Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia

To predict incident bloodstream infection and urinary tract infection (UTI) in infants with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010-2016. Infants with CDH admitted at 22 participating regional neona...

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Veröffentlicht in:The Journal of pediatrics 2018-12, Vol.203, p.101-107.e2
Hauptverfasser: Murthy, Karna, Porta, Nicolas F.M., Pallotto, Eugenia K., Rintoul, Natalie, Keene, Sarah, Chicoine, Louis, Gien, Jason, Brozanski, Beverly S., Johnson, Yvette R., Haberman, Beth, DiGeronimo, Robert, Zaniletti, Isabella, Grover, Theresa R., Asselin, Jeanette, Durand, David, Dykes, Francine, Evans, Jacquelyn, Padula, Michael, Pallotto, Eugenia, Grover, Theresa, Brozanski, Beverly, Piazza, Anthony, Reber, Kristina, Short, Billie
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container_issue
container_start_page 101
container_title The Journal of pediatrics
container_volume 203
creator Murthy, Karna
Porta, Nicolas F.M.
Pallotto, Eugenia K.
Rintoul, Natalie
Keene, Sarah
Chicoine, Louis
Gien, Jason
Brozanski, Beverly S.
Johnson, Yvette R.
Haberman, Beth
DiGeronimo, Robert
Zaniletti, Isabella
Grover, Theresa R.
Asselin, Jeanette
Durand, David
Dykes, Francine
Evans, Jacquelyn
Murthy, Karna
Padula, Michael
Pallotto, Eugenia
Grover, Theresa
Brozanski, Beverly
Piazza, Anthony
Reber, Kristina
Short, Billie
description To predict incident bloodstream infection and urinary tract infection (UTI) in infants with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010-2016. Infants with CDH admitted at 22 participating regional neonatal intensive care units were included; patients repaired or discharged to home prior to admission/referral were excluded. The primary outcome was death or the occurrence of bloodstream infection or UTI prior to discharge. Factors associated with this outcome were used to develop a multivariable equation using 80% of the cohort. Validation was performed in the remaining 20% of infants. Median gestation and postnatal age at referral in this cohort (n = 1085) were 38 weeks and 3.1 hours, respectively. The primary outcome occurred in 395 patients (36%); and was associated with low birth weight, low Apgar, low admission pH, renal and associated anomalies, patch repair, and extracorporeal membrane oxygenation (P 
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We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010-2016. Infants with CDH admitted at 22 participating regional neonatal intensive care units were included; patients repaired or discharged to home prior to admission/referral were excluded. The primary outcome was death or the occurrence of bloodstream infection or UTI prior to discharge. Factors associated with this outcome were used to develop a multivariable equation using 80% of the cohort. Validation was performed in the remaining 20% of infants. Median gestation and postnatal age at referral in this cohort (n = 1085) were 38 weeks and 3.1 hours, respectively. The primary outcome occurred in 395 patients (36%); and was associated with low birth weight, low Apgar, low admission pH, renal and associated anomalies, patch repair, and extracorporeal membrane oxygenation (P &lt; .001 for all; area under receiver operating curve = 0.824; goodness of fit χ2 = 0.52). After omitting death from the outcome measure, admission pH, patch repair of CDH, and duration of central line placement were significantly associated with incident bloodstream infection or UTI. Infants with CDH are at high risk of infection which was predicted by clinical factors. 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subjects Anti-Bacterial Agents - therapeutic use
Apgar Score
Bacteremia - epidemiology
Catheterization, Central Venous - statistics & numerical data
Children's Hospitals Neonatal Consortium (CHNC)
Children's Hospitals Neonatal Database (CHND)
Congenital Abnormalities
congenital diaphragmatic hernia
Databases, Factual
Drug Utilization
Extracorporeal Membrane Oxygenation
Hernias, Diaphragmatic, Congenital - epidemiology
Hernias, Diaphragmatic, Congenital - surgery
Humans
Hydrogen-Ion Concentration
Infant, Low Birth Weight
Infant, Newborn
Intensive Care Units, Neonatal
Kidney - abnormalities
neonatal intensive care
pulmonary hypertension
Retrospective Studies
Risk Assessment
Surgical Mesh
United States - epidemiology
Urinary Tract Infections - epidemiology
title Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia
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