VLBW infants with EOS are at an increased risk of mortality and major morbidities. CoNS was a significant cause of sepsis, infants with CoNS were at a similarly high risk of complication of prematurity and mortality as those with EOS caused by other organisms.
Hospital-acquired infections cause significant mortality and morbidity in preterm infants and increase the length of stay and costs. Differences in the quality of care may be at least partially responsible for the substantial variability seen in the incidence of such infections among different institutions. Various quality assurance programs within neonatal networks around the world target these infections, aiming to reduce their incidence. Comprehensive surveillance programs seem to be effective, especially if educational activities are added on local and network levels, and may help to save lives.Objectives After completing this article, readers should be able to:1. Delineate the role of neonatal networks in prevention of nosocomial infections.
Describe the impact of nosocomial infection on neonatal outcomes. 3. Explain the importance of surveillance for nosocomial infections in preterminfants. 4. Describe how the benchmarking process may help to lower the rate of nosocomial infections.
Background: VLBWI mortality rates vary across NICUs, however few comparisons are available between different national networks.
Aim:To compare and analyze differences in neonatal mortality rates of two VLBWI cohorts from Neonatal Networks in Spain and Japan.Methods: Risk/protective factors, complications, and morbi-mortality outcomes were compared among inborn VLBWI admitted to NICU´s from SEN-1500 (7,006 infants, 63 NICU's) and NRNJ (8,695 infants, 69 NICU's) from 2005 to 2007. Nonparametric independent comparison analysis and logistic regression models were performed to predict mortality adjusting for perinatal risks factors.Results: Significant differences were found in gestation [mean(SD); 29.3(2.9) vs. 28.6(3.3) wks] and birthweigh [1117(271) vs. 1031(304)g. Both, 28-days neonatal and pre-discharge mortality rates were significantly higher in SEN-1500 (12.5% and 14.7%) than in NRNJ (6.4 and 9.2%). Differences in mortality remained even when adjusting for GA, birthweight, prenatal steroid use, 1 and 5 -min Apgar scores and presence of major congenital anomalies. There were many differences in clinical management among networks. In SEN-1500, use of surfactant and high frequency ventilation and DBP and PDA ligation rates were lower, but had higher rates of NEC, grades 3-4 IVH, and specially of sepsis (32.7% vs. 7.3%; p< 0.001).
Conclusion:Differences in neonatal and predischarge mortality rates of VLBWI form SEN-1500 and NRNJ could not completely be explained by initial risk and protective factors. Sepsis-related mortality accounted for 61.3% of the excess mortality in SEN-1500. The implementation of systematic preventive strategies for sepsis seems mandatory.
Acknowledgements: Patients and participantingNICU´s from both SEN-1500 and NRNJ Networks.
Background:We showed crude and adjusted NMR to be significantly lower among VLBWI cared at the NRNJ than in SEN1500 (ESPR 2010). Differences were also found in outcomes like infection, Necrotosing Enterocholitis (NEC) and severe Intraventricular Haemorrhage (IVH 3-4 ).
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