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The impact of a sepsis quality improvement project on neurodisability rates in very low birthweight infants
  1. Jonathan W Davis1,
  2. David Odd2,3,
  3. Sally Jary1,3,
  4. Karen Luyt1,3
  1. 1Regional Neonatal Unit, St. Michael's Hospital, University Hospitals Bristol Foundation NHS Trust, Bristol, UK
  2. 2Regional Neonatal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  3. 3School of Clinical Sciences, University of Bristol, Bristol, UK
  1. Correspondence to Dr Jonathan W Davis, Regional Neonatal Unit, St. Michael's Hospital, University Hospitals Bristol Foundation NHS Trust, Bristol BS28EG, UK; j_davis84{at}hotmail.com

Abstract

Objective Very low birthweight (VLBW; <1500 g) infants with late-onset sepsis (LOS) have an increased risk of neurodisability. Care bundles to reduce bloodstream infections in neonatal intensive care unit (NICU) are effective in reducing LOS. Our aim was to determine if a sepsis reduction bundle introduced through a quality improvement project would impact neurodevelopmental outcomes in VLBW infants.

Design Cohort study.

Setting Level 3 regional NICU in the South West of England.

Patients VLBW infants born between 2002 and 2011.

Interventions A sepsis reduction care bundle implemented between July 2006 and December 2007.

Main outcome measures The primary outcome was risk of coagulase-negative Staphylococcus (CONS) infection diagnosed >3 days of age. Secondary outcomes were death and moderate cognitive impairment. A logistic regression model was derived using the birth era as the independent variable with adjustment for typical confounders.

Results In total, 379 infants were born in the preintervention cohort and 378 in the postintervention cohort. The CONS infection rate was reduced after the intervention (26.7% vs 14.1% p<0.001). Death prior to discharge reduced without reaching statistical significance (14.1% vs10.9%, p=0.195). The rate of cognitive disability reduced in the postintervention cohort (18.8% vs 6.1%, p=0.042). The adjusted ORs (95% CI) for CONS infection, death and cognitive impairment were 0.46 (0.29 to 0.72), 0.73 (0.43 to 1.24) and 0.3 (0.07 to 1.33), respectively.

Conclusions There appears to be an association between reduced cognitive disability and the implementation of a sepsis reduction bundle. Further study in larger series is required to confirm these findings.

  • Neonatal infection
  • Quality improvement
  • Neurodisability

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Footnotes

  • JWD and DO contributed equally.

  • Twitter Follow Jonathan Davis at @jonathan_davis3

  • Contributors The study was conceived by KL. SJ performed the neurodevelopment assessments. The data were analysed by DO. The significance of the findings was discussed by all four authors. The initial manuscript was written by JWD with input from the other authors. JWD and DO contributed equally to the production of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are extracted from unit-specific data from an international data collaboration.

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