Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network
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...
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| Veröffentlicht in: | The Journal of pediatrics 1996-07, Vol.129 (1), p.72-80 |
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| creator | Stoll, Barbara J. Gordon, Tavia Korones, Sheldon B. Shankaran, Seetha Tyson, Jon E. Bauer, Charles R. Fanaroff, Avroy A. Lemons, James A. Donovan, Edward F. Oh, William Stevenson, David K. Ehrenkranz, Richard A. Papile, Lu-Ann Verter, Joel Wright, Linda L. |
| description | 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 |
| doi_str_mv | 10.1016/S0022-3476(96)70192-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_78258499</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022347696701920</els_id><sourcerecordid>78258499</sourcerecordid><originalsourceid>FETCH-LOGICAL-c536t-513480d780c415afe2d5bd432c9d7b38f2b637880ed113318ddae0314593d9353</originalsourceid><addsrcrecordid>eNqFUc1u1DAQthCoLIVHqOQDQnAI2HGcxFxQtRRaqSoSP2fLsSfE4NjBdna1r9Knbbq72iunseb7mfF8CF1Q8p4SWn_4QUhZFqxq6reiftcQKsqCPEErSkRT1C1jT9HqRHmOXqT0hxAiKkLO0Fnb8IbXfIXur1R0uyL4BBknmJJN2Hq8gbjDLmxxZ2Me8Bbs7yFjD8GrDOkjvsQRphAz7mMYcR4A36lsF9ThG5-yzXMGHHq8Hqwz-BqUW1yUX57zqDz-DBtwYRrBZ3y3N12E3yGBinpYOnkb4t-X6FmvXIJXx3qOfn25-rm-Lm6_fb1ZX94WmrM6F5yyqiWmaYmuKFc9lIZ3pmKlFqbpWNuXXc2atiVgKGWMtsYoIIxWXDAjGGfn6M3Bd4rh3wwpy9EmDc6p5b9zkk1b8rYSYiHyA1HHkFKEXk7RjiruJCXyMRO5z0Q-HlyKWu4zkWTRXRwHzN0I5qQ6hrDgr4-4Slq5PiqvbTrRGG3Kar_npwMNlmNsLESZtAWvwdgIOksT7H8WeQBqO6nN</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>78258499</pqid></control><display><type>article</type><title>Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Stoll, Barbara J. ; Gordon, Tavia ; Korones, Sheldon B. ; Shankaran, Seetha ; Tyson, Jon E. ; Bauer, Charles R. ; Fanaroff, Avroy A. ; Lemons, James A. ; Donovan, Edward F. ; Oh, William ; Stevenson, David K. ; Ehrenkranz, Richard A. ; Papile, Lu-Ann ; Verter, Joel ; Wright, Linda L.</creator><creatorcontrib>Stoll, Barbara J. ; Gordon, Tavia ; Korones, Sheldon B. ; Shankaran, Seetha ; Tyson, Jon E. ; Bauer, Charles R. ; Fanaroff, Avroy A. ; Lemons, James A. ; Donovan, Edward F. ; Oh, William ; Stevenson, David K. ; Ehrenkranz, Richard A. ; Papile, Lu-Ann ; Verter, Joel ; Wright, Linda L.</creatorcontrib><description>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 P
EDIATR 1996;129:72-80)</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/S0022-3476(96)70192-0</identifier><identifier>PMID: 8757565</identifier><identifier>CODEN: JOPDAB</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Age of Onset ; Bacterial diseases ; Bacterial Infections - epidemiology ; Bacterial Infections - microbiology ; Bacterial Infections - mortality ; Bacterial sepsis ; Biological and medical sciences ; Cohort Studies ; Female ; Human bacterial diseases ; Humans ; Incidence ; Infant, Newborn ; Infant, Very Low Birth Weight ; Infectious diseases ; Male ; Medical sciences ; Risk Factors ; Sepsis - epidemiology ; Sepsis - microbiology ; Sepsis - mortality</subject><ispartof>The Journal of pediatrics, 1996-07, Vol.129 (1), p.72-80</ispartof><rights>1996 Mosby, Inc.</rights><rights>1996 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-513480d780c415afe2d5bd432c9d7b38f2b637880ed113318ddae0314593d9353</citedby><cites>FETCH-LOGICAL-c536t-513480d780c415afe2d5bd432c9d7b38f2b637880ed113318ddae0314593d9353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0022-3476(96)70192-0$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3172435$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8757565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stoll, Barbara J.</creatorcontrib><creatorcontrib>Gordon, Tavia</creatorcontrib><creatorcontrib>Korones, Sheldon B.</creatorcontrib><creatorcontrib>Shankaran, Seetha</creatorcontrib><creatorcontrib>Tyson, Jon E.</creatorcontrib><creatorcontrib>Bauer, Charles R.</creatorcontrib><creatorcontrib>Fanaroff, Avroy A.</creatorcontrib><creatorcontrib>Lemons, James A.</creatorcontrib><creatorcontrib>Donovan, Edward F.</creatorcontrib><creatorcontrib>Oh, William</creatorcontrib><creatorcontrib>Stevenson, David K.</creatorcontrib><creatorcontrib>Ehrenkranz, Richard A.</creatorcontrib><creatorcontrib>Papile, Lu-Ann</creatorcontrib><creatorcontrib>Verter, Joel</creatorcontrib><creatorcontrib>Wright, Linda L.</creatorcontrib><title>Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>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 P
EDIATR 1996;129:72-80)</description><subject>Age of Onset</subject><subject>Bacterial diseases</subject><subject>Bacterial Infections - epidemiology</subject><subject>Bacterial Infections - microbiology</subject><subject>Bacterial Infections - mortality</subject><subject>Bacterial sepsis</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant, Newborn</subject><subject>Infant, Very Low Birth Weight</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Risk Factors</subject><subject>Sepsis - epidemiology</subject><subject>Sepsis - microbiology</subject><subject>Sepsis - mortality</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUc1u1DAQthCoLIVHqOQDQnAI2HGcxFxQtRRaqSoSP2fLsSfE4NjBdna1r9Knbbq72iunseb7mfF8CF1Q8p4SWn_4QUhZFqxq6reiftcQKsqCPEErSkRT1C1jT9HqRHmOXqT0hxAiKkLO0Fnb8IbXfIXur1R0uyL4BBknmJJN2Hq8gbjDLmxxZ2Me8Bbs7yFjD8GrDOkjvsQRphAz7mMYcR4A36lsF9ThG5-yzXMGHHq8Hqwz-BqUW1yUX57zqDz-DBtwYRrBZ3y3N12E3yGBinpYOnkb4t-X6FmvXIJXx3qOfn25-rm-Lm6_fb1ZX94WmrM6F5yyqiWmaYmuKFc9lIZ3pmKlFqbpWNuXXc2atiVgKGWMtsYoIIxWXDAjGGfn6M3Bd4rh3wwpy9EmDc6p5b9zkk1b8rYSYiHyA1HHkFKEXk7RjiruJCXyMRO5z0Q-HlyKWu4zkWTRXRwHzN0I5qQ6hrDgr4-4Slq5PiqvbTrRGG3Kar_npwMNlmNsLESZtAWvwdgIOksT7H8WeQBqO6nN</recordid><startdate>19960701</startdate><enddate>19960701</enddate><creator>Stoll, Barbara J.</creator><creator>Gordon, Tavia</creator><creator>Korones, Sheldon B.</creator><creator>Shankaran, Seetha</creator><creator>Tyson, Jon E.</creator><creator>Bauer, Charles R.</creator><creator>Fanaroff, Avroy A.</creator><creator>Lemons, James A.</creator><creator>Donovan, Edward F.</creator><creator>Oh, William</creator><creator>Stevenson, David K.</creator><creator>Ehrenkranz, Richard A.</creator><creator>Papile, Lu-Ann</creator><creator>Verter, Joel</creator><creator>Wright, Linda L.</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19960701</creationdate><title>Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network</title><author>Stoll, Barbara J. ; Gordon, Tavia ; Korones, Sheldon B. ; Shankaran, Seetha ; Tyson, Jon E. ; Bauer, Charles R. ; Fanaroff, Avroy A. ; Lemons, James A. ; Donovan, Edward F. ; Oh, William ; Stevenson, David K. ; Ehrenkranz, Richard A. ; Papile, Lu-Ann ; Verter, Joel ; Wright, Linda L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c536t-513480d780c415afe2d5bd432c9d7b38f2b637880ed113318ddae0314593d9353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Age of Onset</topic><topic>Bacterial diseases</topic><topic>Bacterial Infections - epidemiology</topic><topic>Bacterial Infections - microbiology</topic><topic>Bacterial Infections - mortality</topic><topic>Bacterial sepsis</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant, Newborn</topic><topic>Infant, Very Low Birth Weight</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Risk Factors</topic><topic>Sepsis - epidemiology</topic><topic>Sepsis - microbiology</topic><topic>Sepsis - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stoll, Barbara J.</creatorcontrib><creatorcontrib>Gordon, Tavia</creatorcontrib><creatorcontrib>Korones, Sheldon B.</creatorcontrib><creatorcontrib>Shankaran, Seetha</creatorcontrib><creatorcontrib>Tyson, Jon E.</creatorcontrib><creatorcontrib>Bauer, Charles R.</creatorcontrib><creatorcontrib>Fanaroff, Avroy A.</creatorcontrib><creatorcontrib>Lemons, James A.</creatorcontrib><creatorcontrib>Donovan, Edward F.</creatorcontrib><creatorcontrib>Oh, William</creatorcontrib><creatorcontrib>Stevenson, David K.</creatorcontrib><creatorcontrib>Ehrenkranz, Richard A.</creatorcontrib><creatorcontrib>Papile, Lu-Ann</creatorcontrib><creatorcontrib>Verter, Joel</creatorcontrib><creatorcontrib>Wright, Linda L.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stoll, Barbara J.</au><au>Gordon, Tavia</au><au>Korones, Sheldon B.</au><au>Shankaran, Seetha</au><au>Tyson, Jon E.</au><au>Bauer, Charles R.</au><au>Fanaroff, Avroy A.</au><au>Lemons, James A.</au><au>Donovan, Edward F.</au><au>Oh, William</au><au>Stevenson, David K.</au><au>Ehrenkranz, Richard A.</au><au>Papile, Lu-Ann</au><au>Verter, Joel</au><au>Wright, Linda L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>1996-07-01</date><risdate>1996</risdate><volume>129</volume><issue>1</issue><spage>72</spage><epage>80</epage><pages>72-80</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><coden>JOPDAB</coden><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 P
EDIATR 1996;129:72-80)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>8757565</pmid><doi>10.1016/S0022-3476(96)70192-0</doi><tpages>9</tpages></addata></record> |
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| ispartof | The Journal of pediatrics, 1996-07, Vol.129 (1), p.72-80 |
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| subjects | Age of Onset Bacterial diseases Bacterial Infections - epidemiology Bacterial Infections - microbiology Bacterial Infections - mortality Bacterial sepsis Biological and medical sciences Cohort Studies Female Human bacterial diseases Humans Incidence Infant, Newborn Infant, Very Low Birth Weight Infectious diseases Male Medical sciences Risk Factors Sepsis - epidemiology Sepsis - microbiology Sepsis - mortality |
| title | Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network |
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