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ObjectiveTo determine the risk factors for mortality associated with late onset sepsis (LOS) among preterm very-low-birthweight (VLBW) infants.Study DesignWe performed a retrospective cohort study of infants born <32 weeks gestation and <1,500 gm admitted to a Singaporean tertiary-level neonatal intensive care unit. We determined the clinical, microbial, and laboratory risk factors associated with mortality due to culture-positive LOS in this cohort.ResultsA total of 1,740 infants were admitted, of which 169 (9.7%) developed LOS and 27 (16%) died. Compared to survivors, those who died had lower birth gestational age (median 24 vs. 25 weeks, p = 0.02) and earlier LOS occurrence (median 10 vs. 17 days, p = 0.007). There was no difference in the incidence of meningitis (11.1 vs. 16.9%, p = 0.3), NEC (18.5 vs. 14.8%, p = 0.6), or intestinal surgery (18.5 vs. 23.3%, p = 0.6) among infants who died compared to survivors. Gram-negative bacteria accounted for 21/27 (77.8%) LOS-associated deaths and almost all (13/14, 93%) fulminant episodes. The presence of multiorgan failure, as evidenced by the need for mechanical ventilation (100 vs. 79.0%, p = 0.008), elevated lactate (12.4 vs. 2.1 mmol/L, p < 0.001), and inotropic support (92.6 vs. 37.5%, p < 0.001), was significantly associated with mortality. Infants who died had significantly lower white blood cell (WBC) counts (median 4.2 × 109/L vs. 9.9 × 109/L, p = 0.001), lower platelet count (median 40 × 109/L vs. 62 × 109/L, p = 0.01), and higher immature to total neutrophil (I: T) ratio (0.2 vs. 0.1, p = 0.002). Inotrope requirement [AOR 22.4 (95%CI 2.9, 103.7)], WBC <4 × 109/L [AOR 4.7 (1.7, 13.2)], and I: T ratio >0.3 [AOR 3.6 (1.3, 9.7)] were independently associated with LOS mortality.ConclusionsIn a setting with predominantly Gram-negative bacterial infections, the need for inotropic support, leukopenia, and elevated I: T ratio were significantly associated with LOS mortality among preterm VLBW infants.

tertiary care hospital in Eastern India. The sample size was 56, calculated on the basis of a similar pediatric RCT. Patient enrolment occurred between May 2019 and July 2020. Children aged between 1 month and 12 years with suspected septic shock were randomized to receive either ultrasound or clinically guided fluid boluses (in a 1:1 ratio) and subsequently followed up for primary and secondary outcomes. Exclusion criteria were Dengue, Anaphylaxis, Ascites, and patients with pre-existing chronic kidney disease, interstitial lung disease, heart disease, and adrenal insufficiency. Ultrasound was used in the treatment group whenever there was clinical suspicion of inadequate perfusion. Results 68 children were enrolled in the study. 4 patients of Dengue and 4 patients who died within 24 hours were excluded. The number (%) of patients with fluid overload on day 3 of admission was significantly lower in the ultrasound group (25% vs. 62%, p=0.012) as was the CFB% on day 3 (6.8±6.6% vs. 13.4±10.7%, p=0.019). Total fluid bolus was significantly lower {median of 40(30-50) ml/kg vs. 50 (40-80) ml/kg, p=0.003}. Resuscitation time was significantly lower in the ultrasound group (13.4 ± 5.6h vs. 20.5 ± 8h, p=0.002) and so was the requirement of Furosemide (39.3% vs. 71.4%, p=0.016). None of the deaths in the ultrasound group were due to unresolved shock (p=0.101). There was no significant benefit derived from ultrasound in terms of ventilator duration, inotrope/vasopressor requirement, length of PICU/hospital stay, and mortality. Conclusions Due to a lack of comparative studies on this topic, our study adds insight into the utility of ultrasound in improving outcomes in septic shock. Ultrasound made the PICU physician exercise restraint in administering fluid boluses and allowed earlier initiation of inotropes. Ultrasound was found to be significantly better than clinically guided therapy, in preventing fluid overload as well as being quicker in achieving initial hemodynamic stabilization. Hence ultrasound is a potentially useful tool for fluid resuscitation in children with septic shock.