Short‐ and long‐term respiratory outcomes in neonates with ventilator‐associated pneumonia

Abstract

Background and Objective Ventilator‐associated pneumonia (VAP) is a common nosocomial infection in critical care settings and might have important long‐term consequences in neonates. Our aim is to clarify the short‐ and long‐term respiratory outcomes of neonates affected by VAP. Methods Prospective, population‐based, cohort study with 12 months follow‐up based on clinical examinations and diary‐based respiratory morbidity score, conducted in an academic tertiary referral neonatal unit with dedicated follow‐up program. Results A total of 199 inborn neonates consecutively ventilated for at least 48 hours were eligible for the study. One hundred fifty‐one were finally enrolled and classified as “exposed” or “unexposed” to VAP, if they fulfilled (or not) VAP criteria once during their stay. Bronchopulmonary dysplasia (BPD) incidence was significantly higher in exposed (75%) than in unexposed babies (26.8%; relative risk [RR]: 2.8 [1.9‐4.0]; AdjRR: 3.5 [1.002‐12.7]; P = .049; number needed to harm = 2.07), although the composite BPD/mortality did not differ. Exposed patients showed longer intensive care unit stay (87 [43‐116] vs 14 [8‐52] days; St.β = 0.24; P < .0001) and duration of ventilation (15 [10‐25] vs 5 [4‐8] days; St.β = 0.29; P < .0001) than unexposed neonates. Exposed patients also showed less ventilator‐free days (11 [5‐17.7] vs 22 [14‐24] days; St.β = −0.15; P = .05) compared to unexposed. Respiratory infections, use of drugs, rehospitalization for respiratory reasons, home oxygen therapy, their composite outcome, and diary‐based clinical respiratory morbidity score were similar between the cohorts. Conclusion Neonatal VAP seems associated to higher incidence of BPD, longer ventilation, and intensive care stay but it does not affect long‐term respiratory morbidity.

Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia

“…The crude mortality rate between VAP and non-VAP groups in this study were 6.0% and 8.8%, which were lower than the comparable pooled crude mortality rates from the INICC during 2012-2017 (25.8% and 9.5%, respectively). 4 The VFDs of the VAP group (median 5, IQR 0-16 days) in our study was lower than reported in a previous neonatal study (median 11, IQR 5-17.7 days) 13 and adult study (average 11 [95% CI, 0-24]) 18 , but the VFDs of the non-VAP group (median 24, IQR 20-26 days) was similar to another study (median 22, IQR 14-24 days). 13 Our VAP incidence density was 10.86 per 1,000 ventilator-days, similar to previous Spanish (10.9) and Iranian (11.6) studies, 6,17 but lower than earlier French (17.1) and Egyptian (29.2) studies 13,26 and higher than the INICC report (7.5, 95% CI 6.9-8.1).…”

Early surfactant replacement guided by lung ultrasound in preterm newborns with RDS: the ULTRASURF randomised controlled trial

“…The secondary objective was to assess the different levels of oxygen exposure in early life for each group. Other secondary outcomes were SpO 2 /FiO 2 ratio (S/F ratio) after surfactant therapy (see below), the need for mechanical ventilation (MV) (defined as MV during the first 3 days of life [18]), duration of invasive and non-invasive mechanical ventilation, ventilator-free days [19], duration of supplemental oxygen requirements, length of stay in the NICU and bronchopulmonary dysplasia [20].…”

“…These complications were considered to be related to the procedure if they were recorded during the next 30 min after the surfactant therapy. Ventilator-free days were calculated as the number of days in the NICU without invasive mechanical ventilation, within the first 28 days of life; this number is zero for patients who died in the NICU [19].…”

Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants

“…VAP is associated with increased morbidity, mortality, and prolonged length of hospital stay [ 7 ] representing a significant economic burden for the health system and the families [ 8 ].…”