Sepsis a major cause of morbidity, death in VLBW infants

Neonatal sepsis is the most common reason for morbidity and mortality in very low birth weight (VLBW) infants, while Escherichia coli and coagulase-negative staphylococci are the most prevalent pathogens, data from a large German neonatal cohort have shown.

“Sepsis is a major cause of death in neonates,” the authors said. “Knowledge about epidemiology, risk factors, causative pathogens, and outcome of neonatal sepsis is important to improve neonatal care.”

The authors obtained data from 14,926 preterm infants with birth weight <1,500 g and gestational age between 22 0/7 weeks and 31 6/7 between January 2009 and December 2017 and analysed these for frequency of early-onset (EOS) and late-onset sepsis (LOS), as well as for causative pathogens.

Multivariate logistic regression models were used to analyse risk factors for the development of EOS and LOS and outcomes after EOS and LOS.

EOS and LOS occurred in 1.1 percent and 11.0 percent of infants, respectively. The most common pathogen in EOS was E. coli and in LOS coagulase-negative staphylococci. Multidrug-resistant organisms were detected in 8.4 percent and 3.9 percent of EOS and LOS cases, respectively.

Lower gestational age, intra-amniotic infection, and spontaneous delivery were associated with EOS. For LOS, the risk factors were lower gestational age, small for gestational age, central lines, endotracheal ventilation, and history of EOS. Moreover, both EOS and LOS independently correlated with adverse neonatal outcome.

“Multidisciplinary approaches such as antibiotic stewardship, hygiene, and feeding strategies are necessary to further reduce the burden of sepsis in VLBW infants,” the authors said.