Tracheal colonization in preterm infants supported with nasal continuous positive airway pressure

Aly, Hany; Badawy, M.M.; Tomerak, Rania Hosny; El-Kholy, Amani; Hamed, Abeer S.

doi:10.1111/j.1442-200x.2012.03567.x

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…3,6,7 The predominant type of growth varies; gram negative bacilli are as frequent as gram positive organisms. [7][8][9][10] The aetiology of neonatal CLD, also known as bronchopulmonary dysplasia (BPD), is multifactorial and includes ventilator associated lung injury, inflammation and infection. [11][12][13][14][15][16] Infants who are mechanically ventilated for prolonged periods are at higher risk of developing CLD.…”

Section: What This Paper Addsmentioning

confidence: 99%

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Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

Antoine

Inglis

Way

et al. 2020

J Paediatrics Child Health

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Aim: To determine the rate, type and timing of bacterial endotracheal tube (ETT) colonisation in neonates born <32 weeks gestational age (GA); and if bacterial colonisation is associated with chronic lung disease (CLD), septicaemia, length-of-stay or mortality. Methods: All intubated newborns born <32 weeks GA were included. Endotracheal aspirates were routinely obtained three times-per-week. Cohort was divided into three colonisation groups: no growth, normal respiratory flora only, significant bacteria. Logistic regression was performed to identify if ETT bacterial colonisation was associated with CLD, septicaemia or mortality. A general linear model was fitted for lengthof-stay. Results: ETT aspirates were sent from 1054 infants: no growth n = 319, only normal respiratory flora n = 357, and significant bacteria n = 378. ETTs became colonised in 70%, most in the first week of life (82%). Most grew normal respiratory flora (642 infants). In those with significant bacteria, 40% grew Gram-negative species; Klebsiella in 34%. Staphylococcus aureus grew in 104 patients. Adjusted odds ratios for CLD (43% of cohort) compared with no growth were, for normal respiratory flora, 0.58 (95% confidence interval (CI) 0.34-0.99) and, for significant bacteria, 0.48 (95% CI 0.24-0.93). With no overall association between colonisation group and CLD in the adjusted model P = 0.07. The odds of septicaemia (10% of cohort) were 4.50 (95% CI 1.98-10.23, P < 0.001) times greater for significant bacteria compared with no growth. No significant associated was found with mortality or length-of-stay. Conclusions: Bacterial colonisation of ETTs is common. It is associated with more septicaemia. There was no significant association with CLD, longer admission or mortality.

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Section: What This Paper Addsmentioning

confidence: 99%

“…A longer duration of intubation increases the likelihood of bacterial colonisation 3,6,7 . The predominant type of growth varies; gram negative bacilli are as frequent as gram positive organisms 7–10 …”

mentioning

confidence: 99%

Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

Antoine

Inglis

Way

et al. 2020

J Paediatrics Child Health

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“…Results of this study are limited by the fact that it remains unclear whether the bacteria from positive catheter tips had already colonized the trachea [8] or whether colonization took place during catheter removal, which would then not involve a risk of transmission. This would have required an additional intratracheal smear before implementation of the LISAcatheter, which was regarded too invasive.…”

Section: Discussionmentioning

confidence: 95%

Microbiological analyses of nasally guided catheters after less invasive surfactant administration – a pilot study

et al. 2020

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Background: Respiratory distress syndrome (RDS) is a frequent complication of premature birth. Treating RDS by continuous positive airway pressure and less invasive surfactant administration (LISA) may reduce bronchopulmonary dysplasia. Surfactant, however, can be inactivated by bacterial infection. Therefore, potential routes of microbe transmission into the airway are of interest. The aim of this study was to evaluate microbiological contamination of catheters used for LISA procedures and its association with postnatal age. Methods: Catheter tips used for LISA procedures via the nasal route (LISA-n) in infants with RDS were placed into a sterile eSwab container directly after the procedure, cultured and examined for microbiological contamination.Results: Interpretable results could be collected from 20 catheter tips. Four showed positive culture results (20%) with microbes potentially associated with the development of early onset neonatal sepsis. Risk of positive microbe detection increased with postnatal age (< 4 h: 10%; 4-18 h: 20%; > 18 h: 40%).Conclusions: In this pilot study, the risk of tracheal microbe transmission following the LISA-n procedure increased with postnatal age. Although the clinical relevance of this finding is unclear, earlier surfactant administration might reduce the risk of catheter contamination.

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“…Teig et al 25 reported a decrease in incidence of nosocomial sepsis and attributed it to decreased tracheal bacterial colonization associated with LISA technique 81 …”

Section: Short‐term Outcomesmentioning

confidence: 99%

Surfactant delivery via thin catheters: Methods, limitations, and outcomes

Devi

Pandita

2021

Pediatric Pulmonology

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Various less invasive surfactant administration strategies like surfactant replacement therapy via thin catheters, laryngeal mask airway, pharyngeal instillation, and nebulized surfactant are increasingly being practiced to avoid the harmful effects of endotracheal intubation and ventilation. Numerous studies have been done to study surfactant replacement via thin catheters whereas little data is available for other methods. However, there are variations in premedication policies, type of respiratory support used in these studies. Surfactant delivery using thin catheters has been reported to be associated with decrease in the need for mechanical ventilation (MV), duration of MV, bronchopulmonary dysplasia and neonatal mortality. With the current evidence, among all the available surfactant delivery methods, the one using thin catheters appears to be the most feasible and beneficial to improve clinical neonatal outcomes.

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Tracheal colonization in preterm infants supported with nasal continuous positive airway pressure

Abstract: The trachea of premature infants supported with CPAP is at risk for bacterial colonization. Predisposing factors, mechanisms and clinical implications of these novel findings need to be studied.

Cited by 7 publications

References 27 publications

Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

Microbiological analyses of nasally guided catheters after less invasive surfactant administration – a pilot study

Surfactant delivery via thin catheters: Methods, limitations, and outcomes

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