Nosocomial infection in small for gestational age newborns with birth weight <1500 g: a multicentre analysis

Abstract

Objective: To investigate whether preterm newborns who are small for gestational age are at increased risk of nosocomial infections and necrotising enterocolitis. Design, setting and subjects: The German national surveillance system for nosocomial infection in very low birthweight infants uses the US Centers for Disease Control and Prevention criteria. 2918 newborns (24-28 weeks), born between 2000 and 2004, were selected after application of predefined inclusion criteria to ensure similar proportions of small and appropriate weight for gestational age newborns across gestational age groups. Main outcome measures: The outcome criterion was at least one episode of nosocomial sepsis, pneumonia or necrotising enterocolitis. Adjusted odds ratios and corresponding 95% CIs were calculated based on general estimating equation models. Results: The study population consisted of 13% (n = 392) small and 87% (n = 2526) appropriate weight for gestational age infants. 33% (n = 950) of the infants experienced at least one episode of sepsis: 42% (n = 163) of small and 31% (n = 787) of appropriate weight for gestational age newborns (adjusted OR 1.41, 95% CI 1.05 to 1.89). Pneumonia was diagnosed in 6% (n = 171) of infants: 8.4% (n = 33) of small and 5.5% (n = 138) of appropriate weight for gestational age newborns (adjusted OR 1.57, 95% CI 1.19 to 5.57). Necrotising enterocolitis was documented in 5.2% (n = 152) of infants: 7.1% (n = 28) of small and 4.9% of (n = 124) appropriate weight for gestational age newborns (adjusted OR 1.20, 95% confidence interval 0.75 to 1.94). Conclusions: Growth-retarded preterm infants seem to be at increased risk of nosocomial infection, irrespective of the responsible pathogen. Future immunological research should elucidate potential causal associations.

Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls

“…Our rates are comparable to those reported in other studies in the pre-prophylaxis era with rates of 2 to 8% in ELBW and 1 to 2% in VLBW infants [4,16-18]. …”

Revisiting the risk of celiac disease in children born small for gestational age: A sibling design perspective

“…However, in preterm children, feeding problems are a recognized concern, irrespective of birth weight [48]. Another aspect is that SGA children might be exposed to more infections [49], which has previously been associated with a higher risk of CD, although the results have been contradictory [11,17,50].…”

Presumed and definite bacteremia in extremely low gestational age newborns

“…Because late bacteremia is regarded as nosocomial, maternal clinical history and demographics do not appear to be as important as for early-onset bacteremia (2). Nevertheless, antepartum hemorrhage, rupture of membranes > 6 hours, and chorioamnionitis appear to be potentially important antecedents (10). Neonatal co-morbidities also contribute to late-onset bacteremia (2, 10).…”

“…Nevertheless, antepartum hemorrhage, rupture of membranes > 6 hours, and chorioamnionitis appear to be potentially important antecedents (10). Neonatal co-morbidities also contribute to late-onset bacteremia (2, 10). In both early and late-onset bacteremia, low birthweight and prematurity are associated with increased risk (2, 7, 8, 10).…”