Abstract
neonatal sepsis remains one of the leading causes of morbidity and mortality in the neonatal age. The involvement of the myocardium in sepsis remains insufficiently studied, in particular in neonatology, where issues of myocardial dysfunction in neonatal generalized infection seem even more controversial, especially in neonatal sepsis at different gestational terms. Objective. To study specific clinical and anamnestic and echocardiographic parameters in infants depending on gestational age for optimization of the prognosis in neonatal sepsis. Material and research methods. To achieve this goal, we observed 57 newborns with a verified diagnosis of "Neonatal sepsis". Group I (23 patients – 40.3%) included newborns with a gestational age of 37-42 weeks, Group II – 34 premature infants (59.7%) with a gestation of up to 36 weeks. The latter group, depending on the gestational age, was divided into IIA subgroup, which was formed by 21 prematurely born patients with NS with a gestational age of 32-36 weeks, and the IIB subgroup – 13 newborns born before 32 weeks of gestation. Research results. The analysis showed that the severity of the impairment in the general condition of the examined newborns general condition was assessed as severe in 47.8% of newborns of group I, in 88.2% of cases in group II (PI: II <0.05), in 85.7% of representatives of subgroup IIA (PI: IIA <0.05) and in 92.3% of children of subgroup IIB (PI: IIB <0.001). It is shown that every third child (30.4%) of group I, 67.6% of newborns of group II (PI: II <0.05), half (52.4%) of the representatives of subgroup IIA (PII: IIA <0.01) and all seriously ill patients (92.3%) of subgroup IIB (PI: IIB, IIA: IIB <0.05) required cardiopulmonary resuscitation in the delivery room. Thus, in relation to full-term patients, the risk of this significant postnatal factor of emergency is likely to increase: for group II: OR - 4.77 (95% CI 2.63-8.68), RR - 2.17 (95% CI 1.57-3.0), AR = 0.37; and for premature babies with a gestational age of less than 32 weeks (IIB subgroup), respectively: OR – 27.44 (95% CI 11.73-64.19), RR – 7.55 (95% CI 5.58-10.21 ), AR – 0.65. The correlation analysis showed that in premature infants suffering from NS, the increase in the functional capacity of the left ventricular myocardium was associated with the female sex (for EF r = 0.94, P = 0.0001, for FS - r = 0, 94, P = 0.0001) and the number of days of inotropic support (for EF r = 0.68, P = 0.043, for FS - r = 0.71, P = 0.03). Conclusions. The analysis of echocardiographic parameters in the group of premature infants revealed a direct correlation between the ejection fraction and cardiovascular resuscitation immediately after birth (r = 0.64) and the duration of inotropic drugs (r = 0.68).
Highlights
The study showed that among full-term newborns, boys suffered from sepsis significantly more often that indicated a higher risk of developing sepsis for men with odds ratio (OR) – 5.19, relative risk (RR) – 2.28, attributive risk (AR) – 0.39), and for premature babies such a pattern has not been established
The obstetric anamnesis data allowed us to conclude that birth by caesarean section more often took place in the group of patients with neonatal sepsis (NS) of premature infants: OR – 2.7, RR – 1.54, AR – 0.24, which coincides with the trends in the general population of newborns (Shunko, Ye., еt al., 2017) and, apparently, testified to the presence of indications for caesarean section due to certain factors
At the same time, compared with group II, mothers of premature babies with a gestational age of less than 32 weeks had a higher risk of chorioamnionitis
Summary
Sepsis of newborns remains one of the main causes of morbidity and mortality in the neonatal age, in particular, sepsis remains the leading cause of the loss of seriously ill patients in pediatric intensive care units. In both the adult and pediatric populations of patients with sepsis, evidence has been obtained that a decrease in LVEF below 50% does not correlate with the prognosis of severe sepsis or septic cheek (Sevilla Berrios RA., еt al., 2014; Raj S., et al, 2014). The explanation for this may be the greater sensitivity of the myocardial receptors in children before drug exposure, the expressive ability to recover, the absence of comorbidity, and the like. The involvement of the myocardium in sepsis, the so-called “septic cardiomyopathy” (Hawiger J., 2018), is well documented, but insufficiently studied, primarily in pediatric practice and, in particular, in neonatology, where the issue of myocardial dysfunction in neonatal generalized infection looks even more controversial, especially in emergency situations for different gestational periods of patients
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