4.7 Article

Early-Onset Sepsis Among Very Preterm Infants

Journal

PEDIATRICS
Volume 148, Issue 4, Pages -

Publisher

AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2021-052456

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Funding

  1. Agency for Healthcare Research and Quality [K08HS027468]
  2. Centers for Disease Control and Prevention
  3. Children's Hospital of Philadelphia
  4. National Institutes of Health [5UG1HD068244, 5R01AI121383]

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This study investigated the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants from 2018 to 2019. The findings revealed an incidence rate of 13.5 per 1000 very preterm births, with Escherichia coli and group B Streptococcus being the most common pathogens. Infected infants had longer hospital stays and lower survival rates, emphasizing the need for novel preventive strategies.
OBJECTIVES: To determine the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants using a nationally representative cohort from academic and community hospitals to inform empirical antibiotic guidance, highlight risk factors for infection, and aid in prognostication for infected infants. METHODS: Prospective observational study of very preterm infants born weighing 401 to 1500 g or at 22 to 29 weeks' gestational age from January 2018 to December 2019 in 753 Vermont Oxford Network centers. EOS was defined as a culture-confirmed bacterial infection of the blood or cerebrospinal fluid in the 3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without EOS. RESULTS: Of 84 333 included infants, 1139 had EOS for an incidence rate of 13.5 per 1000 very preterm births (99% confidence interval [CI] 12.5-14.6). Escherichia coli (538 of 1158; 46.5%) and group B Streptococcus (218 of 1158; 18.8%) were the most common pathogens. Infected infants had longer lengths of stay (median 92 vs 66 days) and lower rates of survival (67.5% vs 90.4%; adjusted risk ratio 0.82 [95% CI 0.79-0.85]) and of survival without morbidity (26.1% vs 59.4%; adjusted risk ratio 0.66 [95% CI 0.60-0.72]). CONCLUSIONS: In a nationally representative sample of very preterm infants with EOS from 2018 to 2019, approximately one-third of isolates were neither group B Streptococcus nor E coli. Three-quarters of all infected infants either died or survived with a major medical morbidity. The profoundly negative impact of EOS on very preterm infants highlights the need for novel preventive strategies.

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