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  • Clinical Research Article
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Organ dysfunction and mortality in preterm neonates with late-onset bloodstream infection

Pediatric Research volume 94, pages 1044–1050 (2023)Cite this article

Abstract

Background

Organ dysfunction (ODF) in late-onset bloodstream infection (LBSI) is associated with increased risk of adverse outcomes. However, no established definition of ODF exists among preterm neonates. Our objective was to describe an outcome-based ODF definition for preterm infants, and assess factors associated with mortality.

Methods

This is a six-year retrospective study of neonates <35 weeks gestational age, >72 h of age, with non-CONS bacterial/fungal LBSI. Discriminatory ability of each parameter for mortality was evaluated: base deficit ≤−8 mmol/L (BD8), renal dysfunction (urine output <1 cc/kg/h or creatinine ≥100 μmol/L), hypoxic respiratory failure (HRF, ventilated, FiO2 = 1.0), or vasopressor/inotrope use (V/I). Multivariable logistic regression analysis was performed to derive a mortality score.

Results

One hundred and forty-eight infants had LBSI. BD8 had the highest individual predictive ability for mortality (AUROC = 0.78). The combination BD8 + HRF + V/I was used to define ODF (AUROC = 0.84). Fifty-seven (39%) infants developed ODF, among which 28 (49%) died. Mortality increased inversely relative to GA at LBSI-onset (aOR 0.81 [0.67, 0.98]) and directly relative to ODF occurrence (12.15 [4.48, 33.92]). Compared to no-ODF, ODF infants had lower GA and age at illness, and higher frequency of Gram-negative pathogen.

Conclusions

Among preterm neonates with LBSI, significant metabolic acidosis, HRF, and vasopressor/inotrope use may identify infants high risk for mortality. These criteria could help identify patients for future studies of adjunctive therapies.

Impact

  • Sepsis-related organ dysfunction is associated with increased risk of adverse outcomes.

  • Among preterm neonates, significant metabolic acidosis, use of vasopressors/inotropes, and hypoxic respiratory failure may identify high-risk infants.

  • This can be used to target research and quality improvement efforts toward the most vulnerable infants.

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Data availability

The datasets generated during the current study are not publicly available due patient confidentiality; all analyzed data are included in this article.

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Author information

Authors and Affiliations

  1. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Ashraf Kharrat, Faith Zhu, Dany Weisz & Amish Jain

  2. Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada

    Ashraf Kharrat, Faith Zhu, Michelle Baczynski & Amish Jain

  3. MiCare Research Centre, Mount Sinai Hospital, Toronto, ON, Canada

    Xiang Y. Ye

  4. Newborn and Developmental Paediatrics, Sunnybrook Health Sciences, Toronto, ON, Canada

    Dany Weisz

  5. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada

    Amish Jain

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Contributions

A.K. and A.J. conceived, designed, and planned the study, contributed to planning data extraction and analysis, interpretation of results, wrote first and final draft of the publication, and approved the final publication. M.B. and F.Z. contributed to data collection, critically reviewed the manuscript, and approved the final publication. D.W. critically reviewed the study design and the manuscript and approved the final publication. X.Y.Y. performed the statistical analysis and contributed to and approved the final publication.

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Correspondence to Ashraf Kharrat.

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Kharrat, A., Zhu, F., Baczynski, M. et al. Organ dysfunction and mortality in preterm neonates with late-onset bloodstream infection. Pediatr Res 94, 1044–1050 (2023). https://doi.org/10.1038/s41390-023-02541-1

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