A clinical analysis of sepsis in very low birth weight infants
HU Xiao-Shan, ZHU Jin-Gai, JIANG Cheng-Yao, CHEN Xiao-Hui, YU Zhang-Bin, HAN Shu-Ping
Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital, Nanjing 210004, China
Abstract Objective To study the incidence and clinical features of sepsis in very low birth weight (VLBW) infants. Methods The clinical data were collected from VLBW infants, with a birth weight of < 1 500 g, who were admitted to the Department of Neonatology, Maternity Hospital Affiliated to Nanjing Medical University, from January 2019 to June 2020. The incidence of sepsis, distribution of pathogenic bacteria, and risk factors for sepsis were analyzed. Results A total of 369 infants were enrolled, and 138 infants had sepsis, among whom 84 had early-onset sepsis (EOS) and 54 had late-onset sepsis (LOS). Enterococcus faecalis (24%) and Streptococcus (21%) were the main pathogenic bacteria in infants with EOS, and Staphylococcus (41%) and Enterobacter (29%) were the main pathogenic bacteria in infants with LOS. The incidence of EOS and LOS decreased with the increase of gestational age and birth weight (P < 0.05). The multivariate logistic regression analysis showed that a high birth weight was a protective factor against EOS (OR=0.996, 95%CI:0.993-0.998, P < 0.05), while vaginal delivery (OR=2.781, 95%CI:1.190-6.500, P < 0.05) was a risk factor for EOS, and long duration of parenteral nutrition was a risk factor for LOS (OR=1.129, 95%CI:1.067-1.194, P < 0.05). Conclusions Enterococcus faecalis is the most common pathogenic bacteria for EOS, and Staphylococcus is the most common pathogenic bacterium for LOS in VLBW infants. A high birth weight may reduce the risk of EOS in VLBW infants, while vaginal delivery may increase the risk of EOS. Prolonged parenteral nutrition may increase the risk of LOS.
Ongun H, Demir M. Mortality caused by late-onset sepsis in very low birth weight infants:risk analysis and the performance of diagnostic tools[J]. J Coll Physicians Surg Pak, 2020, 30(6):611-616. DOI:10.29271/jcpsp.2020.06.611. PMID:32703346.
[2]
Kim JK, Hwang JH, Lee MH, et al. Mortality rate-dependent variations in antenatal corticosteroid-associated outcomes in very low birth weight infants with 23-34 weeks of gestation:a nationwide cohort study[J]. PLoS One, 2020, 15(10):e0240168. DOI:10.1371/journal.pone.0240168. PMID:33017428. PMCID:PMC7535030.
[3]
Hamilcikan S, Can E, Buke O, et al. Pentoxifylline and Pentaglobin adjuvant therapies for neonatal nosocomial sepsis in neonates less than 1500 g weight[J]. J Pak Med Assoc, 2017, 67(10):1482-1486. PMID:28955060.
[4]
Pisani V, Bizzarri B, Cardi V, et al. Early onset sepsis in very low birth weight newborn infants[J]. J Matern Fetal Neonatal Med, 2012, 25(Suppl 3):21-25. DOI:10.3109/14767058.2012.712348. PMID:23016613.
Mukhopadhyay S, Puopolo KM. Clinical and microbiologic characteristics of early-onset sepsis among very low birth weight infants:opportunities for antibiotic stewardship[J]. Pediatr Infect Dis J, 2017, 36(5):477-481. DOI:10.1097/INF.0000000000001473. PMID:28403049. PMCID:PMC6009981.
[9]
Lee SM, Chang M, Kim KS. Blood culture proven early onset sepsis and late onset sepsis in very-low-birth-weight infants in Korea[J]. J Korean Med Sci, 2015, 30(Suppl 1):S67-S74. DOI:10.3346/jkms.2015.30.S1.S67. PMID:26566360. PMCID:PMC4641066.
[10]
Köstlin-Gille N, Härtel C, Haug C, et al. Epidemiology of early and late onset neonatal sepsis in very low birthweight infants:data from the German neonatal network[J]. Pediatr Infect Dis J, 2021, 40(3):255-259. DOI:10.1097/INF.0000000000002976. PMID:33538544.
[11]
Almudeer AH, Alibrahim MA, Gosadi IM. Epidemiology and risk factors associated with early onset neonatal sepsis in the south of KSA[J]. J Taibah Univ Med Sci, 2020, 15(6):509-514. DOI:10.1016/j.jtumed.2020.08.009. PMID:33318743. PMCID:PMC7715412.
[12]
Klinger G, Levy I, Sirota L, et al. Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants[J]. Am J Obstet Gynecol, 2009, 201:38. e1-6. PMID:19380122.
[13]
Puopolo KM, Benitz WE, Zaoutis TE, et al. Management of neonates born at ≤ 346/7 weeks' gestation with suspected or proven early-onset bacterial sepsis[J]. Pediatrics, 2018, 142(6):e20182896. DOI:10.1542/peds.2018-2896. PMID:30455344.
Escalante MJ, Ceriani-Cernadas JM, D'Apremont I, et al. Late onset sepsis in very low birth weight infants in the South American NEOCOSUR Network[J]. Pediatr Infect Dis J, 2018, 37(10):1022-1027. DOI:10.1097/INF.0000000000001958. PMID:29561518.
de Souza Rugolo LM, Bentlin MR, Mussi-Pinhata M, et al. Late-onset sepsis in very low birth weight infants:a Brazilian Neonatal Research Network Study[J]. J Trop Pediatr, 2014, 60(6):415-421. DOI:10.1093/tropej/fmu038. PMID:25063461.
[19]
Tröger B, Göpel W, Faust K, et al. 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[J]. Pediatr Infect Dis J, 2014, 33(3):238-243. DOI:10.1097/INF.0000000000000031. PMID:24030351.
WANG Ming-Jie, YUE Shao-Jie, LIN Jin, GAO Xi-Rong, PENG Xiao-Ming, CHEN Meng-Yu, PENG Hua-Bao, CAO Bei, ZENG Yun-Qing, WANG Shu-Lian, WEN Bo, HUANG Xi-Lin, LI Xiao-Ping, ZHANG Ai-Zhen, CAO Ting, CHEN Yi-Hua, CHEN Tie-Qiang, YE Chun-Hua, BO Tao, JIANG De-Lin, HUANG Xiu-Qun, REN Na-Fang, TAO Long-Zhang, YAO Fang, TIAN Chang-Jun, LI Hong-Ming, ZHANG Ai-Min, HUANG Fu-Rong, ZHANG Wei-Guo, CHEN Xiang-Hong, LIU Yu-Chan, LIU Zheng-Lin, XU Yan-Shan, MING Jing-Song, CHEN Li, ZHU Ning-Yi, HE Jun-Min, YI Sai-Jun, WANG Tuan-Mei, LI Zhao-Hui, WANG Gui-Tian. A multicenter survey of antibiotic use in very and extremely low birth weight infants in Hunan Province[J]. CJCP, 2020, 22(6): 561-566.