Sepsis In Preterm Infants Research Articles

ObjectiveTo evaluate gestational age, serum amyloid A (SAA), and hemoglobin decline (ΔHb) as diagnostic markers for necrotizing enterocolitis (NEC) secondary to late-onset sepsis (LOS) in preterm infants.MethodsA retrospective study was conducted on 77 preterm infants with LOS admitted to Anhui Provincial Children's Hospital from January 1, 2019, to October 31, 2024. The infants were divided into an NEC group (24 cases) and a non-NEC group (53 cases). Perinatal factors, initial blood counts, C-reactive protein, and SAA levels during early LOS were recorded. ΔHb was calculated as the difference between pre-LOS Hb concentration and initial Hb concentration at LOS onset. Differences were analyzed using the Mann–Whitney U test, χ2 test, or Fisher's exact test. ROC curves were used to evaluate the predictive value.ResultsThe NEC group had significantly lower birth weight, gestational age, white blood cell count, neutrophil count, and lymphocyte count compared to the non-NEC group. In contrast, SAA, ΔHb, asphyxia incidence, and ventilator use rate were significantly higher in the NEC group (P < 0.05). Logistic regression analysis indicated that gestational age, SAA, and ΔHb were independent risk factors for NEC secondary to LOS. ROC curve analysis showed that the optimal cut-off values were 236 days for gestational age, 78.3 mg/L for SAA, and 15 g/L for ΔHb. The combined model had an area under the curve of 0.888 (95% CI: 0.810–0.953, P < 0.001), and the Youden's index was 0.637.ConclusionGestational age, SAA, and ΔHb appear to be useful indicators for predicting NEC secondary to LOS in preterm infants. The ease of obtaining these indicators and their low cost make them suitable for clinical application. However, this study was retrospective with certain uncontrollable factors and a relatively small sample size. Larger prospective studies are recommended for further validation.

BackgroundRobust evidence has consistently demonstrated the impact of antenatal corticosteroid (ACS) administration on reducing mortality and improving short-term neonatal outcomes in singleton preterm infants. However, its effect on neonatal sepsis, particularly early-onset sepsis (EOS), remains poorly understood and requires further investigation. This study aimed to evaluate the potential association between prenatal dexamethasone exposure (PDE) and incidence of EOS in preterm infants.MethodsThis retrospective, single-center observational study included singleton preterm neonates with a gestational age less than 32 weeks or a birth weight below 1,500 g between 2022 and 2024. Participates were stratified into four groups based on PDE: no PDE, partial PDE (1–3 doses), PDE 1–7 days (complete course with delivery within 7 days of administration), and PDE ≥8 days (complete course with delivery more than 7 days after administration). The primary outcome was the incidence of EOS, while secondary outcomes encompassed other short-term neonatal complications.ResultsThe analysis revealed that neonates in the PDE 1–7 days group demonstrated a significantly reduced incidence of EOS compared with the no PDE group [adjusted odds ratio[aOR]: 0.299, 95% confidence interval [95%CI]: 0.122–0.731]. Furthermore, this group exhibited superior outcomes, including lower rates of respiratory distress syndrome (RDS), reduced the need for surfactant treated in RDS cases, and decreased extrauterine growth restriction (EUGR). Notably, the PDE ≥8 days group was associated with an elevated risk of EOS when compared with the PDE 1–7 days group.ConclusionPDE, particularly when a complete course is administered 1–7 days prior to delivery, demonstrates a significant protective effect against EOS in preterm infants. Nevertheless, large-scale multicenter prospective studies are warranted to further validated these findings and to comprehensively evaluate the long-term neurodevelopmental and systemic outcomes associated with PDE administration.

AimTo identify the causative bacteria of healthcare-associated sepsis in preterm infants and analyze their antibiotic resistance trends over ten years, providing evidence for infection prevention strategies.Materials and MethodsWe retrospectively analyzed blood culture data from preterm infants (<37 weeks) with healthcare-associated sepsis (onset >72 hours after birth) admitted between January 2014 and December 2023. Pathogen distribution and antibiotic resistance patterns were compared between two periods (2014–2018 vs 2019–2023).ResultsAmong 9928 preterm infants, 3.3% (332 cases) had positive blood cultures, with incidence increasing from 1.4% (2014–2018) to 2.7% (2019–2023). Gram-negative bacteria remained predominant (48.00% to 61.07%), led by Klebsiella pneumoniae. Gram-positive bacteria increased significantly (5.33% to 31.30%), primarily coagulase-negative staphylococci, while fungal infections decreased (46.67% to 7.63%). Resistance to third-generation cephalosporins persisted in K. pneumoniae (~80%) and increased in Enterobacter cloacae (60% to 90%). Emerging carbapenem resistance was observed in E. coli (0% to 33.33%) and K. pneumoniae (5.25% to 4.08%), with Enterobacter cloacae showing a significant rise (0% to 60%). ESBL-producing strains rose from 13.33% to 30.53%. All Gram-positive isolates remained susceptible to linezolid, except one vancomycin-resistant Staphylococcus capsulatus.ConclusionThe incidence of healthcare-associated sepsis in preterm infants increased significantly, with rising carbapenem resistance in Gram-negative bacteria and a marked increase in coagulase-negative staphylococci. These trends underscore the need for enhanced infection control and judicious antibiotic use guided by blood culture results.

Introduction: Staphylococcus epidermidis (SE) is a predominant hospital-acquired bacterium leading to late-onset sepsis in preterm infants. Recent findings have suggested that postnatal SE infection is associated with short-term neurodevelopmental consequences. However, the potential effects of postnatal SE infection on long-term neuronal plasticity and cognitive functions, which are sensitive to early life brain insults, remain unclear. In light of these findings, we investigated the effects of postnatal SE infection on recognition memory function using a neonatal mouse model. Methods: On postnatal day 4, male and female C57Bl/6 mice were injected intraperitoneally with either 3.5 × 107 colony-forming units of SE or sterile saline. On postnatal day 45 (±5 days), the mice were subjected to the novel object recognition test (NORT) to assess recognition memory function. Following NORT, the brains of the mice were collected for neuronal plasticity analyses by considering maturation of neurons and 3-D analysis of synaptic plasticity and hippocampal, measuring the nerve growth factor (NGF) expression. Results: Postnatal SE infection induced long-term, sex-specific effects on recognition memory and hippocampal neuroplasticity. Female SE-infected mice showed enhanced recognition memory, whereas males showed no significant difference in the recognition memory after neonatal SE infection. At the cellular level, both sexes displayed a significant decrease in doublecortin-positive neurons in the dentate gyrus after SE infection, indicating impaired neuroplasticity. However, male mice showed increased spine density, particularly of immature thin spines and disrupted spatial organization of spines, while females demonstrated no change in spines. Notably, SE infection elevated hippocampal NGF expression in males, but not in females, suggesting sex-specific molecular responses that may contribute to the observed differences in neuroplasticity and cognitive outcomes. Conclusion: This study demonstrates that postnatal SE infection induces long-lasting, sex-specific changes in recognition memory. Early life immune activation disrupted hippocampal neuroplasticity, with males showing greater vulnerability. These findings indicate distinct neurodevelopmental trajectories shaped by neonatal immune challenges in preterm infants, with implications for understanding sex-specific cognitive outcomes.

Objective: This study aims to investigate the impact of low vitamin D levels in cord blood on the incidence of neonatal sepsis in preterm infants. Patients and Methods: This prospective study was conducted at Al-Azhar and Helwan University Hospitals from September 2024 to January 2025. 150 neonate premature infants with a gestational age of &lt;37 weeks were enrolled. In the present study, vitamin D deficiency (group 1, n=75) was defined as a 25-hydroxyvitamin D (25(OH)D) concentration &lt;15 ng/mL; and vitamin D sufficiency (group 2, n =75), 25(OH)D concentration ≥15 ng/mL. Results: All markers were higher in Group 1 compared to the other groups (P &lt; 0.05). Interestingly, the mean Del PCT was lower in group 2 compared to different groups. The cut-off of the umbilical cord CRP was 10.5 mg/L, the sensitivity, specificity, PPV and NPV were 41, 88.0, 29 and 28%, respectively. At a PCT cut-off of 1.18 ng/mL, the sensitivity, specificity, PPV and NPV were 79, 91, 51 and 61%, respectively Conclusion: Our study is one of the few that examines the relationship between neonatal sepsis in preterm newborns and the level of vitamin D in cord blood. Based on the findings of our investigation, we concluded that neonatal sepsis in preterm newborns is not related to vitamin D levels in the cord blood. To investigate these findings further, a larger patient sample or randomized controlled trials are required.

BackgroundPreterm birth associated with intrauterine inflammation (IUI) has been linked to alterations in postnatal immunity and severe inflammatory complications during infancy. However, the impact of IUI on late-onset sepsis (LOS), a leading cause of mortality and morbidity in preterm infants, remains unclear. This study aims to elucidate the effect of IUI on the incidence of LOS in preterm infants by analyzing cytokine levels and white blood cell differential counts in cord blood within 24 h after birth.MethodsThis retrospective cohort study was conducted at a single tertiary neonatal center. Infants born before 37 weeks of gestation between July 2020 and June 2022 were included. Late-onset sepsis (LOS) was defined as sepsis occurring after 72 h of life during the birth hospitalization. Levels of 12 cytokines, including interleukin-1β (IL-1β), IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, tumor necrosis factor-α (TNF-α), interferon-α (IFN-α), and IFN-γ, were measured in cord blood using multiplex bead-based flow immunoassays. Clinical data were extracted from hospital databases. Peripheral white blood cell counts within 24 h after birth were routinely recorded for preterm infants. Logistic regression analysis was used to assess the impact of cytokines and white blood cell counts on the incidence of LOS.ResultsA total of 628 preterm infants were included in this study. The mean gestational age was 33.17 ± 2.25 weeks, and the mean birth weight was 1929.50 ± 516.77 g. Of these, 42 infants (6.7%) developed late-onset sepsis (LOS). Compared to the non-LOS group, cord blood levels of IL-6 [127.81 (399.86) vs. 31.02 (127.48), p = 0.004] and IL-8 [130.37 (202.53) vs. 52.91 (101.43), p = 0.001] were significantly higher in the LOS group. No significant differences were observed in the levels of other cytokines between the groups. Peripheral neutrophil and monocyte counts were significantly lower in the LOS group [5.08 ± 3.46 vs. 8.14 ± 4.90, p < 0.001; 0.98 ± 0.56 vs. 1.37 ± 0.72, p = 0.001, respectively]. Multivariable logistic regression analysis revealed that elevated cord blood IL-6 levels and reduced peripheral neutrophil counts were associated with an increased risk of LOS, after adjusting for gestational age, gestational hypertension, and antenatal steroid use (aOR = 3.113, 95% CI: 1.239–7.819, p = 0.016; aOR = 0.340, 95% CI: 0.818–0.994, p = 0.038, respectively).ConclusionsElevated cord blood IL-6 levels and low peripheral neutrophil counts on the first day after birth are associated with an increased risk of LOS in preterm infants. These findings highlight the potential of these non-invasive biomarkers in clinical practice to improve the prediction of LOS risk. Early identification using these markers may facilitate targeted management strategies, thereby reducing complications and mortality rates. Moreover, the association suggests that intrauterine inflammation may have a lasting impact on immune system responses, potentially influencing susceptibility to infections later in life.

ABSTRACT Staphylococcus haemolyticus is an important cause of sepsis in preterm infants, with gut colonization being recognized as a risk factor for infection. To better understand the diversity of S. haemolyticus among preterm infants, we generated genome sequences of S. haemolyticus strains (n = 140) from 44 stool samples of 22 preterm infants from four hospitals in England. Core genome phylogenetic analyses, incorporating 126 publicly available S. haemolyticus genome sequences, showed that 85/140 (60.1%) of the isolates, from three different hospitals, formed a clonal group with 78/85 (91.7%) strains having Multi-Locus Sequence Type (ST) 49. Antibiotic resistance genes were prevalent in the genomes. There was a strong association between the presence of mecA and phenotypic resistance to oxacillin, and the aacA-aphD gene and phenotypic resistance to gentamicin. While mecA was near-ubiquitous, none of the strains from the preterm infant cohort had a complete Staphylococcal Cassette Chromosome mec (SCCmec) element. The aacA-aphD gene was associated with the transposon Tn4001 in multiple chromosomal and plasmid contexts. Our data suggest the existence of a distinct sub-population of S. haemolyticus that has adapted to colonize the gut of preterm infants, and widespread horizontal gene transfer and recombination among this frequent colonizer of the preterm infant gut.

Comparison of Delta Neutrophil Index and Inflammatory Markers in the Diagnosis of Late-Onset Neonatal Sepsis in Preterm Infants

Based on the immunological properties of maternal colostrum, this study aimed to determine the effect of oropharyngeal colostrum on preventing late-onset sepsis in preterm infants. This clinical trial was conducted from May 2023 to June 2024 at Rouhani Hospital with 70 premature infants. In the control group, no colostrum was administered, while the intervention group received 0.4 ml of colostrum every three hours for seven days, with extraoral massage for better absorption. The relative risk of late-onset sepsis was 55% lower in the intervention group (RR = 0.45, 95% CI: 0.17 to 1.16). Although the difference in sepsis incidence between the groups was not statistically significant (11, 32.4% vs. 5, 14.7% infants, P = 0.086), it was clinically important. The age of achieving full enteral feeding was significantly lower in the intervention group (4.47 ± 2.33 vs. 3.24 ± 2.10 days, P = 0.025), but no significant differences were found in the age of achieving independent oral feeding, weight gain at discharge, or length of hospitalization. This study suggests that oropharyngeal colostrum may help reduce the incidence of late-onset sepsis and decrease the time to achieve full enteral feeding in preterm infants.Trial registration: IRCT, IRCT20230312057698N1. Registered 29 March 2023 prospective, https://irct.behdasht.gov.ir/trial/69281.

For preterm infants, supplementation with probiotics improves rates of necrotizing enterocolitis (NEC) and other morbidities. Case reports of probiotic sepsis have prompted warnings from the American Academy of Pediatrics and the Federal Drug Administration. However, incidence rates of probiotic sepsis are lacking, making it challenging to evaluate risk-benefit tradeoffs. We performed a meta-analysis and review of probiotic sepsis events in preterm infants to evaluate tradeoffs against NEC, mortality, and clinical sepsis outcomes. Dual-reviewers screened 160 articles, selecting 77 for review. Pooled estimates of incidence were computed using random-effect models. Case reports captured infant demographics, hospital course, and outcome. For 20,323 exposed infants across 63 studies, 8 probiotic sepsis cases were identified [estimate: 0% (95% CI: 0-10%)]. Risk-benefit calculations note an additional 62 cases of NEC, 42 deaths, and 92 clinical sepsis events in the unexposed cohort per case of probiotic sepsis. Case reports identified 27 probiotic sepsis events, mostly in extremely-low-birthweight infants (median GA/BW: 28 weeks, 970.0 g) and those at risk for bacterial translocation. Probiotic sepsis is extremely rare in preterm infants, with the greatest risk in an identifiable sub-population. Estimates highlighted increased morbidities in unexposed cohorts compared to probiotic sepsis incidence, suggesting consideration of risk-benefit may be warranted. This study quantifies the risk of probiotic sepsis in preterm infants utilizing a meta-analysis. In over 20,000 exposed infants across 40 randomized trials and 23 observational studies, 8 cases of probiotic sepsis were identified (<0.04%). Assessing this risk against improvements in morbidities with probiotic use, we can expect 62 more cases of NEC, 42 more deaths, and 92 more cases of clinical sepsis per case of probiotic sepsis (1:2500) avoided in the unexposed group. While the use of probiotics carries risk, rates for probiotic sepsis presented by this analysis highlight a favorable benefit/risk ratio in preterm infants.

Association between Duration of Early Empiric Antibiotics and Necrotizing Enterocolitis and Late-Onset Sepsis in Preterm Infants

Background/Objective: Late-onset sepsis (LOS), a systemic infection occurring after 72 h of life, is a significant issue of morbidity and mortality in preterm neonates. Nevertheless, in this population, cultures frequently remain negative, even in the presence of typical clinical signs of sepsis. Materials and Methods: This single-center, retrospective study included preterm infants with a birth weight (BW) < 1500 g and/or a gestational age (GA) ≤ 32 weeks, diagnosed with culture-negative LOS (CNLOS) and culture-proven LOS (CPLOS). The study aimed to determine the incidence of these conditions, describe the frequency of isolated pathogens, and compare clinical profiles, antibiotic usage, morbidity, and mortality between these two groups as well as a no-sepsis group. Results: Among 277 infants, 30 (10.8%) had CPLOS, 83 (30%) had CNLOS, and 164 (59.2%) had no sepsis. Significant differences were found between the groups regarding BW, GA, hospitalization duration, morbidity, and mortality (p < 0.001). CNLOS and CPLOS did not differ in terms of mechanical ventilation or central line use. However, CPLOS infants had a higher rate of thrombocytopenia (p < 0.001), inotrope use (p = 0.006), and mortality (p < 0.001) compared to CNLOS infants. The duration of antibiotic treatment was similar between groups [median DOT (IQR): 20 (14-33) vs. 20 (14-35), p = 0.935]. In the CPLOS group, Gram-negative pathogens were isolated in 42.4% of infants, with Klebsiella oxytoca being the most common; Gram-positive organisms in 36.3%; and fungi in 21.2%. Conclusions: LOS, whether culture-proven or not, was associated with neonatal morbidity and mortality. CPLOS was linked to a worse prognosis, while CNLOS was also frequently diagnosed and associated with increased antibiotic use in Neonatal Intensive Care Units (NICUs).

BackgroundInfections are highly relevant for neonatal mortality and long-term morbidities in survivors. Therefore, it is an urgent need to optimize and evaluate infection prevention and control (IPC) strategies. Several infection outbreaks in German neonatal intensive care units (NICUs) required rapid responses by hospitals and improved future preparedness. As a consequence, German authorities recommended weekly colonization screening on NICUs. This screening aims to detect multidrug-resistant organisms (MDRO) and bacteria with high transmissibility. According to these guidelines, infants colonized with multiresistant gram-negative (MRGN) bacteria with in-vitro resistance to piperacillin and cephalosporins (2MRGN) should be cared wearing non-sterile gloves and gowns in addition to standard hygiene precautions. Whether these extended IPC measures have an individual benefit for infants or contribute to the prevention of infection outbreaks has not yet been scientifically proven. This study aims to evaluate the effect of hand desinfection as compared to hand desinfection + gloves and gowns (barrier care) for the care of 2MRGN colonized infants in NICUs on infection and transmission rates through a multicenter, cluster randomized controlled trial (BALTIC study, Barrier protection to lower transmission and infection rates with Gram-negative 2-MRGN in preterm children).Methods12 participating NICUs were randomly allocated to two trial arms: receiving the intervention “standard precautions with a special focus on hand desinfection” or control (standard precautions “plus” barrier care) for the care of 2MRGN positive infants. Cross over was performed after 12 months for another 12 months per site. Primary outcome was the rate of healthcare-associated (HA) Gram-negative bloodstream infections. Secondary outcomes included transmission rate with screening relevant bacteria, overall rate of clinical and culture-proven infections, number of antibiotic cycles and desinfectant use. Regular trainings and hygiene audits are standardized co-interventions.Benchmarking resultsAccording to our single center data, 9.3% of NICU-treated infants are colonized with 2MRGN during their hospital stay. BALTIC randomized the first center in October 2020 and finished data collection including close-out monitoring in January 2024. Data analysis will be completed in May 2025.ConclusionsBALTIC should contribute to better evidence on the effectiveness of hand desinfection and extended barrier precautions in critically ill newborns. Further benefits include comprehensive multi-center data collection on MDRO colonization dynamics, an improved awareness on IPC strategies and establishment of network platforms including antimicrobial stewardship programs.

Background Both term and preterm neonates can develop sepsis, a potentially lethal and life-threatening condition, during the first 28 days of life. Neonatal sepsis accounts for 8% of all neonatal fatalities. This study aimed to evaluate the predictive power of lab-based diagnostic indices for neonatal sepsis in preterm infants. Methods The Systemic Inflammatory Indices of the two groups of preterms – one control group without sepsis and one case group with sepsis–were compared to assess their value in predicting Neonatal Sepsis. Data from 138 preterm neonates were used in the present study. Systemic Inflammatory Indices were calculated and compared from the collected data in both the case and control groups. Results Platelet count, Pan Immune Inflammation Value (PIV), Platelet to Lymphocyte Ratio (PLR) and Systemic Immune Inflammatory Index (SII) were found to be significant predictors of neonatal sepsis. Platelet count had the highest predictive value, with an AUC value of 0.715 and optimal cut-off value of 219500. It had a sensitivity of 75.4 and specificity of 65.2. Conclusion According to this study, sepsis in preterm infants can be predicted by using systemic inflammatory indices. This will aid in early sepsis diagnosis and management and, in turn, reduce neonatal morbidity and mortality associated with sepsis.

Introduction: We aimed to assess the incidence, risk factors, outcomes, microbial patterns and antimicrobial profiles in pre-mature infants (≤32 weeks’ gestational age [GA]). Methods: This retrospective and observational study was conducted in the neonatal intensive care unit at a tertiary university hospital in Jeddah, Saudi Arabia, from January 2014 to December 2020. Preterm infants born ≤32 gestational weeks were involved, and they were divided into two groups: the sepsis-positive group and the control group who were sepsis free. Data were obtained from our hospital computer system, including demographic data, risk factors, outcomes and blood/cerebrospinal fluid (CSF) cultures and sensitivities. Results: The incidence of neonatal sepsis (NS) was 24.5% amongst preterm infants, with higher rates of morbidity and mortality. Low GA and birth weight of the preterm infants, caesarean section delivery, use of antenatal steroids, chorioamnionitis and lack of antenatal care were the significant risk factors. In general, the most frequently identified isolate was coagulase-negative Staphylococcus (CONS) (50.9%), while in the early-onset sepsis, the most common was Group B streptococcus (41.2%), and in late-onset sepsis, the most common was CONS (55.1%). Conclusion: There is still a high incidence of NS amongst preterm infants. We identified the significant risk factors, emphasising the importance of targeted interventions to mitigate these risk factors. Furthermore, the microbial and antimicrobial profiles in our study can provide a valuable framework for guiding the appropriate selection of effective empiric antimicrobial therapies.

Introduction Inflammation in fetuses and newborns, particularly in the population of preterm infants, is associated with increased mortality and adverse health outcomes. It has been shown that the placental transfer of polyunsaturated fatty acids (PUFAs) is limited in very preterm infants. Studies have demonstrated that low levels of PUFAs correlate with the severity of inflammation in infants' bodies. They are also associated with an increased incidence of diseases, including bronchopulmonary dysplasia and retinopathy of prematurity. One of the beneficial effects of PUFA supplementation is its inhibitory action on inflammatory processes in the body. Aim of the study Supplements containing fatty acids are among the most popular complementary health interventions introduced in children. Considering this potential benefit, we would like to present research studies that describe the relationship between the supplementation of polyunsaturated fatty acids and the levels of inflammatory markers in preterm infants. Materials and MethodsA review of randomized clinical trials (RCTs) published in 2020-2024 regarding the relationship between the supplementation of polyunsaturated fatty acids and the levels of inflammatory markers in preterm infants. Three studies meeting specific selection criteria were identified. Results All the studies discussed in our work demonstrate that supplementation with polyunsaturated fatty acids in preterm infants reduces the levels of inflammatory markers. Research consistently shows that PUFA supplementation lowers IL-6 levels, a cytokine considered a risk factor for sepsis in preterm infants. Conclusion Supplementation with polyunsaturated fatty acids holds potential for modulating inflammatory processes in preterm infants, with efficacy likely influenced by factors such as the specific type of fatty acid used, timing and form of administration, and individual variations in response.

Our aim was to develop a quantitative model for immediately estimating the risk of death and/or brain injury in late-onset sepsis (LOS) in preterm infants, based on objective and measurable data available at the time sepsis is first suspected (i.e., time of blood culture collection). Retrospective study on neonates ≤36 weeks' gestation with a positive blood and/or cerebrospinal fluid culture after 72 hours from birth. Among 3217 preterm live births, 94 cases were included (median gestational age 26.5 weeks' IQR 25.0;28.0), of whom 26 (27.7%) had poor outcomes (17 death; 9 brain injuries). Infants with poor outcomes showed lower postnatal age (11.5 vs 12.5 days, p < 0.001), lower mean blood pressure (30.5 vs 43 mmHg, p < 0.001) and higher lactate levels (4.4 vs 1.5 mmol/l, p < 0.001). Our multivariable model showed good discrimination and calibration (c statistic=0.8618, Hosmer-Lemeshow p = 0.8532), stratifying the population into 3 groups: low-risk (sensitivity 97%, specificity 52%), middle-risk, and high-risk (sensitivity 77%, specificity 80%). This predictive model performs well as a practical and easy-to-use tool to help clinicians early identify the sickest neonates who may benefit from timely and aggressive support (e.g., central line, haemodynamic assessment) and close monitoring (e.g., 1:1 nursing assignment, frequent reassessments). We lack data to early identify the severity of neonatal late-onset sepsis in preterm infants. Delay in treatment contributes to poor prognosis. We developed a model for early prediction of poor outcomes (mortality and brain injuries). The model utilizes immediately available and measurable data at the time sepsis is first suspected. This can help clinicians in tailoring management based on individual risks.

BackgroundOral care with mother's colostrum (OCC) for very-low-birth-weight (VLBW) preterm newborns may provide immune-protective effects that potentially reduce the risk of late-onset sepsis (LOS) and death. Our objective was to assess the effect of OCC on the risk of LOS and mortality in VLBW premature neonates.MethodsA single-center randomized clinical trial was conducted on 65 VLBW preterm neonates. The intervention was oral care administrated every 6hours, starting in the first 24hours of life and lasting for 5days, using either own mother's colostrum (colostrum group) or sterile water (placebo group).ResultsNeonates in the colostrum group were significantly less likely to have LOS (62.5% vs 93.9%, RR = 0.66, p = 0.002), ventilator-associated pneumonia (VAP) (21.9% vs 48.5%, RR = 0.45, p = 0.025), feeding intolerance (56.3% vs 84.3%, RR = 0.66, p = 0.01), and mortality (18.8% vs 57.6%, RR = 0.3, p = 0.001). The time to start enteral nutrition in the colostrum group was shorter (p = 0.04) than in the placebo group. In multivariate analysis, OCC decreased the risk of LOS (OR = 0.12, p = 0.01) and death (OR = 0.14, p = 0.004). Moreover, OCC practice was associated with a faster time to regain birth weight (p = 0.027) and a shorter duration of hospitalization (p = 0.04) in surviving preterm infants.ConclusionOCC is a simple and safe practice that may yield a significant impact in reducing the risk of LOS, VAP, feeding intolerance, and mortality; can shorten time to start enteral feeding with faster regain to birth weight; and can shorten the length of hospital stay in VLBW preterm infants.

Abstract Objective This study aimed to assess the performance of the relatively new hematological marker delta neutrophil index (DNI) and other inflammatory markers in proven sepsis of the very preterm infant. Methods Infants with a gestational age of &lt;32 weeks, who were examined retrospectively for suspected late-onset sepsis (LOS), were evaluated in the study.. Demographic characteristics, laboratory findings, and neonatal morbidity and mortality were compared between infants with blood culture-confirmed sepsis and clinical sepsis. Results The study included 358 infants, 90 with proven sepsis and 268 with clinical sepsis. The mean gestational ages in these groups were 28.2 ± 2 and 28.2 ± 2.1 weeks, and the mean birth weights were 1139 ± 372 and 1148 ± 370 g, respectively (p &gt; 0.05). The proven sepsis group had higher DNI (median 7.1% [range: 0.1–74] vs. 0.6% [range: 0.1–24.7%], p &lt; 0.01], C-reactive protein (CRP; median 5 [range: 1–38] mg/L vs. 1 [range: 1–15] mg/L, p &lt; 0.001), interleukin-6 (median 620 [range: 6.9–5,500] pg/mL vs. 42.2 [range: 2.2–5500] pg/mL, p &lt; 0.01), and procalcitonin (median 6.2 [range: 0.26–86] µg/L vs. 0.6 [range: 0.06–25.7] µg/L, p = 0.002). According to receiver operating characteristic curve analysis, interleukin-6 had the highest area under the curve (AUC) at 0.74 (95% CI: 0.60–0.88, p &lt; 0.01). The AUC values were 0.73 (95% CI: 0.59–0.88, p = 0.01) for procalcitonin, 0.62 (95% CI: 0.44–0.80, p = 0.18) for DNI, and 0.66 (95% CI: 0.50–0.82, p = 0.05) for CRP. Conclusion The DNI showed a statistically significant elevation in infants with proven sepsis; however, its diagnostic performance was lower than that of interleukin-6, CRP, and procalcitonin. Although the results are encouraging in determining the utility of DNI in predicting LOS in preterm infants, further research is needed to validate its predictive value, specifically in this population.

Is neutrophil to lymphocyte ratio an accurate predictor of neonatal sepsis in premature infants?