Background:In 2014, sepsis was the sixth leading cause of infant death in Mississippi. Prematurity, immunological deficit, invasive medical interventions and prolonged hospital stays are associated with increased risk of infections and sepsis in the neonatal period. While sepsis is a significant cause of infant morbidity and mortality, this condition has not been studied in Mississippi.
Methods: We analyzed Mississippi hospital discharge data for all neonatal discharges (0-28 days) from 2010-2011 with SAS 9.3 to determine the prevalence, demographics, resource utilization, comorbidities and pathogens of sepsis associated discharges. Infants with all listed ICD-9-CM codes for septicemia and bacteremia were compared to infants without such diagnoses using chi-square tests and t-tests.
Results: There were 1,357 neonatal discharges with a sepsis diagnosis, yielding a rate of 25.8 sepsis associated discharges per 1,000 neonatal discharges. Among the sepsis associated discharges 28.4 % (385) occurred in infants 72 hours old or less. Only 180 (13.3%) sepsis-related discharges had at least one pathogen-specific ICD-9-CM code: gram-negative bacteria were recorded in 80 discharges, Streptococcus spp in 73 discharges, and Staphylococcus sppin 33 discharges. Compared to all other neonatal discharges, infants with sepsis related-hospitalizations were more likely to be African-Americans (46.0% vs. 39.0%, p <.001), males (56.2% vs. 51.2%, p <.001) and Medicaid beneficiaries (73.0% vs. 55.4%, p <.001). The mean length of stay (7.8 days vs. 2.9 days, p <.001) and mean hospital charges ($29,756.9 vs. $ 5,210.7 p <.001) were higher for neonatal discharges associated with sepsis. Sepsis-related discharges had higher frequencies of coexisting newborn respiratory distress syndrome and apnea (38.5% vs. 3.8%, p <.001), neonatal bradycardia and tachycardia (5.7% vs. 0.6%, p <.001), birth weights less 1,500 g (14.4% vs. 0.8%, p <.001), preterm deliveries (50.8% vs. 12.1%, p <.001), congenital anomalies (16.7% vs. 5.6%, p <.001) and in-hospital mortality (6.6% vs. 0.3%, p <.001).
Conclusion:Our findings revealed that neonatal infections in Mississippi were associated with high prevalence of comorbid conditions, high medical expenditure, lower socioeconomic status, and high in-hospital mortality. Early diagnosis, treatment, and prevention of sepsis are crucial steps for reducing infant morbidity and mortality.