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Question 2: Does coagulase negative staphylococcal sepsis cause neurodevelopmental delay in preterm infants?
  1. Matthew McGovern1,2,
  2. Lisa Flynn3,
  3. Sheena Coyne3,
  4. Eleanor J Molloy1,2,3,4
  1. 1 Department of Paediatrics, Academic Centre, Tallaght Hospital, Trinity College, University of Dublin, Dublin, Ireland
  2. 2 Trinity Translational Medicine Institute, St James’s Hospital, Dublin, Ireland
  3. 3 Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
  4. 4 Deparment of Neonatology, Our Lady’s Children’s Hospital, Dublin, Ireland
  1. Correspondence to Professor Eleanor J Molloy, Department of Paediatrics, Trinity College Dublin, Dublin, Ireland; eleanor.molloy{at}tcd.ie

https://doi.org/10.1136/archdischild-2018-316004

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    Scenario

    A preterm male neonate who was born at 24+2 weeks’ gestation is now 3 weeks old, on full enteral feeds and nasal continuous positive airway pressure in room air. Following multiple episodes of oxygen desaturation and an increase in the oxygen requirement a sepsis evaluation is performed and empiric intravenous antibiotic therapy is commenced according to local guidelines.

    Coagulase negative Staphylococcus (CONS) is subsequently isolated on blood culture. Your registrar has enquired about the possible neurodevelopmental implications of this episode of CONS sepsis.

    Structured clinical question

    Do preterm neonates (patient) requiring treatment for CONS sepsis (intervention) have poorer neurodevelopmental outcomes (outcome) compared with neonates without sepsis (comparison)?

    Search

    Secondary sources: The Cochrane library and DARE were searched and revealed no relevant systematic reviews.

    PubMed: PubMed was searched using the following search strategy: (((neurodevelopment*[Title/Abstract] OR development*[Title/Abstract])) AND (vlbw[Title/abstract] OR Low-birth-weight[Title/Abstract] OR low birth weight[Title/Abstract] OR preterm[Title/Abstract] OR premature[Title/Abstract])) AND (CONS[Title/Abstract] OR sepsis[Title/Abstract]). The search was limited to English publications in humans, within the infant age group (birth 23 months). The search revealed 573 publications, the abstracts of which were reviewed by three authors (MMG, LF, SC). Our literature search identified seven relevant studies: one systematic review and meta-analysis,1 four prospective cohort studies,2–5 one retrospective cohort study6 and one case–control study.7 All studies included looked at preterm neonates <37 weeks with confirmed diagnoses of CONS sepsis in whom the outcomes of interest included either neuroimaging or detailed developmental follow-up. See table 1 for included studies.

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    Table 1

    CONS and neurodevelopmental outcome.

    Commentary

    Late-onset sepsis (LOS) is a commonly encountered problem in the neonatal intensive care unit (NICU) which is associated with increased mortality,8 and prolonged hospital stay in the paediatric population.8 9 CONS organisms, which are …

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    Footnotes

    • Contributors MMG performed the literature review, reviewed the resultant articles and wrote the manuscript. LF and SC performed the literature review, reviewed the resultant articles and contributed to the writing of the manuscript. EJM designed the research question, aided in the review of articles and edited the manuscript before submission.

    • Funding This research was funded by the National Children’s Research Centre, Crumlin, Dublin, Ireland.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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