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Am J Perinatol 2017; 34(07): 633-639
DOI: 10.1055/s-0036-1597130
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Timing of Multiorgan Dysfunction among Hospitalized Infants with Fatal Fulminant Sepsis

James L. Wynn   *
1   Departments of Pediatrics and Pathology, Immunology, and Experimental Medicine, University of Florida, Gainesville, Florida
,
Matthew S. Kelly   *
2   Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
3   Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
,
Daniel K. Benjamin
4   Department of Economics, Clemson University, Clemson, South Carolina
,
Reese H. Clark
5   Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida
,
Rachel Greenberg
2   Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
3   Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
,
Daniel K. Benjamin Jr.
2   Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
3   Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
,
P. Brian Smith
2   Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
3   Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
› Author Affiliations
Further Information

Publication History

10 August 2016

24 October 2016

Publication Date:
06 December 2016 (online)

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Abstract

Objective Identify the progression of specific signs of multiorgan dysfunction among infants with fatal sepsis.

Study Design Cohort study of 679 infants who died within 3 days of the start of a late-onset sepsis (LOS) episode in neonatal intensive care units from 1997 to 2012. We extracted clinical and laboratory data on the day of death (day 0) and the preceding 5 days (days −5 to −1).

Results Median (25th percentile–75th percentile) gestational age was 25 (24–28) weeks. Compared with day −1, day 0 was characterized by an increased requirement for mechanical ventilation and higher mean fraction of inspired oxygen. Measures of cardiorespiratory support and the proportion of infants with neutropenia began to rise on day −2.

Conclusion Hospitalized infants with fatal LOS manifest respiratory, cardiovascular, renal, immune, and hematologic dysfunction. Knowledge of these factors and their timing may be important for the development and testing of novel therapeutics to reduce sepsis mortality.

Keywords

sepsis - infant - neonate - multiorgan dysfunction - death
 

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