Early and late onset sepsis and retinopathy of prematurity in a cohort of preterm infants

Bonafiglia, Elena; Gusson, Elena; Longo, Rosa; Ficial, Benjamim; Tisato, Maria Giulia; Rossignoli, Sara; Caltran, Giulia; Pedrotti, Emilio; Beghini, Renzo; Marchini, Giorgio

doi:10.1038/s41598-022-15804-4

Cited by 18 publications

(18 citation statements)

References 28 publications

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“…We found higher adjusted odds of subsequent severe BPD, cPVL and severe ROP in patients who had experienced one or more culture-positive LOS episodes when compared with non-infected infants. These results are consistent with the existing literature indicating the detrimental effect of LOS and inflammation on both the lungs, eyes and the brain 2 4 7 21 25 34 36…”

Section: Discussionsupporting

confidence: 93%

“…We used logistic regression analysis to evaluate the association between different types of LOS and severe BPD, severe ROP and cPVL. Based on previous reports, [20][21][22][23][24] and by drawing directed acyclic graphs, we selected relevant confounders for the different morbidities, including Apgar 5 min score, CRIB2 score, days of MV in the first week of life, days of antibiotic exposure in the first week of life, severe ICH and early-onset sepsis (EOS). During the 10-year study period, in Norway, there was from 2014 a trend towards increasingly proactive management of preterm infants born at 23 weeks' gestation.…”

Section: Methodsmentioning

confidence: 99%

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Late-onset sepsis in very preterm infants in Norway in 2009–2018: a population-based study

Huncikova

Vatne

Stensvold

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo evaluate epidemiology and outcomes among very preterm infants (<32 weeks’ gestation) with culture-positive and culture-negative late-onset sepsis (LOS).DesignCohort study using a nationwide, population-based registry.Setting21 neonatal units in Norway.ParticipantsAll very preterm infants born 1 January 2009–31 December 2018 and admitted to a neonatal unit.Main outcome measuresIncidences, pathogen distribution, LOS-attributable mortality and associated morbidity at discharge.ResultsAmong 5296 very preterm infants, we identified 582 culture-positive LOS episodes in 493 infants (incidence 9.3%) and 282 culture-negative LOS episodes in 282 infants (incidence 5.3%). Extremely preterm infants (<28 weeks’ gestation) had highest incidences of culture-positive (21.6%) and culture-negative (11.1%) LOS. The major causative pathogens were coagulase-negative staphylococci (49%),Staphylococcus aureus(15%), group B streptococci (10%) andEscherichia coli(8%). We observed increased odds of severe bronchopulmonary dysplasia (BPD) associated with both culture-positive (adjusted OR (aOR) 1.7; 95% CI 1.3 to 2.2) and culture-negative (aOR 1.6; 95% CI 1.3 to 2.6) LOS. Only culture-positive LOS was associated with increased odds of cystic periventricular leukomalacia (cPVL) (aOR 2.2; 95% CI 1.4 to 3.4) and severe retinopathy of prematurity (ROP) (aOR 1.8; 95% CI 1.2 to 2.8). Culture-positive LOS-attributable mortality was 6.3%, higher in Gram-negative (15.8%) compared with Gram-positive (4.1%) LOS, p=0.009. Among extremely preterm infants, survival rates increased from 75.2% in 2009–2013 to 81.0% in 2014–2018, p=0.005. In the same period culture-positive LOS rates increased from 17.1% to 25.6%, p<0.001.ConclusionsLOS contributes to a significant burden of disease in very preterm infants and is associated with increased odds of severe BPD, cPVL and severe ROP.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Late-onset sepsis in very preterm infants in Norway in 2009–2018: a population-based study

Huncikova

Vatne

Stensvold

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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“…Many variables other than oxygen are associated with ROP and we are far from understanding the purportedly complex relationship among then 21 . Among the topics that have received increased attention recently are prenatal risk factors, 22 and postnatal sepsis, 23,24 in particular late neonatal sepsis 25,26 . Both oxygen and infection can trigger systemic inflammation, which makes room for the speculation that inflammation might not be an innocent bystander in ROP etiopathogenesis 27‐29 .…”

Section: Etiologymentioning

confidence: 99%

Retinopathy of prematurity

Dammann

Hartnett

Stahl

2022

Develop Med Child Neuro

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Despite momentous improvements in perinatal care over the past few decades, retinopathy of prematurity (ROP) remains an interdisciplinary challenge for neonatologists and pediatric ophthalmologists. In the USA, treatment-warranted ROP increased from 3.4% to 5.3% between 2009 and 2018 among infants of 30 weeks gestation or less at birth. 1 In the international Vermont Oxford Network data, the median prevalence of severe ROP declined from 9% in 2005 to 6% in 2011, but has not further declined during the years 2011 to 2014. 2 In 2010, an estimated 185 000 infants born preterm developed any ROP and 20 000 subsequently suffered severe visual impairment or blindness. 3 In this review, our goal is to provide an overview of recent developments in our thinking about etiology, pathogenesis, diagnosis, intervention, and outcomes of ROP. Our aim is not to give an exhaustive overview, but to concentrate on novel ideas and findings. Reference to previous reviews is made where appropriate.The incidence of ROP decreases with increasing gestational age at birth, and it occurs mainly, but not exclusively, among infants born extremely preterm (<28 weeks gestational age) in high-income countries. A 'third epidemic' of ROP, however, is ongoing in low-and middle-income countries; here, the majority of infants with severe ROP appear to be more than 29 weeks gestational age. 4 [Correction added on 5 December 2022 after first online publication: In the sentence ''A 'third epidemic' … be more than 29 weeks gestational age'', the word 'less' was updated to 'more'.] The phenotype and disease trajectory in these more mature infants differ appreciably from that in infants born extremely preterm, which comes with its own set of difficulties regarding screening and intervention.ROP is a developmental disorder in that the clinical picture changes over the course of the neonatal and postneonatal periods. In essence, the underlying developmental process of typical retinal vascularization is affected in different ways at different time-points. 5 Clinically, the predominant feature of the disorder is abnormal retinal vascular development, beginning with a first phase of retinal vessel development cessation or delay shortly after birth that is exacerbated during the ensuing

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“…Many studies have indicated that sepsis was closely related to the appearance of any stage of retinopathy and associated with AP-ROP 18 , 19 . In our work, there were no differences in early-onset sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the presence of arterial hypotension during first week of life was related to a higher frequency of ROP development and progression, it could be possibly associated with patient worsening general condition as well as hypoperfusion and subsequent reperfusion problems. Many studies have indicated that sepsis was closely related to the appearance of any stage of retinopathy and associated with AP-ROP 18,19 . In our work, there were no differences in early-onset sepsis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with Retinopathy of Prematurity development and progression

Ramírez

Aranda

Díaz

et al. 2022

Sci Rep

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Several studies propose that Retinopathy of Prematurity (ROP) is a multifactorial disorder implicating many prenatal and postnatal factors. The objective of our study was to determine the incidence and the risk factors that influenced ROP development and progression. We retrospectively compiled data of preterms with birth weight (BW) ≤ 1.500 g and/or gestational age (GA) < 32 weeks, or BW between 1.501 and 2.000 g and/or GA ≥ 32 weeks with oxygen supply > 72 h or unstable clinical course screened for ROP in Regional University Hospital of Málaga from 2015 to 2018. 202 infants (44.7%) developed ROP and 66 exhibited progression (32.7% of ROP infants). In the univariate analysis, many risk factors were associated with ROP. In the subsequent multivariate analysis, GA, oxygen therapy and weight at 28 days of life, mechanical ventilation duration, non-invasive ventilation, surfactant administration and late-onset sepsis were independently associated with the development. However, oxygen therapy duration, late-onset sepsis and weight at 28 days were associated with the progression. The ROP development and progression risk factors were different. Our results are important to facilitate screening, early diagnosis and ROP treatment while reducing unneeded examinations.

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Early and late onset sepsis and retinopathy of prematurity in a cohort of preterm infants

Cited by 18 publications

References 28 publications

Late-onset sepsis in very preterm infants in Norway in 2009–2018: a population-based study

Late-onset sepsis in very preterm infants in Norway in 2009–2018: a population-based study

Retinopathy of prematurity

Risk factors associated with Retinopathy of Prematurity development and progression

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