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Am J Perinatol
DOI: 10.1055/a-2693-0426
Original Article

Organism- and Mortality-Specific Cardiorespiratory Patterns in Late-Onset Neonatal Sepsis: A Four-Neonatal Intensive Care Unit Study of Very Low Birth Weight Infants

Sherry L. Kausch
1   Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Brynne A. Sullivan
1   Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Rakesh Sahni
2   Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
,
Zachary A. Vesoulis
3   Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
,
Colm P. Travers
4   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Douglas E. Lake
1   Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Karen D. Fairchild
1   Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
the Predictive Monitoring Consortium› Author Affiliations
Funding Information We acknowledge the following grants for funding the work presented in this manuscript: grant no: K23 HD097254 (PI: B.A.S.); grant no: R01 HD072071 (Co-PIs K.D.F. and B.A.S., Co-I: D.E.L.); grant no: K23NS111086 (PI: Z.A.V.); and grant no: K23HL157618 (PI: C.P.T.).
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Abstract

Objective

Late-onset neonatal sepsis (LOS) in very low birth weight (VLBW) preterm infants varies in severity from mild to fatal and often presents with cardiorespiratory instability. We hypothesized that heart rate (HR) and systemic oxygenation (SpO2) patterns would differ based on pathogen type and mortality.

Study Design

We analyzed HR and SpO2 changes before LOS diagnosis for Gram-negative, Coagulase-negative Staphylococcus, and other Gram-positive bacteria (GN, CONS, OGP) and compared survivors and nonsurvivors. Using continuous every-2-second vital sign data from 365 VLBW infants in four neonatal intensive care units, we calculated nine HR and SpO2 metrics over a 96-hour window.

Results

GN LOS was associated with a slightly higher HR, more negative skewness of HR, and higher cross correlation of HR-SpO2. Mortality was highest in GN LOS (22.7 vs. 4.6% CONS, 8.8% OGP). Nonsurvivors had distinct HR and SpO2 patterns.

Conclusion

These findings highlight critical cardiorespiratory differences at LOS diagnosis associated with mortality risk.

Key Points

  • Changes in HR and SpO2 patterns varied by organism type prior to late-onset sepsis in VLBW infants.

  • Generally, HR and SpO2 pattern changes showed only small differences based on organism class.

  • Patterns associated with fatal sepsis included lower mean SpO2 and lower standard deviation of HR.

Keywords

neonate - sepsis - infant - very low birth weight - infant - newborn

Ethical Approval

This study was approved by the Institutional Review Board at each site with a waiver of consent (approval number: 21237 at UVA). This study was conducted in accordance with the Declaration of Helsinki.


Note

Namasivayam Ambalavanan4, Colm P. Travers4, Rachel Benz4, Karen D. Fairchild1, Brynne A. Sullivan1, Sherry L. Kausch1, Angela K.S. Gummadi1, Ian German Mesner1, Douglas A. Lake1, Katy Nash Krahn1, Jiaxing Joy Qiu1, J. Randall Moorman1, Carie Taveras2, Rakesh Sahni2, Joseph Isler2, Nim Goldshtrom2, Zachery A. Vesoulis3, Amanda Duncan3


* A list of authors and their affiliations appears at the end of the paper in “Note” section.




Publication History

Received: 03 July 2025

Accepted: 30 August 2025

Article published online:
12 September 2025

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