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Extracorporeal membrane oxygenation and bloodstream infection in congenital diaphragmatic hernia

Sarah Keene1, Theresa R Grover2, Karna Murthy3

  • 1Children's Healthcare of Atlanta at Egleston and Emory University School of Medicine, Atlanta, GA, USA. skeene@emory.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|August 7, 2019
PubMed

Insights

Bloodstream infections (BSI) are rare in infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) early on, but risk rises with treatment duration. Antibiotic use was extensive and not linked to infection rates.

Area of Science:

  • Neonatalogy
  • Pediatric Surgery
  • Infectious Diseases

Background:

  • Congenital diaphragmatic hernia (CDH) is a serious condition requiring advanced respiratory support.
  • Extracorporeal membrane oxygenation (ECMO) is a life-support measure used for critically ill neonates with CDH.
  • Understanding infection risks and antibiotic patterns in these vulnerable infants is crucial for optimizing care.

Purpose of the Study:

  • To determine the incidence of bloodstream infections (BSI) and urinary tract infections (UTI) in infants with CDH undergoing ECMO.
  • To describe the patterns of antibiotic use during ECMO treatment for CDH.
  • To correlate infection rates with ECMO duration and antibiotic administration.

Main Methods:

  • Retrospective analysis of the Children's Hospitals Neonatal Database (2010-2016).
  • Inclusion criteria: infants with CDH treated with ECMO.
  • Outcomes assessed: BSI, UTI, and antimicrobial medication use; infection practices surveyed.

Main Results:

  • 5.3% of 338 CDH infants on ECMO developed at least one BSI.
  • BSI incidence increased significantly with ECMO duration, from 0.6% in the first week to 8.6% after 21 days (p=0.002).
  • Over 95% of patients received antibiotics weekly, irrespective of documented infection.

Conclusions:

  • Confirmed BSI is infrequent in the initial week of ECMO for CDH but escalates with prolonged support.
  • Extensive antibiotic utilization during ECMO did not correlate with infection frequency.
  • Further research is needed to refine antimicrobial stewardship in CDH patients on ECMO.
Abstract

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