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Baczynski M, Kharrat A, Zhu F, Ye XY, Shah PS, Weisz DE, Jain A. Bloodstream Infections in Preterm Neonates and Mortality Associated Risk Factors. J Pediatr. 2021 Jun 21:S0022-3476(21)00561-8.

Objective: To investigate the association of early (±4 hours blood stream infection-onset) clinical and laboratory variables with episode-related mortality (<7 days).

Study design: This was a two-site, retrospective study including 142 neonates <35 weeks gestational age (GA) with positive blood/cerebrospinal fluid (CSF) culture >72 hours of age from organisms other than Coagulase-negative staphylococcus. Early variables were compared between those with blood stream infection-related mortality versus survivors. Multivariable analysis was conducted for the primary outcome and area under the curve (AUC) was estimated for relevant variables.

Results: Neonates with mortality were lower GA at disease-onset. After adjusting for relevant variables, lowest mean blood pressure [MBP, AOR (95% CI) 0.10(1.02, 1.19)] and highest base deficit [ 1.18 (1.06, 1.32)] were independently associated with mortality. AUC was 0.87(0.78, 0.96) for base deficit, increasing to 0.91(0.83, 0.99) with addition of MBP.

Conclusion: Lowest MBP and highest base deficit ±4 hours of blood stream infection-onset identify preterm neonates at-risk of mortality.

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