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  • 1.
    Ohlin, Andreas
    et al.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Bäckman, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Ewald, Uwe
    Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Björkqvist, Maria
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Diagnosis of neonatal sepsis by broad-range 16S real-time polymerase chain reaction2012In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 101, no 4, p. 241-246Article in journal (Refereed)
    Abstract [en]

    Background: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity and specificity, and 16S polymerase chain reaction (PCR) has been suggested as a new diagnostic tool for neonatal sepsis. Objectives: To develop and evaluate a new real-time PCR method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Methods: Immediately after blood culture, a study sample of 0.5–1.0 ml whole blood was collected and used for a novel 16S real-time PCR assay. All positive samples were sequenced. Detailed case studies were performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis. Results: 368 samples from 317 infants were included. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. Seven of the 31 samples with a positive PCR result and a negative blood culture had definite or suspected bacterial sepsis. In five samples, PCR (but not blood culture) could detect a pathogen that was present in a blood culture collected more than 24 h prior to the PCR sample. Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even after the initiation of intravenous antibiotics.

  • 2.
    Wikström, Sverre
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Hövel, Holger
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hansen Pupp, Ingrid
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Fellman, Vineta
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hüppi, Petra S.
    Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
    Ley, David
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hellström-Westas, Lena
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Early Electroencephalography Suppression and Postnatal Morbidities Correlate with Cerebral Volume at Term-Equivalent Age in Very Preterm Infants2018In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 113, no 1, p. 15-20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Early brain activity is associated with long-term outcome. Establishing a relation also with postnatal brain growth may increase our understanding of early life influences on preterm brain development.

    OBJECTIVES: The aim of this study was to investigate whether early electroencephalography (EEG) activity in infants born very preterm is associated with brain volumes at term, and whether postnatal morbidity affects this association.

    METHODS: Very preterm infants (n = 38) with a median gestational age (GA) of 25.6 weeks had early recordings of single-channel EEG. The percentage of suppressed EEG, i.e., interburst intervals (IBI%) between 24 and 72 h of age, was analyzed in relation to brain volumes on magnetic resonance imaging performed at term-equivalent age, taking into account neonatal morbidities.

    RESULTS: Early electrocortical depression and a higher IBI% were associated with increased cerebrospinal fluid volume (CSFV) and lower total brain volume relative to intracranial volume, also after adjustment for GA, postnatal morbidities, morphine administration, and postnatal head growth. Overall, an increase in IBI% to 1 SD from the mean corresponded with an increase in CSFV to +0.7 SD and a decrease in brain volume to -0.7 SD. The presence of 2 or more postnatal morbidities were associated with around 10% lower brain volumes.

    CONCLUSIONS: More suppressed early EEG activity of very preterm infants is associated with lower brain volume and increased CSFV at term age, also when adjusting for postnatal morbidities. The findings indicate the importance of pre- and early postpartal determinants of postnatal brain growth, possibly also including activity-dependent mechanisms for brain growth.

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