title: Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multicenter study from the German Neonatal Network.
abstract: BACKGROUND
  It was the aim of this study to assess whether very-low-birth-weight (VLBW) infants born small for gestational age (SGA; birth weight less than 10th percentile) are at increased risk for late-onset sepsis.
  
  
  METHODS
  This was a prospective, multicenter study of the German Neonatal Network including VLBW infants from 23 to < 32 weeks post menstrual age born 2009-2011. Outcomes were compared between VLBW infants born SGA (birth weight less than tenth percentile according to gestational age and gender) and non-SGA infants. The main outcome measure was at least 1 episode of late-onset sepsis defined as blood-culture-confirmed clinical sepsis occurring at ≥ 72 hours of age.
  
  
  RESULTS
  5886 VLBW infants were included. In SGA infants (n = 692), an increased incidence of late-onset sepsis was noted compared with non-SGA infants (20.1% vs. 14.3 %, P < 0.001). This difference was only observed among infants with a gestational age of 27 to < 32 weeks and attributed to sepsis episodes with coagulase-negative staphylococci (12.8% vs. 8.3%, P < 0.001). Different treatment modalities (eg more frequent use of central venous lines) and longer duration of invasive therapies (parenteral nutrition, mechanical ventilation, hospitalization) may account for the increased sepsis risk with coagulase-negative staphylococci in our SGA cohort. In a multivariate logistic regression analysis, higher gestational age [per week; odds ratio (OR): 0.75, 95% confidence interval (CI): 0.72-0.78, P< 0.0001], treatment with antenatal steroids (OR: 0.7, 95% CI: 0.53-0.92, P = 0.01), German descendance (OR: 0.76, 95% CI: 0.63-0.91, P = 0.003) and prophylaxis with glycopeptide antibiotics (OR: 0.64, 95% CI: 0.47-0.87, P = 0.005) were shown to be protective against late-onset sepsis. In contrast, longer duration of parenteral nutrition (per day; OR: 1.016, 95% CI: 1.011-1.021, P < 0.0001) and SGA were found to be risk factors (OR: 1.31, 95% CI: 1.02-1.68, P= 0.03).
  
  
  CONCLUSIONS
  SGA contributes to the risk of late-onset sepsis in VLBW infants. Future studies are needed to investigate the underlying pathophysiology to guide individualized preventive measures in this vulnerable subgroup.
authors.affiliation: From the *Department of Pediatrics, University of Lübeck, Lübeck; †Department of Pediatrics, University of Magdeburg, Magdeburg; ‡Department of Pediatrics I, University Hospital Essen, University Duisburg, Essen; §Department of Pediatrics, University Homburg, Saar; ¶Department of Neonatology, Children's Hospital, Dortmund; ‖Department of Pediatrics, University of Düsseldorf, Düsseldorf; **Department of Pediatrics, University of Cologne, Cologne; ††Department of Neonatology, Asklepios Hospital Hamburg-Barmbek, Hamburg; ‡‡Department of Neonatology, Vestische Children´s Hospital, Datteln; §§Department of Neonatology, Vivantes Hospital Berlin-Neukölln, Berlin; ¶¶Department of Pediatrics, Carl Gustav Carus University Dresden, Dresden; ‖‖Department of Neonatology, Children´s Hospital Hannover, Auf der Bult, Hannover; ***Department of Neonatology, Olgahospital Stuttgart; †††Department of Neonatology, Children´s Hospital Hamburg, Altona; and ‡‡‡Department of Neonatology, Children´s Hospital Aschaffenburg, Aschaffenburg, Germany.
authors.forename: Birte
authors.initials: B
authors.lastname: Tröger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Göpel
authors.forename: Kirstin
authors.initials: K
authors.lastname: Faust
authors.forename: Thilo
authors.initials: T
authors.lastname: Müller
authors.forename: Gerhard
authors.initials: G
authors.lastname: Jorch
authors.forename: Ursula
authors.initials: U
authors.lastname: Felderhoff-Müser
authors.forename: Ludwig
authors.initials: L
authors.lastname: Gortner
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Heitmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Hoehn
authors.forename: Angela
authors.initials: A
authors.lastname: Kribs
authors.forename: Reinhard
authors.initials: R
authors.lastname: Laux
authors.forename: Claudia
authors.initials: C
authors.lastname: Roll
authors.forename: Michael
authors.initials: M
authors.lastname: Emeis
authors.forename: Michael
authors.initials: M
authors.lastname: Mögel
authors.forename: Jens
authors.initials: J
authors.lastname: Siegel
authors.forename: Matthias
authors.initials: M
authors.lastname: Vochem
authors.forename: Axel
authors.initials: A
authors.lastname: von der Wense
authors.forename: Christian
authors.initials: C
authors.lastname: Wieg
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
authors.forename: Christoph
authors.initials: C
authors.lastname: Härtel
mesh_terms: D015331:Cohort Studies; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology*; D005858:Germany / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality