Bloodstream Infections in Very Low Birth Weight Infants with Intestinal Failure

• Authors: Conrad R. Cole, Cincinnati Children's Hospital; Nellie I. Hansen, RTI International; Rosemary D. Higgins, Eunice Kennedy Shiver Natl Inst Child Hlth & Huma; Edward F. Bell, University of Iowa; Seetha Shankaran, Wayne State University; Abbot R. Laptook, Brown University; Michele C. Walsh, Case Western Reserve University; Ellen C. Hale, Emory University; Nancy S. Newman, Case Western Reserve University; Abhik Das, RTI International; Barbara Stoll, Emory University
• Journal Title: Journal of Pediatrics
• Volume: Volume 160, Number 1
• Publisher: Elsevier: 12 months | 2012-01-01, Pages 54-U102
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jpeds.2011.06.034
• Subjects: Health Sciences, Human Development; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pediatrics; SHORT-BOWEL SYNDROME; NEONATAL RESEARCH NETWORK; LATE-ONSET SEPSIS; PARENTERAL-NUTRITION; PRETERM INFANTS; INTENSIVE-CARE; MANAGEMENT; MORTALITY; OUTCOMES; CHILDREN

Abstract

Objective: To examine pathogens and other characteristics associated with late-onset bloodstream infections (BSIs) in infants with intestinal failure (IF) as a consequence of necrotizing enterocolitis (NEC). Study design: Infants weighing 401-1500 g at birth who survived for >72 hours and received care at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers were studied. The frequency of culture-positive BSI and pathogens were compared in infants with medically managed NEC, NEC managed surgically without IF, and surgical IF. Among infants with IF, the duration of parenteral nutrition (PN) and other outcomes were evaluated. Results: A total of 932 infants were studied (IF, n = 78; surgical NEC without IF, n = 452; medical NEC, n = 402). The proportion with BSI after diagnosis of NEC was higher in the infants with IF than in those with surgical NEC (P =.007) or medical NEC (P <.001). Gram-positive pathogens were most frequent. Among infants with IF, an increased number of infections was associated with longer hospitalization and duration of PN (median stay: 172 for those with 0 infections, 188 days for those with 1 infection, and 260 days for those with ≥2 infections [P =.06]; median duration of PN: 90, 112, and 115 days, respectively [P =.003]) and decreased achievement of full feeds during hospitalization (87%, 67%, and 50%, respectively; P =.03). Conclusion: Recurrent BSIs are common in very low birth weight infants with IF. Gram-positive bacteria were the most commonly identified organisms in these infants.