title: Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network.
abstract: 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.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Nellie
authors.initials: N
authors.lastname: Hansen
authors.forename: Avroy A
authors.initials: AA
authors.lastname: Fanaroff
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.forename: James A
authors.initials: JA
authors.lastname: Lemons
authors.forename: Edward F
authors.initials: EF
authors.lastname: Donovan
authors.forename: Ann R
authors.initials: AR
authors.lastname: Stark
authors.forename: Jon E
authors.initials: JE
authors.lastname: Tyson
authors.forename: William
authors.initials: W
authors.lastname: Oh
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.forename: Sheldon B
authors.initials: SB
authors.lastname: Korones
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: David K
authors.initials: DK
authors.lastname: Stevenson
authors.forename: Lu-Ann
authors.initials: LA
authors.lastname: Papile
authors.forename: W Kenneth
authors.initials: WK
authors.lastname: Poole
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents