Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis

Karen M Puopolo; Sagori Mukhopadhyay; Nellie I Hansen; C Michael Cotten; Barbara J Stoll; Pablo J Sanchez; Edward F Bell; Abhik Das; Angelita M Hensman; Krisa P Van Meurs; Myra H Wyckoff; NICHD Neonatal Research Network

doi:10.1542/peds.2017-0925

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Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis

Journal article

Open access

Peer reviewed

Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis

Karen M Puopolo, Sagori Mukhopadhyay, Nellie I Hansen, C Michael Cotten, Barbara J Stoll, Pablo J Sanchez, Edward F Bell, Abhik Das, Angelita M Hensman, Krisa P Van Meurs, …

Pediatrics (Evanston), Vol.140(5), e20170925

11/2017

DOI: 10.1542/peds.2017-0925

PMCID: PMC5654397

PMID: 28982710

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https://europepmc.org/articles/pmc5654397View

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Abstract

Premature infants are at high risk of early-onset sepsis (EOS) relative to term infants, and most are administered empirical antibiotics after birth. We aimed to determine if factors evident at birth could be used to identify premature infants at lower risk of EOS. Study infants were born at 22 to 28 weeks' gestation in Neonatal Research Network centers from 2006 to 2014. EOS was defined by isolation of pathogenic species from blood or cerebrospinal fluid culture at ≤72 hours age. Infants were hypothesized as "low risk" for EOS when delivered via cesarean delivery, with membrane rupture at delivery, and absence of clinical chorioamnionitis. Frequency of prolonged antibiotics (≥5 days) was compared between low-risk infants and all others. Risks of mortality, EOS, and other morbidities were assessed by using regression models adjusted for center, race, antenatal steroid use, multiple birth, sex, gestation, and birth weight. Of 15 433 infants, 5759 (37%) met low-risk criteria. EOS incidence among infants surviving >12 hours was 29 out of 5640 (0.5%) in the low-risk group versus 209 out of 8422 (2.5%) in the comparison group (adjusted relative risk = 0.24 [95% confidence interval, 0.16-0.36]). Low-risk infants also had significantly lower combined risk of EOS or death ≤12 hours. Prolonged antibiotics were administered to 34% of low-risk infants versus 47% of comparison infants without EOS. Delivery characteristics of extremely preterm infants can be used to identify those with significantly lower incidence of EOS. Recognition of differential risk may help guide decisions to limit early antibiotic use among approximately one-third of these infants.

Registries

Adult

Anti-Bacterial Agents - therapeutic use

Female

Humans

Infant, Extremely Premature

Infant, Newborn

Infant, Premature, Diseases - diagnosis

Infant, Premature, Diseases - drug therapy

Infant, Premature, Diseases - mortality

Male

Risk Factors

Sepsis - diagnosis

Sepsis - drug therapy

Sepsis - mortality

Young Adult

Details

Title: Subtitle: Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis
Creators: Karen M Puopolo - University of Pennsylvania
Sagori Mukhopadhyay - University of Pennsylvania
Nellie I Hansen - RTI International
C Michael Cotten - Duke University
Barbara J Stoll - The University of Texas Health Science Center at Houston
Pablo J Sanchez - Nationwide Children's Hospital
Edward F Bell - University of Iowa
Abhik Das - RTI International
Angelita M Hensman - Women & Infants Hospital of Rhode Island
Krisa P Van Meurs - Stanford University
Myra H Wyckoff - The University of Texas Southwestern Medical Center
NICHD Neonatal Research Network
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.140(5), e20170925
DOI: 10.1542/peds.2017-0925
PMID: 28982710
PMCID: PMC5654397
NLM abbreviation: Pediatrics
ISSN: 0031-4005
eISSN: 1098-4275
Grant note: U10 HD053124 / NICHD NIH HHS UG1 HD027851 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS U10 HD053119 / NICHD NIH HHS U10 HD027871 / NICHD NIH HHS M01 RR008084 / NCRR NIH HHS UL1 RR025764 / NCRR NIH HHS M01 RR016587 / NCRR NIH HHS UG1 HD027880 / NICHD NIH HHS U10 HD040498 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD040492 / NICHD NIH HHS U10 HD021397 / NICHD NIH HHS U10 HD068244 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS U10 HD040521 / NICHD NIH HHS U10 HD068270 / NICHD NIH HHS U10 HD053089 / NICHD NIH HHS U10 HD040689 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD068284 / NICHD NIH HHS U10 HD068278 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS U10 HD034216 / NICHD NIH HHS UL1 TR001111 / NCATS NIH HHS UG1 HD040689 / NICHD NIH HHS M01 RR007122 / NCRR NIH HHS UL1 TR001117 / NCATS NIH HHS U10 HD021385 / NICHD NIH HHS U10 HD068263 / NICHD NIH HHS U10 HD040461 / NICHD NIH HHS
Language: English
Date published: 11/2017
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984354152302771

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