Late-Onset Sepsis Among Extremely Preterm Infants of 24-28 Weeks Gestation: An International Comparison in 10 High-Income Countries

Overview

Journal Neonatology

Publisher Karger

Specialty Gynecology & Obstetrics

Date 2024 Jun 18

PMID 38889700

Authors

Gil Klinger

Brian Reichman

Mikael Norman

Satoshi Kusuda

Malcolm Battin

Kjell Helenius

Tetsuya Isayama

Kei Lui

Mark Adams

Maximo Vento

Stellan Hakansson

Marc Beltempo

Chiara Poggi

Laura San Feliciano

Liisa Lehtonen

Dirk Bassler

Junmin Yang

Prakesh S Shah

Affiliations

Soon will be listed here.

Abstract

Introduction: Despite advances in neonatal care, late-onset sepsis remains an important cause of preventable morbidity and mortality. Neonatal late-onset sepsis rates have decreased in some countries, while in others they have not. Our objective was to compare trends in late-onset sepsis rates in 9 population-based networks from 10 countries and to assess the associated mortality within 7 days of late-onset sepsis.

Methods: We performed a retrospective population-based cohort study. Infants born at 24-28 weeks' gestation between 2007 and 2019 were eligible for inclusion. Late-onset sepsis was defined as a positive blood or cerebrospinal fluid culture. Late-onset sepsis rates were calculated for 3 epochs (2007-11, 2012-15, and 2016-19). Adjusted risk ratios (aRRs) for late-onset sepsis were calculated for each network.

Results: Of a total of 82,850 infants, 16,914 (20.4%) had late-onset sepsis, with Japan having the lowest rate (7.1%) and Spain the highest (44.6%). Late-onset sepsis rates decreased in most networks and remained unchanged in a few. Israel, Sweden, and Finland showed the largest decrease in late-onset sepsis rates. The aRRs for late-onset sepsis showed wide variations between networks. The rate of mortality temporally related to late-onset sepsis was 10.9%. The adjusted mean length of stay for infants with late-onset sepsis was increased by 5-18 days compared to infants with no late-onset sepsis.

Conclusions: One in 5 neonates of 24-28 weeks' gestation develops late-onset sepsis. Wide variability in late-onset sepsis rates exists between networks with most networks exhibiting improvement. Late-onset sepsis was associated with increased mortality and length of stay.

References

Fernandez Colomer B, Cernada Badia M, Coto Cotallo D, Lopez Sastre J . The Spanish National Network "Grupo Castrillo": 22 Years of Nationwide Neonatal Infection Surveillance. Am J Perinatol. 2020; 37(S 02):S71-S75. DOI: 10.1055/s-0040-1714256. View

Hentges C, Silveira R, Procianoy R, Carvalho C, Filipouski G, Fuentefria R . Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight. J Pediatr (Rio J). 2013; 90(1):50-7. DOI: 10.1016/j.jped.2013.10.002. View

Su B, Hsieh W, Hsu C, Chang J, Lien R, Lin C . Neonatal outcomes of extremely preterm infants from taiwan: comparison with Canada, Japan, and the USA. Pediatr Neonatol. 2014; 56(1):46-52. DOI: 10.1016/j.pedneo.2014.05.002. View

Lui K, Lee S, Kusuda S, Adams M, Vento M, Reichman B . Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries. J Pediatr. 2019; 215:32-40.e14. DOI: 10.1016/j.jpeds.2019.08.020. View

Dong Y, Speer C . Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed. 2014; 100(3):F257-63. PMC: 4413803. DOI: 10.1136/archdischild-2014-306213. View

Horbar J, Greenberg L, Buzas J, Ehret D, Soll R, Edwards E . Trends in Mortality and Morbidities for Infants Born 24 to 28 Weeks in the US: 1997-2021. Pediatrics. 2023; 153(1). DOI: 10.1542/peds.2023-064153. View

Kostlin-Gille N, Hartel C, Haug C, Gopel W, Zemlin M, Muller A . Epidemiology of Early and Late Onset Neonatal Sepsis in Very Low Birthweight Infants: Data From the German Neonatal Network. Pediatr Infect Dis J. 2021; 40(3):255-259. DOI: 10.1097/INF.0000000000002976. View

Helenius K, Sjors G, Shah P, Modi N, Reichman B, Morisaki N . Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks. Pediatrics. 2017; 140(6). DOI: 10.1542/peds.2017-1264. View

Klinger G, Sokolover N, Boyko V, Sirota L, Lerner-Geva L, Reichman B . Perinatal risk factors for bronchopulmonary dysplasia in a national cohort of very-low-birthweight infants. Am J Obstet Gynecol. 2012; 208(2):115.e1-9. DOI: 10.1016/j.ajog.2012.11.026. View

10.

Barnette B, Schumacher B, Armenta R, Wynn J, Richardson A, Bradley J . Contribution of Concurrent Comorbidities to Sepsis-Related Mortality in Preterm Infants ≤32 Weeks of Gestation at an Academic Neonatal Intensive Care Network. Am J Perinatol. 2021; 41(2):134-142. PMC: 10233655. DOI: 10.1055/a-1675-2899. View

11.

Ran N, van den Hoogen A, Hemels M . Gram-negative Late-onset Sepsis in Extremely Low Birth Weight Infants Is Emerging in The Netherlands Despite Quality Improvement Programs and Antibiotic Stewardship!. Pediatr Infect Dis J. 2019; 38(9):952-957. DOI: 10.1097/INF.0000000000002408. View

12.

Kelly L, Shah P, Hakansson S, Kusuda S, Adams M, Lee S . Perinatal health services organization for preterm births: a multinational comparison. J Perinatol. 2017; 37(7):762-768. DOI: 10.1038/jp.2017.45. View

13.

Boel L, Banerjee S, Clark M, Greenwood A, Sharma A, Goel N . Temporal trends of care practices, morbidity, and mortality of extremely preterm infants over 10-years in South Wales, UK. Sci Rep. 2020; 10(1):18738. PMC: 7603316. DOI: 10.1038/s41598-020-75749-4. View

14.

Klinger G, Bromiker R, Zaslavsky-Paltiel I, Klinger S, Sokolover N, Lerner-Geva L . Late-Onset Sepsis in Very Low Birth Weight Infants. Pediatrics. 2023; 152(5). DOI: 10.1542/peds.2023-062223. View

15.

Pricoco R, Mayer-Huber S, Paulick J, Benstetter F, Zeller M, Keller M . Impact of a family-centred clinical care programme on short-term outcomes of very low-birth weight infants. Acta Paediatr. 2023; 112(11):2368-2377. DOI: 10.1111/apa.16944. View

16.

Escalante M, Ceriani-Cernadas J, DApremont I, Bancalari A, Webb V, Genes L . Late Onset Sepsis in Very Low Birth Weight Infants in the South American NEOCOSUR Network. Pediatr Infect Dis J. 2018; 37(10):1022-1027. DOI: 10.1097/INF.0000000000001958. View

17.

Adams M, Bassler D, Darlow B, Lui K, Reichman B, Hakansson S . Preventive strategies and factors associated with surgically treated necrotising enterocolitis in extremely preterm infants: an international unit survey linked with retrospective cohort data analysis. BMJ Open. 2019; 9(10):e031086. PMC: 6797308. DOI: 10.1136/bmjopen-2019-031086. View

18.

Dong Y, Glaser K, Speer C . Late-onset sepsis caused by Gram-negative bacteria in very low birth weight infants: a systematic review. Expert Rev Anti Infect Ther. 2019; 17(3):177-188. DOI: 10.1080/14787210.2019.1568871. View

19.

Wojkowska-Mach J, Chmielarczyk A, Strus M, Lauterbach R, Heczko P . Neonate Bloodstream Infections in Organization for Economic Cooperation and Development Countries: An Update on Epidemiology and Prevention. J Clin Med. 2019; 8(10). PMC: 6832148. DOI: 10.3390/jcm8101750. View

20.

DApremont I, Marshall G, Musalem C, Mariani G, Musante G, Bancalari A . Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers. J Pediatr. 2020; 225:44-50.e1. DOI: 10.1016/j.jpeds.2020.05.040. View