Neurodevelopmental Outcome after Late-Onset Bacterial Sepsis in Infants Born before 29 Weeks' Gestation

Neonatal late-onset sepsis is associated with increased mortality and morbidity, adversely impacting long-term outcome. The objective of this study was to examine neurodevelopmental (ND) outcomes at 18 to 24 months' corrected age (CA) in infants with late-onset bacterial sepsis (LOS) and to categorize outcomes based on type of bacterial pathogen in a cohort of preterm infants born less than 29 weeks gestation in Canada.We conducted a retrospective cohort study of all non-anomalous infants born at <29 weeks gestational age (GA) who were admitted to Canadian NICUs, from January 1, 2010, to December 31, 2017, who had an ND assessment at 18 to 24 months' CA at Canadian Neonatal Follow-Up Network clinics. The primary outcome was the composite outcome of death or ND impairment (NDI). Secondary outcomes included significant NDI, and each component of primary outcome. We compared ND outcomes among infants with Gram-positive (GP) sepsis, Gram-negative (GN) sepsis, mixed sepsis, and no sepsis using bivariate and multivariate analyses after adjusting for potential confounders.Of the 3,640 infants included, 823 (22.6%) developed LOS. Of the 823 infants, 569 (69.1%) had GP sepsis, 172 (20.9%) had GN sepsis, and 82 (10%) had mixed sepsis. Infants with LOS had significantly lower birth weight, GA, younger mothers, and significantly higher rates of major neonatal morbidities compared with the no-sepsis group. In multivariable logistic regression, infants with GN sepsis and mixed sepsis had significantly higher odds of death/NDI (GN sepsis, adjusted odds ratio [aOR] = 1.80; 95% CI: 1.27, 2.54; mixed LOS, aOR = 2.38, 95% CI: 1.41, 4.01) as compared with no sepsis.Late-onset bacterial sepsis, particularly Gram-negative and mixed sepsis, was associated with an increased risk of adverse outcomes including death or NDI at 18 to 24 months CA in infants born <29 weeks' GA in Canada. · Late-onset sepsis is an important risk factor for morbidity and mortality in preterm infants.. · The clinical presentations vary depending on the causative bacteria.. · There is limited data on neurodevelopmental outcomes based on type of bacterial pathogen..

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Journal
American Journal of Perinatology
Published
2026-01-29
DOI
https://doi.org/10.1055/a-2779-7133
Primary Topic
Neonatal and Maternal Infections
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article

Neurodevelopmental Outcome after Late-Onset Bacterial Sepsis in Infants Born before 29 Weeks' Gestation

Anie Lapointe, AS Soraisham, Alana Newman, Mary Seshia et al.
American Journal of Perinatology
Neonatal and Maternal Infections
article

Neurodevelopmental Outcome after Late-Onset Bacterial Sepsis in Infants Born before 29 Weeks' Gestation

Anie Lapointe, AS Soraisham, Alana Newman, Mary Seshia, Smita Roychoudhury, Victoria Bizgu, Marie St‐Hilaire, Abhay Lodha, Ann Su Yi, Jo-Anna B. J. Hudson, Marc Beltempo, Caio Barbosa de Oliveira, Anne Synnes, Eugene Ng, Carlos Fajardo, Deepak Louis, Faiza Khurshid, Jehier Afifi, Hala Makary, Bruno Piedboeuf, Prakesh S. Shah, Edith Masse, Valerie Bertelle, Amit Mukerji, Joseph Ting, Orlando Da Silva, Xiang Y. Ye, Rebecca Sherlock, Jennifer Toye, Martine Claveau, Kyong-Soon Lee, Guillaume Ethier, Ayman Abou Mehrem, Jaya Bodani, Cecil Ojah, Lannae Strueby, Keith Barrington, Canadian Neonatal Follow-Up Network (CNFUN) Participating Site Investigators, Ruben Alvaro, Miroslav Stavel, Andrzej Kajetanowicz, Jaideep Kanungo, the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network TM
article en

Abstract

Neonatal late-onset sepsis is associated with increased mortality and morbidity, adversely impacting long-term outcome. The objective of this study was to examine neurodevelopmental (ND) outcomes at 18 to 24 months' corrected age (CA) in infants with late-onset bacterial sepsis (LOS) and to categorize outcomes based on type of bacterial pathogen in a cohort of preterm infants born less than 29 weeks gestation in Canada.We conducted a retrospective cohort study of all non-anomalous infants born at <29 weeks gestational age (GA) who were admitted to Canadian NICUs, from January 1, 2010, to December 31, 2017, who had an ND assessment at 18 to 24 months' CA at Canadian Neonatal Follow-Up Network clinics. The primary outcome was the composite outcome of death or ND impairment (NDI). Secondary outcomes included significant NDI, and each component of primary outcome. We compared ND outcomes among infants with Gram-positive (GP) sepsis, Gram-negative (GN) sepsis, mixed sepsis, and no sepsis using bivariate and multivariate analyses after adjusting for potential confounders.Of the 3,640 infants included, 823 (22.6%) developed LOS. Of the 823 infants, 569 (69.1%) had GP sepsis, 172 (20.9%) had GN sepsis, and 82 (10%) had mixed sepsis. Infants with LOS had significantly lower birth weight, GA, younger mothers, and significantly higher rates of major neonatal morbidities compared with the no-sepsis group. In multivariable logistic regression, infants with GN sepsis and mixed sepsis had significantly higher odds of death/NDI (GN sepsis, adjusted odds ratio [aOR] = 1.80; 95% CI: 1.27, 2.54; mixed LOS, aOR = 2.38, 95% CI: 1.41, 4.01) as compared with no sepsis.Late-onset bacterial sepsis, particularly Gram-negative and mixed sepsis, was associated with an increased risk of adverse outcomes including death or NDI at 18 to 24 months CA in infants born <29 weeks' GA in Canada. · Late-onset sepsis is an important risk factor for morbidity and mortality in preterm infants.. · The clinical presentations vary depending on the causative bacteria.. · There is limited data on neurodevelopmental outcomes based on type of bacterial pathogen..

American Journal of Perinatology
Mount Sinai Hospital (CA), Dalhousie University (CA), Sunnybrook Health Science Centre (CA), Royal Columbian Hospital (CA), University of British Columbia (CA), University of Calgary (CA), University of Toronto (CA), Dr. Everett Chalmers Regional Hospital (CA), Children's Hospital of Eastern Ontario (CA), Moncton Hospital (CA), Saskatoon City Hospital (CA), Montreal Children's Hospital (CA), Cape Breton Regional Hospital (CA), Great Ormond Street Hospital (GB), Saint John Regional Hospital (CA), Izaak Walton Killam Health Centre (CA), St. Boniface Hospital (CA), Surrey Memorial Hospital (CA), Ottawa Hospital (CA), Kingston General Hospital (CA), London Health Sciences Centre (CA), South Health Campus (CA), Hospital for Sick Children (CA), Janeway Children's Health and Rehabilitation Centre (CA), Jewish General Hospital (CA), Centre Hospitalier Universitaire de Sherbrooke (CA), Alberta Children's Hospital (CA), Centre Hospitalier Universitaire Sainte-Justine (CA), Health Sciences Centre (CA), Foothills Medical Centre (CA), Princess Margaret Cancer Centre (CA), Hôpital Maisonneuve-Rosemont (CA), Windsor Regional Hospital (CA), Centre hospitalier universitaire de Québec (CA), Royal Alexandra Hospital (CA), Regina General Hospital (CA), Princess Margaret Hospital (NZ), Victoria General Hospital (CA), SickKids Foundation (CA), Stollery Children's Hospital (CA), B.C. Women's Hospital & Health Centre (CA), University College London (GB), McGill University (CA), Hamilton Health Sciences (CA), McMaster University (CA)
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Neonatal and Maternal Infections
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