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Early-onset sepsis in term infants admitted to neonatal intensive care units (2011–2016)

Journal of Perinatology volume 41, pages 157–163 (2021)Cite this article

Subjects

Abstract

Objectives

Investigate characteristics of term infants culture-evaluated for early-onset sepsis (EOS) in neonatal intensive care units (NICUs), frequencies of organisms causing EOS, and factors associated with EOS.

Study design

Using a cohort design, we identified term infants evaluated for EOS with blood, cerebrospinal fluid, or urine cultures in 326 NICUs (2011–2016). Using multivariable logistic regression, we investigated the association between EOS and demographic characteristics.

Results

Of 142,410 infants, 1197 (0.8%) had EOS, most commonly caused by group B Streptococcus (GBS; 40.6%). Lower EOS risk was associated with low Apgar score, Cesarean delivery, small for gestational age, prenatal antibiotic exposure, and positive or unknown maternal GBS screening result. Increased risk was associated with prolonged rupture of membranes, maternal age <19 years, vasopressor treatment, and ventilator support.

Conclusion(s)

GBS was the most frequent cause of EOS. Early risk factor recognition may help daily management of term infants in NICUs.

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Fig. 1: Inclusion and exclusion of infants discharged from a NICU.

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References

  1. The United Nations Children’s Fund (UNICEF). The neonatal period is the most vulnerable time for a child. 2018. https://data.unicef.org/topic/child-survival/neonatal-mortality/. Accessed 7 Apr 2020.

  2. Kuzniewicz MW, Puopolo KM, Fischer A, Walsh EM, Li S, Newman TB, et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr. 2017;171:365–71.

    Article  Google Scholar 

  3. Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst Rev. 2014:CD007467.

  4. Stoll BJ, Hansen NI, Sanchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011;127:817–26.

    Article  Google Scholar 

  5. Kuzniewicz MW, Walsh EM, Li S, Fischer A, Escobar GJ. Development and implementation of an early-onset sepsis calculator to guide antibiotic management in late preterm and term neonates. Jt Comm J Qual Patient Saf. 2016;42:232–9.

    PubMed  Google Scholar 

  6. Ray JG, Urquia ML, Berger H, Vermeulen MJ. Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units. CMAJ. 2012;184:E956–62.

    Article  Google Scholar 

  7. Warren S, Garcia M, Hankins C. Impact of neonatal early-onset sepsis calculator on antibiotic use within two tertiary healthcare centers. J Perinatol. 2017;37:394–7.

    Article  CAS  Google Scholar 

  8. Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011;128:1155–63.

    Article  Google Scholar 

  9. Dhudasia MB, Mukhopadhyay S, Puopolo KM. Implementation of the sepsis risk calculator at an academic birth hospital. Hosp Pediatr. 2018;8:243–50.

    Article  Google Scholar 

  10. Beavers JB, Bai S, Perry J, Simpson J, Peeples S. Implementation and evaluation of the early-onset sepsis risk calculator in a high-risk university nursery. Clin Pediatr. 2018;57:1080–5.

    Article  Google Scholar 

  11. Singh T, Barnes EH, Isaacs D. Australian Study Group for neonatal infections. Early-onset neonatal infections in Australia and New Zealand, 2002–2012. Arch Dis Child Fetal Neonatal Ed. 2018;104:F248–52.

    Article  Google Scholar 

  12. Sgro M, Shah PS, Campbell D, Tenuta A, Shivananda S, Lee SK, et al. Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008. J Perinatol. 2011;31:794–8.

    Article  CAS  Google Scholar 

  13. Hornik CP, Fort P, Clark RH, Watt K, Benjamin DK Jr, Smith PB, 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:S69–74.

    Article  Google Scholar 

  14. Stoll BJ, Puopolo KM, Hansen NI, Sánchez PJ, Bell EF, Carlo WA, et al. Early-onset neonatal sepsis 2015 to 2017, the rise of Escherichia coli, and the need for novel prevention strategies. JAMA Pediatr. 2020;174:e200593.

    Article  Google Scholar 

  15. Cailes B, Kortsalioudaki C, Buttery J, Pattnayak S, Greenough A, Matthes J, et al. Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed. 2018;103:547–53.

    Article  Google Scholar 

  16. Brown AP, Denison FC. Selective or universal screening for GBS in pregnancy (review). Early Hum Dev. 2018;126:18–22.

    Article  Google Scholar 

  17. Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, et al. Stratification of risk of early-onset sepsis in newborns ≥34 weeks’ gestation. Pediatrics. 2014;133:30–6.

    Article  Google Scholar 

  18. Mukhopadhyay S, Eichenwald EC, Puopolo KM. Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines. J Perinatol. 2013;33:198–205.

    Article  CAS  Google Scholar 

  19. Lin CY, Hsu CH, Huang FY, Chang JH, Hung HY, Kao HA, et al. The changing face of early-onset neonatal sepsis after the implementation of a maternal group B Streptococcus screening and intrapartum prophylaxis policy-a study in one medical center. Pediatr Neonatol. 2011;52:78–84.

    Article  Google Scholar 

  20. Schrag SJ, Farley MM, Petit S, Reingold A, Weston EJ, Pondo T, et al. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics. 2016;138:e20162013. https://doi.org/10.1542/peds.2016-2013.

    Article  Google Scholar 

  21. Nielsen M, Sheikh N, Fitzgerald E, Meehan M, LeBlanc D, Eogan M, et al. Screening for early-onset invasive group B Streptococcal disease in neonates in an Irish hospital (2001–2014): a retrospective audit. Infect Dis. 2017;49:466–70.

    Article  Google Scholar 

  22. Weston EJ, Pondo T, Lewis MM, Martell-Cleary P, Morin C, Jewell B, et al. The burden of invasive early-onset neonatal sepsis in the United States, 2005–2008. Pediatr Infect Dis J. 2011;30:937–41.

    Article  Google Scholar 

  23. Van Dyke MK, Phares CR, Lynfield R, Thomas AR, Arnold KE, Craig AS, et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med. 2009;360:2626–36.

    Article  Google Scholar 

  24. Bandyopadhyay T, Kumar A, Saili A, Randhawa VS. Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis. J Neonatal Perinat Med. 2018;11:145–53.

    Article  CAS  Google Scholar 

  25. Garcia-Prats JA. Prevention and management of meconium aspiration syndrome. UpToDate®; 2019. https://www.uptodate.com/contents/prevention-and-management-of-meconium-aspiration-syndrome. Accessed 7 Apr 2020.

  26. Cohen-Wolkowiez M, Moran C, Benjamin DK, Cotten CM, Clark RH, Benjamin DK Jr., et al. Early and late onset sepsis in late preterm infants. Pediatr Infect Dis J. 2009;28:1052–6.

    Article  Google Scholar 

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Acknowledgements

PTN Steering Committee Members: Daniel K. Benjamin Jr., Christoph Hornik, Kanecia Zimmerman, Phyllis Kennel, and Rose Beci, Duke Clinical Research Institute, Durham, NC; Chi Dang Hornik, Duke University Medical Center, Durham, NC; Gregory L. Kearns, Scottsdale, AZ; Matthew Laughon, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ian M. Paul, Penn State College of Medicine, Hershey, PA; Janice Sullivan, University of Louisville, Louisville, KY; Kelly Wade, Children’s Hospital of Philadelphia, Philadelphia, PA; Paula Delmore, Wichita Medical Research and Education Foundation, Wichita, KS. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): Perdita Taylor-Zapata and June Lee. The Emmes Company, LLC (Data Coordinating Center): Ravinder Anand, Gaurav Sharma, Gina Simone, Kim Kaneshige, and Lawrence Taylor. PTN Publications Committee: Chaired by Thomas Green, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

Funding

This work was supported by Duke Clinical Research Institute’s R25 Summer Training in Academic Research (STAR) Program (Grant #5R25HD076475-07).

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Authors and Affiliations

  1. Duke Clinical Research Institute, Duke University, Durham, NC, USA

    Laura Bech Polcwiartek, P. Brian Smith, Kanecia Zimmerman, Alycia Love, Lance Tiu, Sylvia Murray, Phillip Kang & Rachel G. Greenberg

  2. Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark

    Laura Bech Polcwiartek, Finn Ebbesen & Søren Hagstrøm

  3. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    P. Brian Smith, Kanecia Zimmerman & Rachel G. Greenberg

  4. Department of Economics, Clemson University, Clemson, SC, USA

    Daniel K. Benjamin

  5. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Søren Hagstrøm

  6. Pediatrix Medical Group, Sunrise, FL, USA

    Reese H. Clark

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  1. Laura Bech Polcwiartek
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Corresponding author

Correspondence to Rachel G. Greenberg.

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Conflict of interest

PBS reported being a member of Data and Safety Monitoring Board for United Therapeutics and Seelos; funding from NIH-U2C-RFA-OD-16-006. KZ serves as a consultant to industry for pediatric drug development. RGG reported receiving support from industry for research services (https://dcri.org/about-us/conflict-of-interest/). The other authors declare that they have no conflict of interest.

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Polcwiartek, L.B., Smith, P.B., Benjamin, D.K. et al. Early-onset sepsis in term infants admitted to neonatal intensive care units (2011–2016). J Perinatol 41, 157–163 (2021). https://doi.org/10.1038/s41372-020-00860-3

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