Clinical, laboratory, and microbiological differences between early- and late-onset neonatal sepsis in preterm...

Although neonatal sepsis remains a significant cause of morbidity and mortality in preterm infants, few studies in Vietnam have compared the characteristics of early-onset sepsis (EOS) and late-onset sepsis (LOS).

To compare the clinical, laboratory, and microbiological characteristics of EOS and LOS in preterm neonates at a tertiary obstetric hospital in Vietnam.

This cross-sectional study included 106 preterm infants with culture-confirmed sepsis admitted from August 2022 to May 2024. Clinical data, laboratory results and blood cultures were analyzed. Statistical tests and univariate logistic regression were used to explore differences between EOS and LOS.

Of 106 neonates, 24 (22.6%) had EOS, and 82 (77.4%) had LOS. LOS predominated in extremely preterm, very low birth weight infants and was associated with more severe symptoms, including respiratory distress and abnormal heart rate. EOS cases were more likely to have birth weight ≥ 1500 g and maternal conditions such as intrapartum fever, genital infections, contaminated amniotic fluid and prolonged amniotic fluid leakage (> 18 h). Laboratory analysis revealed higher levels of leukopenia, platelet and cerebrospinal fluid protein in EOS, as well as elevated C-reactive protein and blood protein in LOS. Gram-negative bacteria were predominant in both groups. Escherichia coli was most common in EOS (46%), whereas Klebsiella pneumoniae predominated in LOS (38%).

EOS and LOS in preterm neonates exhibit distinct patterns in perinatal factors, clinical manifestations, laboratory findings and microbiological profiles. Differentiating these two entities may aid in timely diagnosis and guide empirical treatment in settings with limited resources.