Clinical Analysis of Neonatal Ventilator Associated Pneumonia in Neonatal Intensive Care Unit

Abstract

Objective To investigate the risk factors, pathogenic bacteria distribution, drug sensitivity and prognosis of neonatal ventilator associated pneumonia (NVAP) in neonatal intensive care unit (NICU). Methods A retrospective analysis was performed on the clinical data of 80 cases who were admitted to NICU department and received mechanical ventilation (MV) treatment in Lu'an Affiliated Hospital of Anhui Medical University from October 2012 to September 2013. According to whether complicated with NVAP or not, they were divided into NVAP group (n = 20) and non-NVAP group (n = 60). There had no significant differences on general information between two groups (P>0.05). The independent risk factors, pathogenic bacteria distribution, drug sensitivity and prognosis were retrospectively analyzed. Unconditional multiple logistic regression was performed to detected risk factors of NVAP. The study protocol was approved by the Ethical Review Board of Investigation of Lu'an Affiliated Hospital of Anhui Medical University. Informed consent was obtained from all participates' patients. Results The incidence rate was 41.7‰. The independent risk factors for NVAP included gestational age and duration of MV treatment [OR = 0.366, 95%CI(0.149 ~0.844), P = 0.026 ; OR = 1.051, 95% CI (1.008~1.090),P= 0.020], and early use of pulmonary surfactant (PS) and plasma were the protective factors of NVAP [OR=0.048,95%CI(0.004~0.653),P = 0.023; OR=0.071, 95%CI(0.008 ~ 0.628), P=0.017]. The most common isolated bacteria of the pathogen spectrum were Gram-negative bacteria, accounting for 69.2% (18/26), among them, the top three bacteria were acinetobacter baumannii (30.8%,8/26), Klebsiella pneumonia (15.4%,4/26) and Escherichia coli (11.5%, 3/26). NVAP group existed multi-infection, and all combined with fungous infection(23.1%,6/26). The statistically significant differences were found in hospital length of stay and hospitalization expense between NVAP group group and non-NVAP group (t=2.832,P = 0.006; t=3.656,P=0.000), but there had no statistical difference on the mortality between two groups (χ2 = 1.667,P = 0.197). Conclusions The NVAP incidence rate is high in the NIUC department of our hospital. NVAP is influenced by many factors, and the main pathogens for NVAP are Gram-negative bacteria, the multi-drug resistance is severe. It's necessary to strengthen clinician's awareness of NVAP, reasonable application of antibiotics, and take comprehensive measures to preventing NVAP. Key words: Infant, newborn; Pneumonia, ventilator-associated; Risk factors; Noxae; Prognosis