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The effect of late-onset sepsis on mortality across different gestational ages in a neonatal intensive care unit : a historical study

Elsa da Palma Afonso (UGent) , Koenraad Smets (UGent) , Mieke Deschepper (UGent) , Evelien Verstraete (UGent) and Stijn Blot (UGent)
(2023) INTENSIVE AND CRITICAL CARE NURSING. 77.
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Abstract
Objectives: Late-onset sepsis is a frequent complication in neonatal intensive care units. This study aims to un-derstand the effect of late-onset sepsis on mortality in hospitalised neonatal patients across different gestational ages.Design: This is a single-centre, historical cohort study including neonates admitted to hospital during a 10-year period (2002 - 2011). Neonates were stratified by gestational age: extremely preterm (<28 weeks), very preterm (28 to 32 weeks), late preterm (33 to 36 weeks), full term (>37 weeks).Setting: Tertiary NICU in Ghent, Belgium. Main Outcome Measures: Logistic regression analysis was used to assess adjusted relationships between late-onset sepsis and mortality, reported as odds ratio (OR) and 95% confidence interval (CI).Results: A total of 4928 neonates were included, of which 2071 were term (42.0%), 1425 were late preterm (28.9%), 1165 very preterm (23.6%) and 264 were extremely preterm neonates (5.4%). 40 neonates developed late-onset sepsis (8.2 episodes/1000 patient days). Overall, in-hospital mortality was 5.4%. Late-onset sepsis was an independent risk factor for mortality in the total cohort (OR = 2.41; 95% CI = 1.46-3.96). However, when gestational age groups were considered separately, late-onset sepsis was associated with mortality in very pre-term neonates (OR = 2.45; 95% CI = 1.03-5.84) and in the late preterm neonates (OR = 3.92; 95% CI = 1.41-10.87), but not in other neonates. Comorbidities burdening neonatal hospital survival include acute lung disease, brain damage, periventricular leukomalacia, surgery, and broncho-pulmonary dysplasia.Conclusion: Late-onset sepsis is an independent risk factor for mortality in very preterm and late preterm neo-nates. Understanding how late-onset sepsis among other factors impact mortality enables a patient and family-centred approach to nursing care including the anticipation of realistic milestones. Implications for clinical practice: Late-onset sepsis is especially detrimental to preterm neonates and this could be taken into consideration by nurses when communicating with families in the perinatal period.
Keywords
Neonatal, NICU, Late-onset sepsis, Mortality, Gestational age, Pre-term, BIRTH-WEIGHT INFANTS, RISK-FACTORS, INFECTIONS, TRENDS, TIME

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MLA
da Palma Afonso, Elsa, et al. “The Effect of Late-Onset Sepsis on Mortality across Different Gestational Ages in a Neonatal Intensive Care Unit : A Historical Study.” INTENSIVE AND CRITICAL CARE NURSING, vol. 77, Elsevier Sci Ltd, 2023, doi:10.1016/j.iccn.2023.103421.
APA
da Palma Afonso, E., Smets, K., Deschepper, M., Verstraete, E., & Blot, S. (2023). The effect of late-onset sepsis on mortality across different gestational ages in a neonatal intensive care unit : a historical study. INTENSIVE AND CRITICAL CARE NURSING, 77. https://doi.org/10.1016/j.iccn.2023.103421
Chicago author-date
Palma Afonso, Elsa da, Koenraad Smets, Mieke Deschepper, Evelien Verstraete, and Stijn Blot. 2023. “The Effect of Late-Onset Sepsis on Mortality across Different Gestational Ages in a Neonatal Intensive Care Unit : A Historical Study.” INTENSIVE AND CRITICAL CARE NURSING 77. https://doi.org/10.1016/j.iccn.2023.103421.
Chicago author-date (all authors)
da Palma Afonso, Elsa, Koenraad Smets, Mieke Deschepper, Evelien Verstraete, and Stijn Blot. 2023. “The Effect of Late-Onset Sepsis on Mortality across Different Gestational Ages in a Neonatal Intensive Care Unit : A Historical Study.” INTENSIVE AND CRITICAL CARE NURSING 77. doi:10.1016/j.iccn.2023.103421.
Vancouver
1.
da Palma Afonso E, Smets K, Deschepper M, Verstraete E, Blot S. The effect of late-onset sepsis on mortality across different gestational ages in a neonatal intensive care unit : a historical study. INTENSIVE AND CRITICAL CARE NURSING. 2023;77.
IEEE
[1]
E. da Palma Afonso, K. Smets, M. Deschepper, E. Verstraete, and S. Blot, “The effect of late-onset sepsis on mortality across different gestational ages in a neonatal intensive care unit : a historical study,” INTENSIVE AND CRITICAL CARE NURSING, vol. 77, 2023.
@article{01HMVSS1GKK196RFNBSPH3DK4Z,
  abstract     = {{Objectives: Late-onset sepsis is a frequent complication in neonatal intensive care units. This study aims to un-derstand the effect of late-onset sepsis on mortality in hospitalised neonatal patients across different gestational ages.Design: This is a single-centre, historical cohort study including neonates admitted to hospital during a 10-year period (2002 - 2011). Neonates were stratified by gestational age: extremely preterm (<28 weeks), very preterm (28 to 32 weeks), late preterm (33 to 36 weeks), full term (>37 weeks).Setting: Tertiary NICU in Ghent, Belgium. Main Outcome Measures: Logistic regression analysis was used to assess adjusted relationships between late-onset sepsis and mortality, reported as odds ratio (OR) and 95% confidence interval (CI).Results: A total of 4928 neonates were included, of which 2071 were term (42.0%), 1425 were late preterm (28.9%), 1165 very preterm (23.6%) and 264 were extremely preterm neonates (5.4%). 40 neonates developed late-onset sepsis (8.2 episodes/1000 patient days). Overall, in-hospital mortality was 5.4%. Late-onset sepsis was an independent risk factor for mortality in the total cohort (OR = 2.41; 95% CI = 1.46-3.96). However, when gestational age groups were considered separately, late-onset sepsis was associated with mortality in very pre-term neonates (OR = 2.45; 95% CI = 1.03-5.84) and in the late preterm neonates (OR = 3.92; 95% CI = 1.41-10.87), but not in other neonates. Comorbidities burdening neonatal hospital survival include acute lung disease, brain damage, periventricular leukomalacia, surgery, and broncho-pulmonary dysplasia.Conclusion: Late-onset sepsis is an independent risk factor for mortality in very preterm and late preterm neo-nates. Understanding how late-onset sepsis among other factors impact mortality enables a patient and family-centred approach to nursing care including the anticipation of realistic milestones. Implications for clinical practice: Late-onset sepsis is especially detrimental to preterm neonates and this could be taken into consideration by nurses when communicating with families in the perinatal period.}},
  articleno    = {{103421}},
  author       = {{da Palma Afonso, Elsa and Smets, Koenraad and Deschepper, Mieke and Verstraete, Evelien and Blot, Stijn}},
  issn         = {{0964-3397}},
  journal      = {{INTENSIVE AND CRITICAL CARE NURSING}},
  keywords     = {{Neonatal,NICU,Late-onset sepsis,Mortality,Gestational age,Pre-term,BIRTH-WEIGHT INFANTS,RISK-FACTORS,INFECTIONS,TRENDS,TIME}},
  language     = {{eng}},
  pages        = {{8}},
  publisher    = {{Elsevier Sci Ltd}},
  title        = {{The effect of late-onset sepsis on mortality across different gestational ages in a neonatal intensive care unit : a historical study}},
  url          = {{http://doi.org/10.1016/j.iccn.2023.103421}},
  volume       = {{77}},
  year         = {{2023}},
}
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