Clinical sepsis in neonates and young infants, United States, 1988-2006.

OBJECTIVE

To describe the burden and characteristics of clinical neonatal sepsis in the United States and evaluate incidence rates after the issuance of intrapartum antibiotic prophylaxis (IAP) guidelines.

STUDY

DESIGN

This is a cross-sectional study of hospitalizations of infants aged <3 months diagnosed with sepsis from the 1988-2006 National Hospital Discharge Survey. The National Hospital Discharge Survey collects data annually on inpatient discharges from a national probability sample of approximately 500 short-stay hospitals. We examined sepsis hospitalizations, defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes, and compared sepsis hospitalization rates for 2 time periods after the issuance of IAP guidelines (1996-2001 and 2002-2006) with 1988-1995 using national natality data as the population denominator. We used Joinpoint (Surveillance Research Program, National Cancer Institute, Bethesda, Maryland) regression to assess the average annual percent change (AAPC) in rates.

RESULTS

Between 1988 and 2006, there were more than 2.5 million sepsis-related hospitalizations in infants aged <3 months (112 000-146 000 annually). In 2006, the sepsis hospitalization rate was 30.8/1000 births. The rate was more than 3 times higher in preterm infants compared with term infants (85.4/1000 preterm births vs 23.1/1000 term births). The AAPC in sepsis hospitalization rate was -3.6% (95% CI, -5.1% to 2.0%) [corrected] for term infants during 1996-2002 and did not change significantly after issuance of the revised 2002 guidelines. For preterm infants, the AAPC was -1.2% (95% CI, -2.2% to -0.1%) [corrected] annually from 1988 to 2006.

CONCLUSION

Clinical neonatal sepsis declined in the post-IAP era, mirroring trends observed in group B streptococcal early-onset neonatal sepsis surveillance. Preterm infants were affected disproportionately and exhibited a modest but steady decline in sepsis hospitalization rate.