Clinical features and prognostic factors of early phase of infection in newborn infants with early-onset sepsis

Abstract

Purpose: This study was undertaken to investigate the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. Methods: A retrospective analysis of the medical records was conducted in a NICU of a university hospital over a 7.5-year period (Jan 2010-Jun 2017). Results: During the study period, there were 45 (1.2%) episodes of EOS in 3,862 infants. The most common pathogen responsible for EOS was Streptococcus group B (GBS) in 10 cases (22.2%), followed by E. coli in 9 cases (20%). The frequency of Gram-positive sepsis was higher in term than in preterm infants, while the rate of Gram-negative infection was higher in preterm than in term infants (P<0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There was a significant difference in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. In a comparison after adjusting for the difference in gestational age and birth weight between the two groups, Gram-negative pathogens (OR: 42, 95% CI: 1.4~1281.8) and some clinical findings, such as neutropenia (OR: 46, 95% CI: 1.3~1628.7) and decreased activity (OR: 34, 95% CI: 1.8~633.4), were associated with fatality. Conclusion: The common pathogens responsible for EOS in NICU patients are GBS and E. coli. Infection caused by Gram-negative bacteria, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.