title: Timing of Multiorgan Dysfunction among Hospitalized Infants with Fatal Fulminant Sepsis.
abstract: ObjectiveIdentify the progression of specific signs of multiorgan dysfunction among infants with fatal sepsis.Study DesignCohort study of 679 infants who died within 3 days of the start of a late-onset sepsis (LOS) episode in neonatal intensive care units from 1997 to 2012. We extracted clinical and laboratory data on the day of death (day 0) and the preceding 5 days (days -5 to -1).ResultsMedian (25th percentile-75th percentile) gestational age was 25 (24-28) weeks. Compared with day -1, day 0 was characterized by an increased requirement for mechanical ventilation and higher mean fraction of inspired oxygen. Measures of cardiorespiratory support and the proportion of infants with neutropenia began to rise on day -2.ConclusionHospitalized infants with fatal LOS manifest respiratory, cardiovascular, renal, immune, and hematologic dysfunction. Knowledge of these factors and their timing may be important for the development and testing of novel therapeutics to reduce sepsis mortality.
authors.affiliation: Departments of Pediatrics and Pathology, Immunology, and Experimental Medicine, University of Florida, Gainesville, Florida.
authors.forename: James L
authors.initials: JL
authors.lastname: Wynn
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Kelly
authors.affiliation: Department of Economics, Clemson University, Clemson, South Carolina.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.affiliation: Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida.
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Rachel
authors.initials: R
authors.lastname: Greenberg
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
mesh_terms: D016208:Databases, Factual; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009102:Multiple Organ Failure / Q000503:physiopathology*; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000382:microbiology* / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D014481:United States / Q000453:epidemiology