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Neonatal factors related to center variation in the incidence of late-onset circulatory collapse in extremely preterm infants.

ABSTRACT: BACKGROUND:Although late-onset circulatory collapse (LCC) is widely recognized in Japan, its etiology and the reason for center variation in its incidence remain unclear. This study's objectives were to identify the perinatal and neonatal factors related to LCC and to estimate the factors related to the center variation in the incidence of LCC. METHODS:Extremely preterm infants born between 2008 and 2012 who were registered in the database of the Neonatal Research Network, Japan were retrospectively analyzed. LCC was defined as a clinical diagnosis of LCC and the administration of steroids. We first identified the factors that were significantly related to LCC. We then examined the cause of the center variation in the incidence of LCC, using the standardized incidence ratios (SIRs) of LCC and individual factors. RESULTS:The factors significantly associated with LCC included low gestational age (odds ratio [OR]: 1.13), small for date (OR: 1.43), male sex (OR: 1.26), antenatal steroid use (OR: 1.19), respiratory distress syndrome (OR: 1.25), chronic lung disease at 36 weeks (OR: 1.16), periventricular leukomalacia (PVL) (OR: 2.57), necrotizing enterocolitis (OR: 0.59), retinopathy of prematurity (ROP) (OR: 1.73), high-frequency oscillating ventilation (HFOV) use (OR: 1.31), parenteral nutrition (OR: 1.38), and red blood cell (RBC) transfusion (OR: 1.94). The SIR of LCC ranged from 0.05 to 2.94, and was positively correlated with SIRs of PVL, ROP, HFOV use and RBC transfusion. CONCLUSION:PVL, ROP, HFOV use and RBC transfusion were found to be correlated with the center variation in the incidence of LCC.

SUBMITTER: Suzuki Y

PROVIDER: S-EPMC5997318 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Neonatal factors related to center variation in the incidence of late-onset circulatory collapse in extremely preterm infants.

Suzuki Yume Y Kono Yumi Y Hayakawa Takahiro T Shimozawa Hironori H Matano Miyuki M Yada Yukari Y

PloS one 20180612 6

<h4>Background</h4>Although late-onset circulatory collapse (LCC) is widely recognized in Japan, its etiology and the reason for center variation in its incidence remain unclear. This study's objectives were to identify the perinatal and neonatal factors related to LCC and to estimate the factors related to the center variation in the incidence of LCC.<h4>Methods</h4>Extremely preterm infants born between 2008 and 2012 who were registered in the database of the Neonatal Research Network, Japan w ...[more]

PMID: 29894475

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Project description:ImportanceInfection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown.ObjectiveTo determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites.Design, setting, and participantsA multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants.ExposuresLate-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis.Main outcomes and measuresThe primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset.ResultsIn the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks' completed gestation did not reduce the association of the nSOFA score with infection-related mortality.Conclusions and relevanceThe nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population.

Dataset Information

Neonatal factors related to center variation in the incidence of late-onset circulatory collapse in extremely preterm infants.

Publications

Neonatal factors related to center variation in the incidence of late-onset circulatory collapse in extremely preterm infants.

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