Abstract
Objective: The objective of this study was to examine the association of cardiorespiratory events, including apnea, periodic breathing, intermittent hypoxemia (IH), and bradycardia, with late-onset sepsis for extremely preterm infants (<29 weeks of gestational age) on vs off invasive mechanical ventilation. Study design: This is a retrospective analysis of data from infants enrolled in Pre-Vent (ClinicalTrials.gov identifier NCT03174301), an observational study in 5 level IV neonatal intensive care units. Clinical data were analyzed for 737 infants (mean gestational age: 26.4 weeks, SD 1.71). Monitoring data were available and analyzed for 719 infants (47 512 patient-days); of whom, 109 had 123 sepsis events. Using continuous monitoring data, we quantified apnea, periodic breathing, bradycardia, and IH. We analyzed the relationships between these daily measures and late-onset sepsis (positive blood culture >72 hours after birth and ≥5-day antibiotics). Results: For infants not on a ventilator, apnea, periodic breathing, and bradycardia increased before sepsis diagnosis. During times on a ventilator, increased sepsis risk was associated with longer events with oxygen saturation <80% (IH80) and more bradycardia events before sepsis. IH events were associated with higher sepsis risk but did not dynamically increase before sepsis, regardless of ventilator status. A multivariable model including postmenstrual age, cardiorespiratory variables (apnea, periodic breathing, IH80, and bradycardia), and ventilator status predicted sepsis with an area under the receiver operator characteristic curve of 0.783. Conclusion: We identified cardiorespiratory signatures of late-onset sepsis. Longer IH events were associated with increased sepsis risk but did not change temporally near diagnosis. Increases in bradycardia, apnea, and periodic breathing preceded the clinical diagnosis of sepsis.
| Original language | English (US) |
|---|---|
| Article number | 114042 |
| Journal | journal of pediatrics |
| Volume | 271 |
| DOIs | |
| State | Published - Aug 2024 |
Funding
Funding Support: We acknowledge the following NIH grants for funding the work presented in this manuscript. University of Virginia (NCT03174301): U01 HL133708, K23 HD097254, HL133708-05S1. Case Western Reserve University: U01 HL133643. Northwestern University: U01 HL133704. University of Alabama at Birmingham: U01 HL133536, K23 HL157618. University of Miami: U01 HL133689. Washington University: U01 HL133700, F.The National Institutes of Health and the National Heart, Lung, and Blood Institute (NHLBI) provided grant support through cooperative agreements. While NHLBI staff did have input into the study design, conduct, analysis, and manuscript drafting, the content and views expressed are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the U.S. Department of Health and Human Services. Participating sites collected and stored the data while the University of Virginia, the lead data coordinating center (LDCC), analyzed the data. The co-PIs at each site had full access to his/her individual site data and take responsibility for the integrity of the raw waveforms while Drs. Randall Moorman (LDCC co-PI) and Douglas Lake (LDCC co-PI) take responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. Details of individual Pre-Vent Investigators are listed in the Supplemental Appendix, online; available at www.jpeds.com.
Keywords
- apnea
- bradycardia
- intermittent hypoxia
- neonatal late-onset sepsis
- prematurity
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
