Original Article
Hemodynamics in Preterm Infants with Late-Onset Sepsis

https://doi.org/10.1016/j.jpeds.2009.12.026Get rights and content

Objective

To describe the hemodynamic changes with time in preterm infants with clinical sepsis.

Study design

Blood pressure, right ventricular output (RVO), left ventricular output (LVO), and superior vena cava (SVC) flow of infants who had a suspected infection and showed signs of cardiovascular compromise were measured every 12 hours or until there was considered clinical improvement.

Results

Twenty infants with a median gestational age of 27 weeks (range, 25-32 weeks) and weight of 995 g (range, 650-1980 g) were examined. Five patients died. The mean (SD) RVO, LVO, and SVC flow at the first measurement were 555 (133), 441 (164), and 104 (39) mL/kg/min, respectively. The calculated systemic vascular resistance (SVR) was 0.08 (0.04) mm Hg/mL/kg/min. There was no significant change in flow in the 15 surviving infants. Blood pressure and SVR increased from the first to the last measurement (mean difference: blood pressure, 8 mm Hg; 95% CI 3 to −13; systemic vascular resistance, 0.02 mm Hg/mL/kg/min; 95% CI, 0.01 to −0.04). Flows decreased and SVR increased in the 5 non-surviving infants (mean difference: RVO, −318 mL/kg/min; 95% CI, −463 to −174; LVO, −292 mL/kg/min; 95% CI, −473 to −111; SVC flow, –46 mL/kg/min; 95% CI, −77 to −16).

Conclusion

Preterm neonates with sepsis have relatively high left and right cardiac outputs and low SVRs. A decrease in RVO or LVO >50% compared with the initial measurement is associated with mortality.

Section snippets

Methods

We performed an observational cohort study in the neonatal intensive care unit of Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands, between November 2006 and January 2008, and the John Hunter Hospital, Newcastle, Australia, between August 2008 and September 2009. The study was approved by the local ethics committees, and informed consent was obtained from the parents.

Infants <34 weeks gestation with a suspected infection after 72 hours of life were eligible. The

Results

During the study periods, 318 preterm infants <34 weeks gestation were admitted to the unit in Amsterdam, and 257 were admitted in Newcastle. Late onset clinical sepsis developed in 78 infants (13.5%), and treatment was started. Twenty-seven of these infants (4.7%) were eligible for inclusion in the study and had ≥2 predefined signs of hemodynamic disturbance. Seven eligible infants were not examined because the investigator was not available.

Twenty infants with a median gestational age of 27

Discussion

Preterm infants with sepsis after initial volume support have relatively high left and right cardiac outputs and low SVR, similar to the adult with sepsis.

A recent prospective study of 30 children with fluid resistant shock admitted to the pediatric intensive care unit showed that children who had hospital-acquired catheter-associated sepsis had a high cardiac index and low SVR. This pattern was not seen in community-acquired sepsis, in which a normal or low cardiac index was predominant.10 Our

References (20)

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The authors declare no conflicts of interest.

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