Applicability of systemic inflammatory response syndrome (SIRS) and severe sepsis definitions to late onset infections in a quaternary NICU

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.611-611
• Main Authors: Kalb, Elizabeth, Coggins, Sarah, Harris, Mary Catherine, Nawab, Ursula, Grundmeier, Robert, Srinivasan, Lakshmi
• Format: Article
• Language: English
• Subjects: Bacteremia; Blood; Coagulase; Criteria; Fungemia; Gestational age; Infants; Infections; Inflammation; Inflammatory response; Intensive care; Morbidity; Neonatal care; Neonates; Patients; Pediatrics; Renal function; Sepsis; Statistical analysis; Systemic inflammatory response syndrome; Tachycardia
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA7.611

Background: Sepsis is a significant cause of morbidity and mortality. Despite its prevalence and unique presentation, criteria for SIRS and severe sepsis have not been developed in infants. As a result, definitions are often adapted from those established for older pediatric patients. There are no studies examining the performance of these definitions in infants with late onset infections. Aim To characterize patients with late onset infections in a Level 4 NICU meeting criteria for SIRS and severe sepsis as defined by the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) guidelines. Methods: Retrospective chart review of all patients admitted to the Level 4 NICU at the Children's Hospital of Philadelphia between 1/1/16 and 12/31/16 who underwent sepsis evaluations (SEs) with subsequent positive blood cultures. Data were collected to determine whether patients met SIRS or severe sepsis criteria as defined by the IPSCC. Analysis included summary descriptive and chi-square statistics. Results: The cohort included 40 SEs in 33 infants (Table 1). 23 (58%) met criteria for SIRS and 11 (28 %) had severe sepsis. 4 (10%) did not meet the criteria for SIRS but subsequently developed organ dysfunction. Tachycardia and abnormal white blood cell counts were the most common SIRS criteria (Table 2). In patients with severe sepsis, respiratory dysfunction was most common (90%), followed by cardiovascular (45%), hematologic (18%), and renal (9%) dysfunction. Patients ≥ 37 weeks corrected gestational age were more likely to meet SIRS or severe sepsis criteria compared to those < 37 weeks corrected gestational age, but differences were not statistically significant. SIRS and severe sepsis occurred more frequently in patients with gram negative bacteremia and gram positive bacteremia excluding coagulase negative Staphylococcus (CoNS) compared to infants with CoNS bacteremia, fungemia, or polymicrobial infections, but these differences were not statistically significant (Table 1). There were 3 (7.5%) infection-related deaths, all of whom met criteria for SIRS and severe sepsis. Conclusions Almost half the patients with late onset infections did not meet criteria for SIRS in our cohort and fewer met severe sepsis criteria as defined by the IPSCC. Notably, a proportion of those who did not meet SIRS criteria subsequently developed organ dysfunction. Definitions of sepsis and sepsis syndromes specific to neonates and infants require refinement as the pathophysiolo