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Observational Study
. 2022 Dec 1;150(6):e2022058813.
doi: 10.1542/peds.2022-058813.

Late-Onset Sepsis Among Very Preterm Infants

Dustin D Flannery  1   2   3 , Erika M Edwards  4   5   6 , Sarah A Coggins  1   3 , Jeffrey D Horbar  4   6 , Karen M Puopolo  1   2   3
Affiliations
Observational Study

Late-Onset Sepsis Among Very Preterm Infants

Dustin D Flannery et al. Pediatrics. .

Abstract

Objectives: To determine the epidemiology, microbiology, and associated outcomes of late-onset sepsis among very preterm infants using a large and nationally representative cohort of NICUs across the United States.

Methods: Prospective observational study of very preterm infants born 401 to 1500 g and/or 22 to 29 weeks' gestational age (GA) from January 1, 2018, to December 31, 2020, who survived >3 days in 774 participating Vermont Oxford Network centers. Late-onset sepsis was defined as isolation of a pathogenic bacteria from blood and/or cerebrospinal fluid, or fungi from blood, obtained >3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without late-onset sepsis.

Results: Of 118 650 infants, 10 501 (8.9%) had late-onset sepsis for an incidence rate of 88.5 per 1000 (99% confidence interval [CI] [86.4-90.7]). Incidence was highest for infants born ≤23 weeks GA (322.0 per 1000, 99% CI [306.3-338.1]). The most common pathogens were coagulase negative staphylococci (29.3%) and Staphylococcus aureus (23.0%), but 34 different pathogens were identified. Infected infants had lower survival (adjusted risk ratio [aRR] 0.89, 95% CI [0.87-0.90]) and increased risks of home oxygen (aRR 1.32, 95% CI [1.26-1.38]), tracheostomy (aRR 2.88, 95% CI [2.47-3.37]), and gastrostomy (aRR 2.09, 95% CI [1.93-2.57]) among survivors.

Conclusions: A substantial proportion of very preterm infants continue to suffer late-onset sepsis, particularly those born at the lowest GAs. Infected infants had higher mortality, and survivors had increased risks of technology-dependent chronic morbidities. The persistent burden and diverse microbiology of late-onset sepsis among very preterm infants underscore the need for innovative and potentially organism-specific prevention strategies.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLAIMER: Dr Horbar is the president, chief executive and chief scientific officer of Vermont Oxford Network, and an unpaid member of the Vermont Oxford Network Board of Trustees. Dr Edwards receives salary support from Vermont Oxford Network. The other authors have indicated they have no conflicts of interest relevant to this article to disclose.

References

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