Diagnostics of septic myocardial dysfunction in neonates
DOI:
https://doi.org/10.15574/SP.2022.125.19Keywords:
neonate, neonatal sepsis, septic myocardial dysfunctionAbstract
Neonatal sepsis (NS) continues to be the one of the major problems in neonatal practice. This is due to the variability of clinical manifestations and, in part, the lack of available diagnostic markers that are significantly associated with mortality as a result of neonatal sepsis.
The purpose - to study the role of paraclinical markers of myocardial dysfunction in neonates with sepsis.
Materials and methods. To achieve this goal, 87 newborns (the main group) with manifestations of a generalized infectious-inflammatory process were under our observation. The control group included 30 newborns, in which infectious and inflammatory diseases were refuted. Examination and treatment of patients with NS was carried out in accordance with modern international guidelines and recommendations.
Results and discussion. Based on a comprehensive clinical and paraclinical examination of neonates of the main group, it was found that 25 (28.7%) newborns suffered from early sepsis, respectively, the remaining 62 (71.3%) patients had late NS. According to the severity of the condition, 76 (87.4%) children of the main group included in the study required intensive care, which was provided in the neonatal intensive care unit. The average value of procalcitonin in the main observation group was 2.53±0.33 ng/ml, respectively, in the control group - 0.24±0.04 ng/ml (p<0.05). The mean values of creatine phosphokinase, MB fraction and troponin I in the main observation group were 58.44±2.39 U/l and 0.33±0.05 ng/ml, respectively, in the control group - 41.74±2.45 U/l and 0.04±0.01 ng/ml (p<0.05).
Conclusions. Generalized infectious-inflammatory process in neonates is accompanied by increased activity of cardiotropic biochemical markers.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children’s parents was obtained for the research.
No conflict of interests was declared by the authors.
References
Adams-Chapman I, Heyne RJ, DeMauro SB et al. (2018). Follow-up Study of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental impairment among extremely preterm infants in the Neonatal Research Network. Pediatrics. 141 (5): e20173091. https://doi.org/10.1542/peds.2017-3091; PMid:29666163 PMCid:PMC5914487
Beesley SJ, Weber G, Sarge T, Nikravan S, Grissom CK, Lanspa MJ, Shahul S, Brown SM. (2018, Apr). Septic Cardiomyopathy. Crit Care Med. 46 (4): 625-634. https://doi.org/10.1097/CCM.0000000000002851; PMid:29227368
Bezkaravajnyj BA, Solov'eva GA, Kaminskaja DV. (2010). Funkcional'noe sostojanie serdechno-sosudistoj sistemy u novorozhdennogo s gemoliticheskoj bolezn'ju. Zdorov'e rebenka. 4: 118-119.
Besrukov LO, Vlasova ОV, Trekush EZ. (2020). Mathematical model of sepsis of newborn, whose parents lived in places of different environmental situation. Modern Pediatrics. Ukraine. 4 (108): 67-72. https://doi.org/10.15574/SP.2020.108.67
Brocklehurst P, Farrell B, King A et al, INIS Collaborative Group. (2011). Treatment of neonatal sepsis with intravenous immune globulin. N Engl J Med. 365 (13): 1201-1211. https://doi.org/10.1056/NEJMoa1100441; PMid:21962214
Collinson PO, Gaze DC. (2007). Pathophysiology of sepsis-induced myocardial dysfunction. Biomarkers of cardiovascular damage and dysfunction - an overview. Heart Lung Circ. 16 (3): S71-S82. https://doi.org/10.1016/j.hlc.2007.05.006; PMid:17618829
Denning NL, Aziz M, Diao L, Prince JM, Wang P. (2020). Targeting the eCIRP/TREM-1 interaction with a small molecule inhibitor improves cardiac dysfunction in neonatal sepsis. Mol Med. 26 (1): 121. https://doi.org/10.1186/s10020-020-00243-6; PMid:33276725 PMCid:PMC7716442
Dorling J, Abbott J, Berrington J et al, SIFT Investigators Group. (2019). Controlled trial of two incremental milk-feeding rates in preterm infants. N Engl J Med. 381 (15): 1434-1443. https://doi.org/10.1056/NEJMoa1816654; PMid:31597020
Drosatos K et al. (2015). Pathophysiology of sepsis-induced myocardial dysfunction. Pathophysiology of sepsis-related cardiac dysfunction: driven by inflammation, energy mismanagement, or both? Curr Heart Fail Rep. 12: 130-140. https://doi.org/10.1007/s11897-014-0247-z; PMid:25475180 PMCid:PMC4474734
ELFIN trial investigators group. (2019). Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial. Lancet. 393 (10170): 423-433. https://doi.org/10.1016/S0140-6736(18)32221-9
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. (2018, Mar). The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 6 (3): 223-230. https://doi.org/10.1016/S2213-2600(18)30063-8
Greenberg RG, Kandefer S, Do BT et al, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. (2017). Late-onset sepsis in extremely premature infants: 2000-2011. Pediatr Infect Dis J. 36 (8): 774-779. https://doi.org/10.1097/INF.0000000000001570; PMid:28709162 PMCid:PMC5627954
Ivanova OI, Grigoriev EV. (2020). Diagnostic markers of early neonatal sepsis - limitations and perspectives. Messenger of Anesthesiology and resuscitation. 17 (6): 72-79. https://doi.org/10.21292/2078-5658-2020-17-6-72-79
Klymenko TM, Kosenko KO. (2019). Predicting the course of early onset neonatal sepsis in pretern infants. Modern Pediatrics. Ukraine. 8 (104): 19-23. https://doi.org/10.15574/SP.2019.104.19
Li J, Ning B, Wang Y, Li B, Qian J, Ren H, Zhang J et al. (2019). The prognostic value of left ventricular systolic function and cardiac biomarkers in pediatric severe sepsis. Medicine. 98 (13): e15070. https://doi.org/10.1097/MD.0000000000015070; PMid:30921240 PMCid:PMC6456134
Lv X, Wang H Mil. (2016). Pathophysiology of sepsis-induced myocardial dysfunction. Med Res. 3: 30. https://doi.org/10.1186/s40779-016-0099-9; PMid:27708836 PMCid:PMC5037896
Martin L et al. (2019). Pathophysiology of sepsis-induced myocardial dysfunction. The septic heart: current understanding of molecular mechanisms and clinical implications. Chest. 155: 427-437. https://doi.org/10.1016/j.chest.2018.08.1037; PMid:30171861
Matics TJ, Sanchez-Pinto LN. (2017). Adaptation and Validation of a Pediatric Sequential Organ Failure Assessment Score and Evaluation of the Sepsis-3 Definitions in Critically Ill Children. JAMA Pediatr. 171 (10): e172352. https://doi.org/10.1001/jamapediatrics.2017.2352; PMid:28783810 PMCid:PMC6583375
Narogan MV, Bazhenova LK, Kapranova EI, Mel'nikova EV, Belousova NA. (2007). Postgipoksicheskaja disfunkcija serdechno-sosudistoj sistemy u novorozhdennyh detej. Voprosy sovremennoj pediatrii. 6 (3): 42-46.
National Institute for Health and Care Excellence. (2016). Sepsis: recognition, diagnosis and early management. URL: https://www.nice.org.uk/guidance/ng51.
National Institute for Health and Care Excellence. (2021). Neonatal infection: antibiotics for prevention and treatment. URL: https://www.nice.org.uk/guidance/ng195.
Rand KM, Austin NC, Inder TE, Bora S, Woodward LJ. (2016). Neonatal infection and later neurodevelopmental risk in the very preterm infant. J Pediatr. 170: 97-104. https://doi.org/10.1016/j.jpeds.2015.11.017; PMid:26707582
Seymour CW, Liu VX, Iwashyna TJ et al. (2016). Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 315 (8): 762-774. https://doi.org/10.1001/jama.2016.0288; PMid:26903335 PMCid:PMC5433435
Shane AL, Stoll BJ. (2014, Jan). Neonatal sepsis: progress towards improved outcomes. J Infect. 68 (1): S24-32. https://doi.org/10.1016/j.jinf.2013.09.011; PMid:24140138
Singer M, Deutschman CS, Seymour CW et al. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 315 (8): 801-810. https://doi.org/10.1001/jama.2016.0287; PMid:26903338 PMCid:PMC4968574
Stoll BJ, Hansen NI, Adams-Chapman I et al, National Institute of Child Health and Human Development Neonatal Research Network. (2004). Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 292 (19): 2357-2365. https://doi.org/10.1001/jama.292.19.2357; PMid:15547163
Stoll BJ, Hansen NI, Bell EF et al, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. (2015). Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 314 (10): 1039-1051. https://doi.org/10.1001/jama.2015.10244; PMid:26348753 PMCid:PMC4787615
Stoll BJ, Hansen N, Fanaroff AA et al. (2002). Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 110 (2; 1): 285-291. https://doi.org/10.1542/peds.110.2.285; PMid:12165580
Tarnow-Mordi W, Morris J, Kirby A et al, Australian Placental Transfusion Study Collaborative Group. (2017). Delayed versus immediate cord clamping in preterm infants. N Engl J Med. 377 (25): 2445-2455. https://doi.org/10.1056/NEJMoa1711281; PMid:29081267
Wheeler DS, Wong HR, Zingarelli B. (2011, Oct 7). Pediatric Sepsis - Part I: Children are not small adults! Open Inflamm J. 4: 4-15. https://doi.org/10.2174/1875041901104010004; PMid:23723956 PMCid:PMC3665507
Wynn JL, Polin RA. (2020). A neonatal Sequential Organ Failure Assessment score predicts mortality to late-onset sepsis in preterm very low birth weight infants. Pediatr Res. 88 (1): 85-90. https://doi.org/10.1038/s41390-019-0517-2; PMid:31394566 PMCid:PMC7007331
Wynn JL, Wong HR, Shanley TP, Bizzarro MJ, Saiman L, Polin RA. (2014). Time for a neonatal-specific consensus definition for sepsis. Pediatr Crit Care Med. 15 (6): 523-528. https://doi.org/10.1097/PCC.0000000000000157; PMid:24751791 PMCid:PMC4087075
Zhelev VA, Baranovskaya SV, Mikhalev YV, Filippov GP, Serebrov VYu, Yermolenko SP, Popova YuYu. (2007). Pathophysiology of sepsis-induced myocardial dysfunction. Clinical-biochemical markers of myocardial lesions in premature neonates. Bulletin of Siberian Medicine. 6 (4): 86-90. https://doi.org/10.20538/1682-0363-2007-4-86-90
Znamenska TK. (2021). Neonatalnyi sepsys: sytuatsiia v sviti ta v Ukraini. On-lain konferentsiia «Sepsys u novonarodzhenykh: suchasnyi pohliad na problemu»: Kyiv.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
