Korean J Perinatol.  2016 Mar;27(1):53-59. 10.14734/kjp.2016.27.1.53.

Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age

• Yoon SA
• Chun JY
• Ho YH
• Kim JS
• Yoo HS
• Sung SI
• Ahn SY
• Chang YS
• Park WS

• KMID: 2164269
• DOI: http://doi.org/10.14734/kjp.2016.27.1.53

Abstract

PURPOSE
The aim of this study is to determine the clinical characteristics of early onset sepsis (EOS) in micropreemie.
METHODS
We retrospectively reviewed medical records of 107 extremely preterm infants born at 25 or less than 25 weeks of gestation and admitted to the neonatal intensive care unit of Samsung Medical Center from January 2013 to August 2015. Infants were divided into two groups based on the presence of culture-proven EOS in the first 7 days of life. Retrospective analysis of perinatal factors and laboratory findings within the first week of life was done between two groups. We compared the neonatal outcomes among two groups.
RESULTS
Culture-proven EOS was diagnosed in 11 of 107 infants (10.3%). Main pathogen of EOS was Staphylococcus epidermidis (45.5%). There were no significant differences between control group and EOS group in gestational age, birth weight, Apgar score, delivery type and pathologic chorioamnionitis. Among 11 infants with EOS, 9 showed fetal tachycardia (P=0.001). And EOS group presented lower platelet count at 3rd day and 7th day of life than that of control group (P=0.033, P=0.045). Neonatal outcomes in EOS group were compatible with control group. Main cause of death was sepsis in EOS group.
CONCLUSION
In micropreemie, EOS is important factor of mortality. Our data suggest that fetal tachycardia and low platelet count during the first 7 days of life were associated with EOS.

Keyword

Early onset sepsis; Extremely preterm infants

MeSH Terms

Apgar Score
Birth Weight
Cause of Death
Chorioamnionitis
Female
Gestational Age*
Humans
Infant
Infant, Extremely Premature
Infant, Newborn
Intensive Care, Neonatal
Medical Records
Mortality
Platelet Count
Pregnancy
Retrospective Studies
Sepsis*
Staphylococcus epidermidis
Tachycardia

Reference

1). Stoll BJ., Gordon T., Korones SB., Shankaran S., Tyson JE., Bauer CR, et al. Early-onset sepsis in very low birth weight neonates: a report from the national institute of child health and human development neonatal research network. J Pediatr. 1996. 129:72–80.

2). 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.

3). Simonsen KA., Anderson-Berry AL., Delair SF., Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014. 27:21–47.

4). Muller-Pebody B., Johnson AP., Heath PT., Gilbert RE., Henderson KL., Sharland M. Empirical treatment of neonatal sepsis: are the current guidelines adequate? Arch Dis Child Fetal Neonatal Ed. 2011. 96:F4–8.

5). Martius JA., Roos T., Gora B., Oehler MK., Schrod L., Papadopoulos T, et al. Risk factors associated with early-onset sepsis in premature infants. Eur J Obstet Gynecol Reprod Biol. 1999. 85:151–8.

6). Selimovic A., Skokic F., Bazardzanovic M., Selimovic Z. The predictive score for early-onset neonatal sepsis. Turk J Pediatr. 2010. 52:139–44.

7). Coggins SA., Wynn JL., Hill ML., Slaughter JC., Ozdas-Weitkamp A., Jalloh O, et al. Use of a computerized C-reactive protein (CRP) based sepsis evaluation in very low birth weight (VLBW) infants: a five-year experience. PLoS One. 2013. 8:e78602.

8). Steinberger E., Hofer N., Resch B. Cord blood procalcitonin and Interleukin-6 are highly sensitive and specific in the prediction of early-onset sepsis in preterm infants. Scand J Clin Lab Invest. 2014. 74:432–6.

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 Korean Med Sci. 2015. 30(Suppl 1):S67–74.

10). Mukhopadhyay S., Puopolo KM. Risk assessment in neonatal early onset sepsis. Semin Perinatol. 2012. 36:408–15.

11). Stoll BJ., Hansen N., Fanaroff AA., Wright LL., Carlo WA., Ehrenkranz RA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med. 2002. 347:240–7.

12). Yoo HS., Ahn SY., Lee MS., Han YM., Sung SI., Chang YS, et al. Permissive hyperglycemia in extremely low birth weight infants. J Korean Med Sci. 2013. 28:450–60.

13). Ehrenkranz RA., Walsh MC., Vohr BR., Jobe AH., Wright LL., Fanaroff AA, et al. Validation of the national institutes of health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005. 116:1353–60.

14). Papile LA., Burstein J., Burstein R., Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978. 92:529–34.

15). Walsh MC., Kliegman RM., Fanaroff AA. Necrotizing enterocolitis: a practitioner's perspective. Pediatr Rev. 1988. 9:219–26.

16). Fierson WM. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2013. 131:189–95.

17). Polin RA. Committee on F, Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012. 129:1006–15.

18). Ozkan H., Cetinkaya M., Koksal N., Celebi S., Hacimustafao-glu M. Culture-proven neonatal sepsis in preterm infants in a neonatal intensive care unit over a 7 year period: coagulase-negative Staphylococcus as the predominant pathogen. Pediatr Int. 2014. 56:60–6.

19). Ronnestad A., Abrahamsen TG., Medbo S., Reigstad H., Lossius K., Kaaresen PI, et al. Septicemia in the first week of life in a Norwegian national cohort of extremely premature infants. Pediatr. 2005. 115:e262–8.

20). Klinger G., Levy I., Sirota L., Boyko V., Reichman B., Lerner-Geva L., Israel Neonatal N. Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants. Am J Obstet Gynecol. 2009. 201:38. e31–6.

21). Schuchat A., Zywicki SS., Dinsmoor MJ., Mercer B., Roma-guera J., O'Sullivan MJ, et al. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Pediatrics. 2000. 105(1 Pt 1):21–6.

22). Bhandari V. Effective biomarkers for diagnosis of neonatal sepsis. J Pediatric Infect Dis Soc. 2014. 3:234–45.

23). Delanghe JR., Speeckaert MM. Translational research and biomarkers in neonatal sepsis. Clin Chim Acta. 2015. 451(Pt A):46–64.

24). Basu S., Agarwal P., Anupurba S., Shukla R., Kumar A. Elevated plasma and cerebrospinal fluid interleukin-1 beta and tumor necrosis factor-alpha concentration and combined outcome of death or abnormal neuroimaging in preterm neonates with early-onset clinical sepsis. J Perinatol. 2015. 35:855–61.

25). Hornik CP., Benjamin DK., Becker KC., Benjamin DK Jr.., Li J., Clark RH, et al. Use of the complete blood cell count in early-onset neonatal sepsis. Pediatr Infect Dis J. 2012. 31:799–802.

26). Roberts I., Murray NA. Neonatal thrombocytopenia: causes and management. Arch Dis Child Fetal Neonatal Ed. 2003. 88:F359–64.

27). Charoo BA., Iqbal J., Iqbal Q., Mushtaq S., Bhat AW., Nawaz I. Nosocomial sepsis-induced late onset thrombocytopenia in a neonatal tertiary care unit. Hematol Oncol Stem Cell Ther. 2009. 2:349–53.

28). Arif SH., Ahmad I., Ali SM., Khan HM. Thrombocytopenia and bacterial sepsis in neonates. Indian J Hematol Blood Transfus. 2012. 28:147–51.