Original Article
Clinical Sepsis in Neonates and Young Infants, United States, 1988-2006

https://doi.org/10.1016/j.jpeds.2011.12.023Get rights and content

Objective

To describe the burden and characteristics of clinical neonatal sepsis in the United States and evaluate incidence rates after the issuance of intrapartum antibiotic prophylaxis (IAP) guidelines.

Study design

This is a cross-sectional study of hospitalizations of infants aged <3 months diagnosed with sepsis from the 1988-2006 National Hospital Discharge Survey. The National Hospital Discharge Survey collects data annually on inpatient discharges from a national probability sample of approximately 500 short-stay hospitals. We examined sepsis hospitalizations, defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes, and compared sepsis hospitalization rates for 2 time periods after the issuance of IAP guidelines (1996-2001 and 2002-2006) with 1988-1995 using national natality data as the population denominator. We used Joinpoint (Surveillance Research Program, National Cancer Institute, Bethesda, Maryland) regression to assess the average annual percent change (AAPC) in rates.

Results

Between 1988 and 2006, there were more than 2.5 million sepsis-related hospitalizations in infants aged <3 months (112 000-146 000 annually). In 2006, the sepsis hospitalization rate was 30.8/1000 births. The rate was more than 3 times higher in preterm infants compared with term infants (85.4/1000 preterm births vs 23.1/1000 term births). The AAPC in sepsis hospitalization rate was -3.6% (95% CI, -2.1% to 5.1%) for term infants during 1996-2002 and did not change significantly after issuance of the revised 2002 guidelines. For preterm infants, the AAPC was -1.2% (95% CI, -2.2% to 0.1%) annually from 1988 to 2006.

Conclusion

Clinical neonatal sepsis declined in the post-IAP era, mirroring trends observed in group B streptococcal early-onset neonatal sepsis surveillance. Preterm infants were affected disproportionately and exhibited a modest but steady decline in sepsis hospitalization rate.

Section snippets

Methods

We used data from the 1988-2006 National Center for Health Statistics’ National Hospital Discharge Survey (NHDS), a representative survey of discharges from the nation’s nonfederal, short-stay hospitals. The NHDS has received approval by the NCHS Research Ethics Review Board. This study using NHDS data did not require separate institutional review board approval. Sampling for this survey uses a multistage approach; discharges are selected at random from a national probability sample of

Results

From 1988 through 2006, there were an estimated 2.5 million (n = 23 086) sepsis hospitalizations in newborns and infants aged <3 months (112 000-146 000 discharges annually), one-third (836 000) of which were in preterm infants (Table I). Nearly 50% of the sepsis hospitalizations in term infants were in the early-onset subgroup. In 2006, the overall sepsis hospitalization rate was 30.8/1000 live births, with a >3-fold higher rate in preterm infants compared with term infants (85.4/1000 preterm

Discussion

Hospitalizations for neonatal sepsis in term infants decreased by approximately 4% annually after issuance of initial IAP guidelines to prevent GBS sepsis. No further decline was observed after issuance of revised IAP guidelines; however, in term infants and the early-onset subgroup, sepsis hospitalization rates were lower during this period compared with the years before issuance of the first IAP guidelines. These findings mirror previously reported trends in invasive early-onset GBS disease

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    The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors declare no conflicts of interest.

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