Mortality Risk Factors of Early Neonatal Sepsis During COVID-19 Pandemic

Figures & data

Figure 1 Patient flow chart for infants included in the research.

Table 1 Effect of Parameter on Fatal Outcome in Culture-Proven and Culture-Negative Sepsis Groups

Parameter	All (n=172)		p-value	Culture-Proven Sepsis (n=54)		p-value	Culture-Negative Sepsis (n=118)		p-value
	Survivors (n=134)	Dead (n=38)		Survivors (n=48)	Dead (n=6)		Survivors (n=86)	Dead (n=32)
Birth weight, median (IQR)	1755 (1314.75–2395)	960 (742.5–1237.5)	<0.001	2028 (1365–2912.5)	1050 (762.5–1326.25)	0.044	1732.5 (1276.25–2120)	960 (737.5–1117.5)	<0.001
Birth weight, g
Normal (>2500)	30 (22.4%)	6 (15.8%)	>0.05	18 (37.5%)	1 (16.7%)	>0.05	12 (14%)	5 (15.6%)	>0.05
LBW (<2500)	50 (37.3%)	0	<0.001	14 (29.2%)	0	>0.05	36 (41.9%)	0	<0.001
VLBW (<1500)	36 (26.9%)	7 (18.4%)	>0.05	8 (16.6%)	2 (33.3%)	>0.05	28 (32.5%)	5 (15.6%)	>0.05
ELBW (<1000)	18 (13.4%)	25 (65.8%)	<0.001	8 (16.6%)	3 (50%)	>0.05	10 (11.6%)	22 (68.8%)	<0.001
Gestational age, median (IQR)	32 (29.25–35)	27.5 (26–30)	>0.05	33 (30–37.25)	28.5 (27.25–29.75)	0.035	31 (29–34)	27 (25.75–30)	<0.001
Maturity
-Term	18 (13.4%)	4 (10.5%)	>0.05	12 (25%)	0	>0.05	6 (7%)	4 (12.5%)	>0.05
-Preterm (≤37 weeks)	116 (86.6%)	34 (89.5%)		36 (75%)	6 (100%)		80 (93%)	28 (87.5%)
Mode of delivery
-Cesarean section	82 (61.2%)	27 (71%)	>0.05	27 (56.25%)	5 (83.3%)	>0.05	55 (64%)	22 (68.75%)	>0.05
-Vaginal delivery	52 (38.8%)	11 (29%)		21 (43.75%)	1 (16.6%)		31 (36%)	10 (31.25%)
CRP, median (IQR)	0 (0–6)	6 (0–12)	0.002	0 (0–6)	0 (0–6)	>0.05	0 (0–6)	6 (0–12)	0.003
Procalcitonin, median (IQR)	0.23 (0.13–0.54)	0.25 (0.165–0.3575)	>0.05	0.2 (0.11–0.45)	0.1585 (0.1-…)	>0.05	0.2905 (0.1373–0.6750)	0.2650 (0.1650–0.4725)	>0.05
Anti-SARS-CoV-2 Ab, median (IQR)	9.5 (0.43–43.3)	4.8 (0.37–12.16)	>0.05	9.83 (3.81–43.3)	0.36	>0.05	9.5 (0.33–43.3)	5.37 (1.02–12.6)	>0.05
Hospitalization time, median (IQR)	31 (22–47)	6 (2.25–13.75)	<0.001	31 (19–41)	11.5 (7.5–17.75)	0.009	33 (23–48.75)	5 (2–12.25)	<0.001
Comorbidities
- Pneumonia	93 (69.4%)	35 (92.1%)	0.009	39 (81.25%)	6 (100%)	>0.05	54 (62.8%)	29 (90.6%)	0.007
- Anemia	62 (46.3%)	26 (68.4%)	0.016	23 (48%)	4 (66.6%)	>0.05	39 (45.3%)	22 (68.75%)	0.024
- Necrotizing enterocolitis	6 (4.5%)	10 (26.3%)	<0.001	3 (6.25%)	4 (66.6%)	<0.001	3 (3.5%)	6 (18.75%)	0.018
- CNS involvement	132 (98.5%)	35 (92.1%)	>0.05	48 (100%)	6 (100%)	<0.001	84 (97.7%)	29 (90.6%)	>0.05
- Congenital malformations	95 (70.9%)	25 (65.8%)	>0.05	34 (70.8%)	5 (83.3%)	<0.001	61 (70.9%)	20 (62.5%)	>0.05
Mother’s infections
-UTI	39 (29.1%)	16 (42.1%)	>0.05	15 (31.25%)	4 (66.6%)	>0.05	24 (27.9%)	12 (37.5%)	>0.05
-SSTI	1 (0.7%)	0	>0.05	1 (2%)	0	>0.05	0	0	-
-COVID-19 disease	11 (8.2%)	5 (13.2%)	>0.05	3 (6.25%)	0	>0.05	8 (9.3%)	5 (15.6%)	>0.05
-Chorioamnionitis	4 (3%)	0	=0.057	3 (6.25%)	0	>0.05	1 (1.2%)	0	>0.05
-Other infection	11 (8.2%)	4 (10.5%)	>0.05	3 (6.25%)	0	>0.05	9 (10.5%)	4 (12.5%)	>0.05
-No infection	67 (50%)	13 (34.2%)	>0.05	23 (48%)	2 (33.3%)	>0.05	44 (51.1%)	11 (34.4%)	>0.05
Type of pathogen
- CoNS				29 (60.4%)	2 (33.3%)
-E. faecium				4 (8.3%)	0
-S. agalactiae				2 (4.1%)	0
-Enterobacterales				7 (14.5%)	2 (33.3%)
-A. baumanii				3 (6.25%)	0
-Other				4 (8.3%)	2 (33.3%)

Notes: p-value: Comparison between groups was performed using the χ² test (Pearson’s chi-squared test), Mann–Whitney U-test for quantitating variables. Statistical significance if p<0.05 (marked in bold).

Abbreviations: IQR, interquartile range; LBW, low birth weight; VLBW, very low birth weight; ELBW, extremely low birth weight; CRP, C-reactive protein; UTI, urinary tract infection; SSTI, skin and soft tissue infection; COVID-19, coronavirus disease; CoNS, coagulase-negative staphylococci.

Table 2 Results of Anti-SARS-CoV-2 Total Antibody in All Newborns with Sepsis

	Survivors (n=81)	Dead (n=20)	p-value
Anti-SARS-CoV-2 Antibody, %	55 (67.9%)	14 (70.0%)	>0.05
Cases of confirmed maternal COVID-19 disease (PCR test), %	11(13.5%)	4 (20%)	>0.05
Anti-SARS-CoV-2 Antibody, median (IQR)	10.14 (0.42–43)	4.19 (0.36–10.3)	>0.05

Notes: p-value: Comparison between groups was performed using the χ² test (Pearson’s chi-squared test), Mann–Whitney U-test for quantitating variables.

Figure 2 Odds ratio for mortality in culture-positive and culture-negative sepsis groups.

Note: Red – culture-negative sepsis group, green – culture-positive sepsis group.

Abbreviations: ELBW, extremely low birth weight; VLBW, very low birth weight; LBW, low birth weight; CRP, C-reactive protein; NE, necrotizing enterocolitis; UTI, urinary tract infection; SSTI, skin and soft tissue infection; COVID-19, coronavirus disease.

Figure 3 The etiology of neonatal sepsis.