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Published on: November 20, 2015
Infection in late preterm infants
Simonetta Picone1, Roberto Aufieri1, Piermichele Paolillo1
1Division of Neonatology and Neonatal Intensive Care, Casilino General Hospital, Roma, Italy.
Insights
Late preterm infants face higher infection risks due to immature immune systems. Key risk factors include umbilical venous catheter use and antenatal corticosteroid exposure, necessitating clinical vigilance for prompt treatment.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Perinatal Health
Background:
- Late preterm (LP) infants exhibit heightened susceptibility to infections compared to term infants owing to their less mature immune systems.
- Limited existing literature addresses the specific risks and incidence of infection and sepsis in LP infants.
Purpose of the Study:
- To determine the rates of treated infections in moderate and late preterm infants (gestational age 32-36 weeks).
- To identify significant risk factors associated with infection development in this vulnerable population.
Main Methods:
- A retrospective analysis was conducted on 771 moderate and late preterm infants admitted between June 2008 and November 2013.
- Data collection included infection rates, causative pathogens, inflammatory markers (CRP, procalcitonin), and potential risk factors.
Main Results:
- An overall treated infection incidence of 16.6% was observed, with 90% occurring within the first 72 hours of life.
- Identified risk factors for infection included umbilical venous catheter insertion, antenatal corticosteroid prophylaxis, and cesarean section birth.
- Respiratory symptoms were prevalent in a significant majority (78.3%) of infants diagnosed with sepsis.
Conclusions:
- Moderate and late preterm infants demonstrate a substantially elevated risk of infection compared to their term counterparts.
- Clinical suspicion and treatment based on presenting symptoms and inflammatory markers are crucial, especially given frequent negative blood cultures.
- The findings underscore the importance of judicious antibiotic use to prevent overtreatment while managing infection risk in preterm neonates.
Background:
Late preterm (LP) are at higher risk than term infants to develop infections due to their more immature immune system. Little data about the risks and incidence of infection and sepsis in LP are present in literature.
Aims:
To evaluate treated infection rates and risk factors for infection in moderate and late preterm infants (gestational age = 32-36 weeks).
Study Design:
We retrospectively studied a population of 771 moderate and late preterm infants consecutively admitted to our unit from June 2008 to November 2013.
Results:
Treated infections were 128, with an incidence of 16.6%; the 90% (n = 115) occurred during the first 72 hours of life. Blood cultures were positive in 22% of cases, umbilical venous catheter cultures were positive in 26% of cases; Coagulase-negative staphylococci were the most frequently isolated pathogens. Patients of the sepsis group had a C-reactive protein (CRP) mean value of 28.27 mg/L and a procalcitonin mean value of 25.3 μg/L. Risk factors for infections were umbilical venous catheter (UVC) insertion (χ(2) = 15.9; p ≤ 0.05), prophylaxis with antenatal corticosteroids (χ(2) = 16.7; p ≤ 0.05) and birth by cesarean section, with observed values very similar to the expected values (χ(2) = 15.9; p = 0.1). Respiratory symptoms were found in 47 of the 60 patients in the sepsis group (78.3%).
Conclusions:
Late and moderate preterm infants have an increased significant risk of infection compared to term infants. Infections, given the high frequency of negative cultures in neonates, should be often suspected and treated on the basis of clinical features and inflammatory markers, trying always to avoid a possible overtreatment.
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