Early-Onset Sepsis in Preterm Neonates of 22-28 Weeks’ Gestation: An International Cohort Study;
: Duggan, Husharn L.; Shah, Prakesh S.; Battin, Malcolm; Klinger, Gil; Adams, Mark; Vento, Maximo; Lastrucci, Vieri; Rugolo, Ligia Maria Suppo Sousa; Regina, Maria; Håkansson, Stellan; Isayama, Tetsuya; Norman, Mikael; Kusuda, Satoshi; Reichman, Brian; Lehtonen, Liisa; Helenius, Kjell; Lui, Kei Kei; Tan, Kenneth; iNeo Investigators
Publisher: Elsevier BV
: 2026
The Journal of Pediatrics : Clinical Practice
: 200216
: 21
: 2950-5410
DOI: https://doi.org/10.1016/j.jpedcp.2026.200216
: https://doi.org/10.1016/j.jpedcp.2026.200216
: https://research.utu.fi/converis/portal/detail/Publication/527170214
Objective: Early-onset sepsis (EOS) is associated with increased mortality and morbidity in preterm neonates. We aim to study the epidemiology of EOS among extremely preterm neonates across a multinational neonatal registry.
Study design: A retrospective cohort study (2007-2023) of neonates born under 28 weeks' gestation from the International Network for Evaluation of Outcomes in Neonates collaboration, involving 11 national neonatal registries. The definition of EOS was blood or cerebrospinal fluid culture-positive sepsis within the first days after birth (ranging from <2 to <7 days of life). Primary outcome was mortality. Secondary outcome was major morbidities (severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, late-onset sepsis, or bronchopulmonary dysplasia). Univariate and multivariate analyses were performed.
Results: Four thousand three hundred fifty-four of 130,938 (3.3%) neonates with mean (±SD) gestational age 26.1 (±1.7) weeks and birthweight 874 (±241) grams developed EOS. Rates of EOS ranged from 1.6% to 6.6% across International Network for Evaluation of Outcomes in Neonates countries. Pregnancy associated hypertension and caesarean delivery were not associated with EOS. For EOS infants the mortality rate was 35.5% and mortality or morbidity rate was 78.2%. Odds of mortality remained higher after adjustment (AOR, 2.49; 95% CI: 2.27, 2.74) along with mortality or morbidity (AOR, 1.89; 95% CI, 1.70-2.10). Severe neurological injury was the leading complications (AOR, 2.34; 95% CI, 2.11-2.59). Variations in incidence, morbidity, and mortality were also noted between countries.
Conclusion: EOS is common in extremely preterm neonates, varying across countries and associated with higher odds of mortality and morbidity.
Keywords: epidemiology; extremely preterm infants; international registry; neonatal sepsis.
extremely preterm infants, international registry, neonatal sepsis
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The International Network for Evaluating Outcomes of Neonates (iNeo) has been supported by the Canadian Institutes of Health Research [APR-126340 and PBN 150642 to P.S.S.]. The Australian and New Zealand Neonatal Network is predominantly funded by membership contributions from the participating centers. The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research [CTP 87518], and by the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the Canadian Institutes of Health Research (THL). The Israel Neonatal Network very low birth weight infant database is partially funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network of Japan is partly funded by a Health Labor Sciences Research Grant from the Ministry of Health, Labor and Welfare of Japan. The Spanish Neonatal Network is supported by funds from the Spanish Neonatal Society (SENeo). The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs), the Swedish Association of Local Communities and Regions (SALAR) and the participating units. The Swiss Neonatal Network is partially funded by the participating units in the form of membership fees. This research was also supported by Instituto de Investigación Sanitaria Carlos III (Ministry of Science, Innovation and Universities, Kingdom of Spain) [FIS17/0131 to M.V.]; and RETICS funded by the PN 2018-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion, and the European Regional Development Fund (ERDF) [RD16/0022]; and by grants from a regional agreement on clinical research (ALF) between Region Stockholm and Karolinska Institutet [RS2022-0674 to M.N.].
