Trends in the incidence and associated factors of late-onset sepsis associated with improved survival in extremely preterm infants born at 23–26 weeks’ gestation: a retrospective study

Jin Kyu Kim, Yun Sil Chang, Sein Sung, So Yoon Ahn, Won Soon Park

To investigate the trends in the incidence and associated factors of late-onset sepsis (LOS) associated with improved survival in extremely preterm infants. Medical records of 364 infants who were born at 23-26 weeks' gestation from 2000 to 2005 (period I, n = 124) and from 2006 to 2011 (period II, n = 240) were retrospectively reviewed. The infants were stratified into subgroups of 23-24 and 25-26 weeks' gestation within each period, and survival, LOS rate, and clinical characteristics were analyzed. Multivariate logistic regression analyses were completed to identify the clinical factors associated with LOS. The survival rate of 75.8% during period I significantly improved to 85.4% during period II, especially in infants at 23-24 weeks' gestation (55.1% vs. 78.1%, respectively). The LOS rate of 33.1% during period I significantly reduced to 15.8% during period II, especially in infants at 25-26 weeks' gestation (32.0% vs. 8.9%, respectively). The LOS rate per 1000 hospital days of 4.0 during period I significantly reduced to 1.8 during period II. Candida presence reduced from 21.3% during period I to 4.7% during period II. In multivariate analyses, during period I, prolonged intubation, especially in infants at 25-26 weeks' gestation, and necrotizing enterocolitis, especially in infants at 23-24 weeks' gestation, were significantly associated with LOS. Improved survival of infants at 23-24 weeks' gestation was associated with a simultaneous reduction of LOS incidence in infants at 25-26 weeks' gestation. Less-invasive assisted ventilation may be one of the details of improved perinatal and neonatal care that has contributed to lowering risk of infection or death among periviable infants.