Reduction in late-onset sepsis on relocating a neonatal intensive care nursery

Authors

  • Alicia Rose Jones,

    1. The Department of Obstetrics and Gynaecology, The University of Melbourne
    2. Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
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  • Carl Kuschel,

    1. The Department of Obstetrics and Gynaecology, The University of Melbourne
    2. Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
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  • Susan Jacobs,

    1. The Department of Obstetrics and Gynaecology, The University of Melbourne
    2. Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
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  • Lex W Doyle

    Corresponding author
    1. The Department of Obstetrics and Gynaecology, The University of Melbourne
    2. Critical Care and Neurosciences Theme, Murdoch Childrens Research Institute, Parkville
    3. Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
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  • This study was supported in part by the Victorian Government's Operational Infrastructure Support Program.

Prof Lex W Doyle, Department of Obstetrics and Gynaecology, The Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia. Fax: +61 3 8345 3702; email: lwd@unimelb.edu.au

Abstract

Aims:  The aims of this study were to compare rates of late-onset sepsis (LOS) in very preterm or very low birthweight infants before and after relocation to a new nursery and to determine risk factors for LOS.

Methods:  The study was undertaken at The Royal Women's Hospital, Melbourne, which relocated to a new site in June 2008. Infants with birthweight <1500 g or <32 weeks' gestation, born between July and December 2007 (n= 149) and July and December 2008 (n= 152) were included. Each septic episode was identified from blood cultures taken from patients >48 h after birth and was categorised as definite, probable, uncertain or no sepsis.

Results:  Overall, 117 infants had 218 septic episodes. The proportion of infants with clinical LOS decreased from 29.5% in 2007 to 22.4% in 2008 after the relocation, although this was not statistically significant. There was a significant (P < 0.05) reduction in the severity (definite LOS = most severe) of sepsis in 2008 compared with 2007, and in rates of coagulase-negative staphylococcal LOS. Significant risk factors for LOS were: lower birthweight (g; mean −351, 95% confidence interval (CI) −446, −256); lower gestational age (weeks; mean −2.3, 95% CI −2.8, −1.7) and presence of a percutaneous inserted central catheter (odds ratio (OR) 2.56, 95% CI 1.03, 6.67).

Conclusions:  There was a significant reduction in the severity of LOS in very preterm and/or very low birthweight infants that correlated with the relocation from the old to new nursery. Smaller and more immature infants with percutaneous central catheters were more at risk.

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