Perinatal risk factors for neonatal early-onset sepsis: a meta-analysis of observational studies

Guo, Liyan; Han, Wenxiao; Su, Yan; Wang, Na; Chen, Xinqing; Ma, Jinjin; Liang, Jiaojiao; Hao, Ling; Ren, Changjun

doi:10.1080/14767058.2023.2259049

Cited by 5 publications

(1 citation statement)

References 33 publications

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“…EOS confirmed by positive blood cultures is rare with an incidence of 1–4% [ 18 ], but EOS is frequently suspected due to the high prevalence of maternal PROM and chorioamnionitis [ 19 ], and culture-negative EOS is often treated. Other risk factors for EOS are perinatal asphyxia, amniotic fluid meconium contamination, maternal urinary tract infection, and vaginal examinations [ 20 ]. Most often, Group B Streptococcus (GBS) and Escherichia coli ( E. coli ) are the bacteria associated with EOS.…”

Section: Introductionmentioning

confidence: 99%

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Dail,

Everhart,

Iskersky

et al. 2024

TropicalMed

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Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at <32 weeks gestational age (GA) between 2019–2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. Results: The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

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Section: Introductionmentioning

confidence: 99%

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Dail,

Everhart,

Iskersky

et al. 2024

TropicalMed

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Associations between cord serum antibodies against phosphorylcholine and bacterial infections in neonates: a prospective cohort study in singletons and twins

Chen,

Zheng,

Tan

et al. 2024

Preprint

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Background. Antibodies against phosphorylcholine (anti-PC) are reported to protect against infection. However, the association between cord serum anti-PC and bacterial infection in neonates is yet to be investigated. This study aimed to investigate these associations among both singletons and twins. Methods. A total of 1007 neonates (329 singletons and 678 twins) within the hospital-based Shenzhen Baoan Birth & Twin cohort were included in this study. Levels of IgM anti-PC, IgG anti-PC, as well as IgM, IgG, and IgA in cord serum were measured by enzyme-linked immunosorbent assay. Diagnoses of bacterial infections were identified within 0-27 days after birth. Multivariable logistic regression with propensity score adjustment was performed to assess the associations between levels of antibodies and neonatal bacterial infections. Results. The mean (standard deviation) levels of IgM and IgG anti-PC were 46.68 (14.15) ng/ml and 73.68 (30.44) ng/ml, respectively. Neonatal bacterial infections were diagnosed in 24 singletons (7.29%) and 48 twins (7.08%). A higher level of IgM anti-PC was associated with a lower risk of neonatal bacterial infections in the analyses of singletons (Odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.41-0.99) or discordant twin pairs (concerning bacterial infection) (OR: 0.44, 95% CI: 0.20-0.95). Statistically significant association was also shown for IgG among singletons and the first-born twins, but not for IgG anti-PC, IgM, or IgA. Conclusion. A higher cord serum level of IgM anti-PC is associated with a lower risk of bacterial infections in neonates.

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Prenatal and Postnatal Disparities in Very Preterm Infants in a Study of Infections between 2018–2023 in the Southeastern US

Dail,

Everhart,

Iskersky

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: The birthrate of Black preterm (BPT) infant is 65% higher than White preterm (WPT) infants with BPT mortality 2.3 times higher. The incidence of culture positive sepsis is as high as 41% in preterms. This study aimed to examine infections and mortality in BPTs and WPTs. Methods: We enrolled 362 preterms born < 32 weeks gestational age (GA) between 2019-2023 in 5 neonatal intensive care unit (NICU)s to study onset of infections, and dispositions; RedCap data were analyzed for descriptive statistics. Results: 226 BPTs (63.5%) and 107 WPTs (30.8%) enrolled, with 29 other than White or Black, 50.5% female, mean GA of 27.67 weeks and 986.74 grams birthweight. Of 426 suspected infections evaluated in enrolled infants, there were 7 infants with early onset sepsis (EOS) and 39 infants with late onset sepsis (LOS). The incidence of EOS was 1.9% overall, 2.2% in BPTs vs 0.9% in WPTs. LOS incidence was 10.8% overall, 11.9% in BPTs and 9.3% in WPTs. Both BPT and WPT infants had ~ 8% gram-positive LOS events and 3% gram-negative LOS events; however, 82% of all gram-negative LOS episodes occurred in BPTs. There were 27 urinary tract infections and 78% were in BPTs. Two cerebral spinal fluid cultures were positive in BPTs. Necrotizing enterocolitis was diagnosed in 5.8% of the sample, with an incidence of 6.1% in BPTs versus 4.7% in WPTs. Death occurred in 6.0% of the enrolled infants with the rate of death being slightly higher in BPTs (7.0%) versus WPTs (5.6%). Conclusions: BPTs had a higher rate of positive cultures, double the gram-negative infections, a much higher rate of urinary tract infec-tions and a higher rate of mortality than their WPT counterparts. This study emphasizes higher risk of morbidity and mortality for BPTs.

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Perinatal risk factors for neonatal early-onset sepsis: a meta-analysis of observational studies

Cited by 5 publications

References 33 publications

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Associations between cord serum antibodies against phosphorylcholine and bacterial infections in neonates: a prospective cohort study in singletons and twins

Prenatal and Postnatal Disparities in Very Preterm Infants in a Study of Infections between 2018–2023 in the Southeastern US

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