Risk factors and survival for late onset sepsis in very-lowbirth- weight infants in a public hospital, Johannesburg, South Africa

Abstract

Abstract: Background: Despite advances in neonatal care that have improved survival of verylow-birth-weight (VLBW) infants,
neonatal sepsis (NNS) remains a common cause of morbidity and mortality.
Objectives: To review risk factors and short-term outcomes of late onset sepsis (LOS) in VLBW infants at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa.
Methods: This was a secondary analysis of an existing database of VLBW infants admitted at CMJAH from 1st January 2014 to 31st December 2018. Characteristics of infants with LOS were compared with those infants without LOS to elicit factors associated with LOS.
Results: A total of 1974 VLBW infants were enrolled for the study and 698/1974 (35.4%) had LOS. Factors associated with LOS after multivariate logistic regression were patent ductus arteriosus (PDA) (p <0.038), blood transfusion (p <0.001), necrotizing enterocolitis (NEC) (p <0.025), surgery for NEC (p <0.013) and surgery for any other reason (p <0.043). The mortality rate was increased in infants with LOS compared to those without LOS, 31.23% versus 16.38% (p < 0.001). There were 901 episodes of sepsis in 698 infants with LOS. The majority of the sepsis episodes were caused by Grampositive organisms 450/901 (49.9%). Gram-negative and fungal organisms were responsible for 353/901 (39.2%) and 98/901 (10.9%) of the LOS respectively.
Conclusion: A third of VLBW infants in the study developed LOS. Sepsis caused by Gram negative organisms is associated with increased mortality. Active surveillance of LOS and adopting available alternatives to invasive procedures that are medically proven could greatly help to reduce the incidence of LOS in VLBW infants.