Neonatal ventilator-associated pneumonia: a tale of three cities in Canada West

Preterm infants on invasive breathing support are at increased risk for acquired infections called ventilator-associated pneumonias (VAP). Wide heterogeneity exists in diagnostic criteria and management of VAP. The objective of this study is to determine the demographic characteristics and prevalence of VAP according to three different existing criteria used in the neonatal intensive care unit (NICU). We conducted a retrospective study including infants born at < 33 weeks' gestational age (GA) from 3 different NICUs in Western Canada who have been diagnosed with VAP during 2018-2022. The incidence of VAP was categorized based on physicians' discretion, Canadian consensus, and National Healthcare Safety Network (NHSN) criteria. There were 185 neonates diagnosed to have VAP at physicians' discretion, with incidences of 4.6%, 8.9%, and 5.7% in the three NICUs. Among the VAP per physicians' diagnoses, 18.2-55.0% of infants fulfilled the VAP criteria of Canadian consensus, and 10.9-12.5% of them fulfilled the NHSN criteria. Conclusion: We found that 4.6-8.9% of infants born at < 33 weeks GA had VAP diagnosed during their NICU stay. About one-tenth of these cases fulfilled the NHSN criteria. Therefore, there is an urgency to develop neonatal-specific and validated diagnostic criteria for VAP. What is Known: • Preterm infants (33 weeks gestational age) are at increased risk for ventilator-associated pneumonia (VAP), a serious lung infection associated with mechanical ventilation. However, there is significant heterogeneity in the diagnostic criteria and management of VAP, which have not been validated in the neonatal population What is New: • 4.6-8.9% of infants are diagnosed with VAP during their NICU stay. However, only around one-tenth meet the NHSN diagnostic criteria. • These discrepancies highlight an urgent need to develop neonatal-specific, validated diagnostic criteria for VAP.