Late-Onset Sepsis Among Very Preterm Infants

Area of Science:

• Neonatalogy
• Infectious Diseases
• Epidemiology

Background:

• Late-onset sepsis (LOS) is a significant concern in very preterm infants.
• Understanding the epidemiology and outcomes of LOS is crucial for improving neonatal care.

Purpose of the Study:

• To determine the epidemiology, microbiology, and outcomes of late-onset sepsis in very preterm infants.
• To analyze a large, nationally representative cohort of neonatal intensive care units (NICUs) in the United States.

Main Methods:

• A prospective observational study involving 118,650 very preterm infants (401-1500g and/or 22-29 weeks gestational age) from 774 centers.
• Late-onset sepsis was defined as pathogen isolation >3 days after birth.
• Demographics, clinical characteristics, and outcomes were compared between infected and non-infected infants.

Main Results:

• The incidence of late-onset sepsis was 8.9% (88.5 per 1000), with the highest rate in infants born ≤23 weeks gestational age (322.0 per 1000).
• Coagulase-negative staphylococci and Staphylococcus aureus were the most common pathogens.
• Infected infants had lower survival (aRR 0.89) and survivors faced increased risks of home oxygen, tracheostomy, and gastrostomy.

Conclusions:

• A substantial proportion of very preterm infants experience late-onset sepsis, particularly those born at the earliest gestational ages.
• Infected infants have higher mortality, and survivors are at increased risk for technology-dependent chronic morbidities.
• The persistent burden and diverse microbiology of LOS necessitate innovative, organism-specific prevention strategies.