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

Authors and Disclosures

James W. Gray, Birmingham Children's Hospital, Department of Microbiology, Steelhouse Lane, Birmingham, B46NH, UK. jim.gray@bch.nhs.uk

Financial & competing interests disclosure: The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Sidebar: Executive Summary

Value of predicting risk factors for late-onset neonatal sepsis

• Identification of risk factors for late-onset neonatal sepsis (LOS) can assist in preventing infection by facilitating meaningful comparison of infection rates on different neonatal intensive care units (NICUs), identifying high-risk aspects of neonatal care so that infection prevention measures can be effectively targeted and informing the management of outbreaks of infection.

Predicting risk factors for late-onset neonatal sepsis

• There are many challenges to predicting risk factors for LOS. These include difficulties in reproducibly diagnosing and defining LOS, and identifying independent risk factors. These problems are compounded by the fact that many published studies are confined to a single NICU or a small number of units. As a result, sample sizes are often small and findings may not be generally applicable.

Intrinsic risk factors for late-onset neonatal sepsis

• These are risk factors that can not be influenced. The most reliable intrinsic risk factor appears to be birth gestational age.

Extrinsic risk factors for late-onset neonatal sepsis

• These are risk factors that relate to treatment that the individual patient receives and, as a result, they are more variable than intrinsic risk factors. Central venous devices and ventilation are probably the most extrinsic reported risk factors, but there is increasing evidence that parenteral nutrition is the most important independent risk factor.

Infrastructure-related risk factors for late-onset neonatal sepsis

• Various organizational and structural factors on NICUs have been implicated as risk factors for LOS. Further studies are required to confirm these reports.

Risk factors for specific infections

• A number of studies have investigated risk factors for sepsis due to specific pathogens, especially Gram-negative bacteria and candida. There is considerable overlap between risk factors for these infection and those for all-cause sepsis. However, gastrointestinal pathology and previous exposure to broad-spectrum antibiotics are more prominent risk factors for some of these infections.