Abstract
Objectives
To compare blood pressures (BP) between neonates with culture-proven sepsis and clinical sepsis in the first 120 h of sepsis onset and to examine association between BP and in-hospital mortality.
Methods
In this cohort study, consecutively enrolled neonates with ‘culture-proven’ sepsis [growth in blood/ cerebrospinal fluid (CSF) within 48 h] and clinical sepsis (sepsis workup negative, cultures sterile) were analyzed. Their BP was recorded every 3-hourly for initial 120 h and averaged in 20 time-epochs of 6 h each (0–6 h to 115–120 h). BP Z-scores were compared between neonates with culture-proven vs. clinical sepsis and survivors vs. non-survivors.
Results
Two hundred twenty eight neonates (102—culture-proven and 126—clinical sepsis) were enrolled. Both groups had comparable BP Z-scores except significantly lower diastolic BP (DBP) and mean BP (MBP) in 0–6 and 13–18 time-epochs in culture-proven sepsis group. Fifty-four neonates (24%) died during their hospital stay. BP Z-scores in the initial 54 h of sepsis were independently associated with mortality [systolic BP (SBP) Z-scores in first 54 h, DBP Z-scores in first 24 h, and MBP Z-scores in first 24 h] after adjusting for gestational age, birth weight, cesarean delivery, and 5-min Apgar score. On receiver operating characteristic curves, SBP Z-scores showed better discriminative ability than DBP and MBP to identify non-survivors.
Conclusions
Neonates with culture-proven and clinical sepsis had comparable BP Z-scores except low DBP and MBP in the initial few hours in culture-proven sepsis. BP in initial 54 h of sepsis was significantly associated with in-hospital mortality. SBP discriminated non-survivors better than DBP and MBP.
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Funding
Shiv Sajan Saini received funding for this study from the Indian Council of Medical Research, New Delhi, India.
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SSS: Developed the protocol, performed analysis, supervised the patient recruitment, reviewed, and revised the manuscript, and approved the final manuscript as submitted; AKS: Supervised data collection, crosschecked data entry, organized data in excel spreadsheets, reviewed, and revised the manuscript, and approved the final manuscript as submitted; VS, SD, PK: Supervised the patient recruitment, reviewed, and revised the manuscript, and approved the final manuscript as submitted. PK will act as guarantor for this manuscript.
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Institute’s Ethics Committee approved the study (Approval no IEC-04/2019 - 1231 Dated 13.05.2019).
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Saini, S.S., Shrivastav, A.K., Sundaram, V. et al. Early Blood Pressure Changes in Neonatal Sepsis and the Risk of Mortality. Indian J Pediatr 90, 1096–1102 (2023). https://doi.org/10.1007/s12098-023-04597-7
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DOI: https://doi.org/10.1007/s12098-023-04597-7