Comparative Effectiveness of Protocolized Sepsis Care in Neonatal and Pediatric Intensive Care Units

Monday, March 23, 2026

9:00 AM - 10:00 AM Central Time

Location: Connections Central - RST 14

NJ

Nikhila Juluri, N/A

California

Disclosure(s): No relevant financial relationship(s) to disclose.
NM

Nori Minich, n/a

Data Manager/Analyst
Rainbow Babies and Children's Hospital

Disclosure information not submitted.
JP

Jaime Perez, PhD

Clinical Research Biostatistician/Data Scientist III
UHC Center for Clinical Research

Disclosure information not submitted.
SS

Steven Shein, MD, FCCM

Co-Director, Pediatric Critical Care Clinical, Basic & Translational Research Program
Rainbow Babies and Childrens Hospital

Disclosure information not submitted.
JR

James Ross, MD, MS

Assistant Professor of Surgery
University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland OH

Disclosure information not submitted.
PB

Priya Borker, MD

Physician
UPMC Presbyterian

Disclosure information not submitted.
MM

Monty Mazer, MD

Assistant Professor of Pediatrics
University Hospitals of Cleveland/Case Western

Disclosure information not submitted.
Kenneth Remy, MD, MSc, MSCI, FCCM

Case Western Reserve University/University Hospitals Cleveland Medical Center, Ohio

Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Infants under six months of age with sepsis may be admitted to either Neonatal Intensive Care Units (NICUs) or Pediatric Intensive Care Units (PICUs), depending on institutional structure and patient factors. Despite differences in age-specific physiology and care paradigms, few studies have directly compared the impact of sepsis management strategies on clinical outcomes between these settings. This study evaluates the effectiveness of protocolized sepsis care delivered in NICUs vs. PICUs for infants ≤6 months of age.

Methods: With IRB approval, we conducted a retrospective cohort study at a quaternary children's hospital including infants >32 weeks gestational age and ≤6 months chronological age with culture-positive sepsis (June 2017-December 2023). Primary outcomes were ICU/hospital length of stay and mortality at multiple timepoints. Secondary outcomes included sepsis bundle compliance, nosocomial infections, and ICU disposition. Bundle adherence included hemogram/cultures within 24 hours, antibiotics within 180 minutes, fluid resuscitation within 6 hours, and vasopressors within 180 minutes if indicated.

Results: A total of 105 infants met inclusion criteria (NICU: n=63; PICU: n=42). NICU patients were younger (median postmenstrual age: 39.6 (IQR) vs. 45.9 (IQR) weeks; p< 0.001) and more likely female (55.6% vs. 33.3%; p=0.025). Both units had high sepsis bundle adherence (NICU: 55.6%, PICU: 66.7%; p=0.255) with no significant differences in individual components or overall compliance. Illness severity improved over time in both cohorts. At Day 7, of patients still hospitalized, more NICU patients had Phoenix scores < 2 (97.0% vs. 72.0%; p=0.016). NICU and PICU patients had no significant differences in length of stay, nosocomial infections, or mortality at any timepoint, including ICU (3.2% vs. 9.5%, p=0.215) and 1-year mortality (11.1% vs. 11.9%, p>0.999).

Conclusions: Protocolized sepsis care yielded comparable outcomes for infants ≤6 months in NICU and PICU settings, supporting standardized protocols across units. Institutions caring for infants across neonatal and pediatric ICUs can achieve consistent sepsis outcomes through unified protocol implementation. Further multi-center studies are needed to assess generalizability.