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

Brian W. Barnette; Benjamin T. Schumacher; Richard F. Armenta; James L. Wynn; Andrew Richardson; John S. Bradley; Sarah Lazar; Shelley M. Lawrence

doi:10.1055/a-1675-2899

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(02): 134-142
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

Authors

Brian W. Barnette

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, San Diego, College of Medicine, San Diego, California
Benjamin T. Schumacher

²Department of Public Heath, Herbert Wertheim School of Public Health and Longevity Science, UC San Diego School of Medicine, San Diego, California
Richard F. Armenta

³Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marco, San Diego, California
James L. Wynn

⁴Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Florida, College of Medicine, Gainesville, Florida

⁵Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
Andrew Richardson

⁶Department of Pediatrics, Clinical Research Informatics, Rady Children's Hospital San Diego, San Diego, California
John S. Bradley

⁷Division of Infectious Disease, Department of Pediatrics, University of California, San Diego, College of Medicine, San Diego, California
Sarah Lazar

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, San Diego, College of Medicine, San Diego, California
Shelley M. Lawrence

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, San Diego, College of Medicine, San Diego, California

⁸Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California, San Diego, San Diego, California

Abstract

Objective This study sought to identify concurrent major comorbidities in preterm infants ≤32 weeks of gestation that may have contributed to sepsis-related mortality following a diagnosis of bacteremia or blood culture-negative sepsis within the neonatal period (≤28 days of life).

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 the primary cause(s) and timing of death in those diagnosed with bacteremia or blood culture-negative sepsis. 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 with ≤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 Preexisting comorbidities commonly associated with extreme preterm birth contributed to sepsis-related mortality in our patient cohort.

Key Points

Concurrent comorbidities contribute to, and may artificially inflate, sepsis-related mortality.
Absence of a consensus definition for neonatal sepsis complicates the investigation of infection.
Accurate assessment of the incidence of sepsis in very low birth weight infants is vital for future investigations.

Keywords

neonatal sepsis - sepsis-related mortality - prematurity - bacteremia - blood culture-negative sepsis - comorbidities - comfort care

Full Text

References

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