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Early-onset Sepsis Among Preterm Neonates in China, 2015 to 2018

Jiang, Siyuan MD*; Hong, Luyang BM*; Gai, Jianfang MD; Shi, Jingyun MM; Yang, Yi PhD§; Lee, Shoo K. FRCPC¶,‖,#; Cao, Yun MD*,§ on behalf of the REIN-EPIQ Study Group

The Pediatric Infectious Disease Journal: December 2019 - Volume 38 - Issue 12 - p 1236–1241
doi: 10.1097/INF.0000000000002492
Maternal-Neonatal Reports

Background: The epidemiology of early-onset sepsis (EOS) in China is poorly understood because of the paucity of high-quality data. We aimed to examine the epidemiology, pathogen distribution and neonatal outcomes of EOS among a large cohort of preterm infants in China.

Methods: All infants born at <34 weeks of gestation and admitted to 25 tertiary neonatal intensive care units in China from April 2015 to May 2018 were enrolled. EOS was defined as a culture-confirmed infection that occurred within 72 hours after birth.

Results: Among 27,532 enrolled infants, 321 (11.7 cases per 1000 admissions) infants developed EOS, and 61 (19.0%) infants died within seven days after EOS onset. The incidence of EOS among inborn infants in 18 perinatal centers was 9.7 cases per 1000 live births <34 weeks’ gestation (186/19,084). The case fatality rate was 22.6% (42/186). Gram-negative bacteria were responsible for 61.7% of EOS and 82.0% of EOS-related deaths. Escherichia coli (20.3%) was the leading pathogen, followed by Coagulase-negative staphylococcus (16.5%), Achromobacter xylosoxidans (9.0%) and Klebsiella pneumoniae (8.1%). Group B streptococci infections were relatively rare (2.5%). EOS was an independent risk factor for all-cause mortality and retinopathy of prematurity.

Conclusions: There is a high burden of EOS among preterm infants in China with a distinctive pathogen distribution. Longitudinal epidemiologic monitoring, further investigation of causative pathogens and development of targeted strategies for prevention and treatment of EOS are needed.

From the *Department of Neonatology, Children’s Hospital of Fudan University, Shanghai, China

Department of Neonatology, Children’s Hospital of Shanxi, Shanxi, China

Department of Neonatology, Gansu provincial Maternal and Child Hospital, Gansu, China

§NHC Key Laboratory of Neonatal Diseases (Fudan University), Shanghai, China

Maternal-Infant Care Research Centre and Department of Pediatrics Mount Sinai Hospital

Department of Pediatrics

#Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Accepted for publication August 25, 2019.

This study was funded by the China Medical Board (Grant Number: 14-194), Key Developing Discipline of the Shanghai Municipal Health Commission (Pediatrics) (Grant Number: 2016ZB0101), and the Canadian Institutes of Health Research (Grant Number: CTP 87518).

The authors have no conflicts of interest to disclose.

S.J. and L.H. have contributed equally to this work and are first authors.

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: Yun Cao, MD, Department of Neonatology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, China, 201102. E-mail:

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