Risk Factors for Mortality From Late-Onset Sepsis Among Preterm Very-Low-Birthweight Infants: A Single-Center Cohort Study From Singapore

Guan Lin Goh; Charis Shu En Lim; Rehena Sultana; Rowena De La Puerta; Victor Samuel Rajadurai; Kee Thai Yeo

doi:10.3389/fped.2021.801955

Risk Factors for Mortality From Late-Onset Sepsis Among Preterm Very-Low-Birthweight Infants: A Single-Center Cohort Study From Singapore

Front Pediatr. 2022 Jan 31:9:801955. doi: 10.3389/fped.2021.801955. eCollection 2021.

Authors

Guan Lin Goh¹, Charis Shu En Lim², Rehena Sultana³, Rowena De La Puerta¹, Victor Samuel Rajadurai^{1

4

5

6}, Kee Thai Yeo^{1

4

6}

Affiliations

¹ Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
² KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore.
³ Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
⁴ Duke-NUS Medical School, Singapore, Singapore.
⁵ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁶ Lee Kong Chian School of Medicine, Singapore, Singapore.

Abstract

Objective: To determine the risk factors for mortality associated with late onset sepsis (LOS) among preterm very-low-birthweight (VLBW) infants.

Study design: We performed a retrospective cohort study of infants born <32 weeks gestation and <1,500 gm admitted to a Singaporean tertiary-level neonatal intensive care unit. We determined the clinical, microbial, and laboratory risk factors associated with mortality due to culture-positive LOS in this cohort.

Results: A total of 1,740 infants were admitted, of which 169 (9.7%) developed LOS and 27 (16%) died. Compared to survivors, those who died had lower birth gestational age (median 24 vs. 25 weeks, p = 0.02) and earlier LOS occurrence (median 10 vs. 17 days, p = 0.007). There was no difference in the incidence of meningitis (11.1 vs. 16.9%, p = 0.3), NEC (18.5 vs. 14.8%, p = 0.6), or intestinal surgery (18.5 vs. 23.3%, p = 0.6) among infants who died compared to survivors. Gram-negative bacteria accounted for 21/27 (77.8%) LOS-associated deaths and almost all (13/14, 93%) fulminant episodes. The presence of multiorgan failure, as evidenced by the need for mechanical ventilation (100 vs. 79.0%, p = 0.008), elevated lactate (12.4 vs. 2.1 mmol/L, p < 0.001), and inotropic support (92.6 vs. 37.5%, p < 0.001), was significantly associated with mortality. Infants who died had significantly lower white blood cell (WBC) counts (median 4.2 × 10⁹/L vs. 9.9 × 10⁹/L, p = 0.001), lower platelet count (median 40 × 10⁹/L vs. 62 × 10⁹/L, p = 0.01), and higher immature to total neutrophil (I: T) ratio (0.2 vs. 0.1, p = 0.002). Inotrope requirement [AOR 22.4 (95%CI 2.9, 103.7)], WBC <4 × 10⁹/L [AOR 4.7 (1.7, 13.2)], and I: T ratio >0.3 [AOR 3.6 (1.3, 9.7)] were independently associated with LOS mortality.

Conclusions: In a setting with predominantly Gram-negative bacterial infections, the need for inotropic support, leukopenia, and elevated I: T ratio were significantly associated with LOS mortality among preterm VLBW infants.

Keywords: mortality; multi-organ dysfunction; neonatal sepsis; premature infant; risk factors.