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Abstract
Background Impaired hemodynamics in neonatal sepsis increase the mortality.
Objective Studying the changes in hemodynamics and peripheral perfusion in premature infants with suspected sepsis and comparing them with stable matched controls.
Methods Left (LVO) and right ventricular output (RVO), and superior vena cava (SVC) flow were measured using echocardiography in newborn infants with suspected sepsis after DOL 7. Measurements were repeated 3 times q 24 h and when antibiotics were discontinued. Anterior cerebral artery RI and oxygenation of the brain and the kidney were measured by near infrared spectroscopy (NIRS). Vital parameters were monitored. Controls were studied once; matched with cases for GA, BW, and postnatal age.
Results Twelve preterm infants (GA 26.8 ± 2.5 wks; BW 843 ± 225 g) were studied at postnatal age 13.5 (7- 60) days and compared to 12 stable matched controls. Four cases had a positive blood culture, six had an elevated CrP, and 2 had an elevated IL8 only. LVO showed an increase over time reaching a maximum of 404 ± 104 ml/kg/min on the 3rd measurement point (p = 0.046 compared to the 1st measurement) and was higher compared to controls (p = 0.04). SVC flow showed a trend towards increase over time. The control group had a higher SVC flow at the initial measurement (p = 0.05). No significant change in RVO, NIRS, Doppler parameters, and in blood pressure over time or compared to controls, although five cases required circulatory support either by volume therapy, catecholamines or both.
Conclusions Suspected sepsis was associated with haemodynamic changes which may have implications for clinical management.
Average ±SD of left ventricular output (LVO) changes over time, after clinical improvement and LVO in the control group. D/C Abx, discontinuation of antibiotics.