Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Predictors of early-onset neonatal sepsis or death among newborns born at <32 weeks of gestation

Journal of Perinatology volume 39, pages 949–955 (2019)Cite this article

Subjects

Abstract

Objective

To develop a predictive model for early-onset neonatal sepsis or death among infants born at less than 32 weeks of gestation.

Study design

This was a case-control study of all deliveries <32 weeks between 2011 and 2015 in a single tertiary care center. Cases were defined as neonates diagnosed with early-onset sepsis based on a blood or cerebrospinal fluid culture or neonates who expired during the first week of life. Controls consisted of neonates without these outcomes. Variables previously identified to be associated with neonatal sepsis or death were abstracted from the medical record. Bivariable analyses and multivariable logistic regression were used to determine independent risk factors for early-onset neonatal sepsis or death. An ROC curve was created and AUC calculated to estimate the predictive capacity of these associations.

Results

Of 779 eligible neonates, early-onset neonatal sepsis or death occurred in 73 (9.4%). In bivariable analyses, mothers whose neonates were diagnosed with early-onset sepsis or death were more likely to be obese, have an intrapartum fever, and have meconium-stained amniotic fluid, and were less likely to have received betamethasone or antepartum/intrapartum antibiotics. Gestational age at delivery and birth weight was significantly lower among neonates diagnosed with neonatal sepsis or death. In multivariable analyses, factors remaining independently associated with neonatal sepsis or death were earlier gestational age at the time of delivery (specifically <28 weeks), intrapartum fever, presence of meconium-stained amniotic fluid, and lower birth weight. The AUC for this regression was 0.81 (95% confidence interval 0.77–0.83).

Conclusion

Earlier gestational age at the time of delivery, intrapartum fever, meconium, and lower birth weight are independently associated with early-onset neonatal sepsis or death among deliveries occurring at <32 weeks of gestation; these factors can be used to create a model with fair predictive capability.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Wynn JL, Wong HR, Shanley TP, Bizzarro MJ, Saiman L, Polin RA. Time for a neonatal-specific consensus definition for sepsis. Pediatr Crit Care Med. 2014;15:523–28.

    Article  Google Scholar 

  2. Stoll BJ, Hansen NI, Sanchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011;127:817–26.

    Article  Google Scholar 

  3. Schrag SJ, Farley MM, Petit S, Reingold A, Weston EJ, Pondo T, et al. Epidemiology of Invasive Early-Onset Neonatal Sepsis, 2005 to 2014. Pediatrics. 2016;138:e20162013.

    Article  Google Scholar 

  4. Sgro M, Shah PS, Campbell D, Tenuta A, Shivananda S, Lee SK. Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008 Canadian Neonatal Network. J Perinatol. 2011;31:794–8.

    Article  CAS  Google Scholar 

  5. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. J. Am. Med. Assoc. 2015;314:1039–51.

    Article  CAS  Google Scholar 

  6. Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol. 2006;35:706–18.

    Article  Google Scholar 

  7. Stoll BJ, Hansen N. Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol. 2003;27:293–301.

    Article  Google Scholar 

  8. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110:285–91.

    Article  Google Scholar 

  9. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390:1770–80.

    Article  Google Scholar 

  10. Soman M, Green B, Daling J. Risk factors for early neonatal sepsis. Am J Epidemiol. 1985;121:712–9.

    Article  CAS  Google Scholar 

  11. Yancey MK, Duff P, Kubilis P, Clark P, Frentzen BH. Risk factors for neonatal sepsis. Obstet Gynecol. 1996;87:188–94.

    Article  CAS  Google Scholar 

  12. Schuchat A, Zywicki SS, Dinsmoor MJ, Mercer B, Romaguera J, O’Sullivan MJ, et al. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Pediatrics. 2000;105:21–6.

    Article  CAS  Google Scholar 

  13. Herbst A, Källén K. Time between membrane rupture and delivery and septicemia in term neonates. Obstet Gynecol. 2007;110:612–8.

    Article  Google Scholar 

  14. Singh SA, Dutta S, Narang A. Predictive clinical scores for diagnosis of late onset neonatal septicemia. J Trop Pediatr. 2003;49:235–9.

    Article  Google Scholar 

  15. Okascharoen C, Sirinavin S, Thakkinstian A, Kitayaporn D, Supapanachart S. A bedside prediction-scoring model for late-onset neonatal sepsis. J Perinatol. 2005;25:778–83.

    Article  Google Scholar 

  16. Kudawla M, Dutta S, Narang A. Validation of a clinical score for the diagnosis of late onset neonatal septicemia in babies weighing 1000–2500 g. J Trop Pediatr. 2008;54:66–9.

    Article  Google Scholar 

  17. Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011;128:e1155–63.

    Article  Google Scholar 

  18. Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, et al. Stratification of risk of early-onset sepsis in newborns ≥34 weeks’ gestation. Pediatrics. 2014;133:30–6.

    Article  Google Scholar 

  19. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.

    Article  CAS  Google Scholar 

  20. McNeil BJ, Hanley JA. Statistical approaches to the analysis of receiver operating characteristic (ROC) curves. Med Decis Mak. 1984;4:137–50.

    Article  CAS  Google Scholar 

  21. Collins A, Weitkamp JH, Wynn JL. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed. 2018;103:F391–4.

    Article  Google Scholar 

  22. Polin RA, Denson S, Brady MT. Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics. 2012;129:e1104–9.

    Article  Google Scholar 

  23. Sohn AH, Garrett DO, Sinkowitz-Cochran RL, Grohskopf LA, Levine GL, Stover BH, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr. 2001;139:821–7.

    Article  CAS  Google Scholar 

  24. Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr. 2015;61:1–13.

    Article  Google Scholar 

  25. Verstraete EH, Blot K, Mahieu L, Vogelaers D, Blot S. Prediction models for neonatal health care-associated sepsis: a meta-analysis. Pediatrics. 2015;135:e1002–14.

    Article  Google Scholar 

  26. Kimberlin DW, American Academy of Pediatrics. Group B streptococcal infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed., American Academy of Pediatrics, 2015. p. 745.

  27. Popowski T, Goffinet F, Maillard F, Schmitz T, Leroy S, Kayem G. Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study. BMC Pregnancy Childbirth. 2011;11:26.

    Article  Google Scholar 

  28. Hedegaard SS, Wisborg K, Hvas AM. Diagnostic utility of biomarkers for neonatal sepsis - a systematic review. Infect Dis . 2015;47:117–24.

    Article  CAS  Google Scholar 

  29. Bekhof J, Reitsma JB, Kok JH, Van Straaten IH. Clinical signs to identify late-onset sepsis in preterm infants. Eur J Pediatr. 2013;172:501–8.

    Article  Google Scholar 

  30. Ohlin A, Björkqvist M, Montgomery SM, Schollin J. Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis. Acta Paediatr. 2010;99:1635–40.

    Article  Google Scholar 

Download references

Financial disclosures

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA

    Anna Palatnik

  2. Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Lilly Y. Liu

  3. Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Andy Lee & Lynn M. Yee

Authors
  1. Anna Palatnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lilly Y. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andy Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lynn M. Yee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Palatnik.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Each author has indicated that he/she has met the journal’s requirements for authorship.

Presentation: This study was a poster presentation at the 64th annual meeting of the Society for Reproductive Investigation, March 15–18, Orlando, Florida, 2017.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palatnik, A., Liu, L.Y., Lee, A. et al. Predictors of early-onset neonatal sepsis or death among newborns born at <32 weeks of gestation. J Perinatol 39, 949–955 (2019). https://doi.org/10.1038/s41372-019-0395-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0395-9

This article is cited by

Search

Advanced search

Quick links