Delivery characteristics of preterm infants born at 22 to 28 weeks’ gestational age, such as preterm onset labor and preterm amniotic membrane rupture, can assist in identifying infants at low risk of early-onset sepsis, according to findings published in Pediatrics.
“Of concern, prolonged early antibiotic exposure has been associated with increased subsequent risk of late-onset sepsis, necrotizing enterocolitis, severe retinopathy of prematurity and death,” Karen M. Puopolo, MD, PhD, from the division of neonatology at the Children’s Hospital of Philadelphia, and colleagues wrote. “Identification of premature infants at low risk of early-onset sepsis may help guide decisions for initiating and/or discontinuing empirical antibiotic treatments in the first days of life and would be a critical first step in promoting antibiotic stewardship among these infants.”
Specific delivery criteria of preterm infants born at 22 to 28 weeks’ gestational age can identify infants with a 76% lower adjusted risk for early onset sepsis.
To examine whether the risk of early-onset sepsis in premature infants could be distinguished through traits observed at the time of birth, the researchers conducted a study that included infants born in Neonatal Research Network centers at 22 to 28 weeks’ gestation between 2006 and 2014. Puopolo and colleagues defined early-onset sepsis as isolation of pathogenic species from blood or cerebrospinal fluid culture at 72 hours or younger.
Infants at low risk for early-onset sepsis were those delivered via cesarean section who had a ruptured membrane at delivery and an absence of clinical chorioamnionitis. The researchers compared the regularity of prolonged exposure to antibiotics (at least 5 days) in low-risk and all other infants, and they assessed risk of mortality, early-onset sepsis and other morbidities through regression models adapted for center, race, antenatal steroid use, multiple birth, sex, gestation and birth weight.
Of the 15,433 premature infants included, 37% were low risk. The incidence of early-onset sepsis for low-risk infants who survived more than 12 hours was 0.5%, whereas the incidence was 2.5% in all other infants (adjusted RR = 0.24 [95% CI, 0.16-0.36]). Infants categorized as low risk had a considerably reduced chance of developing early-onset sepsis (76%) or death within 12 hours. Prolonged antibiotic use was observed for 34% of low-risk infants, whereas 47% of all other infants without early-onset sepsis were administered prolonged antibiotics.
“Our findings suggest that clinicians did not recognize the differential incidence of early-onset sepsis among low-risk infants or failed to account for it in their antibiotic management decisions,” Puopolo and colleagues wrote. “Although prolonged empirical antibiotic use was lower among low-risk infants than among the comparison infants, the ratio of prolonged antibiotics to number of early-onset sepsis cases was three times higher in the low-risk group. Fewer low-risk infants died at 12 or fewer hours, but those who survived were as sick or sicker than comparison infants.” – by Katherine Bortz
Disclosure: The authors report no relevant financial disclosures.