cefotaxime and Enterocolitis--Necrotizing

Red blood cell (RBC) Thomsen-Friedenreich antigen exposure (T activation) in infants with necrotizing enterocolitis (NEC) has occasionally been associated with posttransfusional intravascular hemolysis thought to be due to anti-T antibodies in the donor plasma.. We describe an infant with NEC and Clostridium perfringens infection complicated by severe hemolysis after plasma transfusion. After this case, infants with confirmed NEC were prospectively evaluated for T activation. We checked for hemolysis in patients with T activation receiving plasma-containing blood products.. The infant had received 80 mL of fresh-frozen plasma (FFP). His RBCs displayed strong T activation, and agglutination was observed with four of six ABO-compatible FFP units. A direct antiglobulin test was negative. IgM-class anti-T antibodies were present in small amounts (titer of 8) in the transfused FFP. Anti-T antibodies from the blood donor were not hemolytic in vitro. In the prospective study, T activation was observed in three of 28 infants with NEC (11%). One infant presented moderate T activation and two infants presented very strong T activation but only moderate decreases in sialic acid expression on the RBC membrane. These three infants presented no signs of hemolysis after transfusion with unwashed blood products or FFP.. Anti-T antibodies are unlikely to be the etiologic factor for the hemolytic reactions observed in infants with NEC and T activation. Massive RBC desialylation and the direct action of bacterial toxins are more probable causes. Strict avoidance of plasma-containing blood products does not seem justified in these infants.

Topics: Adult; Antibodies; Antigens, Tumor-Associated, Carbohydrate; Bacterial Proteins; Blood Donors; Cefotaxime; Clostridium Infections; Clostridium perfringens; Enterocolitis, Necrotizing; Erythrocytes; Female; Hemolysis; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Middle Aged; Plasma Exchange; Prospective Studies

The advancement of neonatology over the past 20 years has allowed a greater number of ELBW infants to survive. However, these advancements have contributed to the increased incidence of acute kidney injury (AKI) seen in this population. Understanding the risk factors for AKI in this population of ELBW infants is imperative for the successful survival of these infants since the morbidity and mortality rates from this disease are increasing.. 1) to determine the prevalence of AKI in ELBW (<  750 grams). 2) to compare the mortality rate of ELBW infants (<  750 grams) with and without AKI; and 3) to identify the associated risk factors of AKI in ELBW infants (<  750 grams).. A retrospective chart review of all infants with AKI as defined by AKIN criterias, admitted to the NICU between 1998 and 2008 was conducted. Case-controls were matched for BW, gestational age and date of birth, (SPSS v17.0 software, using Student's t test, X2 test, and Mann-Whitney U test were used for statistical analysis.. The prevalence rate of ELBW infants (<  750 grams) with AKI admitted at CHMCA NICU from 1998 to 2008 was 26% . The mortality rate of ELBW infants (<  750 grams) with AKI was 54% , compared to 20% in those ELBW infants who did not have AKI. The associated risk factors of AKI in the ELBW infants (<  750 grams) were as follows: presence of maternal placental abruption/bleeding, grade III or IV IVH, PDA, positive culture/s, NEC, use of steroid, nephrotoxic drugs, and longer use of the ventilator and TPN.

Topics: Abruptio Placentae; Acute Kidney Injury; Adult; Amphotericin B; Anti-Bacterial Agents; Case-Control Studies; Cefotaxime; Clindamycin; Creatinine; Diuretics; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Female; Furosemide; Humans; Hydrochlorothiazide; Infant, Extremely Low Birth Weight; Infant, Newborn; Infections; Intracranial Hemorrhages; Ohio; Parenteral Nutrition, Total; Pregnancy; Prevalence; Respiration, Artificial; Retrospective Studies; Risk Factors; Steroids; Survival Rate; Time Factors; Uterine Hemorrhage; Vancomycin; Young Adult