Abstract
Background
Sepsis related acute lung injury (ALI) is established in adults but has not been investigated in premature infants. Herein, we used pulmonary severity score (PSS) trajectories and C-reactive protein (CRP) to examine the relation between sepsis and ALI in premature infants.
Methods
This retrospective study identified 211 sepsis and 123 rule out (RO) events in 443 infants born <31 weeks and <1500 grams. The PSS was calculated prior to, at the time of, and up to 1 week after each event. Initial and peak CRP values were collected for each event.
Results
PSS significantly increased at 0 h from baseline (−72h) and remained increased at all subsequent time points (all p < 0.002) in sepsis events. Mean PSS in sepsis episodes were also higher compared to RO events at +24 h, +48 h, +72 h, and +168 h (all p < 0.004). A positive correlation was noted between peak CRP values in sepsis events and PSS at 0 h, +24 h, +48 h, and +72 h.
Conclusions
The temporal PSS trends and correlation with CRP levels observed in sepsis but not in RO events supports the hypothesis that neonatal sepsis is associated with ALI and contributes to the accumulating evidence that neonatal ARDS occurs.
Impact
-
To evaluate pulmonary severity scores and c-reactive protein values over time to establish an association between preterm neonatal sepsis and acute lung injury (ALI).
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Though sepsis is well established as the most common indirect cause of ALI leading to acute respiratory distress syndrome (ARDS) in adults and pediatrics, this phenomenon remains undefined in neonates.
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This study validates the proposal by the Neonatal ARDS Project that ARDS also occurs in neonates by demonstrating acute and sustained changes in markers of pulmonary injury temporally related to a diagnosis of neonatal sepsis in preterm infants.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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M.H.T. conceptualized and designed the study, designed the data collection instruments, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. H.W.Y. carried out data analyses and reviewed and revised the manuscript. D.O. collected data and reviewed and revised the manuscript. N.S. collected data and reviewed and revised the manuscript. N.K. conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. V.S. conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Tucker, M.H., Yeh, HW., Oh, D. et al. Preterm sepsis is associated with acute lung injury as measured by pulmonary severity score. Pediatr Res 93, 1050–1056 (2023). https://doi.org/10.1038/s41390-022-02218-1
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DOI: https://doi.org/10.1038/s41390-022-02218-1
