию 02.01.2022 Отправлена на доработку 19.02.2022 Принята к печати 07.04.2022
Authors:
Nguyen T.B., PhD, MD, Deputy Head of Hematology Department, Vietnam National Children's Hospital, Hanoi City, Vietnam; Hanoi Medical University, Hanoi City, Vietnam; Nguyen T.N.T., PhD, MD, General Department, Vietnam National Children's Hospital, Hanoi City, Vietnam;
Dang T.H., MD, Hematology Department, Vietnam National Children's Hospital, Hanoi City, Vietnam;
Nguyen B.N., MD, Hematology Department, Vietnam National Children's Hospital, Hanoi City, Vietnam;
Truong T.M.H., Professor, PhD, MD, Emergency Department, Vietnam National Children's Hospital, Hanoi City, Vietnam; Le T.H., Manager of Neonatal Center, Vietnam National Children's Hospital, Hanoi City, Vietnam;
Le N.D., Head of Emergency Department, Vietnam National Children's Hospital, Hanoi City, Vietnam.
Received 02.01.2022 Revision received 19.02.2022 Accepted 07.04.2022
