Referral Neonatal Intensive Care Unit Research Articles

Sociodemographic risk factors, parental stress and social support in the neonatal intensive care unit

ObjectiveInvestigate relationships among neonatal intensive care unit (NICU) parent demographics, reported stress and social support.DesignCross-sectional observation.SettingTertiary referral NICU in Mid-Atlantic USA.PatientsParents (n=300) in the Giving Parents Support trial at enrolment.MeasuresPsychometric...

Racial identification represents significant risk factor for healthcare disparity among patients with severe bronchopulmonary dysplasia treated with tracheostomy

ObjectivesTo characterize the patient population with severe bronchopulmonary dysplasia (BPD) requiring tracheostomy in a large tertiary level 4 neonatal intensive care unit (NICU) and to identify potential targets for improvement in the delivery of high-quality healthcare. MethodsAn IRB-exempt but IRB-registered retrospective review of medical records. Study inclusion criteria: patients treated for severe BPD with tracheostomy under 2 years of age in our tertiary referral center NICU. Control group criteria: 4-year aggregate NICU patient demographics. Basic demographics, maternal history, clinical data points, and outcomes variables were collected. ResultsThere was a statistically significant difference between the two groups in only one variable: racial identification (p-value = 0.036). All data points were then analyzed against racial identification, and statistically significant differences appeared in 4 categories: 1) illicit drug use, 2) birth head circumference and length, 3) days to readmission, and 4) child opportunity index scores. There was not a statistically significant difference in any other maternal characteristics or medical comorbidities, NICU length of stay, age at tracheostomy, or decannulation status. ConclusionThe incidence of our tracheostomy in infants with severe BPD was significantly higher (p = 0.036) in the subjects whose families identified as racially African American or Black, a marked contrast to our general NICU population and our overall tracheostomy population. The timing of the first readmission to the hospital was shorter for Caucasian or White infants compared to African American or Black infants. COI demonstrated statistically significantly poorer resources for African American or Black infants compared to White infants with tracheostomy. All other perinatal and outcome measurements did not differ significantly between the two racial groups. This suggests that this racial disparity is present and needs further investigation to better assess its impact on risk and outcomes as we develop pathways for high-quality healthcare delivery.

Prevalence, risk factors, and molecular analysis of vancomycin-resistant Enterococci colonization in a referral neonatal intensive care unit: a prospective study in northern Iran

Vancomycin-resistant enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing nosocomial infections. Few data are available on the epidemiology of VRE colonization or infection in neonates, and is of recent interest. This study analyzes the prevalence of neonatal VRE colonization in a neonatal intensive care unit (NICU), and describes risk factors and molecular phenotypes associated with VRE colonization. We performed a prospective epidemiological study on neonates admitted to an NICU. We compared neonates with VRE isolates detected in rectal swab cultures to those without. Association of VRE colonization with risk factors was tested by using univariate and multivariate methods. During a period of 18 months, amongst 180 neonates enrolled in the study, 76 (42.2%) were colonized by VRE. VRE isolates were resistant to amikacin in 68%, gentamicin in 26%, and ampicillin in 17.1% of cases. Molecular analysis showed the vanA gene in all isolates. Two VRE-positive patients developed infection during the observation time. No deaths occurred during this period. Prematurity (P=0.023), low birth weight (P=0.019), history of admission in other hospitals (P=0.00), and antibiotic therapy for more than seven days (P=0.01) were identified as risk factors for VRE colonization. Newborn susceptibility to early colonization with VRE in NICUs is increased in preterm and low birth weight newborns. All VRE colonization in the NICU was related to the acquisition of the vanA gene. Adherence to infection control policies and antimicrobial stewardship strategies are of the highest importance.

Lung Ultrasound Characteristics in Neonates With Positive Real Time Polymerase Chain Reaction for SARS-CoV-2 on a Tertiary Level Referral Hospital in Mexico City.

IntroductionAcute respiratory syndrome secondary to SARS-CoV-2 virus infection has been declared a pandemic since December 2019. On neonates, severe presentations are infrequent but possible. Lung ultrasound (LUS) has been shown to be useful in diagnosing lung involvement and following up patients, giving more information, and reducing exposure compared to traditional examination.MethodsLUS was performed after the diagnosis of SARS-CoV-2 infection with respiratory Real Time Polymerase Chain Reaction RT-PCR with portable equipment protected with a silicone sleeve. If hemodynamic or cardiology consultation was necessary, a prepared complete ultrasound machine was used. Ten regions were explored (anterior superior and inferior, lateral, and posterior superior and inferior, right and left), and a semiquantitative score (LUSS) was calculated. Disease severity was determined with a pediatric modified score.ResultsThirty-eight patients with positive RT-PCR were admitted, 32 (81%) of which underwent LUS. Included patients had heterogenous diagnosis and gestational ages as expected on a referral neonatal intensive care unit (NICU) (median, ICR: 36, 30–38). LUS abnormalities found were B-line interstitial pattern 90%, irregular/interrupted/thick pleural line 88%, compact B-lines 65%, small consolidations (≤5 mm) 34%, and extensive consolidations (≥5 mm) 37%. Consolidations showed posterior predominance (70%). LUSS showed a median difference between levels of disease severity and ventilatory support (Kruskal–Wallis, p = 0.001) and decreased with patient improvement (Wilcoxon signed-rank test p = 0.005). There was a positive correlation between LUSS and FiO2 needed (Spearman r = 0.72, p = 0.01). The most common recommendation to the attending team was pronation (41%) and increase in positive end expiratory pressure (34%). Five patients with comorbidities died. A significant rank difference of LUSS and FiO2 needed between survivors and non-survivors was found (Mann–Whitney U-test, p = 0.005).ConclusionLUS patterns found were like the ones described in other series (neonatal and pediatrics). Eighty-eight percent of the studies were performed with handheld affordable equipment. While there is no specific pattern, it varies according to gestational age and baseline diagnosis LUS, which were shown to be useful in assessing lung involvement that correlated with the degree of disease severity and respiratory support.

Profile of Nosocomial Sepsis in a Neonatal Intensive Care Unit of Tertiary Care Hospital in Eastern Part of Nepal

Introduction: Nosocomial sepsis constitutes a global health problem. They lead to significant morbidity and mortality in both developed and resource-limited countries. The objective of the study was to describe the profile of nosocomial sepsis in neonatal intensive care unit (NICU). Methods: This was a prospective descriptive study conducted in a teaching and referral NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. Profile of nosocomial infection was analyzed with descriptive statistics. P value of < 0.05 was considered significant wherever applicable. Results: The incidence rate and density of nosocomial sepsis were 47.3% and 39.3 infections per 1000 patient-days respectively. Blood stream infection was the commonest nosocomial infection. Pseudomonas aeruginosa was the most commonly isolated agent in blood cultures of patients with nosocomial sepsis. Conclusions: This study revealed a high incidence of nosocomial sepsis. Hence, there is urgent need to adopt policies to prevent these infections.

Chest-to-Back Skin-to-Skin Contact to Regulate Body Temperature for Low Birth Weight and/or Premature Babies: A Crossover Randomized Controlled Clinical Trial.

Skin-to-skin contact (SSC) is one of the critical components of kangaroo mother care (KMC), which is an intervention to enhance the survival of low birth weight (LBW) and/or premature infants in low-income settings. Chest-to-chest (CC) contact has been practiced widely; however, mothers face practical challenges to continuously provide CC-SSC. Hence, we assessed the efficacy of chest-to-back (CB) SSC as an alternative to CC-SSC in regulating body temperature for LBW and/or premature babies in Ethiopia. We applied a noninferiority clinical trial among LBW and/or premature infants admitted to a referral hospital neonatal intensive care unit (NICU) in Ethiopia. The study randomized the infants into two crossover arms; arm 1 applied first CB-SSC followed by CC-SSC, and arm 2 applied first CC-SSC followed by CB-SSC. The outcome measure was a change in skin temperature. We used a linear mixed-effect model for analysis. The result showed no statistically significant difference in the mean temperature between the comparison arms. In conclusion, we found that the CB-SSC was not inferior to the CC-SSC in regulating body temperature of the babies. Thus, CB-SSC can be further investigated as an alternative to CC-SSC in the kangaroo care model in low-income settings.

The effect of repeated high-fidelity in situ simulation-based training on self-efficacy, self-perceived leadership qualities and team performance: A quasi-experimental study in a NICU-setting

BackgroundSimulation-based training has been widely used in various disciplines and has increasingly been recognized as useful in healthcare education during the past decade. In nursing schools, simulation-based training was initially used to train nursing students. However, there is a growing trend to use simulation-based training for continuing education and lifelong learning among professional healthcare workers. ObjectivesTo investigate if simulation-based training has an effect on self-efficacy, self-perceived leadership qualities and team performance in a neonatal intensive care unit. DesignTime series design. SettingOne referral neonatal intensive care unit in a general hospital in Flanders, Belgium. ParticipantsConvenience sample of 71 nurses and midwives. MethodsParticipants were involved in a series of three simulation-based training sessions. Before and after these series, a set of validated questionnaires was completed to measure the self-efficacy and self-perceived leadership qualities of the participants. Each session was videotaped and assessed for team performance (n = 8). ResultsParticipating in repeated high-fidelity in situ simulation-based training resulted in a significant increase in self-efficacy (p < 0.001) and self-perceived leadership qualities (p < 0.001). The intervention did not lead to a significant improved team performance (p = 0.209). ConclusionRepeated high-fidelity in situ simulation-based training in the NICU had a positive effect on self-efficacy and self-perceived leadership abilities in registered nurses and midwives in acute care situations. Repeated participation in simulation-based training had a positive effect on these outcomes, regardless of the number of years of NICU experience. The effect on team performance could not be confirmed in this study.

Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU.

BackgroundMother’s milk improves outcomes. Referral neonatal intensive care units face unique lactation challenges with maternal–infant separation and maternal pump dependency. Little is known about lactation resource allocation in this high-risk population.Research AimsTo determine differences in human milk outcomes, (1) the proportion of infants fed exclusive or any mother’s milk and (2) recorded number and volume of pumped mothers’ milk bottles, between two models of lactation care in a referral neonatal intensive care unit.MethodsThis retrospective, longitudinal, two-group comparison study utilized medical record individual feeding data for infants admitted at ≤ Day 7 of age and milk room storage records from reactive and proactive care model time periods (April, 2017–March, 2018; May, 2018–April, 2019). The reactive care model (n = 509 infants, 58% male, median birth weight and gestational age of 37 weeks,) involved International Board Certified Lactation Consultant referral for identified lactation problems; whereas, the proactive model (n = 472 infants, 56% male, median birth weight and gestational age 37 weeks) increased International Board Certified Lactation Consultant staffing, who then saw all admissions. Comparisons were performed using chi square, Mann Whitney, and t-tests.ResultsA proactive lactation approach was associated with an increase in the receipt of any mother’s milk from 74.3% to 80.2% (p = .03) among participants in the proactive model group. Additionally, their milk room mean monthly bottle storage increased from 5153 (SD 788) to 6620 (SD 1314) bottles (p < .01).ConclusionsIn this retrospective study at a tertiary referral neonatal intensive care unit, significant improvement inhuman milk outcomes suggests that increased resources for proactive lactation care may improve mother’s milk provision for a high-risk population.

The Role of a NICU Hepatology Consult Service in Assessing Liver Dysfunction in the Premature Infant

Liver dysfunction is common in the neonatal intensive care unit (NICU). Literature exists on the presentation of primary liver disease in the NICU but little has been published on general liver dysfunction in the NICU. This is a retrospective observational study of hepatology consultations and outcomes in a large referral NICU. 157 babies were evaluated by a single hepatologist and followed to resolution of disease, death, or lost to follow-up as outpatients. Infectious etiologies were the most common cause for liver dysfunction in the NICU, followed by shock, genetic abnormalities, cardiac disease, large heme loads, and hypothyroidism. Primary liver disease was rare. Liver dysfunction in the sick preterm infant was often multifactorial, and the distribution of diagnoses differs from that seen in the term baby. The liver dysfunction may last well beyond discharge from the NICU and may result in death.

Magnitude and risk of neonatal death in neonatal intensive care unit at referral hospital in Godeo Zone: a prospective cohort study.

Introductioneven though newborn health is apriority agenda in Ethiopia, neonates’ risk of dying is unacceptable and one of the ten countries which accounts to two-third of global neonatal death. The magnitude and risk of death in the referral care facility was not well studied in the study area. This study was aimed to estimate neonatal death and its determinant.Methodsa prospective cohort study was conducted from November 2016 to January 2018 among neonates admitted to Dilla University Referral Hospital Neonatal Intensive Care Unit. We generated descriptive statistics and Cox-proportional hazard model to identify independent risk factors of neonatal death.Resultswe identified 913 neonates with 6836 person-days of follow-up. Overall, 11.6% (n = 106) deaths of neonates were recorded. The estimated hazard ratios of neonatal death were higher among neonates whose mothers did not attend ANC follow up (HR=3.23), delivery assisted by TBA (HR=2.19), and maternal age ≥ 30 years at birth (HR=2.04). Urban residence [HR=0.54], family size of ≤ 3 (HR=0.47) and family size of 4 - 6 (HR=0.49), absence of abortion (HR=0.55), absence of illness during pregnancy (HR=0.47), iron folate intake (HR=0.29), birth weight ≥ 2500 grams (HR=0.43) were found to be protective factors.Conclusionneonatal death at referral neonatal intensive care unit was relatively high. Early management of complications, improving quality of services at neonatal intensive care unit and ensuring maternal continuum of care are recommended to increase survival of neonates. Besides, maternal and neonatal health-related factors were among the independent risk factors that need to design context-based policy and interventions.

Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

BackgroundPatent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes.ResultEchocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group.ConclusionEchocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

Mortality, morbidity and clinical care in a referral neonatal intensive care unit in Haiti

Neonatal mortality rates in Haiti are among the highest in the Western hemisphere. Few mothers deliver with a skilled birth attendant present, and there is a significant lack of pediatricians. The neonatal intensive care unit (NICU) at St. Damien Pediatric Hospital, a national referral center, is one of only five neonatology departments in Haiti. In order to target limited resources toward improving outcomes, this study seeks to describe clinical care in the St. Damien NICU. A retrospective medical record review was performed on available medical records on all admissions to the NICU between April 2016 and April 2017. 220 neonates were admitted to the NICU within the study epoch. The mortality rate was 14.5%. Death was associated with a maternal diagnosis of hypertension (p = 0.03) and neonatal diagnoses of lower gestational age (p<0.0001), lower birth weight (p<0.0001), prematurity (p = 0.002), RDS p = 0.01), sepsis (p<0.0001) and kernicterus (p = 0.04). The most common diagnoses were sepsis, chorioamnionitis, respiratory distress syndrome, jaundice, prematurity and perinatal asphyxia. This study demonstrates that preterm birth, sepsis, RDS and kernicterus are key contributors to neonatal mortality in a Haitian national pediatric referral center NICU and as such are promising interventional targets for reducing the neonatal mortality rate in Haiti.

Prevalence and predictors of urinary tract infection in full-term and preterm neonates

BackgroundEarly and prompt diagnosis of urinary tract infection (UTI) in neonates has important therapeutic implications. The aim of this study was to evaluate the prevalence of UTI in neonates admitted to a referral neonatal intensive care unit (NICU) and to identify predictors associated with an increased risk of UTI in NICU population.ResultsThe prevalence of culture-proven UTI in the studied neonates was 6.67%. Moreover, UTI was more frequent (70%) among full-term neonates. Additionally, both fever and pyuria were the only clinical and laboratory findings that showed significant association with UTI (p < 0.05). Binary logistic regression revealed that neonates with pyuria in urine analysis were 5.44 times more liable to have UTI, while the presence of fever constitutes a risk of only 0.166 (odds ratios were 5.44 and 0.166, respectively). Additionally, sensitivity, specificity, positive predictive value, and negative predictive value of the regression model were 50.0, 94.5, 20.05, and 98.57%, respectively.ConclusionsWe conclude that UTI is not uncommon in full-term neonates admitted in NICU. Additionally, pyuria was significantly related to positive urine culture and its detection in urine analysis increases the likelihood of UTI by 5.44 times.

Primary immunodeficiency testing in a Massachusetts tertiary care NICU: persistent challenges in the extremely premature population.

Background:Prematurity presents a diagnostic challenge in interpreting primary immunodeficiency (PID) testing.Methods:We retrospectively reviewed the charts of all infants in our level IV referral NICU in Massachusetts with immunologic testing performed from 2006–2018.Results:The overall rate of PID testing was enriched in our population, with 1% of admitted patients having extended immunologic testing. The addition of TREC newborn screening in Massachusetts in 2009 increased the proportion of infants tested for PID in our NICU by 3-fold (1.21% post-NBS vs 0.46% pre-NBS). A majority of the term and late preterm (T/LP, ≥ 34 weeks) infants (31 of 41, 76%) and very premature (VP, 29–33 weeks) infants (12 of 17, 71%) who had immune testing had a genetic diagnosis associated with secondary immunodeficiency or a PID. Most infants who were born extremely premature (EP, < 29 weeks) (25 of 29, 86%) had no identifiable cause of immunodeficiency besides prematurity, despite a mean postmenstrual age of 40.1 weeks at the time of testing.Conclusion:Persistent immune derangements were present within a subgroup of the extremely premature population through term postmenstrual age. EP infants with significant infectious history and abnormal immune testing at term-corrected age should be considered for genetic testing.

Predicting survival in infants born at

There are no available predictive models for survival in extremely preterm (EP) infants admitted to a referral Level IV neonatal intensive care unit (NICU) after the first day of life (DOL). To determine if there are clinical variables present at admission that are associated with survival in an outborn EP population. Data were analyzed from EP infants admitted before DOL 100 from 2008 to 2016 (n = 744). We found that prophylactic indomethacin (OR 1.98 (1.20-3.25) p = 0.007), admit DOL (OR 1.05 (1.02-1.08) p < 0.001), and birth in Franklin County, (OR 2.02 (95% CI, 1.04-3.90) p = 0.04) were all associated with survival. Using ROC analysis, the area under the curve for the provisional survival score was 0.69 (95% CI, 0.64-0.75; p < 0.0001). There are factors on admission to a referral Level IV NICU associated with survival in EP patients.

Thirteen ribs and long gap oesophageal atresia: The embryological hypothesis for exploration.

Context:Since the gap between two atretic segments of oesophagus is a critical determinant of prognosis for oesophageal atresia/tracheoesophageal fistula (EA/TEF), the search for a surrogate non-invasive pre-operative marker of long gap atresia continues.Aims:The purpose of the study was to compare the presence of normal and supernumerary ribs with length of EA and survival rates.Settings and Design:A prospective observational study was conducted at a tertiary care referral neonatal intensive care unit in North Karnataka, India, from January 2016 to June 2019.Subjects and Methods:Amongst babies with EA/TEF, pre-operative radiograph helped determine the number of ribs, and babies were divided into two groups; Group I: babies with 12 ribs and Group II: babies with supernumerary ribs.Statistical Analysis Used:Nominal variables were expressed as percentage and continuous variables as mean standard deviation. MedCalc software was used to compare proportions and means. A P < 0.05 was considered statistically significant.Results:Of the 61 cases, 51 were operated. Long gap EA was predominantly seen amongst babies in Group II (40% in Group II vs. 27% in Group I, P = 0.424). Survival rates by percentage were lower in babies in Group II (60% in Group II vs. 80% in Group I, P = 0.188). Both the above findings were proven statistically insignificant. The overall survival rate amongst the study population was 78.4% (39/51).Conclusions:Supernumerary ribs were associated with a higher occurrence of long gap EA and lower survival rates, though statistically insignificant. Multicentre collaboration may provide significant input for strengthening or refuting the above hypothesis.

Bereaved Parents' Perceptions of Infant Suffering in the NICU

ContextIt is challenging to provide supportive intensive care to infants in the neonatal intensive care unit (NICU), giving them every chance for survival, while also trying to minimize suffering for both the infant and parents. Parents who believe their infant is suffering may alter treatment goals based on their perceptions; however, it is unknown how parents come to believe that their infant may be suffering. ObjectivesTo examine bereaved parents' perceptions of infant suffering in the NICU. MethodsParents completed a qualitative interview exploring their perceptions of the level of suffering that their infant experienced at the end of life. Parents whose infant died in a large Midwestern Level IV regional referral NICU from July 2009 to July 2014 were invited to participate. Thirty mothers and 16 fathers from 31 families (31 of 249) participated in telephone interviews between three months and five years after their infant's death. ResultsFour themes emerged from the qualitative analysis: 1) the presence/absence of suffering, 2) indicators of suffering, 3) temporal components of suffering (trajectory), and 4) influence of perceived suffering on parents, infants, and clinical decision making. ConclusionParents used signs exhibited by infants, as well as information they received from the health care team to form their perceptions of suffering. Perceived suffering followed different trajectories and influenced the decisions that parents made for their infant. Soliciting parent perspectives may lead to improvements in the understanding of infant well-being, particularly suffering, as well as how parents rely on these perceptions to make treatment decisions for their infant.

Factors associated with development of early and late pulmonary hypertension in preterm infants with bronchopulmonary dysplasia.

ObjectiveTo investigate factors associated with development of early and late pulmonary hypertension (E/LPH) in preterm infants with bronchopulmonary dysplasia (BPD).Study designA retrospective case-control observational study of preterm infants with BPD admitted to a level IV referral neonatal intensive care unit over 5 years. We compared pre- and postnatal characteristics between infants with or without BPD-associated EPH and LPH.ResultsFifty-nine out of 220 infants (26.8%) had LPH, while 85 out of 193 neonates (44%) had EPH. On multiple logistic regression, novel factors associated with development of BPD–LPH included presence of maternal diabetes, EPH, tracheostomy, tracheitis, intraventricular hemorrhage (IVH, grade ≥3) and systemic steroid use. For EPH, these were maternal diabetes, IVH grade ≥3, high frequency ventilator use, and absence of maternal antibiotics use.ConclusionWe identified novel factors and confirmed previously established factors with development of LPH and EPH, which can help develop a screening strategy in BPD patients.

Surviving Sepsis in a Referral Neonatal Intensive Care Unit: Association between Time to Antibiotic Administration and In-Hospital Outcomes

To determine if time to antibiotic administration is associated with mortality and in-hospital outcomes in a neonatal intensive care unit (NICU) population. We conducted a prospective evaluation of infants with suspected sepsis between September 2014 and February 2018; sepsis was defined as clinical concern prompting blood culture collection and antibiotic administration. Time to antibiotic administration was calculated from time of sepsis identification, defined as the order time of either blood culture or an antibiotic, to time of first antibiotic administration. We used linear models with generalized estimating equations to determine the association between time to antibiotic administration and mortality, ventilator-free and inotrope-free days, and NICU length of stay in patients with culture-proven sepsis. Among 1946 sepsis evaluations, we identified 128 episodes of culture-proven sepsis in 113 infants. Among them, prolonged time to antibiotic administration was associated with significantly increased risk of mortality at 14days (OR, 1.47; 95% CI, 1.15-1.87) and 30days (OR, 1.47; 95% CI, 1.11-1.94) as well as fewer inotrope-free days (incidence rate ratio, 0.91; 95% CI, 0.84-0.98). No significant associations with ventilator-free days or NICU length of stay were demonstrated. Among infants with sepsis, delayed time to antibiotic administration was an independent risk factor for death and prolonged cardiovascular dysfunction. Further study is needed to define optimal timing of antimicrobial administration in high-risk NICU populations.

Nosocomial Sepsis and its Risk Factors: A Cross-Sectional Study in a Neonatal Intensive Care Unit

Introduction: Nosocomial sepsis is a common and serious infection of neonates who are admitted in intensive care unit. They lead to significant morbidity and mortality in both developed and resource limited countries. The neonatal intensive care unit (NICU) is a suitable environment for disseminating the infections and, hence, needs preventive intervention. The study was carried out to determine the risk factors for nosocomial sepsis in neonatal intensive care unit.&#x0D; Material and Methods: This was a cross-sectional study conducted in a seven bedded teaching and referral hospital NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. Nosocomial sepsis was diagnosed according to the CDC criteria. Risk factors for nosocomial sepsis were analyzed with Chi-square test and Logistic regression model. P-value of &lt;0.05 was considered significant.&#x0D; Results: Low birth weight (both preterm and IUGR) and mechanical ventilation were found to be related with nosocomial sepsis.&#x0D; Conclusions: Low birth weight and mechanical ventilation were the most important risk factors fornosocomial sepsis.