Risk Factors for Late-Onset Sepsis in Preterm Infants: A Multicenter Case-Control Study
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Published on: January 12, 2018
Sofia El Manouni El Hassani1,2, Daniel J C Berkhout3,4, Hendrik J Niemarkt5
1Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands, s.elmanounielhassani@vumc.nl.
Insights
Identifying risk factors for late-onset sepsis (LOS) in preterm infants is crucial. Prolonged parenteral feeding increases LOS risk, while breast milk may offer protection against specific infections like coagulase-negative staphylococcus.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Clinical Epidemiology
Background:
- Late-onset sepsis (LOS) is a significant threat to preterm infants, impacting mortality and morbidity.
- Early detection and antibiotic treatment are vital for improving outcomes in neonatal intensive care units (NICUs).
- Identifying specific risk factors can aid in targeted prevention strategies for LOS.
Purpose of the Study:
- To identify clinical and demographic risk factors associated with late-onset sepsis (LOS) in preterm infants.
- To investigate the relationship between feeding methods and the development of LOS.
- To differentiate risk factors for gram-positive versus gram-negative LOS.
Main Methods:
- A multicenter case-control study involving preterm infants born at ≤30 weeks gestation across 9 NICUs.
- Daily collection of demographical and clinical data up to 28 days postnatally.
- Univariate and multivariate regression analyses were used to identify risk factors in a 1:1 matched case-control cohort.
Main Results:
- Every additional day of parenteral feeding was associated with an increased risk of LOS (aOR=1.29).
- Antibiotic administration showed a decreased risk for LOS (OR=0.08).
- Formula feeding was an independent risk factor for coagulase-negative staphylococcus LOS (CoNS-LOS) (OR=3.779), while cephalosporin use was inversely related to CoNS-LOS.
Conclusions:
- Prolonged parenteral nutrition increases the risk of LOS in preterm infants.
- Breast milk administration demonstrated a protective effect against CoNS-LOS.
- Advancing enteral feeding, particularly with breast milk, may reduce parenteral feeding duration and consequently lower the risk of LOS.
Background:
Late-onset sepsis (LOS) in preterm infants is a leading cause of mortality and morbidity. Timely recognition and initiation of antibiotics are important factors for improved outcomes. Identification of risk factors could allow selection of infants at an increased risk for LOS.
Objectives:
The aim was to identify risk factors for LOS.
Methods:
In this multicenter case-control study, preterm infants born at ≤30 weeks of gestation were included at 9 neonatal intensive care units. Detailed demographical and clinical data were collected daily up to day 28 postnatally. Clinical and demographic risk factors were identified using univariate and multivariate regression analyses in a 1: 1 matched case-control cohort.
Results:
In total, 755 infants were included, including 194 LOS cases (41 gram-negative cases, 152 gram-positive cases, and 1 fungus). In the case-control cohort, every additional day of parenteral feeding increased the risk for LOS (adjusted OR = 1.29; 95% CI 1.07-1.55; p = 0.006), whereas antibiotics administration decreased this risk (OR = 0.08; 95% CI 0.01-0.88; p = 0.039). These findings could largely be attributed to specific LOS-causative pathogens, since these predictive factors could be identified for gram-positive, but not for gram-negative, LOS cases. Specifically cephalosporins administration prior to clinical onset was inversely related to coagulase-negative staphylococcus LOS (CoNS-LOS) development. Formula feeding was an independent risk factor for development of CoNS-LOS (OR = 3.779; 95% CI 1.257-11.363; p = 0.018).
Conclusion:
The length of parenteral feeding was associated with LOS, whereas breastmilk administration was protective against CoNS-LOS. A rapid advancement of enteral feeding, preferably with breastmilk, may proportionally reduce the number of parenteral feeding days and consequently the risk for LOS.
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