PB1023 - Development of Sepsis induced Coagulopathy is associated with death in late onset sepsis in Neonates

Background: Previous studies have described sepsis induced coagulopathy in neonates but have not explicitly associated its development with clinical outcomes. We examined the clinical course of neonates with late onset sepsis who were simultaneously assessed for a coagulopathy.

Aims: To establish the impact of the development of sepsis induced coagulopathy as defined by ISTH SIC criteria on outcomes in late onset neonatal sepsis

Methods: Retrospective data from a tertiary level neonatal unit was collected from January 2018- December 2021 on all neonates who had both a blood culture for late onset sepsis and a conventional coagulation test performed. Sepsis induced Coagulopathy (SIC) was defined by modified International Society of Thrombosis and Haemostasis criteria with the neonatal sequential organ failure assessment replacing the adult sequential organ failure assessment score. A binomial logistic regression was performed examining the association between SIC and i) mortality and ii) Major bleeds defined as a grade III/IV Intraventricular haemorrhage, Pulmonary haemorrhage, non IVH intracranial bleed, and rectal or gastric bleeding that occurred after the diagnosis of sepsis/ septic episode. Gestational age was included as an independent variable to control for its effect on mortality and bleeding risk.

Results: From 417 neonates in the examined epoch, 34 patients met inclusion criteria. 19 neonates had a diagnosis of sepsis induced coagulopathy based on modified international society of thrombosis and haemostasis criteria whilst 15 did not. Neonates who met an SIC diagnosis had a significant increase in their odds of death (OR 7.5 95%CI 1.36-17.23) without increase in major bleeding (OR 1.2 95% CI 0.23-7.23).

Conclusion(s): Development of sepsis induced coagulopathy in late onset neonatal sepsis is associated with an increased risk of death. Further studies examining this process may provide therapeutic avenues in the treatment of neonatal sepsis and aid prognostication.