TY - JOUR
T1 - Ventilator-Associated Pneumonia in Extremely Preterm Neonates in a Neonatal Intensive Care Unit
T2 - Characteristics, Risk Factors, and Outcomes
AU - Apisarnthanarak, Anucha
AU - Holzmann-Pazgal, Galit
AU - Hamvas, Aaron
AU - Olsen, Margaret A.
AU - Fraser, Victoria J.
PY - 2003/12/1
Y1 - 2003/12/1
N2 - Objective. To determine the rates, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in extremely preterm neonates in a neonatal intensive care unit (NICU). Methods. A prospective cohort study was conducted at the St Louis Children's Hospital on all patients who had birth weight ≤2000 g and were admitted to the NICU for ≥48 hours from October 2000 to July 2001. Extremely preterm neonates were defined as neonates with estimated gestational age (EGA) <28 weeks. The primary outcome was the development of VAP. Secondary outcomes were death and NICU length of stay (LOS). Multiple logistic regression was performed to determine independent predictors for VAP and mortality. Results. A total of 229 patients were enrolled. Sixty-seven (29%) had EGA <28 weeks. Nineteen episodes of VAP occurred in 19 (28.3%) of 67 mechanically ventilated patients. VAP rates were 6.5 per 1000 ventilator days for patients with EGA <28 weeks and 4 per 1000 ventilator days for EGA ≥28 weeks. By multivariate analysis, bloodstream infection before VAP (adjusted odds ratio: 3.5; 95% confidence interval [CI]: 1.2-10.8) was an independent risk factor for VAP after adjustment for the duration of endotracheal intubation. Ventilator-associated pneumonia (adjusted odds ratio: 3.4; 95% CI: 1.2-12.3) was an independent predictor of mortality. A strong association between VAP and mortality was observed in neonates who stayed in the NICU >30 days (relative risk: 8.0; 95% CI: 1.9-35.0). Patients with VAP also had prolonged NICU LOS (median: 138 vs 82 days). Conclusions. VAP occurred at high rates in extremely preterm neonates and was associated with increased mortality. Additional studies are needed to develop interventions to prevent VAP in NICU patients.
AB - Objective. To determine the rates, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in extremely preterm neonates in a neonatal intensive care unit (NICU). Methods. A prospective cohort study was conducted at the St Louis Children's Hospital on all patients who had birth weight ≤2000 g and were admitted to the NICU for ≥48 hours from October 2000 to July 2001. Extremely preterm neonates were defined as neonates with estimated gestational age (EGA) <28 weeks. The primary outcome was the development of VAP. Secondary outcomes were death and NICU length of stay (LOS). Multiple logistic regression was performed to determine independent predictors for VAP and mortality. Results. A total of 229 patients were enrolled. Sixty-seven (29%) had EGA <28 weeks. Nineteen episodes of VAP occurred in 19 (28.3%) of 67 mechanically ventilated patients. VAP rates were 6.5 per 1000 ventilator days for patients with EGA <28 weeks and 4 per 1000 ventilator days for EGA ≥28 weeks. By multivariate analysis, bloodstream infection before VAP (adjusted odds ratio: 3.5; 95% confidence interval [CI]: 1.2-10.8) was an independent risk factor for VAP after adjustment for the duration of endotracheal intubation. Ventilator-associated pneumonia (adjusted odds ratio: 3.4; 95% CI: 1.2-12.3) was an independent predictor of mortality. A strong association between VAP and mortality was observed in neonates who stayed in the NICU >30 days (relative risk: 8.0; 95% CI: 1.9-35.0). Patients with VAP also had prolonged NICU LOS (median: 138 vs 82 days). Conclusions. VAP occurred at high rates in extremely preterm neonates and was associated with increased mortality. Additional studies are needed to develop interventions to prevent VAP in NICU patients.
KW - Characteristics
KW - Neonatal intensive care unit
KW - Neonates
KW - Nosocomial infections
KW - Outcomes
KW - Risk factors
KW - Ventilator-associated pneumonia
UR - http://www.scopus.com/inward/record.url?scp=0346139501&partnerID=8YFLogxK
U2 - 10.1542/peds.112.6.1283
DO - 10.1542/peds.112.6.1283
M3 - Article
C2 - 14654598
AN - SCOPUS:0346139501
VL - 112
SP - 1283
EP - 1289
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 6 I
ER -