Mortality caused by late-onset sepsis in very low birth weight infants: risk analysis and the performance of diagnostic tools
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CitationOngun, H., & Demir, M. (2020). Mortality caused by late-onset sepsis in very low birth weight infants: risk analysis and the performance of diagnostic tools.
Objective: To assess the risk on late-onset sepsis attributed mortality in very low birth weight (VLBW) infants. Study Design: Observational study. Place and Duration of Study: Level-III Neonatal Intensive Care Unit, Istinye University, Antalya Medical Park Hospital, Turkey, between January 2014 and December 2018. Methodology: Perinatal characteristics and clinical features of 198 septic preterm neonates were evaluated to predict sepsis-attributed mortality. ROC analysis was employed to drive optimal-cutoffs for laboratory parameters and logistic regression to calculate mortality risk factors using SPSS version-22 and MedCalc software. Results: Mean gestational age was 28.91 +/- 2.67 weeks. Umbilical catheterisation was the principal risk factor for culture-positive sepsis (OR 2.860, 95%CI: 1.232-6.639). Outborn infants were more likely to deliver surfactant and longer intubation (p=0.013, and p=0.005, respectively), manifested frequent BPD (p=0.014), and at greater risk of proven sepsis and mortality (OR: 1.796, 95%CI: 1.011-3.191; OR: 1.950, 95%CI: 1.002-3.794). Low Apgar scores necrotising enterocolitis (NEC) and prolonged intubation were independent risk factors for mortality (OR: 13.840, 95%CI: 6.384-30.005; OR: 5.410, 95%CI: 2.113-13.849; OR: 10.037, 95%CI: 4.700-21.434). An increase in high-sensitivity C-reactive protein (hsCRP)-ratio >6.08-fold afforded good sensitivity and specificity (AUC: 0.914; sensitivity: 89.36%, specificity: 86.09%). Logistic regression of various combinations has shown a >6.08-fold change in hsCRP-ratio over 24-hours and platelet counts <88x10(9)/L optimally predicted mortality (OR: 27.983, 95%CI: 9.704-80.697). Conclusion: Low Apgar scores, NEC and prolonged intubation are independent risk factors for mortality of VLBW infants. Birth in level III-IV NICUs featuring special neonatal care, avoidance of prolonged intubation, and timely prediction of fatal sepsis using hsCRP ratio and platelets could prevent sepsis-related mortality.