CC BY-NC-ND 4.0 · Am J Perinatol
DOI: 10.1055/a-1675-2899
Original Article

Contribution of Concurrent Comorbidities to Sepsis-Related Mortality in Preterm Infants ≤ 32 Weeks of Gestation at an Academic Neonatal Intensive Care Network

Concurrent Comorbidities and Sepsis-Related Mortality
Brian W Barnette
1  Pediatrics, Rady Children's Hospital San Diego, San Diego, United States (Ringgold ID: RIN14444)
2  Pediatrics, University of California San Diego Health Sciences, La Jolla, United States (Ringgold ID: RIN315531)
,
3  Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego Health Sciences, La Jolla, United States (Ringgold ID: RIN315531)
,
Richard F Armenta
4  Kinesiology, California State University San Marcos, San Marcos, United States (Ringgold ID: RIN14673)
,
James L. Wynn
5  Department of Pediatrics, University of Florida, Gainesville, United States
,
Andrew Richardson
1  Pediatrics, Rady Children's Hospital San Diego, San Diego, United States (Ringgold ID: RIN14444)
,
John S Bradley
1  Pediatrics, Rady Children's Hospital San Diego, San Diego, United States (Ringgold ID: RIN14444)
2  Pediatrics, University of California San Diego Health Sciences, La Jolla, United States (Ringgold ID: RIN315531)
,
Sarah Lazar
1  Pediatrics, Rady Children's Hospital San Diego, San Diego, United States (Ringgold ID: RIN14444)
2  Pediatrics, University of California San Diego Health Sciences, La Jolla, United States (Ringgold ID: RIN315531)
,
Shelley M Lawrence
6  Pediatrics, University of California San Diego, La Jolla, United States (Ringgold ID: RIN8784)
1  Pediatrics, Rady Children's Hospital San Diego, San Diego, United States (Ringgold ID: RIN14444)
› Author Affiliations
Supported by: Division of Intramural Research, National Institute of Allergy and Infectious Diseases R01AI134982
Supported by: National Institute of General Medical Sciences R01GM128452
Supported by: Eunice Kennedy Shriver National Institute of Child Health and Human Development R01HD089939,R01HD095547-03,R01HD097081,R01HD099250
Supported by: National Institute of Biomedical Imaging and Bioengineering R43EB029863

Objective: The lack of a consensus definition for neonatal sepsis may complicate the accurate calculation of sepsis-related mortality in infants ≤ 32 weeks of gestation. This study evaluates whether concurrent major comorbidities influenced neonatal sepsis-related mortality in this patient population following a diagnosis of bacteremia or blood culture-negative sepsis. Study Design: This is a retrospective chart review of infants ≤ 32 weeks of gestation, who were admitted to a single academic network of multiple neonatal intensive care units between January 1, 2012 and December 31, 2015, to determine if concurrent co-morbidities contributed to bacteremia or blood culture-negative sepsis- related morality. Direct comparisons between early-onset sepsis (EOS; ≤ 72 hours) and late-onset sepsis (LOS; > 72 hours) were made. Results: In our study cohort of 939 total patients ≤ 32 weeks of gestation, 182 infants were diagnosed with 198 episodes of sepsis and 7.7% (14/182) died. Mortality rates did not significantly differ between neonates with bacteremia or blood culture-negative sepsis (7/14 each group), and those diagnosed with EOS compared with LOS (6/14 vs. 8/14). Nearly 80% (11/14) of infants were transitioned to comfort care prior to their death secondary to a coinciding diagnosis of severe grade 3 or 4 intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and/or intestinal perforation. Conclusion: Those with sepsis-related mortality had pre-existing comorbidities that are commonly associated with extreme preterm birth. The contribution of comorbidities to sepsis-related mortality should be considered in future investigations designed to evaluate the efficacy of therapeutics and/or technologies that target sepsis-mediated pathways.



Publication History

Received: 27 April 2021

Accepted after revision: 22 September 2021

Publication Date:
21 October 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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