Bárbara B P Lobo1, Sergio T M Marba2, Helymar C Machado3, Jamil P S Caldas2. 1. Department of Pediatrics, State University of Campinas - Unicamp, School of Medical Sciences, Campinas, São Paulo, Brazil. barbarabplobo@gmail.com. 2. Department of Pediatrics, State University of Campinas - Unicamp, School of Medical Sciences, Campinas, São Paulo, Brazil. 3. State University of Campinas - Unicamp, Women's Hospital, São Paulo, Campinas, Brazil.
Abstract
Death is a frequent occurrence in late-onset neonatal sepsis (LOS). We aimed to evaluate if the Neonatal Sequential Organ Failure Assessment (nSOFA) is associated with mortality due to LOS in very low birth weight (VLBW) infants. This is a single-center Brazilian cohort study including VLBW infants admitted between 2006 and 2020 who were diagnosed with LOS caused by Staphylococcus aureus, Enterococcus sp or Gram-negative bacteria. The primary outcome was mortality associated with sepsis. Two groups of patients-survivors and non-survivors-were compared regarding descriptive maternal and neonatal variables and the nSOFA score, evaluated at nine moments, from 48 hours before the diagnosis of sepsis to 48 hours later (T-48, T-24, T-12, T-6, T0, T+6, T+12, T+24, T+48). Diagnostic accuracy was expressed as the area under the curve (AUC). Among the 1574 VLBW infants hospitalized in the period, 114 episodes of culture-confirmed LOS occurred. There were 21 sepsis-related deaths (18.4%), mostly from Gram-negative bacteria and Enterococcus sp. There were no statistically significant differences between the groups regarding maternal and neonatal variables. Median nSOFA was significantly higher in the non-survivor group at all time points (range 2 to 13 versus 1 to 3). In the logistic regression analysis, each increment of one point in the score significantly increases the risk of death in eight of the nine moments, but no difference was found in T-24. Time T-6 had the best accuracy (88.1%). Conclusion: The nSOFA score was significantly associated with the risk of death from LOS in VLBW infants. What is Known: • The neonatal sepsis may result in organ dysfunction and death, and it is important to find indicators that could identify this clinical progression. • The nSOFA score was proposed in 2020 to predict mortality from LOS, but since it is recent and still in the research phase, further studies are important to improve it before being widely used in clinical practice. What is New: • We showed a significative association between higher nSOFA scores and mortality. Our results corroborate the validity and the importance of the nSOFA score and highlight its high NPV.
Death is a frequent occurrence in late-onset neonatal sepsis (LOS). We aimed to evaluate if the Neonatal Sequential Organ Failure Assessment (nSOFA) is associated with mortality due to LOS in very low birth weight (VLBW) infants. This is a single-center Brazilian cohort study including VLBW infants admitted between 2006 and 2020 who were diagnosed with LOS caused by Staphylococcus aureus, Enterococcus sp or Gram-negative bacteria. The primary outcome was mortality associated with sepsis. Two groups of patients-survivors and non-survivors-were compared regarding descriptive maternal and neonatal variables and the nSOFA score, evaluated at nine moments, from 48 hours before the diagnosis of sepsis to 48 hours later (T-48, T-24, T-12, T-6, T0, T+6, T+12, T+24, T+48). Diagnostic accuracy was expressed as the area under the curve (AUC). Among the 1574 VLBW infants hospitalized in the period, 114 episodes of culture-confirmed LOS occurred. There were 21 sepsis-related deaths (18.4%), mostly from Gram-negative bacteria and Enterococcus sp. There were no statistically significant differences between the groups regarding maternal and neonatal variables. Median nSOFA was significantly higher in the non-survivor group at all time points (range 2 to 13 versus 1 to 3). In the logistic regression analysis, each increment of one point in the score significantly increases the risk of death in eight of the nine moments, but no difference was found in T-24. Time T-6 had the best accuracy (88.1%). Conclusion: The nSOFA score was significantly associated with the risk of death from LOS in VLBW infants. What is Known: • The neonatal sepsis may result in organ dysfunction and death, and it is important to find indicators that could identify this clinical progression. • The nSOFA score was proposed in 2020 to predict mortality from LOS, but since it is recent and still in the research phase, further studies are important to improve it before being widely used in clinical practice. What is New: • We showed a significative association between higher nSOFA scores and mortality. Our results corroborate the validity and the importance of the nSOFA score and highlight its high NPV.
Authors: Mervyn Singer; Clifford S Deutschman; Christopher Warren Seymour; Manu Shankar-Hari; Djillali Annane; Michael Bauer; Rinaldo Bellomo; Gordon R Bernard; Jean-Daniel Chiche; Craig M Coopersmith; Richard S Hotchkiss; Mitchell M Levy; John C Marshall; Greg S Martin; Steven M Opal; Gordon D Rubenfeld; Tom van der Poll; Jean-Louis Vincent; Derek C Angus Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: James L Wynn; Hector R Wong; Thomas P Shanley; Matthew J Bizzarro; Lisa Saiman; Richard A Polin Journal: Pediatr Crit Care Med Date: 2014-07 Impact factor: 3.624
Authors: Eric Giannoni; Philipp K A Agyeman; Martin Stocker; Klara M Posfay-Barbe; Ulrich Heininger; Ben D Spycher; Sara Bernhard-Stirnemann; Anita Niederer-Loher; Christian R Kahlert; Alex Donas; Antonio Leone; Paul Hasters; Christa Relly; Thomas Riedel; Claudia Kuehni; Christoph Aebi; Christoph Berger; Luregn J Schlapbach Journal: J Pediatr Date: 2018-07-24 Impact factor: 4.406
Authors: Barbara J Stoll; Nellie Hansen; Avroy A Fanaroff; Linda L Wright; Waldemar A Carlo; Richard A Ehrenkranz; James A Lemons; Edward F Donovan; Ann R Stark; Jon E Tyson; William Oh; Charles R Bauer; Sheldon B Korones; Seetha Shankaran; Abbot R Laptook; David K Stevenson; Lu-Ann Papile; W Kenneth Poole Journal: Pediatrics Date: 2002-08 Impact factor: 7.124
Authors: James L Wynn; Matthew S Kelly; Daniel K Benjamin; Reese H Clark; Rachel Greenberg; Daniel K Benjamin; P Brian Smith Journal: Am J Perinatol Date: 2016-12-06 Impact factor: 3.079