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: A systematic review and meta-analysis of QI studies was conducted across PubMed, Embase, Cochrane Library, and Web of Science (inception to March 19th, 2025). Studies were included if they reported pre-post QI outcomes for LOS in preterm infants (gestational age < 37 weeks), with effect sizes synthesized as odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was evaluated using Results: Of 9,705 identified studies, 29 (21 for meta-analysis, 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.