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Published on: April 3, 2026
Exploratory Hemodynamic and Hematologic Trajectories by Culture Status Among Neonates Evaluated for Infection
Andra Rotea1, Bogdan Rotea1, Vlad Alexandru Meche1
1Doctoral School, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania.
Background:
Neonates evaluated for infection undergo rapid physiologic transition, making isolated measurements difficult to interpret. Because a positive culture field does not by itself establish clinical sepsis, we explored whether physiologic and laboratory trajectories differed by recorded culture status during the first three postnatal days.
Methods:
This single-center prospective observational longitudinal study included 65 neonates with linked measurements on days 1, 2, and 3. The exposure was a binary culture field in the source database; specimen source, organism identity, and pathogen-versus-contaminant adjudication were unavailable. Group-specific medians were summarized, and gestational-age-adjusted linear models with patient-clustered robust standard errors tested culture status, time, and culture-status-by-time effects.
Results:
The cohort included 26 culture-positive and 39 culture-negative neonates. On day 1, the culture-positive group had lower median systolic blood pressure (48.5 vs. 57.0 mmHg), diastolic blood pressure (24.5 vs. 33.0 mmHg), and MAP (31.0 vs. 41.0 mmHg), more negative base excess (-7.65 vs. -3.60 mmol/L), and lower platelet counts (219 vs. 282 × 109/L). Diastolic pressure rose in both groups and converged by day 3; the adjusted culture-status-by-time interaction was significant (p = 0.012). MAP increased over time, but its interaction was not significant (p = 0.244). Culture-positive status was associated with a lower day-1 platelet count (adjusted beta, -73.0 × 109/L; 95% CI, -128.1 to -17.8; p = 0.010), without evidence of a differential platelet trajectory (interaction p = 0.623). CRP was retained as a descriptive outcome only because of lower-limit censoring.
Conclusions:
Recorded culture status was associated with selected early hemodynamic, metabolic, and hematologic differences in this small exploratory cohort. These associations cannot be considered sepsis-specific and require confirmation after clinical culture adjudication, standardized timestamping and blood-pressure measurement, inclusion of fatal cases, and adjustment for illness severity and treatment exposures.
