Resistive Index in Late-Onset Neonatal Sepsis

Abstract

Background and Objectives: Hemodynamics in neonatal sepsis is complex and poorly understood. Several studies have reported conflicting findings on cerebral blood flow (CBF) in sepsis from severely increased flow to severely decreased flow. The objective of our study was to study CBF by measuring the resistive index (RI) of the anterior cerebral artery in late-onset neonatal sepsis (LONS). Methods: All newborn infants admitted in our neonatal intensive care unit with suspected LONS during the period from January 2017 to December 2017 underwent point-of-care transcranial Doppler ultrasonography to measure the RI of the anterior cerebral artery within 24 h of clinical presentation before starting inotropes if at all required. Infants with congenital heart disease, perinatal asphyxia, major congenital malformations, and genetic syndromes were excluded. Neonates with positive culture were included in the final analysis. Results: Of 89 suspected LONS, 33 were culture positive and were analyzed. The mean admission weight was 2.33 ± 0.76 kg. The mean gestational age was 33.5 ± 3.4 wk. Most common organism isolated was Klebsiella pneumoniae (82%). The RI was high in 54.5% (17 of 33) and normal in 45.5% (15 of 33) cases. Conclusions: LONS is a unique and complex hemodynamic state and we found it associated with the high RI indicating decreased CBF. A larger study may help in more understanding of this unique hemodynamic association.

Point of Care Neonatal Ultrasound in Late-Onset Neonatal Sepsis

“…Abnormalities seen on brain ultrasound during and/or after LONS with proven sepsis in 84 patients were IVH grade I in 10 cases, IVH grade II in 6 cases, IVH grade III in 2 cases, and periventricular leukomalacia (PVL) grade I in 27 cases. 18 In the study done by Dinakara P et al, 9 preterm neonates with abnormal findings on CUS, 43% had intracranial bleed, 17% had cerebral oedema, 4% had thalamic hyper echogenicity, 8% had PVL, and 8% with other findings. 9 Culture positive sepsis is an important risk factor for ventricular dilation, PVL, and IVH in preterm infants.…”

“…Our findings are similar to those reported in other studies conducted in India. [15][16][17][18] Most common finding in brain USG in our study was IVH followed by ventriculitis. Similar results were found in the prospective study (INFANT study) which included 117 preterm infants with suspected LOS.…”