Early and late onset sepsis in late preterm infants.
BACKGROUND
Preterm birth is increasing worldwide, and late preterm births, which comprise more than 70% of all preterm births, account for much of the increase. Early and late onset sepsis results in significant mortality in extremely preterm infants, but little is known about sepsis outcomes in late preterm infants.


METHODS
This is an observational cohort study of infants <121 days of age (119,130 infants less than or equal to 3 days of life and 106,142 infants between 4 and 120 days of life) with estimated gestational age at birth between 34 and 36 weeks, admitted to 248 neonatal intensive care units in the United States between 1996 and 2007.


RESULTS
During the study period, the cumulative incidence of early and late onset sepsis was 4.42 and 6.30 episodes per 1000 admissions, respectively. Gram-positive organisms caused the majority of early and late onset sepsis episodes. Infants with early onset sepsis caused by Gram-negative rods and infants with late onset sepsis were more likely to die than their peers with sterile blood cultures (odds ratio [OR]: 4.39, 95% CI: 1.71-11.23, P = 0.002; and OR: 3.37, 95% CI: 2.35-4.84, P < 0.001, respectively).


CONCLUSIONS
Late preterm infants demonstrate specific infection rates, pathogen distribution, and mortality associated with early and late onset sepsis. The results of this study are generalizable to late preterm infants admitted to the special care nursery or neonatal intensive care unit.
Cohen-Wolkowiez
Michael
M
Department of Pediatrics, Duke University, Durham, NC 27715, USA.
Moran
Cassandra
C
Benjamin
Daniel K
DK
Cotten
C Michael
CM
Clark
Reese H
RH
Benjamin
Daniel K
DK
Smith
P Brian
PB
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001769:Blood / Q000382:microbiology; D002648:Child; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D011446:Prospective Studies; D012307:Risk Factors; D013292:Streptococcus agalactiae / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology; D055815:Young Adult