title: Very low birth weight neonates who survive early-onset sepsis do not have an increased risk of developing late-onset sepsis.
abstract: BACKGROUND
  Very low birth weight neonates (≤ 1500 g, VLBWs) have a high rate of infection and distinct baseline immune function compared with more mature populations. In critically ill children and adults, sepsis increases subsequent infection risk. It is unknown whether sepsis modifies the risk of subsequent infection in VLBWs.
  
  
  METHODS
  We conducted a retrospective cohort study of VLBWs≤32weeks of gestation at birth cared for in 312 neonatal intensive care units in the United States from 1997 to 2011 (n=103,376). Early-onset sepsis (EOS, culture-positive only) and late-onset sepsis (LOS, culture-positive or clinical) cases were identified. Cox proportional hazard models were used to control for clinical variables between neonates with and without EOS to determine if EOS modified risk of LOS, necrotizing enterocolitis (NEC), or death.
  
  
  RESULTS
  LOS occurred in 12,112/102,317 (11.8%) neonates without EOS and in 133/1059 (12.6%) of those with EOS. After adjustment for clinical variables, the risk of LOS was not different between neonates with or without a history of EOS (hazard ratio [HR]=0.92; 95% confidence interval [CI] 0.74, 1.16). EOS increased the risk of 120-day mortality (HR=1.78; 95% CI 1.49, 2.13).
  
  
  CONCLUSIONS
  In contrast to findings in children and adults, EOS was not associated with an increased risk of LOS in this cohort. Age-specific investigations are needed to determine if post-sepsis immunologic alterations are present.
authors: Duke University-National University of Singapore, Singapore.
authors: Cheryl B
authors: CB
authors: Lin
authors: Christoph P
authors: CP
authors: Hornik
authors: Reese
authors: R
authors: Clark
authors: C Michael
authors: CM
authors: Cotten
authors: Daniel K
authors: DK
authors: Benjamin
authors: Michael
authors: M
authors: Cohen-Wolkoweiz
authors: P Brian
authors: PB
authors: Smith
authors: James L
authors: JL
authors: Wynn
mesh_terms: D017668:Age of Onset; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D019102:Infant, Very Low Birth Weight; D008297:Male; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*