Patterns of Infections among Extremely Preterm Infants

Area of Science:

• Neonatology
• Infectious Diseases
• Perinatal Medicine

Background:

• Infections are a primary cause of mortality in extremely preterm infants.
• Sepsis poses a significant threat to neonates born between 24-0/7 and 27-6/7 weeks of gestation.

Purpose of the Study:

• To evaluate the incidence, pathogenesis, and in-hospital outcomes of sepsis in extremely preterm infants.
• To analyze the association between infection, antibiotic treatment, and in-hospital morbidities and mortality.

Main Methods:

• Post hoc analysis of prospective data from the Preterm Epo Neuroprotection (PENUT) Trial (NCT #01378273).
• Inclusion of 936 extremely preterm infants (24-0/7 to 27-6/7 weeks gestation).
• Analysis of culture-positive infection data, antibiotic course details, morbidities, and mortality.

Main Results:

• 24% of infants had at least one positive blood culture; 6% had early-onset sepsis (EOS) and 20% had late-onset sepsis (LOS).
• Coagulase-negative Staphylococci (CoNS) and Escherichia coli were the most frequent pathogens for EOS.
• LOS was associated with increased risk of necrotizing enterocolitis and death; confirmed EOS showed no significant association with outcomes.

Conclusions:

• Antibiotic use for presumed sepsis is more frequent than confirmed infection rates in extremely preterm infants.
• Late-onset sepsis significantly increases the risk of adverse in-hospital outcomes and mortality.
• Further research into antibiotic stewardship and management of culture-negative sepsis is warranted.