Sepsis in Premature Newborns with Congenital Heart Disease Emina Hadzimuratovic, MD, Senka Mesihovic Dinarevic, MD, PhD, and Admir Hadzimuratovic, MD Pediatric Clinic, University Medical Center Sarajevo, Sarajevo, Bosnia and Herzegovina ABSTRACT Objective. To determine the incidence and distribution of neonatal sepsis in premature newborns with congenital heart disease (CHD) according to gestational and postnatal age, time of onset, and type and frequency of causing agents, and compare it with premature newborns without CHD. Design, Setting, Patients. A clinical investigation on 80 premature newborns admitted to neonatal intensive care unit (NICU) of Pediatric Clinic University Medical Center Sarajevo, Bosnia and Herzegovina, between October 23, 2007 and March 18, 2009. We analyzed the incidence and distribution of neonatal sepsis in premature newborns with CHD according to gestational and postnatal age, time of onset, and type and frequency of causing agents, and compared it with premature NICU patients without CHD. Results. Of the 80 premature newborns included in our study, 14 had CHD with patent ductus arteriosus as the most common type of anomaly. Culture-proven sepsis was diagnosed in 28.57% premature newborns with CHD and 12.12% premature newborns without CHD. The three most common causing agents were Staphylococcus aureus, Klebsiella species, and Serratia species. Conclusion. Premature newborns with CHD have a higher risk of acquiring sepsis during hospitalization in NICU, probably because of longer duration of hospitalization and need for invasive procedures such as mechanical ventilation, central venous catheters, and parenteral nutrition. Key Words. Premature Newborn; Sepsis; Congenital Heart Disease Introduction B acterial sepsis continue to be a major cause of morbidity and mortality in newborns, particularly in low-birth-weight infants. 1–3 Neonatal sepsis is a systemic inflammatory response to an infectious process caused by bacte- ria, viruses, fungi, protozoa, or rickettsia. 3 Neonatal sepsis has some specifics: • Newborn is less capable of an inflammatory response because of immature humoral and cellular immunity. • With neonatal intensive care unit (NICU) development, extremely and very low-birth- weight newborns survive and stay in a hospital environment for a long time. • Coexisting conditions can make difficult the diagnosis and treatment of neonatal sepsis. • Transplacental, mother-to-fetus transmission of infectious agents where mother’s infection is often undiagnosed. 2 Neonatal sepsis may be categorized as early (0–6 days) and late (7 days and more). Early-onset sepsis syndrome is associated with acquisition of microorganisms from the mother. Late sepsis syndrome is acquired from the caregiv- ing environment. The overall incidence of neonatal sepsis is approximately 2 per 1000 live births, but in NICU, the incidence is as high as 14%. The early signs of sepsis in the newborn are nonspecific. Therefore, many newborns undergo diagnostic studies and the initiation of treatment before the presence of sepsis has been proven. 3 The mortality rate in neonatal sepsis may be as high as 50%. Infection is a major cause of mortality during the first month of life, contributing to 13–15% of all neonatal deaths. 4–6 The aim of this study was to analyze the inci- dence and distribution of neonatal sepsis in pre- mature newborns with congenital heart disease (CHD) according to gestational and postnatal age, 435 © 2010 Copyright the Authors Congenital Heart Disease © 2010 Wiley Periodicals, Inc. Congenit Heart Dis. 2010;5:435–438