Risk Factors for Health Care–Associated Sepsis in Critically Ill Neonates Stratified by Birth Weight

Evelien Hilde Verstraete, Kris De Coen, Dirk Vogelaers, Stijn Blot

Health care-associated bloodstream infection (HABSI) is a frequent complication in neonatal intensive care (NIC). Research on risk factors stratified by birth-weight and adjusted for severity of illness and comorbidities is limited. Our objective is to describe independent risk factors for HABSI in critically ill neonates with emphasis on risk variation between birth-weight groups. We performed a single-center historical cohort study in a tertiary referral center. A NIC-audit system was used to identify eligible neonates admitted for ≥72 hours (2002-2011). HABSI is defined according to National Institute of Child Health and Human Development criteria. Risk factors for HABSI were assessed by univariate and logistic regression analysis for the total cohort and for birth-weight subgroups, i.e. neonates ≤1500 g and >1500 g. A total of 342 neonates developed HABSI in 5134 admissions of ≥72 hours (6.7%). Very-low-birth-weight, total parenteral nutrition (TPN), mechanical ventilation, gastrointestinal disease, surgery (cardiac and other type), and renal insufficiency are independent risk factors for the total cohort. Gastrointestinal disease and cardiac surgery are independent risk factors in both birth-weight groups; mechanical ventilation (odds ratio [OR] 2.6, confidence interval [CI] 1.6- 4.0) and other type of surgery (OR 4.3, CI 2.1-8.8) are solely independent risk factors in the ≤1500 g cohort; TPN is exclusively an independent risk factor (OR 7.9, CI 3.9-16.2) in the > 1500 g cohort. In our NICU, risk stratification by birth-weight revealed some difference. Special attention concerning infection control practices is for neonates receiving TPN, mechanical ventilation, cardiac surgery, and with a gastrointestinal disease.