Intended for healthcare professionals

Clinical Review ABC of preterm birth

Infection in the preterm infant

BMJ 2004; 329 doi: (Published 25 November 2004) Cite this as: BMJ 2004;329:1277
  1. William McGuire,
  2. Linda Clerihew,
  3. Peter W Fowlie


    Systemic infection in preterm infants has two categories with distinct aetiologies and outcomes.

    Early onset infection—acquired in the intrapartum period and presenting in the first 48-72 hours after birth.

    Late onset infection—usually acquired in hospital and clinically evident more than 72 hours after birth (usually after the first week of life).

    Early onset infection


    Early onset systemic infection includes bacteraemia, pneumonia, meningitis, and urinary tract infection. Although rare, early onset infection is a serious complication of preterm birth. In North America the incidence of bacteraemia proved by culture in very low birthweight (< 1500 g) infants is 1.5% of live births. The principal pathogens responsible are Group B streptococci and Escherichia coli. Congenital listeriosis (caused by spread of Listeria monocytogenes across the placenta after the mother has eaten infected food) is rare in North America and the United Kingdom but more common in some areas in Europe.

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    Gram negative bacilli, particularly E coli, are an increasingly common cause of early onset infection in very low birthweight infants

    In many developed countries the incidence of Group B streptococcal infection has fallen in the past decade, perhaps because of the greater use of intrapartum antibiotic treatment for women with specific risk factors. During this period, however, there has been a rise in the incidence of infection with Gram negative coliforms Microbiological surveillance should be continued to identify changes in the epidemiology of early onset infection, particularly antibiotic resistance.

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    Micro-organisms causing early onset infection in very low birthweight infants*

    Presentation and treatment

    Most infants with early onset systemic infection will present with signs of sepsis, such as respiratory distress or fever, in the first 12 hours after birth. Presentation can be delayed, and microbiological diagnosis may be difficult, especially if the mother has received intrapartum antibiotics. As it is difficult to rule out systemic infection …

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