Link: https://www.ncbi.nlm.nih.gov/pubmed/30217691

J Pediatr. 2018 Sep 11. pii: S0022-3476(130937-5. doi: 10.1016/j.jpeds.2018.07.032. [Epub ahead of print]
Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia.
Murthy K1, Porta NFM2, Pallotto EK3, Rintoul N4, Keene S5, Chicoine L6, Gien J7, Brozanski BS8, Johnson YR9, Haberman B10, DiGeronimo R11, Zaniletti I12, Grover TR13; Children's Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus Group.
Collaborators (12)
Author information
Abstract
OBJECTIVE:
To predict incident bloodstream infection and urinary tract infection (UTI) in infants with congenital diaphragmatic hernia (CDH).

STUDY DESIGN:
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.

RESULTS:
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.

CONCLUSIONS:
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.

Copyright © 2018 Elsevier Inc. All rights reserved.

KEYWORDS:
Children's Hospitals Neonatal Consortium (CHNC); Children's Hospitals Neonatal Database (CHND); congenital diaphragmatic hernia; neonatal intensive care; pulmonary hypertension

PMID: 30217691 DOI: 10.1016/j.jpeds.2018.07.032
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