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Cernada M, De Alba Romero C, Fernández-Colomer B, González-Pacheco N, González M, Couce ML. Health care-associated infections in neonatology. An Pediatr (Barc) 2024; 100:46-56. [PMID: 38177038 DOI: 10.1016/j.anpede.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Health care-associated infections are common in neonatology, but there is no consensus on their definitions. This makes it difficult to compare their incidence or assess the effectiveness of prevention bundles. This is why we think it is very important to achieve a consensus on the definitions and diagnostic criteria for one of the most frequent causes of morbidity in hospitalised neonates. This document aims to standardise the definitions for the most frequent health care-associated infections, such as catheter-associated bloodstream infection, ventilator-associated pneumonia and surgical wound infection, as well as the approach to their diagnosis and treatment.
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Affiliation(s)
- María Cernada
- Servicio de Neonatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | - María González
- Servicio de Neonatología, Hospital Materno-Infantil Regional Málaga, Málaga, Spain
| | - María Luz Couce
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago, Santiago de Compostela, Spain.
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Zheng X, He D, Yang Z, Chen L, Jiang M, Qi Y, Qin F, Yu J, Peng Y, Liu L, Hei M. Dwell time and bloodstream infection incidence of umbilical venous catheterization in China. Pediatr Investig 2023; 7:239-246. [PMID: 38050540 PMCID: PMC10693663 DOI: 10.1002/ped4.12403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/21/2023] [Indexed: 12/06/2023] Open
Abstract
Importance Central line-associated bloodstream infection (CLABSI) is one of the most serious complications of central venous access devices. Reducing the risk of CLABSI is of utmost significance in efforts to improve neonatal mortality rates and enhance long-term prognosis. Objective To determine the dwell time and incidence of CLABSI of umbilical venous catheterization (UVC) for preterm infants in China. Methods Preterm infants with UVC admitted to 44 tertiary neonatal intensive care units in 24 provinces in China were enrolled. Study period was from November 2019 to August 2021. The end point of observations was 48 h after umbilical venous (UV) catheter removal. The primary outcomes were dwell time of UV catheter and UVC-associated CLABSI. Data between infants with UV catheter dwell time ≤7 days and >7 days, and with birth weight (BW) ≤1000 g and >1000 g were compared. Results In total, 2172 neonates were enrolled (gestational age 30.0 ± 2.4 weeks, BW 1258.5 ± 392.8 g). The median UV catheter dwell time was 7 (6-10) days. The incidence of UVC-associated CLABSI was 3.03/1000 UV catheter days. For infants with UV catheter dwell time ≤7 days and >7 days, the UVC-associated CLABSI incidence was 3.71 and 2.65 per 1000 UV catheter days, respectively, P = 0.23. For infants with UVC dwell times of 3-6, 7-12, and 13-15 days, the UVC-associated CLABSI rates were 0.14%, 0.68%, and 2.48% (P < 0.01). The Kaplan-Meier plot of UV catheter dwell time to CLABSI showed no difference between infants with BW ≤1000 g and >1000 g (P = 0.60). Interpretation The median dwell time of UV catheter was 7 days, and the incidence of UVC-associated CLABSI was 3.03/1000 catheter days in China. The daily risk of UVC-associated CLABSI and other complications increased with the dwell time.
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Affiliation(s)
- Xu Zheng
- Neonatal Center, Beijing Children's Hospital, Capital Medical UniversityNational Center of Children's HealthBeijingChina
| | - Dan He
- Guiyang Maternal and Child Health Care HospitalGuiyang Children's HospitalGuizhouChina
| | - Zixin Yang
- Neonatal Center, Beijing Children's Hospital, Capital Medical UniversityNational Center of Children's HealthBeijingChina
| | - Lu Chen
- Neonatal Center, Beijing Children's Hospital, Capital Medical UniversityNational Center of Children's HealthBeijingChina
| | - Min Jiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical UniversityNational Center of Children's HealthBeijingChina
| | - Yujie Qi
- Neonatal Center, Beijing Children's Hospital, Capital Medical UniversityNational Center of Children's HealthBeijingChina
| | - Fei Qin
- Neonatal Center, Beijing Children's Hospital, Capital Medical UniversityNational Center of Children's HealthBeijingChina
| | - Jie Yu
- Neonatal Center, Beijing Children's Hospital, Capital Medical UniversityNational Center of Children's HealthBeijingChina
| | - Yaguang Peng
- Center for Clinical Epidemiology and Evidence‐based Medicine, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Ling Liu
- Guiyang Maternal and Child Health Care HospitalGuiyang Children's HospitalGuizhouChina
| | - Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical UniversityNational Center of Children's HealthBeijingChina
- Key Laboratory of Major Diseases in ChildrenMinistry of EducationBeijingChina
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Mills M, Chanani N, Wolf M, Bauser-Heaton H, Beshish A, Aljiffry A, Zinyandu T, Maher K. Durable Vascular Access in Neonates in the Cardiac ICU: A Novel Technique for Tunneled Femoral Central Venous Catheters. Pediatr Crit Care Med 2023; 24:919-926. [PMID: 37458510 DOI: 10.1097/pcc.0000000000003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES There is an ongoing need for a method of obtaining long-term venous access in critically ill pediatric patients that can be completed at the bedside and results in a durable, highly functional device. We designed a novel technique for tunneled femoral access to address this need. Herein, we describe the procedure and review the outcomes at our institution. DESIGN A single-center retrospective chart review identifying patients who underwent tunneled femoral central venous catheter (tfCVC) placement between 2017 and 2021 using a two-puncture technique developed by our team. SETTING Academic, Quaternary Children's Hospital with a dedicated pediatric cardiac ICU (CICU). PATIENTS Patients in our pediatric CICU who underwent this procedure. INTERVENTIONS Tunneled femoral central line placement. MEASUREMENTS AND MAIN RESULTS One hundred eighty-two encounters were identified in 161 patients. The median age and weight at the time of catheter placement was 22 days and 3.2 kg. The median duration of the line was 22 days. The central line-associated bloodstream infection (CLABSI) rate was 0.75 per 1,000-line days. The prevalence rate of thrombi necessitating pharmacologic treatment was 2.0 thrombi per 1,000-line days. There was no significant difference in CLABSI rate per 1,000-line days between the tfCVC and nontunneled peripherally inserted central catheters placed over the same period in a similar population (-0.40 [95% CI, -1.61 to 0.82; p = 0.52]) and no difference in thrombus rates per 1,000-line days (1.37 [95% CI, -0.15 to 2.89; p = 0.081]). CONCLUSIONS tfCVCs can be placed by the intensivist team using a two-puncture technique at the bedside with a high-rate of procedural success and low rate of complications. Advantages of this novel technique of obtaining vascular access include a low rate of CLABSIs, the ability to place it at the bedside, and preservation of the upper extremity vasculature.
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Affiliation(s)
- Marcos Mills
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Nikhil Chanani
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Michael Wolf
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Holly Bauser-Heaton
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Asaad Beshish
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Alaa Aljiffry
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Tawanda Zinyandu
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Kevin Maher
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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Salonen S, Tammela O, Koivisto AM, Korhonen P. Umbilically and Peripherally Inserted Thin Central Venous Catheters Have Similar Risks of Complications in Very Low-Birth-Weight Infants. Clin Pediatr (Phila) 2023; 62:1361-1368. [PMID: 36942607 PMCID: PMC10548765 DOI: 10.1177/00099228231161299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Catheter complications can be life-threatening in very low-birth-weight (VLBW) infants. We retrospectively evaluated non-elective removals of the first thin (1-2F) umbilical vein catheters (tUVCs (n = 92)) and peripherally inserted central venous catheters (PICCs (n = 103)) among 195 VLBW infants. Catheters were removed non-electively in 78 infants (40%), typically due to suspected infection (n = 42) or catheter dislocation (n = 30). Infants with complications had lower birth weights and gestational ages than others. The frequencies and causes of catheter removal were similar in the tUVC and PICC groups. Thirty-one infants had true catheter infections. The number of infections/1000 catheter days was higher in the tUVC group than in the PICC group. In a multivariable analysis, gestational age was associated with catheter infection, but catheter type was not. The odds of catheter complications decreased with increasing gestational age, but no clear association with thin catheter type was found.
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Affiliation(s)
- S. Salonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - O. Tammela
- Tampere Center for Child Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
| | - A. M. Koivisto
- Faculties of Social Science and Health Science, Tampere University, Tampere, Finland
| | - P. Korhonen
- Tampere Center for Child Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
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Jansen SJ, Ree IMC, Broer L, de Winter D, de Haas M, Bekker V, Lopriore E. Neonatal sepsis in alloimmune hemolytic disease of the fetus and newborn: A retrospective cohort study of 260 neonates. Transfusion 2023; 63:117-124. [PMID: 36334304 PMCID: PMC10099948 DOI: 10.1111/trf.17176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/30/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Among neonates with hemolytic disease of the fetus and newborn (HDFN), we aimed to describe the frequency of central-line use, indications for insertion, and incidence of confirmed and suspected sepsis, including antibiotic treatment over a 10-year surveillance period. STUDY DESIGN AND METHODS All neonates with HDFN admitted to our neonatal intensive care unit between January 2012 and December 2021 were included in this retrospective, cohort study. Annual proportions of infants with a central-line and central-line-associated bloodstream infection (CLABSI) rates (per 1000 central-line days and per 100 infants) were evaluated. Numbers of confirmed and suspected early- and late-onset sepsis episodes were assessed over the entire study period. RESULTS Of the 260 included infants, 25 (9.6%) were evaluated for suspected sepsis, with 16 (6.2%) having ≥1 confirmed sepsis episode. A total of 123 central-lines were placed in 98 (37.7%) neonates, with impending exchange transfusion (ET) being the most frequent indication. Of the 34 (34.7%) neonates in whom a central-line was placed due to impending ET, 11 (32.4%) received no ET. Overall CLABSI incidence was 13.58 per 1000 central-line days. Neonates with a central-line had a higher risk for confirmed late-onset infection (RR 1.11, 95% CI: 1.04-1.20) and sepsis work-up (RR 1.10, 95% CI: 1.03-1.17) compared to infants without a central-line. CONCLUSIONS Sepsis incidence among neonates with HDFN remains high, in particular in those with a central-line. Considering the substantial proportion of neonates with a central-line without eventual ET, central-line placement should be delayed until the likelihood of ET is high.
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Affiliation(s)
- Sophie J Jansen
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Isabelle M C Ree
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Department of Hematology, Center for Clinical Transfusion Research, Amsterdam, The Netherlands
| | - Lana Broer
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Derek de Winter
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Department of Hematology, Center for Clinical Transfusion Research, Amsterdam, The Netherlands
| | - Masja de Haas
- Department of Hematology, Center for Clinical Transfusion Research, Amsterdam, The Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Rabie D, Mostafa MF, Abdel Halim RM, Ezzat OA. Central line-associated bloodstream infection (CLABSI) with three different vascular access in neonatal intensive care unit. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-022-00108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Central venous catheters (CVCs) are a mandatory aspect in the neonatal intensive care units. Unfortunately, bloodstream infection is a frequent complication of CVCs. A needleless connector is attached to the end of CVC to allow infusion of fluids. We aimed to assess the effect of needleless connectors on central line-associated blood stream infection, and to assess rate of occurrence of bloodstream infection with the use of three different types of venous access in neonates.
Methods
This study is a prospective, randomized, comparative study which was held at the Neonatal Intensive Care, Faculty of Medicine, Ain Shams University. The study recruited 120 neonates who were categorized into three groups according to the type of inserted CVC: group A with umbilical venous catheter, group B with peripherally inserted central catheter, and group C with non-tunneled central venous catheter, and each group was further subdivided into two groups according to the use of needleless connector. Criteria of central line-associated bloodstream infection (CLABSI) and central line-related bloodstream infection (CLRBSI) were applied.
Results
The study included 120 neonates, a multivariable logistic regression analysis was held for two predictors (type of CVC and use of needleless connector) of CLABSI/CLRBSI, it revealed that the use of needleless connector was associated with significant lower incidence of CLABSI/CLRBSI (P value < 0.05, adjusted odds ratio [aOR] = 0.303), the use of peripheral inserted central catheter (PICC) was also associated with the lowest incidence of CLABSI/CLRBSI (P value = 0.015, aOR = 0.284). Another multivariable logistic regression analysis was done for four predictors (type of CVC, use of needleless connector, gestational age, and catheter dwell time) which revealed that the gestational age (P value = 0.001, aOR = 0.691) and catheter dwell time (P value = 0.004, aOR = 1.313) were the only independent predictors for the occurrence of CLABSI/CLRBSI.
Conclusion
The use of needleless connector can lower the incidence of CLABSI/CLRBSI, PICC line was associated with the lowest incidence of CLABSI/CLRBSI among the three types of CVCs. Low gestational age and long catheter dwell time were found to be the main risk factors for increasing the incidence of CLABSI/CLRBSI.
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Outcomes of Femoral Arterial Catheterisation in Neonates: A Retrospective Cohort Study. CHILDREN 2022; 9:children9081259. [PMID: 36010148 PMCID: PMC9406862 DOI: 10.3390/children9081259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
Background: To review the outcome of all femoral arterial catheter (FAC) insertions in a single, large neonatal unit over a 12 year period, we will describe the incidence of harms arising from FAC insertion and to identify risk factors associated with ischaemic injury. Methods: Retrospective survey of data relating to all episodes of FAC insertion in a single neonatal intensive care unit over a 12 year period up to 2020. Results: 146 FACs were inserted into 139 babies with a median (interquartile range) gestation and birth weight of 27 (24 to 37) weeks and 1092 (682 to 2870) g. Impaired limb perfusion occurred in 32 (22%). This was transient and recovered with no injury in 26 of the 32. There was an increased risk of impaired limb perfusion in babies with lower weight at the time of insertion; from 5.7% in babies over 3000 g to 34.7% in babies under 1000 g (relative risk 6.1 (1.5 to 24.6)). Six babies (4%) had ischaemic injury. Risk factors for ischaemic injury included weight below 1000 g (four cases), pre-existing partial arterial obstruction (two cases), concerns about limb perfusion prior to FAC insertion (two cases) and a delay in removing the FAC after recognition of the poor perfusion (five cases). Two clinicians inserted 71 (50%) FACs and had no associated injuries. Conclusions: FAC can be used in neonates, although there is a risk of ischaemic injury, particularly in very small babies. Our data can be used to inform decisions about patient selection for this procedure.
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王 琳, 赵 小, 刘 辉, 邓 丽, 梁 红, 段 思, 杨 依, 张 华. [Evidence-based standardized nutrition protocol can shorten the time to full enteral feeding in very preterm/very low birth weight infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:648-653. [PMID: 35762431 PMCID: PMC9250396 DOI: 10.7499/j.issn.1008-8830.2202121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To investigate whether evidence-based standardized nutrition protocol can facilitate the establishment of full enteral nutrition and its effect on short-term clinical outcomes in very preterm/very low birth weight infants. METHODS A retrospective analysis was performed on the medical data of 312 preterm infants with a gestational age of ≤32 weeks or a birth weight of <1 500 g. The standardized nutrition protocol for preterm infants was implemented in May 2020; 160 infants who were treated from May 1, 2019 to April 30, 2020 were enrolled as the control group, and 152 infants who were treated from June 1, 2020 to May 31, 2021 were enrolled as the test group. The two groups were compared in terms of the time to full enteral feeding, the time to the start of enteral feeding, duration of parenteral nutrition, the time to recovery to birth weight, the duration of central venous catheterization, and the incidence rates of common complications in preterm infants. RESULTS Compared with the control group, the test group had significantly shorter time to full enteral feeding, time to the start of enteral feeding, duration of parenteral nutrition, and duration of central venous catheterization and a significantly lower incidence rate of catheter-related bloodstream infection (P<0.05). There were no significant differences between the two groups in the mortality rate and the incidence rate of common complications in preterm infants including grade II-III necrotizing enterocolitis (P>0.05). CONCLUSIONS Implementation of the standardized nutrition protocol can facilitate the establishment of full enteral feeding, shorten the duration of parenteral nutrition, and reduce catheter-related bloodstream infection in very preterm/very low birth weight infants, without increasing the risk of necrotizing enterocolitis.
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Affiliation(s)
| | | | | | | | | | | | | | - 华岩 张
- 费城儿童医院 及宾夕法尼亚大学佩雷尔曼医学院新生儿科,美国宾夕法尼亚州费城
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Fang L, Zhang M, Wu L, Wang R, Lin B, Yao J, Chen D. Is preterm donor milk better than preterm formula for very-low-birth-weight infants? Food Nutr Res 2021; 65:5346. [PMID: 34650391 PMCID: PMC8494261 DOI: 10.29219/fnr.v65.5346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/20/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background Preterm human milk has advantages over preterm formula (PF), but it may compromise some functions after pasteurization. Objective To explore the effects of preterm donor milk (DM) on growth, feeding tolerance, and severe morbidity in very-low-birth-weight infants. Method This was a single-center, prospective cohort study that included 304 preterm infants weighing <1,500 g or of gestational age <32 weeks. If the mother's own milk was insufficient, the parents decided to use PF (n = 155) or DM (n = 149). The two groups were uniformly managed according to the standard NICU protocol. Growth parameters, feeding tolerance, and severe morbidity such as necrotizing enterocolitis, were compared between the two groups. Results The daily weight gain and weekly head growth in the DM group were not different from those in the PF group (P > 0.05). Feeding intolerance in the DM group was significantly lower than that in PF group (P < 0.05), and parenteral nutrition time and hospitalization time were also shorter than that in the PF group (P < 0.05). Moreover, the incidence of necrotizing enterocolitis and sepsis was also significantly lower in the DM group (P < 0.05). Conclusion The study indicated that preterm DM does not affect the growth of very-low-birth-weight infants. Further, it significantly reduces feeding intolerance, helps achieve full enteral feeding early, and has protective effects against necrotizing enterocolitis and sepsis. Thus, compared with formula, preterm DM can lower the rate of infection in preterm infants and is worthy of promotion.
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Affiliation(s)
- Lingyu Fang
- Neonatal Intensive Care Unit, Quanzhou Women and Children's Hospital, Quanzhou, Fujian, China
| | - Meili Zhang
- Neonatal Intensive Care Unit, Quanzhou Women and Children's Hospital, Quanzhou, Fujian, China
| | - Lianqiang Wu
- Neonatal Intensive Care Unit, Quanzhou Women and Children's Hospital, Quanzhou, Fujian, China
| | - Ruiquan Wang
- Neonatal Intensive Care Unit, Quanzhou Women and Children's Hospital, Quanzhou, Fujian, China
| | - Bangbang Lin
- Administrative Office, Quanzhou Women and Children's Hospital, Quanzhou, Fujian, China
| | - Jianfeng Yao
- Reproductive Medicine Center, Quanzhou Women and Children's Hospital, Quanzhou, Fujian, China
| | - Dongmei Chen
- Neonatal Intensive Care Unit, Quanzhou Women and Children's Hospital, Quanzhou, Fujian, China
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Tran VL, Greenberg J, Nuibe A. Evaluating the Incidence of Sepsis Post-Central Catheter Removal When Using Prophylactic Vancomycin in the Neonatal Intensive Care Unit. J Pediatr Pharmacol Ther 2021; 26:728-733. [PMID: 34588937 DOI: 10.5863/1551-6776-26.7.728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/14/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE With no consensus, the practice of using prophylactic antibiotics prior to central venous catheter (CVC) removal in NICU patients remains controversial. The objective of this study was to compare the incidence of sepsis post-CVC removal in those who received a dose of vancomycin prophylactically with those who did not. METHODS This single-center, retrospective chart review included NICU patients who had CVCs removed. Patients were excluded if they had a confirmed or suspected infection at the time of CVC removal or if the indwelling CVC was removed prior to 30 days from insertion. Primary outcome was the occurrence of a sepsis evaluation within 72 hours from CVC removal. Secondary outcomes included the development of acute kidney injury, source and identification of positive cultures, time to onset of suspected or confirmed sepsis, and the appropriate administration of intravenous vancomycin. RESULTS Eighty-two CVC removals received prophylactic vancomycin (P-VAN), and 22 CVCs did not receive prophylactic vancomycin (NP-VAN) prior to CVC removal. There were no significant differences in patient demographics between groups and median duration of indwelling CVC. Two clinical sepsis evaluations occurred in the P-VAN group compared with none in the NP-VAN group. Of all the P-VAN CVC removals, 45 (55%) received vancomycin appropriately. There were no statistical differences in all evaluated secondary outcomes. CONCLUSIONS Vancomycin administered prophylactically prior to CVC removal did not reduce the number of subsequent clinical sepsis evaluations or infections in NICU patients.
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Secco IL, Reichembach MT, Pereira HP, Silva RPGVCD. Prevalence of central venous catheter salvage in newborn with staphylococcal bloodstream infection. Rev Bras Enferm 2021; 74:e20201073. [PMID: 34431937 DOI: 10.1590/0034-7167-2020-1073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/14/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to establish the prevalence of salvage of central venous catheters in newborns with bloodstream infection caused by coagulase-negative staphylococci. METHODS retrospective cross-sectional study with 136 newborns admitted to the Neonatal Intensive Care Unit between 2011 and 2017. The total of 143 infection events undergoing antibiotic therapy were evaluated. RESULTS among the 143 infection events, 39 catheters in which antibiotic therapy was used were saved and in 69 cases, the device was removed. Positive central blood culture and single lumen catheter were factors associated with salvage failure. The probability of salvage decreased with infections diagnosed from 15 days of using the catheter. Negative blood culture raised the chance of salvage by fourfold. CONCLUSIONS the use of antibiotic therapy in the treatment of infections resulted in a low prevalence of salvage of the central venous catheter. The probability of salvage was associated with variables of the device.
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Ratchagame V, Prabakaran V. Comparison of Risks from Central Venous Catheters and Peripheral Intravenous Lines among Term Neonates in a Tertiary Care Hospital, India. J Caring Sci 2021; 10:57-61. [PMID: 34222113 PMCID: PMC8242296 DOI: 10.34172/jcs.2021.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/22/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction: Venous access in neonates is a basic yet critical component in neonatal intensive care unit (NICU). Central venous access and peripheral intravenous access are mostly preferred for delivering medications and intravenous fluids. This study aimed to compare the risks involved in central venous catheters and peripheral intravenous lines among term neonates. Methods: A prospective cohort study was carried out among 78 term neonates in the NICU of a tertiary care center in puducherry in India. Convenience sampling technique was used to enroll the neonates who met the inclusion criteria. Data pertaining to demographic and clinical characteristics, cannulation details, indwelling time, and incidence of thrombosis, phlebitis, occlusion, extravasation, and sepsis were collected by direct observation and from case record. Data were analyzed using SPSS software version 21. To analyze the data, descriptive statistics including frequency, percentage, mean, and standard deviation and inferential statistics including Fisher’s exact test were utilized. Results: Our findings indicated that the risks of thrombosis and phlebitis were significantly higher in peripheral intravenous line group than the central venous group. There was no statistically significant association between the risks and demographic and clinical characteristics in both of the venous access system. Conclusion: According to our results, the use of central venous catheter among neonates showed lower risks than peripheral intravenous lines. Hence, using central venous catheter may be given priority in the NICUs.
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Affiliation(s)
- Vicknesh Ratchagame
- Department of Pediatric Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vetriselvi Prabakaran
- Department of Pediatric Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Hussain AS, Ahmed AM, Arbab S, Ariff S, Ali R, Demas S, Zeb J, Rizvi A, Saleem A, Farooqi J. CLABSI reduction using evidence based interventions and nurse empowerment: a quality improvement initiative from a tertiary care NICU in Pakistan. Arch Dis Child 2021; 106:394-400. [PMID: 32253277 DOI: 10.1136/archdischild-2019-318779] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Central line associated bloodstream infection (CLABSI) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). We designed a CLABSI Prevention Package (CPP) to decrease NICU CLABSI rates, using evidence-proven interventions. DESIGN This was a quality improvement (QI) project. Data collection was divided into three phases (pre-implementation, implementation and post implementation). SQUIRE2.0 guidelines were used to design, implement and report this QI initiative. SETTING A tertiary care level 3 NICU at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. PATIENTS All patients admitted to the AKUH NICU from 1 January 2016 to 31 March 2018 who had a central line in place during their NICU admission. INTERVENTIONS CPP used evidence-based interventions focusing on hand hygiene, aseptic central line insertion techniques and central line care, prevention of fungal infections and nurse empowerment. MAIN OUTCOME MEASURES CLABSI rates pre and post intervention were recorded. Secondary outcomes were risk factors for CLABSI, device (central line) utilisation ratio, CLABSI related mortality and micro-organism profile. RESULTS CLABSI rates decreased from 17.1/1000 device days to 5.0/1000 device days (relative risk (RR)=0.36, CI=0.17-0.74). Device (central line) utilisation ratio declined from 0.30 to 0.25. Out of 613 patients enrolled in our study, 139 (22.7%) died. Mortality was higher in CLABSI group (n=20, 44%) as compared with non CLABSI group (n=119, 21.1%) (p<0.001). Gestational age of <27 weeks was an independent risk factor for CLABSI (RR=4.45, CI=1.10-18.25, p=0.03). A total of 158 pathogens were isolated among which 68 were associated with CLABSI. Gram-negative bacteria 31 (47.7%) were the most common cause of CLABSI. Ninety-seven (61%) micro-organisms were multi-drug resistant. CONCLUSIONS CPP was effective in decreasing NICU CLABSI rates and can be used as a model to decrease NICU CLABSI rates in low or middle-income countries.
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Affiliation(s)
- Ali Shabbir Hussain
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Anjum Mohyuddin Ahmed
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Saba Arbab
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shabina Ariff
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rehan Ali
- Department of Pediatrics, The Indus Hospital, Karachi, Sindh, Pakistan
| | - Simon Demas
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Jehan Zeb
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Arjumand Rizvi
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Ali Saleem
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Joveria Farooqi
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
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Invasive Candida Infections in Neonates after Major Surgery: Current Evidence and New Directions. Pathogens 2021; 10:pathogens10030319. [PMID: 33803104 PMCID: PMC7999498 DOI: 10.3390/pathogens10030319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Infections represent a serious health problem in neonates. Invasive Candida infections (ICIs) are still a leading cause of mortality and morbidity in neonatal intensive care units (NICUs). Infants hospitalized in NICUs are at high risk of ICIs, because of several risk factors: broad spectrum antibiotic treatments, central catheters and other invasive devices, fungal colonization, and impaired immune responses. In this review we summarize 19 published studies which provide the prevalence of previous surgery in neonates with invasive Candida infections. We also provide an overview of risk factors for ICIs after major surgery, fungal colonization, and innate defense mechanisms against fungi, as well as the roles of different Candida spp., the epidemiology and costs of ICIs, diagnosis of ICIs, and antifungal prophylaxis and treatment.
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Heijting IE, Antonius TAJ, Tostmann A, de Boode WP, Hogeveen M, Hopman J. Sustainable neonatal CLABSI surveillance: consensus towards new criteria in the Netherlands. Antimicrob Resist Infect Control 2021; 10:31. [PMID: 33546759 PMCID: PMC7866773 DOI: 10.1186/s13756-021-00900-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) are a main focus of infection prevention and control initiatives in neonatal care. Standardised surveillance of neonatal CLABSI enables intra- and interfacility comparisons which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands and several criteria are used for local monitoring of CLABSI incidence rates. To achieve standardised CLABSI surveillance we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria (SC). METHODS A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI SC was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of three expert panel rounds. RESULTS The expert panel achieved consensus on Dutch neonatal CLABSI SC. Neonatal CLABSI is defined as a bloodstream infection occurring more than 72 h after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by one or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: 1. a bacterial or fungal pathogen is identified from one or more blood cultures; 2. the patient has clinical symptoms of sepsis and 2A) a common commensal is identified in two separate blood cultures or 2B) a common commensal is identified by one blood culture and C-reactive protein level is above 10 mg/L in the first 36 h following blood culture collection. CONCLUSIONS The newly developed Dutch neonatal CLABSI SC are concise, specified to the neonatal population and comply with a single blood culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI SC is needed to identify best practices for infection prevention and control.
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Affiliation(s)
- I E Heijting
- Department of Paediatrics, Division of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Radboud Institute for Health Sciences, Internal Postal Code 804, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands.
| | - T A J Antonius
- Department of Paediatrics, Division of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Radboud Institute for Health Sciences, Internal Postal Code 804, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - A Tostmann
- Unit of Hygiene and Infection Control, Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W P de Boode
- Department of Paediatrics, Division of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Radboud Institute for Health Sciences, Internal Postal Code 804, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - M Hogeveen
- Department of Paediatrics, Division of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Radboud Institute for Health Sciences, Internal Postal Code 804, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - J Hopman
- Department of Quality and Safety, Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Gilbert R, Brown M, Faria R, Fraser C, Donohue C, Rainford N, Grosso A, Sinha AK, Dorling J, Gray J, Muller-Pebody B, Harron K, Moitt T, McGuire W, Bojke L, Gamble C, Oddie SJ. Antimicrobial-impregnated central venous catheters for preventing neonatal bloodstream infection: the PREVAIL RCT. Health Technol Assess 2020; 24:1-190. [PMID: 33174528 DOI: 10.3310/hta24570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Clinical trials show that antimicrobial-impregnated central venous catheters reduce catheter-related bloodstream infection in adults and children receiving intensive care, but there is insufficient evidence for use in newborn babies. OBJECTIVES The objectives were (1) to determine clinical effectiveness by conducting a randomised controlled trial comparing antimicrobial-impregnated peripherally inserted central venous catheters with standard peripherally inserted central venous catheters for reducing bloodstream or cerebrospinal fluid infections (referred to as bloodstream infections); (2) to conduct an economic evaluation of the costs, cost-effectiveness and value of conducting additional research; and (3) to conduct a generalisability analysis of trial findings to neonatal care in the NHS. DESIGN Three separate studies were undertaken, each addressing one of the three objectives. (1) This was a multicentre, open-label, pragmatic randomised controlled trial; (2) an analysis was undertaken of hospital care costs, lifetime cost-effectiveness and value of information from an NHS perspective; and (3) this was a retrospective cohort study of bloodstream infection rates in neonatal units in England. SETTING The randomised controlled trial was conducted in 18 neonatal intensive care units in England. PARTICIPANTS Participants were babies who required a peripherally inserted central venous catheter (of 1 French gauge in size). INTERVENTIONS The interventions were an antimicrobial-impregnated peripherally inserted central venous catheter (coated with rifampicin-miconazole) or a standard peripherally inserted central venous catheter, allocated randomly (1 : 1) using web randomisation. MAIN OUTCOME MEASURE Study 1 - time to first bloodstream infection, sampled between 24 hours after randomisation and 48 hours after peripherally inserted central venous catheter removal. Study 2 - cost-effectiveness of the antimicrobial-impregnated peripherally inserted central venous catheter compared with the standard peripherally inserted central venous catheters. Study 3 - risk-adjusted bloodstream rates in the trial compared with those in neonatal units in England. For study 3, the data used were as follows: (1) case report forms and linked death registrations; (2) case report forms and linked death registrations linked to administrative health records with 6-month follow-up; and (3) neonatal health records linked to infection surveillance data. RESULTS Study 1, clinical effectiveness - 861 babies were randomised (antimicrobial-impregnated peripherally inserted central venous catheter, n = 430; standard peripherally inserted central venous catheter, n = 431). Bloodstream infections occurred in 46 babies (10.7%) randomised to antimicrobial-impregnated peripherally inserted central venous catheters and in 44 (10.2%) babies randomised to standard peripherally inserted central venous catheters. No difference in time to bloodstream infection was detected (hazard ratio 1.11, 95% confidence interval 0.73 to 1.67; p = 0.63). Secondary outcomes of rifampicin resistance in positive blood/cerebrospinal fluid cultures, mortality, clinical outcomes at neonatal unit discharge and time to peripherally inserted central venous catheter removal were similar in both groups. Rifampicin resistance in positive peripherally inserted central venous catheter tip cultures was higher in the antimicrobial-impregnated peripherally inserted central venous catheter group (relative risk 3.51, 95% confidence interval 1.16 to 10.57; p = 0.02) than in the standard peripherally inserted central venous catheter group. Adverse events were similar in both groups. Study 2, economic evaluation - the mean cost of babies' hospital care was £83,473. Antimicrobial-impregnated peripherally inserted central venous catheters were not cost-effective. Given the increased price, compared with standard peripherally inserted central venous catheters, the minimum reduction in risk of bloodstream infection for antimicrobial-impregnated peripherally inserted central venous catheters to be cost-effective was 3% and 15% for babies born at 23-27 and 28-32 weeks' gestation, respectively. Study 3, generalisability analysis - risk-adjusted bloodstream infection rates per 1000 peripherally inserted central venous catheter days were similar among babies in the trial and in all neonatal units. Of all bloodstream infections in babies receiving intensive or high-dependency care in neonatal units, 46% occurred during peripherally inserted central venous catheter days. LIMITATIONS The trial was open label as antimicrobial-impregnated and standard peripherally inserted central venous catheters are different colours. There was insufficient power to determine differences in rifampicin resistance. CONCLUSIONS No evidence of benefit or harm was found of peripherally inserted central venous catheters impregnated with rifampicin-miconazole during neonatal care. Interventions with small effects on bloodstream infections could be cost-effective over a child's life course. Findings were generalisable to neonatal units in England. Future research should focus on other types of antimicrobial impregnation of peripherally inserted central venous catheters and alternative approaches for preventing bloodstream infections in neonatal care. TRIAL REGISTRATION Current Controlled Trials ISRCTN81931394. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 57. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK, London, UK
| | - Michaela Brown
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Caroline Fraser
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Chloe Donohue
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Naomi Rainford
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | | | | | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Dalhousie University IWK Health Centre, Halifax, NS, Canada
| | - Jim Gray
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Tracy Moitt
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Sam J Oddie
- Centre for Reviews and Dissemination, University of York, York, UK.,Bradford Neonatology, Bradford Royal Infirmary, Bradford, UK
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Occurrence and Risk Factors for Unplanned Catheter Removal in a PICU: Central Venous Catheters Versus Peripherally Inserted Central Venous Catheters. Pediatr Crit Care Med 2020; 21:e635-e642. [PMID: 32433440 DOI: 10.1097/pcc.0000000000002426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to identify the occurrence and risk factors for unplanned catheter removal due to catheter-associated complications and the effects on catheter survival probability in a PICU. DESIGN Retrospective, single-center, observational study of cases involving conventional central venous catheters or peripherally inserted central venous catheters. SETTING The PICU of a tertiary children's hospital. PATIENTS Consecutive PICU patients with central venous catheters between April 2016 and February 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified unplanned catheter removals that were related to central line-associated bloodstream infection, thrombosis, and mechanical complications. During the study period, 582 central venous catheters and 474 peripherally inserted central venous catheters were identified. The median durations of catheter placement were 4.0 days for central venous catheters and 13.0 days for peripherally inserted central venous catheters (p < 0.001), and unplanned catheter removals due to catheter-associated complications were in 52 (8.9%) central venous catheter cases and 132 (27.8%) peripherally inserted central venous catheter cases (p < 0.001) (15.0 and 16.0 per 1,000 catheter-days, respectively [p = 0.75]). Unplanned catheter removal was associated with a peripheral catheter tip position among both central venous catheters and peripherally inserted central venous catheters (p < 0.001 and p = 0.001), and it was associated with surgical patient status among peripherally inserted central venous catheters (p = 0.009). In contrast, the use of ultrasound-guided insertion was associated with a lower occurrence of unplanned catheter removal among peripherally inserted central venous catheters (p = 0.01). With regard to catheter survival probability, there was no significant difference between central venous catheters and peripherally inserted central venous catheters (p = 0.23). However, peripherally inserted central venous catheters had a lower occurrence of central line-associated bloodstream infection than central venous catheters (p = 0.03), whereas there was no significant difference in the rates of thrombosis (p = 0.29) and mechanical complications (p = 0.84) between central venous catheters and peripherally inserted central venous catheters. CONCLUSIONS In a PICU, peripherally inserted central venous catheters had lower occurrence of central line-associated bloodstream infection than central venous catheters; however, similar catheter survival probabilities were observed between both catheters. A central catheter tip position for both catheters and ultrasound-guided insertion for peripherally inserted central venous catheters may help limit unplanned catheter removal due to catheter-associated complications.
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18
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Bayoumi MAA, Van Rens MFP, Chandra P, Francia ALV, D'Souza S, George M, Shahbal S, Elmalik EE, Cabanillas IJE. Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit. J Vasc Access 2020; 22:243-253. [PMID: 32602399 PMCID: PMC7983328 DOI: 10.1177/1129729820928182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced. Methods: In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. A before- versus after-intervention study was designed to determine whether the establishment of the epicutaneo-caval catheter insertion team is associated with increased success rates and a decreased risk of catheter-related complications. Success rates and other catheter-related parameters were traced from 2016 onward. Collected data were analyzed for three consecutive years: 2016, 2017, and 2018. Results: The epicutaneo-caval catheter team inserted 1336 catheters over 3 years. Both first prick (from 57.7% to 66.9%; p = 0.023) and overall success (from 81.7% to 97.6%; p < 0.0001) rates significantly improved. In 2018, the number of tunneled or surgically inserted central venous catheters came down to zero (p < 0.0001). Overall catheter-related complications were significantly lower following the epicutaneo-caval catheter team’s establishment (p < 0.0001) while there was no significant decrease noted (p = 0.978) in central line–associated bacterial stream infection rates. Conclusion: A dedicated epicutaneo-caval catheter team is a promising intervention to increase success rates and significantly decrease catheter-related complications in Neonatal Intensive Care Unit. Standardizing epicutaneo-caval catheter placement is important; however, standardizing catheter maintenance seems essential to the improvement of central line–associated bacterial stream infection rates.
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Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Matheus F P Van Rens
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Airene L V Francia
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sunitha D'Souza
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Majee George
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Saad Shahbal
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Einas E Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Irian J E Cabanillas
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
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19
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Qu Y, Li Y, Cameron DR, Easton CD, Zhu X, Zhu M, Salwiczek M, Muir BW, Thissen H, Daley A, Forsythe JS, Peleg AY, Lithgow T. Hyperosmotic Infusion and Oxidized Surfaces Are Essential for Biofilm Formation of Staphylococcus capitis From the Neonatal Intensive Care Unit. Front Microbiol 2020; 11:920. [PMID: 32477314 PMCID: PMC7237634 DOI: 10.3389/fmicb.2020.00920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/17/2020] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus capitis is an opportunistic pathogen often implicated in bloodstream infections in the neonatal intensive care unit (NICU). This is assisted by its ability to form biofilms on indwelling central venous catheters (CVC), which are highly resistant to antibiotics and the immune system. We sought to understand the fundamentals of biofilm formation by S. capitis in the NICU, using seventeen clinical isolates including the endemic NRCS-A clone and assessing nine commercial and two modified polystyrene surfaces. S. capitis clinical isolates from the NICU initiated biofilm formation only in response to hyperosmotic conditions, followed by a developmental progression driven by icaADBC expression to establish mature biofilms, with polysaccharide being their major extracellular polymer substance (EPS) matrix component. Physicochemical features of the biomaterial surface, and in particular the level of the element oxygen present on the surface, significantly influenced biofilm development of S. capitis. A lack of highly oxidized carbon species on the surface prevented the immobilization of S. capitis EPS and the formation of mature biofilms. This information provides guidance in regard to the preparation of hyperosmolar total parenteral nutrition and the engineering of CVC surfaces that can minimize the risk of catheter-related bloodstream infections caused by S. capitis in the NICU.
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Affiliation(s)
- Yue Qu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Yali Li
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia.,Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia
| | - David R Cameron
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Christopher D Easton
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Xuebo Zhu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minli Zhu
- The Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mario Salwiczek
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Benjamin W Muir
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Helmut Thissen
- The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC, Australia
| | - Andrew Daley
- Department of Microbiology, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - John S Forsythe
- Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia
| | - Anton Y Peleg
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Trevor Lithgow
- Infection and Immunity Theme, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
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20
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Moon K, Athalye‐Jape GK, Rao U, Rao SC. Early versus late parenteral nutrition for critically ill term and late preterm infants. Cochrane Database Syst Rev 2020; 4:CD013141. [PMID: 32266712 PMCID: PMC7138920 DOI: 10.1002/14651858.cd013141.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently conducted randomised controlled trials (RCTs) suggest that late commencement of parenteral nutrition (PN) may have clinical benefits in critically ill adults and children. However, there is currently limited evidence regarding the optimal timing of commencement of PN in critically ill term and late preterm infants. OBJECTIVES To evaluate the benefits and safety of early versus late PN in critically ill term and late preterm infants. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (5 April 2019), MEDLINE Ovid (1966 to 5 April 2019), Embase Ovid (1980 to 5 April 2019), EMCare (1995 to 5 April 2019) and MEDLINE via PubMed (1966 to 5 April 2019). We searched for ongoing or recently completed clinical trials, and also searched the grey literature and reference lists of relevant publications. SELECTION CRITERIA We included RCTs comparing early versus late initiation of PN in term and late preterm infants. We defined early PN as commencing within 72 hours of admission, and late PN as commencing after 72 hours of admission. Infants born at 37 weeks' gestation or more were defined as term, and infants born between 34 and 36+6 weeks' gestation were defined as late preterm. DATA COLLECTION AND ANALYSIS Two review authors independently selected the trials, extracted the data and assessed the risk of bias. Treatment effects were expressed using risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous data. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS Two RCTs were eligible for inclusion. Data were only available from a subgroup (including 209 term infants) from one RCT in children (aged from birth to 17 years) conducted in Belgium, the Netherlands and Canada. In that RCT, children with medium to high risk of malnutrition were included if a stay of 24 hours or more in the paediatric intensive care unit (PICU) was expected. Early PN and late PN were defined as initiation of PN within 24 hours and after day 7 of admission to PICU, respectively. The risk of bias for the study was considered to be low for five domains and high for two domains. The subgroup of term infants that received late PN had significantly lower risk of in-hospital all-cause mortality (RR 0.35, 95% confidence interval (CI) 0.14 to 0.87; RD -0.10, 95% CI -0.18 to -0.02; number needed to treat for an additional beneficial outcome (NNTB) = 10; 1 trial, 209 participants) and neonatal mortality (death from any cause in the first 28 days since birth) (RR 0.29, 95% CI 0.10 to 0.88; RD -0.09, 95% CI -0.16 to -0.01; NNTB = 11; 1 trial, 209 participants). There were no significant differences in rates of healthcare-associated blood stream infections, growth parameters and duration of hospital stay between the two groups. Neurodevelopmental outcomes were not reported. The quality of evidence was considered to be low for all outcomes, due to imprecision (owing to the small sample size and wide confidence intervals) and high risk of bias in the included studies. AUTHORS' CONCLUSIONS Whilst late commencement of PN in term and late preterm infants may have some benefits, the quality of the evidence was low and hence our confidence in the results is limited. Adequately powered RCTs, which evaluate short-term as well as long-term neurodevelopmental outcomes, are needed.
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Affiliation(s)
- Kwi Moon
- Perth Children's HospitalPharmacy DepartmentPerthAustralia
- The University of Western AustraliaCentre for Neonatal Research and Education, Medical SchoolPerthAustralia
| | - Gayatri K Athalye‐Jape
- The University of Western AustraliaCentre for Neonatal Research and Education, Medical SchoolPerthAustralia
- Perth Children's Hospital and King Edward Memorial Hospital for WomenDepartment of NeonatologySubiacoAustralia
| | - Uday Rao
- University of NewcastleNewcastle Upon TyneUK
| | - Shripada C Rao
- The University of Western AustraliaCentre for Neonatal Research and Education, Medical SchoolPerthAustralia
- Perth Children's Hospital and King Edward Memorial Hospital for WomenDepartment of NeonatologySubiacoAustralia
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Snyder AN, Burjonrappa S. Central line associated blood stream infections in gastroschisis patients: A nationwide database analysis of risks, outcomes, and disparities. J Pediatr Surg 2020; 55:286-291. [PMID: 31708200 DOI: 10.1016/j.jpedsurg.2019.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/26/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE The aim of this study was to determine the risk of central line associated blood-stream infections (CLABSI) in neonatal gastroschisis patients, risk factors, outcomes, and financial implications. METHODS The 2016 Healthcare Cost and Utilization Project (HCUP)'s kid's inpatient database (KID), a national database of pediatric inpatient admissions across the United States, was used to obtain a large sample of gastroschisis admissions. Incidence of CLABSI in the gastroschisis patient population was compared to the incidence of CLABSI in the database. To further study the factors influencing CLABSI in gastroschisis, demographic and clinical features of patients were analyzed. Categorical variables were analyzed using Fisher's exact test or Pearson's chi-squared test. Odds ratios (OR) with 95% confidence intervals (CI) for variables found to have significance (p < 0.05) were calculated. FINDINGS Incidence of CLABSI in this database for pediatric inpatients was 4449 out of 298,862 central line insertions [1.48%] and was 81 out of 2032 [3.9%] (OR 2.83, 95% CI 2.26-3.54, p < 0.001) in the gastroschisis cohort. African American neonates had a significantly higher risk of CLABSI with gastroschisis. Prematurity and low birth-weight in gastroschisis were protective from CLABSI, along with patients from suburban areas or admitted in the Southern USA. Average costs were greater in gastroschisis patients with CLABSI, increasing from $281,779 to $421,970 (p = 0.008). The average length of stay increased from 31 days to 38 days with a CLABSI (p < 0.001). CONCLUSIONS In gastroschisis patients, CLABSI incidence is high and adds great morbidity and expense. For uncertain reasons, premature and low birth weight babies appear to be protected. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alana N Snyder
- University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - Sathyaprasad Burjonrappa
- University of South Florida Morsani College of Medicine, Tampa General Hospital, 1 Tampa General Circle, Tampa, FL 33606, USA.
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Umbilical Venous Catheters and Peripherally Inserted Central Catheters: Are They Equally Safe in VLBW Infants? A Non-Randomized Single Center Study. ACTA ACUST UNITED AC 2019; 55:medicina55080442. [PMID: 31390790 PMCID: PMC6723053 DOI: 10.3390/medicina55080442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022]
Abstract
Background and Objective: Peripherally inserted central catheters (PICC) and umbilical venous catheters (UVC) are frequently used for vascular access in neonatal intensive care units (NICUs). While there is a significant need for these devices for critically ill neonates, there are many complications associated with their use. We aimed at investigating the incidence of UVC and PICC complications in very low birth weight (VLBW) infants. Materials and Methods: This is an observational study performed with neonates of the tertiary General Hospital of Piraeus, Greece, during an 18 month-period. Seventy-one neonates were recruited and divided into two groups: 34 neonates with PICC and 37 neonates with UVC. We recorded: Catheter dwell time, the causes of catheter removal, other complications, infections, and catheter tip colonization rates. Results: No significant statistical differences were noticed between the 2 study groups with regards to demographic characteristics, causes for catheter removal, catheter indwelling time or the incidence of nosocomial infection. Eleven UVC tips and no PICC tips were proved colonized (p = 0.001) following catheter removal. Conclusions: The incidence of complications associated with the use of UVCs and PICCs in VLBW infants did not significantly differ in our study. Their use seems to be equally safe. Further studies, with larger samples, are necessary to confirm our results.
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Lutwick L, Al-Maani AS, Mehtar S, Memish Z, Rosenthal VD, Dramowski A, Lui G, Osman T, Bulabula A, Bearman G. Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases. Int J Infect Dis 2019; 84:22-29. [PMID: 31005622 DOI: 10.1016/j.ijid.2019.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022] Open
Abstract
A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview recommendations on managing and preventing vascular catheter infections, specifically for the prevention and management of central line-associated bloodstream infections. These recommendations are intended to provide insight for healthcare professionals regarding the prevention of infection in the placement and maintenance of the catheter and diagnosis as well as treatment of catheter infection. Aspects of this area in pediatrics and in limited-resource situations and a discussion regarding the selection of empiric or targeted antimicrobial therapy are particular strengths of this position paper.
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Affiliation(s)
- Larry Lutwick
- Mayo Clinic Health Care System, Eau Claire, WI, USA.
| | | | | | - Ziad Memish
- Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | | | | | - Grace Lui
- The Chinese University of Hong Kong, Hong Kong, China
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24
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Moon K, Athalye-Jape GK, Rao U, Rao SC. Early versus late parenteral nutrition for critically ill term and late preterm infants. Hippokratia 2018. [DOI: 10.1002/14651858.cd013141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kwi Moon
- Perth Children's Hospital; Pharmacy Department; Perth Australia
- The University of Western Australia; Centre for Neonatal Research and Education, Medical School; Perth Australia
| | - Gayatri K Athalye-Jape
- The University of Western Australia; Centre for Neonatal Research and Education, Medical School; Perth Australia
- Perth Children's Hospital and King Edward Memorial Hospital for Women; Department of Neonatology; Subiaco Australia
| | - Uday Rao
- University of Newcastle; Newcastle Upon Tyne UK
| | - Shripada C Rao
- The University of Western Australia; Centre for Neonatal Research and Education, Medical School; Perth Australia
- Perth Children's Hospital and King Edward Memorial Hospital for Women; Department of Neonatology; Subiaco Australia
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