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Clinical and Laboratory Factors That Predict Death in Very Low Birth Weight Infants Presenting With Late-onset Sepsis

Levit, Orly MD*; Bhandari, Vineet MD, DM*; Li, Fang-Yong MPH; Shabanova, Veronika MPH; Gallagher, Patrick G. MD*; Bizzarro, Matthew J. MD*

The Pediatric Infectious Disease Journal: February 2014 - Volume 33 - Issue 2 - p 143–146
doi: 10.1097/INF.0000000000000024
Original Studies

Background: Late-onset sepsis (LOS) in very low birth weight (VLBW) infants is associated with significant morbidity and mortality. The ability to predict mortality in infants with LOS based on clinical and laboratory factors at presentation of illness remains limited.

Objectives: To identify predictors of sepsis-associated mortality from a composite risk profile that includes demographic data, category of infecting organism, clinical and laboratory data at onset of illness.

Study Design: Data were collected from VLBW infants with at least 1 episode of LOS admitted to Yale Neonatal Intensive Care Unit from 1989 through 2007. Episodes were categorized as Gram-positive, Gram-negative or fungal. Multivariate logistic regression analysis was used to compare and contrast different types of infections and to assess independent risk factors for death.

Results: Four hundred twenty-four cases of LOS were identified in 424 VLBW infants. Of these, 262 (62%) were categorized as Gram-positive, 126 (30%) as Gram-negative and 36 (8%) as fungal. Multivariate analyses revealed that infants with Gram-positive infections had significantly lower odds of death compared to those with Gram-negative (adjusted odds ratio: 0.17; 95% confidence interval: 0.08–0.36) or fungal LOS (adjusted odds ratio: 0.22; 95% confidence interval: 0.07–0.64). Need for intubation, initiation of pressors, hypoglycemia and thrombocytopenia as presenting laboratory signs of infection and necrotizing enterocolitis were independent risk factors for sepsis-related death.

Conclusions: We identified presenting clinical and laboratory factors, including category of infecting organism, which predict the increased risk of LOS-related death. This information can be useful in estimating prognosis shortly after the onset of disease.

Supplemental Digital Content is available in the text.

From the *Department of Pediatrics and Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT.

Accepted for publication August 22, 2013.

The project was partially supported by National Institutes of Health T32 HD007094.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Orly Levit, MD, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.