Journal article
Impact of Early-Onset Sepsis and Antibiotic Use on Death or Survival with Neurodevelopmental Impairment at 2 Years of Age among Extremely Preterm Infants
The Journal of pediatrics, Vol.221, pp.39-46.e5
06/2020
DOI: 10.1016/j.jpeds.2020.02.038
PMCID: PMC7248124
PMID: 32446491
Abstract
To evaluate the hypothesis that early-onset sepsis increases risk of death or neurodevelopmental impairment (NDI) among preterm infants; and that among infants without early-onset sepsis, prolonged early antibiotics alters risk of death/NDI.
Retrospective cohort study of infants born at the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers (2006-2014) at 22-26 weeks of gestation and birth weight 401-1000 g. Early-onset sepsis defined as growth of a pathogen from blood or cerebrospinal fluid culture ≤72 hours after birth. Prolonged early antibiotics was defined as antibiotics initiated ≤72 hours and continued ≥5 days without culture-confirmed infection, necrotizing enterocolitis, or spontaneous perforation. Primary outcome was death before follow-up or NDI assessed at 18-26 months corrected age. Poisson regression was used to estimate adjusted relative risk (aRR) and CI for early-onset sepsis outcomes. A propensity score for receiving prolonged antibiotics was derived from early clinical factors and used to match infants (1:1) with and without prolonged antibiotic exposure. Log binomial models were used to estimate aRR for outcomes in matched infants.
Among 6565 infants, those with early-onset sepsis had higher aRR (95% CI) for death/NDI compared with infants managed with prolonged antibiotics (1.18 [1.06-1.32]) and to infants without prolonged antibiotics (1.23 [1.10-1.37]). Propensity score matching was achieved for 4362 infants. No significant difference in death/NDI (1.04 [0.98-1.11]) was observed with or without prolonged antibiotics among the matched cohort.
Early-onset sepsis was associated with increased risk of death/NDI among extremely preterm infants. Among matched infants without culture-confirmed infection, prolonged early antibiotic administration was not associated with death/NDI.
Details
- Title: Subtitle
- Impact of Early-Onset Sepsis and Antibiotic Use on Death or Survival with Neurodevelopmental Impairment at 2 Years of Age among Extremely Preterm Infants
- Creators
- Sagori Mukhopadhyay - University of PennsylvaniaKaren M. Puopolo - Children's Hospital of PhiladelphiaNellie I. Hansen - RTI InternationalScott A. Lorch - University of PennsylvaniaSara B. DeMauro - Children's Hospital of PhiladelphiaRachel G. Greenberg - Duke UniversityC. Michael Cotten - Duke UniversityPablo J. Sánchez - The Ohio State UniversityEdward F. Bell - University of IowaEric C. Eichenwald - University of PennsylvaniaBarbara J. Stoll - The University of Texas Health Science CenterNational Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.221, pp.39-46.e5
- DOI
- 10.1016/j.jpeds.2020.02.038
- PMID
- 32446491
- PMCID
- PMC7248124
- NLM abbreviation
- J Pediatr
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100000002, name: National Institutes of Health; DOI: 10.13039/100009633, name: Eunice Kennedy Shriver National Institute of Child Health and Human Development; DOI: 10.13039/100000097, name: National Center for Research Resources; DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences
- Language
- English
- Date published
- 06/2020
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984353846302771
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