Infections in VLBW infants: studies from the NICHD neonatal research network
Section snippets
Randomized clinical trials
The Network conducted or participated in 11 randomized controlled trials (RCTs) that span a wide array of neonatal problems (Table 1). 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 Infection was the primary study outcome for 2 of these trials: “A controlled trial of intravenous immune globulin (IVIG) to reduce nosocomial infections in VLBW infants”3 and “Parenteral glutamine supplementation in extremely low birth weight (ELBW) infants: A multicenter randomized clinical trial.”12 In the IVIG trial, 2,416
Registry data: published observational studies
The Network has maintained a registry of all VLBW infants born and/or cared for at participating centers since 1987. The registry was developed to describe the populations at each participating center, to survey neonatal practices, to assess neonatal morbidity and mortality rates, and to provide information for planning randomized clinical trials.14, 15, 16, 17, 18 Information related to infection has always been included in the registry, although definitions and the exact variables collected
Studies of antenatal corticosteroids
A National Institutes of Health (NIH) Consensus Conference on the effect of corticosteroids for fetal maturation on perinatal outcomes was convened to evaluate scientific data on the use and impact of antenatal steroids.19 An aritcle summarizing Network data on antenatal steroids was presented.20 Antenatal steroid use and clinical outcomes were evaluated for 9,949 infants enrolled in the Network’s VLBW registry between 1988 and 1992. Antenatal steroid use was classified as complete (mother
Infection studies
The Network has published several studies that specifically address infection in VLBW infants. Fanaroff et al22 reviewed data from the Network’s IVIG trial to determine the incidence, clinical presentation, laboratory features, risk factors, morbidity, and mortality associated with late-onset septicemia in VLBW patients enrolled in the trial. Sixteen percent (395 of 2,416) of infants enrolled in the trial developed late-onset sepsis over the study period. The predominant presenting clincial
Conclusion
Early and late-onset infections remain important causes of morbidity and mortality among VLBW preterm infants. Although various maternal and infant risk factors have been noted, extreme prematurity is the greatest risk for infection. The increasing survival of extremely immature very low birth weight infants has resulted in a cohort of infants at prolonged risk for acquired infection. Because acquired infection is a common occurrence among VLBW infants that results in considerable morbidity and
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Bloodstream Infections in Preterm Neonates and Mortality-Associated Risk Factors
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