Postoperative sepsis in infants below 6 months of age

Abstract

Postoperative sepsis syndrome is a frequent complication in infants below 6 months of age and causes significant prolongation of hospital stay. Adequate prevention and therapeutic strategies warrant further prospective investigations.

Combined epidural‐general anaesthesia vs general anaesthesia in neonatal gastrointestinal surgery: A randomized controlled trial

“…In their single‐centre study of patients < 6 months who underwent abdominal and thoracic operations, Kessler et al observed a 6.9% sepsis rate. They identified young postnatal age, prolonged surgical time, the presence of a central venous catheter and pre‐operative antibiotic treatment as risk factors for sepsis . In our study, no significant differences were observed between the CEGA and GA groups, with respect to patient age, weight, surgical time, or duration of central venous catheters.…”

Surgical site infections in infants admitted to the neonatal intensive care unit

“…In addition, the types of surgical interventions usually performed in neonates are also clearly distinct. More recently, Kessler reported a rate of post-operative sepsis of 6.9 % in a smaller cohort of infants of less than 6 months of age admitted to a tertiary care pediatric institution in Switzerland (n = 260) [19]. In this latter study a low gestation, certain types of surgeries as well as a prolonged operative time were associated with an increased rate of post-operative infection, although only the most severe cases of sepsis were included [19].…”

“…More recently, Kessler reported a rate of post-operative sepsis of 6.9 % in a smaller cohort of infants of less than 6 months of age admitted to a tertiary care pediatric institution in Switzerland (n = 260) [19]. In this latter study a low gestation, certain types of surgeries as well as a prolonged operative time were associated with an increased rate of post-operative infection, although only the most severe cases of sepsis were included [19]. Only a minority of infants with SSI presented a positive blood culture in our study, which emphasizes the importance of considering all infant with a clinical diagnosis of SSI regardless of blood culture results.…”

“…Some studies excluded significant neonatal risk groups such as very low birth weight (VLBW) infants [11][12][13]. Finally, other neonatal studies were performed in an ambulatory care setting or in resourcelimited countries [12,[14][15][16][17][18][19], which limits generalization of data to the neonatal intensive care setting where most high-risk interventions occur [10,20]. Given the frequent occurrence of surgical interventions and serious clinical consequences of infection in neonates, and the lack of recent data reporting rates of SSI in this age group, we sought to determine the incidence and clinical impact of SSI in a population-based cohort of infants admitted to a large provincial tertiary care neonatal unit.…”

Author reply

“…[2] Based on a review of the epidemiology of sepsis in the United States (high rates in winter, low rates in summer, high rates in the northeast, low rates in the west, [3] higher rates for African-Americans than white Americans, and comorbid diseases linked to low serum 25-hydroxyvitmin D [25(OH)D]), it was hypothesized that higher serum 25(OH)D levels could reduce the risk of sepsis. As the design of the reported study [1] was observational and retrospective, conclusions on preventive strategies can only be drawn with caution. [5] Thus, it would be worthwhile supplementing infants preparing for surgery with vitamin D to bring their serum 25(OH)D levels above 40 ng/mL (100 nmol/L), the level that has generally been found associated with optimal health.…”