Paediatric Department, Stavanger University Hospital, Stavanger, Norway.
Department of Clinical Science, University of Bergen, Bergen, Hordaland, Norway.
Arch Dis Child Fetal Neonatal Ed. 2023 Sep;108(5):478-484. doi: 10.1136/archdischild-2022-324977. Epub 2023 Feb 2.
To evaluate epidemiology and outcomes among very preterm infants (<32 weeks' gestation) with culture-positive and culture-negative late-onset sepsis (LOS).
Cohort study using a nationwide, population-based registry.
21 neonatal units in Norway.
All very preterm infants born 1 January 2009-31 December 2018 and admitted to a neonatal unit.
Incidences, pathogen distribution, LOS-attributable mortality and associated morbidity at discharge.
Among 5296 very preterm infants, we identified 582 culture-positive LOS episodes in 493 infants (incidence 9.3%) and 282 culture-negative LOS episodes in 282 infants (incidence 5.3%). Extremely preterm infants (<28 weeks' gestation) had highest incidences of culture-positive (21.6%) and culture-negative (11.1%) LOS. The major causative pathogens were coagulase-negative staphylococci (49%), (15%), group B streptococci (10%) and (8%). We observed increased odds of severe bronchopulmonary dysplasia (BPD) associated with both culture-positive (adjusted OR (aOR) 1.7; 95% CI 1.3 to 2.2) and culture-negative (aOR 1.6; 95% CI 1.3 to 2.6) LOS. Only culture-positive LOS was associated with increased odds of cystic periventricular leukomalacia (cPVL) (aOR 2.2; 95% CI 1.4 to 3.4) and severe retinopathy of prematurity (ROP) (aOR 1.8; 95% CI 1.2 to 2.8). Culture-positive LOS-attributable mortality was 6.3%, higher in Gram-negative (15.8%) compared with Gram-positive (4.1%) LOS, p=0.009. Among extremely preterm infants, survival rates increased from 75.2% in 2009-2013 to 81.0% in 2014-2018, p=0.005. In the same period culture-positive LOS rates increased from 17.1% to 25.6%, p<0.001.
LOS contributes to a significant burden of disease in very preterm infants and is associated with increased odds of severe BPD, cPVL and severe ROP.
评估培养阳性和培养阴性晚发性败血症（ LOS）极低早产儿（<32 周）的流行病学和结局。
使用全国性、基于人群的登记处进行队列研究。
挪威的 21 个新生儿病房。
2009 年 1 月 1 日至 2018 年 12 月 31 日出生并入住新生儿病房的所有极低早产儿。
发病率、病原体分布、 LOS 相关死亡率和出院时相关发病率。
在 5296 名极低早产儿中，我们在 493 名婴儿中发现了 582 例培养阳性 LOS 发作（发病率为 9.3%），在 282 名婴儿中发现了 282 例培养阴性 LOS 发作（发病率为 5.3%）。极早产儿（<28 周）的培养阳性（21.6%）和培养阴性（11.1%） LOS 发生率最高。主要病原体为凝固酶阴性葡萄球菌（49%）、（15%）、B 组链球菌（10%）和（8%）。我们观察到，与培养阳性（调整比值比[aOR]1.7；95%置信区间[CI]1.3 至 2.2）和培养阴性（aOR 1.6；95%CI 1.3 至 2.6）LOS 相关，严重支气管肺发育不良（BPD）的发生风险增加。只有培养阳性的 LOS 与囊性室管膜下白质软化（cPVL）（aOR 2.2；95%CI 1.4 至 3.4）和严重早产儿视网膜病变（ROP）（aOR 1.8；95%CI 1.2 至 2.8）的发生风险增加相关。培养阳性 LOS 相关死亡率为 6.3%，革兰氏阴性（15.8%）高于革兰氏阳性（4.1%），p=0.009。在极早产儿中，存活率从 2009-2013 年的 75.2%增加到 2014-2018 年的 81.0%，p=0.005。在同一时期，培养阳性 LOS 的发生率从 17.1%增加到 25.6%，p<0.001。
LOS 导致极低早产儿疾病负担显著增加，并与严重 BPD、cPVL 和严重 ROP 的发生风险增加相关。
