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PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1283-1289

Ventilator-Associated Pneumonia in Extremely Preterm Neonates in a Neonatal Intensive Care Unit: Characteristics, Risk Factors, and Outcomes

Anucha Apisarnthanarak, MD*, Galit Holzmann-Pazgal, MD*, Aaron Hamvas, MD{ddagger}, Margaret A. Olsen, PhD, MPH* and Victoria J. Fraser, MD*

* Division of Infectious Diseases, Departments of Pediatrics and Internal Medicine
{ddagger} Division of Newborn Medicine, St Louis Children’s Hospital, Washington University School of Medicine, St Louis, Missouri

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.

Key Words: ventilator-associated pneumonia • neonates • neonatal intensive care unit • risk factors • characteristics • nosocomial infections • outcomes

Abbreviations: VAP, ventilator-associated pneumonia • ICU, intensive care unit • LOS, length of stay • NICU, neonatal intensive care unit • EGA, estimated gestational age • SNAP-PE, Score of Neonatal Acute Physiology-Perinatal Extension • NNIS, National Nosocomial Infection Surveillance • BSI, bloodstream infection • CI, confidence interval

Received for publication Dec 10, 2002; Accepted Apr 30, 2003.




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