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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Culture-Confirmed Bacterial Sepsis and Invasive Fungal Infection in Preterm Infants: NICU Resource Burden, Major
Sergiu Costescu1, Adrian Ratiu2, Bogdan Cerbu1,3
1Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Insights
Late-onset infections like bacterial sepsis and candidemia in preterm infants increase neonatal morbidity and NICU resource use. These infections also significantly impact caregiver mental health, leading to distress at discharge.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Caregiver Mental Health
Background:
- Very preterm infants face risks from late-onset infections and prolonged NICU stays.
- These factors can negatively affect caregiver well-being.
Purpose of the Study:
- To evaluate neonatal outcomes in preterm infants with culture-confirmed infections.
- To assess caregiver psychosocial status in relation to infection phenotypes.
Main Methods:
- A prospective cohort study of 87 preterm infants (March 2023-December 2025).
- Infants categorized into no infection, bacterial sepsis, or candidemia groups.
- Neonatal outcomes and caregiver psychosocial status (SF-36, WHOQOL-BREF, HADS, PHQ-9, GAD-7) were assessed.
Main Results:
- Candidemia presented later and required longer treatment than bacterial sepsis.
- Infection groups showed higher rates of composite adverse outcomes and ROP requiring treatment.
- NICU length of stay and ventilation days increased significantly with infection.
- Caregiver mental health scores declined, and depression scores increased, correlating with NICU burden.
Conclusions:
- Culture-confirmed infections, especially candidemia, are linked to increased neonatal morbidity.
- Infections necessitate greater NICU resource utilization.
- Significant caregiver distress is associated with neonatal infection in the NICU setting.
Background And Objectives:
Very preterm infants are vulnerable to late-onset infection and prolonged NICU exposure, with potential downstream effects on caregiver health. We evaluated neonatal outcomes and caregiver psychosocial status across culture-confirmed infection phenotypes.
Methods:
We investigated a single-center prospective cohort (March 2023-December 2025) of 87 preterm infants assigned to one of three groups: no proven infection (n = 44), bacterial sepsis (n = 31), or candidemia (n = 12). Neonatal outcomes included a composite adverse endpoint (death or major morbidity) and resource utilization. Caregivers completed the SF-36, WHOQOL-BREF, HADS, PHQ-9, GAD-7, and Body Image Scale near discharge.
Results:
Candidemia occurred later than bacterial sepsis (day of life 17.8 ± 4.8 vs. 10.1 ± 3.9; p < 0.001) and had a longer time to effective therapy (23.3 ± 9.5 vs. 13.3 ± 5.3 h; p = 0.004). The composite adverse outcome was 27.3% in the no-infection group versus 54.8% in the bacterial group and 58.3% in the candidemia group (p = 0.025); ROP requiring treatment increased from 4.5% to 29.0% and 25.0% (p = 0.012). Length of stay rose from 39.7 ± 10.2 to 50.1 ± 11.9 and 60.9 ± 13.1 days (p < 0.001), and ventilation days from 15.7 ± 7.6 to 23.3 ± 7.5 and 34.2 ± 10.4 (p < 0.001). Caregiver SF-36 mental health (MCS) scores decreased from 44.7 ± 7.5 to 38.5 ± 6.0 and 36.7 ± 6.4 (p < 0.001), while PHQ-9 scores increased from 9.4 ± 3.9 to 11.6 ± 3.3 and 15.5 ± 4.6 (p < 0.001); NICU burden correlated with PHQ-9 scores (r = 0.52, p < 0.001).
Conclusions:
Culture-confirmed infection, particularly candidemia, was associated with higher neonatal morbidity, markedly greater resource use, and substantial caregiver distress at discharge.
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