Which Factors Predict Hospital-Acquired Late-Onset Neonatal Sepsis?

James W. Gray


Pediatr Health. 2008;2(4):477-484. 

In This Article


The wide variation in the incidence and microbial causes of LOS between centers has prompted considerable interest in identifying risk factors that could be used both to make allowance for unalterable risk factors when comparing infection rates, and to inform efficient infection prevention and control measures in individual units. However, many of the published studies of risk factors for LOS have been undertaken in single or small numbers of centers. These studies are often disadvantaged by relatively small sample sizes, and there is little guarantee that the findings in a single study can be generalized. Nevertheless, a few important conclusions can be drawn.

There is growing evidence that it is possible to compare infection rates by stratifying for a small number of independent risk factors. These risk factors are likely to be those that carry a wholly or largely unalterable risk of infection, such as birth gestational age and administration of PN. However, further, preferably larger, multicenter studies are required to validate the use of risk factors for this purpose, and also to better define the temporal relationship between risk factors and sepsis. Multicenter studies might also have to take account of less thoroughly investigated risk factors (such as recent surgery) that may not be observed on all NICUs. Other major risk factors, such as central venous device use or ventilation, should probably not be used for stratification, because it is likely that variation in the care of such devices is probably a major contributor to differences in infection rates. However, an understanding of these and other risk factors is still important to inform improvements in infection prevention and control, and to manage outbreaks of infection with particular pathogens or at a particular anatomic site. A small number of studies have suggested that infrastructural matters may also affect infection rates, but the findings, so far, must be regarded as preliminary, and further work is required to explore the true impact of these factors.

The prediction of risk factors for LOS is already an important tool in monitoring and managing risks of infection on NICUs. However, further studies are required before risk factors can be confidently used to provide a more accurate comparison of infection rates between different NICUs.


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