Late-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network - 12/10/17
Abstract |
OBJECTIVE: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993). METHODS: The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively. RESULTS: Of 6911 infants who survived beyond 3 days, 1696 (25%) had one or more episodes of blood culture-proven sepsis. The vast majority of infections (73%) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55% of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p <0.01). Late-onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p <0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p <0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17% vs 7%; p <0.0001), especially if they were infected with gram-negative organisms (40%) or fungi (28%). Deaths attributed to infection increased with increasing chronologic age. Whereas only 4% of deaths in the first 3 days of life were attributed to infection, 45% of deaths after 2 weeks were related to infection. CONCLUSIONS: Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs. (J PEDIATR 1996;129:63-71)
Le texte complet de cet article est disponible en PDF.Abbreviations : BPD, IVH, NEC, NICHD, RDS, VLBW
Plan
 | From Emory University, Atlanta, Georgia; George Washington University Biostatistics Center, Rockville, Maryland; University of Tennessee at Memphis; Wayne State University, Detroit, Michigan; University of Texas Southwestern Medical Center, Dallas; University of Miami, Miami, Florida; Case Western Reserve University, Cleveland, Ohio; Indiana University, Indianapolis; University of Cincinnati, Cincinnati, Ohio; Women and Infants Hospital, Providence, Rhode Island; Stanford University, Stanford, California; Yale University, New Haven, Connecticut; University of New Mexico, Albuquerque; and the National Institute of Child Health and Human Development, Bethesda, Maryland |
| Supported by the National Institute of Child Health and Human Development through Cooperative Agreements: U10 HD21397, U10 HD27853, U10 HD27871, U10 HD21364, U10 HD21415, U10 HD27856, U10 HD27904, U10 HD27881, U10 HD21385, U10 HD27880, U10 HD27851, U10 HD21373, and U01 HD19897. |
 | Reprint requests: Barbara J. Stoll, MD, Emory University School of Medicine, Department of Pediatrics, 2040 Ridgewood Dr., Atlanta, GA 30322. |
| 9/20/73290 |
Vol 129 - N° 1
P. 63-71 - juillet 1996 Retour au numéro
Article précédent
- Isolated X-linked thrombocytopenia in two unrelated families is associated with point mutations in the Wiskott-Aldrich syndrome protein gene
- Geneviève de Saint Basile, Rémi Dufourcq Lagelouse, Nathalie Lambert, Klaus Schwarz, Bernard Le Mareck, Sylvie Odent, Nicole Schlegel, Alain Fischer
- Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network
- Barbara J. Stoll, Tavia Gordon, Sheldon B. Korones, Seetha Shankaran, Jon E. Tyson, Charles R. Bauer, Avroy A. Fanaroff, James A. Lemons, Edward F. Donovan, William Oh, David K. Stevenson, Richard A. Ehrenkranz, Lu-Ann Papile, Joel Verter, Linda L. Wright
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