Levy Michaël, Le Sache Nolwenn, Mokhtari Mostafa, Fagherazzi Guy, Cuzon Gaelle, Bueno Benjamin, Fouquet Virginie, Benachi Alexandra, Eleni Dit Trolli Sergio, Tissieres Pierre
Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, 78, Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Centre de référence Maladie Rare: Hernie de Coupole Diaphragmatique, 94270, Le Kremlin-Bicêtre, France.
Ann Intensive Care. 2017 Dec;7(1):32. doi: 10.1186/s13613-017-0254-9. Epub 2017 Mar 21.
Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly and remains among the most challenging ICU-managed disease. Beside severe pulmonary hypertension, lung hypoplasia and major abdominal surgery, infective complications remain major determinants of outcome. However, the specific incidence of sepsis as well as associated risk factors is unknown.
This prospective, 4-year observational study took place in the pediatric intensive care and neonatal medicine department of the Paris South University Hospitals (Le Kremlin-Bicêtre, France), CDH national referral center and involved 62 neonates with CDH.
During their ICU stay, 28 patients (45%) developed 38 sepsis episodes. Ventilator-associated pneumonia (VAP: 23/38; 31.9 VAP per 1000 days of mechanical ventilation) and central line-associated blood stream infections (CLABSI: 5/38; 5.5 per 1000 line days) were the most frequently encountered infections. Multivariate analysis showed that gestational age at birth and intra-thoracic position of liver were significantly associated with the occurrence of sepsis. Infected patients had longer duration of mechanical and noninvasive ventilation (16.2 and 5.8 days, respectively), longer delay to first feeding (1.2 days) and a longer length of stay in ICU (23 days), but there was no difference in mortality.
Healthcare-associated infections, and more specifically VAP, are the main infective threat in children with CDH. Sepsis has a significant impact on the duration of ventilator support and ICU length of stay but does not impact mortality. Low gestational age and intra-thoracic localization of the liver are two independent risk factors associated with sepsis.
先天性膈疝（CDH）是一种罕见的先天性异常疾病，仍然是重症监护病房（ICU）最难处理的疾病之一。除了严重的肺动脉高压、肺发育不全和大型腹部手术外，感染性并发症仍然是影响预后的主要因素。然而，脓毒症的具体发病率以及相关危险因素尚不清楚。
这项前瞻性、为期4年的观察性研究在巴黎南大学医院（法国克里姆林 - 比塞特）的儿科重症监护和新生儿医学科进行，该科室是法国先天性膈疝国家转诊中心，研究纳入了62例先天性膈疝新生儿。
在重症监护病房住院期间，28例患者（45%）发生了38次脓毒症发作。呼吸机相关性肺炎（VAP：23/38；每1000天机械通气发生31.9次VAP）和中心静脉导管相关血流感染（CLABSI：5/38；每1000导管日发生5.5次）是最常见的感染类型。多因素分析显示，出生时的胎龄和肝脏的胸腔内位置与脓毒症的发生显著相关。感染患者的机械通气和无创通气时间更长（分别为16.2天和5.8天），首次喂养延迟时间更长（1.2天），在重症监护病房的住院时间更长（23天），但死亡率没有差异。
医疗保健相关感染，尤其是VAP，是先天性膈疝患儿主要的感染威胁。脓毒症对呼吸机支持时间和重症监护病房住院时间有显著影响，但不影响死亡率。低胎龄和肝脏的胸腔内定位是与脓毒症相关的两个独立危险因素。
