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Early-onset neonatal infections in Australia and New Zealand, 2002–2012
  1. Tarun Singh1,2,
  2. Elizabeth H Barnes3,
  3. David Isaacs2,4
  4. Australian Study Group for Neonatal Infections
    1. 1 Department of Neonatology, Westmead Hospital, Westmead, New South Wales, Australia
    2. 2 Children’s Hospital at Westmead, Westmead, New South Wales, Australia
    3. 3 NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
    4. 4 Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
    1. Correspondence to Prof. David Isaacs, Department of Infectious Diseases and Microbiology, Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; david.isaacs{at}


    Background The epidemiology of early-onset neonatal sepsis (EONS) varies over time, and requires regular surveillance.

    Objective To analyse data on EONS in Australia and New Zealand.

    Methods Retrospective analysis of data collected longitudinally from multiple neonatal units from 2002 to 2012.

    Results Of 386 423 live births, 454 infants had EONS. The incidence rate of EONS was 1.20 per 1000 live births in 2002 and 0.83 in 2012, decreasing by 4% per year (95% CI 1% to 7%, p=0.007). Group B streptococcus (GBS) (37%) and Escherichia coli (25%) were the most prevalent organisms. The early-onset GBS (EOGBS) incidence rate was 0.43/1000 live births, with no evidence of change over time (p=0.3). Of EOGBS-infected babies, 62% were born at term compared with 8% with early-onset E. coli sepsis, p<0.0001. The mortality of E. coli early-onset sepsis (EOS) (25%) was higher than GBS (11%), but this difference in mortality was no longer significant after adjusting for gestation and birth weight. Mortality from EOS fell significantly over the study period (17% per year, 95% CI 10 to 24, p<0.0001).

    Conclusions GBS was the most common cause of early sepsis, but the incidence was lower than prior to the introduction of intrapartum antibiotic prophylaxis, and remained steady over time. The mortality of early-onset E. coli sepsis was significantly higher than GBS sepsis, but this may have been because almost all babies with E. coli were born preterm, rather than a difference in virulence.

    • group B streptococcus
    • Escherichia coli
    • mortality
    • ESBL
    • antibiotic resistance

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    • Contributors TS analysed the collected data and wrote the manuscript. EHB did all the statistical analyses and reviewed and helped finalise the manuscript. DI conceived the study, collected all the data, and reviewed and helped finalise the manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Royal Alexandra Hospital Ethics Board and regional ethics boards.

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

    • Data sharing statement The database containing deidentified neonatal data on infections and antibiotic use is available on request to bona fide researchers.

    • Collaborators The Australasian Study Group for Neonatal Infections consists of: C Barfield (Monash Medical Centre, Melbourne Australia); D Bourchier (Waikato, New Zealand); G Bury, P Dargaville (Hobart Hospital, Tasmania, Australia); D Cartwright (Royal Women’s Hospital, Brisbane, Australia); A Daley, P McDougall, J Royle (The Royal Children’s Hospital, Melbourne, Australia); B Darlow (Christchurch, New Zealand); S Fraser, J Holberton (Mercy Hospital, Melbourne, Australia); L Gilbert, MD FRACP FRCPA (Westmead Hospital, Sydney, Australia); K Grimwood, MD FRACP (Wellington, New Zealand); The late D Henderson-Smart, H Jeffery (King George V Hospital, Sydney, Australia); R Halliday, D Isaacs (The Children’s Hospital at Westmead, Sydney, Australia); R Kohan (King Edward Memorial Hospital, Perth, Australia); A McPhee (Women’s and Children’s Hospital, Adelaide, Australia); R Messer (Cairns Base Hospital, Cairns, Australia); D Tudehope, D Knight (Mater Hospital, Brisbane, Australia).