Evaluation of factors for poor outcome in preterm newborns with posthemorrhagic hydrocephalus associated with late-onset neonatal sepsis

Abstract

PurposePreterm newborns, due to many factors, are at increased risk for poor neural development, intraventricular hemorrhages, infections, and higher rate of mortality. The aim of this study was to evaluate the risk factors associated with poor outcome in preterm neonates with late-onset neonatal sepsis (LONS) who had posthemorrhagic hydrocephalus and underwent neurosurgical procedures for treatment of the hydrocephalus.Patients and methodsPreterm neonates who had undergone insertion of ventriculoperitoneal shunt or Ommaya reservoir, during the 10-year period at University Children’s Hospital, were retrospectively analyzed. According to the presence or absence of LONS, patients were divided into LONS group and non-LONS group. In both groups, we analyzed demographic and clinical data as well as nondependent factors. Additionally, we evaluated the patients who had lethal outcome in respect to all the analyzed factors.ResultsA total of 74 patients were included in the study, 35 in LONS group and 39 in control group. Patients in LONS group were born significantly earlier with lower birth weight, needed significantly higher O2 inspiratory concentration, and had longer duration of mechanical ventilation when compared to the nonseptic group. Five patients in LONS group had lethal outcome, and for these patients we identified a grade American Society of Anaesthesiologists score of 4 (P=0.000), ductus arteriosus persistens (P=0.000), bronchopulmonary dysplasia (P=0.003), and pneumothorax (P=0.003) as independent preoperative risk factors for lethal outcome.ConclusionNeurosurgical procedures are relatively safe in neonates with posthemorrhagic hydrocephalus without LONS after birth. However, if LONS is present, various conditions such as preoperative high grade American Society of Anaesthesiologists score, ductus arteriosus persistens, bronchopulmonary dysplasia, and pneumothorax markedly increase the risk for a lethal outcome after the operation.

The relationship between Apgar score and gender with the incidence of neonatal sepsis: systematic review

“…In the research results of Gutbir et al it is stated that an Apgar score with a low score is at risk of experiencing neonatal sepsis with a relative risk of 1.28, in line with the results of research from 9 literatures discussing Apgar scores with a low score can be 3 times greater risk to suffer from neonatal sepsis (p value<0.05, 95% CI: 1.3-7-7, OR: 3.2). 1,[9][10][11][12][13][14][15][16] Assessment of the Apgar score can be done at the same time as the examination of sex, gender is one of the risk factors for neonatal sepsis. The gender at risk for infection is higher in the male sex, this is in accordance with the results of the study of Murthy, et al that male infants are 1.3 times higher risk of infection (p value=0.03, 95% CI: 1.02-1.68, OR: 1.3) compared to female infants, this is in line with the results of 5 literature studies which state that male sex is at risk 1.31 (p value=0.003, 95% CI: 1.22-1.41, OR: 1.31) had a higher risk of infection and even death than women.…”

“…The gender at risk for infection is higher in the male sex, this is in accordance with the results of the study of Murthy, et al that male infants are 1.3 times higher risk of infection (p value=0.03, 95% CI: 1.02-1.68, OR: 1.3) compared to female infants, this is in line with the results of 5 literature studies which state that male sex is at risk 1.31 (p value=0.003, 95% CI: 1.22-1.41, OR: 1.31) had a higher risk of infection and even death than women. [13][14][15][17][18][19] Table 3 shows the results of the analysis that 10 of the 14 literatures that discuss the Apgar score, the results of research from 10 literatures that the 5th minute Apgar score value of less than seven is an independent predictor of the risk of neonatal sepsis with a p value<0.01 (95% CI: 8.31-41.45, OR: 18.56) with a mean risk of 16.9%. 1,9,13 A low Apgar score at minute 5 has a risk of 3.47 times more likely to be infected (p value=0.000, 95% CI: 2.53-4.41, OR: 3.47) and even cause death, compared to newborns born with Apgar normal scores.…”

Red cell distribution width as a predictor of late‐onset Gram‐negative sepsis

“…Epidemiological data on neonates show that the predominant pathogens causing LOS are coagulase‐negative staphylococci (CONS), followed by Gram‐negative bacteria, and fungi . However, owing to low levels of toxin production, CONS infections in neonates are not as serious as late‐onset Gram‐negative sepsis (LOGNS) . Biomarkers that aid in the early diagnosis of LOS in preterm infants are of paramount importance owing to high rates of morbidity and mortality associated with this condition because the presenting signs are often non‐specific and microbiological culture results are not available within the first 48–72 h of infection …”

“…3 However, owing to low levels of toxin production, CONS infections in neonates are not as serious as late-onset Gram-negative sepsis (LOGNS). 1,3 Biomarkers that aid in the early diagnosis of LOS in preterm infants are of paramount importance owing to high rates of morbidity and mortality associated with this condition because the presenting signs are often non-specific and microbiological culture results are not available within the first 48-72 h of infection. 2 Red blood-cell distribution width (RDW) is a quantitative measure of variability in the size of circulating erythrocytes.…”

“…Late‐onset sepsis (LOS), defined as neonatal sepsis occurring after 3 days of postnatal age, represents an important cause of morbidity and mortality in preterm infants . The incidence of LOS has increased in parallel with the improvement in the survival of premature infants, particularly those with extremely low birthweight, and is an ongoing major global public health issue.…”