Cardiac Output in Late Onset Neonatal Sepsis

• Main Authors: Sujata Deshpande, Pradeep Suryawanshi, Ninad Chaudhary, Rajesh Maheshwari
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2017-11-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: culture positive sepsis; functional echocardiography; neonate
• Online Access: https://jcdr.net/articles/PDF/10871/30312_CE(RA1)_F(T)_PF1(PB_AP)_PFA(MJ_GG).pdf

Introduction: Haemodynamics in sepsis is complex. Clinical variables such as heart rate, blood pressure and capillary refill time have been demonstrated to be misleading in their accuracy. Measurements of central blood flow such as cardiac output provide haemodynamic information, which may be different from the assumed underlying physiology. Aim: To evaluate the Right Ventricular Output (RVO) and Left Ventricular Output (LVO) in neonates diagnosed with late onset sepsis, with the help of functional echocardiography (FnECHO). Materials and Methods: This prospective cohort study was conducted at a tertiary care neonatal unit of Western India from March 2015 to November 2015. All infants admitted in the NICU with suspected late onset sepsis underwent FnECHO within 12 hours of onset of clinical signs, before initiation of inotropic support. Right Ventricular Output and LVO were recorded. Infants with positive culture results were included in the final analysis. Infants with early onset or culture negative sepsis, perinatal asphyxia, congenital heart disease, major congenital malformations and genetic syndromes were excluded from the study. Descriptive statistics were used to analyse data. Unpaired t-test was used for comparison of means of two independent groups. Results: Thirty one infants were analysed, of which two-thirds were preterm. Majority of patients (24, 77.4%) in the study group had gram-negative sepsis. Mean (±SD) RVO and LVO of the infants with late onset sepsis were 313 mL/kg/minute (±110.4) and 347 mL/kg/minute (±139.9) respectively, which were higher than normal values. The higher values of RVO and LVO were seen in patients with gram-negative sepsis (338 and 378 mL/kg/minute respectively), while remaining in the normal range in patients with gram-positive sepsis (225 and 240 mL/ kg/minute respectively). Conclusion: Neonates with late onset sepsis showed high RVO and LVO as demonstrated by FnECHO. The higher cardiac output values were predominantly seen in patients with gram-negative sepsis as compared to those with gram-positive sepsis.