Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age

Shin Ae Yoon; Ji Young Chun; Yo Han Ho; Ji Sook Kim; Hye Soo Yoo; Se In Sung; So Yoon Ahn; Yun Sil Chang; Won Soon Park

doi:10.14734/kjp.2016.27.1.53

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Yoon, Chun, Ho, Kim, Yoo, Sung, Ahn, Chang, and Park: Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age

Original Article

Korean J Perinatol 2016;27(1):53-59.

Published online: 19 March 2016

DOI: https://doi.org/10.14734/kjp.2016.27.1.53

Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age

Shin Ae Yoon, M.D., Ji Young Chun, M.D., Yo Han Ho, M.D., Ji Sook Kim, M.D., Hye Soo Yoo, M.D., Se In Sung, M.D., So Yoon Ahn, M.D., Yun Sil Chang, M.D., Won Soon Park, M.D.

Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: So Yoon Ahn, M.D. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea Tel: +82.2-3410-1373, Fax: +82.2-3410-0043 E-mail: soyoon.ahn@samsung.com

Received 5 February 2016 Revised 25 February 2016 Accepted 27 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The aim of this study is to determine the clinical characteristics of early onset sepsis (EOS) in micropreemie.

Methods:

We retrospectively reviewed medical records of 107 extremely preterm infants born at 25 or less than 25 weeks of gestation and admitted to the neonatal intensive care unit of Samsung Medical Center from January 2013 to August 2015. Infants were divided into two groups based on the presence of culture-proven EOS in the first 7 days of life. Retrospective analysis of perinatal factors and laboratory findings within the first week of life was done between two groups. We compared the neonatal outcomes among two groups.

Results:

Culture-proven EOS was diagnosed in 11 of 107 infants (10.3%). Main pathogen of EOS was Staphylococcus epidermidis (45.5%). There were no significant differences between control group and EOS group in gestational age, birth weight, Apgar score, delivery type and pathologic chorioamnionitis. Among 11 infants with EOS, 9 showed fetal tachycardia (P=0.001). And EOS group presented lower platelet count at 3^rd day and 7^th day of life than that of control group (P=0.033, P=0.045). Neonatal outcomes in EOS group were compatible with control group. Main cause of death was sepsis in EOS group.

Conclusion:

In micropreemie, EOS is important factor of mortality. Our data suggest that fetal tachycardia and low platelet count during the first 7 days of life were associated with EOS.

Keywords: Early onset sepsis, Extremely preterm infants

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Table 1.

Demographics of Subjects

Variable	^{+4 +3} Control group (N=96)	^{+0 +1} EOS group (N=11)	P- value
Gestational age (wks)	24.2±0.9 (21⁺⁴-25⁺³)	23.5±1.5 (21⁺⁰-25⁺¹)	0.148
Birth weight (g)	664.7±159.9 (300-1,150)	593.6±141.3 (370-840)	0.161
Male	57 (59.4%)	6 (54.5%)	0.758
One-minute Apgar score	4.1±1.3	4.4±1.4	0.552
Five-minute Apgar score	6.7±1.4	6.5±1.6	0.582
Delivery type, C/sec	27 (28.1%)	6 (54.5%)	0.072
Small for gestational age	18 (18.8%)	2 (18.2%)	0.963
Antenatal steroids	90 (93.8%)	10 (90.9%)	0.718
Pathologic chorioamnionitis	51 (53.1%)	6 (54.5%)	0.929
Pregnancy-induced hypertension	11 (11.5%)	0 (0%)	0.236
Gestational diabetes mellitus	4 (4.2%)	0 (0%)	0.488

The values in the table are expressed as mean±SD or number (%). Abbreviation: EOS, early onset sepsis.

Table 2.

Perinatal Factors Associated with Early Onset Sepsis

	Control group (N=96)	EOS group (N=11)	P- value
PROM	27/96 (28.1%)	6/11 (54.5%)	0.094
PROM duration (hrs)∗	124 (19-1728)	83 (72-216)	0.627
Maternal antibiotics use	67/96 (69.8%)	8/11 (72.7%)	0.840
Duration of maternal antibiotics use (days)∗	3.0 (1-30)	4.5 (2-12)	0.603
Maternal fever	2/96 (2.1%)	1/11 (9.1%)	0.182
Maternal tachycardia	44/96 (45.8%)	2/11 (18.2%)	0.079
Maternal leukocytosis	30/94 (31.9%)	4/10 (40%)	0.604
Maternal CRP rising	56/72 (77.8%)	9/9 (100%)	0.114
Maternal vaginal colonization	21/66 (31.8%)	1/7 (14.3%)	0.336
Fetal tachycardia	37 (38.5%)	10 (90.9%)	0.001

The values in the table are number (%). ∗ Median (range). Abbreviations: EOS, early onset sepsis; PROM, premature rupture of membrane; CRP, C-reactive protein.

Table 3.

Laboratory Findings within the First Week of Life Related to Early Onset Sepsis

	WBC count∗ (K/µL)	CRP level∗ (mg/dL)		Platelet count (K /µL)
	Control group EOS group (N=96) (N=11)	Control group (N=96)	EOS group (N=11)	Control group (N=96)	EOS group (N=11)
1^st day	6,070 (620-44,640) 6,510 (1,370-34,310)	0.03 (0.03-2.4)	0.03 (0.03-0.06)	200.1±84.1	180.8±86.4
3^rd day	10,600 (490-73,230) 9,700 (1,330-23,120)	0.2 (0.03-3.1)	0.2 (0.03-3.3)	164.3±79.3	110.2±73.4^†
7^th day	13,720 (490-68,230) 16,915 (6,750-51,140)	0.1 (0.03-3.8)	0.8 (0.03-5.2)	130.2±72.1	80.9±79.5^†

The values in the table are expressed as mean±SD ∗Median (range),

^† P< 0.05 Abbreviations: EOS, early onset sepsis; WBC, white blood cell; CRP, C-reactive protein.

Table 4.

Comparison of Clinical Outcomes between Control and Early onset Sepsis Group

Outcome	Control group (N=96)	EOS group (N=11)	P-value
BPD (≥moderate)	34/85 (40%)	4/9 (44.4%)	) 0.786
IVH (3)	17/95 (17.9%)	3/10 (30%)	0.856
PVL	7/95 (7.4%)	1/10 (10%)	0.765
NEC (≥ Stage 2b)	9/96 (9.3%)	0 (0%)	0.286
ROP requiring lase treatment	er 23/76 (30.3%)	2/8 (25%)	0.757
Mortality	22/96 (22.9%)	4/11 (36.4%)	0.325

The values in the table are number (%)

Abbreviation: EOS, early onset sepsis; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; NEC, necrotizing enterocolitis; ROP, retinopathy of prematurity.

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