Skip to main content

Advertisement

SpringerLink
Log in

Different antibiotic strategies in transient tachypnea of the newborn: an ambispective cohort study

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The purpose of this study is to determine the outcome and infection-related events in neonates with transient tachypnea of the newborn (TTN) managed with an antibiotic initiation strategy. An ambispective cohort study was carried out to compare two different antibiotic strategies in of TTN patients. The first strategy is based on clinical risk evaluation, in which antibiotics are initiated according to clinical signs, while the other is a combined strategy that integrates information regarding clinical signs, perinatal risk factors, and lab-based surveillance of infectious indicators. The antibiotic use in the combined strategy group (n = 716) was lower than that of the control group (n = 769) (35.06 vs 54.75 %, P < 0.01). Outcomes including total duration of antibiotic therapy (5.45 ± 4.17 vs 5.18 ± 3.45 days, P = 0.36), mortality (0 vs 0), length of hospital stay (7.78 ± 4.20 vs 8.14 ± 3.62 days, P = 0.07), and hospital readmission (4.89 vs 4.94 %, P = 0.94) did not differ; nor did infection-related events such as nosocomial infection (2.93 vs 2.99 %, P = 0.95), infectious pneumonia (18.30 vs 19.90 %, P = 0.43), septicemia (1.96 vs 1.95 %, P = 0.99), and necrotizing enterocolitis (0.14 vs 0.26 %).

Conclusion: The combined strategy effectively reduces antibiotic usage during incidences of TTN with no negative impact on the clinical outcome.

What is Known:

• TTN is easy to be confused with infection only based on clinical signs.

• Many TTN patients had been treated with unnecessary antibiotics.

What is New:

• Our combined strategy for TTN can reduce antibiotics usage.

• New strategy did not increase the incidence of infection and adverse outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CRP:

C-reactive protein

GA:

Gestational ages

HIV:

Human immunodeficiency virus

nCPAP:

Nasal continuous positive airway pressure

NICU:

Neonatal intensive care unit

PCT:

Procalcitonin

TTN:

Transient tachypnea of the newborn

WBC:

White blood cells

References

  1. Benitz WE, Han MY, Madan A, Ramachandra P (1998) Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 102(4):E41. doi:10.1542/peds.102.4.e41

    Article  CAS  PubMed  Google Scholar 

  2. Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L (2004) Diagnosis of neonatal sepsis: a clinical and laboratory challenge. Clin Chem 50(2):279–287. doi:10.1373/clinchem.2003.025171

    Article  CAS  PubMed  Google Scholar 

  3. Cipolla D, Giuffre M, Mammina C, Corsello G (2011) Prevention of nosocomial infections and surveillance of emerging resistances in NICU. J Matern Fetal Neonatal Med 24(suppl 1):23–26. doi:10.3109/14767058.2011.607567

    Article  PubMed  Google Scholar 

  4. Costa S, Rocha G, Leitao A, Guimaraes H (2012) Transient tachypnea of the newborn and congenital pneumonia: a comparative study. J Matern Fetal Neonatal Med 25(7):992–994. doi:10.3109/14767058.2011.604366

    Article  PubMed  Google Scholar 

  5. Escobar GJ, Li DK, Armstrong MA, Gardner MN, Folck BF, Verdi JE, Xiong B, Bergen R (2000) Neonatal sepsis workups in infants ≥2000 grams at birth: a population-based study. Pediatrics 106(2 Pt 1):256–263. doi:10.1542/peds.106.2.256

    Article  CAS  PubMed  Google Scholar 

  6. Franz AR, Steinbach G, Kron M, Pohlandt F (1999) Reduction of unnecessary antibiotic therapy in newborn infants using interleukin-8 and C-reactive protein as markers of bacterial infections. Pediatrics 104(3):447–453. doi:10.1542/peds.104.3.447

    Article  CAS  PubMed  Google Scholar 

  7. Gray JW (2007) Surveillance of infection in neonatal intensive care units. Early Hum Dev 83(3):157–163. doi:10.1016/j.earlhumdev.2007.01.006

    Article  PubMed  Google Scholar 

  8. Greenberg D, Shinwell ES, Yagupsky P, Greenberg S, Leibovitz E, Mazor M, Dagan R (1997) A prospective study of neonatal sepsis and meningitis in Southern Israel. Pediatr Infect Dis J 16(8):768–773. doi:10.1097/00006454-199708000-00008

    Article  CAS  PubMed  Google Scholar 

  9. Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB (2008) Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ 336(7635):85–87. doi:10.1136/bmj.39405.539282.BE

    Article  PubMed Central  PubMed  Google Scholar 

  10. Helve O, Janer C, Pitkanen O, Andersson S (2007) Expression of the epithelial sodium channel in airway epithelium of newborn infants depends on gestational age. Pediatrics 120(6):1311–1316. doi:10.1542/peds. 2007-0100

    Article  PubMed  Google Scholar 

  11. Hemels MA, van den Hoogen A, Verboon-Maciolek MA, Fleer A, Krediet TG (2011) A seven-year survey of management of coagulase-negative staphylococcal sepsis in the neonatal intensive care unit: vancomycin may not be necessary as empiric therapy. Neonatology 100(2):180–185. doi:10.1159/000324852

    Article  CAS  PubMed  Google Scholar 

  12. Hermansen CL, Lorah KN (2007) Respiratory distress in the newborn. Am Fam Physician 76(7):987–994

    PubMed  Google Scholar 

  13. Martin RJ, Fanaroff AA, Walsh MC (2011) Fanaroff and Martin’s neonatal-perinatal medicine: diseases of the fetus and infant, 9th edn. Elsevier, Philadelphia

  14. Mishra UK, Jacobs SE, Doyle LW, Garland SM (2006) Newer approaches to the diagnosis of early onset neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 91(3):F208–F212. doi:10.1136/adc.2004.064188

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Nizet V, Klein JO (2011) Infectious diseases of the fetus and newborn infant, 7th edn. Elsevier, Philadelphia

    Google Scholar 

  16. Nuntnarumit P, Pinkaew O, Kitiwanwanich S (2002) Predictive values of serial C-reactive protein in neonatal sepsis. J Med Assoc Thail 85(Suppl 4):S1151–S1158

    Google Scholar 

  17. Ottolini MC, Lundgren K, Mirkinson LJ, Cason S, Ottolini MG (2003) Utility of complete blood count and blood culture screening to diagnose neonatal sepsis in the asymptomatic at risk newborn. Pediatr J Inf Dis 22(5):430–434. doi:10.1097/01.inf.0000068206.11303.dd

    Google Scholar 

  18. Patel SJ, Saiman L, Duchon JM, Evans D, Ferng YH, Larson E (2012) Development of an antimicrobial stewardship intervention using a model of actionable feedback. Interdiscip Perspect Infect Dis 2012:150367. doi:10.1155/2012/150367

    PubMed Central  PubMed  Google Scholar 

  19. Polin RA, Committee on Fetus and Newborn (2012) Management of neonates with suspected of proven early-onset bacterial sepsis. Pediatrics 129(5):1006–1015. doi:10.1542/peds. 2012-0541

    Article  PubMed  Google Scholar 

  20. Polin RA, Denson S, Brady MT (2012) Strategies for prevention of health care-associated infections in the NICU. Pediatrics 129(4):e1085–e1093. doi:10.1542/peds. 2012-0145

    Article  PubMed  Google Scholar 

  21. Salem SY, Sheiner E, Zmora E, Vardi H, Shoham-Vardi I, Mazor M (2006) Risk factors for early neonatal sepsis. Arch Gynecol Obstet 274(4):198–202. doi:10.1007/s00404-006-0135-1

    Article  PubMed  Google Scholar 

  22. Stocker M, Berger C, McDougall J, Giannoni E (2013) Recommendations for term and late preterm infants at risk for perinatal bacterial infection. Swiss Med Wkly 143:w13873. doi:10.4414/smw.2013.13873

    PubMed  Google Scholar 

  23. te Pas AB, Davis PG, Hooper SB, Morley CJ (2008) From liquid to air: breathing after birth. J Pediatr 152(5):607–611. doi:10.1016/j.jpeds.2007.10.041

    Article  Google Scholar 

  24. Tripathi N, Cotten CM, Smith PB (2012) Antibiotic use and misuse in the neonatal intensive care unit. Clin Perinatol 39(1):61–68. doi:10.1016/j.clp.2011.12.003

    Article  PubMed Central  PubMed  Google Scholar 

  25. Weintraub AS, Cadet CT, Perez R, DeLorenzo E, Holzman IR, Stroustrup A (2013) Antibiotic use in newborns with transient tachypnea of the newborn. Neonatology 103(3):235–240. doi:10.1159/000346057

    Article  CAS  PubMed  Google Scholar 

  26. Yu Z, Liu J, Sun Q, Qiu Y, Han S, Guo X (2010) The accuracy of the procalcitonin test for the diagnosis of neonatal sepsis: a meta-analysis. Scand J Infect Dis 42(10):723–733. doi:10.3109/00365548.2010.489906

    Article  PubMed  Google Scholar 

  27. Yurdakok M, Ozek E (2012) Transient tachypnea of the newborn: the treatment strategies. Curr Pharm Des 18(21):3046–3049. doi:10.2174/1381612811209023046

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This project was supported by the National Natural Science Foundation of China (Grant Nos. 81370738, 81100457, 81401233), National Key Development Program of Clinical Specialties (neonatology) (Grant No. 1311200003303), and National Key Technology R&D Program (Grant No. 2012BA104B04).

Conflict of interest

The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript. This study did not have a financial relationship with the organization that sponsored the research.

Authors’ contribution

Jinhui Li and Jinlin Wu both performed this study and wrote the manuscript. Both authors contributed to the final version.

Ethical statement

This study was approved by Program for Protection of Human Subjects and the Research Ethics Committee of the West China Second University Hospital, Sichuan University. Our manuscript complies with the ethical standards required by this journal.

Author information

Author notes

    Authors and Affiliations

    1. Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20 3rd Section of South Ren Ming Road, Chengdu, 610041, Sichuan, People’s Republic of China

      Jinhui Li, Jinlin Wu, Yong Hu, Xiaoyan Yang, Dezhi Mu & Bin Xia

    2. The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China

      Lizhong Du

    Authors
    1. Jinhui Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jinlin Wu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Lizhong Du
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Yong Hu
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Xiaoyan Yang
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Dezhi Mu
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Bin Xia
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Bin Xia.

    Additional information

    Communicated by Patrick Van Reempts

    Revisions received: 17 February 2015 / 11 March 2015

    Jinhui Li and Jinlin Wu contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Li, J., Wu, J., Du, L. et al. Different antibiotic strategies in transient tachypnea of the newborn: an ambispective cohort study. Eur J Pediatr 174, 1217–1223 (2015). https://doi.org/10.1007/s00431-015-2526-4

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00431-015-2526-4

    Keywords

    Search

    Navigation