Journal
EARLY HUMAN DEVELOPMENT
Volume 88, Issue 11, Pages 905-909Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.earlhumdev.2012.07.009
Keywords
Preterm; Neonate; Sepsis; Immunoparalysis
Categories
Funding
- United States government [1R01HD057956-02, 1R01FD003519-01, 1U10-HD45962-06, 1K24HD058735-01]
- Thrasher Research Foundation
- U.S. government [HHSN267200700051C]
- National Institute of Child Health and Human Development [1K23HD064814-01]
- [HHSN2752010000021]
- [NICHD-1K23HD060040-01]
- [DHHS-1R18AE000028-01]
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Background: Very low birth weight neonates (<= 1500 g, VLBWs) have a high rate of infection and distinct baseline immune function compared with more mature populations. In critically ill children and adults, sepsis increases subsequent infection risk It is unknown whether sepsis modifies the risk of subsequent infection in VLBWs. Methods: We conducted a retrospective cohort study of VLBWs <= 32 weeks of gestation at birth cared for in 312 neonatal intensive care units in the United States from 1997 to 2011 (n =103,376). Early-onset sepsis (EOS, culture-positive only) and late-onset sepsis (LOS, culture-positive or clinical) cases were identified. Cox proportional hazard models were used to control for clinical variables between neonates with and without EOS to determine if EOS modified risk of LOS, necrotizing enterocolitis (NEC), or death. Results: LOS occurred in 12,112/102,317 (11.8%) neonates without EOS and in 133/1059 (12.6%) of those with EOS. After adjustment for clinical variables, the risk of LOS was not different between neonates with or without a history of EOS (hazard ratio [HR] = 0.92; 95% confidence interval [CI] 0.74, 1.16). EOS increased the risk of 120-day mortality (HR = 1.78; 95% CI 1.49, 2.13). Conclusions: In contrast to findings in children and adults, EOS was not associated with an increased risk of LOS in this cohort. Age-specific investigations are needed to determine if post-sepsis immunologic alterations are present. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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