Early-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: Early-onset sepsis (occurring within 72 hours of birth) is included in the differential diagnosis of most very low birth weight (VLBW) neonates. To determine the current incidence of early-onset sepsis, risk factors for disease, and the impact of early-onset sepsis on subsequent hospital course, we studied a cohort of 7861 VLBW neonates (401 to 1500 gm) admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991-1993). METHODS: The NICHD Neonatal Research Network maintains a prospectively collected registry on all VLBW neonates born or cared for at participating centers. Data from this registry were analyzed retrospectively. RESULTS: Blood culture-proven early-onset sepsis was uncommon, occurring in only 1.9% of VLBW neonates. Group B streptococcus was the most frequent pathogen associated with early-onset sepsis (31%), followed by Escherichia coli (16%) and Haemophilus influenzae (12%). Decreasing gestational age was associated with increased rates of infection. Antibiotic therapy for suspected sepsis is frequently initiated at birth in VLBW neonates. Almost half of the infants in this cohort were considered to have clinical sepsis and continued to receive antibiotics for 5 or more days, despite a negative blood culture result in 98% of cases. These findings underscore the difficulty of ruling out sepsis in the symptomatic immature neonate and the special concern for culture-negative clinical sepsis in the face of maternal antibiotic use.Neonates with early-onset sepsis were significantly more likely to have subsequent comorbidities, including severe intraventricular hemorrhage, patent ductus arteriosus, and prolonged assisted ventilation. Although 26% of VLBW neonates with early-onset sepsis died, only 4% of the 950 deaths that occurred in the first 72 hours of life were attributed to infection. For those infants discharged alive, early-onset sepsis was associated with a significantly prolonged hospital stay (86 vs 69 days; p <0.02). CONCLUSIONS: Early-onset sepsis remains an important but uncommon problem among VLBW preterm infants. Improved diagnostic strategies are needed to enable the clinician to distinguish between the infected and the uninfected VLBW neonate with symptoms and to target continued antibiotic therapy to those who are truly infected. (J PEDIATR 1996;129:72-80)
Le texte complet de cet article est disponible en PDF.Abbreviations : BPD, IVH, NEC, NICHD, ROM, 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. |
| 0022-3476/96/$5.00 + 0 9/20/74003 |
Vol 129 - N° 1
P. 72-80 - juillet 1996 Retour au numéro
Article précédent
- Late-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
- Clinical outcome of ulcerative colitis in children
- Jeffrey S. Hyams, Patricia Davis, Kathy Grancher, Trudy Lerer, Christopher J. Justinich, James Markowitz
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