J Korean Med Sci.  2015 Oct;30(Suppl 1):S67-S74. 10.3346/jkms.2015.30.S1.S67.

Blood Culture Proven Early Onset Sepsis and Late Onset Sepsis in Very-Low-Birth-Weight Infants in Korea

• Lee SM
• Chang M
• Kim KS

• KMID: 2351138
• DOI: http://doi.org/10.3346/jkms.2015.30.S1.S67

Abstract

Neonatal sepsis remains one of the most important causes of death and co-morbidity in very-low-birth-weight (VLBW) infants. The aim of this study was to determine the current incidences of early-onset sepsis (EOS) and late-onset sepsis (LOS), the distribution of pathogens, and the impact of infection on co-morbidities in VLBW infants. We analyzed the data including sepsis episode from 2,386 VLBW infants enrolled in Korean Neonatal Network from January 2013 to June 2014. We defined EOS as a positive blood culture occurring between birth and 7 days of life and LOS after 7 days of life. Sepsis was found in 21.1% of VLBW infants. The risk of sepsis was inversely related to birth weight and gestational age. EOS was found in only 3.6% of VLBW infants, however the mortality rate was as high as 34.1%. EOS was associated with the increased odds for bronchopulmonary dysplasia and intraventricular hemorrhage. The vast majority of EOS was caused by Gram-positive organisms, particularly coagulase-negative staphylococci (30.6%). LOS developed in 19.4% of VLBW infants with a 16.1% mortality rate. Pathogens in LOS were dominated by coagulase-negative staphylococci (38.3%). Twenty-five percent and fifty percent of first LOS episode occurred after 12 days and 20 days from birth, respectively. Younger and smaller VLBW infants showed the earlier occurrence day for the 25% of first LOS episode. This study provides a recent nationwide epidemiology of sepsis in VLBW infants in Korea. Based on this study, successful strategies to reduce infections would improve survival and reduce morbidity.

Keyword

Sepsis; Infant; Very-Low-Birth-Weight; Risk Factors; Korean Neonatal Network; South Korea

MeSH Terms

Coagulase/metabolism
Databases, Factual
Gestational Age
Gram-Negative Bacteria/isolation & purification
Gram-Positive Bacteria/isolation & purification
Humans
Incidence
Infant, Newborn
*Infant, Very Low Birth Weight
Kaplan-Meier Estimate
Republic of Korea/epidemiology
Risk Factors
Sepsis/*epidemiology/microbiology/mortality
Staphylococcus/enzymology/isolation & purification
Coagulase

Figure

• 

  Fig. 1 Days to first episode of LOS in VLBW infants using Kaplan Meier curves. Quartile estimates according to the time variable duration showed as follows; 25 percentile of the first LOS episode occurred after the12 days from birth, 50% percentile after 20 days from birth, and 75 percentile after 33 days from birth.

• 

  Fig. 2 Kaplan Meier probability curve for first episode of LOS according to gestational age groups (A) and birth weight groups (B). The younger the gestational age, the higher the probability of first LOS episode. The smaller the birth weight, the higher the probability of first LOS episode (log-rank test for trend P < 0.001).

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