WIP 152 - PREMILOC Hydrocortisone Use and Risk of Late Onset Sepsis

Poster Number: WIP 152
Publication Number: WIP 152.877

Background: Sepsis is a major cause of morbidity and mortality in neonates, especially in the fragile extremely low birth weight population. Neonatal sepsis has conventionally been categorized as early-onset (typically within the first 72 hours of life) or late-onset (after 72 hours of life). Late-onset infections tend to be associated with nosocomial and post-natal exposures. In 2016, a randomized controlled trial (PREMILOC) showed improved rate of survival without bronchopulmonary dysplasia in extremely preterm infants who received a 10-day course of prophylactic low-dose hydrocortisone. However, it also found an increased rate of sepsis (defined as a positive blood culture or diagnosis of pneumonia) in the 24-25 week subgroup.

Objective: To determine if early exposure to prophylactic hydrocortisone is associated with an increased risk of late-onset sepsis, expanded to include urine and cerebrospinal fluid (CSF) infections, in premature neonates of less than 25 weeks’ gestation.

Design/Methods: This was a 7-year retrospective review of 148 extremely preterm neonates of less than 25 weeks’ gestation admitted to a level III delivery hospital NICU. Patient demographic and clinical data was extracted from the electronic medical record and tracked in a novel, IRB-exempt “Tiny Baby Database”. Infants were considered to have late-onset sepsis if they had a positive blood, urine, or CSF culture or a physician diagnosis of pneumonia between 72 hours of life and 21 days of life. Duration of PREMILOC hydrocortisone was recorded. Infants were considered to have completed a course of hydrocortisone if they received a pre-defined 10 day regimen (as per the original PREMILOC trial). Infants will be stratified according to whether or not they completed a course of hydrocortisone. Statistical analysis will be completed to detect whether significant differences exist in the incidence of late onset sepsis between the groups.