Abstract
Sepsis is commonly known to affect neonatal outcomes. We assessed how much center-to-center variability of the sepsis rate affects the outcomes of very-low-birth-weight infants (VLBWIs). 7,493 VLBWIs registered in the Korean Neonatal Network from 2013 to 2016 were classified into three groups according to the sepsis rate: low sepsis group (LS) < 25th percentile versus intermediate sepsis group (IS) 25th–75th versus high sepsis group (HS) ≥ 75th. The incidence density of sepsis for the LS, IS, and HS groups were 1.17, 3.17, and 8.88 cases/1,000 person-days. After propensity score matching was done for multiple antenatal and perinatal factors, the odds ratio of death, moderate to severe bronchopulmonary dysplasia and/or death, periventricular leukomalacia, and survival without major morbidities for the HS group were 2.0 (95% confidence interval 1.4–2.8), 1.9 (1.5–2.4), 1.5 (1.1–2.3) and 0.7 (0.5–0.8) when compared with the IS group, and 2.2 (1.6–3.2), 2.3 (1.8–2.9), 2.0 (1.3–2.9), and 0.7 (0.6–0.9) when compared with the LS group. There were no significant differences in those outcomes between the LS and IS groups. Hence, nationwide quality improvements to control the sepsis rate especially in units with a high sepsis rate will be helpful to improve the outcomes of VLBWIs.
Highlights
Since 2013, almost all the NICUs in South Korea have been participating in the nationwide Korean Neonatal Network (KNN)
A total of 7,493 VLBW infants from 67 hospitals were included after the exclusion of 693 infants: 425 infants transferred to a ward, pediatric intensive care unit or other hospital; 6 infants admitted more than one year; 19 infants with no information about sepsis, and 243 infants with a major congenital anomaly
After propensity score matching for gestational age (GA), gender, small for gestational age (SGA), multiple pregnancies, cesarean section, hypertensive disorders of pregnancy, histologic chorioamnionitis (HCA), oligohydramnios, complete course of antenatal corticosteroid (ACS) use, delivery room resuscitation, and 5 minute Apgar score, 846 infants were included in each group for the analysis (Fig. 1)
Summary
Since 2013, almost all the NICUs in South Korea have been participating in the nationwide Korean Neonatal Network (KNN). According to an analysis of the KNN database in 2014, the sepsis rate in VLBW infants in South Korea was 21.1%, and the late-onset sepsis (LOS) rate was 19.4% with a 16.1% mortality rate[12]. Such a sepsis rate is similar to that of the Canadian Neonatal Network, higher than that of the Neonatal Research Network of Japan[13]. The aim of this study was to show how much the sepsis rate or the incidence density of sepsis is different between NICUs in South Korea and how this unit variation affects the neonatal outcomes in VLBW infants
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