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Published on: November 20, 2015
Organ dysfunction and mortality in preterm neonates with late-onset bloodstream infection
Ashraf Kharrat1,2, Faith Zhu3,4, Michelle Baczynski4
1Department of Paediatrics, University of Toronto, Toronto, ON, Canada. ashraf.kharrat@sinaihealth.ca.
Insights
Organ dysfunction in preterm infants with bloodstream infections is linked to higher mortality. Key indicators include metabolic acidosis, hypoxic respiratory failure, and vasopressor use, helping identify high-risk neonates.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Critical Care
Background:
- Organ dysfunction (ODF) in late-onset bloodstream infection (LBSI) correlates with adverse outcomes in neonates.
- No standardized definition for ODF exists in preterm infants.
- This study aimed to define ODF based on outcomes and identify mortality predictors in preterm neonates.
Purpose of the Study:
- To establish an outcome-based definition for organ dysfunction in preterm neonates with LBSI.
- To identify clinical factors associated with mortality in this vulnerable population.
- To develop a predictive score for mortality risk.
Main Methods:
- Retrospective study of neonates (<35 weeks gestational age) with LBSI.
- Evaluation of parameters: base deficit ≤-8 mmol/L (BD8), renal dysfunction, hypoxic respiratory failure (HRF), and vasopressor/inotrope (V/I) use.
- Multivariable logistic regression to derive a mortality score.
Main Results:
- 148 neonates with LBSI; 57 (39%) developed ODF, with 49% mortality.
- BD8 showed high individual predictive ability (AUROC=0.78).
- A combination of BD8 + HRF + V/I defined ODF (AUROC=0.84), strongly predicting mortality (aOR 12.15).
Conclusions:
- Metabolic acidosis (BD8), HRF, and V/I use are key indicators of mortality risk in preterm neonates with LBSI.
- The proposed ODF definition can aid in identifying high-risk infants for targeted interventions.
- These findings support future research into adjunctive therapies for sepsis-related ODF.
Background:
Organ dysfunction (ODF) in late-onset bloodstream infection (LBSI) is associated with increased risk of adverse outcomes. However, no established definition of ODF exists among preterm neonates. Our objective was to describe an outcome-based ODF definition for preterm infants, and assess factors associated with mortality.
Methods:
This is a six-year retrospective study of neonates <35 weeks gestational age, >72 h of age, with non-CONS bacterial/fungal LBSI. Discriminatory ability of each parameter for mortality was evaluated: base deficit ≤-8 mmol/L (BD8), renal dysfunction (urine output <1 cc/kg/h or creatinine ≥100 μmol/L), hypoxic respiratory failure (HRF, ventilated, FiO2 = 1.0), or vasopressor/inotrope use (V/I). Multivariable logistic regression analysis was performed to derive a mortality score.
Results:
One hundred and forty-eight infants had LBSI. BD8 had the highest individual predictive ability for mortality (AUROC = 0.78). The combination BD8 + HRF + V/I was used to define ODF (AUROC = 0.84). Fifty-seven (39%) infants developed ODF, among which 28 (49%) died. Mortality increased inversely relative to GA at LBSI-onset (aOR 0.81 [0.67, 0.98]) and directly relative to ODF occurrence (12.15 [4.48, 33.92]). Compared to no-ODF, ODF infants had lower GA and age at illness, and higher frequency of Gram-negative pathogen.
Conclusions:
Among preterm neonates with LBSI, significant metabolic acidosis, HRF, and vasopressor/inotrope use may identify infants high risk for mortality. These criteria could help identify patients for future studies of adjunctive therapies.
Impact:
Sepsis-related organ dysfunction is associated with increased risk of adverse outcomes. Among preterm neonates, significant metabolic acidosis, use of vasopressors/inotropes, and hypoxic respiratory failure may identify high-risk infants. This can be used to target research and quality improvement efforts toward the most vulnerable infants.
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