Early-Onset Sepsis Among Very Preterm Infants

Area of Science:

• Neonatalogy
• Infectious Diseases
• Epidemiology

Background:

• Early-onset sepsis (EOS) poses a significant threat to very preterm infants.
• Understanding the epidemiology and microbiology of EOS is crucial for effective management and prevention.

Purpose of the Study:

• To determine the epidemiology and microbiology of EOS in very preterm infants.
• To inform empirical antibiotic guidance and risk factor identification for EOS.
• To aid in prognostication for infants diagnosed with EOS.

Main Methods:

• A prospective observational study was conducted on very preterm infants (401-1500g or 22-29 weeks' gestation) from January 2018 to December 2019.
• Data were collected from 753 Vermont Oxford Network centers.
• EOS was defined as culture-confirmed bacterial infection within 3 days of birth; demographics, clinical characteristics, and outcomes were compared between infected and non-infected infants.

Main Results:

• The incidence of EOS was 13.5 per 1000 very preterm births (99% CI 12.5-14.6) among 84,333 infants.
• The most common pathogens were *Escherichia coli* (46.5%) and group B *Streptococcus* (18.8%).
• Infected infants experienced longer hospital stays and significantly lower survival rates (67.5% vs 90.4%) and survival without morbidity (26.1% vs 59.4%).

Conclusions:

• Approximately one-third of EOS cases involved pathogens other than group B *Streptococcus* or *E. coli*.
• Three-quarters of infected infants either died or had major medical morbidity.
• The severe impact of EOS underscores the urgent need for novel preventive strategies in very preterm infants.