Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants

Avroy A. Fanaroff, Sheldon B. Korones, Linda L. Wright, Joel Verter, Ronald L. Poland, Charles R. Bauer, Jon E. Tyson, Joseph B. Philips, William Edwards, Jerold F. Lucey, Charlotte S. Catz, Seetha Shankaran, William Oh

Research output: Contribution to journalArticlepeer-review

336 Scopus citations


Background. Septicemia is a major antecedent of morbidity and mortality in very low birth weight (501- to 1500-g) infants. Our purpose was to determine prospectively the incidence, clinical presentation, laboratory features, risk factors, morbidity and mortality associated with late onset septicemia in infants 501 to 1500 g. Methods. Clinical data were prospectively collected for 2416 infants enrolled in a multicenter trial to determine the efficacy of intravenous immunoglobulin in preventing nosocomial infections. Septicemia was confirmed by positive blood culture in 395 symptomatic infants. Multivariate analyses of factors associated with septicemia were performed. Results. Sixteen percent of VLBW infants developed septicemia at a median age of 17 days. Factors associated with septicemia by logistic regression included male gender, lower gestational age and birth weight and decreased baseline serum IgG concentrations. Increasing apnea (55%), feeding intolerance, abdominal distension or guaiac-positive stools (43%), increased respiratory support (29%), lethargy and hypotonia (23%) were the dominant presenting features of septicemia. An abnormal white blood cell count (46%), unexplained metabolic acidosis (11%) and hyperglycemia (10%) were the most common laboratory indicators. Septicemic infants, compared with nonsepticemic infants, had significantly increased mortality (21% vs. 9%), longer hospital stay (98 vs. 58 days) and more serious morbidity, including severe intraventricular hemorrhage, bronchopulmonary dysplasia and increased ventilator days (P < 0.001). Conclusions. Late onset septicemia is common in very low birth weight infants, and the rate is inversely proportional to gestational age and birth weight. Septicemia is more common in males and those with low initial serum IgG values. A set of clinical signs (apnea, bradycardia, etc.) and laboratory values (leukocytosis, immature white blood cells and neutropenia) increase the probability of late onset sepsis, but they have poor positive predictive value.

Original languageEnglish (US)
Pages (from-to)593-598
Number of pages6
JournalPediatric Infectious Disease Journal
Issue number7
StatePublished - Jul 1998


  • Gamma-globulin
  • Immunoglobulin
  • National Institute of Child Health and Human Development Neonatal Research Network
  • Nosocomial infection
  • Prematurity
  • Sepsis
  • Very low birth weight infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)


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