Factors associated with late-onset sepsis in neonates admitted to a Neonatal Intensive Care Unit in Southern Brazil

Authors

• Simone Minuzzi Catto Vaz Northwestern University of the State of Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brazil. https://orcid.org/0000-0003-0103-7115
• Karine Raquel Uhdich Kleibert Northwestern University of the State of Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brazil. https://orcid.org/0000-0001-7511-1977
• Cibele Thome Da Cruz Rebelato Northwestern University of the State of Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brazil. https://orcid.org/0000-0002-1875-8309
• Carmen Cristiane Schultz Northwestern University of the State of Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brazil. https://orcid.org/0000-0001-9989-1277
• Amanda Emanuela Buzanello Northwestern University of the State of Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brazil. https://orcid.org/0000-0002-9319-9359
• Christiane de Fátima Colet Northwestern University of the State of Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brazil. https://orcid.org/0000-0003-2023-5088

DOI:

https://doi.org/10.17058/reci.v16i.20652

Keywords:

Newborn, Neonatal sepsis, Neonatal Intensive Care Units, Preterm Birth

Abstract

Background and Objectives: Late-onset neonatal sepsis is one of the main healthcare-associated infections affecting newborns admitted to neonatal intensive care units, with high incidence rates and a significant impact on neonatal morbidity and mortality. The objective of the study was to analyze factors associated with the development of late-onset sepsis in newborns admitted to neonatal intensive care units (NICUs). Methods: Retrospective documentary cohort study. Data were collected from the medical records and discharge summaries of neonates admitted to the NICU from January 2016 to December 2020 at a philanthropic general hospital in the northwestern region of the state of Rio Grande do Sul, Brazil. The data were analyzed using descriptive, analytical, and inferential statistics. Results: Late-onset sepsis occurred in 34% of the 494 newborns included in the study. The mean age at diagnosis of late-onset sepsis was 10 days; 52.9% of blood cultures were positive. Late-onset sepsis was associated with a lower number of prenatal appointments (p = 0.003), gestational age and prematurity (p = 0.001), complications during pregnancy (p = 0.001), blood transfusion (p < 0.001), corticosteroid use (p = 0.02), resuscitation at birth (p = 0.01), and very low birth weight (p = 0.001). Conclusion: The incidence of late-onset sepsis in the NICU was high compared with rates reported in the literature. Developing strategies to reduce these rates is necessary, focusing on the quality of care and prevention measures while considering the different risk factors present during the hospitalization and hospital stay of newborns.

References

1. Cloherty JP, Eichenwald EC, Stark AR. Manual de Neonatologia. 7a ed. Rio de Janeiro: Guanabara Koogan; 2015. ISBN: 9788527727099.

2. Organização Pan-Americana da Saúde, Centro Latino-Americano de Perinatologia, Saúde da Mulher e Reprodutiva. Prevenção de infecções relacionadas à assistência à saúde em neonatologia [Internet]. Montevidéu: CLAP/SMR-OPS/OMS; 2016. Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/biblioteca/opas-prevencao-de-infeccoes-relacionadas-a-assistencia-a-saude-em-neonatologia/

3. Ribeiro SNS, Carvalho MGS, Pereira SA, editores. Fisioterapia neonatal: evidências e boas práticas. 1a ed. Rio de Janeiro: Medbook; 2024. ISBN: 9786557831038.

4. Machado FR, Cavalcanti AB, Bozza FA, Ferreira EM, Angotti Carrara FS, Sousa JL, et al. The epidemiology of sepsis in Brazilian intensive care units (the SPREAD study): a multicenter prospective observational study. Lancet Infect Dis. 2017;17(11):1180-1189. DOI: https://doi.org/10.1016/S1473-3099(17)30322-5

5. Wynn JL, Polin RA. Progress in the management of neonatal sepsis: the importance of a consensus definition. Pediatr Res. 2018;83(1):13-15. DOI: https://doi.org/10.1038/pr.2017.224

6. Korang SK, Safi S, Nava C, Kukkonen K, Jakobsen JC, Gluud C, et al. Antibiotic regimens for late-onset neonatal sepsis. Cochrane Database Syst Rev. 2021;2021(5):CD013836. DOI: https://doi.org/10.1002/14651858.CD013836.pub2

7. Al-Shehab M, Abdul-Ghani R, Elnemr M, Al-Sabai N, Al-Maktari A, Al-Aghbari M, et al. Comparison of risk factors, clinical characteristics, laboratory findings and bacterial etiology between early-onset and late-onset neonatal sepsis in Sana’a City, Yemen. BMC Pediatr. 2025;25(1):208. DOI: https://doi.org/10.1186/s12887-025-05553-4

8. Cunha JB, Brito AR, editores. Neonatologia. 1a ed. Barueri: Manole; 2022. ISBN: 9786555765106.

9. Herbozo C, Julca I, Flores F, Hernandez R, Zunt J, Garcia C, et al. Incidence and microbiological characteristics of neonatal late onset sepsis in a neonatal intensive care unit in Peru. Int J Infect Dis. 2021;108:171-175. DOI: https://doi.org/10.1016/j.ijid.2021.05.012

10. Costa MGR, Martins CC, Ramos MSX, Matos SMA, Silva GS. Incidência de sepse tardia entre recém-nascidos prematuros em uma maternidade no interior da Bahia. Braz J Infect Dis. 2023;27(Supl 1):103176. DOI: https://doi.org/10.1016/j.bjid.2023.103176

11. Caldas JPS, Montera LC, Calil R, Marba STM. Temporal trend in early sepsis in a very low birth weight infants' cohort: an opportunity for a rational antimicrobial use. J Pediatr (Rio J). 2021;97(4):414-419. DOI: https://doi.org/10.1016/j.jped.2020.07.006

12. Gerios L, Rodrigues VHB, Corrente JE, Rugolo LMSS, Bentlin MR. Late-onset sepsis in very low birth weight premature infants: a 10-year review of a Brazilian tertiary university hospital - the challenge remains. Am J Perinatol. 2024;41(S 01):e1725-e1731. DOI: https://doi.org/10.1055/s-0043-1768702

13. Laranjeira P, Laranjeira A, Perches R, Pires A. Perfil das infecções de origem tardia em uma unidade de terapia intensiva neonatal. Res Pediatr. 2018;8(2):77-81. DOI: https://doi.org/10.25060/residpediatr-2018.v8n2-04

14. Freitas FTM, Araujo AFOL, Melo MIS, Oliveira SR, Santos A. Late-onset sepsis and mortality among neonates in a Brazilian Intensive Care Unit: a cohort study and survival analysis. Epidemiol Infect. 2019;147:e208. DOI: https://doi.org/10.1017/S095026881900092X

15. Santos LAN, Nunes JPJ, Souza LAP, Ramos V, Rocha J. Prevalência de sepse em neonatos internados em um hospital escola. Renome [Internet]. 2019; 8(2):58-66. Disponível em: https://www.periodicos.unimontes.br/index.php/renome/article/view/2654

16. Oliveira CRV, Macedo IN, Bendicho MT, Silva LB. Utilização de antimicrobianos em uma Unidade de Terapia Intensiva Neonatal: um estudo transversal retrospectivo. Res Soc Dev. 2021;10(11):e29810111794. DOI: https://doi.org/10.33448/rsd-v10i1.11794

17. Serviço de Arquivo Médico e Estatística (SAME). Ocupação de leitos da UTI Neonatal [relatório não publicado]. Ijuí: Associação Hospital de Caridade Ijuí; 2021.

18. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. DOI: https://doi.org/10.1001/jama.2016.0287

19. Venturini APC. Atualização de protocolo assistencial para triagem de sepse neonatal precoce e tardia do Hospital de Clínicas de Porto Alegre [trabalho de conclusão de curso na Internet]. Porto Alegre: Universidade Federal do Rio Grande do Sul; 2022. Disponível em: https://lume.ufrgs.br/handle/10183/236408

20. World Health Organization. Preterm birth [Internet]. Genebra: WHO; 2023. Disponível em: https://www.who.int/news-room/fact-sheets/detail/preterm-birth

21. Jatsho J, Nishizawa Y, Pelzom D, Thinley S. Clinical and bacteriological profile of neonatal sepsis: a prospective hospital-based study. Int J Pediatr. 2020;2020:1835945. DOI: https://doi.org/10.1155/2020/1835945

22. Hammoud MS, Al-Taiar A, Al-Abdi SY, Bozaid H, Khan A, Al-Muralitharan S, et al. Late-onset neonatal sepsis in Arab states in the Gulf region: two-year prospective study. Int J Infect Dis. 2017;55:125-130. DOI: https://doi.org/10.1016/j.ijid.2017.01.006

23. Stylianou-Riga P, Boutsikou T, Kouis P, Kolokotroni O, Boutsikou M, Vakhti S, et al. Epidemiology, risk factors, clinical presentation and complications of late-onset neonatal sepsis among preterm neonates in Cyprus: a prospective case-control study. BMC Pediatr. 2024;24(1):50. DOI: https://doi.org/10.1186/s12887-023-04359-6

24. Feil AC, Kurtz T, Abreu PO, Santos RM. Sepse tardia em Unidade de Tratamento Intensivo Neonatal. Rev Epidemiol Control Infec. 2018;8(4):450-456. DOI: https://doi.org/10.17058/reci.v8i4.11581

25. Rio Grande do Sul. Secretaria de Estado da Saúde. Guia do pré-natal e puerpério na Atenção Primária à Saúde [Internet]. Porto Alegre: SES-RS; 2024. Disponível em: https://atencaoprimaria.rs.gov.br/upload/arquivos/202404/25124004-guia-do-pre-natal-2024.pdf

26. Katzung BG, Trevor AJ. Farmacologia Básica e Clínica. 13a ed. Porto Alegre: AMGH; 2017. ISBN: 9788580555967.

27. Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017;3(3):CD004454. DOI: https://doi.org/10.1002/14651858.CD004454.pub3

28. Blankenship SA, Brown KE, Simon LE, Geist R, Tuuli MG. Antenatal corticosteroids in preterm small-for-gestational age infants: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(4):100215. DOI: https://doi.org/10.1016/j.ajogmf.2020.100215

29. New HV, Berryman J, Bolton-Maggs PHB, Cantwell C, Chalmers EA, Davies T, et al. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol. 2016;175(5):784-828. DOI: https://doi.org/10.1111/bjh.14233

30. Webbe JWH, Longford N, Battersby C, Uthaya S, Modi N. Outcomes in relation to early parenteral nutrition use in preterm neonates born between 30 and 33 weeks' gestation: a propensity score matched observational study. Arch Dis Child Fetal Neonatal Ed. 2022;107(2):131-136. DOI: https://doi.org/10.1136/archdischild-2021-321643

31. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770-1780. DOI: https://doi.org/10.1016/S0140-6736(17)31002-4