Do pacifiers increase the risk of nosocomial diarrhoea? A cohort study

Abstract

DesignProspective cohort study.SettingTeaching paediatric hospital—Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Northeast Brazil.Participants378 of 536 infants admitted in paediatric wards from April to October 2009 were daily assessed during hospital stay until the first episode of nosocomial diarrhoea (ND), death or discharge. Infants with community-acquired diarrhoea, respiratory or haemodynamic instability and who stayed in hospital for <24 h were excluded.Primary and secondary outcome measuresIncidence and risk factors for ND and rates of pacifier faecal contamination.Results33 ND episodes occurred in 378 infants, with a cumulative incidence of 8.7% and density of 11.25/1000 patients-day. ND occurred in 8.2% (16/194) of pacifier users compared with 9.2% (17/184) in non-users (adjusted OR=0.88, 95% CI 0.43 to 1.80). In multivariate logistic regression analysis, duration of oxygen use (OR=1.61; 95% CI 1.18 to 2.20) and days of antimicrobial use (OR=1.62, 95% CI 1.34 to 1.94) were associated with higher risk of ND, whereas being breast fed (OR=0.40, 95% CI 0.17 to 0.93) and each day of hospital stay (OR=0.65, 95% CI 0.53 to 0.80) were protective factors. Faecal coliforms were isolated in 16% (27/169) of tested pacifiers, 77.8% of which had more than 100 000 CFU/ml. The probability of a child remaining free of an episode of diarrhoea up to the seventh day of hospitalisation in the ward was 91.2% (95% CI 87.7% to 94.9%). The log-rank test showed no statistical difference between pacifier users and non-users.ConclusionsND is a frequent healthcare-associated infection in paediatric wards, but the use of pacifiers during the stay in hospital does not seem to affect the incidence of ND in infants in many settings where the burden of diarrhoea is still high.

Prevalence of Non-Nutritive Sucking Habits and Potential Influencing Factors among Children in Urban Communities in Nigeria

“…It is essential to understand the extent non-nutritive sucking habit relates to the burden of acute diarrhea among children because of its well-known usage in the urban communities. However, two previous studies in Brazil ( 6 , 21 ) found no significant association between acute diarrhea and non-nutritive sucking habit. One reason for the discrepancy in the findings could be the differences in the study designs.…”

“…While our study was cross-sectional in design and relied on mothers’ ability to recall events that occurred within 3 months before they were interviewed, participants were prospectively followed up in those studies ( 6 , 21 ). Moreover, those studies ( 6 , 21 ) investigated only plastic nipple dummy sucking while our study considered both plastic nipple dummy and finger sucking. These two non-nutritive sucking materials play the same role of calming and pacifying children in the Nigerian context.…”

“…In situations where good sanitation and hygiene practices cannot be guaranteed, the risk of contamination of non-nutritive sucking materials by infectious microbes potentially put children at risk of infections. However, contrary to the theory of microbial contamination, community-based cross-sectional ( 6 ) and hospital-based cohort ( 21 ) studies in Brazil, reported no association between pacifier use and community-acquired diarrhea. These authors suggested that in contaminated environments the added risk of using pacifiers would not significantly change the incidence of diarrhea.…”