Late-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network☆,☆☆,★,★★
Section snippets
Population database
The NICHD Neonatal Research Network is a consortium of tertiary academic neonatal centers. The Network maintains a registry of all VLBW infants cared for at participating centers. This registry was described previously6 and is reviewed in the related article on early-onset sepsis.6a
Late-onset sepsis was defined as positive results on one or more blood cultures obtained after 72 hours of life, in the presence of clinical signs or symptoms suggestive of infection. The specific indications for
Incidence of infection
Between May 1, 1991, and Dec. 31, 1993, a total of 7861 VLBW neonates were admitted to Network centers. Because this study reviews infections occurring after 72 hours of life, neonates who died in the first 3 days of life were excluded from the analysis of late-onset infection (however, the section on “mortality attributed to infection” does include deaths associated with both early-onset and late-onset infection). The results presented are based on 6911 neonates who survived at least 3 days.
DISCUSSION
Late-onset sepsis occurred frequently among VLBW neonates receiving care at the 12 NICHD Neonatal Research Network centers. Approximately one fourth of all VLBW neonates who survived beyond 3 days of age had at least one episode of late-onset sepsis; 25% of infected infants had multiple episodes. Birth weight and gestational age were the greatest risk factors for the development of late-onset sepsis. Incidence of infection increased with decreasing birth weight and gestational age.
Acknowledgements
We thank the research nurses of the NICHD Neonatal Research Network for careful data collection.
Members of the NICHD Neonatal Research Network are as follows: from Pennsylvania State University College of Medicine, Hershey: Ronald L. Poland, MD, Chairman; Case Western Reserve University, Cleveland, Ohio: Avroy A. Fanaroff, MB, BCh, Maureen Hack, MB, ChB, and Nancy Shenker Newman, RN; University of Cincinnati, Cincinnati, Ohio: Edward F. Donovan, MD, Reginald C. Tsang, MD, and Marcia Mersmann,
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Cited by (0)
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From Emory University, Atlanta, Georgia; George Washington University Biostatistics Center, Rockville, Maryland; University of Tennessee at Memphis; Wayne State University, Detroit, Michigan; University of Texas Southwestern Medical Center, Dallas; University of Miami, Miami, Florida; Case Western Reserve University, Cleveland, Ohio; Indiana University, Indianapolis; University of Cincinnati, Cincinnati, Ohio; Women and Infants Hospital, Providence, Rhode Island; Stanford University, Stanford, California; Yale University, New Haven, Connecticut; University of New Mexico, Albuquerque; and the National Institute of Child Health and Human Development, Bethesda, Maryland
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Supported by the National Institute of Child Health and Human Development through Cooperative Agreements: U10 HD21397, U10 HD27853, U10 HD27871, U10 HD21364, U10 HD21415, U10 HD27856, U10 HD27904, U10 HD27881, U10 HD21385, U10 HD27880, U10 HD27851, U10 HD21373, and U01 HD19897.
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Reprint requests: Barbara J. Stoll, MD, Emory University School of Medicine, Department of Pediatrics, 2040 Ridgewood Dr., Atlanta, GA 30322.
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