Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network - PubMed (original) (raw)

Multicenter Study

. 2002 Aug;110(2 Pt 1):285-91.

doi: 10.1542/peds.110.2.285.

Nellie Hansen, Avroy A Fanaroff, Linda L Wright, Waldemar A Carlo, Richard A Ehrenkranz, James A Lemons, Edward F Donovan, Ann R Stark, Jon E Tyson, William Oh, Charles R Bauer, Sheldon B Korones, Seetha Shankaran, Abbot R Laptook, David K Stevenson, Lu-Ann Papile, W Kenneth Poole

Affiliations

Multicenter Study

Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network

Barbara J Stoll et al. Pediatrics. 2002 Aug.

Abstract

Objective: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 6956 VLBW (401-1500 g) neonates admitted to the clinical centers of the National Institute of Child Health and Human Development Neonatal Research Network over a 2-year period (1998-2000).

Methods: The National Institute of Child Health and Human Development Neonatal Research Network maintains a prospective registry of all VLBW neonates admitted to participating centers within 14 days of birth. Expanded infection surveillance was added in 1998.

Results: Of 6215 infants who survived beyond 3 days, 1313 (21%) had 1 or more episodes of blood culture-proven late-onset sepsis. The vast majority of infections (70%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 48% of infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of late-onset sepsis included patent ductus arteriosus, prolonged ventilation, prolonged intravascular access, bronchopulmonary dysplasia, and necrotizing enterocolitis. Infants who developed late-onset sepsis had a significantly prolonged hospital stay (mean length of stay: 79 vs 60 days). They were significantly more likely to die than those who were uninfected (18% vs 7%), especially if they were infected with Gram-negative organisms (36%) or fungi (32%).

Conclusions: Late-onset sepsis remains an important risk factor for death among VLBW preterm infants and for prolonged hospital stay among VLBW survivors. Strategies to reduce late-onset sepsis and its medical, social, and economic toll need to be addressed urgently.

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