Full Text Journal Articles by
Author Tuuli Metsvaht

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Meropenem vs standard of care for treatment of neonatal late onset sepsis (NeoMero1): A randomised controlled trial.

Irja Lutsar, Corine Chazallon, Ursula Trafojer, Vincent Meiffredy de Cabre, Cinzia Auriti, Chiara Bertaina, Francesca Ippolita Calo Carducci, Fuat Emre Canpolat, Susanna Esposito, Isabelle Fournier, Maarja Hallik, Paul T Heath, Mari-Liis Ilmoja, Elias Iosifidis, Jelena Kuznetsova, Laurence Meyer, Tuuli Metsvaht, George Mitsiakos, Zoi Dorothea Pana, Fabio Mosca, Lorenza Pugni, Emmanuel Roilides, Paolo Rossi, Kosmas Sarafidis, Laura Sanchez, Michael Sharland, Vytautas Usonis, Adilia Warris, Jean-Pierre Aboulker, Carlo Giaquinto, ,

BACKGROUND:The early use of broad-spectrum antibiotics remains the cornerstone for the treatment of neonatal late onset sepsis (LOS). However, which antibiotics should be used is still debatable, as relevant studies were conducted more than 20 years ago, recruited in single centres or countries, evaluated antibiotics not in clinical use anymore ... Read more >>

PLoS ONE (PloS one)
[2020, 15(3):e0229380]

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Population pharmacokinetics and pharmacodynamics of dobutamine in neonates on the first days of life.

Maarja Hallik, Mari-Liis Ilmoja, Joseph F Standing, Hiie Soeorg, Tiiu Jalas, Maila Raidmäe, Karin Uibo, Kristel Köbas, Margit Sõnajalg, Kalev Takkis, Rūta Veigure, Karin Kipper, Joel Starkopf, Tuuli Metsvaht,

AIMS:To describe the pharmacokinetics (PK) and concentration-related effects of dobutamine in critically ill neonates in the first days of life, using nonlinear mixed effects modelling. METHODS:Dosing, plasma concentration and haemodynamic monitoring data from a dose-escalation study were analysed with a simultaneous population PK and pharmacodynamic model. Neonates receiving continuous infusion ... Read more >>

Br J Clin Pharmacol (British journal of clinical pharmacology)
[2020, 86(2):318-328]

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Medicines prescription patterns in European neonatal units.

Inge Mesek, Georgi Nellis, Jana Lass, Tuuli Metsvaht, Heili Varendi, Helle Visk, Mark A Turner, Anthony J Nunn, Jennifer Duncan, Irja Lutsar,

Background Hospitalized neonates receive the highest number of drugs compared to all other age groups, but consumption rates vary between studies depending on patient characteristics and local practices. There are no large-scale international studies on drug use in neonatal units. Objective We aimed to describe drug use in European neonatal ... Read more >>

Int J Clin Pharm (International journal of clinical pharmacy)
[2019, 41(6):1578-1591]

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Population Pharmacokinetics and Dosing of Milrinone After Patent Ductus Arteriosus Ligation in Preterm Infants.

Maarja Hallik, Mari-Liis Ilmoja, Tõnis Tasa, Joseph F Standing, Kalev Takkis, Rūta Veigure, Karin Kipper, Tiiu Jalas, Maila Raidmäe, Karin Uibo, Joel Starkopf, Tuuli Metsvaht,

OBJECTIVES:The postoperative course of patent ductus arteriosus ligation is often complicated by postligation cardiac syndrome, occurring in 10-45% of operated infants. Milrinone might prevent profound hemodynamic instability and improve the recovery of cardiac function in this setting. The present study aimed to describe the population pharmacokinetics of milrinone in premature ... Read more >>

Pediatr Crit Care Med (Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies)
[2019, 20(7):621-629]

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Effect of allopurinol in addition to hypothermia treatment in neonates for hypoxic-ischemic brain injury on neurocognitive outcome (ALBINO): study protocol of a blinded randomized placebo-controlled parallel group multicenter trial for superiority (phase III).

Christian A Maiwald, Kim V Annink, Mario Rüdiger, Manon J N L Benders, Frank van Bel, Karel Allegaert, Gunnar Naulaers, Dirk Bassler, Katrin Klebermaß-Schrehof, Maximo Vento, Hercilia Guimarães, Tom Stiris, Luigi Cattarossi, Marjo Metsäranta, Sampsa Vanhatalo, Jan Mazela, Tuuli Metsvaht, Yannique Jacobs, Axel R Franz, ,

BACKGROUND:Perinatal asphyxia and resulting hypoxic-ischemic encephalopathy is a major cause of death and long-term disability in term born neonates. Up to 20,000 infants each year are affected by HIE in Europe and even more in regions with lower level of perinatal care. The only established therapy to improve outcome in ... Read more >>

BMC Pediatr (BMC pediatrics)
[2019, 19(1):210]

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Genetic Relatedness of Staphylococcus haemolyticus in Gut and Skin of Preterm Neonates and Breast Milk of Their Mothers.

Hiie Soeorg, Hanna Kadri Metsvaht, Evamaria Elisabet Keränen, Imbi Eelmäe, Mirjam Merila, Mari-Liis Ilmoja, Tuuli Metsvaht, Irja Lutsar,

BACKGROUND:Staphylococcus haemolyticus is a common colonizer and cause of late-onset sepsis (LOS) in preterm neonates. By describing genetic relatedness, we aimed to determine whether mother's breast milk (BM) is a source of S. haemolyticus colonizing neonatal gut and skin and/or causing LOS. METHODS:S. haemolyticus was isolated from stool and skin ... Read more >>

Pediatr. Infect. Dis. J. (The Pediatric infectious disease journal)
[2019, 38(3):308-313]

Cited: 1 time

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Drug prescription pattern in European neonatal units

Inge Mesek, Georgi Nellis, Jana Lass, Tuuli Metsvaht, Heili Varendi, Helle Visk, Mark Turner, Anthony Nunn, Jennifer Duncan, Irja Lutsar,

ABSTRACT Background Hospitalized neonates receive the highest number of drugs compared to all other age groups, but consumption rates vary between studies depending on patient characteristics and local practices. There are no large scale international studies on drug use in neonatal units. We aimed to describe drug use in European ... Read more >>

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Meropenem vs standard of care for treatment of neonatal late onset sepsis (NeoMero1): a randomised controlled trial

Irja Lutsar, Corine Chazallon, Ursula Trafojer, Vincent Meiffredy de Cabre, Cinzia Auriti, Chiara Bertaina, Francesca Ippolita Calo Carducci, Fuat Emre Canpolat, Susanna Esposito, Isabelle Fournier, Maarja Hallik, Paul Heath Frcpch, Mari-Liis Ilmoja, Elias Iosifidis, Jelena Kuznetsova, Laurence Meyer, Tuuli Metsvaht, George Mitsiakos, Zoi Dorothea Pana, Fabio Mosca, Lorenza Pugni, Emmanuel Roilides, Paolo Rossi, Kosmas Sarafidis, Laura Sanchez, Michael Sharland, Vytautas Usonis, Adilia Warris, Jean-Pierre Aboulker, Carlo Giaquinto, ,

Abstract Background The early use of broad-spectrum antibiotics remains the cornerstone for the treatment of neonatal late onset sepsis (LOS). However, which antibiotics should be used is still debatable, as relevant studies were conducted more than 20 years ago, were single centre or country, insufficiently powered, evaluated antibiotics not in ... Read more >>

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External evaluation of population pharmacokinetic models for vancomycin in neonates

Tõnis Tasa, Riste Kalamees, Jaak Vilo, Irja Lutsar, Tuuli Metsvaht,

Abstract Introduction Numerous vancomycin population pharmacokinetic (PK) models of neonates have been published. We aimed to comparatively evaluate a set of these models by quantifying their model-based and Bayesian concentration prediction performances using an external retrospective dataset, and estimate their attainment rates in predefined therapeutic target ranges. Methods Implementations of ... Read more >>

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Genetic relatedness of Gram-negative bacteria colonizing gut and skin of neonates and mother's own milk.

Ülle Parm, Jelena Štšepetova, Imbi Eelmäe, Mirjam Merila, Mari-Liis Ilmoja, Tuuli Metsvaht, Irja Lutsar, Hiie Soeorg,

OBJECTIVE:We described colonization of mother's own milk with Gram-negative bacteria and its relationship with neonatal colonization. STUDY DESIGN:Gram-negative bacteria isolated from weekly collected stool, skin and mother's own milk of hospitalized preterm (n = 49) and healthy term neonates (n = 20) were genotyped. Colonization-related factors were determined by logistic regression. RESULTS:Gram-negative bacteria were ... Read more >>

J Perinatol (Journal of Perinatology)
[2018, 38(11):1503-1511]

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Plasma and CSF pharmacokinetics of meropenem in neonates and young infants: results from the NeoMero studies.

Eva Germovsek, Irja Lutsar, Karin Kipper, Mats O Karlsson, Tim Planche, Corine Chazallon, Laurence Meyer, Ursula M T Trafojer, Tuuli Metsvaht, Isabelle Fournier, Mike Sharland, Paul Heath, Joseph F Standing, ,

Background:Sepsis and bacterial meningitis are major causes of mortality and morbidity in neonates and infants. Meropenem, a broad-spectrum antibiotic, is not licensed for use in neonates and infants below 3 months of age and sufficient information on its plasma and CSF disposition and dosing in neonates and infants is lacking. Objectives:To ... Read more >>

J. Antimicrob. Chemother. (The Journal of antimicrobial chemotherapy)
[2018, 73(7):1908-1916]

Cited: 1 time

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Higher intake of coagulase-negative staphylococci from maternal milk promotes gut colonization with mecA-negative Staphylococcus epidermidis in preterm neonates.

Hiie Soeorg, Sirli Treumuth, Hanna Kadri Metsvaht, Imbi Eelmäe, Mirjam Merila, Mari-Liis Ilmoja, Irja Lutsar, Tuuli Metsvaht,

OBJECTIVE:We aimed to determine factors associated with gut colonization of preterm neonates with coagulase-negative staphylococci (CoNS) from maternal milk (MM). STUDY DESIGN:CoNS isolated from weekly collected stool and MM of hospitalized preterm (n = 49) and healthy term neonates (n = 20) were genotyped. Colonization-related factors were determined by Cox proportional hazards regression. RESULT:Gut ... Read more >>

J Perinatol (Journal of Perinatology)
[2018, 38(10):1344-1352]

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Long-Term Effects of Inhaled Budesonide for Bronchopulmonary Dysplasia.

Dirk Bassler, Eric S Shinwell, Mikko Hallman, Pierre-Henri Jarreau, Richard Plavka, Virgilio Carnielli, Christoph Meisner, Corinna Engel, Alexander Koch, Karen Kreutzer, Johannes N van den Anker, Matthias Schwab, Henry L Halliday, Christian F Poets, ,

BACKGROUND:The long-term effects on neurodevelopment of the use of inhaled glucocorticoids in extremely preterm infants for the prevention or treatment of bronchopulmonary dysplasia are uncertain. METHODS:We randomly assigned 863 infants (gestational age, 23 weeks 0 days to 27 weeks 6 days) to receive early (within 24 hours after birth) inhaled ... Read more >>

N. Engl. J. Med. (The New England journal of medicine)
[2018, 378(2):148-157]

Cited: 7 times

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DosOpt: A Tool for Personalized Bayesian Dose Adjustment of Vancomycin in Neonates.

Tõnis Tasa, Tuuli Metsvaht, Riste Kalamees, Jaak Vilo, Irja Lutsar,

Our main aim has been to design a framework to improve vancomycin dosing in neonates. This required the development and verification of a computerized dose adjustment application, DosOpt, to guide the selection.Model fitting in DosOpt uses Bayesian methods for deriving individual pharmacokinetic (PK) estimates from population priors and patient therapeutic ... Read more >>

Ther Drug Monit (Therapeutic drug monitoring)
[2017, 39(6):604-613]

Cited: 1 time

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The role of breast milk in the colonization of neonatal gut and skin with coagulase-negative staphylococci.

Hiie Soeorg, Tuuli Metsvaht, Imbi Eelmäe, Mirjam Merila, Sirli Treumuth, Kristi Huik, Marika Jürna-Ellam, Mari-Liis Ilmoja, Irja Lutsar,

BackgroundWe aimed to determine the genetic relatedness between Staphylococcus epidermidis colonizing breast milk (BM) and BM-fed neonates during the first month of life.MethodsS. epidermidis was isolated from the stool and skin swabs of 20 healthy term and 49 preterm neonates hospitalized in the neonatal intensive care unit and from the ... Read more >>

Pediatr. Res. (Pediatric research)
[2017, 82(5):759-767]

Cited: 2 times

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The CLOSED trial; CLOnidine compared with midazolam for SEDation of paediatric patients in the intensive care unit: study protocol for a multicentre randomised controlled trial.

Antje Neubert, Manuel Alberto Baarslag, Monique van Dijk, Joost van Rosmalen, Joseph F Standing, Yucheng Sheng, Wolfgang Rascher, Deborah Roberts, Jackie Winslade, Louise Rawcliffe, Sara M Hanning, Tuuli Metsvaht, Viviana Giannuzzi, Peter Larsson, Pavla Pokorná, Alessandra Simonetti, Dick Tibboel, ,

INTRODUCTION:Sedation is an essential part of paediatric critical care. Midazolam, often in combination with opioids, is the current gold standard drug. However, as it is a far-from-ideal agent, clonidine is increasingly being used in children. This drug is prescribed off-label for this indication, as many drugs in paediatrics are. Therefore, ... Read more >>

BMJ Open (BMJ open)
[2017, 7(6):e016031]

Cited: 0 times

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Age-Appropriate Formulations Including Pharmaceutical Excipients in Neonatal Medicines.

Karin Kogermann, Jana Lass, Georgi Nellis, Tuuli Metsvaht, Irja Lutsar,

BACKGROUND:The development of appropriate pharmaceutical formulations for routine neonatal practice is challenging because of the developmental characteristics and the need for it to be specifically ageappropriate. This has led to wide use of extemporaneous formulations, which lack standardized procedures that can result in medication errors in clinical practice resulting in ... Read more >>

Curr. Pharm. Des. (Current pharmaceutical design)
[2017, 23(38):5779-5789]

Cited: 2 times

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Coagulase-Negative Staphylococci in Human Milk From Mothers of Preterm Compared With Term Neonates.

Hiie Soeorg, Tuuli Metsvaht, Imbi Eelmäe, Hanna Kadri Metsvaht, Sirli Treumuth, Mirjam Merila, Mari-Liis Ilmoja, Irja Lutsar,

Human milk is the preferred nutrition for neonates and a source of bacteria. Research aim: The authors aimed to characterize the molecular epidemiology and genetic content of staphylococci in the human milk of mothers of preterm and term neonates.Staphylococci were isolated once per week in the 1st month postpartum from ... Read more >>

J Hum Lact (Journal of human lactation : official journal of International Lactation Consultant Association)
[2017, 33(2):329-340]

Cited: 3 times

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Coagulase negative staphylococcal sepsis in neonates: do we need to adapt vancomycin dose or target?

Helgi Padari, Kersti Oselin, Tõnis Tasa, Tuuli Metsvaht, Krista Lõivukene, Irja Lutsar,

Despite differences in types of infection and causative organisms, pharmacokinetic-pharmacodynamic (PKPD) targets of vancomycin therapy derived from adult studies are suggested for neonates. We aimed to identify doses needed for the attainment of AUC/MIC > 400 and AUC/MIC > 300 in neonates with sepsis and correlate these targets with recommended doses and treatment outcome.Neonates ... Read more >>

BMC Pediatr (BMC pediatrics)
[2016, 16(1):206]

Cited: 5 times

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A highly sensitive method for the simultaneous UHPLC-MS/MS analysis of clonidine, morphine, midazolam and their metabolites in blood plasma using HFIP as the eluent additive.

Rūta Veigure, Rudolf Aro, Tuuli Metsvaht, Joseph F Standing, Irja Lutsar, Koit Herodes, Karin Kipper, ,

In intensive care units, the precise administration of sedatives and analgesics is crucial in order to avoid under- or over sedation and for appropriate pain control. Both can be harmful to the patient, causing side effects or pain and suffering. This is especially important in the case of pediatric patients, ... Read more >>

J. Chromatogr. B Analyt. Technol. Biomed. Life Sci. (Journal of chromatography. B, Analytical technologies in the biomedical and life sciences)
[2017, 1052:150-157]

Cited: 0 times

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Symptomatic Neonatal Arterial Ischemic Stroke With Prenatal and Postnatal Neuroimaging.

Mati Pulver, Kristiina Juhkami, Dagmar Loorits, Pilvi Ilves, Jaanika Kuld, Eve Õiglane-Šlik, Tuuli Metsvaht, Rael Laugesaar,

The authors report a girl born at term via planned cesarean delivery. Three days earlier, an antenatal magnetic resonance imaging study, showing no cerebral lesions in the fetus, was performed. Ten minutes after delivery, signs of progressive respiratory failure developed and the infant was transferred to the intensive care unit. ... Read more >>

Child Neurol Open (Child neurology open)
[2017, 4:2329048X17730460]

Cited: 0 times

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Molecular epidemiology of Staphylococcus epidermidis in neonatal intensive care units.

Hiie Soeorg, Kristi Huik, Ülle Parm, Mari-Liis Ilmoja, Tuuli Metsvaht, Irja Lutsar,

Late-onset sepsis (LOS) in preterm neonates is increasingly reported to be associated with gut-colonizing Staphylococcus epidermidis. We aimed to describe the molecular epidemiology of S. epidermidis colonizing the gut of neonates hospitalized in two neonatal intensive care units. S. epidermidis from rectal swabs were typed by multilocus variable-number tandem-repeat analysis ... Read more >>

APMIS (APMIS : acta pathologica, microbiologica, et immunologica Scandinavica)
[2017, 125(1):63-73]

Cited: 3 times

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Development and Evaluation of a Gentamicin Pharmacokinetic Model That Facilitates Opportunistic Gentamicin Therapeutic Drug Monitoring in Neonates and Infants.

Eva Germovsek, Alison Kent, Tuuli Metsvaht, Irja Lutsar, Nigel Klein, Mark A Turner, Mike Sharland, Elisabet I Nielsen, Paul T Heath, Joseph F Standing,

Trough gentamicin therapeutic drug monitoring (TDM) is time-consuming, disruptive to neonatal clinical care, and a patient safety issue. Bayesian models could allow TDM to be performed opportunistically at the time of routine blood tests. This study aimed to develop and prospectively evaluate a new gentamicin model and a novel Bayesian ... Read more >>

Antimicrob. Agents Chemother. (Antimicrobial agents and chemotherapy)
[2016, 60(8):4869-4877]

Cited: 13 times

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Dosing of Milrinone in Preterm Neonates to Prevent Postligation Cardiac Syndrome: Simulation Study Suggests Need for Bolus Infusion.

Maarja Hallik, Tõnis Tasa, Joel Starkopf, Tuuli Metsvaht,

Milrinone has been suggested as a possible first-line therapy for preterm neonates to prevent postligation cardiac syndrome (PLCS) through decreasing systemic vascular resistance and increasing cardiac contractility. The optimal dosing regimen, however, is not known.To model the dosing of milrinone in preterm infants for prevention of PLCS after surgical closure ... Read more >>

Neonatology (Neonatology)
[2017, 111(1):8-11]

Cited: 0 times

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Product Substitution as a Way Forward in Avoiding Potentially Harmful Excipients in Neonates.

Georgi Nellis, Tuuli Metsvaht, Heili Varendi, Jana Lass, Jennifer Duncan, Anthony J Nunn, Mark A Turner, Irja Lutsar,

Our objectives were to explore the possibility of avoiding neonatal exposure to potentially harmful excipients of interest (EOI)-parabens, polysorbate 80, propylene glycol, benzoates, saccharin sodium, sorbitol and ethanol-through product substitution in Europe.We performed a 3-day service evaluation survey and a 1-day point prevalence study in 20 and 21 European countries, ... Read more >>

Paediatr Drugs (Paediatric drugs)
[2016, 18(3):221-230]

Cited: 3 times

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