Your browser doesn't support javascript.
loading
Apnea, Intermittent Hypoxemia, and Bradycardia Events Predict Late-Onset Sepsis in Infants Born Extremely Preterm.
Kausch, Sherry L; Lake, Douglas E; Di Fiore, Juliann M; Weese-Mayer, Debra E; Claure, Nelson; Ambalavanan, Namasivayam; Vesoulis, Zachary A; Fairchild, Karen D; Dennery, Phyllis A; Hibbs, Anna Maria; Martin, Richard J; Indic, Premananda; Travers, Colm P; Bancalari, Eduardo; Hamvas, Aaron; Kemp, James S; Carroll, John L; Moorman, J Randall; Sullivan, Brynne A.
Afiliação
  • Kausch SL; Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA. Electronic address: Slk7s@virginia.edu.
  • Lake DE; Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.
  • Di Fiore JM; Department of Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH.
  • Weese-Mayer DE; Division of Autonomic Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
  • Claure N; Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL.
  • Ambalavanan N; Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
  • Vesoulis ZA; Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
  • Fairchild KD; Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA.
  • Dennery PA; Department of Pediatrics, Brown University School of Medicine, Providence, RI.
  • Hibbs AM; Department of Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH.
  • Martin RJ; Department of Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH.
  • Indic P; Department of Electrical Engineering, University of Texas at Tyler, Tyler, TX.
  • Travers CP; Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
  • Bancalari E; Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL.
  • Hamvas A; Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
  • Kemp JS; Division of Pediatric Pulmonology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
  • Carroll JL; Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AK.
  • Moorman JR; Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.
  • Sullivan BA; Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA.
J Pediatr ; 271: 114042, 2024 Aug.
Article em En | MEDLINE | ID: mdl-38570031
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.
Assuntos
Palavras-chave
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Apneia / Bradicardia / Sepse / Lactente Extremamente Prematuro / Hipóxia Limite: Female / Humans / Male / Newborn Idioma: En Revista: J Pediatr Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Apneia / Bradicardia / Sepse / Lactente Extremamente Prematuro / Hipóxia Limite: Female / Humans / Male / Newborn Idioma: En Revista: J Pediatr Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos