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Sepsis risk factors in infants with congenital diaphragmatic hernia

Michaël Levy1,2, Nolwenn Le Sache1,2, Mostafa Mokhtari2

  • 1Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, 78, Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.

Annals of Intensive Care
|March 22, 2017
PubMed

Insights

Sepsis, particularly ventilator-associated pneumonia, is a significant threat for infants with congenital diaphragmatic hernia (CDH), increasing ICU stay but not mortality. Low gestational age and liver position are key risk factors for sepsis in CDH patients.

Area of Science:

  • Pediatric critical care medicine
  • Neonatology
  • Infectious disease epidemiology

Background:

  • Congenital diaphragmatic hernia (CDH) is a complex neonatal condition with high ICU mortality.
  • Infective complications, including sepsis, significantly impact patient outcomes in CDH.
  • The incidence and risk factors for sepsis in CDH neonates are not well-established.

Purpose of the Study:

  • To determine the incidence of sepsis in neonates with CDH.
  • To identify risk factors associated with sepsis development in this population.
  • To evaluate the impact of sepsis on clinical outcomes, including mortality and length of ICU stay.

Main Methods:

  • Prospective, 4-year observational study conducted in a French national referral center.
  • Involved 62 neonates diagnosed with CDH admitted to the pediatric intensive care and neonatal medicine department.
  • Sepsis episodes were monitored, and risk factors were analyzed using multivariate analysis.

Main Results:

  • Sepsis occurred in 45% of CDH patients (28/62), with 38 episodes documented.
  • Ventilator-associated pneumonia (VAP) and central line-associated blood stream infections (CLABSI) were the most common infections.
  • Independent risk factors for sepsis included lower gestational age at birth and intrathoracic liver position; sepsis prolonged ventilation and ICU stay but did not affect mortality.

Conclusions:

  • Healthcare-associated infections, especially VAP, pose a major threat to neonates with CDH.
  • Sepsis significantly increases the duration of mechanical ventilation and overall ICU length of stay for CDH patients.
  • Low gestational age and intrathoracic liver position are identified as independent risk factors for sepsis in neonates with CDH.
Abstract

Keywords:
Central line-associated bloodstream infectionCongenital diaphragmatic herniaHealthcare-associated infectionSepsisVentilator-associated pneumonia

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