Neonatal infections in England: the NeonIN surveillance network
- Stefania Vergnano1,
- Esse Menson2,
- Nigel Kennea3,
- Nick Embleton4,
- Alison Bedford Russell5,
- Timothy Watts6,
- Michael J Robinson7,
- Andrew Collinson8,
- Paul T Heath9
- 1Division of Child Health, St George's, University of London, London, UK
- 2The Evelina Children's Hospital, Westminster, London UK
- 3St George's Hospital NHS Trust, Tooting, London, UK
- 4Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- 5Heart of England NHS Trust, Birmingham, UK
- 6St Thomas' Hospital, London, UK
- 7Hope Hospital, Salford, Manchester, UK
- 8Neonatal Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- 9Division of Child Health, St George's, University of London, London, UK
- Correspondence to Dr Stefania Vergnano, Division of Child Health, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK;
- Accepted 26 April 2010
- Published Online First 27 September 2010
Introduction Neonatal infection is an important cause of morbidity and mortality. Neonatal infection surveillance networks are necessary for defining the epidemiology of infections and monitoring changes over time.
Design Prospective multicentre surveillance using a web-based database.
Setting 12 English neonatal units.
Participants Newborns admitted in 2006–2008, with positive blood, cerebrospinal fluid or urine culture and treated with antibiotics for at least 5 days.
Outcome measure Incidence, age at infection, pathogens and antibiotic resistance profiles.
Results With the inclusion of coagulase negative Staphylococci (CoNS), the incidence of all neonatal infection was 8/1000 live births and 71/1000 neonatal admissions (2007–2008). The majority of infections occurred in premature (<37 weeks) and low birthweight (<2500 g) infants (82% and 81%, respectively). The incidence of early onset sepsis (EOS; ≤48 h of age) was 0.9/1000 live births and 9/1000 neonatal admissions, and group B Streptococcus (58%) and Escherichia coli (18%) were the most common organisms. The incidence of late onset sepsis (LOS; >48 h of age) was 3/1000 live births and 29/1000 neonatal admissions (7/1000 live births and 61/1000 admissions including CoNS) and the most common organisms were CoNS (54%), Enterobacteriaceae (21%) and Staphylococcus aureus (18%, 11% of which were methicillin resistant S aureus). Fungi accounted for 9% of LOS (72% Candida albicans). The majority of pathogens causing EOS (95%) and LOS (84%) were susceptible to commonly used empiric first line antibiotic combinations of penicillin/gentamicin and flucloxacillin/gentamicin, respectively (excluding CoNS).
Conclusions The authors have established NeonIN in England and defined the current epidemiology of neonatal infections. These data can be used for benchmarking among units, international comparisons and as a platform for interventional studies.
Competing interests None.
Ethics approval The NeonIN study received ethics approval from the London-Surrey Borders Research Ethics Committee in April 2005 (05/Q0806/34). Each participating centre received separate approval from their local ethics committees prior to joining the network.
Provenance and peer review Not commissioned; externally peer reviewed.