Quality improvement interventions to prevent late-onset sepsis in premature infants: a systematic review and meta-analysis

Background: Late-onset sepsis (LOS) is a life-threatening complication in preterm infants, with reported incidence rates of 1%-30% that vary by clinical and geographical factors. Quality improvement (QI) bundles integrating infection control, nutrition, and device management show promise in reducing LOS, but evidence remains fragmented due to heterogeneous definitions and mixed study populations. Methods: ≥ 50%. Subgroup analyses explored LOS definition impacts (time windows: ≥48 h, ≥72 h, other) and meta-regression tested covariates (study year, sample size, quality). Results: < 0.0). Conclusion: QI bundles significantly reduce LOS in preterm infants, including VLBW and ELBW subgroups, through core components like multidisciplinary teams, hand hygiene, and central line management. Given outcome variations by diagnostic criteria, standardizing LOS definitions is crucial. These bundles should be integrated into routine care globally. Future efforts should prioritize standardized reporting, antibiotic stewardship, and equitable implementation, especially in low-resource settings, by building on existing evidence and broader healthcare principles.