What question did this study set out to answer?

To evaluate neonatal outcomes and caregiver psychosocial status in preterm infants with culture-confirmed infections.

March 29, 2026Diseases0 citationsOpen Access

Culture-Confirmed Bacterial Sepsis and Invasive Fungal Infection in Preterm Infants: NICU Resource Burden, Major Morbidity, and Caregiver Psychological Distress

SCSergiu CostescuVictor Babeș University of Medicine and Pharmacy Timișoara ARAdrian RațiuVictor Babeș University of Medicine and Pharmacy Timișoara BCBianca CerbuVictor Babeș University of Medicine and Pharmacy Timișoara

Key Points

To evaluate neonatal outcomes and caregiver psychosocial status in preterm infants with culture-confirmed infections.
Single-center prospective cohort study
Evaluated 87 preterm infants assigned to three groups: no infection, bacterial sepsis, candidemia
Assessed neonatal outcomes including mortality, morbidity, and resource use
Caregivers completed various validated psychosocial questionnaires near discharge
Candidemia occurred later than sepsis and required longer to achieve effective therapy
Composite adverse outcomes were significantly higher in infection groups compared to the no-infection group
Length of NICU stay and ventilation days increased across infection categories
Caregiver mental health scores decreased while depression scores increased, correlating with NICU burden

Abstract

Background and Objectives: Very preterm infants are vulnerable to late-onset infection and prolonged NICU exposure, with potential downstream effects on caregiver health. We evaluated neonatal outcomes and caregiver psychosocial status across culture-confirmed infection phenotypes. Methods: We investigated a single-center prospective cohort (March 2023–December 2025) of 87 preterm infants assigned to one of three groups: no proven infection (n = 44), bacterial sepsis (n = 31), or candidemia (n = 12). Neonatal outcomes included a composite adverse endpoint (death or major morbidity) and resource utilization. Caregivers completed the SF-36, WHOQOL-BREF, HADS, PHQ-9, GAD-7, and Body Image Scale near discharge. Results: Candidemia occurred later than bacterial sepsis (day of life 17.8 ± 4.8 vs. 10.1 ± 3.9; p < 0.001) and had a longer time to effective therapy (23.3 ± 9.5 vs. 13.3 ± 5.3 h; p = 0.004). The composite adverse outcome was 27.3% in the no-infection group versus 54.8% in the bacterial group and 58.3% in the candidemia group (p = 0.025); ROP requiring treatment increased from 4.5% to 29.0% and 25.0% (p = 0.012). Length of stay rose from 39.7 ± 10.2 to 50.1 ± 11.9 and 60.9 ± 13.1 days (p < 0.001), and ventilation days from 15.7 ± 7.6 to 23.3 ± 7.5 and 34.2 ± 10.4 (p < 0.001). Caregiver SF-36 mental health (MCS) scores decreased from 44.7 ± 7.5 to 38.5 ± 6.0 and 36.7 ± 6.4 (p < 0.001), while PHQ-9 scores increased from 9.4 ± 3.9 to 11.6 ± 3.3 and 15.5 ± 4.6 (p < 0.001); NICU burden correlated with PHQ-9 scores (r = 0.52, p < 0.001). Conclusions: Culture-confirmed infection, particularly candidemia, was associated with higher neonatal morbidity, markedly greater resource use, and substantial caregiver distress at discharge.

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