Early-onset sepsis in preterm-very-low-birth-weight neonates in Taiwan: A nationwide cohort study of incidence, outcomes, and risk factors.

BACKGROUND

This cohort study aimed to investigate the impact of early onset sepsis (EOS) on preterm-very-low-birth-weight neonates (PVLBW) before discharge.

METHODS

This study utilized data from the Taiwan Neonatal Network (TNN) and focused on neonates weighing less than 1500 g at a gestational age between 22 and 32 + 6 weeks, from 2016 to 2021. EOS was defined as a culture-confirmed bacterial infection of the blood or cerebrospinal fluid within three days of birth. Multivariate logistic regression analysis was performed to calculate the adjusted odds ratio (AOR) to identify independent risk factors for EOS while controlling for factors present at birth.

RESULTS

Out of the 7349 eligible PVLBW neonates, 208 (2.83%) experienced EOS, with a mortality rate of 29.3% (61/208). The independent risk factors for EOS included maternal chorioamnionitis (AOR: 4.10), male sex (AOR: 1.38), and a lower 1-min Apgar score (AOR: 0.83). Neonates with EOS exhibited significantly higher rates of severe outcomes, including severe intraventricular hemorrhage (25.26% vs. 8.05%), periventricular leukomalacia (8.25% vs. 3.42%), chronic lung disease (48.94% vs. 31.43%), severe retinopathy of prematurity (23.13% vs. 12.81%), necrotizing enterocolitis (8.33% vs. 4.69%), and late-onset sepsis (31.58% vs. 8.96%) compared to the non-EOS group.

CONCLUSION

This study provides the first nationwide epidemiological data on early onset sepsis in neonates with PVLBW. Our findings indicate that EOS in neonates with PVLBW significantly increases the risk of mortality and severe adverse outcomes. Further investigations of the pathogens involved are warranted to develop strategies and predictive tools to improve patient outcomes.