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Risk Factors for the Development of Ventilator – Associated Pneumonia in Critically-Ill Neonates
Mona Afify*, Salha AI-Zahrani* and Maha A Nouh**
Department of Biology and Microbiology, Science College for Girls, King Abd-Elaziz University* and Pediatrics Department, Royal Commission Hospital in Yunbu**- Kingdom of Saudia Arabia.
Abstract: Ventilator-associated pneumonia (VAP), viewed as an inevitable consequence of critical illness, is increasingly accepted as an avoidable adverse health care incident. Whereas morbidity and mortality from VAP is well-documented in adults, it is poorly studied in children.This investigation was conducted to determine characteristics and possible risk factors for VAP, in critically ill neonates admitted to the neonatal intensive care unit (NICU). According to clinical pulmonary infection score (CPIS), 33 neonates were selected as having VAP and 24 neonates who did not develop VAP were assigned as non-VAP group. All neonates were subjected to case history, clinical examination, ABG, chest X-ray, and laboratory investigations (CBC, serum albumin, serum CRP, and blood culture). Neonates with VAP were subjected to broncheo-alveolar lavage (BAL) sampling. The BAL samples were subjected to macroscopic and microscopic examination, as well as quantitative cultures. Obtained results revealed that indications for mechanical ventilation (MV) included respiratory distress syndrome (RDS), congenital pneumonia, meconium aspiration syndrome (MAS), and hypoxic ischemic encephalopathy (HIE), with nonsignificant differences between VAP group and non-VAP group. VAP rates were significantly increased with decreased body weight and gestational age and with increased duration of NICU admission, duration of MV and use of invasive maneuvers. VAP was significantly associated with hypothermia, mucopurulent endotracheal tube (ETT) secretions, and radiological findings. The use of inotrops and corticosteroids was significantly noted among neonates with VAP than that among non-VAP neonates. Raised serum C-reactive protein (CRP), hypoalbuminemia and positive blood cultures were significantly associated with increased VAP rates. Cultures of BAL samples revealed Klebsiella pneumoniae (in 33%), Pseudomonas aeruginosa (in 21%), Staphylococcus aureus (in 15%), Escherichia coli (in 15%), Pneumococci (in 6%) and Candida albicans (in 9%). There was nonsignificant similarity in the type of organisms cultivated from either blood or BAL. In conclusion risk factors for the development of VAP include; 1) decreased body weight and gestational age, 2) increased duration of NICU admission, MV, and use of invasive maneuvers, 3) hypothermia, mucopurulent ETT secretions and the use of inotrops/ corticosteroids, 4) raised serum CRP, hypoalbuminemia and positive blood cultures and 5) nosocomial infection by Klebsiella, Pseudomonas,Staph aureus, E coli and Candida.
[Mona Afify, Salha AI-Zahrani and Maha A Nouh. Risk Factors for the Development of Ventilator – Associated Pneumonia in Critically-Ill Neonates. Life Sci J 2012;9(1):302-307] (ISSN:1097-8135). http://www.lifesciencesite.com. 43
Key words: nosocomial infection-neonatal pneumonia-mechanical ventilation. Full Text 43