title: Risk Factors and Outcomes of Late-Onset Bacterial Sepsis in Preterm Neonates Born at < 32 Weeks' Gestation.
abstract: OBJECTIVE
  This study aims to identify the incidence, risk factors, and outcomes of late-onset sepsis in preterm neonates in Canadian neonatal intensive care units (NICUs).
  
  
  METHODS
  This retrospective analysis included preterm infants born at < 32 weeks' gestation and admitted to 29 NICUs in the Canadian Neonatal Network during the years 2010 and 2011. Infants were classified into three groups: no infection, gram-positive infection, and gram-negative infection. Late-onset sepsis was defined as positive blood and/or spinal fluid cultures after 3 days of birth. Risk factors and the primary outcome of mortality or bronchopulmonary dysplasia (BPD) were compared between the groups.
  
  
  RESULTS
  Out of the 7,509 neonates, 6,405 (85%) had no infection, 909 (12%) had gram-positive, and 195 (3%) had gram-negative infections. Lower gestation, higher Score for Neonatal Acute Physiology, version II scores, the presence of central catheters for > 4 days, parenteral nutrition for > 7 days, and prolonged duration of nothing by mouth were associated with late-onset sepsis. After controlling for confounders, the odds ratio (OR) of mortality/BPD were higher in infants who had gram-negative (OR 2.79, 95% confidence interval [CI] 1.96-3.97) and gram-positive (OR 1.44, 95% CI 1.21-1.71) sepsis as compared with no infection.
  
  
  CONCLUSIONS
  Bacterial late-onset sepsis in very preterm neonates was associated with mortality and BPD. Neonates with gram-negative sepsis had the highest risk of adverse outcomes as compared with gram-positive sepsis or no sepsis.
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
authors.forename: Ann L
authors.initials: AL
authors.lastname: Jefferies
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Eugene W
authors.initials: EW
authors.lastname: Yoon
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology*; D002170:Canada / Q000453:epidemiology; D002405:Catheterization, Central Venous; D005865:Gestational Age; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000401:mortality*; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000401:mortality*; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors