Abstract
No consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology.What is Known:• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease.What is New:• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.
Highlights
Ventilator-associated pneumonia (VAP) is the second most common cause of antibiotic use on the neonatal intensive care unit (NICU) [1]
The multiparameter VAP score including Lung ultrasound (LU) could be useful in diagnosing VAP in neonates with underlying lung pathology
Used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease
Summary
Ventilator-associated pneumonia (VAP) is the second most common cause of antibiotic use on the neonatal intensive care unit (NICU) [1]. VAP is associated with higher incidence of bronchopulmonary dysplasia, prolonged mechanical ventilation and hospital stay [2]. Definition of VAP is challenging in neonates with no international consensus [3]. VAP is generally defined as a nosocomial lower airway infection in intubated patients with onset after more than 48 h of invasive mechanical ventilation [4]. Frequently applied definitions from Centres for Disease Control and Prevention (CDC) and European Centre for Disease Prevention and Control (ECDC) are difficult to apply mainly due to the absence of specific clinical and laboratory findings. Comparison of agreement between four diagnostic criteria showed only moderate agreement [5]
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