Fatty acid metabolism in newborns with sepsis; Report 1 — New clinical outcome prediction scale (original) (raw)
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Lipid Metabolic Disturbances in Severe Sepsis: Clinical Significance and New Methods of Correction
General Reanimatology, 2009
Цель исследования-выявить основные закономерности развития расстройств липидного обмена при тяжелом сепсисе и оценить эффективность парентерального применения новых сбалансированных липидных эмульсий у данной категории больных. Материал и методы. Проведено проспективное исследование у 88 больных с тяже лым сепсисом различной этиологии в ОРИТ Свердловской областной клинической больницы №1. Из показате лей липидного обмена оценивались холестерин и триглицериды (ТГ) в сыворотке крови, а также липопротеиды высокой плотности, низкой плотности и индекс атерогенности. Из маркеров системного воспаления и дополни тельных критериев тяжести сепсиса определяли сывороточные уровни С реактивного белка, оксида азота, лак тата, Д димеров, антивоспалительного цитокина IL 4 и провоспалительного цитокина IL 8. Забор сыворотки проводили на 1 е, 3 и, 5 е и 7 е сутки от момента поступления в ОРИТ. Сравнительный анализ количественных признаков проводили с помощью статистической программы «Statistica 6.0». Результаты. Выявлена тесная взаимосвязь между тяжестью состояния пациентов по шкале APACHE II, степенью выраженности ПОН по шка ле SOFA и степенью легочного повреждения по шкале MURREY c исходным уровнем триглицеридов сыворот ки крови у больных с тяжелым сепсисом. Полученные данные свидетельствуют о высокой реанимационной ле тальности у пациентов с высоким уровнем ТГ. Клиническая оценка эффективности нового метода коррекции расстройств липидного обмена при тяжелом сепсисе показала, что у больных, получавших сбалансированные (обогащенные омега 3 жирными кислотами), жировые эмульсии в виде 20% раствора Липоплюса выявлены низ кие показатели тяжести состояния по APACHE II в течение первых 7 суток интенсивной терапии и достоверно позитивная динамика ПОН по шкале SOFA. Выявлена специфическая динамика маркеров системного воспале ния: С реактивного протеина, IL 8 и IL 4-подтверждающая возможность воздействия на систему про и анти воспалительных медиаторов с помощью сбалансированных липидных эмульсий. Заключение. Исходно повы шенный уровень ТГ сыворотки крови можно рассматривать как дополнительный критерий тяжести сепсиса. Применение сбалансированных жировых эмульсий нового поколения в программе парентерального питания больных с тяжелым сепсисом позволяет уменьшить тяжесть состояния и выраженность ПОН, а также оказыва ет воздействие на систему про и антивоспалительных медиаторов. Ключевые слова: тяжелый сепсис, расстрой ства липидного обмена, сбалансированные жировые эмульсии. Objective: to reveal the basic regularities in the development of lipid metabolic disturbances in severe sepsis and to evaluate the efficiency of parenteral use of new balanced lipid emulsions in this cohort of patients. Subjects and methods. A prospective study was conducted in 88 patients with severe sepsis of different etiologies in the inten sive care unit (ICI), Sverdlovsk Regional Clinical Hospital One. Among the lipid metabolic parameters, serum cho lesterol, triglycerides (TG), high density lipoproteins, low density lipoproteins, and atherogenicity index were measured. Out of the systemic inflammatory markers and the additional criteria for sepsis severity, the serum lev els of C reactive protein, nitric oxide, lactate, D dimers, the anti inflammatory cytokine IL 4 and the proinflam matory cytokine IL 8 were determined. Serum was taken on days 1, 3, 5, and 7 after admission to the ICI. The quan titative attributes were comparatively analyzed by the statistical program «Statistica 6.0». Results. The severity assessed by the APACHE II scale, the degree of multiple organ failures (MOF) evaluated by the SOFA scale, and lung lesion according to the MURREY scale were found to be closely related to the baseline serum TG levels in patients with severe sepsis. The findings suggest that patients with high TG levels have much higher resuscitative Адрес для корреспонденции (Correspondence to
Reliable and questionable diagnostic criteria for early0onset sepsis
Ukrainian journal of Perinatology and Pediatrics, 2021
Neonatal sepsis is a significant cause of mortality among newborns, especially in low and middle income countries with poor economic development. It is important to start the appropriate treatment as soon as possible, as this prevents most deaths from sepsis and reduces the occurrence of residual neurological lesions due to septic meningitis. The article provides an overview of modern literature data on the principles of diagnosis of early neonatal sepsis; mentions the main etiological factors and ways of infection by potential pathogens. Diagnostic criteria for early neonatal sepsis have been analyzed and have been classified as doubt-ful or credible. An important role is given to the assessment of potential risk factors for the development of the septic process, including data on history of pregnancy and childbirth, clinical and laboratory indicators of the baby after birth. The nonspecificity of most clinical signs of sepsis and their comparison with clinical manifestations in me...
Fecal Calprotectin Levels Dynamics in Newborns with High-Risk of Necrotizing Enterocolitis
Pediatric pharmacology
Background. Necrotizing enterocolitis (NEC) is severe gastrointestinal disease in newborns, its early clinical symptoms are nonspecific. Fecal сalprotectin (Cp) is considered as one of the early biomarkers of NEC, thus, its use in newborns is poorly known.Objective. The aim of the study is to evaluate clinical significance of fecal Cp measuring as an early NEC marker in newborns. Methods. The prospective cohort observational study included high-risk newborns (gestational age (GA) ˂ 33 weeks and/or body weight ˂ 1500 g) and moderate risk newborns (GV≥ 33 weeks at suspicion on NEC) of NEC admitted to the neonatal intensive care unit on the 1st day of life. The Cp level was studied via immune colorimetric method on the 3rd and 7th days of life in high-risk children and in all children at NEC manifestation. All patients were divided into 2 main subgroups after the end of the follow-up period: newborns with developed NEC (a) and children without NEC (b). Obtained Cp values were compared ...
Russian Journal of Cardiology
Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death r...
Use of corticosteroids in the sepsis in pediatric patients updates (sepsis in children)
Serbian Journal of Anesthesia and Intensive Therapy
The specific characteristics of the pediatric population, the lack of evidence, as well as the small number of studies made treatment of septic shock in children one of the biggest challenges in intensive care units. The Surviving Sepsis Campaign issued in 2020 new guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. The first guide on this topic was published in 2004, and has been reviewed every four years since. Sepsis is a leading cause of healthcare utilization for children worldwide, and early recognition and appropriate management of children with sepsis and sepsis-associated organic dysfunction are crucial for the outcome. Although the new guidelines covered publications up to May 2017, this review also included some recently published studies. Following the innovations in this area, practical application and implementation of guidelines are important for the management of septic shock and sepsis-associated organ dysfunction in ch...
Особливості електролітного балансу в крові новонароджених із ураженням нирок на фоні асфіксії
2015
The study of the concentration of main electrolytes in serum of blood and erythrocytes in neonates with impaired renal function due to asphyxia is important, because it allows to determine violations of their content and balance, tactics of infusion and diuretic therapy. The purpose of the work is explore the features of the content and balance of electrolytes (sodium, potassium, calcium, magnesium) in serum and red blood cells of newborns with disturbance kidney function due to asphyxia. The study involved 200 term infants with signs of disturbance kidney function: 100 children who have suffered severe asphyxia, 100 childrenwith moderate asphyxia. Comparison group consisted of 20 infants without asphyxia at birth. The content of electrolytes determined by emission photometry, also expected ratios in pairs Na/K and Ca/Mg and transmembrane ratio of trace elements. The critical period of formation electrolyte imbalances in neonates with impaired renal function due to moderate asphyxia is the early neonatal period, in case of severe asphyxiaall neonatal period. The feature of ischemic renal impairment in newborns is the development of serum hypernatremia and hyperkalemia, hypocalcemia and hypomagnesemia, decrease the ratio of Na/K and increase Ca/Mg. Red blood cell pool of macroelements in case of neonatorum ischemic nephropathy is characterized by the growth of sodium level and deficiency of potassium, calcium and magnesium, as well as growth transmineralisation Na/K ratio and decrease Ca/Mg. Growth transmembrane ratios relative to sodium and magnesium reflects their transport into the cell, and reducing ratios relative potassium and calcium indicates the predominance of these electrolyte transport in the extracellular fluid. Changes in serum and intracellular electrolyte content and balance must be considered during infusion therapy in infants with impaired renal function due to asphyxia.
American Journal of Physiology-Gastrointestinal and Liver Physiology, 2020
Background: Necrotizing enterocolitis (NEC) is a manifestation of maladaptive intestinal responses in preterm infants centrally medicated by unattenuated inflammation. Early in the postnatal period, preterm infants develop a deficit in arachidonic and docosahexaenoic acid, both potent regulators of inflammation. We hypothesized that the fatty acid composition of parenteral lipid emulsions uniquely induces blood and intestinal fatty acid profiles which, in turn, modifies the risk of NEC development. Methods: 42 preterm pigs were randomized to receive one of three lipid emulsions containing 100% soybean oil (SO), 15% fish oil (MO15), or 100% fish oil (FO100) with enteral feedings over an 8-day protocol. Blood and distal ileum tissue were collected for fatty acid analysis. The distal ileum underwent histologic, proteomic, and metabolomic analyses. Results: Eight pigs (3/14 SO (21 %), 3/14 MO15 (21%), and 2/14 FO100 (14%)) developed NEC. No differences in NEC risk were evident between g...