{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:26:04Z","timestamp":1792819564439,"version":"4.5.0"},"reference-count":78,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Retinopathy of prematurity (ROP) is a major morbidity of preterm infants causing visual impairment, including blindness, for which timely treatment is vital and prevention is key. Increasing evidence suggests that exposure to neonatal sepsis contributes to ROP development.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the association between neonatal sepsis and ROP in 2 large-scale cohorts of preterm infants born at less than 29 weeks\u2019 gestation.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study was conducted using data from the German Neonatal Network (GNN) and Norwegian Neonatal Network (NNN). The GNN involves 68 and the NNN includes 21 level III neonatal intensive care units. Participants were infants born at a gestation of 22 weeks and 0 days to 28 weeks and 6 days and enrolled in the GNN between January 1, 2009, and December 31, 2022, and NNN between January 1, 2009, and December 31, 2018. Data were analyzed from February through September 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Single or multiple episodes of culture-proven sepsis.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Any ROP and treatment-warranted ROP.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 12\u202f794 infants in the GNN (6043 female [47.2%] and 6751 male [52.8%]; mean [SD] gestational age, 26.4 [1.5] weeks) and 1844 infants in the NNN (866 female [47.0%] and 978 male [53.0%]; mean [SD] gestational age, 25.6 [1.5] weeks), the mean (SD) birth weight was 848 (229) g and 807 (215) g, respectively. Any ROP was present in 6370 infants (49.8%) in GNN and 620 infants (33.6%) in NNN, and treatment-warranted ROP was present in 840 infants (6.6%) in GNN and 140 infants (7.6%) in NNN. In both cohorts, there were increasing rates of treatment-warranted ROP with each sepsis episode (no sepsis: 572 of 10\u202f658 infants [5.4%] in GNN and 85 of 1492 infants (5.7%) in NNN; 1 episode: 190 of 1738 infants in GNN [10.9%] and 29 of 293 infants [9.9%] in NNN; 2 episodes: 53 of 314 infants in GNN [16.9%] and 13 of 49 infants [26.5%] in NNN; 3 episodes: 25 of 84 infants [29.8%] in GNN and 3 of 10 infants [30.0%] in NNN). After adjusting for multiple confounders in the GNN dataset, the number of sepsis episodes was associated with ROP and treatment-warranted ROP compared with 0 episodes (1 episode: adjusted odds ratio [aOR], 1.44 [95% CI, 1.27-1.63]; P<\/jats:italic>\u2009&amp;lt;\u2009.001 and OR, 1.60 [95% CI, 1.31-1.96]; P<\/jats:italic>\u2009&amp;lt;\u2009.001, respectively; 2 episodes: OR, 1.81 [95% CI, 1.35-2.42]; P<\/jats:italic>\u2009&amp;lt;\u2009.001 and OR, 2.38 [95% CI, 1.68-3.37]; P<\/jats:italic>\u2009&amp;lt;\u2009.001, respectively; 3 episodes: OR, 4.39 [95% CI, 2.19-8.78]; P<\/jats:italic>\u2009&amp;lt;\u2009.001 and OR, 3.88 [95% CI, 2.29-6.55]; P<\/jats:italic>\u2009&amp;lt;\u2009.001, respectively). These associations were confirmed for any ROP by propensity score matching (for example, the aOR with propensity score matching was 1.76 [95% CI, 1.54-2.02]; P<\/jats:italic>\u2009&amp;lt;\u2009.001 for 1 episode vs 0 episodes and 1.58 [95% CI, 1.12-2.22]; P<\/jats:italic>\u2009=\u2009.007 for 3 episodes vs 0 or 1 episode). In the NNN dataset, surgical NEC was associated with treatment-warranted ROP (multivariable analysis: aOR, 3.37 [95% CI, 1.78-6.37]; P<\/jats:italic>\u2009&amp;lt;\u2009.001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study found that in the large-scale GNN cohort, recurrent culture-proven sepsis was associated with ROP and treatment-warranted ROP in infants born at less than 29 weeks.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.23933","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T15:49:16Z","timestamp":1721922556000},"page":"e2423933","source":"Crossref","is-referenced-by-count":33,"title":["Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants"],"prefix":"10.1001","volume":"7","author":[{"given":"Kirsten","family":"Glaser","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Women\u2019s and Children\u2019s Health, University of Leipzig Medical Center, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"H\u00e4rtel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Klingenberg","sequence":"additional","affiliation":[{"name":"Paediatric Research Group, Faculty of Health Sciences, University of Troms\u00f8-Arctic University of Norway, Troms\u00f8, Norway"},{"name":"Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egbert","family":"Herting","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats I.","family":"Fortmann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian P.","family":"Speer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans J.","family":"Stensvold","sequence":"additional","affiliation":[{"name":"Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuzana","family":"Huncikova","sequence":"additional","affiliation":[{"name":"Paediatric Department, Stavanger University Hospital, Stavanger, Norway"},{"name":"Department of Clinical Science, University of Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arild E.","family":"R\u00f8nnestad","sequence":"additional","affiliation":[{"name":"Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway"},{"name":"Medical Faculty, Institute for Clinical Medicine, University of Oslo, Oslo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin M.","family":"Nentwich","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Stahl","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"Dammann","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts"},{"name":"Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany"},{"name":"Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"G\u00f6pel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirstin","family":"Faust","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Thome","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Guthmann","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"von der Wense","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Wieg","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Weller","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"H\u00f6hn","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Olbertz","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Felderhoff-M\u00fcser","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Rossi","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Teig","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European 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section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Bohnhorst","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Kribs","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Vochem","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Wellmann","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Eichhorn","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Wintgens","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"B\u00f6ttger","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Fl\u00fcgel","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mechthild","family":"Hubert","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"D\u00f6rdelmann","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Hillebrand","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network 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Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Humberg","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Carolin","family":"Longardt","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"for the German Neonatal 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Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"K\u00fcster","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Fuchs","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"K\u00f6rner","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Brune","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Urlichs","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bergh\u00e4user","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Proquitt\u00e9","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Morhart","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Lindner","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Schl\u00f6sser","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Welfhard","family":"Schneider","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schroth","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Rieger-Fackeldey","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Dohle","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaqueline","family":"Bauer","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"V\u00f6lkl","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network Investigators, and the Infection, Inflammation, Immunology and Immunisation section of the European Society for Paediatric Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Brevis Nunez","sequence":"additional","affiliation":[{"name":"for the German Neonatal Network, the Norwegian Neonatal Network 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