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Infection rates in surgical neonates and infants receiving parenteral nutrition: a five-year prospective study

S C Donnell1, N Taylor, H K F van Saene

  • 1Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.

The Journal of Hospital Infection
|December 11, 2002
PubMed

Insights

Septicemia in surgical neonates and infants on parenteral nutrition is primarily gut-derived. Microbial translocation from the gut causes most septicemia, necessitating new preventive strategies.

Area of Science:

  • Pediatric Surgery
  • Neonatal Intensive Care
  • Infectious Diseases

Background:

  • Parenteral nutrition (PN) is essential for surgical neonates and infants.
  • Septicemia poses a significant risk in this vulnerable population.
  • The origin and predominant pathogens of PN-associated septicemia require further elucidation.

Purpose of the Study:

  • To investigate the incidence and sources of septicemia in surgical neonates and infants receiving PN.
  • To identify the predominant microorganisms causing septicemia.
  • To determine the role of microbial translocation in septicemic episodes.

Main Methods:

  • Prospective, observational cohort study of 208 surgical neonates and infants (1992-1997).
  • Surveillance oropharyngeal and rectal cultures, with blood cultures on clinical indication.
  • Diagnosis of microbial translocation based on matching microorganisms in blood and gut/oropharynx.
  • Weekly liver function monitoring.

Main Results:

  • Septicemia incidence was 15%, predominantly caused by coagulase-negative staphylococci and enterococci (86%).
  • Microbial translocation accounted for 84% of septicemic episodes in 76% of patients.
  • Potential pathogens caused later-onset septicemia with more impaired liver function.

Conclusions:

  • Septicemia in neonates and infants on PN is largely a gut-derived phenomenon.
  • Microbial translocation is the primary driver of septicemia in this cohort.
  • Novel preventive strategies targeting gut integrity and microbial translocation are required.

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