Clinical Indicators of Late-Onset Sepsis Workup in Very Low-Birth-Weight Infants in the Neonatal Intensive Care Unit

Abstract

Background Late-onset sepsis (LOS) in very low-birth-weight (VLBW) infants is associated with significant morbidity and mortality.

Objectives To determine the incidence of LOS workup, association, and predictive value of clinical indicators leading to culture-positive versus culture-negative sepsis workup.

Methods All sepsis workups performed after 7 days of life, in neonates with birth weight of < 1,500 g were included. Each case (culture-positive workup) was matched with a control (culture-negative workup) for gestational age (GA), birth weight, corrected gestational age, and chronological age, at the time of workup. The clinical indicators leading to the performance of sepsis workup were compared between cases and controls.

Results The incidence of culture-positive workup was 87/345 (25.2%) and that of LOS was 84/279 (30.1%). Among various clinical indicators, hypothermia and apnea were significantly associated with culture-positive sepsis workup (p = 0.015 and 0.004, respectively), with a positive predictive value of 81.2 and 71.4%, respectively.

Conclusion In VLBW infants, one-fourth of sepsis workups resulted in a positive culture. Apnea and hypothermia were the most significant predictors of culture-positive workup after matching for GA, birth weight, chronological age, and corrected GA at the time of the workup.

Keywords

late-onset sepsis - sepsis workup - very low birth weight - neonate - newborn

• References

• 1 Tröger B, Göpel W, Faust K , et al; German Neonatal Network. Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multicenter study from the German Neonatal Network. Pediatr Infect Dis J 2014; 33 (3) 238-243
• 2 Hornik CP, Fort P, Clark RH , et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev 2012; 88 (Suppl. 02) S69-S74
• 3 Stoll BJ, Hansen N, Fanaroff AA , et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1) 285-291
• 4 van der Ree M, Tanis JC, Van Braeckel KN, Bos AF, Roze E. Functional impairments at school age of preterm born children with late-onset sepsis. Early Hum Dev 2011; 87 (12) 821-826
• 5 Hentges CR, Silveira RC, Procianoy RS , et al. Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight. J Pediatr (Rio J) 2014; 90 (1) 50-57
• 6 Fanaroff AA, Korones SB, Wright LL , et al; The National Institute of Child Health and Human Development Neonatal Research Network. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. Pediatr Infect Dis J 1998; 17 (7) 593-598
• 7 American Academy of Pediatrics. Group B streptococcal infections. In: Kimberlin DW, ed. Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015: 745
• 8 Lahra MM, Beeby PJ, Jeffery HE. Intrauterine inflammation, neonatal sepsis, and chronic lung disease: a 13-year hospital cohort study. Pediatrics 2009; 123 (5) 1314-1319
• 9 Bekhof J, Reitsma JB, Kok JH, Van Straaten IH. Clinical signs to identify late-onset sepsis in preterm infants. Eur J Pediatr 2013; 172 (4) 501-508
• 10 Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015; 100 (3) F257-F263
• 11 Kudawla M, Dutta S, Narang A. Validation of a clinical score for the diagnosis of late onset neonatal septicemia in babies weighing 1000-2500 g. J Trop Pediatr 2008; 54 (1) 66-69
• 12 Shah J, Jefferies AL, Yoon EW, Lee SK, Shah PS ; Canadian Neonatal Network. Risk Factors and Outcomes of Late-Onset Bacterial Sepsis in Preterm Neonates Born at < 32 Weeks' Gestation. Am J Perinatol 2015; 32 (7) 675-682
• 13 Tsai MH, Hsu JF, Chu SM , et al. Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis. Pediatr Infect Dis J 2014; 33 (1) e7-e13
• 14 Gur I, Markel G, Nave Y, Vainshtein I, Eisenkraft A, Riskin A. A mathematical algorithm for detection of late-onset sepsis in very-low birth weight infants: a preliminary diagnostic test evaluation. Indian Pediatr 2014; 51 (8) 647-650
• 15 Mularoni A, Madrid M, Azpeitia A, Valls i Soler A. The role of coagulase-negative staphylococci in early onset sepsis in a large European cohort of very low birth weight infants. Pediatr Infect Dis J 2014; 33 (5) e121-e125
• 16 Bradford R, Manan RA, Garland SM, Daley AJ, Deighton MA. Coagulase-negative staphylococci in low birth weight infants: environmental factors affecting biofilm production in Staphylococcus epidermidis. Curr Microbiol 2011; 62 (3) 850-854
• 17 Eggink BH, Rowen JL. Primary osteomyelitis and suppurative arthritis caused by coagulase-negative staphylococci in a preterm neonate. Pediatr Infect Dis J 2003; 22 (6) 572-573
• 18 Gruskay J, Harris MC, Costarino AT, Polin RA, Baumgart S. Neonatal Staphylococcus epidermidis meningitis with unremarkable CSF examination results. Am J Dis Child 1989; 143 (5) 580-582
• 19 Craft A, Finer N. Nosocomial coagulase negative staphylococcal (CoNS) catheter-related sepsis in preterm infants: definition, diagnosis, prophylaxis, and prevention. J Perinatol 2001; 21 (3) 186-192 Review
• 20 Leante-Castellanos JL, Lloreda-García JM, García-González A , et al. Central-peripheral temperature gradient: an early diagnostic sign of late-onset neonatal sepsis in very low birth weight infants. J Perinat Med 2012; 40 (5) 571-576