In the first part of this thesis we describe a study on the effects of expanding and modernizing the neonatal care capacity in the Academic Hospital Paramaribo (AZP), Suriname. Here we see a decrease in mortality among newborns admitted to the AZP, but an unchanged high incidence of serious infections (sepsis). In a subsequent national benchmark study, we show that the incidence of early (<72 hours after birth) onset neonatal sepsis in Suriname is comparable to data from high-income countries. However, a follow-up study using a birth cohort shows that the mostly hospital care-related late (>72 hours) onset neonatal sepsis (LONS), is a much more important challenge in this setting. In the second part, we first describe a study showing that viral respiratory infections are an important cause of serious respiratory infections in children in Suriname, with respiratory syncytial virus (RSV) being the most common cause in infants. Worldwide, acute viral bronchiolitis is the most common lower respiratory tract infection leading to hospitalization in young infants, with RSV being the most common causative agent. In a literature review, we show that there is convincing evidence that activated neutrophils, activated vascular endothelium and their interactions, are key components in the pathophysiology of severe disease course in acute bronchiolitis. And then, in a pilot clinical study, we show that markers of endothelium and neutrophil activation are associated with disease severity in acute viral bronchiolitis.
|Qualification||Doctor of Philosophy|
|Place of Publication||[Groningen]|
|Publication status||Published - 2021|