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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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 |
doi_str_mv | 10.1016/j.jpeds.2018.07.032 |
format | Article |
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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 < .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. Early identification and low threshold for sepsis evaluations in high-risk infants may attenuate acquisition and the consequences of these infections.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2018.07.032</identifier><identifier>PMID: 30217691</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>The Journal of pediatrics, 2018-12, Vol.203, p.101-107.e2</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-e8077bd584d310b16b384cf1a5a2cb733d19cda32175a43ce79ebc9f6e2d7713</citedby><cites>FETCH-LOGICAL-c359t-e8077bd584d310b16b384cf1a5a2cb733d19cda32175a43ce79ebc9f6e2d7713</cites><orcidid>0000-0002-6135-8503 ; 0000-0001-8244-9765 ; 0000-0003-3363-9663</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpeds.2018.07.032$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30217691$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Murthy, Karna</creatorcontrib><creatorcontrib>Porta, Nicolas F.M.</creatorcontrib><creatorcontrib>Pallotto, Eugenia K.</creatorcontrib><creatorcontrib>Rintoul, Natalie</creatorcontrib><creatorcontrib>Keene, Sarah</creatorcontrib><creatorcontrib>Chicoine, Louis</creatorcontrib><creatorcontrib>Gien, Jason</creatorcontrib><creatorcontrib>Brozanski, Beverly S.</creatorcontrib><creatorcontrib>Johnson, Yvette R.</creatorcontrib><creatorcontrib>Haberman, Beth</creatorcontrib><creatorcontrib>DiGeronimo, Robert</creatorcontrib><creatorcontrib>Zaniletti, Isabella</creatorcontrib><creatorcontrib>Grover, Theresa R.</creatorcontrib><creatorcontrib>Asselin, Jeanette</creatorcontrib><creatorcontrib>Durand, David</creatorcontrib><creatorcontrib>Dykes, Francine</creatorcontrib><creatorcontrib>Evans, Jacquelyn</creatorcontrib><creatorcontrib>Murthy, Karna</creatorcontrib><creatorcontrib>Padula, Michael</creatorcontrib><creatorcontrib>Pallotto, Eugenia</creatorcontrib><creatorcontrib>Grover, Theresa</creatorcontrib><creatorcontrib>Brozanski, Beverly</creatorcontrib><creatorcontrib>Piazza, Anthony</creatorcontrib><creatorcontrib>Reber, Kristina</creatorcontrib><creatorcontrib>Short, Billie</creatorcontrib><creatorcontrib>Children's Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus Group</creatorcontrib><title>Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><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 < .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. Early identification and low threshold for sepsis evaluations in high-risk infants may attenuate acquisition and the consequences of these infections.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Apgar Score</subject><subject>Bacteremia - epidemiology</subject><subject>Catheterization, Central Venous - statistics & numerical data</subject><subject>Children's Hospitals Neonatal Consortium (CHNC)</subject><subject>Children's Hospitals Neonatal Database (CHND)</subject><subject>Congenital Abnormalities</subject><subject>congenital diaphragmatic hernia</subject><subject>Databases, Factual</subject><subject>Drug Utilization</subject><subject>Extracorporeal Membrane Oxygenation</subject><subject>Hernias, Diaphragmatic, Congenital - epidemiology</subject><subject>Hernias, Diaphragmatic, Congenital - surgery</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Infant, Low Birth Weight</subject><subject>Infant, Newborn</subject><subject>Intensive Care Units, Neonatal</subject><subject>Kidney - abnormalities</subject><subject>neonatal intensive care</subject><subject>pulmonary hypertension</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgical Mesh</subject><subject>United States - epidemiology</subject><subject>Urinary Tract Infections - epidemiology</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOwzAQRS0EgvL4AiSUJZuEsZ3EyYIFKo9WqgRC7C3HnhSH1il2CuLvcWlhyWo0o3vnzhxCzilkFGh51WXdCk3IGNAqA5EBZ3tkRKEWaVlxvk9GAIylPBflETkOoQOAOgc4JEccGBVlTUdk9uTRWD1YN0-ebXhL-jaZuhbjpHeJdZtGuSEkn3Z4Tca9m6Ozg1okt1atXr2aL9VgdTJB76w6JQetWgQ829UT8nJ_9zKepLPHh-n4ZpZqXtRDihUI0Ziiyg2n0NCy4VWuW6oKxXQjODe01kbxeGOhcq5R1Njoui2RGSEoPyGX27Ur37-vMQxyaYPGxUI57NdBMgoF5AWDOkr5Vqp9H4LHVq68XSr_JSnIDUXZyR-KckNRgpCRYnRd7ALWzRLNn-cXWxRcbwUYv_yw6GXQFp2OKH1EJ01v_w34BhMng_8</recordid><startdate>201812</startdate><enddate>201812</enddate><creator>Murthy, Karna</creator><creator>Porta, Nicolas F.M.</creator><creator>Pallotto, Eugenia K.</creator><creator>Rintoul, Natalie</creator><creator>Keene, Sarah</creator><creator>Chicoine, Louis</creator><creator>Gien, Jason</creator><creator>Brozanski, Beverly S.</creator><creator>Johnson, Yvette R.</creator><creator>Haberman, Beth</creator><creator>DiGeronimo, Robert</creator><creator>Zaniletti, Isabella</creator><creator>Grover, Theresa R.</creator><creator>Asselin, Jeanette</creator><creator>Durand, David</creator><creator>Dykes, Francine</creator><creator>Evans, Jacquelyn</creator><creator>Murthy, Karna</creator><creator>Padula, Michael</creator><creator>Pallotto, Eugenia</creator><creator>Grover, Theresa</creator><creator>Brozanski, Beverly</creator><creator>Piazza, Anthony</creator><creator>Reber, Kristina</creator><creator>Short, Billie</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6135-8503</orcidid><orcidid>https://orcid.org/0000-0001-8244-9765</orcidid><orcidid>https://orcid.org/0000-0003-3363-9663</orcidid></search><sort><creationdate>201812</creationdate><title>Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-e8077bd584d310b16b384cf1a5a2cb733d19cda32175a43ce79ebc9f6e2d7713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Apgar Score</topic><topic>Bacteremia - epidemiology</topic><topic>Catheterization, Central Venous - statistics & numerical data</topic><topic>Children's Hospitals Neonatal Consortium (CHNC)</topic><topic>Children's Hospitals Neonatal Database (CHND)</topic><topic>Congenital Abnormalities</topic><topic>congenital diaphragmatic hernia</topic><topic>Databases, Factual</topic><topic>Drug Utilization</topic><topic>Extracorporeal Membrane Oxygenation</topic><topic>Hernias, Diaphragmatic, Congenital - epidemiology</topic><topic>Hernias, Diaphragmatic, Congenital - surgery</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Infant, Low Birth Weight</topic><topic>Infant, Newborn</topic><topic>Intensive Care Units, Neonatal</topic><topic>Kidney - abnormalities</topic><topic>neonatal intensive care</topic><topic>pulmonary hypertension</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surgical Mesh</topic><topic>United States - epidemiology</topic><topic>Urinary Tract Infections - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Murthy, Karna</creatorcontrib><creatorcontrib>Porta, Nicolas F.M.</creatorcontrib><creatorcontrib>Pallotto, Eugenia K.</creatorcontrib><creatorcontrib>Rintoul, Natalie</creatorcontrib><creatorcontrib>Keene, Sarah</creatorcontrib><creatorcontrib>Chicoine, Louis</creatorcontrib><creatorcontrib>Gien, Jason</creatorcontrib><creatorcontrib>Brozanski, Beverly S.</creatorcontrib><creatorcontrib>Johnson, Yvette R.</creatorcontrib><creatorcontrib>Haberman, Beth</creatorcontrib><creatorcontrib>DiGeronimo, Robert</creatorcontrib><creatorcontrib>Zaniletti, Isabella</creatorcontrib><creatorcontrib>Grover, Theresa R.</creatorcontrib><creatorcontrib>Asselin, Jeanette</creatorcontrib><creatorcontrib>Durand, David</creatorcontrib><creatorcontrib>Dykes, Francine</creatorcontrib><creatorcontrib>Evans, Jacquelyn</creatorcontrib><creatorcontrib>Murthy, Karna</creatorcontrib><creatorcontrib>Padula, Michael</creatorcontrib><creatorcontrib>Pallotto, Eugenia</creatorcontrib><creatorcontrib>Grover, Theresa</creatorcontrib><creatorcontrib>Brozanski, Beverly</creatorcontrib><creatorcontrib>Piazza, Anthony</creatorcontrib><creatorcontrib>Reber, Kristina</creatorcontrib><creatorcontrib>Short, Billie</creatorcontrib><creatorcontrib>Children's Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Murthy, Karna</au><au>Porta, Nicolas F.M.</au><au>Pallotto, Eugenia K.</au><au>Rintoul, Natalie</au><au>Keene, Sarah</au><au>Chicoine, Louis</au><au>Gien, Jason</au><au>Brozanski, Beverly S.</au><au>Johnson, Yvette R.</au><au>Haberman, Beth</au><au>DiGeronimo, Robert</au><au>Zaniletti, Isabella</au><au>Grover, Theresa R.</au><au>Asselin, Jeanette</au><au>Durand, David</au><au>Dykes, Francine</au><au>Evans, Jacquelyn</au><au>Murthy, Karna</au><au>Padula, Michael</au><au>Pallotto, Eugenia</au><au>Grover, Theresa</au><au>Brozanski, Beverly</au><au>Piazza, Anthony</au><au>Reber, Kristina</au><au>Short, Billie</au><aucorp>Children's Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2018-12</date><risdate>2018</risdate><volume>203</volume><spage>101</spage><epage>107.e2</epage><pages>101-107.e2</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>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 < .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. Early identification and low threshold for sepsis evaluations in high-risk infants may attenuate acquisition and the consequences of these infections.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30217691</pmid><doi>10.1016/j.jpeds.2018.07.032</doi><orcidid>https://orcid.org/0000-0002-6135-8503</orcidid><orcidid>https://orcid.org/0000-0001-8244-9765</orcidid><orcidid>https://orcid.org/0000-0003-3363-9663</orcidid></addata></record> |
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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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