Late-onset XXXX in very low birth weight neonates: the experience of the NICHD Neonatal Research Network.

@entity1 @entity295 @entity3166 @entity2461 @entity281 @entity2107 @entity1162 @entity204
OBJECTIVE: Late-onset @entity295 (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) @entity1 . To determine the current incidence of late-onset @entity295 , risk factors for disease, and the impact of late-onset @entity295 on subsequent hospital course, we evaluated a cohort of 6956 VLBW (401-1500 g) neonates admitted to the clinical centers of the National Institute of @entity1 Health and @entity1 Development Neonatal Research Network over a 2-year period (1998-2000). METHODS: The National Institute of @entity1 Health and @entity1 Development Neonatal Research Network maintains a prospective registry of all VLBW neonates admitted to participating centers within 14 days of birth. Expanded infection surveillance was added in 1998. RESULTS: Of 6215 @entity1 who survived beyond 3 days, 1313 (21%) had 1 or more episodes of blood culture-proven late-onset @entity295 . The vast majority of @entity281 (70%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 48% of @entity281 . Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of late-onset @entity295 included @entity2461 , prolonged ventilation, @entity1162 , @entity2107 , and @entity3166 . @entity1 who developed late-onset @entity295 had a significantly prolonged hospital stay (mean length of stay: 79 vs 60 days). They were significantly more likely to die than those who were uninfected (18% vs 7%), especially if they were infected with Gram-negative organisms (36%) or fungi (32%). CONCLUSIONS: Late-onset @entity295 remains an important risk factor for @entity204 among VLBW preterm @entity1 and for prolonged hospital stay among VLBW survivors. Strategies to reduce late-onset @entity295 and its medical, social, and economic toll need to be addressed urgently.
