kkmalaysia 
|
 |
« on: November 22, 2010, 12:28:28 pm » |
|
Two biomarkers that identify sepsis and intestinal damage in preterm infants could help doctors avoid unnecessary antibiotic treatments and may become important predictors for the lethal conditions.
Late onset (>72 hours) of both sepsis and necrotizing enterocolitis is associated with short bowel syndrome, liver disease, poor neurodevelopment and death in some cases.
However, the warning signs for these diseases, such as fever, are often non-specific and inconspicuous, and there are no effective tests to confirm diagnosis. For example, blood cultures for sepsis may require 48 hours of incubation, after which false negatives are still possible.
“There is no good way to diagnose [these],” said lead researcher Associate Professor Terrence Poon, of the Department of Pediatrics at the Chinese University of Hong Kong. “Once a baby has a symptom on the first day, we can pick up about 45 percent of cases… But we never want to miss a case.”
A case-control study has identified two proteins, proapolipoprotein CII (Apo) and serum amyloid A (SAA), that indicate the potential presence of sepsis (whole-body infection) and necrotizing enterocolitis (bowel tissue death), respectively. These proteins were found in plasma samples taken upon symptom presentation in 77 infants with sepsis or necrotizing enterocolitis and compared to 77 unaffected infants. [J Clin Invest doi:10.1172/JCI40196]
The biomarkers were validated from a prospective cohort study and a combined ApoSAA score was developed to categorize infants for treatment.
“Because we can never afford to lose a baby we treat all babies with antibiotics,” Poon said of current treatment practices.
However, he added that unnecessary antibiotic treatment risks building resistance in infants, especially when their immune system is not fully developed.
The negative predictive value of the ApoSAA score was 100 percent. Using the ApoSAA score, Poon said neonatologists were able to withhold antibiotic treatment treatment in 45 percent of non-sepsis cases at day 0 and 16 percent on day 1.
Positive predictive value in high risk cases was 75 percent, implying a false-positive rate of 25 percent.
“The excellent diagnostic performance of the ApoSAA score allows us to propose a strategy to clinically triage suspected late-onset sepsis/necrotizing enterocolitis infants… and to judiciously allocate resources by targeting those who truly require urgent treatment and intensive care,” the authors said. “This strategy could preclude over half of the true negative cases from receiving antibiotics unnecessarily or with very early stoppage of treatment.”
Source: Medical Tribune
|
