title: Early sepsis does not increase the risk of late sepsis in very low birth weight neonates.
abstract: OBJECTIVE
  To examine whether preterm very low birth weight (VLBW) infants have an increased risk of late-onset sepsis (LOS) following early-onset sepsis (EOS).
  
  
  METHODS
  Retrospective analysis of VLBW infants (401-1500 g) born September 1998 through December 2009 who survived >72 hours and were cared for within the National Institute of Child Health and Human Development Neonatal Research Network. Sepsis was defined by growth of bacteria or fungi in a blood culture obtained ≤ 72 hours of birth (EOS) or >72 hours (LOS) and antimicrobial therapy for ≥ 5 days or death <5 days while receiving therapy. Regression models were used to assess risk of death or LOS by 120 days and LOS by 120 days among survivors to discharge or 120 days, adjusting for gestational age and other covariates.
  
  
  RESULTS
  Of 34,396 infants studied, 504 (1.5%) had EOS. After adjustment, risk of death or LOS by 120 days did not differ overall for infants with EOS compared with those without EOS [risk ratio (RR): 0.99 (0.89-1.09)] but was reduced in infants born at <25 weeks gestation [RR: 0.87 (0.76-0.99), P = .048]. Among survivors, no difference in LOS risk was found overall for infants with versus without EOS [RR: 0.88 (0.75-1.02)], but LOS risk was reduced in infants with birth weight 401-750 g who had EOS [RR: 0.80 (0.64-0.99), P = .047].
  
  
  CONCLUSIONS
  Risk of LOS after EOS was not increased in VLBW infants. Surprisingly, risk of LOS following EOS appeared to be reduced in the smallest, most premature infants, underscoring the need for age-specific analyses of immune function.
authors.affiliation: Department of Pediatrics, Vanderbilt University, Nashville, TN, USA. james.wynn@vanderbilt.edu
authors.forename: James L
authors.initials: JL
authors.lastname: Wynn
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D019102:Infant, Very Low Birth Weight; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016019:Survival Analysis