medwireNews: Relocating to a newly designed neonatal intensive care nursery significantly reduces severe late-onset sepsis (LOS) rates in very-preterm and/or very-low-birthweight infants, although it remains relatively common, conclude Australian scientists.
The team, led by Lex Doyle from The Royal Women's Hospital in Melbourne, writes in the Journal of Paediatrics and Child Health: "The reductions in LOS correlate with the change of campus to a new nursery with greater space per cot... The reduction in patient density in the new nursery, combined with a new building with fewer resident pathogens, may have thus contributed to the changes in infection patterns seen."
The researchers compared blood cultures taken more than 48 h after birth from 55 infants with birthweights of less than 1500 g or born at less than 32 weeks' gestation during 2007 with those taken from a further 62 infants during 2008, after relocation of the hospital's neonatal intensive care units and special care nurseries to a specially designed facility.
The proportion of infants with any LOS did not change significantly between the two study periods. However, the number of definite or serious cases of LOS fell significantly between 2007 and 2008, from 37.2% to 26.7%.
Furthermore, the number of episodes of clinical infections, as a percentage of all septic work-ups, fell significantly, from 59.3% to 45.7%. Analysis of the blood cultures also revealed that there were significantly more coagulase-negative staphylococci cases in 2007 compared with 2008, at an odds ratio of 2.30.
Infants with clinical LOS were significantly less mature and lighter at birth than infants without clinical LOS, at a mean gestational age of 27.3 weeks versus 29.6 weeks and a mean birthweight of 958 g versus 1310 g.
On univariate analysis, significant independent risk factors for clinical LOS were lower birthweight and gestational age, and the presence of a percutaneous inserted central catheter (PICC). After adjusting for gestational age and birthweight, only PICC remained a significant risk factor for clinical LOS, at an odds ratio of 2.56.
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