Arch Dis Child Fetal Neonatal Ed 98:F65-F69 doi:10.1136/fetalneonatal-2011-301276
  • Original articles

Seasonal variations in healthcare-associated infection in neonates in Canada

  1. Shoo K Lee1
  1. 1Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
  2. 2Department of Pediatrics, University of Regina, Saskatoon, Canada
  3. 3Department of Newborn and Developmental Pediatrics Sunnybrook Health Sciences Center, Toronto, Canada
  1. Correspondence to Prakesh S Shah, Department of Paediatrics, Rm 775 A, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; pshah{at}
  1. Contributors Prakesh S Shah initiated the concept, developed the draft, analysed data and wrote the manuscript. Woojin Yoon participated in the design, analysed the data, prepared the results and reviewed the manuscript. Kate Bassil participated in the design, concept, and revision and editing of the manuscript. Michael Dunn participated in the design, interpretation and revision of the manuscript. Zarin Kalapesi participated in the design, and contributed to interpretation of results and editing of the manuscript. Shoo K Lee participated in the design of the study, review of results and manuscript preparation.

  • Received 27 October 2011
  • Accepted 5 March 2012
  • Published Online First 3 May 2012


Objective To assess the seasonal pattern of healthcare-associated infections (HCAI) among neonates and to describe the trend of HCAI.

Design Secondary analyses of database.

Setting The Canadian Neonatal Network database (2003–2009).

Participants Neonates with HCAI defined as blood/cerebrospinal fluid positive with pathogenic organism in a symptomatic infant after 2 days of age.

Main outcome measure The incidence rate for HCAI per 1000 days with a 95% CI, for the 4 warmest months (June–September) was compared with the remaining 8 months, to calculate the incidence rate ratio (IRR).

Results Of 75 629 total infants, 4305 (5.7%) had HCAI (3367 had 1 and 938 had >1 episodes). Infants who had HCAI were of lower gestation, birth weight and Apgar score; but had higher severity of illness scores and clinical chorioamnionitis. There was a borderline increase in all HCAI (IRR 1.05, 95% CI 1.00 to 1.11) and a significant increase in Gram-negative HCAI (IRR 1.20, 95% CI 1.04 to 1.39) during the summer months. Overall, there was a 20% reduction in HCAI from 4.45/1000 days in January 2003 to 3.54/1000 days in December 2009 (mean difference 0.91/1000 days (95% CI 0.89 to 0.92).

Conclusions Gram-negative infections were significantly increased during the summer months of the year compared with the rest of the year among neonates. Overall, there was a significant temporal reduction in HCAI rates over the study period.


  • Competing interests None.

  • Ethics approval Research Ethics Board or Quality improvement committee at each hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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