Clinical and haemodynamic characteristics of preterm infants with early onset sepsis

Early onset sepsis (EOS) in preterm infants is associated with high morbidity and mortality. Improved characterisation of the haemodynamic presentation of EOS could lead to more effective and targeted treatments.

We performed a retrospective observational study of preterm infants ≤32 week' gestation with EOS between 2010 and 2020 and gathered clinical, haemodynamic and echocardiographic data.

Of the 2198 admitted infants, 27 infants (median gestational age 28 weeks, median birthweight 1174 g) developed EOS with predominantly gram-negative pathogens and the overall mortality rate was 33.3%. Besides hypotension, clinical signs were non-specific, and over half of infants were normotensive in the first 72 h of life. Those with hypotension received more fluid resuscitation, inotropic support and had a higher mortality compared to the normotensive infants. Cardiac ultrasound was available in 18 infants and commonly revealed higher as expected cardiac output, pulmonary hypertension and diastolic dysfunction.

Preterm infants with EOS had a high mortality rate, especially when they progressed from sepsis to septic shock. Echocardiography revealed a normal haemodynamic pattern, or one suggestive of vasodilatation and warm shock physiology. Targeting this pathophysiology earlier might improve outcomes.