Risk Factors for Mortality From Late-Onset Sepsis Among Preterm Very-Low-Birthweight Infants: A Single-Center Cohort Study From Singapore

Goh, Guan Lin; Lim, C.S.E.; Sultana, Rehena; Puerta, R. de la; Rajadurai, Victor Samuel; Yeo, Kee Thai

doi:10.3389/fped.2021.801955

Cited by 17 publications

(11 citation statements)

References 54 publications

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“…Our results confirm the findings in a previous study of VLBW infants that multiple biomarkers can discriminate between GN sepsis and GP sepsis at the time of positive blood culture (12). Since Gram-negative infections and NEC are known to carry higher morbidity and mortality, this finding might be a useful adjunct clinical decision support tool in helping pick the appropriate empiric antibiotic therapy and institute treatment early (30)(31)(32). The current study adds to our prior work (12) because we analyzed samples remote from suspected sepsis.…”

Section: Discussionsupporting

confidence: 89%

Inflammatory biomarkers and physiomarkers of late-onset sepsis and necrotizing enterocolitis in premature infants

Kumar,

Kausch,

Gummadi

et al. 2024

Front. Pediatr.

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BackgroundEarly diagnosis of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in very low birth weight (VLBW, <1,500 g) infants is challenging due to non-specific clinical signs. Inflammatory biomarkers increase in response to infection, but non-infectious conditions also cause inflammation. Cardiorespiratory data contain physiological biomarkers, or physiomarkers, of sepsis that may be useful in combination with inflammatory hematologic biomarkers for sepsis diagnosis.ObjectivesTo determine whether inflammatory biomarkers measured at the time of LOS or NEC diagnosis differ from times without infection and whether biomarkers correlate with cardiorespiratory sepsis physiomarkers in VLBW infants.MethodsRemnant plasma sample collection from VLBW infants occurred with blood draws for routine laboratory testing and suspected sepsis. We analyzed 11 inflammatory biomarkers and a pulse oximetry sepsis warning score (POWS). We compared biomarker levels obtained at the time of gram-negative (GN) bacteremia or NEC, gram-positive (GP) bacteremia, negative blood cultures, and no suspected infection.ResultsWe analyzed 188 samples in 54 VLBW infants. Several biomarkers were increased at the time of GN LOS or NEC diagnosis compared with all other samples. POWS was higher in patients with LOS and correlated with five biomarkers. IL-6 had 78% specificity at 100% sensitivity to detect GN LOS or NEC and added information to POWS.Conclusion(s)Inflammatory plasma biomarkers discriminate sepsis due to GN bacteremia or NEC and correlate with cardiorespiratory physiomarkers.

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Section: Discussionsupporting

confidence: 89%

Inflammatory biomarkers and physiomarkers of late-onset sepsis and necrotizing enterocolitis in premature infants

Kumar,

Kausch,

Gummadi

et al. 2024

Front. Pediatr.

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“…Recently, the requirement for inotropic support was assessed to predict the mortality rate in newborns with sepsis. In a study population similar to ours, weighing under 1500 g and born before 32 weeks of gestation, the mortality risk was shown to be 22 times higher in a group of newborns requiring inotropic support [ 29 ]. The pooled OR for the need for vasoactive agents obtained from 20 studies analyzed in a recently published meta-analysis was 6.5 [ 23 ].…”

Section: Discussionmentioning

confidence: 96%

Predictors of Mortality in Early Neonatal Sepsis: A Single-Center Experience

Jovičić¹,

Milosavljević

Folić

et al. 2023

Medicina

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Background and Objectives: Early neonatal sepsis is associated with a significant mortality rate despite modern treatment strategies. Our aim was to identify risk factors contributing to the occurrence of death in newborns with early neonatal sepsis. Materials and Methods: We conducted a retrospective cross-sectional study that included newborns with early sepsis who received care in the intensive and semi-intensive care units at the Institute of Neonatology, Belgrade, Serbia. Newborns with early neonatal sepsis who died comprised the case group, whereas those who survived made up the control group. The diagnostic and therapeutic approach to the septic condition was carried out independently of this study, according to valid hospital protocols and current good practice guidelines. The influence of a large number of variables on the examined dichotomous outcome, as well as the mutual interaction of potential predictor variables, was examined by binary logistic regression. Results: The study included 133 pregnant women and 136 newborns with early neonatal sepsis, of which 51 (37.5%) died, while the remaining 85 newborns (62.5%) survived. Newborns who died had a statistically significantly lower birth weight compared to those who survived (882.8 ± 372.2 g vs. 1660.9 ± 721.1 g, p = 0.000). Additionally, compared to newborns who survived, among the deceased neonates there was a significantly higher proportion of extremely preterm newborns (74.5% vs. 22.4%, p = 0.000). The following risk factors for the occurrence of death in early neonatal sepsis were identified: low birth weight, sepsis caused by gram-negative bacteria, and the use of double-inotropic therapy and erythrocyte transfusion during the first week. Conclusions: Pediatricians should pay special attention to infants with early neonatal sepsis in whom any of the identified risk factors are present in order to prevent a fatal outcome.

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“…Furthermore, in our study, E. coli was the leading pathogen (29.2%) in regional general hospital, and the proportion was significantly higher than in national general hospital and maternal and child health care hospital. Other studies showed that the prevalence of Gram-negative bacteria was associated with high mortality ( 47 – 49 ). The proportion of complications and comorbidities, especially pneumonia and meningitis, were higher in regional general hospital, which might independently lead to sepsis-attributable mortality ( 50 , 51 ).…”

Section: Discussionmentioning

confidence: 99%

Etiology and clinical characteristics of neonatal sepsis in different medical setting models: A retrospective multi-center study

Dong

et al. 2022

Front. Pediatr.

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ObjectiveGeneral hospitals admit lower gestational age neonates than maternal and child health care centers, therefore associated with a higher morbidity and mortality. This study aimed to assess the etiology and clinical characteristics of neonatal sepsis in different medical setting models.MethodsNeonates admitted to 5 tertiary medical centers, including one national general hospital, two maternal and child health care hospitals and two regional general hospitals, in central-south China with culture-proven sepsis between January 2010 and December 2019 were included in the study. We compared maternal and neonatal characteristics, pathogen distribution, treatment and neonatal outcomes among 3 different medical setting models in this retrospective cohort.ResultsWe identified 757 episodes of culture-proven sepsis in 757 neonates. The predominant pathogens were coagulase-negative staphylococci, Klebsiella pneumoniae, Escherichia coli and Group B streptococci. A total of 683 neonates with detailed information were involved in further comparison; 54.6% were from the national general hospital, 35.9% were from the maternal and child health care hospital, and 9.5% were from the regional general hospital. Neonates in national and regional general hospitals had significantly lower gestational age and birthweight (P < 0.001). Patterns of pathogen distribution were different among these medical setting models. Early-onset sepsis was more common in maternal and child health care hospitals (61.4% vs. 42.1% vs. 46.7%, P < 0.001), while hospital-acquired late-onset sepsis was more common in national and regional general hospitals (32.7% vs. 33.3% vs. 11.4%, P < 0.001). The proportion of complications or comorbidities of neonates in maternal and child health care hospitals were significantly lower than neonates in national and regional general hospitals (P < 0.001). The case fatality rate was significantly higher in regional general hospitals (10.8% vs. 3.2% vs. 0.8%, P = 0.001).ConclusionWe report distinct patterns of clinical characteristics, pathogens and outcomes in patient subgroups with neonatal sepsis from national general hospital, maternal and child health care hospital and regional general hospital. It might have some implications for improvement of prevention, management and empirical antibiotic use in neonatal sepsis in different setting models, especially in resource-limited settings from middle and low-income countries.

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Risk Factors for Mortality From Late-Onset Sepsis Among Preterm Very-Low-Birthweight Infants: A Single-Center Cohort Study From Singapore

Cited by 17 publications

References 54 publications

Inflammatory biomarkers and physiomarkers of late-onset sepsis and necrotizing enterocolitis in premature infants

Inflammatory biomarkers and physiomarkers of late-onset sepsis and necrotizing enterocolitis in premature infants

Predictors of Mortality in Early Neonatal Sepsis: A Single-Center Experience

Etiology and clinical characteristics of neonatal sepsis in different medical setting models: A retrospective multi-center study

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