Timing of Death and Rates of IVH, RDS, and NEC Among Infants With Neonatal Sepsis [27A

Abstract

INTRODUCTION: This study sought to evaluate infants with sepsis, stratified by preterm and term delivery, based on their rates of neonatal death (<28 days of life), infant death (28 days-one year), intraventricular hemorrhage (IVH), respiratory distress syndrome (RDS), and necrotizing enterocolitis (NEC). METHODS: This is a retrospective cohort study of non-anomalous, singleton and twin deliveries in the US. We compared preterm and term babies who died with sepsis. We also compared rates of IVH, RDS, and NEC among infants with sepsis. Results were analyzed using Pearson Chi-Squared tests to control for maternal race, maternal age, insurance status, education level, diabetes, chronic hypertension, preeclampsia, chorioamnionitis, postpartum hemorrhage, cesarean section, nulliparity, and gestational age. RESULTS: Rates of IVH, RDS, and NEC were significantly higher among infants with neonatal sepsis compared to non-septic infants. Rates of neonatal and infant death were increased in the sepsis group. These patterns are consistent among both preterm and term babies. Sepsis yielded an odds ratio of greater than 1 for all morbidities and mortalities examined. The one exception to this trend was neonatal death among preterm infants (OR: 0.52; 95% CI: 0.43-0.62%). CONCLUSION: Fetal AC <10th percentile identifies a cohort at higher risk for SGA who may have been overlooked with estimated fetal weight <10th percentile alone. This cohort can benefit from increased surveillance and additional pre- and post-natal counseling. Further, as a high portion of these patients delivered preterm, AC can guide timing of antenatal corticosteroids for fetal lung development and transfer to tertiary care centers when necessary.