Neonatal sepsis in alloimmune hemolytic disease of the fetus and newborn: A retrospective cohort study of 260 neonates

BACKGROUND: Among neonates with hemolytic disease of the fetus and newborn (HDFN), we aimed to describe the frequency of central‐line use, indications for insertion, and incidence of confirmed and suspected sepsis, including antibiotic treatment over a 10‐year surveillance period. STUDY DESIGN AND METHODS: All neonates with HDFN admitted to our neonatal intensive care unit between January 2012 and December 2021 were included in this retrospective, cohort study. Annual proportions of infants with a central‐line and central‐line‐associated bloodstream infection (CLABSI) rates (per 1000 central‐line days and per 100 infants) were evaluated. Numbers of confirmed and suspected early‐ and late‐onset sepsis episodes were assessed over the entire study period. RESULTS: Of the 260 included infants, 25 (9.6%) were evaluated for suspected sepsis, with 16 (6.2%) having ≥1 confirmed sepsis episode. A total of 123 central‐lines were placed in 98 (37.7%) neonates, with impending exchange transfusion (ET) being the most frequent indication. Of the 34 (34.7%) neonates in whom a central‐line was placed due to impending ET, 11 (32.4%) received no ET. Overall CLABSI incidence was 13.58 per 1000 central‐line days. Neonates with a central‐line had a higher risk for confirmed late‐onset infection (RR 1.11, 95% CI: 1.04–1.20) and sepsis work‐up (RR 1.10, 95% CI: 1.03–1.17) compared to infants without a central‐line. CONCLUSIONS: Sepsis incidence among neonates with HDFN remains high, in particular in those with a central‐line. Considering the substantial proportion of neonates with a central‐line without eventual ET, central‐line placement should be delayed until the likelihood of ET is high.