Risk Factors for Late-Onset Sepsis in Preterm Infants: A Multicenter Case-Control Study

Abstract

Background: Late-onset sepsis (LOS) in preterm infants is a leading cause of mortality and morbidity. Timely recognition and initiation of antibiotics are important factors for improved outcomes. Identification of risk factors could allow selection of infants at an increased risk for LOS. Objectives: The aim was to identify risk factors for LOS. Methods: In this multicenter case-control study, preterm infants born at ≤30 weeks of gestation were included at 9 neonatal intensive care units. Detailed demographical and clinical data were collected daily up to day 28 postnatally. Clinical and demographic risk factors were identified using univariate and multivariate regression analyses in a 1: 1 matched case-control cohort. Results: In total, 755 infants were included, including 194 LOS cases (41 gram-negative cases, 152 gram-positive cases, and 1 fungus). In the case-control cohort, every additional day of parenteral feeding increased the risk for LOS (adjusted OR = 1.29; 95% CI 1.07–1.55; p = 0.006), whereas antibiotics administration decreased this risk (OR = 0.08; 95% CI 0.01–0.88; p = 0.039). These findings could largely be attributed to specific LOS-causative pathogens, since these predictive factors could be identified for gram-positive, but not for gram-negative, LOS cases. Specifically cephalosporins administration prior to clinical onset was inversely related to coagulase-negative staphylococcus LOS (CoNS-LOS) development. Formula feeding was an independent risk factor for development of CoNS-LOS (OR = 3.779; 95% CI 1.257–11.363; p = 0.018). Conclusion: The length of parenteral feeding was associated with LOS, whereas breastmilk administration was protective against CoNS-LOS. A rapid advancement of enteral feeding, preferably with breastmilk, may proportionally reduce the number of parenteral feeding days and consequently the risk for LOS.

Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs

“…Late-onset sepsis (LOS), one of the major contributor to death of preterm infants in neonatal intensive care unit (NICU), is defined as infants with pathogen isolated from the blood culture drawn ≥72 h postnatally and pathogen based antibiotic treatment was continued for ≥5 days [5], with morbidity and mortality rates of 20-38% and 13-19%, respectively [5]. Several neonatal diseases have been identified as risk factors for the development of LOS, including NEC [6].…”

Diet Modulates the High Sensitivity to Systemic Infection in Newborn Preterm Pigs

“…The risk of late onset sepsis (LOS) is 20-40%, with increasing risks at lower gestational ages (1,2). Use of infant formula, or prolonged use of parenteral nutrition, and associated use of catheters, increases the risk of LOS (3). Use of milk based diets shorten the time to full enteral feeding, and thereby removal of central venous catheters as well as reduces the incidence of necrotizing enterocolitis (NEC) (4,5).…”

Introduction of less invasive surfactant administration (LISA), impact on diagnostic and therapeutic procedures in early life: a historical cohort study

“…Moreover, the attending clinician could be less inclined to withhold feeding advancement in non-ventilated infants, who are deemed in a better clinical condition more often. Aggressive feeding strategies may reduce the risk of late-onset sepsis, without increasing the risk of NEC [ 31 , 32 ]. Therefore, we think that this difference in enteral feeding advancement may be beneficial for those infants.…”