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Antimicrobial therapy utilization in neonates with hypoxic-ischemic encephalopathy (HIE): a report from the Children’s Hospital Neonatal Database (CHND)

Journal of Perinatology volume 40, pages 70–78 (2020)Cite this article

Subjects

Abstract

Objective(s)

Quantify antimicrobial therapy (AMT) use in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia (HIE/TH).

Study design

Newborns with HIE/TH were identified from the Children’s Hospital Neonatal Database (CHND). Early infection (onset ≤7 days of life) was defined as “confirmed” (culture proven) or “suspected infection” (culture negative but treated) and compared with a “no infection” group.

Results

1501/1534 (97.8%) neonates received AMT. 36 (2.3%) had confirmed, 255 (16.6%) suspected, and 1243 (81.0%) had no infection. The median (IQR) AMT duration was 13 (8–21), 8 (7–10), and 3 (3–7) days for the three groups, respectively (p < 0.001). AMT duration of use varied significantly across centers, adjusted for covariates (OR 1.88, 95% CI: 1.43–2.46).

Conclusion(s)

Incidence of early confirmed infection in neonates with HIE/TH (23/1000) is significantly higher than reported rates of early onset sepsis in term and near term infants (0.5–1.0/1000 live births). Antimicrobial-stewardship opportunities exist in infants with negative cultures.

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Acknowledgements

We are indebted to the following institutions that serve the infants and their families; these institutions have also invested in, and continue to participate in the CHND. The site sponsors/contributors for the CHND are also included:

1. Children’s Healthcare of Atlanta, Atlanta, GA (Francine Dykes, Anthony Piazza)

2. Children’s Healthcare of Atlanta at Scottish Rite (Gregory Sysyn)

3. Children’s Hospital of Alabama, Birmingham, AL (Carl Coghill, Allison Black)

4. Le Bonheur Children’s Hospital, Memphis, TN (Ramasubbareddy Dhanireddy)

5. Children’s Hospital Boston, Boston, MA (Anne Hansen, Tanzeema Houssain)

6. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL (Karna Murthy, Gustave Falciglia)

7. Cincinnati Children’s Hospital, Cincinnati, OH (Beth Haberman, Breda Poindexter, Amy Nathan, Kristin Nelson, Paul Kingma, Stefanie Riddle, Stephanie Merhar, Heather Kaplan)

8. Nationwide Children’s Hospital, Columbus, OH (Kristina Reber)

9. Children’s Medical Center, Dallas, TX (Rashmin Savani, Luc Brion, Noorjahan Ali)

10. Children’s Hospital Colorado, Aurora, CO (Theresa Grover)

11. Children’s Hospital of Michigan, Detroit, MI (Girija Natarajan)

12. Cook Children’s Health Care System, Fort Worth, TX (Jonathan Nedrelow, Annie Chi, Yvette Johnson)

13. Texas Children’s Hospital, Houston, TX (Gautham Suresh)

14. Riley Children’s Hospital, Indianapolis, IN (William Engle, Lora Simpson, Gregory Sokol)

15. Children’s Mercy Hospitals & Clinics, Kansas City, MO (Eugenia Pallotto)

16. Arkansas Children’s Hospital, Little Rock, AR (Robert Lyle, Becky Rogers)

17. Children’s Hospital Los Angeles, Los Angeles, CA (Lisa Kelly [deceased], Steven Chin, Rachel Chapman)

18. American Family Children’s Hospital, Madison, WI (Jamie Limjoco, Lori Haack)

19. Children’s Hospital & Research Center Oakland, Oakland, CA (David Durand, Jeanette Asselin, Art D’Harlingue, Priscilla Joe)

20. The Children’s Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula, David Munson)

21. St. Christopher’s Hospital for Children, Philadelphia, PA (Suzanne Touch)

22. Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Beverly Brozanski)

23. St. Louis Children’s Hospital, St Louis, MO (Tasnim Najaf, Rakesh Rao, Amit Mathur)

24. All Children’s Hospital, St. Petersburg, FL (Victor McKay)

25. Rady Children’s Hospital, San Diego, CA (Mark Speziale, Brian Lane, Laural Moyer)

26. Children’s National Medical Center, Washington, DC (Billie Short)

27. AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan)

28. Primary Children’s Medical Center, Salt Lake City, UT (Con Yee Ling)

29. Children’s Hospital of Wisconsin, Milwaukee, WI (Michael Uhing, Ankur Datta)

30. Children’s Hospital of Omaha (Lynne Willett, Nicole Birge)

31. Florida Hospital for Children (Rajan Wadhawan)

32. Seattle Children’s Hospital, Seattle, WA (Elizabeth Jacobsen-Misbe, Robert DiGeronimo, Zeenia Billimoria)

33. Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee)

34. Children’s Hospital Orange County, Los Angeles, CA (Michel Mikhael, Irfan Ahmad)

Author information

Authors and Affiliations

  1. Pediatrics, Washington University School of Medicine, St. Louis, MO, USA

    Rakesh Rao

  2. Pediatrics, Hospital for Sick Children, Toronto, ON, Canada

    Kyong-Soon Lee

  3. Children’s Hospitals Association, Columbia, MO, USA

    Isabella Zaniletti

  4. Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Toby D. Yanowitz

  5. Pediatrics/Neonatology, Seattle Children’s Hospital/University of Washington, Seattle, WA, USA

    Robert DiGeronimo

  6. Pediatrics/Neonatology, Northwestern University, Chicago, IL, USA

    Maria L. V. Dizon & Karna Murthy

  7. Pediatrics, Emory University, Atlanta, GA, USA

    Shannon E. Hamrick

  8. Children’s Hospital of Michigan, Detroit, MI, USA

    Girija Natarajan

  9. Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA

    Eric S. Peeples

  10. Pediatrics, St Louis University, St louis, MO, USA

    Amit M. Mathur

  11. Neonatology, Children’s National Health Systems, Washington, DC, DC, USA

    An Massaro

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  1. Rakesh Rao
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Correspondence to Rakesh Rao.

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Conflict of interest

IZ is an employee of Children’s Hospitals Association, Inc, (Overland Park, KS). KM is a Board member of the Children’s Hospital National Consortium (CHNC, Kansas City, MO). All other authors have no financial disclosures relevant to this article to disclose. KM is a Board member of the Children’s Hospital National Consortium (CHNC, Kansas City, MO). All other authors have no conflicts of interest relevant to this article to disclose.

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Data presented in the manuscript were presented partially (abstract) at the Pediatric Academic Societies meeting in Toronto, Canada, in May 2018.

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Rao, R., Lee, KS., Zaniletti, I. et al. Antimicrobial therapy utilization in neonates with hypoxic-ischemic encephalopathy (HIE): a report from the Children’s Hospital Neonatal Database (CHND). J Perinatol 40, 70–78 (2020). https://doi.org/10.1038/s41372-019-0527-2

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