Association between Congenital Anomalies and Late-Onset Bacterial Infections in Neonates Admitted to Neonatal Intensive Care Units in Australia and New Zealand: A Population-Based Cohort Study

Abrar Ahmad Chughtai; Naomi Spotswood; Tobias Strunk; Trisha Parmar; Tim Schindler; Himanshu Popat; Sharon Sue Wen Chow; Kei Lui; Australian and New Zealand Neonatal Network

doi:10.1159/000540276

Association between Congenital Anomalies and Late-Onset Bacterial Infections in Neonates Admitted to Neonatal Intensive Care Units in Australia and New Zealand: A Population-Based Cohort Study

Neonatology. 2024 Sep 19:1-11. doi: 10.1159/000540276. Online ahead of print.

Authors

Abrar Ahmad Chughtai¹, Naomi Spotswood^{2

3}, Tobias Strunk^{4

5}, Trisha Parmar⁶, Tim Schindler⁶, Himanshu Popat⁷, Sharon Sue Wen Chow⁸, Kei Lui⁹; Australian and New Zealand Neonatal Network

Affiliations

¹ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia, abrar.chughtai@unsw.edu.au.
² Women's and Children's Services, Royal Hobart Hospital, Hobart, Tasmania, Australia.
³ Burnet Institute, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Washington, Australia.
⁵ Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Washington, Australia.
⁶ Royal Hospital for Women, University of New South Wales, Sydney, New South Wales, Australia.
⁷ Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, NHMRC Clinical Trial Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁸ Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
⁹ School of Clinical Medicine, Discipline of Paediatrics and Child Health, University of New South Wales, Royal Hospital for Women, Sydney, New South Wales, Australia.

PMID: 39299217
DOI: 10.1159/000540276

Abstract

Introduction: Compromised neonatal intensive care unit neonates are at risk of acquiring late-onset infections (late-onset sepsis [LOS]). Neonates born with congenital anomalies (CAs) could have an additional LOS risk.

Methods: Utilising the population-based Australian and New Zealand Neonatal Network data from 2007 to 2017, bacterial LOS rates were determined in very preterm (VPT, <32 week), moderately preterm (MPT, 32-36 weeks), and term (FT, 37-41 weeks) neonates with or without CA. Stratified by major surgery, the association between CA and bacterial LOS was evaluated.

Results: Of 102,808 neonates, 37.7%, 32.8%, and 29.6% were born VPT, MPT, and FT, respectively. Among these, 3.4% VPT, 7.5% MPT, and 16.2% FT neonates had CA. VPT neonates had the highest LOS rate (11.1%), compared to MPT (1.8%) and FT (1.8%) neonates. LOS rates were higher in CA neonates than those without (8.2% versus 5.1% adjusted relative risk [aRR] 1.67, 95% confidence interval [CI]: 1.45-1.92). Neonates with surgery had a higher LOS rate (14.2%) than neonates without surgery (4.4%, p < 0.001). Among the neonates without surgery, CA neonates had consistently higher LOS rates than those without CA (VPT 14.3% vs. 9.6% [aRR 1.32, 95% CI: 1.11-1.57]; MPT 4% vs. 0.9% [aRR 4.45, 95% CI: 3.23-6.14]; and FT 2% vs. 0.7% [aRR 2.87, 95% CI: 1.97-4.18]). For the neonates with surgery, CAs were not associated with additional LOS risks.

Conclusion: Overall, we reported higher rates of LOS in neonates with CA compared to those without CA. Regardless of gestation, CA was associated with an increased LOS risk among non-surgical neonates. Optimisation of infection prevention strategies for CA neonates should be explored. Future studies are needed to evaluate if the infection risk is caused by CA or associated complications.

Keywords: Bacterial infections; Birth defects; Congenital anomalies; Infections; Neonatal intensive care units; Sepsis.