The effect of late-onset sepsis on mortality across different gestational ages in a neonatal intensive care unit: A historical study

• Published in: Intensive & critical care nursing 2023-08, Vol.77, p.103421-103421, Article 103421
• Main Authors: Afonso, Elsa, Smets, Koenraad, Deschepper, Mieke, Verstraete, Evelien, Blot, Stijn
• Format: Article
• Language: English
• Subjects: Age of onset; Birth weight; Brain damage; Clinical medicine; Clinical nursing; Cohort analysis; Cohort Studies; Dysplasia; Female; Gastrointestinal diseases; Gestational Age; Hospitals; Humans; Infant; Infant, Newborn; Infant, Premature; Infections; Intensive care; Intensive Care Units, Neonatal; Laboratories; Late-onset sepsis; Lung diseases; Mortality; Neonatal; Neonatal care; Neonatal units; Newborn babies; NICU; Nurses; Pathogens; Patients; Perinatal period; Pre-term; Pregnancy; Regression analysis; Retrospective Studies; Sepsis; Sepsis - complications; Surgery; Traumatic brain injury; Variables; Ventilators
• ISSN: 0964-3397; 1532-4036
• DOI: 10.1016/j.iccn.2023.103421

Late-onset sepsis is a frequent complication in neonatal intensive care units. This study aims to understand the effect of late-onset sepsis on mortality in hospitalised neonatal patients across different gestational ages. This is a single-centre, historical cohort study including neonates admitted to hospital during a 10-year period (2002 – 2011). Neonates were stratified by gestational age: extremely preterm (37 weeks). Tertiary NICU in Ghent, Belgium. Logistic regression analysis was used to assess adjusted relationships between late-onset sepsis and mortality, reported as odds ratio (OR) and 95% confidence interval (CI). A total of 4928 neonates were included, of which 2071 were term (42.0%), 1425 were late preterm (28.9%), 1165 very preterm (23.6%) and 264 were extremely preterm neonates (5.4%). 40 neonates developed late-onset sepsis (8.2 episodes/1000 patient days). Overall, in-hospital mortality was 5.4%. Late-onset sepsis was an independent risk factor for mortality in the total cohort (OR = 2.41; 95% CI = 1.46–3.96). However, when gestational age groups were considered separately, late-onset sepsis was associated with mortality in very preterm neonates (OR = 2.45; 95% CI = 1.03–5.84) and in the late preterm neonates (OR = 3.92; 95% CI = 1.41–10.87), but not in other neonates. Comorbidities burdening neonatal hospital survival include acute lung disease, brain damage, periventricular leukomalacia, surgery, and broncho-pulmonary dysplasia. Late-onset sepsis is an independent risk factor for mortality in very preterm and late preterm neonates. Understanding how late-onset sepsis among other factors impact mortality enables a patient and family-centred approach to nursing care including the anticipation of realistic milestones. Late-onset sepsis is especially detrimental to preterm neonates and this could be taken into consideration by nurses when communicating with families in the perinatal period.