242 - Mortality Reduction in Neonatal Sepsis in Tele-ICU-Supported NICUs: A Multicenter Cohort Analysis of Neonates in India

Publication Number: 1229.242

Deepika Kurup, Boston Children's Hospital, Boston, MA, United States; Geetanjali Srivastava, acuity neocare private limited, Lucknow, Uttar Pradesh, India; Dileep Unnikrishnan, Cloudphysician Healthcare, Cleveland, OH, United States; Sitarah Mathias, Boston Children's Hospital, Boston, MA, United States; Christopher Duggan, Boston Children's Hospital, Boston, MA, United States; Carl D. Britto, Boston Children's Hospital, Boston, MA, United States

Background: Neonatal sepsis causes an estimated 190,000 deaths annually in India. Early recognition and prompt management is critical for survival. Telemedicine-enabled neonatal intensive care units (tele-NICU) may enhance timely escalation through continuous monitoring and specialist review.

Objective: To evaluate the effect of tele-NICU implementation on outcomes in neonatal sepsis including dynamics of vasopressor use.

Design/Methods: Multicenter cohort analysis of 11,060 neonates admitted to 24 level I–III NICUs (rural + semi-urban only) across 12 Indian states between January 2021–June 2025. Primary outcome: time to vasopressor initiation among neonates with sepsis. Secondary outcomes: mortality, ventilator-free days (VFD), invasive mechanical ventilation (IMV) duration, temporal trends in pressor use, and ICU-to-pressor-hour ratios.

Results: Of 11,060 neonates, 702 (6.4%) had laboratory confirmed (early + late onset) sepsis and received antibiotics within 1 hour of clinical suspicion. Among these, 65.2% required only fluid resuscitation; 34.8% received vasopressors: dobutamine (19.4%), norepinephrine (7.4%), or combination therapy (1.6% norepinephrine + vasopressin). Median time to initiation of vasoactives was 2.5 hours (IQR 0–19.25) and 35% received them within 1 hour of admission. Time to first vasopressor showed no significant yearly variation (2021–2025; Dunn's test, all Holm-adjusted p > 0.05), indicating consistent practice patterns. Mortality among neonates with septic shock was 11% (78/702). Each study year was associated with 44% reduction in death odds (OR 0.56, 95% CI 0.45–0.70). Median VFD was 24 days (IQR 18–34); median IMV duration 41 hours (IQR 25–76). Median monthly ICU-hours, pressor-hours, and number of admissions were 1,400 (IQR 352–5,444), 264 (IQR 93.5–856), and 11.5 (IQR 3–31), respectively. Across the study period (2021–2025), the ratio of total ICU hours to total vasopressor hours demonstrated variable trends by year. While no significant changes were observed in 2021–2023, a significant decline in the ratio occurred from 2024 (β = –0.027, p = 0.003), indicating a relative increase in vasopressor use compared with total NICU hours reflecting enhanced ability to care for sicker neonates, improved operational capacity and efficient escalation under the maturing tele-NICU model.

Conclusion(s): Tele-NICUs demonstrated consistent, timely hemodynamic escalation with significant mortality reduction over time (44% annual odds reduction). These findings highlight tele-NICU potential for improving neonatal sepsis outcomes in resource-limited settings.