Risk factors predisposing to neonatal infection in mechanically ventilated newborns

Abstract EN

Background: Nosocomial infections are one of ihe leading causes of morluHty and morhidi/y in neonalal intensive cure iDiits (NICUs).

A constant and active surveillance system is necessary lo control the fad ors that cause and aggr avale the risk of these infections.

Aim of the study: The purpose oflliis study was lo identify the risk factors predisposing to neonalal infections in niechanically venlUated newborns in the NICU of Assiut University Children ’s Hospital.

Patients and methods: A prospective study was conducted over a period of one year (from Januarv 1 lo Decernher 31.

20}3), 175 non infected niechanically ventikited neonates were incinded.

For ail cases, ntelicnlous hislory was laken, fuU clinical examination was done and laboralorv warkup was done in the form of complété hlood coimt (CBC).

C réactivé protein (CRP), interleiikin-6 (lL6j, chest X-ray (CXR), hlood culture and endotracheal tube (ETT) aspirate culture that were collected and processed ut initiation of mechaiiical ventilation and after appearancc of clinical evidence of infection i'ai least 4H hours after ventilation) lo detect and confirm neonalal infections.

Results: Oui of 175 slndied neonates: 138 (78.9%) developed neonalal infections.

Most of the infections were caused bv Klehsiella Spp, coagulase negative staphylococci, staphylococcus aitreus, E-coli.

fungi that represented (25%, 40.5%), (22%, 9.5%), (19%, 7%), (16%, 38%), (11%, 2%) in ,hlood and ETT aspirate cultures respeclively.

The main neonalal i}}feclions were ventilator-associated pneumonia (44.9%).

followed by bloodstream infection (40.5%) and necrotizing enterocoUtis (12.6%).

Muhiple régression analysis revealed that risk of neonatal infection was significantly increased in very low birth weight (< 1500 gin), low birth weighl neonates (1500-2500 gm), gestational âge group 28-32 weeks, gestational âge group 33-36 weeks, increased duration of mechanical ventilation, reintubations, duration ofNICUslay.

centrcd venons line and ils duration, duration of perïpheral line and total parenteral nutrition and ils duration wilh OR --- 8.59, 4.17, 3.38, 2.85, 6.53, 4.59, 5.46, 5.82, 4.61, 3.8.

1.88, 2.53 and P - 0.003, 0.007, 0.008.

0.037, OOOJ, O.OU, 0.007, 0.006, 0.005, 0.01, 0.037, 0.044 respeclively.

Conclusion: High incidence rate of neonalal infections in neonates admitled to NICU was documented, particidarly in prématuré and low birth weight neonates on mechanical ventilation.

Early identification of neonatal infections and ils risk factors remain the kevs II) siiccessful management ofthis condition.