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Neonatal sepsis and cardiovascular dysfunction I: mechanisms and pathophysiology

Pediatric Research volume 95, pages 1207–1216 (2024)Cite this article

Abstract

The highest incidence of sepsis across all age groups occurs in neonates leading to substantial mortality and morbidity. Cardiovascular dysfunction frequently complicates neonatal sepsis including biventricular systolic and/or diastolic dysfunction, vasoregulatory failure, and pulmonary arterial hypertension. The haemodynamic response in neonatal sepsis can be hyperdynamic or hypodynamic and the underlying pathophysiological mechanisms are heterogeneous. The diagnosis and definition of both neonatal sepsis and cardiovascular dysfunction complicating neonatal sepsis are challenging and not consensus-based. Future developments in neonatal sepsis management will be facilitated by common definitions and datasets especially in neonatal cardiovascular optimisation.

Impact

  • Cardiovascular dysfunction is common in neonatal sepsis but there is no consensus-based definition, making calculating the incidence and designing clinical trials challenging.

  • Neonatal cardiovascular dysfunction is related to the inflammatory response, which can directly target myocyte function and systemic haemodynamics.

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Fig. 1: Pathogenesis of sepsis-induced cardiac dysfunction in a neonate.
Fig. 2: Vasoregulatory dysfunction in neonatal sepsis.

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Authors and Affiliations

  1. Department of Paediatric Cardiology, Children’s Health Ireland at Crumlin, Dublin, Ireland

    Sophie M. Duignan & Orla Franklin

  2. Department of Pediatrics, UC Davis Children’s Hospital, Sacramento, CA, USA

    Satyan Lakshminrusimha

  3. Children’s Heart Centre, BC Children’s Hospital, Vancouver, BC, Canada

    Kathryn Armstrong

  4. Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Nijmegen, The Netherlands

    Willem P. de Boode & Willem P. de Boode

  5. School of Medicine, Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland

    Afif El-Khuffash

  6. Discipline of Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland

    Orla Franklin & Eleanor J. Molloy

  7. Department of Neonatology, Children’s Health Ireland at Crumlin, Dublin, Ireland

    Eleanor J. Molloy

  8. Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland

    Eleanor J. Molloy

  9. Paediatric Neurodisability, Children’s Health Ireland at Tallaght, Dublin, Ireland

    Eleanor J. Molloy

  10. Department of Paediatrics, Tergooi Hospital, Blaricum, The Netherlands

    Franz B. Plötz

  11. Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Amsterdam, The Netherlands

    Franz B. Plötz

  12. Neonatal Health and Development, Telethon Kids Institute, Perth, WA, Australia

    Tobias Strunk

  13. Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, WA, Australia

    Tobias Strunk

  14. Department of Neonatology, Pirogov Russian National Research Medical University, Moscow, Russia

    Marina Degtyareva

  15. Neonatology, Clinic for Paediatric Cardiology, Intensive Care and Neonatology, University Medical Centre Göttingen, Göttingen, Germany

    Helmut Küster

  16. Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Eric Giannoni

  17. Department of Pediatrics, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA

    Joseph M. Bliss

  18. Department of Pediatrics, Division Neonatology, ErasmusMCMedical Center Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    H. Rob Taal

  19. Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway

    Claus Klingenberg

  20. Paediatric Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway

    Claus Klingenberg

  21. Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden

    Lars Naver

  22. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    Lars Naver

  23. UMC Utrecht, Wilhelmina Children’s Hospital, Woman and Baby, Neonatology and Utrecht University, Utrecht, The Netherlands

    Agnes van den Hoogen

Authors
  1. Sophie M. Duignan
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  2. Satyan Lakshminrusimha
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  3. Kathryn Armstrong
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  4. Willem P. de Boode
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  5. Afif El-Khuffash
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  6. Orla Franklin
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  7. Eleanor J. Molloy
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Consortia

Infection, Inflammation, Immunology and Immunisation (I4) section of the European Society for Paediatric Research (ESPR)

  • Willem P. de Boode
  • , Eleanor J. Molloy
  • , Franz B. Plötz
  • , Tobias Strunk
  • , Marina Degtyareva
  • , Helmut Küster
  • , Eric Giannoni
  • , Joseph M. Bliss
  • , H. Rob Taal
  • , Claus Klingenberg
  • , Lars Naver
  •  & Agnes van den Hoogen

Contributions

S.M.D and E.J.M: manuscript design, manuscript draft. All authors contributed to editing, including revising the paper for important intellectual content and approved the final draft. S.L: created figures.

Corresponding author

Correspondence to Eleanor J. Molloy.

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The authors declare no competing interests.

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Duignan, S.M., Lakshminrusimha, S., Armstrong, K. et al. Neonatal sepsis and cardiovascular dysfunction I: mechanisms and pathophysiology. Pediatr Res 95, 1207–1216 (2024). https://doi.org/10.1038/s41390-023-02926-2

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  • DOI: https://doi.org/10.1038/s41390-023-02926-2

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