Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France.
Institute for Integrative Biology (I2BC), South Paris-Saclay University, Orsay, France.
Pediatr Pulmonol. 2019 Dec;54(12):1982-1988. doi: 10.1002/ppul.24487. Epub 2019 Aug 27.
Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critical care settings and might have important long-term consequences in neonates. Our aim is to clarify the short- and long-term respiratory outcomes of neonates affected by VAP.
Prospective, population-based, cohort study with 12 months follow-up based on clinical examinations and diary-based respiratory morbidity score, conducted in an academic tertiary referral neonatal unit with dedicated follow-up program.
A total of 199 inborn neonates consecutively ventilated for at least 48 hours were eligible for the study. One hundred fifty-one were finally enrolled and classified as "exposed" or "unexposed" to VAP, if they fulfilled (or not) VAP criteria once during their stay. Bronchopulmonary dysplasia (BPD) incidence was significantly higher in exposed (75%) than in unexposed babies (26.8%; relative risk [RR]: 2.8 [1.9-4.0]; RR: 3.5 [1.002-12.7]; P = .049; number needed to harm = 2.07), although the composite BPD/mortality did not differ. Exposed patients showed longer intensive care unit stay (87 [43-116] vs 14 [8-52] days; St.β = 0.24; P < .0001) and duration of ventilation (15 [10-25] vs 5 [4-8] days; St.β = 0.29; P < .0001) than unexposed neonates. Exposed patients also showed less ventilator-free days (11 [5-17.7] vs 22 [14-24] days; St.β = -0.15; P = .05) compared to unexposed. Respiratory infections, use of drugs, rehospitalization for respiratory reasons, home oxygen therapy, their composite outcome, and diary-based clinical respiratory morbidity score were similar between the cohorts.
Neonatal VAP seems associated to higher incidence of BPD, longer ventilation, and intensive care stay but it does not affect long-term respiratory morbidity.
呼吸机相关性肺炎（VAP）是重症监护病房常见的医院获得性感染，可能对新生儿产生重要的长期后果。我们的目的是阐明 VAP 对新生儿的短期和长期呼吸结局的影响。
这是一项前瞻性、基于人群的队列研究，对 199 名至少接受 48 小时通气的住院新生儿进行了为期 12 个月的随访，随访方式是临床检查和基于日记的呼吸发病率评分。研究在一家拥有专门随访计划的学术性三级转诊新生儿病房进行。
199 名符合条件的新生儿连续接受至少 48 小时通气，最终有 151 名被纳入研究并分为 VAP 暴露组和非暴露组，他们在住院期间是否符合 VAP 标准。暴露组（75%）支气管肺发育不良（BPD）的发生率明显高于非暴露组（26.8%；相对风险 [RR]：2.8 [1.9-4.0]；RR：3.5 [1.002-12.7]；P=0.049；危害人数需要=2.07），尽管 BPD/死亡率的复合结果没有差异。暴露组患者的重症监护病房住院时间（87 [43-116] vs 14 [8-52] 天；Stβ=0.24；P<0.0001）和通气时间（15 [10-25] vs 5 [4-8] 天；Stβ=0.29；P<0.0001）均长于非暴露组。与非暴露组相比，暴露组患者的呼吸机无使用天数（11 [5-17.7] vs 22 [14-24] 天；Stβ=-0.15；P=0.05）更少。两组间的呼吸道感染、药物使用、因呼吸道原因再次住院、家庭氧疗、其复合结局以及基于日记的临床呼吸发病率评分无差异。
新生儿 VAP 似乎与更高的 BPD 发生率、更长的通气时间和重症监护病房住院时间相关，但不会影响长期的呼吸发病率。
