Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study

J Pediatr. 2018 Oct:201:106-114.e4. doi: 10.1016/j.jpeds.2018.05.048. Epub 2018 Jul 24.


Objective: To assess the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS).

Study design: All newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015 were included in the study. We defined EOS as infection occurring <3 days after birth, and LOS as infection ≥3 days after birth. Infants with LOS were classified as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission. Incidence was estimated based on the number of livebirths in Switzerland and adjusted for the proportion of admissions at centers participating in the study.

Results: We identified 444 episodes of blood culture-proven sepsis in 429 infants; 20% of cases were EOS, 62% hospital-acquired LOS, and 18% community-acquired LOS. The estimated national incidence of EOS, hospital-acquired LOS, and community-acquired LOS was 0.28 (95% CI 0.23-0.35), 0.86 (0.76-0.97), and 0.28 (0.23-0.34) per 1000 livebirths. Compared with EOS, hospital-acquired LOS occurred in infants of lower gestational age and was more frequently associated with comorbidities. Community-acquired LOS was more common in term infants and in male infants. Mortality was 18%, 12%, and 0% in EOS, hospital-acquired LOS, and community-acquired LOS, and was higher in preterm infants, in infants with septic shock, and in those requiring mechanical ventilation.

Conclusions: We report a high burden of sepsis in neonates with considerable mortality and morbidity. EOS, hospital-acquired LOS, and community-acquired LOS affect specific patient subgroups and have distinct clinical presentation, pathogens and outcomes.

Keywords: bacteremia; invasive infections; meningitis; newborn.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chorioamnionitis / epidemiology
  • Cohort Studies
  • Community-Acquired Infections / epidemiology*
  • Community-Acquired Infections / microbiology
  • Comorbidity
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care Units, Neonatal
  • Male
  • Meningitis, Bacterial / epidemiology
  • Neonatal Sepsis / epidemiology*
  • Neonatal Sepsis / microbiology
  • Pregnancy
  • Respiration, Artificial / statistics & numerical data
  • Sex Factors
  • Switzerland / epidemiology
  • Urinary Tract Infections / epidemiology