Late-Onset Sepsis Among Extremely Preterm Infants During the COVID-19 Pandemic

Abstract

Objectives: To compare incidence of late-onset sepsis (LOS) among extremely preterm infants before and during the COVID-19 pandemic.

Methods: Multicenter cohort study of infants with birthweight 401 to 1000 g or gestational age 22 to 28 weeks. LOS was defined as a bacterial or fungal pathogen isolated from blood or cerebrospinal fluid culture obtained after 72 hours of age. Primary outcome was LOS incidence calculated as incidence proportion (LOS cases among all admissions) and incidence rate (LOS events/1000 patient days). A multivariable Poisson regression model was used to compare the adjusted risk of LOS incidence proportion before (1/1/18-3/31/20) and during the pandemic (4/1/20-12/31/21). An interrupted time series analysis using a generalized linear mixed model with center as a random effect was used to compare LOS incidence rates during the 2 periods.

Results: Among 6509 eligible infants, LOS incidence proportion was not different before (18.2%) and during the pandemic (16.9%; P = .18). The adjusted relative risk (95% CI) for LOS was 0.93 (0.82-1.05) and for LOS or mortality was 0.98 (0.88-1.08) during the pandemic compared to the period before the pandemic. In the interrupted time series analysis, there was no significant change in LOS incidence rates at the start of the pandemic (0.219, 95% CI, -0.453 to 0.891) or microbiology of LOS, and change in trends of LOS incidence rates before and during the pandemic was not significant (-0.005, 95% CI, -0.025 to 0.015).

Conclusions: In a large multicenter study of extremely preterm infants, rates of LOS remained unchanged during the pandemic.