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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

Brian W. Barnette
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, San Diego, College of Medicine, San Diego, California
,
Benjamin T. Schumacher 
2   Department of Public Heath, Herbert Wertheim School of Public Health and Longevity Science, UC San Diego School of Medicine, San Diego, California
,
Richard F. Armenta
3   Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marco, San Diego, California
,
James L. Wynn
4   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Florida, College of Medicine, Gainesville, Florida
5   Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
,
Andrew Richardson
6   Department of Pediatrics, Clinical Research Informatics, Rady Children's Hospital San Diego, San Diego, California
,
John S. Bradley
7   Division of Infectious Disease, Department of Pediatrics, University of California, San Diego, College of Medicine, San Diego, California
,
Sarah Lazar
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, San Diego, College of Medicine, San Diego, California
,
Shelley M. Lawrence
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, San Diego, College of Medicine, San Diego, California
8   Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California, San Diego, San Diego, California
› Author Affiliations Funding S.M.L.: Institute of Allergy and Infectious Disease; 2017 (R01AI134982), Institute: Eunice Kennedy Shriver Institute of Child Health and Human Development; 2020 (R01HD099250). J.L.W.: National Institute of General Medicine Sciences; April 2018 (R01GM128452), Institute: Eunice Kennedy Shriver Institute of Child Health and Human Development; August 2017 (R01HD089939), Institute: Eunice Kennedy Shriver Institute of Child Health and Human Development; July 2019 (R01HD097081), Insitute of Biomedical Imagining and Bioengineering; September 2020 (R43EB029863). J.S.B.: Institute: Eunice Kennedy Shriver Institute of Child Health and Human Development; July 2018 (R01HD095547–03).
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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

Author' Contribution

The study's conceptualization and design were spearheaded by B.W.B., J.L.W., and S.M.L. The data acquisition involved efforts from B.W.B., S.L., and A.R. B.W.B., B.T.S., R.F.A., and S.M.L. played pivotal roles in the analysis and interpretation of the gathered data. The initial draft of the manuscript was collaboratively crafted by B.W.B. and S.M.L. All authors contributed significantly to the critical revision of the manuscript.




Publication History

Received: 27 April 2021

Accepted: 22 September 2021

Accepted Manuscript online:
21 October 2021

Article published online:
31 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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