OBJECTIVES: To compare 2 days of antibiotic therapy (AT) to 4 days of AT in neonates with pneumonia and to assess the usefulness of neutrophil values (NV), C-reactive protein (CRP), and procalcitonin (PCT) in this population. DESIGN: The study population consisted of consecutive, eligible term neonates begun on AT for suspected pneumonia. Of 51 neonates, 26 qualified for randomization (14, 2-day group; 12, 4-day group). NV were obtained with the initial evaluation and 12 and 24 hours later. CRP and PCT were obtained 12 and 48 hours after the initial evaluation. RESULTS: None of the 12 neonates in the 4-day group developed recurrent respiratory symptoms. Three of the 14 neonates randomized to the 2-day group had recurrence of symptoms, resulting in study termination. NV, CRP, and PCT were similar in the 2- and 4-day groups. In the three neonates who developed respiratory symptoms, all absolute total neutrophil values and five out of nine absolute total immature neutrophil values were abnormal. However, all immature:total neutrophil values were normal, and CRP was strikingly elevated in only one neonate; only one of six PCT values was abnormal. In a secondary analysis of all 51 study neonates, CRP and PCT did not provide additional benefit over NV in differentiating neonates with pneumonia. CONCLUSIONS: Four days of AT appears to be adequate for selected term neonates with pneumonia; however, 2 days of AT appears to be inadequate for this population. Relative to NV, CRP and PCT appear to have a limited role.
RCT Entities:
OBJECTIVES: To compare 2 days of antibiotic therapy (AT) to 4 days of AT in neonates with pneumonia and to assess the usefulness of neutrophil values (NV), C-reactive protein (CRP), and procalcitonin (PCT) in this population. DESIGN: The study population consisted of consecutive, eligible term neonates begun on AT for suspected pneumonia. Of 51 neonates, 26 qualified for randomization (14, 2-day group; 12, 4-day group). NV were obtained with the initial evaluation and 12 and 24 hours later. CRP and PCT were obtained 12 and 48 hours after the initial evaluation. RESULTS: None of the 12 neonates in the 4-day group developed recurrent respiratory symptoms. Three of the 14 neonates randomized to the 2-day group had recurrence of symptoms, resulting in study termination. NV, CRP, and PCT were similar in the 2- and 4-day groups. In the three neonates who developed respiratory symptoms, all absolute total neutrophil values and five out of nine absolute total immature neutrophil values were abnormal. However, all immature:total neutrophil values were normal, and CRP was strikingly elevated in only one neonate; only one of six PCT values was abnormal. In a secondary analysis of all 51 study neonates, CRP and PCT did not provide additional benefit over NV in differentiating neonates with pneumonia. CONCLUSIONS: Four days of AT appears to be adequate for selected term neonates with pneumonia; however, 2 days of AT appears to be inadequate for this population. Relative to NV, CRP and PCT appear to have a limited role.
Authors: Pavel Prusakov; Debra A Goff; Phillip S Wozniak; Azraa Cassim; Catherine E A Scipion; Soledad Urzúa; Andrea Ronchi; Lingkong Zeng; Oluwaseun Ladipo-Ajayi; Noelia Aviles-Otero; Chisom R Udeigwe-Okeke; Rimma Melamed; Rita C Silveira; Cinzia Auriti; Claudia Beltrán-Arroyave; Elena Zamora-Flores; Maria Sanchez-Codez; Eric S Donkor; Satu Kekomäki; Nicoletta Mainini; Rosalba Vivas Trochez; Jamalyn Casey; Juan M Graus; Mallory Muller; Sara Singh; Yvette Loeffen; María Eulalia Tamayo Pérez; Gloria Isabel Ferreyra; Victoria Lima-Rogel; Barbara Perrone; Giannina Izquierdo; María Cernada; Sylvia Stoffella; Sebastian Okwuchukwu Ekenze; Concepción de Alba-Romero; Chryssoula Tzialla; Jennifer T Pham; Kenichiro Hosoi; Magdalena Cecilia Calero Consuegra; Pasqua Betta; O Alvaro Hoyos; Emmanuel Roilides; Gabriela Naranjo-Zuñiga; Makoto Oshiro; Victor Garay; Vito Mondì; Danila Mazzeo; James A Stahl; Joseph B Cantey; Juan Gonzalo Mesa Monsalve; Erik Normann; Lindsay C Landgrave; Ali Mazouri; Claudia Alarcón Avila; Fiammetta Piersigilli; Monica Trujillo; Sonya Kolman; Verónica Delgado; Veronica Guzman; Mohamed Abdellatif; Luis Monterrosa; Lucia Gabriella Tina; Khalid Yunis; Marco Antonio Belzu Rodriguez; Nicole Le Saux; Valentina Leonardi; Alessandro Porta; Giuseppe Latorre; Hidehiko Nakanishi; Michal Meir; Paolo Manzoni; Ximena Norero; Angela Hoyos; Diana Arias; Rubén García Sánchez; Alexandra K Medoro; Pablo J Sánchez Journal: EClinicalMedicine Date: 2021-01-29
Authors: N Sreekumaran Nair; Leslie Edward Lewis; Shruti Murthy; Myron Anthony Godinho; Theophilus Lakiang; Bhumika T Venkatesh Journal: BMJ Open Date: 2017-09-15 Impact factor: 2.692