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Nosocomial infection in small for gestational age newborns with birthweight < 1500 g: A multicentre analysis
  1. Dorothee Brigitte Bartels (bartels.dorothee{at}mh-hannover.de)
  1. Hannover Medical School, Germany
    1. Frank Schwab (frank.schwab{at}charite.de)
    1. Charité-University Medicine Berlin, Germany
      1. Christine Geffers (christine.geffers{at}charite.de)
      1. Charité-University Medicine Berlin, Germany
        1. Christian F Poets (christian-f.poets{at}med.uni-tuebingen.de)
        1. University of Tuebingen, Germany
          1. Petra Gastmeier (gastmeier.petra{at}mh-hannover.de)
          1. Hannover Medical School, Charité-University Medicine Berlin, Germany

            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.

            • necrotizing enterocolitis
            • pneumonia
            • sepsis
            • surveillance system
            • very low birth weight

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