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Minerva Anestesiologica 2018 July;84(7):829-35

DOI: 10.23736/S0375-9393.18.12296-6


language: English

Incidence and risk factors of ventilator-associated pneumonia in neonatal intensive care unit: a first French study

Guillaume GESLAIN 1, Isabelle GUELLEC 1, Romain GUEDJ 2, Julia GUILBERT 1, Sandrine JEAN 1, Cécile VALENTIN 1, Maryne DEMOULIN 1, Yohann SOREZE 1, Ricardo CARBAJAL 2, Pierre-Louis LEGER 1, Jerome RAMBAUD 1

1 Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, UPMC University, Paris, France; 2 Department of Pediatric Emergency, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, UPMC University, Paris, France


BACKGROUND: Ventilator-associated pneumonia (VAP) is a severe intensive complication and remains under estimated in neonatal intensive care unit (NICU). Center for Disease Control defined criteria for adults and pediatrics without neonatal criteria. The objective of this article was to evaluate the rate, the risks factors and the outcome of neonates suffering from ventilator-associated pneumonia in a French NICU.
METHODS: We conducted a prospective observational study within a one-year period in our NICU. Three hundred and eighty-one neonates under 28 days of age were included. Data analyses were performed using Fischer exact-test, Kolgomorov analysis, Mann-Whitney test and logistic regression.
RESULTS: Seventeen patients were diagnosed with ventilator-associated pneumonia. Incidence rate of VAP was 8.8 per 1000 invasive mechanical ventilator days. The median age at diagnosis was 20 days (range: 4-45). Extremely low birth weight (under than 1000 grams) were significantly associated with VAP (OR=4.31 [95% CI: 1.38-13.39]). Newborns suffering from VAP had a significantly longer duration of invasive ventilation (median: 16 days [range 4-75] versus 3 days [range 1-28], P<0.001) and hospital length of stay (median: 34 days [range 7-91] versus 7 days [range 1-56], P<0.001). Mortality rate was significantly higher in patient with VAP (P=0.028).
CONCLUSIONS: We describe the first French study on VAP in a neonatal population. Amongst nosocomial infections, VAP is a complication with severe consequences for NICU patients. Larger studies are needed to better define a diagnosis strategy and prevention bundle.

KEY WORDS: Ventilator-associated pneumonia - Neonatal intensive care - Cross infection

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