Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network.
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 1 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.
Stoll
Barbara J
BJ
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Hansen
Nellie
N
Fanaroff
Avroy A
AA
Wright
Linda L
LL
Carlo
Waldemar A
WA
Ehrenkranz
Richard A
RA
Lemons
James A
JA
Donovan
Edward F
EF
Stark
Ann R
AR
Tyson
Jon E
JE
Oh
William
W
Bauer
Charles R
CR
Korones
Sheldon B
SB
Shankaran
Seetha
S
Laptook
Abbot R
AR
Stevenson
David K
DK
Papile
Lu-Ann
LA
Poole
W Kenneth
WK
D000890:Anti-Infective Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D019102:Infant, Very Low Birth Weight; D008297:Male; D012042:Registries; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016019:Survival Analysis
D000890:Anti-Infective Agents