Nosocomial infection in small for gestational age newborns with birthweight < 1500 g: A multicentre analysis

Dorothee Brigitte Bartels ^1*, Frank Schwab ², Christine Geffers ², Christian F Poets ³ and Petra Gastmeier ⁴

¹ Hannover Medical School, Germany
² Charité-University Medicine Berlin, Germany
³ University of Tuebingen, Germany
⁴ Hannover Medical School, Charité-University Medicine Berlin, Germany

^* To whom correspondence should be addressed. E-mail: bartels.dorothee{at}mh-hannover.de.

Accepted 19 April 2007

Abstract

Objective:To investigate whether neonates born pre-term and small for gestational age are at increased risk of nosocomial infections and necrotizing enterocolitis.

Design, Setting, and Patients:The German national surveillance system for nosocomial infection in very low birthweight infants uses Center for Disease Control criteria. Applying pre-defined inclusion criteria to ensure similar proportions of small and appropriate weight for gestational age neonates across gestational age groups, n=2918 neonates (24-28 weeks), born between 2000 and 2004, were selected.

Main Outcome Measures:Outcome criteria were having experienced at least one nosocomial sepsis, pneumonia, or necrotizing enterocolitis. Adjusted odds ratios and corresponding 95% confidence intervals were calculated based on General Estimating Equation models.

Results:The study population consisted of 13% (n=392) small and 87% (n=2526) appropriate weight for gestational age infants. Thirty three percent had at least one episode of sepsis, 42% of small and 31% of appropriate weight for gestational age infants (adjusted odds ratio 1.41, 95% confidence interval 1.05-1.89). Pneumonia was diagnosed in 6%, 8.4% in small and 5.5% in appropriate weight for gestational age newborns (adjusted odds ratio 1.57, 95% confidence interval 1.19-5.57). Necrotizing enterocolitis was documented in 5.2% of infants, 7.1% in small and 4.9% in appropriate weight for gestational age infants (adjusted odds ratio 1.20, 95% confidence interval 0.98-2.28).

Conclusions:Growth retarded preterm infants appear to be at increased risk of nosocomial infection, irrespective of the pathogen involved. Future immunologic research should elucidate potential causal associations.

Keywords: necrotizing enterocolitis, pneumonia, sepsis, surveillance system, very low birth weight

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