Early onset sepsis in Suriname: Epidemiology, Pathophysiology and Novel Diagnostic Concepts

Rens Zonneveld

Early onset sepsis in Suriname: Epidemiology, Pathophysiology and Novel Diagnostic Concepts

Vertaalde titel van de bijdrage: Early onset sepsis in Suriname: Epidemiologie, Pathofysiologie en nieuwe concepten voor diagnostiek

Rens Zonneveld

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Early Onset Sepsis (EOS) wordt gedefinieerd als een bacteriële infectie in de bloedbaan van een pasgeborene binnen 72 uur na geboorte. In Westerse landen krijgt 1 op de 1000 (0.1%) pasgeborenen EOS. Het tijdig aantonen of uitsluiten van EOS is moeilijk en veel pasgeborenen worden te laat of onnodig behandeld met antibiotica. Het onderzoek in dit proefschrift richt zich op EOS in Suriname en op de ontstekingsreactie in het bloedvat en daarop gebaseerde methoden van detectie voor het stellen van de juiste diagnose. De resultaten zijn als volgt. Het aantal gevallen van EOS in Suriname is 50-100 (5-10%) op 1000 pasgeborenen en 30% van alle pasgeborenen krijgt antibiotica voor een verdenking op EOS. De online verkrijgbare EOS Calculator helpt om het risico op EOS in te schatten. Lage bloedwaarden van de immature granulocyt, een bepaald type afweercel, voorspellen afwezigheid van EOS en helpen om onnodige antibiotica te voorkomen. De bloedspiegels van twee groepen eiwitten in het bloed, de endothelial cell adhesion molecules en sheddases, zijn hoog maar niet geassocieerd met EOS. Meting van de zogenaamde Angiopoietins laat zien dat er een disbalans ontstaat tijdens EOS tussen de twee belangrijke vormen Ang-1 en Ang-2. Dit geeft aan dat de binnenbekleding van het bloedvat - het endotheel - betrokken is bij de ontstekingsreactie tijdens EOS. De resultaten van dit proefschrift tonen aan dat EOS een groot probleem is in Suriname. Verder onderzoek moet uitwijzen of genoemde methoden in de kliniek kunnen worden gebruikt om EOS aan te tonen of uit te sluiten.

Vertaalde titel van de bijdrage	Early onset sepsis in Suriname: Epidemiologie, Pathofysiologie en nieuwe concepten voor diagnostiek
Originele taal-2	English
Kwalificatie	Doctor of Philosophy
Toekennende instantie	Rijksuniversiteit Groningen
Begeleider(s)/adviseur	Molema, Ingrid, Supervisor Plötz, Frans B, Co-supervisor, Externe Persoon van Meurs, Matijs, Co-supervisor
Datum van toekenning	11-dec.-2017
Plaats van publicatie	[Groningen]
Uitgever	Rijksuniversiteit Groningen
Gedrukte ISBN's	978-94-034-0256-7
Elektronische ISBN's	978-94-034-0257-4
Status	Published - 2017

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Title and ContentsFinal publisher's version, 219 KB
Chapter 1Final publisher's version, 216 KB
Chapter 2Final publisher's version, 448 KB
Chapter 3Final publisher's version, 224 KB
Chapter 4Final publisher's version, 350 KB
Chapter 5Final publisher's version, 1,05 MB
Chapter 6Final publisher's version, 943 KB
Chapter 7Final publisher's version, 741 KB
Chapter 8Final publisher's version, 1,38 MB
Chapter 9Final publisher's version, 529 KB
AppendicesFinal publisher's version, 991 KB
Complete ThesisFinal publisher's version, 6,35 MB
PropositionsFinal publisher's version, 30,1 KB

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title = "Early onset sepsis in Suriname: Epidemiology, Pathophysiology and Novel Diagnostic Concepts",

abstract = "Early Onset Sepsis (EOS) is defined as a bacterial infection in a newborns bloodstream within 72 hours after birth. In Western countries, incidence of EOS is 1 in 1,000 (0.1%). Timely detection or exclusion of EOS is difficult and many newborns are either diagnosed too late or treated unnecessarily with antibiotics. The research in this thesis focuses on EOS in Suriname and on methods for detection or exclusion of EOS based on aspects of the inflammatory response in the blood vessel. The results are as follows. The number of cases of EOS in Suriname is 50-100 in 1,000 newborns and 30% of newborns receive antibiotics for suspected EOS. The online EOS Calculator helps to estimate the risk of EOS. Low blood levels of the immature granulocyte, a specific type of immune cell, predict absence of EOS in newborns, which helps to prevent unnecessary antibiotics. The blood levels of two groups of proteins in the blood, the endothelial cell adhesion molecules and sheddases are high but not associated with EOS. Measurement of the Angiopoietins reveals a dysbalance during EOS between the two major forms Ang-1 and Ang-2. This indicates that the inner lining of the blood vessel - the endothelium - is involved in the inflammatory response during EOS. The results of thesis show that EOS is a major problem in Suriname. Further research is necessary to determine whether the methods mentioned above are useful in the clinic to detect or exclude EOS.",

author = "Rens Zonneveld",

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N2 - Early Onset Sepsis (EOS) is defined as a bacterial infection in a newborns bloodstream within 72 hours after birth. In Western countries, incidence of EOS is 1 in 1,000 (0.1%). Timely detection or exclusion of EOS is difficult and many newborns are either diagnosed too late or treated unnecessarily with antibiotics. The research in this thesis focuses on EOS in Suriname and on methods for detection or exclusion of EOS based on aspects of the inflammatory response in the blood vessel. The results are as follows. The number of cases of EOS in Suriname is 50-100 in 1,000 newborns and 30% of newborns receive antibiotics for suspected EOS. The online EOS Calculator helps to estimate the risk of EOS. Low blood levels of the immature granulocyte, a specific type of immune cell, predict absence of EOS in newborns, which helps to prevent unnecessary antibiotics. The blood levels of two groups of proteins in the blood, the endothelial cell adhesion molecules and sheddases are high but not associated with EOS. Measurement of the Angiopoietins reveals a dysbalance during EOS between the two major forms Ang-1 and Ang-2. This indicates that the inner lining of the blood vessel - the endothelium - is involved in the inflammatory response during EOS. The results of thesis show that EOS is a major problem in Suriname. Further research is necessary to determine whether the methods mentioned above are useful in the clinic to detect or exclude EOS.

AB - Early Onset Sepsis (EOS) is defined as a bacterial infection in a newborns bloodstream within 72 hours after birth. In Western countries, incidence of EOS is 1 in 1,000 (0.1%). Timely detection or exclusion of EOS is difficult and many newborns are either diagnosed too late or treated unnecessarily with antibiotics. The research in this thesis focuses on EOS in Suriname and on methods for detection or exclusion of EOS based on aspects of the inflammatory response in the blood vessel. The results are as follows. The number of cases of EOS in Suriname is 50-100 in 1,000 newborns and 30% of newborns receive antibiotics for suspected EOS. The online EOS Calculator helps to estimate the risk of EOS. Low blood levels of the immature granulocyte, a specific type of immune cell, predict absence of EOS in newborns, which helps to prevent unnecessary antibiotics. The blood levels of two groups of proteins in the blood, the endothelial cell adhesion molecules and sheddases are high but not associated with EOS. Measurement of the Angiopoietins reveals a dysbalance during EOS between the two major forms Ang-1 and Ang-2. This indicates that the inner lining of the blood vessel - the endothelium - is involved in the inflammatory response during EOS. The results of thesis show that EOS is a major problem in Suriname. Further research is necessary to determine whether the methods mentioned above are useful in the clinic to detect or exclude EOS.

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