Early-Onset Sepsis Among Very Preterm Infants

Pediatrics. 2021 Oct;148(4):e2021052456. doi: 10.1542/peds.2021-052456. Epub 2021 Sep 7.

Abstract

Objectives: To determine the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants using a nationally representative cohort from academic and community hospitals to inform empirical antibiotic guidance, highlight risk factors for infection, and aid in prognostication for infected infants.

Methods: Prospective observational study of very preterm infants born weighing 401 to 1500 g or at 22 to 29 weeks' gestational age from January 2018 to December 2019 in 753 Vermont Oxford Network centers. EOS was defined as a culture-confirmed bacterial infection of the blood or cerebrospinal fluid in the 3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without EOS.

Results: Of 84 333 included infants, 1139 had EOS for an incidence rate of 13.5 per 1000 very preterm births (99% confidence interval [CI] 12.5-14.6). Escherichia coli (538 of 1158; 46.5%) and group B Streptococcus (218 of 1158; 18.8%) were the most common pathogens. Infected infants had longer lengths of stay (median 92 vs 66 days) and lower rates of survival (67.5% vs 90.4%; adjusted risk ratio 0.82 [95% CI 0.79-0.85]) and of survival without morbidity (26.1% vs 59.4%; adjusted risk ratio 0.66 [95% CI 0.60-0.72]).

Conclusions: In a nationally representative sample of very preterm infants with EOS from 2018 to 2019, approximately one-third of isolates were neither group B Streptococcus nor E coli. Three-quarters of all infected infants either died or survived with a major medical morbidity. The profoundly negative impact of EOS on very preterm infants highlights the need for novel preventive strategies.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / complications
  • Bacterial Infections / drug therapy
  • Datasets as Topic
  • Escherichia coli / isolation & purification
  • Female
  • Humans
  • Incidence
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases* / drug therapy
  • Infant, Premature, Diseases* / epidemiology
  • Infant, Premature, Diseases* / microbiology
  • Infant, Premature, Diseases* / mortality
  • Length of Stay
  • Male
  • Neonatal Sepsis* / complications
  • Neonatal Sepsis* / drug therapy
  • Neonatal Sepsis* / microbiology
  • Neonatal Sepsis* / mortality
  • Prospective Studies
  • Streptococcus agalactiae / isolation & purification
  • Survival Analysis
  • United States / epidemiology

Substances

  • Anti-Bacterial Agents