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Incidence, Clinical Characteristics and Risk Factors for Adverse Outcome in Neonates With Late-onset Sepsis

Tsai, Ming-Horng MD*†‡; Hsu, Jen-Fu MD†§; Chu, Shih-Ming MD†§; Lien, Reyin MD†§; Huang, Hsuan-Rong MD†§; Chiang, Ming-Chou MD†§; Fu, Ren-Huei MD, PhD†§; Lee, Chiang-Wen MD, PhD; Huang, Yhu-Chering MD, PhD†¶

The Pediatric Infectious Disease Journal: January 2014 - Volume 33 - Issue 1 - p e7–e13
doi: 10.1097/INF.0b013e3182a72ee0
Original Studies

Background: Late-onset sepsis (LOS) is a common complication in the neonatal intensive care unit. We aimed to describe the epidemiology, clinical characteristics and risk factors for adverse outcome in neonates with LOS.

Methods: We conducted a cohort study of all neonates with LOS at the neonatal intensive care unit of a Tertiary Taiwan Medical Center from January 2004 through December 2011 and used multivariate logistic regression to identify risk factors for final adverse outcome.

Results: Among 5010 neonates over 253,644 neonate-days, 713 (14.2%) experienced a total of 942 episodes of LOS (incidence rate, 3.71 episodes per 1000 neonate-days). Although the rates of LOS were inversely proportional to birth weight and gestational age, the incidence rates were comparable among extremely preterm, late preterm and full term neonates. Fungemia was found to have significantly higher rate of infectious complication (30.8%), persistent bloodstream infection (19.2%) and sepsis attributable mortality (23.1%). The overall mortality rate was 12.6% (90/713), and sepsis attributable mortality rate was 7.2% (68/942 episodes). Independent predictors of in-hospital mortality were Pseudomonas LOS (adjusted odds ratio [OR], 14.31; 95% confidence interval [CI]: 3.87–53.0), fungemia (OR, 5.69; 95% CI: 2.48–13.01), presence of congenital anomalies (OR, 4.12; 95% CI: 1.60–10.60), neuromuscular comorbidities (OR, 3.34; 95% CI: 1.66–6.73) and secondary pulmonary hypertension with/without cor pulmonale (OR, 23.48; 95% CI: 5.96–92.49).

Conclusions: LOS predisposes hospitalized neonates to increased risk of mortality or morbidity, especially caused by Pseudomonas aeruginosa or Candida spp. More aggressive treatment strategy is worth consideration in neonates with presumed LOS, particularly those with certain underlying chronic conditions.

From the *Department of Pediatrics, Division of Neonatology and Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Yunlin; College of Medicine, Chang Gung University, Taoyuan; Chang Gung University of Science and Technology, Chiayi; §Department of Pediatrics, Division of Pediatric Neonatology; and Department of Pediatrics, Division of Pediatric Infectious Disease, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Accepted for publication June 25, 2013.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Yhu-Chering Huang, MD, PhD, Division of Pediatric Infection Disease, Department of Pediatrics, Chang Gung Memorial Hospital, 5, Fu-Shing St., Kwei-Shan, Taoyuan 333, Taiwan. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.