Predictive Factors of Late-onset Sepsis in Preterm Infants and Nurses’ Practices for the Prevention of Sepsis in Pediatric Intensive Care Units
Article Sidebar
Main Article Content
Abstract
Purpose: To investigate the predictive factors of late-onset sepsis in preterm infants and to study the practices of nurses for the prevention of sepsis in the pediatric intensive care unit.
Design: Case-control study and descriptive study.
Methods: The sample were 151 preterm infants who were admitted at the neonatal/pediatric intensive care units of three tertiary hospitals affiliated with Ministry of Defense located in Bangkok and divided into 40 cases and 111 controls. Twenty-eight nurses from three settings were also the study participants. Data were collected during the period of August to December, 2022 using an infant’s medical record form, severity of illness assessment form, a nurse’s general information record form, and an observation form of nurses’ practices to prevent sepsis in the neonatal/pediatric intensive care units. Data were analyzed by using descriptive statistics and logistic regression.
Main findings: The results indicated that severity of illness, amount of breast milk received and duration of retained central venous catheter could significantly predict 56% (R2 = .56) of late-onset sepsis in preterm infants. The severity of illness was the strongest predictive factor for late-onset sepsis in preterm infants (OR = 22.64, 95%CI = 6.52, 78.62). In addition, 82.1% of the nurses working in the three settings had a high level of practices for the prevention of sepsis.
Conclusion and recommendations: Based on the finding, severity of illness, amount of breast milk received and duration of central venous catheter insertion affected the late-onset sepsis in preterm infants. Thus, nurses should develop a care model or a guideline for prematurity care to effectively prevent the late-onset sepsis by assessing an infant’s severity of illness since the admission, promoting the adequacy of breast milk received more than 80% per day, limiting the duration of retained central venous catheter not longer than 14 days.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright Notice: Nursing Science Journal of Thailand has exclusive rights to publish and distribute the manuscript and all contents therein. Without the journal’s permission, the dissemination of the manuscript in another journal or online, and the reproduction of the manuscript for non-educational purpose are prohibited.
Disclaimer: The opinion expressed and figures provided in this journal, NSJT, are the sole responsibility of the authors. The editorial board bears no responsibility in this regard.
References
Husada D, Chanthavanich P, Chotigeat U, Sunttarattiwong P, Sirivichayakul C, Pengsaa K, et al. Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand. BMC Infect Dis. 2020;20(1):151. doi: 10.1186/s12879-020-4875-5.
Wright N, Francis L, Bonney D, Wang Z, Francis J. Epidemiology of early and late-onset neonatal sepsis in an Australian regional special care nursery with a high proportion of Aboriginal and Torres Strait Islander births. J Paediatr Child Health. 2022;58(9):1594-600. doi: 10.1111/jpc.16050.
Procianoy RS, Silveira RC. The challenges of neonatal sepsis management. J Pediatr (Rio J). 2020;96 Suppl 1:80-6. doi: 10.1016/j.jped.2019.10.004.
Silva SM, de Cássia Pinheiro da Motta G, Nunes CR, Schardosim JM, da Cunha ML. Late-onset neonatal sepsis in preterm infants with birth weight under 1.500 g. Rev Gaúcha Enferm. 2015;36(4):84-9. doi: 10.1590/1983-1447.2015.04.50892. (in Portuguese).
Jiang S, Yang C, Yang C, Yan W, Shah V, Shah PS, et al. Epidemiology and microbiology of late-onset sepsis among preterm infants in China, 2015-2018: a cohort study. Int J Infect Dis. 2020;96:1-9. doi: 10.1016/j.ijid.2020.03.034.
Mitha A, Foix-L'Hélias L, Arnaud C, Marret S, Vieux R, Aujard Y, et al. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants. Pediatrics. 2013;132(2):372-80. doi: 10.1542/peds.2012-3979.
Hentges CR, Silveira RC, Procianoy RS, Carvalho CG, Filipouski GR, Fuentefria RN, et al. Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight. J Pediatr (Rio J). 2014;90(1):50-7. doi: 10.1016/j.jped.2013.10.002.
Coggins SA, Glaser K. Updates in late-onset sepsis: risk assessment, therapy, and outcomes. Neoreviews. 2022;23(11):738-55. doi: 10.1542/neo.23-10-e738.
Bury G, Leroux S, Leon Borrego C, Gras Leguen C, Mitanchez D, Gascoin G, et al. Diagnosis of neonatal late-onset infection in very preterm infant: inter-observer agreement and international classifications. Int J Environ Res Public Health. 2021;18(3):882. doi: 10.3390/ijerph18030882.
Tsai MH, Wu IH, Lee CW, Chu SM, Lien R, Huang HR, et al. Neonatal gram-negative bacillary late-onset sepsis: a case-control-control study on a prospectively collected database of 5,233 admissions. Am J Infect Control. 2016;44(2):146-53. doi: 10.1016/j.ajic.2015.09.009.
Köstlin-Gille N, Härtel C, Haug C, Göpel W, Zemlin M, Müller A, et al. Epidemiology of early and late onset neonatal sepsis in very low birthweight infants: data from the German neonatal network. Pediatr Infect Dis J. 2021;40(3):255-9. doi: 10.1097/INF.0000000000002976.
Shah J, Jefferies AL, Yoon EW, Lee SK, Shah PS, Canadian Neonatal Network. Risk factors and outcomes of late-onset bacterial sepsis in preterm neonates born at < 32 weeks' gestation. Am J Perinatol. 2015;32(7):675-82. doi: 10.1055/s-0034-1393936.
de Sousa JCS, de Carvalho AVD, Monte de Prada LC, Marinho AP, de Lima KF, Macedo SKO, et al. Nutritional factors associated with late-onset sepsis in very low birth weight newborns. Nutrients. 2021;14(1):196. doi: 10.3390/nu14010196.
El Manouni El Hassani S, Berkhout DJC, Niemarkt HJ, Mann S, de Boode WP, Cossey V, et al. Risk factors for late-onset sepsis in preterm infants: a multicenter case-control study. Neonatology. 2019;116(1):42-51. doi: 10.1159/000497781.
Xiong X, Wang H, Chen X, Yang C, Chen L, Lin B, et al. The relationship between the amount of breastfeeding and late-onset sepsis in very low birth weight infants within 4 weeks after birth. Research Square [Internet]. 2022 [cited 2023 Jun 29];41:1-11. Available from https://assets.researchsquare.com/files/rs-1278663/v1/e36121fa-909c-4eb8-bf4a-cd46ec45d5b3.pdf?c=1648628955. doi: 10.21203/rs.3.rs-1278663/v1.
Hylander MA, Strobino DM, Dhanireddy R. Human milk feedings and infection among very low birth weight infants. Pediatrics. 1998;102(3):E38. doi: 10.1542/peds.102.3.e38.
Thanomsingh P, Sithinamsuwan K. Risk factors for late-onset sepsis in very low birth weight neonates at Maharat Nakhon Ratchasima Hospital. Thai Journal of Pediatrics. 2021;58(1):39-48. (in Thai).
Wangruangsatid R, Rangsiyanon J, Rungchay A, Dumminsek P, Saisuwan W. Maternal preparation guideline for taking care of premature infants after discharge in Thailand: a systematic review. Songklanagarind Journal of Nursing. 2019;39(1):66-78. (in Thai).
Batthula V, Somnath SH, Datta V. Reducing late-onset neonatal sepsis in very low birthweight neonates with central lines in a low-and-middle-income country setting. BMJ Open Qual. 2021;10 Suppl 1:e001353. doi: 10.1136/bmjoq-2021-0013.
Ezike OC, Nwaneri AC, Odikpo LC, Onyia EN, Makata NE, Irodi CC, et al. Infection control practices among nurses working in neonatal intensive care units (NICU) of two selected tertiary hospitals in Enugu, Nigeria. International Journal of Africa Nursing Sciences. 2021;15:100344. doi: 10.1016/j.ijans.2021.100344.
Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr. 2001;138(1):92-100. doi: 10.1067/mpd.2001.109608.
Harvey ND. A simple guide to inter-rater, intra-rater and test-retest reliability for animal behaviour studies [Internet]. Québec, Canada: OSF Preprints; 2021 [cited 2023 Jun 29]. Available from: https://osf.io/8stpy.
Moltu SJ, Bronsky J, Embleton N, Gerasimidis K, Indrio F, Köglmeier J, et al. Nutritional management of the critically ill neonate: a position paper of the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2021;73(2):274-89. doi: 10.1097/mpg.0000000000003076.
Brown A, Shenker N. Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study. BMC Pregnancy Childbirth. 2022;22(1):455. doi: 10.1186/s12884-022-04789-7.
Selby LM, Rupp ME, Cawcutt KA. Prevention of central-line associated bloodstream infections: 2021 update. Infect Dis Clin North Am. 2021;35(4):841-56. doi: 10.1016/j.idc.2021.07.004.
Bamrasnaradura Infectious Diseases Institute, Department of Diseases Control, Ministry of Public Health. Guide to infection control in the healthcare setting. Bangkok: Aksorn Graphic and Design Publishing; 2020. 132 p. (in Thai).