Late-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

Abstract

Objective: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993). Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Of 6911 infants who survived beyond 3 days, 1696 (25%) had one or more episodes of blood culture-proven sepsis. The vast majority of infections (73%) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55% of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p <0.01). Late- onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p <0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p <0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17% vs 7%; p <0.0001), especially if they were infected with gram-negative organisms (40%) or fungi (28%). Deaths attributed to infection increased with increasing chronologic age. Whereas only 4% of deaths in the first 3 days of life were attributed to infection, 45% of deaths after 2 weeks were related to infection. Conclusions: Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.

Original languageEnglish
Pages (from-to)63-71
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
Bronchopulmonary Dysplasia
Infection
Necrotizing Enterocolitis
Registries
Length of Stay
Hemorrhage
Patent Ductus Arteriosus
Coagulase
Staphylococcus
Artificial Respiration
Intubation
Birth Weight
Premature Infants
Gestational Age
Ventilation

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). Late-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), 63-71.

Late-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. 63-71.

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, 'Late-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. 63-71.
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. / Late-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. 63-71.
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abstract = "Objective: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993). Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Of 6911 infants who survived beyond 3 days, 1696 (25{\%}) had one or more episodes of blood culture-proven sepsis. The vast majority of infections (73{\%}) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55{\%} of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p <0.01). Late- onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p <0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p <0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17{\%} vs 7{\%}; p <0.0001), especially if they were infected with gram-negative organisms (40{\%}) or fungi (28{\%}). Deaths attributed to infection increased with increasing chronologic age. Whereas only 4{\%} of deaths in the first 3 days of life were attributed to infection, 45{\%} of deaths after 2 weeks were related to infection. Conclusions: Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.",
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T1 - Late-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: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993). Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Of 6911 infants who survived beyond 3 days, 1696 (25%) had one or more episodes of blood culture-proven sepsis. The vast majority of infections (73%) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55% of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p <0.01). Late- onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p <0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p <0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17% vs 7%; p <0.0001), especially if they were infected with gram-negative organisms (40%) or fungi (28%). Deaths attributed to infection increased with increasing chronologic age. Whereas only 4% of deaths in the first 3 days of life were attributed to infection, 45% of deaths after 2 weeks were related to infection. Conclusions: Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.

AB - Objective: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993). Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Of 6911 infants who survived beyond 3 days, 1696 (25%) had one or more episodes of blood culture-proven sepsis. The vast majority of infections (73%) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55% of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p <0.01). Late- onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p <0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p <0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17% vs 7%; p <0.0001), especially if they were infected with gram-negative organisms (40%) or fungi (28%). Deaths attributed to infection increased with increasing chronologic age. Whereas only 4% of deaths in the first 3 days of life were attributed to infection, 45% of deaths after 2 weeks were related to infection. Conclusions: Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.

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