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Risk Factors for Infection in Neonates With Intestinal Failure
Dana Wu1, Rhonda Van Oerle2, Andrea Martinez3
1Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Insights
Neonates with intestinal failure often develop infections, with prematurity and complex gastroschisis as key risk factors. While infections impact growth, they did not significantly alter weight gain trajectories in this study.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Infectious Diseases
Background:
- Neonates with intestinal failure (IF) face significant infection risks from central venous access and surgery.
- Infections in IF can lead to systemic inflammation, sepsis, and impaired growth.
- Preventative strategies are crucial for managing IF-related infections.
Purpose of the Study:
- Identify risk factors for infection in neonates with IF.
- Assess the impact of infection on growth in this vulnerable population.
- Inform the development of targeted preventative strategies.
Main Methods:
- Retrospective comparative study of 86 neonates with IF (2018-2022).
- Clinical data, intestinal pathology, nutrition, and growth were analyzed.
- Infection groups (bloodstream, other, none) compared using Mann-Whitney and Kruskal-Wallis tests.
Main Results:
- 59% of infants developed infection; 22% had bloodstream infections (BSI), 37% other infections (OI).
- Infection was linked to lower gestational age, birthweight, and presence of a stoma.
- All infants with complex gastroschisis contracted infections; growth (weight gain) was suboptimal but similar across groups.
Conclusions:
- Infection is common in neonates with IF shortly after diagnosis.
- Key risk factors include prematurity, complex gastroschisis, and stoma presence.
- While growth is generally suboptimal, infection did not significantly impact weight gain trajectories.
Purpose:
Neonates with intestinal failure (IF) are at risk for infection due to central venous access, and intestinal surgery. Infection can cause systemic inflammation and sepsis, potentially affecting growth. The purpose of this study was to identify risk factors for, and the potential impact of infection to help with preventative strategies.
Methods:
A retrospective review of infants with IF, at a single centre from 2018 to 2022 was conducted. Clinical characteristics, intestinal pathology, nutritional intake, and growth were compared among infants with bloodstream infection (BSI), other infection (OI) (urinary, respiratory, or wound), or no infection (NI) within 2 months of diagnosis. Mann-Whitney and Kruskal-Wallis tests were used for comparisons with p-values <0.05 considered significant.
Results:
Eighty-six infants were included, with gastroschisis (41%) and necrotizing enterocolitis (26%) the most common diagnoses. Fifty-nine % of infants developed infection (22% BSI and 37% OI). Those with BSI or OI had a lower gestational age and birthweight, and were more likely to have a stoma. All infants with complex gastroschisis developed infection compared to 38% of infants with simple gastroschisis. Median daily weight gain was suboptimal across all groups and did not differ over 6 weeks following infection.
Conclusion:
Most infants with IF develop infection shortly after diagnosis. Risk factors include prematurity, complex gastroschisis, and the presence of a stoma. Growth was suboptimal but did not differ among infants with or without infection.
Type Of Study:
Retrospective Review.
Level Of Evidence:
Level III Retrospective Comparative Study.
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