Breedveld, M.P. (2009) Incidentie en kenmerken van Late-onset sepsis bij prematuren in een level III neonatale intensive care unit. thesis, Other studies (UMCG).
Full text available on request.Abstract
Abstract Background and aim Late-onset sepsis (LOS) is a serious problem among premature infants and is associated with substantial morbidity and mortality. Diagnosis of LOS in premature neonates is difficult because clinical signs may vary widely and can be aspecific. The aim of this study was to determine the incidence and clinical characteristics of late onset sepsis in premature infants with aspecific signs of infection in our level III Neonatal Intensive Care Unit (NICU). Methods A prospective observational study of neonates with a gestational age <34 weeks was performed over a 2-year period (2005-2007) in our level-III NICU. Signs and symptoms during episodes of clinical instability occurring after 3 days of age, suggesting infection were collected. Epidemiologic data were recorded and evaluated. LOS was defined as proven sepsis (blood-culture positive sepsis) and clinical sepsis (severe signs of infection without positive blood-culture). Results In 348 admitted patients (mean birthweight 1463 gram [SD 485], mean gestational age 30 weeks [SD 2.3]) the incidence of LOS was 84/348 (24%). A total of 200 episodes of clinical instability suggesting infection, were documented in 152/348 patients (43.7%). LOS occurred in 93/200 episodes (46.5%). In 107/200 episodes (53.5%) suspicion of infection was rejected. Prematures with LOS had significantly more often signs or symptoms of pale discoloration (66% vs. 36%; p < .01), prolonged capillary refill (51% vs. 26%; p<.01), increase of oxygen requirement (39% vs. 22%; p = .01), increase in assisted ventilation (62% vs. 34%; p < .01) and apathy (51% vs. 31%; p = .01) than patients without LOS. Most common pathogens were gram positive bacteria (90.2%), mainly coagulase negative streptococcus (27.5%) and Bacillus cereus (27.5%). Seven of 348 (2%) patients died. In 3 patients the main cause of death was proven sepsis. Conclusion The incidence of LOS in prematures < 34 weeks in our NICU is 24%. In 46.5% of episodes with aspecific signs of infection LOS was found. Patients with LOS had significantly more often signs or symptoms of pale discoloration, prolonged capillary refill, increase of oxygen requirement, increase in assisted ventilation and apathy.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Prof. dr. P.L.P. Brand |
| Supervisor name: | Dagelijkse begeleider: Drs. J. Bekhof and Amalia neonatologie/high-care kinderafdeling and Isala Klinieken Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:00 |
| Last Modified: | 25 Jun 2020 11:00 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2035 |
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