Early-onset sepsis in very low birth weight neonates: A report from the national institute of child health and human development neonatal research network

B. J. Stoll, T. Gordon, S. B. Korones, S. Shankaran, J. E. Tyson, Charles R Bauer, A. A. Fanaroff, J. A. Lemons, E. F. Donovan, W. Oh, D. K. Stevenson, R. A. Ehrenkranz, L. A. Papile, J. Verter, L. L. Wright

Research output: Contribution to journalArticle

692 Citations (Scopus)

Abstract

Objective: Early-onset sepsis (occurring within 72 hours of birth) is included in the differential diagnosis of most very low birth weight (VLBW) neonates. To determine the current incidence of early-onset sepsis, risk factors for disease, and the impact of early-onset sepsis on subsequent hospital course, we studied a cohort of 7861 VLBW neonates (401 to 1500 gm) admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991- 1993). Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry on all VLBW neonates born or cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Blood culture-proven early-onset sepsis was uncommon, occurring in only 1.9% of VLBW neonates. Group B streptococcus was the most frequent pathogen associated with early-onset sepsis (31%), followed by Escherichia coli (16%) and Haemophilus influenzae (12%). Decreasing gestational age was associated with increased rates of infection. Antibiotic therapy for suspected sepsis is frequently initiated at birth in VLBW neonates. Almost half of the infants in this cohort were considered to have clinical sepsis and continued to receive antibiotics for 5 or more days, despite a negative blood culture result in 98% of cases. These findings underscore the difficulty of ruling out sepsis in the symptomatic immature neonate and the special concern for culture- negative clinical sepsis in the face of maternal antibiotic use. Neonates with early-onset sepsis were significantly more likely to have subsequent comorbidities, including severe intraventricular hemorrhage, patent ductus arteriosus, and prolonged assisted ventilation. Although 26% of VLBW neonates with early-onset sepsis died, only 4% of the 950 deaths that occurred in the first 72 hours of life were attributed to infection. For those infants discharged alive, early-onset sepsis was associated with a significantly prolonged hospital stay (86 vs 69 days; p <0.02). Conclusions: Early-onset sepsis remains an important but uncommon problem among VLBW preterm infants. Improved diagnostic strategies are needed to enable the clinician to distinguish between the infected and the uninfected VLBW neonate with symptoms and to target continued antibiotic therapy to those who are truly infected.

Original languageEnglish
Pages (from-to)72-80
Number of pages9
JournalJournal of Pediatrics
Volume129
Issue number1
StatePublished - Sep 3 1996
Externally publishedYes

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National Institute of Child Health and Human Development (U.S.)
Very Low Birth Weight Infant
Sepsis
Newborn Infant
Research
Anti-Bacterial Agents
Registries
Parturition
Streptococcus agalactiae
Patent Ductus Arteriosus
Haemophilus influenzae
Infection
Premature Infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Stoll, B. J., Gordon, T., Korones, S. B., Shankaran, S., Tyson, J. E., Bauer, C. R., ... Wright, L. L. (1996). Early-onset sepsis in very low birth weight neonates: A report from the national institute of child health and human development neonatal research network. Journal of Pediatrics, 129(1), 72-80.

Early-onset sepsis in very low birth weight neonates : A report from the national institute of child health and human development neonatal research network. / Stoll, B. J.; Gordon, T.; Korones, S. B.; Shankaran, S.; Tyson, J. E.; Bauer, Charles R; Fanaroff, A. A.; Lemons, J. A.; Donovan, E. F.; Oh, W.; Stevenson, D. K.; Ehrenkranz, R. A.; Papile, L. A.; Verter, J.; Wright, L. L.

In: Journal of Pediatrics, Vol. 129, No. 1, 03.09.1996, p. 72-80.

Research output: Contribution to journalArticle

Stoll, BJ, Gordon, T, Korones, SB, Shankaran, S, Tyson, JE, Bauer, CR, Fanaroff, AA, Lemons, JA, Donovan, EF, Oh, W, Stevenson, DK, Ehrenkranz, RA, Papile, LA, Verter, J & Wright, LL 1996, 'Early-onset sepsis in very low birth weight neonates: A report from the national institute of child health and human development neonatal research network', Journal of Pediatrics, vol. 129, no. 1, pp. 72-80.
Stoll, B. J. ; Gordon, T. ; Korones, S. B. ; Shankaran, S. ; Tyson, J. E. ; Bauer, Charles R ; Fanaroff, A. A. ; Lemons, J. A. ; Donovan, E. F. ; Oh, W. ; Stevenson, D. K. ; Ehrenkranz, R. A. ; Papile, L. A. ; Verter, J. ; Wright, L. L. / Early-onset sepsis in very low birth weight neonates : A report from the national institute of child health and human development neonatal research network. In: Journal of Pediatrics. 1996 ; Vol. 129, No. 1. pp. 72-80.
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abstract = "Objective: Early-onset sepsis (occurring within 72 hours of birth) is included in the differential diagnosis of most very low birth weight (VLBW) neonates. To determine the current incidence of early-onset sepsis, risk factors for disease, and the impact of early-onset sepsis on subsequent hospital course, we studied a cohort of 7861 VLBW neonates (401 to 1500 gm) admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991- 1993). Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry on all VLBW neonates born or cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Blood culture-proven early-onset sepsis was uncommon, occurring in only 1.9{\%} of VLBW neonates. Group B streptococcus was the most frequent pathogen associated with early-onset sepsis (31{\%}), followed by Escherichia coli (16{\%}) and Haemophilus influenzae (12{\%}). Decreasing gestational age was associated with increased rates of infection. Antibiotic therapy for suspected sepsis is frequently initiated at birth in VLBW neonates. Almost half of the infants in this cohort were considered to have clinical sepsis and continued to receive antibiotics for 5 or more days, despite a negative blood culture result in 98{\%} of cases. These findings underscore the difficulty of ruling out sepsis in the symptomatic immature neonate and the special concern for culture- negative clinical sepsis in the face of maternal antibiotic use. Neonates with early-onset sepsis were significantly more likely to have subsequent comorbidities, including severe intraventricular hemorrhage, patent ductus arteriosus, and prolonged assisted ventilation. Although 26{\%} of VLBW neonates with early-onset sepsis died, only 4{\%} of the 950 deaths that occurred in the first 72 hours of life were attributed to infection. For those infants discharged alive, early-onset sepsis was associated with a significantly prolonged hospital stay (86 vs 69 days; p <0.02). Conclusions: Early-onset sepsis remains an important but uncommon problem among VLBW preterm infants. Improved diagnostic strategies are needed to enable the clinician to distinguish between the infected and the uninfected VLBW neonate with symptoms and to target continued antibiotic therapy to those who are truly infected.",
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T1 - Early-onset sepsis in very low birth weight neonates

T2 - A report from the national institute of child health and human development neonatal research network

AU - Stoll, B. J.

AU - Gordon, T.

AU - Korones, S. B.

AU - Shankaran, S.

AU - Tyson, J. E.

AU - Bauer, Charles R

AU - Fanaroff, A. A.

AU - Lemons, J. A.

AU - Donovan, E. F.

AU - Oh, W.

AU - Stevenson, D. K.

AU - Ehrenkranz, R. A.

AU - Papile, L. A.

AU - Verter, J.

AU - Wright, L. L.

PY - 1996/9/3

Y1 - 1996/9/3

N2 - Objective: Early-onset sepsis (occurring within 72 hours of birth) is included in the differential diagnosis of most very low birth weight (VLBW) neonates. To determine the current incidence of early-onset sepsis, risk factors for disease, and the impact of early-onset sepsis on subsequent hospital course, we studied a cohort of 7861 VLBW neonates (401 to 1500 gm) admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991- 1993). Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry on all VLBW neonates born or cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Blood culture-proven early-onset sepsis was uncommon, occurring in only 1.9% of VLBW neonates. Group B streptococcus was the most frequent pathogen associated with early-onset sepsis (31%), followed by Escherichia coli (16%) and Haemophilus influenzae (12%). Decreasing gestational age was associated with increased rates of infection. Antibiotic therapy for suspected sepsis is frequently initiated at birth in VLBW neonates. Almost half of the infants in this cohort were considered to have clinical sepsis and continued to receive antibiotics for 5 or more days, despite a negative blood culture result in 98% of cases. These findings underscore the difficulty of ruling out sepsis in the symptomatic immature neonate and the special concern for culture- negative clinical sepsis in the face of maternal antibiotic use. Neonates with early-onset sepsis were significantly more likely to have subsequent comorbidities, including severe intraventricular hemorrhage, patent ductus arteriosus, and prolonged assisted ventilation. Although 26% of VLBW neonates with early-onset sepsis died, only 4% of the 950 deaths that occurred in the first 72 hours of life were attributed to infection. For those infants discharged alive, early-onset sepsis was associated with a significantly prolonged hospital stay (86 vs 69 days; p <0.02). Conclusions: Early-onset sepsis remains an important but uncommon problem among VLBW preterm infants. Improved diagnostic strategies are needed to enable the clinician to distinguish between the infected and the uninfected VLBW neonate with symptoms and to target continued antibiotic therapy to those who are truly infected.

AB - Objective: Early-onset sepsis (occurring within 72 hours of birth) is included in the differential diagnosis of most very low birth weight (VLBW) neonates. To determine the current incidence of early-onset sepsis, risk factors for disease, and the impact of early-onset sepsis on subsequent hospital course, we studied a cohort of 7861 VLBW neonates (401 to 1500 gm) admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991- 1993). Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry on all VLBW neonates born or cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Blood culture-proven early-onset sepsis was uncommon, occurring in only 1.9% of VLBW neonates. Group B streptococcus was the most frequent pathogen associated with early-onset sepsis (31%), followed by Escherichia coli (16%) and Haemophilus influenzae (12%). Decreasing gestational age was associated with increased rates of infection. Antibiotic therapy for suspected sepsis is frequently initiated at birth in VLBW neonates. Almost half of the infants in this cohort were considered to have clinical sepsis and continued to receive antibiotics for 5 or more days, despite a negative blood culture result in 98% of cases. These findings underscore the difficulty of ruling out sepsis in the symptomatic immature neonate and the special concern for culture- negative clinical sepsis in the face of maternal antibiotic use. Neonates with early-onset sepsis were significantly more likely to have subsequent comorbidities, including severe intraventricular hemorrhage, patent ductus arteriosus, and prolonged assisted ventilation. Although 26% of VLBW neonates with early-onset sepsis died, only 4% of the 950 deaths that occurred in the first 72 hours of life were attributed to infection. For those infants discharged alive, early-onset sepsis was associated with a significantly prolonged hospital stay (86 vs 69 days; p <0.02). Conclusions: Early-onset sepsis remains an important but uncommon problem among VLBW preterm infants. Improved diagnostic strategies are needed to enable the clinician to distinguish between the infected and the uninfected VLBW neonate with symptoms and to target continued antibiotic therapy to those who are truly infected.

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