Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia.

Document Type

Article

Publication Date

12-1-2018

Identifier

DOI: 10.1016/j.jpeds.2018.07.032

Abstract

OBJECTIVE: To predict incident bloodstream infection and urinary tract infection (UTI) in infants with congenital diaphragmatic hernia (CDH).

STUDY DESIGN: We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010-2016. Infants with CDH admitted at 22 participating regional neonatal intensive care units were included; patients repaired or discharged to home prior to admission/referral were excluded. The primary outcome was death or the occurrence of bloodstream infection or UTI prior to discharge. Factors associated with this outcome were used to develop a multivariable equation using 80% of the cohort. Validation was performed in the remaining 20% of infants.

RESULTS: Median gestation and postnatal age at referral in this cohort (n = 1085) were 38 weeks and 3.1 hours, respectively. The primary outcome occurred in 395 patients (36%); and was associated with low birth weight, low Apgar, low admission pH, renal and associated anomalies, patch repair, and extracorporeal membrane oxygenation (P < .001 for all; area under receiver operating curve = 0.824; goodness of fit χ2 = 0.52). After omitting death from the outcome measure, admission pH, patch repair of CDH, and duration of central line placement were significantly associated with incident bloodstream infection or UTI.

CONCLUSIONS: Infants with CDH are at high risk of infection which was predicted by clinical factors. Early identification and low threshold for sepsis evaluations in high-risk infants may attenuate acquisition and the consequences of these infections.

Journal Title

The Journal of pediatrics

Volume

203

First Page

101

Last Page

107

MeSH Keywords

Anti-Bacterial Agents; Apgar Score; Bacteremia; Catheterization, Central Venous; Congenital Abnormalities; Databases, Factual; Drug Utilization; Extracorporeal Membrane Oxygenation; Hernias, Diaphragmatic, Congenital; Humans; Hydrogen-Ion Concentration; Infant, Low Birth Weight; Infant, Newborn; Intensive Care Units, Neonatal; Kidney; Retrospective Studies; Risk Assessment; Surgical Mesh; United States; Urinary Tract Infections

Keywords

Children's Hospitals Neonatal Consortium (CHNC); Children's Hospitals Neonatal Database (CHND); congenital diaphragmatic hernia; neonatal intensive care; pulmonary hypertension

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