Journal Article

Early-onset sepsis in very preterm neonates in Australia and New Zealand, 2007–2018

Shah, Prakeshkumar S, Stewart, Michael, Luig, Melissa, Boom, Jutta vanden, Austin, Nicola C, Edmonds, Liza, Duggan, Husharn L, Battin, Malcolm, Schmidt, Peter, Berry, Andrew, Kuschel, Carl, Collins, Clare, Rajadurai, Victor Samuel, Hickey, Leah, Dhawan, Anjali, Stack, Jacqueline, Paradisis, Mary, Darlow, Brian, Gill, Andy, Nothdurft, Karen, Koh, Guan, Spotswood, Naomi, Stewart, Alice, Carlisle, Hazel, Morris, Peter, Badawi, Nadia, Richardson, Vaughan, Greenhalgh, Mark, Davis, Jonathan, Barker, David, Casalaz, Dan, Tan, Kenneth, Morris, Scott, Buksh, Mariam, Numa, Andrew, Ng, Linda, Pillow, Jane, Doyle, Lex, Cooke, Lucy, Sharp, Mary, Lui, Kei, Bolisetty, Srinivas, Birch, Pita, Hunt, Rod, Popat, Himanshu, Mildenhall, Lindsay, Koorts, Pieter, Headley, Bevan, Merida, Natalie, Chow, Sharon S W, Korostenski, Larissa, Paoli, Tony De, Downe, Lyn, Chambers, Georgina, Craven, John, Austin, Nicola, Hammond, Barbara, Andersen, Chad, Holberton, Jim

2023

Overview

ObjectiveTo evaluate the epidemiology and population trends of early-onset sepsis in very preterm neonates admitted to neonatal intensive care units (NICU) in Australia and New Zealand.DesignRetrospective observational cohort study using a dual-nation registry database.Setting29 NICUs that have contributed to the Australian and New Zealand Neonatal Network.ParticipantsNeonates born at <32 weeks’ gestation born between 2007 and 2018 and then admitted to a NICU.Main outcome measuresMicroorganism profiles, incidence, mortality and morbidity.ResultsOver the 12-year period, 614 early-onset sepsis cases from 43 178 very preterm admissions (14.2/1000 admissions) were identified. The trends of early-onset sepsis incidence remained stable, varying between 9.8 and 19.4/1000 admissions (linear trend, p=0.56). The leading causative organisms were Escherichia coli (E. coli) (33.7%) followed by group B Streptococcus (GBS) (16.1%). The incidence of E. coli increased between 2007 (3.2/1000 admissions) and 2018 (8.3/1000 admissions; p=0.02). Neonates with E. coli had higher odds of mortality compared with those with GBS (OR=2.8, 95% CI 1.2 to 6.1). Mortality due to GBS decreased over the same period (2007: 0.6/1000 admissions, 2018: 0.0/1000 admissions; p=0.01). Early-onset sepsis tripled the odds of mortality (OR=3.0, 95% CI 2.4 to 3.7) and halved the odds of survival without morbidity (OR=0.5, 95% CI 0.4 to 0.6).ConclusionEarly-onset sepsis remains an important condition among very preterm populations. Furthermore, E. coli is a dominant microorganism of very preterm early-onset sepsis in Australia and New Zealand. Rates of E. coli have been increasing in recent years, while GBS-associated mortality has decreased.

• Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group LTD
• Subject: Antibiotics / Australia - epidemiology / Birth weight / Cerebrospinal fluid / Disease prevention / E coli / Epidemiology / Escherichia coli / Fatalities / Gestational age / Hemorrhage / Hospitals / Humans / Incidence / Infant, Extremely Premature / Infant, Newborn / Infections / Intensive care / Lung diseases / Morbidity / Mortality / Neonatal care / Neonates / Neonatology / New Zealand - epidemiology / Newborn babies / Observational studies / Original research / Pediatrics / Premature babies / Premature birth / Regression analysis / Retrospective Studies / Sepsis / Sepsis - epidemiology / Streptococcal Infections - epidemiology / Streptococcus agalactiae / Trends / Ventilators