Bloodstream Infections in Preterm Neonates and Mortality-Associated Risk Factors

Objective To investigate the association of early (+/- 4 hours after onset of bloodstream infection) clinical and laboratory variables with episode-related mortality (<7 days). Study design This 2-site retrospective study included 142 neonates born at <35 weeks of gestational age with positive blood/cerebrospinal fluid (CSF) culture at >72 hours of age from organisms other than coagulase-negative Staphylococcus. Early variables were compared between those with bloodstream infection-related mortality and survivors. Multivariable analysis was conducted for the primary outcome, and the area under the curve (AUC) was estimated for relevant variables. Results The neonates who died were of lower gestational age at disease onset. After adjusting for relevant variables, lowest mean blood pressure (MBP) (aOR, 0.10; 95% CI, 1.02-1.19) and highest base deficit (aOR, 1.18; 95% CI, 1.06-1.32) were independently associated with mortality. The AUC was 0.87 (95% CI, 0.78-0.96) for base deficit, increasing to 0.91 (95% CI, 0.83-0.99) with the addition of MBP. Conclusion Low MBP and high base deficit within +/- 4 hours of bloodstream infection onset identify preterm neonates at risk of mortality.