Valentina Dell'Orto1, Nadege Bourgeois-Nicolaos2, Caroline Rouard2, Olivier Romain1, Shivani Shankar-Aguilera1, Florence Doucet-Populaire2, Daniele De Luca3. 1. Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Pediatrics and Neonatal Critical Care, Paris, France. 2. Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Microbiology, Paris, France; Division of Microbiology, School of Pharmacy, Paris Sud-Saclay University, Paris, France. 3. Assistance Publique-Hopitaux de Paris, South Paris University Hospitals, Medical Center "A. Béclère", Division of Pediatrics and Neonatal Critical Care, Paris, France; School of Medicine, Paris Sud-Saclay University, Paris, France. Electronic address: dm.deluca@icloud.com.
Abstract
OBJECTIVES: To establish the reference values, diagnostic accuracy, and effect of various factors on cell count in intubated preterm neonates subjected to nonbronchoscopic bronchoalveolar lavage. STUDY DESIGN: This prospective, cross-sectional, blinded study included preterm neonates ventilated for any reason who underwent nonbronchoscopic bronchoalveolar lavage if they had not previously received postnatal antibiotics or steroids. Lavage was performed before surfactant replacement, if any. A gentle ventilation policy was applied. Pneumonia was diagnosed using clinical criteria, without considering cell count. Investigators performing cell counts were blinded to the clinical data. RESULTS: There were 276 neonates enrolled; 36 had congenital or ventilator-associated pneumonia. In the 240 noninfected babies, median neutrophil count increased significantly after the first 2 days of ventilation (day 1, 2 cells per field [IQR, 0.0-9.5 cells per field]; day 2, 2 cells per field [IQR, 0-15 cells per field]; day 3, 20 cells per field [IQR, 2-99 cells per field]; day 4, 15 cells per field [IQR, 2-96 cells per field]; P < .0001). No significant difference was seen over time in infected babies. Multivariate analysis indicated pneumonia (standardized β = 0.134; P = .033) and the time spent under mechanical ventilation before nonbronchoscopic bronchoalveolar lavage as factors significantly influencing neutrophil count (standardized β = 0.143; P = .027). Neutrophil count was correlated with the duration of ventilation (rho = 0.28; P <.001). Neutrophil counts were higher in infected (24 cells/field [IQR, 5-78] cells/field) than in noninfected babies (4 cells/field [IQR, 1-24 cells/field]; P <.001) and had an moderate reliability for pneumonia within the first 2 days of ventilation (area under the curve, 0.745; (95% CI, 0.672-0.810; P = .002). CONCLUSIONS: We provide reference values for airway neutrophil counts in ventilated preterm neonates. Bronchoalveolar lavage neutrophils significantly increase after 2 days of ventilation. Neutrophil count has moderate accuracy to diagnose pneumonia, but only within the first 2 days of ventilation.
OBJECTIVES: To establish the reference values, diagnostic accuracy, and effect of various factors on cell count in intubated preterm neonates subjected to nonbronchoscopic bronchoalveolar lavage. STUDY DESIGN: This prospective, cross-sectional, blinded study included preterm neonates ventilated for any reason who underwent nonbronchoscopic bronchoalveolar lavage if they had not previously received postnatal antibiotics or steroids. Lavage was performed before surfactant replacement, if any. A gentle ventilation policy was applied. Pneumonia was diagnosed using clinical criteria, without considering cell count. Investigators performing cell counts were blinded to the clinical data. RESULTS: There were 276 neonates enrolled; 36 had congenital or ventilator-associated pneumonia. In the 240 noninfected babies, median neutrophil count increased significantly after the first 2 days of ventilation (day 1, 2 cells per field [IQR, 0.0-9.5 cells per field]; day 2, 2 cells per field [IQR, 0-15 cells per field]; day 3, 20 cells per field [IQR, 2-99 cells per field]; day 4, 15 cells per field [IQR, 2-96 cells per field]; P < .0001). No significant difference was seen over time in infected babies. Multivariate analysis indicated pneumonia (standardized β = 0.134; P = .033) and the time spent under mechanical ventilation before nonbronchoscopic bronchoalveolar lavage as factors significantly influencing neutrophil count (standardized β = 0.143; P = .027). Neutrophil count was correlated with the duration of ventilation (rho = 0.28; P <.001). Neutrophil counts were higher in infected (24 cells/field [IQR, 5-78] cells/field) than in noninfected babies (4 cells/field [IQR, 1-24 cells/field]; P <.001) and had an moderate reliability for pneumonia within the first 2 days of ventilation (area under the curve, 0.745; (95% CI, 0.672-0.810; P = .002). CONCLUSIONS: We provide reference values for airway neutrophil counts in ventilated preterm neonates. Bronchoalveolar lavage neutrophils significantly increase after 2 days of ventilation. Neutrophil count has moderate accuracy to diagnose pneumonia, but only within the first 2 days of ventilation.
Authors: Cassandra R Moats; Kurt T Randall; Tonya M Swanson; Hugh B Crank; Kimberly M Armantrout; Aaron M Barber-Axthelm; Nicole D Burnett; Theodore R Hobbs; Lauren D Martin; Roxanne M Gilbride; Scott Hansen; Jeremy V Smedley Journal: Comp Med Date: 2020-11-05 Impact factor: 0.982
Authors: Joseph Y Ting; Julie Autmizguine; Michael S Dunn; Julie Choudhury; Julie Blackburn; Shikha Gupta-Bhatnagar; Katrin Assen; Julie Emberley; Sarah Khan; Jessica Leung; Grace J Lin; Destiny Lu-Cleary; Frances Morin; Lindsay L Richter; Isabelle Viel-Thériault; Ashley Roberts; Kyong-Soon Lee; Erik D Skarsgard; Joan Robinson; Prakesh S Shah Journal: Front Pediatr Date: 2022-07-08 Impact factor: 3.569