Am J Perinatol 2024; 41(05): 580-585
DOI: 10.1055/a-1739-3678
Original Article

Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia

1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Manapat Phatigomet
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Supaporn Dissaneevate
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Waricha Janjindamai
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Supika Kritsaneepaiboon
2   Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
› Author Affiliations
Funding None.

Abstract

Objective This study aimed to compare the ventilator-free days (VFDs) at day 28 and the short-term outcomes in neonates with and without ventilator-associated pneumonia (VAP and non-VAP groups).

Study Design We performed a cohort study in a Thai neonatal intensive care unit between 2014 and 2020 to identify the VFDs in VAP and non-VAP neonates. Univariate and multivariate analyses were performed.

Results The incidences of VAP rates were 5.76% (67/1,163 neonates) and 10.86 per 1,000 (92/8,469) ventilator days. The medians (interquartile ranges [IQRs]) of gestational age and birth weight in the VAP versus non-VAP groups were 31 (27–35) versus 34 (30–38) weeks, and 1,495 (813–2,593) versus 2,220 (1,405–2,940) g (p < 0.001, both), respectively. The medians (IQRs) of VFDs at 28 days in the VAP and non-VAP groups were 5 (0–16) and 24 (20–26) days (p < 0.001). From the univariate analysis, the lower VFDs, longer ventilator days, and higher rates of moderate-to-severe bronchopulmonary dysplasia (BPD), postnatal steroids for BPD, length of stay, and daily hospital cost in the VAP group were significantly higher than in the non-VAP group. From the multivariate analysis, the VAP group had significantly lower VFDs (regression coefficient = −10.99, standard error = 1.11, p < 0.001) and higher BPD (adjusted risk ratio = 18.70; 95% confidence interval = 9.17–39.5, p < 0.001) than the non-VAP group.

Conclusion Neonatal VAP lead to lower VFDs and a higher frequency of BPD. A multimodal strategy with a VAP prevention bundle care should be used in indicated cases to reduce the occurrence of neonatal VAP.

Key Points

  • The VFDs of the neonatal VAP was lower than reported in adult study.

  • There are limited data on VFDs in VAP during the neonatal period.

  • Neonatal VAP reduces VFDs and increases BPD rates compared with non-VAP infants.

Authors' Contributors

A.T. conceptualized and designed the study, contributed to data acquisition, supervised the data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. M.P., G.M., S.D., W.J., and S.K. contributed to the study conceptualization, data acquisition and analysis and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.




Publication History

Received: 24 October 2021

Accepted: 12 January 2022

Accepted Manuscript online:
13 January 2022

Article published online:
14 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Maneenil G, Premprat N, Janjindamai W, Dissaneevate S, Phatigomet M, Thatrimontrichai A. Correlation and Prediction of Oxygen Index from Oxygen Saturation Index in Neonates with Acute Respiratory Failure. Am J Perinatol 2024; 41 (02) 180-186
  • 2 Tekin R, Dal T, Pirinccioglu H, Oygucu SE. A 4-year surveillance of device-associated nosocomial infections in a neonatal intensive care unit. Pediatr Neonatol 2013; 54 (05) 303-308
  • 3 Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics 2003; 112 (6, pt. 1): 1283-1289
  • 4 Rosenthal VD, Bat-Erdene I, Gupta D. et al; International Nosocomial Infection Control Consortium. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. Am J Infect Control 2020; 48 (04) 423-432
  • 5 Kawanishi F, Yoshinaga M, Morita M. et al. Risk factors for ventilator-associated pneumonia in neonatal intensive care unit patients. J Infect Chemother 2014; 20 (10) 627-630
  • 6 Afjeh SA, Sabzehei MK, Karimi A, Shiva F, Shamshiri AR. Surveillance of ventilator-associated pneumonia in a neonatal intensive care unit: characteristics, risk factors, and outcome. Arch Iran Med 2012; 15 (09) 567-571
  • 7 Yalaz M, Altun-Köroğlu O, Ulusoy B. et al. Evaluation of device-associated infections in a neonatal intensive care unit. Turk J Pediatr 2012; 54 (02) 128-135
  • 8 Thatrimontrichai A, Janjindamai W, Dissaneevate S, Maneenil G, Kritsaneepaiboon S. Risk factors and outcomes of ventilator-associated pneumonia from a neonatal intensive care unit, Thailand. Southeast Asian J Trop Med Public Health 2019; 50: 537-545
  • 9 Thatrimontrichai A, Rujeerapaiboon N, Janjindamai W. et al. Outcomes and risk factors of ventilator-associated pneumonia in neonates. World J Pediatr 2017; 13 (04) 328-334
  • 10 Yuan TM, Chen LH, Yu HM. Risk factors and outcomes for ventilator-associated pneumonia in neonatal intensive care unit patients. J Perinat Med 2007; 35 (04) 334-338
  • 11 Tan B, Xian-Yang X, Zhang X. et al. Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units: a meta-analysis. Am J Infect Control 2014; 42 (08) 902-910
  • 12 Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics 2009; 123 (04) 1108-1115
  • 13 Dell'Orto V, Raschetti R, Centorrino R. et al. Short- and long-term respiratory outcomes in neonates with ventilator-associated pneumonia. Pediatr Pulmonol 2019; 54 (12) 1982-1988
  • 14 Petdachai W. Ventilator-associated pneumonia in a newborn intensive care unit. Southeast Asian J Trop Med Public Health 2004; 35 (03) 724-729
  • 15 Fallahi M, Dasht AS, Naeempour N, Bassir M, Ghadamli P. Ventilator-associated pneumonia in hospitalized newborns in a neonatal intensive care unit. Arch Pediatr Infect Dis 2014; 3: e16514
  • 16 Deng C, Li X, Zou Y. et al. Risk factors and pathogen profile of ventilator-associated pneumonia in a neonatal intensive care unit in China. Pediatr Int 2011; 53 (03) 332-337
  • 17 Cernada M, Aguar M, Brugada M. et al. Ventilator-associated pneumonia in newborn infants diagnosed with an invasive bronchoalveolar lavage technique: a prospective observational study. Pediatr Crit Care Med 2013; 14 (01) 55-61
  • 18 Esperatti M, Ferrer M, Giunta V. et al. Validation of predictors of adverse outcomes in hospital-acquired pneumonia in the ICU. Crit Care Med 2013; 41 (09) 2151-2161
  • 19 Yehya N, Harhay MO, Curley MAQ, Schoenfeld DA, Reeder RW. Reappraisal of ventilator-free days in critical care research. Am J Respir Crit Care Med 2019; 200 (07) 828-836
  • 20 Bhalla AK, Yehya N, Mack WJ, Wilson ML, Khemani RG, Newth CJL. The association between inhaled nitric oxide treatment and ICU mortality and 28-day ventilator-free days in pediatric acute respiratory distress syndrome. Crit Care Med 2018; 46 (11) 1803-1810
  • 21 Thatrimontrichai A, Pannaraj PS, Janjindamai W, Dissaneevate S, Maneenil G, Apisarnthanarak A. Intervention to reduce carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2020; 41 (06) 710-715
  • 22 The Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network. (NHSN). Pneumonia (ventilator-associated [VAP] and non-ventilator-associated pneumonia [PNEU]) event. Accessed March 13, 2020 at: http://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf
  • 23 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
  • 24 Azab SF, Sherbiny HS, Saleh SH. et al. Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP prevention Bundle”: a cohort study. BMC Infect Dis 2015; 15: 314
  • 25 Pinilla-González A, Solaz-García Á, Parra-Llorca A. et al. Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants. J Perinatol 2021; 41 (06) 1467-1473
  • 26 Gokce IK, Kutman HGK, Uras N, Canpolat FE, Dursun Y, Oguz SS. Successful implementation of a bundle strategy to prevent ventilator-associated pneumonia in a neonatal intensive care unit. J Trop Pediatr 2018; 64 (03) 183-188
  • 27 Janjindamai W, Pasee S, Thatrimontrichai A. The optimal predictors of readiness for extubation in low birth weight infants. J Med Assoc Thai 2017; 100 (04) 427-434
  • 28 Thatrimontrichai A, Sirianansopa K, Janjindamai W, Dissaneevate S, Maneenil G. Comparison of endotracheal reintubation between nasal high-frequency oscillation and continuous positive airway pressure in neonates. Am J Perinatol 2020; 37 (04) 409-414
  • 29 Thatrimontrichai A. Evidence-based neonatal care. J Health Sci Med Res 2019; 37: 163-169