Late onset infection in very low birth weight infants in Malaysian Level 3 neonatal nurseries

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Background.The purpose of this study was to examine the rate and mortality from late onset infection occurring in very low birth weight infants admitted to Malaysian nurseries.Methods.Data on all infants 1500 g or below admitted to the 20 participating Level 3 nurseries were analyzed for late onset infection (clinical infection and positive blood or cerebrospinal fluid culture occurring after 48 h of life).Results.The overall survival of the 962 study infants was 69%. The rate of late onset infection was 19.3%. The mortality in those with late onset infection was 30.8%. The most common infecting organism was Klebsiella pneumoniae, accounting for 38.3% of infections and 46.9% of deaths in infants with infection, followed by coagulase-negative staphylocci, 17.6 and 12.2%, respectively. On logistic regression analysis risk factors for late onset Gram-negative compared with Gram-positive infection were endotracheal intubation at birth and blood transfusion. Hypoglycemia was associated with Gram-positive infection.Conclusion.The late onset infection rate in Malaysian very low birth weight infants does not differ from that reported from developed countries, but the mortality is higher. This could be because of an excess of Gram-negative infections.

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