Late-onset Sepsis in Extremely Premature Infants 2000-2011

• Type of Material: Article
• Authors: Rachel G. Greenberg, Duke University; Sarah Kandefer, RTI International; Barbara T. Do, RTI International; P. Brian Smith, Duke University; Barbara Stoll, Emory University; Edward F. Bell, University of Iowa; Waldemar A. Carlo, University of Alabama Birmingham; Abbot R. Laptook, Brown University; Pablo J. Sanchez, University of Texas Southwestern Medical Center; Seetha Shankaran, Wayne State University; Krisa P. Van Meurs, Stanford University School of Medicine and Lucile Packard Children’s Hospital; M. Bethany Ball, Stanford University; Ellen C. Hale, Emory University; Nancy S. Newman, Case Western Reserve University; Abhik Das, RTI International; Rosemary D. Higgins, National Institutes of Health; C. Michael Cotten, Duke University
• Language: English
• Date: 2017-08-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/INF.0000000000001570
• Title of Journal or Parent Work: Pediatric Infectious Disease Journal
• ISSN: 0891-3668
• Volume: 36
• Issue: 8
• Start Page: 774
• End Page: 779
• Grant/Funding Information: Dr Smith receives research support from Cempra Pharmaceuticals (subaward to HHS0100201300009C) and industry for neonatal and pediatric drug development (www.dcri.duke.edu/research/coi.jsp).; Dr Cotten receives salary support from the U.S. Department of Health and Human Services (DHHS-1R18AE000028-01).; Dr Smith receives salary support for research from the NIH and the National Center for Advancing Translational Sciences of the NIH (UL1TR001117), the NICHD (HHSN275201000003I and 1R01-HD081044-01), and the Food and Drug Administration (1R18-FD005292-01).; Research reported in this publication was supported by grant support from the National Institutes of Health (NIH) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) for the Neonatal Research Network’s Generic Database Study.; Dr Greenberg received funding from an NIH training grant (5T32HD043728-10).
• Keywords: Immunology; NEONATAL RESEARCH NETWORK; Life Sciences & Biomedicine; THAN 25 WEEKS; NEURODEVELOPMENTAL OUTCOMES; HUMAN-MILK; BIRTH-WEIGHT INFANTS; NECROTIZING ENTEROCOLITIS; Infectious Diseases; Science & Technology; late-onset sepsis; neonatal intensive care unit; INTENSIVE-CARE; QUALITY-IMPROVEMENT; Pediatrics; WEEKS GESTATIONAL-AGE; PRETERM INFANTS; extremely premature infants
• Research Categories: Environmental Sciences; Health Sciences, Medicine and Surgery

Abstract

Background: Late-onset sepsis (LOS) is an important cause of death and neurodevelopmental impairment in premature infants. The purpose of this study was to assess overall incidence of LOS, distribution of LOS-causative organisms and center variation in incidence of LOS for extremely premature infants over time. Methods: In a retrospective analysis of infants 401-1000 g birth weight and 22-28 6/7 weeks of gestational age born at 12 National Institute of Child Health and Human Development Neonatal Research Network centers in the years 2000-2005 (era 1) or 2006-2011 (era 2) who survived >72 hours, we compared the incidence of LOS and pathogen distribution in the 2 eras using the χ2test. We also examined the effect of birth year on the incidence of LOS using multivariable regression to adjust for nonmodifiable risk factors and for center. To assess whether the incidence of LOS was different among centers in era 2, we used a multivariable regression model to adjust for nonmodifiable risk factors. Results: Ten-thousand one-hundred thirty-one infants were studied. LOS occurred in 2083 of 5031 (41%) infants in era 1 and 1728 of 5100 (34%) infants in era 2 (P < 0.001). Birth year was a significant predictor of LOS on adjusted analysis, with birth years 2000-2009 having a significantly higher odds of LOS than the reference year 2011. Pathogens did not differ, with the exception of decreased fungal infection (P < 0.001). In era 2, 9 centers had significantly higher odds of LOS compared with the center with the lowest incidence. Conclusions: The incidence of LOS decreased over time. Further investigation is warranted to determine which interventions have the greatest impact on infection rates.