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Clinical impact of NEC-associated sepsis on outcomes in preterm infants
Objective To determine risk factors and outcomes of necrotizing enterocolitis (NEC)-associated sepsis in infants with NEC. Methods A retrospective review comparing demographic and clinical information in infants with and without NEC-associated sepsis (defined as positive blood culture at the time of...
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| Published in: | Pediatric research 2022-12, Vol.92 (6), p.1705-1715 |
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| container_issue | 6 |
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| container_title | Pediatric research |
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| creator | Garg, Parvesh Mohan Paschal, Jaslyn L. Ansari, Md Abu Yusuf Block, Danielle Inagaki, Kengo Weitkamp, Jörn-Hendrik |
| description | Objective
To determine risk factors and outcomes of necrotizing enterocolitis (NEC)-associated sepsis in infants with NEC.
Methods
A retrospective review comparing demographic and clinical information in infants with and without NEC-associated sepsis (defined as positive blood culture at the time of NEC onset).
Results
A total of 209 infants with medical (
n
= 98) and surgical NEC (
n
= 111) had a median gestational age of 27 weeks (IQR 25; 30.5) and a median birth weight of 910 g [IQR 655; 1138]. Fifty of 209 (23.9%) infants had NEC-associated sepsis. Infants with NEC-associated sepsis had lower median GA (26.4 vs. 27.4 weeks;
p
= 0.01), lower birth weight (745 vs. 930 g;
p
= 0.009), were more likely mechanically ventilated [
p
|
| doi_str_mv | 10.1038/s41390-022-02034-7 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2645471456</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2645471456</sourcerecordid><originalsourceid>FETCH-LOGICAL-c419t-759d4ef868c91a94a617082f5354be27cf171c25754f72ce206529e625db25ca3</originalsourceid><addsrcrecordid>eNp9kL1OwzAURi0EoqXwAgzIEgtLwL9xPKKoFKQKFpgt13VQqiQOvsnA22NIAYmBwbLle-7n64PQOSXXlPDiBgTlmmSEsbQIF5k6QHMqeboSQh2iOSGcZlzrYoZOAHaEUCELcYxmXHLJUnWOVmVTd7WzDa7b3roBhwo_LsvMAgRX28FvMfgeasChw2EcXGg94LrDffSDj206VrYb4BQdVbYBf7bfF-jlbvlc3mfrp9VDebvOnKB6yJTUW-GrIi-cplYLm1NFClalecTGM-UqqqhjUklRKeY8I7lk2udMbjdMOssX6GrK7WN4Gz0Mpq3B-aaxnQ8jGJYLKVT6Z57Qyz_oLoyxS9MZpmQuiVKFTBSbKBcDQPSV6WPd2vhuKDGfms2k2STN5kuzUanpYh89blq__Wn59poAPgGQSt2rj79v_xP7Afzzhb4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2756507785</pqid></control><display><type>article</type><title>Clinical impact of NEC-associated sepsis on outcomes in preterm infants</title><source>Springer Nature</source><creator>Garg, Parvesh Mohan ; Paschal, Jaslyn L. ; Ansari, Md Abu Yusuf ; Block, Danielle ; Inagaki, Kengo ; Weitkamp, Jörn-Hendrik</creator><creatorcontrib>Garg, Parvesh Mohan ; Paschal, Jaslyn L. ; Ansari, Md Abu Yusuf ; Block, Danielle ; Inagaki, Kengo ; Weitkamp, Jörn-Hendrik</creatorcontrib><description>Objective
To determine risk factors and outcomes of necrotizing enterocolitis (NEC)-associated sepsis in infants with NEC.
Methods
A retrospective review comparing demographic and clinical information in infants with and without NEC-associated sepsis (defined as positive blood culture at the time of NEC onset).
Results
A total of 209 infants with medical (
n
= 98) and surgical NEC (
n
= 111) had a median gestational age of 27 weeks (IQR 25; 30.5) and a median birth weight of 910 g [IQR 655; 1138]. Fifty of 209 (23.9%) infants had NEC-associated sepsis. Infants with NEC-associated sepsis had lower median GA (26.4 vs. 27.4 weeks;
p
= 0.01), lower birth weight (745 vs. 930 g;
p
= 0.009), were more likely mechanically ventilated [
p
< 0.001], received dopamine [
p
< 0.001], had more evidence of acute kidney injury [60% vs. 38.4%,
p
= 0.01], longer postoperative ileus (16 [13.0; 22.0] vs. 12 [8; 16] days;
p
= 0.006), higher levels of C-reactive protein, lower platelet counts, longer hospitalization compared to infants without NEC-associated sepsis. On multivariate regression, cholestasis was an independent risk factor for NEC-associated sepsis (OR 2.94; 95% CI 1.1–8.8,
p
= 0.038).
Conclusion
NEC-associated sepsis was associated with greater hemodynamic support, acute kidney injury, longer postoperative ileus, and hospitalization on bivariate analysis, and cholestasis was associated with higher odds of sepsis on multi regression analysis.
Impact
NEC-associated sepsis was present in 24% of infants with NEC. Gram-positive bacteria, Gram-negative bacteria, and
Candida
were found in 15.3%, 10.5%, and 2.8% of cases, respectively.
Infants with NEC-associated sepsis had a greater inflammatory response (CRP levels), received more blood transfusion before NEC onset, frequently needed assisted ventilation ionotropic support, and had acute kidney injury after NEC onset.
NEC infants with Gram-negative sepsis had higher portal venous gas, received more platelet transfusions before NEC onset, and had higher CRP levels and lower median lymphocyte counts at 24 h after NEC onset than those with Gram-positive sepsis.</description><identifier>ISSN: 0031-3998</identifier><identifier>EISSN: 1530-0447</identifier><identifier>DOI: 10.1038/s41390-022-02034-7</identifier><identifier>PMID: 35352003</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>Birth Weight ; Clinical Research Article ; Enterocolitis, Necrotizing - complications ; Enterocolitis, Necrotizing - surgery ; Gallbladder diseases ; Gastrointestinal diseases ; Gestational Age ; Gram-positive bacteria ; Humans ; Ileus ; Infant ; Infant, Newborn ; Infant, Premature ; Kidneys ; Medicine ; Medicine & Public Health ; Necrosis ; Pediatric Surgery ; Pediatrics ; Retrospective Studies ; Sepsis ; Sepsis - complications</subject><ispartof>Pediatric research, 2022-12, Vol.92 (6), p.1705-1715</ispartof><rights>The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc 2022</rights><rights>2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.</rights><rights>The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc 2022.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-759d4ef868c91a94a617082f5354be27cf171c25754f72ce206529e625db25ca3</citedby><cites>FETCH-LOGICAL-c419t-759d4ef868c91a94a617082f5354be27cf171c25754f72ce206529e625db25ca3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35352003$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garg, Parvesh Mohan</creatorcontrib><creatorcontrib>Paschal, Jaslyn L.</creatorcontrib><creatorcontrib>Ansari, Md Abu Yusuf</creatorcontrib><creatorcontrib>Block, Danielle</creatorcontrib><creatorcontrib>Inagaki, Kengo</creatorcontrib><creatorcontrib>Weitkamp, Jörn-Hendrik</creatorcontrib><title>Clinical impact of NEC-associated sepsis on outcomes in preterm infants</title><title>Pediatric research</title><addtitle>Pediatr Res</addtitle><addtitle>Pediatr Res</addtitle><description>Objective
To determine risk factors and outcomes of necrotizing enterocolitis (NEC)-associated sepsis in infants with NEC.
Methods
A retrospective review comparing demographic and clinical information in infants with and without NEC-associated sepsis (defined as positive blood culture at the time of NEC onset).
Results
A total of 209 infants with medical (
n
= 98) and surgical NEC (
n
= 111) had a median gestational age of 27 weeks (IQR 25; 30.5) and a median birth weight of 910 g [IQR 655; 1138]. Fifty of 209 (23.9%) infants had NEC-associated sepsis. Infants with NEC-associated sepsis had lower median GA (26.4 vs. 27.4 weeks;
p
= 0.01), lower birth weight (745 vs. 930 g;
p
= 0.009), were more likely mechanically ventilated [
p
< 0.001], received dopamine [
p
< 0.001], had more evidence of acute kidney injury [60% vs. 38.4%,
p
= 0.01], longer postoperative ileus (16 [13.0; 22.0] vs. 12 [8; 16] days;
p
= 0.006), higher levels of C-reactive protein, lower platelet counts, longer hospitalization compared to infants without NEC-associated sepsis. On multivariate regression, cholestasis was an independent risk factor for NEC-associated sepsis (OR 2.94; 95% CI 1.1–8.8,
p
= 0.038).
Conclusion
NEC-associated sepsis was associated with greater hemodynamic support, acute kidney injury, longer postoperative ileus, and hospitalization on bivariate analysis, and cholestasis was associated with higher odds of sepsis on multi regression analysis.
Impact
NEC-associated sepsis was present in 24% of infants with NEC. Gram-positive bacteria, Gram-negative bacteria, and
Candida
were found in 15.3%, 10.5%, and 2.8% of cases, respectively.
Infants with NEC-associated sepsis had a greater inflammatory response (CRP levels), received more blood transfusion before NEC onset, frequently needed assisted ventilation ionotropic support, and had acute kidney injury after NEC onset.
NEC infants with Gram-negative sepsis had higher portal venous gas, received more platelet transfusions before NEC onset, and had higher CRP levels and lower median lymphocyte counts at 24 h after NEC onset than those with Gram-positive sepsis.</description><subject>Birth Weight</subject><subject>Clinical Research Article</subject><subject>Enterocolitis, Necrotizing - complications</subject><subject>Enterocolitis, Necrotizing - surgery</subject><subject>Gallbladder diseases</subject><subject>Gastrointestinal diseases</subject><subject>Gestational Age</subject><subject>Gram-positive bacteria</subject><subject>Humans</subject><subject>Ileus</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Kidneys</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Necrosis</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Sepsis - complications</subject><issn>0031-3998</issn><issn>1530-0447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kL1OwzAURi0EoqXwAgzIEgtLwL9xPKKoFKQKFpgt13VQqiQOvsnA22NIAYmBwbLle-7n64PQOSXXlPDiBgTlmmSEsbQIF5k6QHMqeboSQh2iOSGcZlzrYoZOAHaEUCELcYxmXHLJUnWOVmVTd7WzDa7b3roBhwo_LsvMAgRX28FvMfgeasChw2EcXGg94LrDffSDj206VrYb4BQdVbYBf7bfF-jlbvlc3mfrp9VDebvOnKB6yJTUW-GrIi-cplYLm1NFClalecTGM-UqqqhjUklRKeY8I7lk2udMbjdMOssX6GrK7WN4Gz0Mpq3B-aaxnQ8jGJYLKVT6Z57Qyz_oLoyxS9MZpmQuiVKFTBSbKBcDQPSV6WPd2vhuKDGfms2k2STN5kuzUanpYh89blq__Wn59poAPgGQSt2rj79v_xP7Afzzhb4</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Garg, Parvesh Mohan</creator><creator>Paschal, Jaslyn L.</creator><creator>Ansari, Md Abu Yusuf</creator><creator>Block, Danielle</creator><creator>Inagaki, Kengo</creator><creator>Weitkamp, Jörn-Hendrik</creator><general>Nature Publishing Group US</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20221201</creationdate><title>Clinical impact of NEC-associated sepsis on outcomes in preterm infants</title><author>Garg, Parvesh Mohan ; Paschal, Jaslyn L. ; Ansari, Md Abu Yusuf ; Block, Danielle ; Inagaki, Kengo ; Weitkamp, Jörn-Hendrik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-759d4ef868c91a94a617082f5354be27cf171c25754f72ce206529e625db25ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Birth Weight</topic><topic>Clinical Research Article</topic><topic>Enterocolitis, Necrotizing - complications</topic><topic>Enterocolitis, Necrotizing - surgery</topic><topic>Gallbladder diseases</topic><topic>Gastrointestinal diseases</topic><topic>Gestational Age</topic><topic>Gram-positive bacteria</topic><topic>Humans</topic><topic>Ileus</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Kidneys</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Necrosis</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Sepsis - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garg, Parvesh Mohan</creatorcontrib><creatorcontrib>Paschal, Jaslyn L.</creatorcontrib><creatorcontrib>Ansari, Md Abu Yusuf</creatorcontrib><creatorcontrib>Block, Danielle</creatorcontrib><creatorcontrib>Inagaki, Kengo</creatorcontrib><creatorcontrib>Weitkamp, Jörn-Hendrik</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garg, Parvesh Mohan</au><au>Paschal, Jaslyn L.</au><au>Ansari, Md Abu Yusuf</au><au>Block, Danielle</au><au>Inagaki, Kengo</au><au>Weitkamp, Jörn-Hendrik</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical impact of NEC-associated sepsis on outcomes in preterm infants</atitle><jtitle>Pediatric research</jtitle><stitle>Pediatr Res</stitle><addtitle>Pediatr Res</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>92</volume><issue>6</issue><spage>1705</spage><epage>1715</epage><pages>1705-1715</pages><issn>0031-3998</issn><eissn>1530-0447</eissn><abstract>Objective
To determine risk factors and outcomes of necrotizing enterocolitis (NEC)-associated sepsis in infants with NEC.
Methods
A retrospective review comparing demographic and clinical information in infants with and without NEC-associated sepsis (defined as positive blood culture at the time of NEC onset).
Results
A total of 209 infants with medical (
n
= 98) and surgical NEC (
n
= 111) had a median gestational age of 27 weeks (IQR 25; 30.5) and a median birth weight of 910 g [IQR 655; 1138]. Fifty of 209 (23.9%) infants had NEC-associated sepsis. Infants with NEC-associated sepsis had lower median GA (26.4 vs. 27.4 weeks;
p
= 0.01), lower birth weight (745 vs. 930 g;
p
= 0.009), were more likely mechanically ventilated [
p
< 0.001], received dopamine [
p
< 0.001], had more evidence of acute kidney injury [60% vs. 38.4%,
p
= 0.01], longer postoperative ileus (16 [13.0; 22.0] vs. 12 [8; 16] days;
p
= 0.006), higher levels of C-reactive protein, lower platelet counts, longer hospitalization compared to infants without NEC-associated sepsis. On multivariate regression, cholestasis was an independent risk factor for NEC-associated sepsis (OR 2.94; 95% CI 1.1–8.8,
p
= 0.038).
Conclusion
NEC-associated sepsis was associated with greater hemodynamic support, acute kidney injury, longer postoperative ileus, and hospitalization on bivariate analysis, and cholestasis was associated with higher odds of sepsis on multi regression analysis.
Impact
NEC-associated sepsis was present in 24% of infants with NEC. Gram-positive bacteria, Gram-negative bacteria, and
Candida
were found in 15.3%, 10.5%, and 2.8% of cases, respectively.
Infants with NEC-associated sepsis had a greater inflammatory response (CRP levels), received more blood transfusion before NEC onset, frequently needed assisted ventilation ionotropic support, and had acute kidney injury after NEC onset.
NEC infants with Gram-negative sepsis had higher portal venous gas, received more platelet transfusions before NEC onset, and had higher CRP levels and lower median lymphocyte counts at 24 h after NEC onset than those with Gram-positive sepsis.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>35352003</pmid><doi>10.1038/s41390-022-02034-7</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0031-3998 |
| ispartof | Pediatric research, 2022-12, Vol.92 (6), p.1705-1715 |
| issn | 0031-3998 1530-0447 |
| language | eng |
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| source | Springer Nature |
| subjects | Birth Weight Clinical Research Article Enterocolitis, Necrotizing - complications Enterocolitis, Necrotizing - surgery Gallbladder diseases Gastrointestinal diseases Gestational Age Gram-positive bacteria Humans Ileus Infant Infant, Newborn Infant, Premature Kidneys Medicine Medicine & Public Health Necrosis Pediatric Surgery Pediatrics Retrospective Studies Sepsis Sepsis - complications |
| title | Clinical impact of NEC-associated sepsis on outcomes in preterm infants |
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