{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:27:55Z","timestamp":1789673275128,"version":"4.0.1"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the risk factors for mortality associated with late onset sepsis (LOS) among preterm very-low-birthweight (VLBW) infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We performed a retrospective cohort study of infants born &amp;lt;32 weeks gestation and &amp;lt;1,500 gm admitted to a Singaporean tertiary-level neonatal intensive care unit. We determined the clinical, microbial, and laboratory risk factors associated with mortality due to culture-positive LOS in this cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,740 infants were admitted, of which 169 (9.7%) developed LOS and 27 (16%) died. Compared to survivors, those who died had lower birth gestational age (median 24 vs. 25 weeks, <jats:italic>p<\/jats:italic> = 0.02) and earlier LOS occurrence (median 10 vs. 17 days, <jats:italic>p<\/jats:italic> = 0.007). There was no difference in the incidence of meningitis (11.1 vs. 16.9%, <jats:italic>p<\/jats:italic> = 0.3), NEC (18.5 vs. 14.8%, <jats:italic>p<\/jats:italic> = 0.6), or intestinal surgery (18.5 vs. 23.3%, <jats:italic>p<\/jats:italic> = 0.6) among infants who died compared to survivors. Gram-negative bacteria accounted for 21\/27 (77.8%) LOS-associated deaths and almost all (13\/14, 93%) fulminant episodes. The presence of multiorgan failure, as evidenced by the need for mechanical ventilation (100 vs. 79.0%, <jats:italic>p<\/jats:italic> = 0.008), elevated lactate (12.4 vs. 2.1 mmol\/L, <jats:italic>p<\/jats:italic> &amp;lt; 0.001), and inotropic support (92.6 vs. 37.5%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001), was significantly associated with mortality. Infants who died had significantly lower white blood cell (WBC) counts (median 4.2 \u00d7 10<jats:sup>9<\/jats:sup>\/L vs. 9.9 \u00d7 10<jats:sup>9<\/jats:sup>\/L, <jats:italic>p<\/jats:italic> = 0.001), lower platelet count (median 40 \u00d7 10<jats:sup>9<\/jats:sup>\/L vs. 62 \u00d7 10<jats:sup>9<\/jats:sup>\/L, <jats:italic>p<\/jats:italic> = 0.01), and higher immature to total neutrophil (I: T) ratio (0.2 vs. 0.1, <jats:italic>p<\/jats:italic> = 0.002). Inotrope requirement [AOR 22.4 (95%CI 2.9, 103.7)], WBC &amp;lt;4 \u00d7 10<jats:sup>9<\/jats:sup>\/L [AOR 4.7 (1.7, 13.2)], and I: T ratio &amp;gt;0.3 [AOR 3.6 (1.3, 9.7)] were independently associated with LOS mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In a setting with predominantly Gram-negative bacterial infections, the need for inotropic support, leukopenia, and elevated I: T ratio were significantly associated with LOS mortality among preterm VLBW infants.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2021.801955","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T07:22:14Z","timestamp":1643613734000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Risk Factors for Mortality From Late-Onset Sepsis Among Preterm Very-Low-Birthweight Infants: A Single-Center Cohort Study From Singapore"],"prefix":"10.3389","volume":"9","author":[{"given":"Guan Lin","family":"Goh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charis Shu En","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehena","family":"Sultana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowena","family":"De La Puerta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Samuel","family":"Rajadurai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee 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