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Table 2 Episodes of neonatal bloodstream infections stratified according to primary bacteremia and bacteremia with various foci of infection

From: Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus

Characteristics Neonatal BSIs with specific focus of infection (total n = 167) Primary bacteremia
(n = 781)
Meningitis
(n = 51)
VAP (n = 36) CLABSI
(n = 57)
NEC (n = 21) Othersb
(n = 7)
Demographic characteristics
 Birth body weight (g), median (IQR) 2375 (1405–2905)** 960 (820–1600)** 1267.5 (911–2680) 1480 (1065–2040)* 2330 (1600–2700)* 1240 (880–1880)
 Gestational age (weeks), median (IQR) 35.0 (30.0–38.0)** 27.0 (25.0–31.0)** 29.5 (27.0–37.0) 29.0 (27.0–34.0) 37.0
(32–38)**
30.0 (27.0–34.0)
 Male sex, n (%) 30 (58.8) 21 (58.3) 29 (50.9) 10 (47.6) 5 (71.4) 405 (51.9)
Onset of BSI (day), median (IQR) 33.5 (17.8–60.3) 30 (20–58)* 25 (17–45.5) 19 (12–43)** 42 (11–73) 28 (17.0–53.0)
Perinatal history
 Low Apgar score at 5 min ( 7) 13 (25.5)** 22 (61.1)** 26 (45.6) 5 (23.8)** 2 (28.6)** 351 (44.9)
 Perinatal asphyxia 6 (11.8) 13 (36.1)** 4 (7.0) 2 (9.5) 0 (0) 62 (7.9)
Underlying chronic conditionsa
 Congenital anomalies 2 (3.9) 2 (5.6) 4 (7.0) 0 (0) 2 (28.6) 55 (7.0)
 Neurological comorbidities 23 (45.1)** 5 (13.9) 3 (5.3) 1 (4.8) 1 (14.3) 91 (11.7)
 Complicated congenital heart disease 0 (0) 0 (0) 3 (5.3) 0 (0) 0 (0) 32 (4.1)
 Acyanotic CHD with heart failure 0 (0) 1 (2.8) 3 (5.3) 0 (0) 0 (0) 17 (2.2)
 Bronchopulmonary dysplasia 9 (17.6) 23 (63.9)** 15 (26.3) 6 (28.6) 2 (28.6) 243 (31.1)
 Pulmonary hypertension 1 (2.0) 1 (2.8) 3 (5.3) 0 (0) 0 (0) 23 (2.9)
 Gastrointestinal pathology 0 (0) 1 (2.8) 4 (7.0) 3 (14.3) 0 (0) 54 (6.9)
 Renal 1 (2.0) 1 (2.8) 2 (3.5) 1 (4.8) 0 (0) 25 (3.2)
 Cholestasisb 4 (7.8) 9 (25.0) 13 (22.8) 6 (28.6) 4 (57.1)** 147 (18.8)
Clinical septic symptoms
 Fever (temperature > 38 °C) 33 (64.7) 8 (22.2) 26 (45.6) 6 (28.6) 4 (57.1) 319 (40.8)
 Apnea ± bradycardia and/or cyanosis 31 (60.8) 32 (88.9) 40 (70.2) 16 (76.2) 5 (71.4) 528 (67.6)
 Abdominal distension ± feeding intolerance 31 (60.8) 27 (75.0)* 27 (47.4) 21 (100)** 5 (71.4)* 457 (58.5)
 Tachycardia 15 (29.4) 5 (13.9) 13 (22.8) 6 (28.6) 1 (14.3) 177 (22.7)
 Hyper- or hypoglycemia 14 (27.5) 14 (38.9) 11 (19.3) 8 (38.1) 1 (14.3) 206 (26.4)
 Septic shock 8 (15.7) 11 (30.6)* 6 (10.5) 9 (42.9)** 2 (28.6) 126 (16.1)
 Disseminated intravascular coagulopathy 8 (15.7)* 5 (13.9) 3 (5.3) 5 (23.8)* 1 (14.3) 62 (7.9)
Laboratory parameter
 Leukopenia (WBC count <4000/uL) 12 (23.5) 6 (16.7) 5 (8.8) 9 (42.9)** 3 (42.9)** 127 (16.3)
 Leukocytosis (WBC count >20,000/uL) 14 (27.5) 14 (38.9)* 13 (22.8) 5 (23.8) 4 (57.1)** 217 (27.8)
 WBC shift to left (immature WBC ≥ 20%) 10 (19.6) 7 (19.4) 3 (5.3) 7 (33.3)** 1 (14.3) 89 (11.4)
 Anemia (hemoglobin <11.0 mg/dL) 22 (43.1) 23 (63.9)** 26 (45.6) 13 (61.9)** 2 (28.6) 291 (37.3)
 Thrombocytopenia (platelet <80,000/uL) 16 (31.4) 21 (58.3)** 19 (33.3) 11 (52.4)** 1 (14.3) 267 (34.2)
 Metabolic acidosis 12 (23.5) 15 (41.7)** 6 (11.8) 10 (47.7)** 1 (14.3) 139 (17.8)
 Prolonged PT and/or aPTT 12 (23.5) 11 (30.5) 12 (21.1) 11 (52.4)** 1 (14.3) 196 (25.1)
Sequences of BSI during hospitalization
 1st episode 41 (80.4) 27 (75.0) 42 (73.7) 19 (90.5) 4 (57.1) 584 (74.8)
 2nd episode 7 (13.7) 6 (16.7) 12 (21.1) 1 (4.8) 2 (28.6) 126 (16.1)
 3rd (or greater) episode 3 (5.9) 3 (8.3) 3 (5.3) 1 (4.8) 1 (14.3) 71 (9.1)
  1. All data were expressed as number (percentage %), unless indicated otherwise
  2. NTISS neonatal therapeutic intervention scoring system, IQR interquartile range, SD standard deviation, BSI bloodstream infection, NSD natural vaginal delivery, C/S cesarean section
  3. *P < 0.05; **P < 0.001; P values are the comparisons between BSIs with specific infectious focus and primary bacteremia
  4. aIndicating the presence of chronic conditions or comorbidities at onset of bloodstream infection, and some patients had >1 underlying chronic conditions. Each patient with an underlying chronic condition is compared with those without that specific condition
  5. bIndicating direct bilirubin ≥1.5 mg/dL or more than 50% of the total bilirubin