Impact of Early-Onset Sepsis and Antibiotic Use on Death or Survival with Neurodevelopmental Impairment at 2 Years of Age among Extremely Preterm Infants - 20/05/20
, Karen M. Puopolo, MD, PhD 1, 2, Nellie I. Hansen, MPH 3, Scott A. Lorch, MD, MSCE 1, 2, Sara B. DeMauro, MD, MSCE 1, 2, Rachel G. Greenberg, MD, MB, MHS 4, C. Michael Cotten, MD, MHS 4, Pablo J. Sánchez, MD 5, Edward F. Bell, MD 6, Eric C. Eichenwald, MD 1, 2, Barbara J. Stoll, MD 7on behalf of the
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network∗
Abstract |
Objective |
To evaluate the hypothesis that early-onset sepsis increases risk of death or neurodevelopmental impairment (NDI) among preterm infants; and that among infants without early-onset sepsis, prolonged early antibiotics alters risk of death/NDI.
Study design |
Retrospective cohort study of infants born at the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers (2006-2014) at 22-26 weeks of gestation and birth weight 401-1000 g. Early-onset sepsis defined as growth of a pathogen from blood or cerebrospinal fluid culture ≤72 hours after birth. Prolonged early antibiotics was defined as antibiotics initiated ≤72 hours and continued ≥5 days without culture-confirmed infection, necrotizing enterocolitis, or spontaneous perforation. Primary outcome was death before follow-up or NDI assessed at 18-26 months corrected age. Poisson regression was used to estimate adjusted relative risk (aRR) and CI for early-onset sepsis outcomes. A propensity score for receiving prolonged antibiotics was derived from early clinical factors and used to match infants (1:1) with and without prolonged antibiotic exposure. Log binomial models were used to estimate aRR for outcomes in matched infants.
Results |
Among 6565 infants, those with early-onset sepsis had higher aRR (95% CI) for death/NDI compared with infants managed with prolonged antibiotics (1.18 [1.06-1.32]) and to infants without prolonged antibiotics (1.23 [1.10-1.37]). Propensity score matching was achieved for 4362 infants. No significant difference in death/NDI (1.04 [0.98-1.11]) was observed with or without prolonged antibiotics among the matched cohort.
Conclusions |
Early-onset sepsis was associated with increased risk of death/NDI among extremely preterm infants. Among matched infants without culture-confirmed infection, prolonged early antibiotic administration was not associated with death/NDI.
Le texte complet de cet article est disponible en PDF.Keywords : prolonged early antibiotics, culture-negative infection
Abbreviations : aRR, AUR, BW, CSF, LOS, IVH, NDI, NEC, NRN, PS, SIP
Plan
Vol 221
P. 39 - juin 2020 Retour au numéro
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