Elsevier

The Journal of Pediatrics

Volume 162, Issue 6, June 2013, Pages 1120-1124.e1
The Journal of Pediatrics

Original Article
Late-Onset Sepsis in Very Low Birth Weight Infants from Singleton and Multiple-Gestation Births

https://doi.org/10.1016/j.jpeds.2012.11.089Get rights and content

Objectives

To describe and compare the incidence of late-onset sepsis (LOS) and demographic and clinical characteristics associated with LOS in very low birth weight (VLBW) infants from singleton and multiple births, and to examine the heritability of susceptibility to LOS among VLBW twins by comparing same-sex and unlike-sex twin pairs.

Study design

The study group comprised infants with birth weight 401-1500 g seen at clinical centers of the Eunice Kennedy Shriver National Institute of Child and Human Development Neonatal Research Network between 2002 and 2008. Only the first episode of LOS was included in our analysis. Stepwise logistic regression models were fitted separately for singleton and multiple pregnancies to examine the maternal and neonatal factors associated with LOS. LOS due solely to gram-negative bacteria in singleton and multiple pregnancies was also examined in separate models. The heritability of LOS was estimated by examining the concordance of LOS in twins from same-sex and unlike-sex pairs.

Results

LOS occurred in 25.0% (3797 of 15 178) of singleton and 22.6% (1196 of 5294) of multiple-birth VLBW infants. Coagulase-negative staphylococci were the most common infecting organisms, accounting for 53.2% of all LOS episodes in singletons and 49.2% in multiples. Escherichia coli and Klebsiella species were the most commonly isolated gram-negative organisms, and Candida albicans was the most commonly isolated fungus. Concordance of LOS did not differ significantly between same-sex and unlike-sex twin pairs.

Conclusion

LOS remains a common problem in VLBW infants. The incidence of LOS is similar for singleton and multiple-birth infants. The similar concordance of LOS in same-sex and unlike-sex twin pairs provides no evidence that susceptibility to LOS among VLBW infants is genetically determined.

Section snippets

Methods

The study group comprised infants with birth weight 401-1500 g born between January 1, 2002, and December 31, 2008, and seen at NRN clinical centers. Eligibility criteria changed in January 2008 to inborn infants with birth weight 401-1000 g or gestational age 22-28 6/7 weeks. Trained research nurses entered maternal demographic, pregnancy, and delivery information and infant data collected from birth to hospital discharge, death, or 120 days of life into a registry of VLBW infants maintained

Incidence of Infection

A total of 16 713 VLBW singleton infants and 5860 VLBW twins or higher-order multiple-born infants were admitted to NRN centers between 2002 and 2008. Data on LOS status were available for 15 178 singletons and 5294 multiples who met the study's eligibility criteria. The overall rate of LOS was 25.0% (males, 27.3%; females, 22.8%) among singletons and 22.6% (males, 25.2%; females, 20.0%) among multiples. Rates of LOS were similar between singletons and multiples in all gestational age and birth

Discussion

LOS continues to be a major cause of mortality and morbidity among VLBW infants. In the present study, 24.4% of the VLBW infants born between 2002 and 2008 developed at least 1 episode of sepsis beyond day 3 of life. This rate is higher than reported previously. Using the NRN database, Stoll et al6 reported an incidence rate of 21.1% during the period 1998-2000. The greatest increase was seen in the group of infants with birth weight 400-750 g, in whom LOS increased from 42.8% to 52.8%. The

References (28)

  • E.E. Rubin et al.

    Group B streptococcal disease in twins: failure of empiric therapy to prevent late onset disease in the second twin

    Pediatr Infect Dis J

    (1991)
  • W.E. Benitz et al.

    Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review

    Pediatrics

    (1999)
  • K.S. Doran et al.

    Late-onset group B streptococcal infection in identical twins: insight to disease pathogenesis

    J Perinatol

    (2002)
  • M.J. Simchen et al.

    Neonatal outcome in growth-restricted versus appropriately grown preterm infants

    Am J Perinatol

    (2000)
  • Cited by (0)

    Supported by grants from the National Institutes of Health (NIH) and the Eunice Kennedy Shriver National Institute of Child and Human Development (NICHD) for the Neonatal Research Network's Generic Database and Follow-up Studies. Data collected at participating sites of the NICHD Neonatal Research Network were transmitted to RTI International, the data coordinating center for the network, which stored, managed, and analyzed the data for this study. R.H. is an employee of NIH and assisted with the study design, analysis, interpretation of data, writing of the report, and the decision to submit it for publication. The authors declare no conflicts of interest.

    A list of members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network is available at www.jpeds.com (Appendix).

    View full text