Characterization of neonatal multisystem organ failure in the surgical newborn

With advances in critical care, multisystem organ failure (MSOF) has replaced single organ failure as the major cause of death in adult patients. The purpose of this report is to characterize neonatal MSOF (NMSOF) in the surgical newborn. The records of 84 infants who died during a 5-year period in the surgical neonatal intensive care unit were reviewed. There was sufficient information available in 10 newborns to characterize the NMSOF syndrome. Criteria for renal, hepatic, microvascular, pulmonary, cardiac, and hematologic failure were developed. The sequence of organ failure was determined by calculating the number of days prior to death when these criteria were first noted. Systemic infections were recorded. The sequence of organ failure was as follows: microvascular (edema) 17 +/- 10 days, renal 14 +/- 7 days, hepatic 13 +/- 5 days, hematologic 8 +/- 4 days, pulmonary 5 +/- 2 days, and cardiac 3 +/- 2 days. Adult respiratory distress syndrome (ARDS) was absent. The 10 infants showed both culture-positive sepsis (8) and culture-negative sepsis (2). This is the first report to characterize NMSOF in newborn surgical patients. The earliest findings were edema, followed by renal and hepatic failure. In contrast to adult MSOF, anasarca is a prominent early finding, pulmonary failure develops late, and classic ARDS is absent.