Affiliation:
1. aDivision of Neonatology
2. bClinical Futures, Children’s Hospital of Philadelphia; Philadelphia, Pennsylvania
3. cDepartment of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
4. dLarner College of Medicine
5. eCollege of Engineering and Mathematical Sciences at the University of Vermont, Burlington, Vermont
6. fVermont Oxford Network, Burlington, Vermont
Abstract
OBJECTIVES
To determine the epidemiology, microbiology, and associated outcomes of late-onset sepsis among very preterm infants using a large and nationally representative cohort of NICUs across the United States.
METHODS
Prospective observational study of very preterm infants born 401 to 1500 g and/or 22 to 29 weeks’ gestational age (GA) from January 1, 2018, to December 31, 2020, who survived >3 days in 774 participating Vermont Oxford Network centers. Late-onset sepsis was defined as isolation of a pathogenic bacteria from blood and/or cerebrospinal fluid, or fungi from blood, obtained >3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without late-onset sepsis.
RESULTS
Of 118 650 infants, 10 501 (8.9%) had late-onset sepsis for an incidence rate of 88.5 per 1000 (99% confidence interval [CI] [86.4–90.7]). Incidence was highest for infants born ≤23 weeks GA (322.0 per 1000, 99% CI [306.3–338.1]). The most common pathogens were coagulase negative staphylococci (29.3%) and Staphylococcus aureus (23.0%), but 34 different pathogens were identified. Infected infants had lower survival (adjusted risk ratio [aRR] 0.89, 95% CI [0.87–0.90]) and increased risks of home oxygen (aRR 1.32, 95% CI [1.26–1.38]), tracheostomy (aRR 2.88, 95% CI [2.47–3.37]), and gastrostomy (aRR 2.09, 95% CI [1.93–2.57]) among survivors.
CONCLUSIONS
A substantial proportion of very preterm infants continue to suffer late-onset sepsis, particularly those born at the lowest GAs. Infected infants had higher mortality, and survivors had increased risks of technology-dependent chronic morbidities. The persistent burden and diverse microbiology of late-onset sepsis among very preterm infants underscore the need for innovative and potentially organism-specific prevention strategies.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology and Child Health