Nosocomial Infections in Neonates Supported by Extracorporeal Membrane Oxygenation: First French Retrospective Study.

How to cite this article: Rambaud J, Allioux C, Jean S, Guilbert J, Guellec I, Demoulin M, et al. Nosocomial Infections in Neonates Supported by Extracorporeal Membrane Oxygenation: First French Retrospective Study. Indian J Crit Care Med 2019;23(9):392-395.

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

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.

Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation.

OBJECTIVES: Extracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions. STUDY DESIGN: This was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support. MEASUREMENTS: The assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography. RESULTS: Thirty-four infants <3 months of age were included in the study over a period of 18 months. The ECMO duration was 10±7 days. The survival rate was 50% (17/34 patients), and the proportion of brain injuries was 20% (7/34 patients). The mean StcO2 during ECMO in the non-survivors was reduced in both hemispheres (p = 0.0008 right, p = 0.03 left) compared to the survivors. StcO2 was also reduced in deceased or brain-injured patients compared to the survivors without brain injury (p = 0.002). CONCLUSION: StcO2 appears to be a strong prognostic factor of survival and of the presence of cerebral lesions in young infants during ECMO.