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Previous Volume 347:240-247 July 25, 2002 Number 4 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Eschenbach, D. A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background It is uncertain whether the rates and causes of early-onset sepsis (that occurring within 72 hours after birth) among very-low-birth-weight infants have changed in recent years, since antibiotics have begun to be used more widely during labor and delivery.

Methods We studied 5447 very-low-birth-weight infants (those weighing between 401 and 1500 g) born at centers of the Neonatal Research Network of the National Institute of Child Health and Human Development between 1998 and 2000 who had at least one blood culture in the first three days of life and compared them with 7606 very-low-birth-weight infants born at centers in the network between 1991 and 1993.

Results Early-onset sepsis (as confirmed by positive blood cultures) was present in 84 infants in the more recent birth cohort (1.5 percent). As compared with the earlier birth cohort, there was a marked reduction in group B streptococcal sepsis (from 5.9 to 1.7 per 1000 live births of infants weighing 401 to 1500 g, P<0.001) and an increase in Escherichia coli sepsis (from 3.2 to 6.8 per 1000 live births, P=0.004); the overall rate of early-onset sepsis was not significantly changed. Most E. coli isolates from the recent birth cohort (85 percent) were resistant to ampicillin, and mothers of infants with ampicillin-resistant E. coli infections were more likely to have received intrapartum ampicillin than were those with ampicillin-sensitive strains (26 of 28 with sensitivity data vs. 1 of 5, P=0.01). Infants with early-onset sepsis were more likely to die than uninfected infants (37 percent vs. 13 percent, P<0.001), especially if they were infected with gram-negative organisms.

Conclusions Early-onset sepsis remains an uncommon but potentially lethal problem among very-low-birth-weight infants. The change in pathogens over time from predominantly gram-positive to predominantly gram-negative requires confirmation by ongoing surveillance.

Source Information

From the Department of Pediatrics, Emory University School of Medicine, Atlanta (B.J.S.); Research Triangle Institute, Research Triangle Park, N.C. (N.H., W.K.P.); the Department of Pediatrics, Case Western Reserve University, Cleveland (A.A.F.); the National Institute of Child Health and Human Development, Bethesda, Md. (L.L.W.); the Department of Pediatrics, University of Alabama, Birmingham (W.A.C.); the Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. (R.A.E.); the Department of Pediatrics, Indiana University School of Medicine, Indianapolis (J.A.L.); the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati (E.F.D.); the Department of Newborn Medicine, Brigham and Women's Hospital, Boston (A.R.S.); the University of Texas at Houston, Houston (J.E.T.); Women and Infant's Hospital, Providence, R.I. (W.O.); the Department of Pediatrics, University of Miami, Miami (C.R.B.); the Newborn Center, University of Tennessee–Memphis, Memphis (S.B.K.); the Division of Neonatal and Perinatal Medicine, Wayne State University, Detroit (S.S.); the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (A.R.L.); the Division of Neonatology, Stanford University Medical Center, Palo Alto, Calif. (D.K.S.); and the Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque (L.-A.P.).

Address reprint requests to Dr. Stoll at the Department of Pediatrics, Emory University School of Medicine, 2040 Ridgewood Dr., NE, Atlanta, GA 30322.

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