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Multicenter Study
. 2017 Nov;140(5):e20170925.
doi: 10.1542/peds.2017-0925. Epub 2017 Oct 5.

Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis

Karen M Puopolo  1   2 , Sagori Mukhopadhyay  3   2 , Nellie I Hansen  4 , C Michael Cotten  5 , Barbara J Stoll  6 , Pablo J Sanchez  7 , Edward F Bell  8 , Abhik Das  9 , Angelita M Hensman  10 , Krisa P Van Meurs  11   12 , Myra H Wyckoff  13 ; NICHD Neonatal Research Network
Affiliations
Multicenter Study

Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis

Karen M Puopolo et al. Pediatrics. 2017 Nov.

Abstract

Background: Premature infants are at high risk of early-onset sepsis (EOS) relative to term infants, and most are administered empirical antibiotics after birth. We aimed to determine if factors evident at birth could be used to identify premature infants at lower risk of EOS.

Methods: Study infants were born at 22 to 28 weeks' gestation in Neonatal Research Network centers from 2006 to 2014. EOS was defined by isolation of pathogenic species from blood or cerebrospinal fluid culture at ≤72 hours age. Infants were hypothesized as "low risk" for EOS when delivered via cesarean delivery, with membrane rupture at delivery, and absence of clinical chorioamnionitis. Frequency of prolonged antibiotics (≥5 days) was compared between low-risk infants and all others. Risks of mortality, EOS, and other morbidities were assessed by using regression models adjusted for center, race, antenatal steroid use, multiple birth, sex, gestation, and birth weight.

Results: Of 15 433 infants, 5759 (37%) met low-risk criteria. EOS incidence among infants surviving >12 hours was 29 out of 5640 (0.5%) in the low-risk group versus 209 out of 8422 (2.5%) in the comparison group (adjusted relative risk = 0.24 [95% confidence interval, 0.16-0.36]). Low-risk infants also had significantly lower combined risk of EOS or death ≤12 hours. Prolonged antibiotics were administered to 34% of low-risk infants versus 47% of comparison infants without EOS.

Conclusions: Delivery characteristics of extremely preterm infants can be used to identify those with significantly lower incidence of EOS. Recognition of differential risk may help guide decisions to limit early antibiotic use among approximately one-third of these infants.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Center variation in proportion of infants treated with prolonged antibiotics. Shown are the proportion of infants treated with prolonged antibiotics (gray bars) and EOS incidence (black bars) by NRN center, expressed as percent of total infants at each center. Centers are sorted by increasing incidence of EOS. A, Low-risk infant cohort. The rate of EOS was 0% at centers 1, 2, 11, 14, 18, and 22 and 0.2% at centers 6 and 7. B, Comparison infant cohort. The rate of EOS was 0% at center 14. Two centers were excluded from the Figure: 1 center that left the NRN in 2006 and had no low-risk infants and another center that left the NRN in 2011 and had only 2 low-risk infants.
See this image and copyright information in PMC

References

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