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Nosocomial infections in neonates receiving extracorporeal membrane oxygenation
S E Coffin1, L M Bell, M Manning
1Division of Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, PA 19104, USA.
Objective:
To determine the incidence of, and risk factors for, nosocomial infections in neonates during and after treatment with extracorporeal membrane oxygenation (ECMO).
Design:
A retrospective cohort study of all infants treated with ECMO during a 4-year period.
Patients:
26 neonates experiencing 32 nosocomial infections, and 54 neonates with no nosocomial infections.
Setting:
A large, urban children's hospital.
Results:
30% of neonates treated with ECMO experienced at least one nosocomial infection. The rate of nosocomial infections was 10.3 per 1,000 patient-days. Risk factors significantly associated with nosocomial infection included duration of ECMO > 7 days (mean, 12 vs 7 days; odds ratio [OR], 2.84; 95% confidence interval [CI95], 0.96-8.56); neonatal intensive care-unit stay > 21 days (mean, 44 vs 19 days; OR, 8.73; CI95, 2.49-31.94); hospitalization > 50 days (mean, 63 vs 29 days; OR, 5.44; CI95, 1.47-20.87); and surgical procedure before or during ECMO (46% vs 22%; OR, 4.58 CI95, 1.25 to 17.38).
Conclusions:
Nosocomial infections occurred in 30% of patients undergoing ECMO. Although nosocomial infections were not associated with an increase in mortality, hospitalization was prolonged.