Universität zu Köln

Troeger, Birte, Goepel, Wolfgang, Faust, Kirstin, Mueller, Thilo, Jorch, Gerhard, Felderhoff-Mueser, Ursula, Gortner, Ludwig, Heitmann, Friedhelm, Hoehn, Thomas, Kribs, Angela, Laux, Reinhard, Roll, Claudia, Emeis, Michael, Moegel, Michael, Siegel, Jens, Vochem, Matthias, von der Wense, Axel, Wieg, Christian, Herting, Egbert and Haertel, Christoph (2014). Risk for Late-onset Blood-culture Proven Sepsis in Very-lowbirth Weight Infants Born Small for Gestational Age: A Large Multicenter Study from the German Neonatal Network. Pediatr. Infect. Dis. J., 33 (3). S. 238 - 244. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1532-0987

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Abstract

Background: It was the aim of this study to assess whether very-low-birth-weight (VLBW) infants born small for gestational age (SGA; birth weight less than 10th percentile) are at increased risk for late-onset sepsis. Methods: This was a prospective, multicenter study of the German Neonatal Network including VLBW infants from 23 to < 32 weeks post menstrual age born 2009-2011. Outcomes were compared between VLBW infants born SGA (birth weight less than tenth percentile according to gestational age and gender) and non-SGA infants. The main outcome measure was at least 1 episode of late-onset sepsis defined as blood-culture-confirmed clinical sepsis occurring at 72 hours of age. Results: 5886 VLBW infants were included. In SGA infants (n = 692), an increased incidence of late-onset sepsis was noted compared with non-SGA infants (20.1% vs. 14.3 %, P < 0.001). This difference was only observed among infants with a gestational age of 27 to < 32 weeks and attributed to sepsis episodes with coagulase-negative staphylococci (12.8% vs. 8.3%, P < 0.001). Different treatment modalities (eg more frequent use of central venous lines) and longer duration of invasive therapies (parenteral nutrition, mechanical ventilation, hospitalization) may account for the increased sepsis risk with coagulase-negative staphylococci in our SGA cohort. In a multivariate logistic regression analysis, higher gestational age [per week; odds ratio (OR): 0.75, 95% confidence interval (CI): 0.72-0.78, P< 0.0001], treatment with antenatal steroids (OR: 0.7, 95% CI: 0.53-0.92, P = 0.01), German descendance (OR: 0.76, 95% CI: 0.63-0.91, P = 0.003) and prophylaxis with glycopeptide antibiotics (OR: 0.64, 95% CI: 0.47-0.87, P = 0.005) were shown to be protective against late-onset sepsis. In contrast, longer duration of parenteral nutrition (per day; OR: 1.016, 95% CI: 1.011-1.021, P < 0.0001) and SGA were found to be risk factors (OR: 1.31, 95% CI: 1.02-1.68, P= 0.03). Conclusions: SGA contributes to the risk of late-onset sepsis in VLBW infants. Future studies are needed to investigate the underlying pathophysiology to guide individualized preventive measures in this vulnerable subgroup.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Troeger, Birte UNSPECIFIED UNSPECIFIED UNSPECIFIED Goepel, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Faust, Kirstin UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Thilo UNSPECIFIED UNSPECIFIED UNSPECIFIED Jorch, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Felderhoff-Mueser, Ursula UNSPECIFIED UNSPECIFIED UNSPECIFIED Gortner, Ludwig UNSPECIFIED UNSPECIFIED UNSPECIFIED Heitmann, Friedhelm UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoehn, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kribs, Angela UNSPECIFIED UNSPECIFIED UNSPECIFIED Laux, Reinhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Roll, Claudia UNSPECIFIED UNSPECIFIED UNSPECIFIED Emeis, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Moegel, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Siegel, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Vochem, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED von der Wense, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Wieg, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Herting, Egbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Haertel, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-443994
DOI:	10.1097/INF.0000000000000031
Journal or Publication Title:	Pediatr. Infect. Dis. J.
Volume:	33
Number:	3
Page Range:	S. 238 - 244
Date:	2014
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1532-0987
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NOSOCOMIAL INFECTION; PRETERM INFANTS; BIRTH; TERM; MORTALITY; HYPERTENSION; RESTRICTION; PROPHYLAXIS; TEICOPLANIN; VANCOMYCIN Multiple languages Immunology; Infectious Diseases; Pediatrics Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/44399