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Published on: November 20, 2015
Early and late onset sepsis in late preterm infants
Michael Cohen-Wolkowiez1, Cassandra Moran, Daniel K Benjamin
1Department of Pediatrics, Duke University, Durham, NC 27715, USA.
Insights
Late preterm infants experience significant rates of early and late onset sepsis. Sepsis in these infants, particularly Gram-negative infections, is associated with increased mortality risk.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Public Health
Background:
- Late preterm births (34-36 weeks gestation) are increasing globally and represent a significant proportion of all preterm births.
- While sepsis outcomes are known for extremely preterm infants, data for late preterm infants remain limited.
- Sepsis poses a significant mortality risk in preterm neonates.
Purpose of the Study:
- To investigate the incidence, causative organisms, and mortality associated with early and late onset sepsis in late preterm infants.
- To characterize sepsis outcomes specifically within the late preterm infant population.
Main Methods:
- Observational cohort study of 119,130 infants <=3 days old and 106,142 infants 4-120 days old.
- Included infants born between 34 and 36 weeks gestation, admitted to 248 US neonatal intensive care units (NICUs) from 1996-2007.
- Analyzed cumulative incidence, pathogen distribution, and mortality rates for early and late onset sepsis.
Main Results:
- Cumulative incidence of early onset sepsis was 4.42/1000 admissions; late onset sepsis was 6.30/1000 admissions.
- Gram-positive organisms were the most common cause of both early and late onset sepsis.
- Infants with Gram-negative early onset sepsis (OR: 4.39) and any late onset sepsis (OR: 3.37) had significantly higher mortality.
Conclusions:
- Late preterm infants exhibit distinct sepsis infection rates, pathogen profiles, and mortality risks.
- Findings are generalizable to late preterm infants managed in special care nurseries and NICUs.
- Highlights the need for targeted sepsis surveillance and management in late preterm infants.
Background:
Preterm birth is increasing worldwide, and late preterm births, which comprise more than 70% of all preterm births, account for much of the increase. Early and late onset sepsis results in significant mortality in extremely preterm infants, but little is known about sepsis outcomes in late preterm infants.
Methods:
This is an observational cohort study of infants <121 days of age (119,130 infants less than or equal to 3 days of life and 106,142 infants between 4 and 120 days of life) with estimated gestational age at birth between 34 and 36 weeks, admitted to 248 neonatal intensive care units in the United States between 1996 and 2007.
Results:
During the study period, the cumulative incidence of early and late onset sepsis was 4.42 and 6.30 episodes per 1000 admissions, respectively. Gram-positive organisms caused the majority of early and late onset sepsis episodes. Infants with early onset sepsis caused by Gram-negative rods and infants with late onset sepsis were more likely to die than their peers with sterile blood cultures (odds ratio [OR]: 4.39, 95% CI: 1.71-11.23, P = 0.002; and OR: 3.37, 95% CI: 2.35-4.84, P < 0.001, respectively).
Conclusion:
Late preterm infants demonstrate specific infection rates, pathogen distribution, and mortality associated with early and late onset sepsis. The results of this study are generalizable to late preterm infants admitted to the special care nursery or neonatal intensive care unit.
