Hemodynamic Assessment in Newborn Infants With Sepsis: A Prospective Observational Study

Sepsis is defined as SIRS (systemic inflammatory response syndrome) in the presence of confirmed or suspected infection. Neonatal sepsis remains a major cause of morbidity and mortality and is frequently complicated by septic shock, resulting in impaired tissue perfusion and organ dysfunction. Hemodynamic alterations in septic neonates are heterogeneous and often under-recognized. The primary objective of this study was to characterize the hemodynamic profile of neonates with sepsis for early detection of circulatory dysfunction using functional echocardiography. The secondary objective was to evaluate the requirement for vasoactive support and associated outcomes.

This prospective observational study included 288 neonates with clinical sepsis admitted to the neonatal intensive care unit (NICU) at King George's Medical University, Lucknow, India. Sepsis was diagnosed based on the presence of ≥2 clinical signs, suggestive of infection, including feeding intolerance, temperature instability, apnea, lethargy or poor reflexes, and capillary refill time greater than three seconds. These criteria were applied uniformly at the time of admission, and organ dysfunction was assessed using the neonatal Sequential Organ Failure Assessment (nSOFA) score. Septic shock was defined by clinical and hemodynamic evidence of circulatory failure requiring vasoactive support. Laboratory evaluation included sepsis screen, blood cultures, and cerebrospinal fluid analysis, where indicated. Hemodynamic assessment was performed using bedside functional two-dimensional echocardiography, evaluating preload, myocardial contractility, and afterload parameters.

Of the 288 neonates with sepsis, 102 (35.4%) developed septic shock. Neonates with shock had significantly lower gestational age and birth weight, and a higher incidence of feeding intolerance and prolonged capillary refill time. Laboratory abnormalities included lower total leukocyte counts and higher C-reactive protein levels and immature-to-total neutrophil ratios (p < 0.001). Functional echocardiography demonstrated impaired myocardial contractility and altered perfusion parameters in the shock group. Overall, 80.4% of neonates with septic shock required inotropes and/or vasopressors. Mortality was significantly higher among neonates with shock compared to those without shock (46.1% vs. 9.1%). Blood and cerebrospinal fluid cultures predominantly yielded gram-negative organisms, with Klebsiella pneumoniae and Acinetobacter baumannii being the most common isolates.

Septic shock is common among neonates with sepsis, particularly in preterm and low-birth-weight infants, and is associated with significant hemodynamic compromise and high mortality. Early recognition of circulatory dysfunction using a combination of clinical assessment, laboratory markers, and functional echocardiography allows timely, targeted hemodynamic interventions with fluids, inotropes, and vasopressors, potentially improving neonatal outcomes.