Table 3:
Outcomes in Neonates with Gram positive and Gram negative sepsis compared with neonates with negative blood culture at NEC onset
| Total Cohort | Gram Positive sepsis | Negative Blood Culture | p value | Total Cohort | Gram Negative Sepsis | Negative blood Culture | p value | |
|---|---|---|---|---|---|---|---|---|
| N=186 | N=29 | N=157 | N=174 | N=17 | N=157 | |||
| Prenatal Information | ||||||||
| Pregnancy-Induced Hypertension, n (%) | 52 (28.1%) | 5 (17.2%) | 47 (30.1%) | 0.233 | 54 (31.2%) | 7 (41.2%) | 47 (30.1%) | 0.511 |
| Chorioamnionitis, n (%) | 16 (8.65%) | 2 (6.90%) | 14 (8.97%) | 1 | 16 (9.25%) | 2 (11.8%) | 14 (8.97%) | 0.66 |
| Antenatal Steroids, n (%) | 113 (63.8%) | 19 (67.9%) | 94 (63.1%) | 0.789 | 105 (63.3%) | 11 (64.7%) | 94 (63.1%) | 1 |
| Infant Demographics | ||||||||
| Gestational Age (weeks), median (IQR) | 27.1 [25.0;31.1] | 26.4 [24.3;27.5] | 27.6 [25.0;31.6] | 0.018 | 27.5 [25.0;31.3] | 27.5 [24.4;29.6] | 27.6 [25.0;31.6] | 0.249 |
| Birth Weight (grams), median (IQR) | 915 [680;1500] | 760 [630;1000] | 940 [690;1620] | 0.032 | 930 [686;1585] | 790 [670;1080] | 940 [690;1620] | 0.246 |
| Male Gender, n (%) | 112 (60.2%) | 18 (62.1%) | 94 (59.9%) | 0.988 | 106 (60.9%) | 12 (70.6%) | 94 (59.9%) | 0.55 |
| Ethnicity, n (%) | 0.742 | 0.025 | ||||||
| Caucasian | 40 (21.6%) | 5 (17.2%) | 35 (22.4%) | 36 (20.8%) | 1 (5.88%) | 35 (22.4%) | ||
| Latino | 5 (2.70%) | 1 (3.45%) | 4 (2.56%) | 4 (2.31%) | 0 (0.00%) | 4 (2.56%) | ||
| African American | 139 (75.1%) | 23 (79.3%) | 116 (74.4%) | 130 (75.1%) | 14 (82.4%) | 116 (74.4%) | ||
| Other | 1 (0.54%) | 0 (0.00%) | 1 (0.64%) | 3 (1.73%) | 2 (11.8%) | 1 (0.64%) | ||
| Mode of Delivery, n (%) | 0.735 | 0.159 | ||||||
| C-section | 130 (69.9%) | 19 (65.5%) | 111 (70.7%) | 126 (72.4%) | 15 (88.2%) | 111 (70.7%) | ||
| Vaginal | 56 (30.1%) | 10 (34.5%) | 46 (29.3%) | 48 (27.6%) | 2 (11.8%) | 46 (29.3%) | ||
| Outborn, n (%) | 109 (58.9%) | 20 (71.4%) | 89 (56.7%) | 0.211 | 98 (56.3%) | 9 (52.9%) | 89 (56.7%) | 0.969 |
| Infant Medical Information Prior to NEC | ||||||||
| PDA, n (%) | 90 (48.6%) | 18 (62.1%) | 72 (46.2%) | 0.17 | 83 (48.0%) | 11 (64.7%) | 72 (46.2%) | 0.231 |
| PDA, Indomethacin Treated, n (%) | 20 (11.0%) | 2 (7.14%) | 18 (11.8%) | 0.744 | 22 (13.0%) | 4 (25.0%) | 18 (11.8%) | 0.231 |
| NEC Disease Features | ||||||||
| Clinical Presentation, n (%) | 0.051 | 0.016 | ||||||
| Abdominal Distension | 133 (71.5%) | 26 (89.7%) | 107 (68.2%) | 124 (71.3%) | 17 (100%) | 107 (68.2%) | ||
| Bloody Stools | 41 (22.0%) | 2 (6.90%) | 39 (24.8%) | 39 (22.4%) | 0 (0.00%) | 39 (24.8%) | ||
| Feeding Intolerance | 12 (6.45%) | 1 (3.45%) | 11 (7.01%) | 11 (6.32%) | 0 (0.00%) | 11 (7.01%) | ||
| Radiological Findings, n (%) | ||||||||
| Pneumatosis | 78 (42.6%) | 11 (37.9%) | 67 (43.5%) | 0.725 | 75 (43.9%) | 8 (47.1%) | 67 (43.5%) | 0.982 |
| Pneumoperitoneum | 52 (28.4%) | 9 (31.0%) | 43 (27.9%) | 0.907 | 50 (29.2%) | 7 (41.2%) | 43 (27.9%) | 0.269 |
| Portal Venous Gas | 6 (3.28%) | 0 (0.00%) | 6 (3.90%) | 0.592 | 9 (5.26%) | 3 (17.6%) | 6 (3.90%) | 0.047 |
| Age of NEC Onset (days), median (IQR) | 16.0 [8.00;30.0] | 12.0 [8.00;25.0] | 17.0 [8.00;31.0] | 0.495 | 16.5 [8.00;31.0] | 15.0 [8.00;25.0] | 17.0 [8.00;31.0] | 0.744 |
| Length of Bowel Resected (cm), median (IQR) | 5.00 [0.00;23.0] | 15.0 [0.00;27.2] | 4.20 [0.00;16.9] | 0.201 | 5.00 [0.00;16.9] | 9.05 [1.72;20.3] | 4.20 [0.00;16.9] | 0.395 |
| Region of Bowel Resected, n (%) | 1 | 1 | ||||||
| Small Bowel Resected | 53 (61.6%) | 10 (58.8%) | 43 (62.3%) | 51 (63.0%) | 8 (66.7%) | 43 (62.3%) | ||
| Combined Large and Small Bowel Resected | 33 (38.4%) | 7 (41.2%) | 26 (37.7%) | 30 (37.0%) | 4 (33.3%) | 26 (37.7%) | ||
| Short Bowel Syndrome, n (%) | 38 (40.9%) | 10 (50.0%) | 28 (38.4%) | 0.495 | 37 (43.0%) | 9 (69.2%) | 28 (38.4%) | 0.077 |
| Post-Operative Intestinal Features | ||||||||
| Post-Operative Ileus Days (days), median (IQR) | 13.0 [9.00;16.2] | 15.5 [13.0;19.2] | 12.0 [7.25;15.8] | 0.017 | 12.0 [9.00;16.5] | 14.0 [11.0;18.0] | 12.0 [7.25;15.8] | 0.171 |
| Attainment of Full Enteral Feedings (120 mL/kg) (days), median (IQR) | 55.0 [28.5;79.0] | 63.0 [28.5;94.0] | 53.0 [29.0;76.5] | 0.617 | 57.0 [30.0;85.5] | 89.5 [62.2;120] | 53.0 [29.0;76.5] | 0.044 |
| Duration of Parenteral Nutrition (days), median (IQR) | 65.0 [31.0;99.5] | 79.0 [38.0;143] | 61.5 [30.2;95.8] | 0.093 | 65.0 [27.5;99.5] | 113 [25.0;130] | 61.5 [30.2;95.8] | 0.155 |
| Post-Operative Systemic Course | ||||||||
| Assisted Ventilation (intubated), n (%) | 113 (63.1%) | 25 (86.2%) | 88 (58.7%) | 0.006 | 102 (61.1%) | 14 (82.4%) | 88 (58.7%) | 0.2 |
| 24h Pressor Support, n (%) | 90 (50.0%) | 18 (66.7%) | 72 (47.1%) | 0.095 | 87 (51.2%) | 15 (88.2%) | 72 (47.1%) | 0.003 |
| AKI by Serum Creatinine Present, n (%) | 57 (32.9%) | 9 (33.3%) | 48 (32.9%) | 1 | 58 (35.8%) | 10 (62.5%) | 48 (32.9%) | 0.038 |
| AKI by Serum Creatinine, n (%) | 0.388 | 0.034 | ||||||
| Normal | 116 (67.1%) | 18 (66.7%) | 98 (67.1%) | 104 (64.2%) | 6 (37.5%) | 98 (67.1%) | ||
| Stage 1 | 27 (15.6%) | 2 (7.41%) | 25 (17.1%) | 30 (18.5%) | 5 (31.2%) | 25 (17.1%) | ||
| Stage 2 | 15 (8.67%) | 4 (14.8%) | 11 (7.53%) | 12 (7.41%) | 1 (6.25%) | 11 (7.53%) | ||
| Stage 3 | 15 (8.67%) | 3 (11.1%) | 12 (8.22%) | 16 (9.88%) | 4 (25.0%) | 12 (8.22%) | ||
| AKI by Urine Output Present, n (%) | 43 (24.9%) | 13 (48.1%) | 30 (20.5%) | 0.005 | 34 (21.0%) | 4 (25.0%) | 30 (20.5%) | 0.747 |
| AKI by Urine Output, n (%) | 0.008 | 0.422 | ||||||
| Normal | 130 (75.1%) | 14 (51.9%) | 116 (79.5%) | 128 (79.0%) | 12 (75.0%) | 116 (79.5%) | ||
| Stage 1 | 4 (2.31%) | 2 (7.41%) | 2 (1.37%) | 2 (1.23%) | 0 (0.00%) | 2 (1.37%) | ||
| Stage 2 | 26 (15.0%) | 8 (29.6%) | 18 (12.3%) | 22 (13.6%) | 4 (25.0%) | 18 (12.3%) | ||
| Stage 3 | 13 (7.51%) | 3 (11.1%) | 10 (6.85%) | 10 (6.17%) | 0 (0.00%) | 10 (6.85%) | ||
| AKI by Urine Output and Serum Creatinine Present, n (%) | 77 (41.4%) | 19 (65.5%) | 58 (36.9%) | 0.008 | 70 (40.2%) | 12 (70.6%) | 58 (36.9%) | 0.015 |
| Platelet Transfusion, n (%) | 86 (48.3%) | 16 (59.3%) | 70 (46.4%) | 0.305 | 86 (51.2%) | 16 (94.1%) | 70 (46.4%) | 0.001 |
| Sepsis Variables | ||||||||
| Central Line Present (days), median (IQR) | 148 (82.7%) | 23 (82.1%) | 125 (82.8%) | 1 | 139 (82.7%) | 14 (82.4%) | 125 (82.8%) | 1 |
| Duration of Antibiotics, median (IQR) | 7.00 [5.00;10.0] | 10.0 [6.00;13.5] | 7.00 [5.00;10.0] | 0.177 | 7.00 [5.00;10.0] | 7.00 [4.00;13.5] | 7.00 [5.00;10.0] | 0.992 |
| CRP on Day of NEC Onset, median (IQR) | 2.30 [0.70;6.05] | 3.10 [0.90;6.80] | 2.15 [0.70;5.90] | 0.296 | 2.35 [0.70;6.20] | 4.95 [2.22;15.3] | 2.15 [0.70;5.90] | 0.026 |
| CRP at 24 Hours after NEC Onset, median (IQR) | 3.90 [1.20;14.2] | 7.70 [1.80;17.7] | 3.80 [1.20;13.2] | 0.253 | 4.60 [1.37;14.7] | 15.3 [8.35;19.7] | 3.80 [1.20;13.2] | 0.004 |
| CRP at 48 Hours after NEC Onset, median (IQR) | 4.30 [1.30;15.9] | 11.1 [2.38;23.2] | 3.70 [1.12;15.6] | 0.038 | 4.00 [1.25;16.5] | 20.1 [8.90;22.4] | 3.70 [1.12;15.6] | 0.021 |
| Discharge | ||||||||
| Length of Stay (days), median (IQR) | 94.0 [46.0;142] | 127 [82.0;171] | 87.5 [41.5;133] | 0.013 | 89.0 [40.0;136] | 122 [26.0;161] | 87.5 [41.5;133] | 0.57 |
| Death, n (%) | 40 (21.5%) | 6 (20.7%) | 34 (21.7%) | 1 | 40 (23.0%) | 6 (35.3%) | 34 (21.7%) | 0.228 |
Abbreviations: NEC = necrotizing enterocolitis; AKI = acute kidney injury; CRP = c-reactive protein; WBC = white blood cell; ANC = absolute neutrophil count Continuous variables are presented as mean (standard deviation) and differences were tested with 2-sample t-test if normality has been met and, if not normally distributed, as median with interquartile range and Mann-Whitney U test were applied.
Categorical variables are presented as count (column percentage). Differences in categorical measures’ associations were tested using the Chi- squared test when cell counts were adequate, otherwise Fisher’s Exact were used with low expected cell counts. The presence of bold values signifies p < 0.05.