Late-Onset Sepsis in Very Low Birth Weight Infants.

Area of Science:

• Neonatalogy
• Infectious Diseases
• Epidemiology

Background:

• Late-onset sepsis (LOS) poses a significant threat to very low birth weight (VLBW) infants, contributing to substantial morbidity and mortality.
• Identifying risk factors and understanding temporal trends in LOS are crucial for improving outcomes in this vulnerable population.

Purpose of the Study:

• To identify key risk factors associated with the development of late-onset sepsis in VLBW infants.
• To analyze temporal trends in overall and pathogen-specific rates of LOS over a 25-year period.

Main Methods:

• A population-based study analyzed data from 31,612 VLBW infants born between 1995 and 2019.
• Bivariate and multivariable analyses were employed to determine risk factors for LOS, defined by clinical symptoms and microbiologic confirmation.
• The study period was divided into four epochs to compare temporal changes in LOS rates.

Main Results:

• Infants born before 27 weeks gestation and those requiring delivery room resuscitation had a significantly increased risk of LOS.
• A notable decrease in LOS rates was observed, from 29.5% (1995-2000) to 13.0% (2013-2019).
• Pathogen-specific rates declined, with significant reductions in gram-negative and fungal infections across all epochs, and gram-positive infections in the most recent epoch.

Conclusions:

• Gestational age less than 27 weeks is the most potent risk factor for LOS in VLBW infants.
• Over 25 years, pathogen-specific LOS rates decreased approximately twofold for bacterial infections and sixfold for fungal infections.
• These findings highlight improvements in neonatal care and infection control strategies for VLBW infants.