Daily ReportOct 10, 2026
Sepsis, October 10 edition
We read 4 papers and selected 3.
Summary
Today's most impactful sepsis research spans prevention, biomarker discovery, and bedside microcirculatory monitoring. The strongest evidence comes from a systematic review and meta-analysis showing that harmful traditional umbilical cord care remains common, while two prospective studies identify dynamic proteomic and microvascular changes that may support future neonatal sepsis diagnosis and septic shock monitoring.
Research Themes
- Prevention of neonatal sepsis through safer umbilical cord care
- Targeted proteomics for neonatal sepsis biomarkers
- Longitudinal peripheral microcirculatory monitoring in septic shock
Selected Articles
1. The prevalence of harmful traditional umbilical cord care practices and associated factors in newborns: a systematic review and meta-analysis.
This systematic review and meta-analysis included 15 studies and 15,368 participants. Harmful traditional umbilical cord care practices affected 31.63% of newborns, while home delivery and lack of maternal education were significantly associated with these practices.
Impact: The study quantifies a modifiable community-level contributor to neonatal sepsis and identifies practical targets for prevention programs. Its findings support integrating caregiver education and institutional delivery strategies into neonatal infection prevention.
Clinical Implications: Neonatal health programs should discourage application of non-sterile substances to the umbilical cord, strengthen counseling during antenatal and postnatal care, and promote facility-based delivery, particularly for families with limited education or home births.
Key Findings
- The pooled prevalence of harmful traditional umbilical cord care was 31.63% (95% CI, 25.07-38.19) across 15 studies involving 15,368 participants.
- Commonly reported substances included ointment (42.08%), food oil (35.05%), butter (34.24%), ash (26.28%), and Vaseline petroleum jelly (25.14%).
- Home delivery and lack of maternal education were associated with higher prevalence, with pooled adjusted odds ratios of 3.74 and 3.22, respectively.
Methodological Strengths
- The review searched multiple major bibliographic databases and applied Joanna Briggs Institute quality criteria.
- Random-effects pooling, heterogeneity assessment, publication-bias assessment, and subgroup analyses were conducted.
Limitations
- The included studies may have differed substantially in definitions, populations, and measurement of cord-care practices, contributing to heterogeneity.
- The findings demonstrate associations rather than establishing that specific cord-care practices directly caused neonatal sepsis.
Future Directions: Future studies should use standardized definitions, prospectively evaluate educational and facility-delivery interventions, and directly measure neonatal infection outcomes after replacing harmful practices with evidence-based dry or antiseptic cord care.
BACKGROUND: Harmful umbilical cord care practices remain a major public health concern in various developing countries, contributing significantly to neonatal sepsis, which accounts for approximately 15% of all neonatal deaths globally. Despite known health risks, many caregivers continue to rely on traditional methods. This systematic review and meta-analysis aimed to quantify the national prevalence of such practices and identify associated factors. METHODS: A systematic literature search was conducted using PubMed Central, Cochrane Library, Web of Science, Scopus, and Google Scholar for publications from 2012 to September 2025. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) criteria. Heterogeneity was assessed with I² statistics and Cochran's Q test, and a random-effects model was applied. Publication bias was evaluated using funnel plots and Egger's test, with subgroup analyses conducted to explore heterogeneity among studies. RESULTS: A total of 15 studies with 15,368 study participants were used for analysis. The overall pooled prevalence of harmful traditional umbilical cord care practices in newborns was 31.63% (95% CI: 25.07, 38.19). Types of harmful substances applied on the cord: the pooled prevalence of butter is 34.24%; Vaseline petroleum jelly, 25.14%; body lotion, 6.64%; ash, 26.28%; food oil, 35.05%; cow dung, 8.81%; and ointment, 42.08%, respectively.
2. Targeted proteomics in late-onset neonatal sepsis: an exploratory analysis.
This exploratory longitudinal study analyzed targeted proteomic changes in 15 preterm neonates with late-onset neonatal sepsis, eight controls, and ten in vitro stimulation samples. Sixty-six proteins changed during sepsis, with inflammatory proteins increasing and proteins related to development, growth, and metabolism decreasing; many changes normalized within 48 hours.
Impact: The combination of serial clinical sampling and pathogen-specific in vitro stimulation helps distinguish direct pathogen-induced responses from secondary systemic changes. This provides a mechanistic foundation for developing time-sensitive biomarkers in a population where early diagnosis is particularly difficult.
Clinical Implications: The identified protein patterns may eventually support adjunctive diagnosis or monitoring of late-onset neonatal sepsis, but they should not yet guide clinical decisions because the cohort was small and independent validation was not performed.
Key Findings
- Sixty-six proteins showed altered expression during late-onset neonatal sepsis in preterm infants.
- Upregulated proteins were mainly cytokines and chemokines, whereas downregulated proteins were linked to development, growth, and metabolism.
- Most proteomic alterations normalized within 48 hours, and in vitro E. coli or S. epidermidis stimulation reproduced a subset of changes.
Methodological Strengths
- Longitudinal sampling at sepsis onset and 24 and 48 hours captured the temporal dynamics of protein expression.
- Parallel in vitro stimulation with two clinically relevant pathogens provided a mechanistic comparison with patient-derived changes.
Limitations
- The study included only 15 neonates with late-onset neonatal sepsis and eight controls, limiting statistical precision and generalizability.
- The exploratory findings were not validated in a larger independent cohort and may be affected by prematurity, illness severity, or treatment-related confounding.
Future Directions: Future research should validate candidate proteins in larger multicenter cohorts, assess diagnostic performance against standard clinical and microbiological measures, and determine whether serial protein panels can distinguish infection from noninfectious inflammation before antibiotic treatment.
BACKGROUND: Late-onset neonatal sepsis (LONS) is a major cause of morbidity and mortality in preterm infants, but early diagnosis remains difficult. We aimed to identify candidate proteomic biomarkers of LONS and evaluate whether these changes could be reproduced by in vitro stimulation. METHODS: Longitudinal blood samples were collected from preterm neonates with suspected LONS and non-septic controls in two neonatal intensive care units, at onset and after 24 and 48 hours. In parallel, whole blood from preterm neonates without LONS was stimulated in vitro with E. coli and S. epidermidis. Protein expression was quantified using targeted proteomics. RESULTS: Fifteen neonates with LONS, eight controls, and ten in vitro stimulation samples were included. Sixty-six proteins showed altered expression during LONS. Upregulated proteins were predominantly cytokines and chemokines, whereas downregulated proteins were associated with development, growth, and metabolism. Most alterations normalized within 48 hours. In vitro stimulation reproduced expression changes for a subset of proteins, suggesting direct pathogen-induced immune responses.
3. Nailfold Capillaroscopy Reveals Peripheral Microcirculatory Trajectories in Septic Shock.
In this prospective two-center study, nailfold capillaroscopy was performed during septic shock and after hemodynamic stabilization. Among 21 enrolled patients, 15 had paired assessments; capillary length increased significantly, and survivors showed a greater increase in red blood cell velocity than non-survivors, although the study was small and exploratory.
Impact: The study demonstrates that peripheral microcirculation may follow a distinct recovery trajectory despite apparent systemic stabilization. Serial, noninvasive nailfold capillaroscopy could complement macrocirculatory assessment and generate individualized physiological information at the bedside.
Clinical Implications: Serial nailfold capillaroscopy may help identify persistent or recovering microcirculatory dysfunction after hemodynamic stabilization, but it is not ready to guide therapy or prognostic decisions without validation in larger cohorts.
Key Findings
- Among 21 enrolled patients, 19 had analyzable baseline recordings and 15 had paired assessments; four patients died before reassessment.
- In the paired cohort, red blood cell velocity increased from 0.295 to 0.550 mm/s, while median capillary-length change was 42.1 μm (P = 0.0125).
- The median change in red blood cell velocity was 0.393 mm/s in survivors versus -0.127 mm/s in non-survivors, although the association with lactate clearance was imprecise and not statistically significant.
Methodological Strengths
- The prospective two-center design assessed patients at predefined clinical stages: shock and clinician-confirmed hemodynamic stabilization.
- The study prespecified mortality, longitudinal microcirculatory changes, and the association between red blood cell velocity and lactate clearance.
Limitations
- The sample was very small, with only 15 paired assessments, and four patients died before reassessment, creating potential survivor bias.
- Outcome-stratified analyses were post hoc and exploratory, and the association between red blood cell velocity change and lactate clearance was not statistically significant.
Future Directions: Larger multicenter studies should standardize nailfold capillaroscopy acquisition and analysis, assess interobserver and device reproducibility, and test whether serial microcirculatory measurements can guide resuscitation or improve risk stratification beyond conventional hemodynamic and biochemical variables.
BackgroundSepsis-induced microcirculatory dysfunction may persist despite systemic hemodynamic stabilization, yet longitudinal changes in peripheral microvascular structure and flow during recovery remain insufficiently characterized. We used nailfold capillaroscopy (NFC) to characterize these changes during recovery from septic shock.MethodsIn this prospective two-center study, patients with Sepsis-3 septic shock underwent NFC during shock and after clinician-confirmed hemodynamic stabilization. Baseline NFC analyses required analyzable initial recordings; longitudinal analyses required paired assessments and survival to reassessment. Mortality was prespecified as the primary outcome. Longitudinal NFC changes and the association between change in red blood cell (RBC) velocity and lactate clearance were prespecified; outcome-stratified analyses were post hoc and exploratory.ResultsOf 25 patients meeting clinical eligibility criteria, 21 were enrolled, 19 had analyzable baseline NFC recordings, and 15 had paired assessments; four died before reassessment. Baseline RBC velocity was 0.268 mm/s in survivors and 0.290 mm/s in non-survivors (P = 0.653). In the paired cohort, RBC velocity increased from 0.295 to 0.550 mm/s; median within-patient change was 0.167 mm/s (95% CI, 0.067 to 0.609; P = 0.1531). The median within-patient change in capillary length was 42.1 μm (95% CI, -7.3 to 65.3; P = 0.0125).