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Published on: November 20, 2015
Apnea, Intermittent Hypoxemia, and Bradycardia Events Predict Late-Onset Sepsis in Extremely Preterm Infants
Sherry L Kausch1, Douglas E Lake2, Juliann M Di Fiore3
1Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA.
Insights
Cardiorespiratory changes like apnea and bradycardia can signal early sepsis in preterm infants. These events, particularly on ventilators, help predict sepsis risk, aiding timely intervention.
Area of Science:
- Neonatal Medicine
- Cardiorespiratory Physiology
- Infectious Disease
Background:
- Early detection of late-onset sepsis (LOS) in extremely preterm infants is critical.
- Cardiorespiratory events (apnea, periodic breathing, bradycardia, intermittent hypoxemia) are potential early sepsis indicators.
- Understanding these events' association with LOS in infants on versus off mechanical ventilation is crucial.
Approach:
- Retrospective analysis of data from 737 extremely preterm infants (<29 weeks GA) in the Pre-Vent study.
- Utilized continuous monitoring data from 719 infants (47,512 patient-days) to quantify cardiorespiratory events.
- Examined relationships between daily cardiorespiratory measures and LOS (positive blood culture >72h, ≥5d antibiotics).
Key Points:
- For non-ventilated infants, apnea, periodic breathing, and bradycardia increased before sepsis diagnosis.
- For ventilated infants, longer intermittent hypoxemia (IH) events (IH80) and more bradycardia preceded sepsis.
- IH events were linked to higher sepsis risk but did not show a temporal increase before diagnosis, irrespective of ventilation.
Conclusions:
- Identified distinct cardiorespiratory signatures preceding LOS in extremely preterm infants.
- Apnea, periodic breathing, and bradycardia serve as significant early warning signs for sepsis.
- While IH events correlate with sepsis risk, their temporal pattern differs, requiring consideration of ventilation status.
Objectives:
Detection of changes in cardiorespiratory events, including apnea, periodic breathing, intermittent hypoxemia (IH), and bradycardia, may facilitate earlier detection of sepsis. Our objective was to examine the association of cardiorespiratory events with late-onset sepsis for extremely preterm infants (<29 weeks' gestational age (GA)) on versus off invasive mechanical ventilation.
Study Design:
Retrospective analysis of data from infants enrolled in Pre-Vent (ClinicalTrials.gov identifier NCT03174301), an observational study in five level IV neonatal intensive care units. Clinical data were analyzed for 737 infants (mean GA 26.4w, SD 1.71). Monitoring data were available and analyzed for 719 infants (47,512 patient-days), of whom 109 had 123 sepsis events. Using continuous monitoring data, we quantified apnea, periodic breathing, bradycardia, and IH. We analyzed the relationships between these daily measures and late-onset sepsis (positive blood culture >72h after birth and ≥5d antibiotics).
Results:
For infants not on a ventilator, apnea, periodic breathing, and bradycardia increased before sepsis diagnosis. During times on a ventilator, increased sepsis risk was associated with longer IH80 events and more bradycardia events before sepsis. IH events were associated with higher sepsis risk, but did not dynamically increase before sepsis, regardless of ventilator status. A multivariable model predicted sepsis with an AUC of 0.783.
Conclusion:
We identified cardiorespiratory signatures of late-onset sepsis. Longer IH events were associated with increased sepsis risk but did not change temporally near diagnosis. Increases in bradycardia, apnea, and periodic breathing preceded the clinical diagnosis of sepsis.
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