Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Network

Barbara J. Stoll, Nellie Hansen, Avroy A. Fanaroff, Linda L. Wright, Waldemar A. Carlo, Richard A. Ehrenkranz, James A. Lemons, Edward F. Donovan, Ann R. Stark, Jon E. Tyson, William Oh, Charles R. Bauer, Sheldon B. Korones, Seetha Shankaran, Abbot R. Laptook, David K. Stevenson, Lu Ann Papile, W. Kenneth Poole

Research output: Contribution to journalArticle

1480 Scopus citations

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 6956 VLBW (401-1500 g) neonates admitted to the clinical centers of the National Institute of Child Health and Human Development Neonatal Research Network over a 2-year period (1998-2000). Methods. The National Institute of Child Health and Human Development Neonatal Research Network maintains a prospective registry of all VLBW neonates admitted to participating centers within 14 days of birth. Expanded infection surveillance was added in 1998. Results. Of 6215 infants who survived beyond 3 days, 1313 (21%) had I or more episodes of blood culture-proven late-onset sepsis. The vast majority of infections (70%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 48% of infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of late-onset sepsis included patent ductus arteriosus, prolonged ventilation, prolonged intravascular access, bronchopulmonary dysplasia, and necrotizing enterocolitis. Infants who developed late-onset sepsis had a significantly prolonged hospital stay (mean length of stay: 79 vs 60 days). They were significantly more likely to die than those who were uninfected (18% vs 7%), especially if they were infected with Gram-negative organisms (36%) or fungi (32%). Conclusions. Late-onset sepsis remains an important risk factor for death among VLBW preterm infants and for prolonged hospital stay among VLBW survivors. Strategies to reduce late-onset sepsis and its medical, social, and economic toll need to be addressed urgently.

Original languageEnglish (US)
Pages (from-to)285-291
Number of pages7
JournalPediatrics
Volume110
Issue number2 I
DOIs
StatePublished - 2002

Keywords

  • Infant
  • Newborn infant
  • Premature
  • Sepsis
  • Very low birth weight infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Stoll, B. J., Hansen, N., Fanaroff, A. A., Wright, L. L., Carlo, W. A., Ehrenkranz, R. A., Lemons, J. A., Donovan, E. F., Stark, A. R., Tyson, J. E., Oh, W., Bauer, C. R., Korones, S. B., Shankaran, S., Laptook, A. R., Stevenson, D. K., Papile, L. A., & Kenneth Poole, W. (2002). Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Network. Pediatrics, 110(2 I), 285-291. https://doi.org/10.1542/peds.110.2.285