TY - JOUR
T1 - Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia
AU - Children's Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus Group
AU - Murthy, Karna
AU - Porta, Nicolas F.M.
AU - Pallotto, Eugenia K.
AU - Rintoul, Natalie
AU - Keene, Sarah
AU - Chicoine, Louis
AU - Gien, Jason
AU - Brozanski, Beverly S.
AU - Johnson, Yvette R.
AU - Haberman, Beth
AU - DiGeronimo, Robert
AU - Zaniletti, Isabella
AU - Grover, Theresa R.
AU - Asselin, Jeanette
AU - Durand, David
AU - Dykes, Francine
AU - Evans, Jacquelyn
AU - Murthy, Karna
AU - Padula, Michael
AU - Pallotto, Eugenia
AU - Grover, Theresa
AU - Brozanski, Beverly
AU - Piazza, Anthony
AU - Reber, Kristina
AU - Short, Billie
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/12
Y1 - 2018/12
N2 - Objective: To predict incident bloodstream infection and urinary tract infection (UTI) in infants with congenital diaphragmatic hernia (CDH). Study design: We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010-2016. Infants with CDH admitted at 22 participating regional neonatal intensive care units were included; patients repaired or discharged to home prior to admission/referral were excluded. The primary outcome was death or the occurrence of bloodstream infection or UTI prior to discharge. Factors associated with this outcome were used to develop a multivariable equation using 80% of the cohort. Validation was performed in the remaining 20% of infants. Results: Median gestation and postnatal age at referral in this cohort (n = 1085) were 38 weeks and 3.1 hours, respectively. The primary outcome occurred in 395 patients (36%); and was associated with low birth weight, low Apgar, low admission pH, renal and associated anomalies, patch repair, and extracorporeal membrane oxygenation (P <.001 for all; area under receiver operating curve = 0.824; goodness of fit χ2 = 0.52). After omitting death from the outcome measure, admission pH, patch repair of CDH, and duration of central line placement were significantly associated with incident bloodstream infection or UTI. Conclusions: Infants with CDH are at high risk of infection which was predicted by clinical factors. Early identification and low threshold for sepsis evaluations in high-risk infants may attenuate acquisition and the consequences of these infections.
AB - Objective: To predict incident bloodstream infection and urinary tract infection (UTI) in infants with congenital diaphragmatic hernia (CDH). Study design: We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010-2016. Infants with CDH admitted at 22 participating regional neonatal intensive care units were included; patients repaired or discharged to home prior to admission/referral were excluded. The primary outcome was death or the occurrence of bloodstream infection or UTI prior to discharge. Factors associated with this outcome were used to develop a multivariable equation using 80% of the cohort. Validation was performed in the remaining 20% of infants. Results: Median gestation and postnatal age at referral in this cohort (n = 1085) were 38 weeks and 3.1 hours, respectively. The primary outcome occurred in 395 patients (36%); and was associated with low birth weight, low Apgar, low admission pH, renal and associated anomalies, patch repair, and extracorporeal membrane oxygenation (P <.001 for all; area under receiver operating curve = 0.824; goodness of fit χ2 = 0.52). After omitting death from the outcome measure, admission pH, patch repair of CDH, and duration of central line placement were significantly associated with incident bloodstream infection or UTI. Conclusions: Infants with CDH are at high risk of infection which was predicted by clinical factors. Early identification and low threshold for sepsis evaluations in high-risk infants may attenuate acquisition and the consequences of these infections.
KW - Children's Hospitals Neonatal Consortium (CHNC)
KW - Children's Hospitals Neonatal Database (CHND)
KW - congenital diaphragmatic hernia
KW - neonatal intensive care
KW - pulmonary hypertension
UR - http://www.scopus.com/inward/record.url?scp=85053029679&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2018.07.032
DO - 10.1016/j.jpeds.2018.07.032
M3 - Article
C2 - 30217691
AN - SCOPUS:85053029679
SN - 0022-3476
VL - 203
SP - 101-107.e2
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -