Abstract
Background
The pathogenesis of late-onset sepsis (LOS) in preterm infants is poorly understood and knowledge about risk factors, especially prenatal risk factors, is limited. This study aimed to assess the association between the cause of preterm birth and LOS in very preterm infants.
Methods
2052 very preterm singletons from a national population-based cohort study alive at 72 h of life were included. Survival without LOS was compared by cause of preterm birth using survival analysis and Cox regression models.
Results
437 (20.1%) had at least one episode of LOS. The frequency of LOS varied by cause of preterm birth: 17.1% for infants born after preterm labor, 17.9% after preterm premature rupture of membranes, 20.3% after a placental abruption, 20.3% after isolated hypertensive disorders, 27.5% after hypertensive disorders with fetal growth restriction (FGR), and 29.4% after isolated FGR. In multivariate analysis, when compared to infants born after preterm labor, the risk remained higher for infants born after hypertensive disorders (hazard ratio HR = 1.7, 95% CI = 1.2–2.5), hypertensive disorders with FGR (HR = 2.6, 95% CI = 1.9–3.6) and isolated FGR (HR = 2.9, 95% CI = 1.9–4.4).
Conclusion
Very preterm infants born after hypertensive disorders or born after FGR had an increased risk of LOS compared to those born after preterm labor.
Impact
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Late-onset sepsis risk differs according to the cause of preterm birth.
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Compared with those born after preterm labor, infants born very preterm because of hypertensive disorders of pregnancy and/or fetal growth restriction display an increased risk for late-onset sepsis.
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Antenatal factors, in particular the full spectrum of causes leading to preterm birth, should be taken into consideration to better prevent and manage neonatal infectious morbidity and inform the parents.
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Acknowledgements
We are grateful for the participation of all families of preterm infants in the EPIPAGE-2 cohort study and for the cooperation of all maternity and neonatal units in France. The EPIPAGE-2 study has been funded with support from the French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund for Autonomy; The French EQUIPEX Program of Investments in the Future (reference ANR-11-EQPX-0038). The PremUp Foundation. The Fondation de France (reference 00050329). M.L. has been supported by grants from the French Society of Pediatrics. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
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Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data: all authors. Drafting the article or revising it critically for important intellectual content: M.L., L.F., P.B., and E.L. Final approval of the version to be published: all authors
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Consent for participation was provided by mothers at delivery. EPIPAGE-2 was approved by the Committee for the Protection of People participating in biomedical research (reference CPP SC-2873).
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Letouzey, M., Foix-L’Hélias, L., Torchin, H. et al. Cause of preterm birth and late-onset sepsis in very preterm infants: the EPIPAGE-2 cohort study. Pediatr Res 90, 584–592 (2021). https://doi.org/10.1038/s41390-021-01411-y
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DOI: https://doi.org/10.1038/s41390-021-01411-y
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